The Measured Dosetm Staying Healthy and Safe on Your Medication

S ta n yin tio g he edica althy and safe on your m THE MEASURED DOSETM STAYING HEALTHY AND SAFE ON YOUR MEDICATION

The exercises within this book can help you learn more about medication safety. Use this workbook to learn about medications, your health, substance misuse and how to get help if you’re struggling with substance misuse and pain medicines. SECTION PAGE 1. All About Me 2 In this workbook you will: While medications are important tools in the fight against pain, Learn about types of medicines 2. First Things First: What Are Medicines? 4 relying on them often comes with Learn about the importance of medication safety a heavy price. 3. Substance Use Disorder (SUD) 6 Better understand substance use disorder (SUD) Side effects 4. The Substance Use Epidemic 10 Learn about pain and how to manage it safely Addiction Discover tips for preventing and treating 5. Opioids: A Closer Look 13 substance misuse Dependence Withdrawal Learn the difference between addiction, 6. Pain 18

dependence and withdrawal Sickness of Contents Table Death 7. The Risks of Substance Misuse 24 Find helpful resources and much more 8. Addiction, Dependence and Withdrawal 26

9. Overdose 31

PUBLIC HEALTH ALERT 10. Preventing and Treating Substance Misuse 34 Each year in the United States, there are more than 200,000 cases of opioid overdoses reported. This book will help you learn how you can help fight 11. Ending Stigma 36 ! substance use disorder, for yourself and those you love. 12. Helpful Tips for Staying Safe 38

DISCLAIMER. This book provides general information about medication, pain management 13. Talking with Your Doctor 40 and related issues. The information does not constitute medical advice and is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consulting with a licensed health professional. Consult with a qualified physician or health care practitioner 14. Tools and Resources 44 to discuss specific individual issues or health needs and to professionally address personal medical concerns. In My Own Words

MY INFO ES and D Name: HOP REA MY MS Address:

City/State/Zip: Have a stronger body Phone: ( ) Live longer Be more Email Address: in control See healthy results for myself MY DOCTOR’S INFO Get a better job Feel better

1. All About Me My Family Doctor: Have more Phone: ( ) energy Finish school Be active with Specialist: Type: my family Be a Phone: ( ) good parent

Hospital: What are my goals in life? Phone: ( ) 1.) MY INSURANCE INFO 2.) Primary Health Insurance Provider Type: (circle one)

Private Medicare Medicaid Other 3.) Company:

Member Number: What are my health goals? Group Plan Number: 1.) Phone: ( )

Website: 2.)

3.) 2 3 In this book, we will talk about medicines. Medicines can also be Medicines come in many different forms... called medication, meds, drugs or prescriptions. For the purposes of this book, we will use the word medicine.

Medicines prescribed and overseen by your doctor help to treat and manage health conditions. Some medicines may C REA ELS interact with other medicines or vitamins you are taking. LIQUIDS DROPS O MS, G INTMENTS

Most medicines are given to: Cure a disease or condition Treat a medical condition Relieve symptoms of an illness Prevent illness

, INHALERS PATCHES There are two basic kinds of medicines: PRESCRIPTION: OVER-THE-COUNTER: Prescription medicines are prescribed These are medicines that you can find at a VITAMINS by a doctor or other health professional. pharmacy and get without a prescription. Ask your pharmacist about over-the-counter medicines that may work for you. IN S HER & TABLETS JECTIONS U BS S PPLEMENT

ASK Always ask your doctor or pharmacist about possible side YOUR effects. Both prescription and over-the-counter medicines DOCTOR! can be misused and have side effects. Also ask if it’s safe to 2. First Things First: What Are Medicines? take more than one medicine at the same time. Any medicines—prescription and over-the-counter—can have dangerous side effects. Always ask your doctor and/or pharmacist about the side effects of your medicines, especially if taking more than one at the 4 same time. See page 40 for more questions to ask your doctor. 5 SUBSTANCE USE

DISORDER (SUD) LEVELS of DRINKING3 Substance use disorder (SUD) is the clinical condition when substance use (drug, alcohol or other) causes significant impact in someone’s life. A SUD can be classified as mild, MODERATE BINGE DRINKING HEAVY DRINKING DRINKING moderate or severe. SUD may be diagnosed when the repeated use of alcohol or drugs impairs a person’s abilities. Up to 1 drink per Drinking 5 or more alcoholic drinks on Drinking 5 or more Health problems, disability or problems at school, work or day for women the same occasion on at least 1 day in drinks on the same home may be a result of the continued use of the substance. and 2 drinks per the past 30 days. Usually 4 drinks for occasion on each day for men. women and 5 drinks for men over a 2 of 5 or more days in AMONG THE MOST hour period. the past 30 days. COMMON ADDICTIONS1,2

Drinking too much can put you at risk of developing an alcohol use TOBACCO disorder (AUD), as well as other health and safety problems. Genetics (NICOTINE) 37.8 also play a part in becoming a risk factor for developing an AUD. MILLION

ALCOHOL MARIJUANA 15 3.9 MILLION MILLION ASK 3. Substance Use Disorder (SUD) YOUR Always be honest with CDC Excessive alcohol use DOCTOR! your doctor about how OPIOID PAIN COCAINE HEROIN causes much alcohol you drink. Says... 88,000 MEDICINES 4 860,000 626,000 Alcohol can interact deaths each year in the U.S. 2.1 with medicines you are MILLION *Centers for Disease taking. Ask your doctor Control and Prevention for resources to help you quit drinking, if needed. TRANQUILIZERS STIMULANTS SEDATIVES INHALANTS 618,000 540,000 (BARBITURATES) 110,000 205,000

6 As of 2016 7 OPIOIDS INCLUDE: ASK oxycodone/hydrocodone/codeine/morphine/fentanyl/heroin YOUR Ask your doctor about resources available to help you quit smoking. DOCTOR!

CDC More than 480,000 OPIOIDS LESSEN THE AWARENESS OF Says... deaths each year in the U.S. are caused by cigarette smoking. PAIN. BUT THEY CAN ALSO PRODUCE: Tobacco is the most commonly used substance.5 Drowsiness

Mental confusion Smokefree.gov has some effective tips for quitting the smoking habit and freeing yourself Euphoria from the grip of tobacco use disorder.

Nausea

Constipation

Labored breathing CDC Youth who drink alcohol are more likely to experience: Says... • School, social, physical and legal problems • Unwanted, unplanned and unprotected sexual activity • Higher risk of suicide • Alcohol-related car accidents and injuries • Memory problems • Abuse of other drugs6 THIS BOOK WILL GO INTO MORE DETAIL ABOUT OPIOIDS ON PAGE 13.

8 9 HEADLINES and DEADLINES 8 RISKS ON THE RISE Opioids killed more than 42,000 people in 2016. That was more than any year on record. The U.S. is in the grip of a substance epidemic. The risk of There are several reasons for this rise in overdose has never been higher, but this trend has been on substance use, misuse and addiction: course for more than ten years. Many more prescriptions being written and filled More than 64,000 people died Greater acceptance of using medicines for pain from overdoses in 2016 alone, about 66 percent of all drug overdoses are Together, these factors have helped create a sort of perfect storm of prescription drug availability. caused by opioids.7 WAKE-UP CALL

REALITY MORE AMERICANS ARE NOW KILLED BY DRUGS THAN BY CARS Deaths from motor vehicle crashes were twice as high as fatal drug overdoses Do you know anyone who died due to a drug overdose? in 1999. Today, it’s the opposite. There are nearly 40 percent more deaths yes no from overdoses today than in 1999. Most of these drug overdoses are from prescription opioids and heroin. How can you prevent overdose for you and those around you? 4. The Substance Use Epidemic What’s that pill? NALOXONE has the power to reverse an opioid overdose. Learn more about naloxone on page 32. Did you drop your pill bottle and mix up your medications? Did you find a pill on the floor? If you come across pills and you don’t Naloxone is used for treating an opioid emergency. know what they are, there are websites available to help you These situations may include overdose or possible identify them. You can enter the size, shape and imprint of the overdose with signs of breathing problems and code found on the pill to determine your pill type. You can also extreme sleepiness or not being able to respond. ask your pharmacist for assistance. 10 11 5. Opioids: A Closer Look We have all been impacted in some way by the opioid epidemic. Take a few minutes PAIN AND THE BRAIN to think of how the opioid epidemic has impacted our lives and how we can help. Opioids are a class of medicines that work to take away pain.

How has the opioid epidemic affected me? When pain signals reach the brain, opioids act to block the signal. They affect the areas in the brain that control emotion. The desired result is less pain. The ongoing use and abuse of opioids can lead to physical dependence and withdrawal symptoms. Opioids can come in tablet, capsule, liquid or other forms.

G In My Own Words Loss of job Lost Health ENERIC NAMES or income friends problems codeine Family Strained More awareness of fentanyl difficulties relationships the issue hydrocodone How can I help end the opioid epidemic? morphine oxycodone

Opiate refers to opium, naturally found in the poppy plant. Opioid refers to the class of drugs that includes both

Use this page to write about yourself. natural (opiates), semi-synthetic and synthetic (opioid) compounds. Opioid medicines can be:

Natural (made from the poppy plant) Seek help Talk to friends Learn more Learn about and family about SUD prevention Semi-synthetic (changed in a lab from the poppy plant)

Organize a Help someone Learn about Talk to Fully synthetic (completely manmade) support group get help naloxone my doctor 12 13 CDC Almost 18 out of every 100 people have used Says... illegal medicines or misused prescription medicines.9 When used as prescribed, opioids can be effective in fighting THE EFFECTS pain. They have been for thousands of years. Opioid HOW OPIOIDS WORK OF OPIOIDS medicines tell the brain to stop sending pain messages to areas of the body experiencing damage. Humans have opioid receptors in the brain, spinal cord and elsewhere in the body. Opioid medicines attach to these receptors. This tells the brain to stop sending messages of pain, which results in less pain and a pleasing effect. But one of the reasons why your doctor needs to manage these pain medicines so closely is that they can cause side effects and dependence.

Stops pain signals from reaching the brain Opioid attaches to opioid receptor The Short-Term Side The Long-Term Side Effects of Opioids Effects of Opioids

Drowsiness Physical dependence and possible addiction Slowed breathing Death Shoulder injury Constipation Liver damage Unconsciousness Brain damage Nausea Less effectiveness with managing pain Itching Withdrawal symptoms, such as: Opioids for pain can only be prescribed by a doctor. He or she will assess your Restlessness pain levels and adjust the dosage for the best pain management. While you’re Muscle and bone pain YOUR on opioids, you’ll need to check in with your doctor on a regular basis. Ask him PAIN, or her to help with a schedule of visits or calls to monitor your progress. Vomiting Diarrhea YOUR ASK Insomnia How your pain is responding to the medicine YOUR Cold flashes DOCTOR DOCTOR! If you’re having any side effects Prepare to If any medicine interactions or health issues discuss with might be raising your risk for side effects your doctor: If there are alternative treatments 14 15 Researchers are now studying the long-term effects of opioid addiction on the brain. This can affect: Medication-Assisted Treatment (MAT) is a specialized MAT: treatment plan that combines the use of medications Decision-making skills with counseling and behavioral therapies, to provide Behavior-regulating ability MEDICATION- a “whole-patient” approach to the treatment of ASSISTED substance use disorders. Research shows that Response to stressful situations a combination of medication and therapy can TREATMENT successfully treat these disorders, and can help sustain recovery.10

Prescription Chronic opioid use results in changes to the brain, like rewiring the brain, The goal of MAT is recovery and the ability for someone to be able to live opioids take that leads to impaired judgment and a self-directed life and reach their full potential. MAT had been proven to control of be an effective treatment plan that lessens the need for detox services. decision making. Recovery includes access to evidence-based clinical treatment and recovery the brain support services that can11, 12: At the same time, opioids change another part Improve patient survival of the brain that limits a person’s ability to stop Help a patient stay in treatment taking them. Lessen illegal opiate use Increase the patient’s ability to get a job and keep it

Improve birth outcomes for pregnant women with SUDs SUD Percent of Americans using heroin report by the#s 80 misusing prescription opioids first.13

16 My Personal Pain Assessment If your doctor were to assess your level of pain right now, how would you respond? PAIN, PAIN GO AWAY

6. Pain ASK YOURSELF: Pain comes in different varieties. It can be quick and short-lived or chronic and last a long while. Pain acts as a warning system. It’s your Where on my body do I feel pain?

body’s way of letting your brain know that something’s wrong. People When do I feel pain? experience pain differently. Pain that may be tolerable or aggravating to What does the pain feel like? Sharp? Throbbing? Dull? Shooting? you might be unbearable to another. Still, medical people have systems for classifying types of pain. Does the pain radiate or travel to other body areas?

How long have I had the pain?

When did the pain start?

How often does it occur? ASSESSING Doctors were convinced that pain What was I doing when the pain started? should be evaluated as a vital sign - What causes the pain to ease? PAIN like temperature. However, these vital What triggers the pain and makes it worse? signs are objective, whereas pain is subjective. What has the pain kept me from doing? How bad is it when it’s at its worst?

How long does the pain last?

Does it come on suddenly or more gradually?

What time of day do I usually feel the pain? CDC The amount of prescription opioids sold to pharmacies, hospitals and doctors’ offices nearly quadrupled (x4) from Says... What treatment have I used for the pain? 1999 to 2010, yet there had not been an overall change in the amount of pain that Americans reported.14

18 Feel free to share this with your health care professional. 19 Help you feel better Let you be more active ASK Pain medicines can interfere with some other medications. Medicines for pain can: Improve your mood YOUR It’s important to ask your doctor about side effects and drug DOCTOR! interactions, including over-the-counter medicines, vitamins, herbs and supplements. While some medicines require a doctor’s prescription, others can be bought over-the-counter. OTHER PAIN TREATMENTS • Helps with pain but doesn’t reduce swelling. Chronic pain usually calls for pain medicines. Pain medicines often work ACETAMINOPHEN • Available over-the-counter without a prescription. • Shouldn’t be taken with certain other medicines. best when used with other treatments. These additional treatments may • Overusing acetaminophen can result in liver or kidney damage. help you feel better or help you deal with the pain. Your health care team might suggest you try one or more of these treatments. • Ease pain and swelling, and work better for some than acetaminophen. • Some can be bought without a prescription; some higher strength • PT can help lessen pain and swelling. It can increase strength Pain Medicines NSAIDs versions require a prescription. and range of motion. It can relieve chronic pain caused by (Non-Steroidal Anti- • Take the lowest dosage that eases your pain. Inflammatory Drugs) • Can cause stomach bleeding, kidney damage. back and joint issues, headaches, arthritis, fibromyalgia and (Ibuprofen, naproxen) • Can interfere with some medicines used for treating hypertension, PHYSICAL nerve damage. congestive heart failure, high blood pressure and preventing kidney failure. THERAPY (PT) • PT usually includes strength and flexibility exercises. It may • Increase the incidence of heart disease. include massage, ice, heat or ultrasound treatments. • Ask your health care team about physical therapy if chronic • Strong pain medicines only available by prescription. pain makes it hard for you to move and do daily tasks. • Opioids can be deadly if combined with alcohol or other drugs. Ask your doctor if you can take opioids if you are currently taking other prescription medicines. • Counseling can help keep pain from overtaking your life. It can • Opioid pain medicines include oxycodone, hydrocodone and morphine. help you relax and sleep better. OPIOIDS • Side effects can include constipation, dizziness, sleepiness, sweating, nausea and vomiting, trouble breathing. • Through counseling, you can learn how to quit smoking, • Ask for your doctor’s help when it’s time to stop taking opioids. He COUNSELING drinking or overeating in response to pain. or she will create a medication withdrawal plan (called a taper). This will gradually lessen the amount of your medicine. It may take • Counseling can help you manage feelings of depression, anger weeks or even months to gradually and safely cut down your dose and get off your opioid medicine. and low self-worth. Balanced emotions help control pain.

• Relaxation therapy may include meditation, yoga, deep OTHER • A doctor may prescribe medicines for pain other than the ones PRESCRIPTION listed above. breathing exercises and muscle relaxation. • Antidepressants, muscle relaxants and sedatives may be MEDICINES effective as part of a complete pain treatment plan. • Relaxation exercises can help slow down your body and calm RELAXATION your mind. ASK • Relaxation practices can lower your blood pressure, slow It’s important to ask your doctor or pharmacist if it’s safe to take down your heart rate and breathing, and lessen muscle YOUR several medicines at the same time. Some medicines can be taken 20 DOCTOR! together, but some can cause serious side effects, including death. tension. All of these things can help relieve chronic pain. 21 TIPS TO KEEP PAIN FROM BECOMING A MAJOR PART OF YOUR LIFE. Quit smoking Quitting smoking makes managing pain easier. Many people think that being physically active will make 4 Smoking raises inflammation levels and the pain, swelling and redness that go with it Work exercise their pain worse. In fact, exercise is one of the best into your daily treatments for chronic pain. In most cases, an exercise Inflammation just makes chronic pain worse 1routine program should be part of your treatment plan. Smoking harms blood vessels so less blood can circulate Smoking slows down healing after surgery or injury Exercise releases endorphins in the brain that lift your mood and help block pain signals ASK Talk to your doctor about programs and medicines to help you Exercise strengthens muscles, helping prevent future injuries YOUR quit smoking. See Smokefree.gov for more ideas.

Help Yourself Try one-on-one work with a trainer or therapist, group/class activity or DOCTOR! exercise on your own as part of a regular routine Taking your mind off the pain with fun events with friends Walking is one of the best exercises. It can be done anywhere Plan activities and family can go a long way in providing relief. Plan activities for mental with loved ones so you don’t focus too much on the pain. ASK relief Try different activities you might enjoy: Check with your health care team before starting an exercise 5 YOUR program. They’ll help you find the best plan for you and your pain. DOCTOR! Gardening Playing cards Movies Making crafts Reduce stress Stress can make your body more sensitive to pain. Reading Cooking or other fun activities 2 to relieve pain Reducing stress can relieve chronic pain. Meeting friends for a meal Listen to soothing music Read Get support Support from family, friends and others with Meditate 6 from others similar conditions is a big part of feeling better. Download a relaxing program that guides you through relaxing exercises Join a support group with others who have chronic pain Ask others for ideas on treating pain Stay away from Alcohol can change the way many pain medicines work. Rely on family and friends to keep you company and provide emotional support alcohol while on Mixing alcohol and opioids or any strong medicine can pain medicines lead to side effects such as: 3 Things I could do to feel better: Nausea and vomiting Changes in blood sugar that can cause seizures Dehydration Changes in blood pressure Irregular heart rate Dizziness or fainting Lack of concentration 22 Coma 23 ONE IN FOUR DEATHS TODAY IS DUE TO ALCOHOL, BRAIN STRAIN TOBACCO AND PRESCRIPTION DRUG USE.15 Medicine can even change the chemistry of the brain. These changes can make That’s a pretty sobering fact. More deaths, sickness and it harder for a person to make decisions. It can also lead to cravings for the disability are caused by the effects of medicine misuse than medicine and seeking them out to use more. Before long, the user is dealing with from any other preventable health condition. a dependency issue.

Nicotine, cocaine, marijuana and other drugs of abuse affect the brain’s reward NUMBER OF PEOPLE AGED 12 OR OLDER WITH A PAST circuit. Addictive medicines provide a kind of shortcut to the brain’s reward 16 YEAR SUBSTANCE USE DISORDER: 2016 center. They flood it with dopamine, bringing on a feeling of happiness and well-

20.1 Million people with SUD being (euphoria). Over time the brain no longer feels euphoria and needs more - 15.1 Million alcohol medicines to just feel normal. - 4 Million marijuana - 1.8 Million prescription pain medication Other risks from substance misuse include behavioral or psychological problems. These may include: - 900,000 cocaine - 700,000 methamphetamine Paranoia - 600,000 heroin Aggressiveness Addiction Hallucinations 7. The Risks of Substance Misuse People with a substance use disorder also have a higher risk of: Impaired judgment Injuries17 Impulsiveness 18 Accidents Loss of self-control Social, emotional and family problems, including domestic violence19

ASK If you have concerns about your safety at home, talk to FIND DEA’s Resource for Parents, YOUR your doctor. There are resources to help you and your OUT Educators and Caregivers: DOCTOR! family stay safe and stop abuse. MORE getsmartaboutdrugs.gov 24 25 Addiction is a condition that causes someone to use a DEPENDENCE substance or behave in a certain VS ADDICTION Prevention is the #1 cure for addiction. way.

The rewarding effects compel One can be dependent ADDICTION PREVENTION him or her to repeatedly pursue without being addicted. that behavior despite serious Addiction to medicines is a global public health hazard. Addiction is a chronic brain disease characterized by a person seeking reward and/or relief by using substances. consequences. Addiction is the compulsive seeking out of medicines to take, despite the serious harmful effects they have. Under the care of a health team, the short-term medical use of medicines rarely leads to addiction. Addiction may involve the use of substances such as: The National Institute on Drug Abuse (NIDA) definesaddiction as an enduring Sugar and other foods condition that triggers the user to compulsively search out and use substances.20 Caffeine Inhalants Addiction is the continued use of a Nicotine WHAT IS substance, despite the physical, social ADDICTION? and financial problems caused by using. Marijuana Alcohol COMMON SYMPTOMS ARE: • Criminal activity Cocaine and other recreational drugs • Risky behavior Opioids • Illness • Isolation • Relationship problems

• Denial PAIN Heroin is an extremely dangerous drug with • Secrecy POINTS no accepted medical use in the United States. 8. Addiction, Dependence and Withdrawal

26 27 Misusing Opioids

ASK Ask your doctor about alternative pain medicines. There are many non-opioid YOUR options that can be just as effective without the risks. DOCTOR!

259 MILLION Number of prescriptions written for WHAT IS opioids in 2012. This would have been SUD more than enough to give every American WITHDRAWAL? by the #s adult his or her own bottle of pills.21 When a person cuts back or stops using some medicines after long-term or heavy use, withdrawal symptoms can surface. Opioid withdrawal syndrome is one of the strongest of all withdrawals. It can be extremely painful and uncomfortable. Many times, addiction and continued use of these medicines stem from the fear of having to feel the withdrawal symptoms. “MISUSING” OPIOIDS CAN MEAN: Those with opioid withdrawal have strong cravings for the medicine, along with feeling unwell in general. Taking an opioid prescribed for someone else (even if you’re taking it to reduce your own pain) Therapy and psychological help from Taking a higher dose of an opioid than prescribed a mental health expert, when used with a complete SUD treatment plan, can lessen the symptoms and side ASK If you or a loved one shows signs of dependence or YOUR addiction, share your symptoms with your doctor and effects of withdrawal. Learn more DOCTOR! ask for advice. about treatment on page 35.

28 29 This brief test is often administered to patients upon an initial visit Confusion, delirium or seeming drunk 9. Overdose 22 before beginning opioid therapy for pain management. SIGNS OF Will not wake up or respond to someone’s voice or touch Score if Score if Nausea or vomiting Check each box that applies female male OVERDOSE Extreme constipation 1. Family history of • Alcohol 1 3 FROM Pinpoint pupils substance misuse 3 •Illegal drugs 2 COMMONLY Extreme tiredness, or unable to wake up •Prescription medicines 4 4 Breathing problems, such as slowed or irregular breathing PRESCRIBED Stopped breathing 2. Personal history of • Alcohol 3 3 Slow heartbeat and/or low blood pressure substance misuse •Illegal drugs 4 3 OPIOIDS Cold, clammy skin or bluish skin around the lips or •Prescription medicines 5 4 under the fingernails 3. Age • Mark in box if 16-45 years 1 1 Goosebumps Opioid Risk Tool 4. History of preadolescent sexual abuse 3 0 The most dangerous side effect of opioid overdose is depressed breathing. When 5. Psychological • Attention-Deficit/ 2 2 the brain can’t get the oxygen it needs, it can cause other organs to shut down. disease Hyperactivity Disorder; Obsessive Compulsive Disorder; Bipolar WARNING: Disorder; Schizophrenia Never leave someone alone in the grip of an opioid • Depression 1 1 overdose. That person could fall asleep and die due to ! depressed breathing or stop breathing completely. TOTAL SCORE = 0-3 = Low risk 4-7= Moderate risk 8 and up= High risk

ASK Discuss with your doctor the results of this YOUR score. Ask your doctor or care manager if you DOCTOR! have any questions about its meaning. RESCUE 911 An overdose from a strong prescription opioid can be CDC Every three minutes, a woman goes into the emergency room for abusing powerful pain medicines. Since 1999, deaths from life-threatening. If someone you know has overdosed, Says... prescription overdoses among women have risen more than 400 call 911 right away. Get emergency medical help. Roll the percent vs 265 percent for men.23 person on his or her side while you await the ambulance to prevent choking. If the person is conscious, talk and OUD Opioid misuse affects every adult age bracket. The problem keep him or her awake. Never leave the person alone. among older Americans is becoming an urgent public AND health issue. Prescription opioid overdose rates are highest 30 AGE among people ages 25 to 54 years.24 31 TO PREVENT OPIOID OVERDOSE: ASK If you or someone you care for has opioids at home, you may be able to YOUR get naloxone as a nasal spray from your local drug store, if it is available • Ask your doctor and pharmacist about DOCTOR! in your state without a prescription. drug safety, dose and side effects. • Don’t take more medicine than prescribed. • Take the least amount of medicine possible. Your goal should be to make the pain tolerable — pain you can live ARE YOU AT RISK with — not to eliminate all pain. OF OVERDOSE? • Never mix pain medicines with alcohol, SUD by the sleeping pills or illegal substances. People exposed to prescription or illegal #s opioids should know the risks involved. • Store medicine safely where children can’t reach it. These risks may lead to accidental, life- • Get rid of unused medicines right away. 26,000+ threatening or deadly opioid overdose. • Learn where to access naloxone and how to use it. lives saved High-risk people include: Number of overdoses reportedly Anyone taking prescription opioids reversed between 1996 and 2014. Those taking prescription opioids in Naloxone is an anti-opioid used to reverse the symptoms of These reports were from organizations combination with other substances NALOXONE to opioid overdose, including respiratory depression and septic providing community-based overdose such as alcohol or sleeping the shock. This powerful and lifesaving medicine is available as a prevention services, including the use medicines RESCUE nasal spray, auto injector and traditional injection. 25 of naloxone, in the U.S. Those with medical conditions such as depression or lung/liver disease NALOXONE has the power to help reverse an opioid overdose. Anyone who injects opioids such as ASK heroin or fentanyl YOUR REMEMBER: Naloxone does not take DOCTOR! Anyone with a reduced tolerance to the place of emergency medical care. opioids Call 911 or get emergency medical help right away after giving the first dose of Chronic conditions, aging and Anyone with a history of substance naloxone, even if the person wakes up. pregnancy are especially important misuse, dependence or nonmedical times to talk to your doctor. use of illegal or prescription HOW IT WORKS medicines • Chronic conditions can change A dose acts within two minutes. It completely removes all signs of opioid intoxication, how our bodies digest a drug. reversing an opioid overdose. Naloxone can be used on both adults and children and can be administered by first responders, family members or caregivers. For high potency • As we age, our bodies process opioids, like fentanyl, more than one dose may be required. medicines differently. • Pregnancy medicines can FIND OUT MORE ASK impact the baby’s growth and PrescribeToPrevent: Ask your doctor or pharmacist about a co-prescription for naloxone for development. YOUR you and/or a loved one. Your pharmacy may be able to provide naloxone PrescribeToPrevent.org DOCTOR! without a prescription or refer you to a local agency that can provide it.

32 33 PREVENTION EDUCATION Preventing a substance use disorder is no easy task. It has to start in childhood and carry through into adolescence and adulthood. Screening TREATMENT While there are several treatment options and early intervention have proven to be effective. available in dealing with substance use OPTIONS FOR disorder, these have proven to be the Positive messages Programs that teach additional prevention most successful: that children and teens can help children and teens: DRUG ADDICTION receive from parents, Resist social pressures to experiment with teachers, doctors, media or use substances and other community Strengthen self-esteem sources about the Improve communication skills Behavioral counseling dangers of alcohol, Improve decision-making Medicines (for opioid, tobacco or alcohol addiction) tobacco and drug abuse Manage stress and anxiety can help influence them Advocate for their needs Evaluation and treatment for co-occurring mental health to make good decisions. Check for local resources in your school, issues (depression, antisocial personality disorder, bipolar in your community or by visiting disorder, anxiety) operationprevention.com Long-term follow-up to prevent relapse If you’re in need of treatment for yourself or someone close to you, start with Support systems (family, friends, caregivers)26 your doctors and health care team. Learn about what medicines can help you.

ASK If you or a loved one need treatment or have questions YOUR about treatment options, your doctor can help. Ask your SUPPORT GROUPS DOCTOR! doctor about treatment options. There are also hotlines, like the SAMHSA Helpline that can provide information about Two of the best-known 12-step support programs for addiction are: local treatment options. Alcoholics Anonymous (“AA”) SAMHSA HELPLINE: 1-800-622-HELP (4357) Narcotics Anonymous (“NA”) These programs let groups work together to help and encourage people This hotline is also crucial in suicide prevention! Call today if the cycle of substance use is taking over your life or to get resources for someone who to stay clean from drugs and alcohol. Many times, they go along with a needs help. rehab program, but can be attended long after the rehab is completed.

SAMHSA (SUBSTANCE ABUSE AND MENTAL HEALTH ADMINISTRATION) helpline is available at no cost 24/7 365 days a year and offers treatment referral and information services

10. Preventing and Treating Substance Misuse 10. Preventing and Treating for people and families dealing with substance use or mental health issues. 34 35 36 11. Ending Stigma 3. CalltheSAMHSA Helpline(1-800-622-HELP) formoreadvice, 2. 1. TIPS FORTALKING WITH YOURPROVIDER Make sureyourprovider knowswhatmedicinesyou’reMake taking. Ask any questionsyouhaveifthink youmayhavea including important questionstoaskyour doctor, ifneeded. substance usedisorder. Stigma isabarriertotreatment. and askforhelp. You arenotalone. professionals aretrainedtotreatSUD.Speakup There’s noshameinseekingtreatment.Medical programs after theyenroll. toquittreatment morelikely they’re and help for with aSUDoften don’tseekhelp,delayasking with theproblem.Becauseofthisfear, those whenadmittingjudgment ofothers to of shame.People feartheembarrassment and carrySubstance usedisorders ahighamount

dealing

What canyoudopersonallytopreventstigma Has stigmaorshamingaffectedyou?yesno REALITY ? 37 38 12. Helpful Tips for Staying Safe 3. Throw 1. MixMedicines mixing up their own medicines by mistake. mixing uptheirownmedicinesbymistake. to theenvironment,water like supply. adultsfrom Inaddition,safestoragecankeep lessen theriskofharmfromaccidentalorintentionalmisuse.Itcanalsopreventdamage When medicinesarenolongerneeded,it’s vitaltodisposeofthemsafely. This helps grounds. dirt, kitty litter orusedcoffee an unpleasantsubstancelike or tablet,combinethepillswith Without crushingthecapsules household trash. Throw thecontainerinyour STORAGE FOR SAFE TIPS the U.S. Food &Drug Administration (FDA). Here are sometips for disposingofmedicinesfrom Use amedicinelock box Dispose ofunused/expiredmedicines Keep medicinessafelystoredoutofsight 4. ScratchOut 2. Place plastic bag. container, such asasealed Place themixtureina container. it unreadable. Throw outthe medicine package tomake your emptypillbottle orempty on theprescriptionlabelof Scratch info out allpersonal 27 takebackday.dea.gov For moreinfoandtofindmedicinedisposal locationsinyourarea,visit reach ofchildren. Childrencanaccidentally overdose anddie. MAT medicines, shouldbelocked inasafeplace,especially outof MAT medications canalsobedisposedof. All medicines,including safe collectionsites. wind upinthewronghands,DEAhassetthesenationalevents,providing unused medicinesandpreventmisuse.Becauseprescription Back Day Sponsored bytheDrugEnforcement Agency (DEA),the TAKE BACK DAY DOCTOR! YOUR ASK in April andOctobereach yearprovides theopportunity todisposeof SUD by the in yourarea. pharmacist formoreinformationaboutsafemedicinedisposal Ask yourdoctor, localhealthdepartment, lawenforcementor # s National Take Back Dayin April 2018. Tons ofprescriptionscollectedat 474.5 ainl Prescription TakeNational 28 39 ALWAYS ASK QUESTIONS BEFORE TAKING YOUR MEDICINE. QUESTIONS FOR MY DOCTOR OR CASE MANAGER

ASK Make sure that you understand everything about Q:______YOUR taking your medicine. If you have any questions, talk DOCTOR! to your doctor, pharmacist or care manager. A:______

Q:______Some questions you might ask: A:______I’m not sure how often I should take this medicine. Can you explain? Q:______I’m having trouble taking my medicine. Can a family member or A:______health care member give it to me instead?

Are there any short-term/long-term side effects I should watch for? Q:______A:______What time of day should I take this medicine? Or does it matter?

When can I stop taking this medicine? Q:______A:______Are there any medicines I should avoid taking with this?

Am I taking any medicines that this could interact with? Q:______13. Talking With Your Doctor With Your 13. Talking A:______Are there any foods to stay away from when taking this medicine?

How long do I need to take this medicine before it starts working? Q:______A:______Are there any alternative treatments (instead of taking this medicine)?

What’s the brand name or generic name of this medicine? Q:______A:______What should I do if I miss a dose?

What should I do if I accidentally take more than I’m supposed to? Q:______A:______What are the possible side effects? 40 41 QUESTIONS FOR MY DOCTOR OR CASE MANAGER MY NOTES

Q:______A:______Q:______A:______Q:______A:______Q:______A:______Q:______A:______

Q:______A:______Q:______A:______Q:______A:______Q:______A:______42 43 INSTRUCTIONS: Use this chart to write down the medical conditions you have and the MY MEDICINE MANAGER medicines you take to treat them. Use a dry erase, non-permanent marker to add/erase entries as needed. The static cling material will adhere to most smooth, dry surfaces.

DIETARY WHEN TAKEN DATE MEDICAL CONDITION PRESCRIPTION OVER-THE-COUNTER MEDICINES MEDICINES SUPPLEMENTS A.M / P.M.

Peel at corner and apply to smooth surface. 44 14. Tools and Resources permission of CenteneCorporation. You maynotalter or removeanytrademark, copyrightorothernotice. by anymeans,electronic, mechanical,photocopying,recording,orotherwise, withoutthepriorwritten may bereproduced,distributed, displayed,storedinaretrievalsystem,ortransmitted inanyformor Corporation andareprotected byUnitedStatesandinternationalcopyrightlaw. No partofthispublication © 2019CenteneCorporation. All rightsreserved. All materialsareexclusivelyownedby Centene Pills Anonymous: Anonymous:Gamers Online Anonymous:Overeaters Nar-Anon: Marijuana Heroin Anonymous: Anonymous:Gamblers Food AddictsAnonymous: Families Anonymous: Emotions Anonymous: Co-Dependents Co-Anon: Meth Anonymous: Crystal Cocaine Anonymous: Al-Anon/Alateen: Adult Childrenof Alcoholics: SUPPORT GROUPS ihs.gov/asap/ Indian HealthService: Alcohol andSubstance Abuse Program (ASAP) niaaa.nih.gov and Alcoholism on AlcoholAbuse Institute National 301-443-1124 drugabuse.gov National InstituteonDrug Abuse 314-962-3456 ncada-stl.org National Councilon Alcoholism andDrug Abuse (NCADA) National SuicidePrevention Lifeline:1-800-273-TALK (8255) National Helpline:1-800-622-HELP(4357) findtreatment.samhsa.gov Substance Abuse andMentalHealthServices Administration (SAMHSA) 1-800-CDC-INFO (1-800-232-4636), cdc.gov forCenters DiseaseandPrevention (CDC) co-anon.org Anonymous: nar-anon.org Anonymous: pillsanonymous.org al-anon.org heroinanonymous.org ca.org familiesanonymous.org emotionsanonymous.org gamblersanonymous.org marijuana-anonymous.org oa.org crystalmeth.org foodaddictsanonymous.org olganon.org adultchildren.org coda.org TTY: 1-888-232-6348 12 11 10 9 8 statistics/overdose-death-rates 7 28 ucm186187.htm ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ 27 publications/effective-treatments-opioid-addiction/effective-treatments-opioid-addiction 26 www.cdc.gov/mmwr/preview/mmwrhtml/mm6423a2.htm 25 databriefs/db294.htm 24 prescriptionpainkilleroverdoses/index.html 23 22 21 drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction 20 19 18 drugfacts/drugged-driving 17 FFR1-2016/NSDUH-FFR1-2016.pdf Survey 16 publications/health-consequences-drug-misuse/death 15 guidelines_at-a-glance-a.pdf 14 publications/drugfacts/heroin#ref 13 6 5 4 3 samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf 2 1 WORKS CITED CDC:SmokingandTobacco Use. CDC:UnderstandingtheEpidemic. CDC:OpioidOverdose. NationalInstituteonDrugUse:OverdoseDeathRates. FactSheets-UnderageDrinking. Ibid. CDC:FactSheets-AlcoholUseandYour Health. SAMHSA:Resultsfromthe2016NationalSurveyonDrugUseandHealth:DetailedTables. CDC: CurrentCigaretteSmokingAmongAdults—UnitedStates,2016. DEANationRx Takeback Day. FDA:DisposalofUnusedMedicines: WhatYou ShouldKnow. NationalInstituteonDrug Abuse: EffectiveTreatments forOpioidAddiction. OpioidOverdosePreventionProgramsProvidingNaloxone toLaypersons—UnitedStates,2014. DrugAbuse.gov:OpioidRiskTool. CDC:OpioidPainkillerPrescribing. NationalInstituteonDrugAbuse:Drugs,Brains,andBehavior:TheScienceofAddiction. CDC:IntimatePartnerViolence. Ibid. NationalInstituteonDrugAbuse:ConsequencesofMisuse. CDCGuidelineforPrescribingOpioidsChronicPain. NationalInstituteonDrugAbuse:Prescriptionopioidsandheroin. 12SAMHSA:RecoveryandSupport. Ibid. SAMHSA:Medical-AssistedTreatment (MAT). CDC:DrugOverdoseDeathsintheUnitedStates,1999–2016. NationalInstituteonDrugAbuse:DruggedDriving. SAMHSA:KeySubstanceUseandMentalHealthIndicatorsintheUnitedStates:Resultsfrom2016 National CDC:PrescriptionPainkillerOverdoses. on DrugUseandHealth,Figure42. Retrieved fromhttps://www.cdc.gov/drugoverdose/index.html Retrieved from https://takebackday.dea.gov/ Retrieved fromhttps://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm Retrieved from Retrieved fromhttps://www.cdc.gov/alcohol/fact-sheets/underage-drinking.htm Retrieved fromdrugabuse.gov/sites/default/files/files/OpioidRiskTool.pdf Retrieved fromhttps://www.cdc.gov/drugoverdose/opioids/index.html Retrieved fromhttps://www.cdc.gov/vitalsigns/opioid-prescribing/index.html Retrieved fromhttps://www.samhsa.gov/data/sites/default/files/NSDUH- Retrievedfromhttps://www.cdc.gov/vitalsigns/ Retrievedfromhttps://www.samhsa.gov/medication-assisted-treatment Retrieved fromhttps://www.samhsa.gov/recovery https://www.cdc.gov/ViolencePrevention/intimatepartnerviolence/ Retrieved fromhttps://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm Retrieved fromhttps://www.drugabuse.gov/related-topics/trends- Retrieved fromhttps://www.drugabuse.gov/publications/ Retrieved fromhttps://www.cdc.gov/drugoverdose/pdf/ Retrieved fromhttps://www.fda.gov/Drugs/ Retrieved fromhttps://www.cdc.gov/nchs/products/ Retrieved fromhttps://www.drugabuse.gov/ Retrieved fromhttp://dx.doi.org/10.15585/mmwr.mm6702a1 Retrieved fromhttps://www.drugabuse.gov/ Retrieved fromhttps://www.drugabuse.gov/ Retrieved fromhttps://www. Retrieved fromhttps://www. Retrieved fromhttps:// Use this workbook to learn about:

Types of medicines Substance Use Disorder (SUD) Medication safety Pain and how to manage it safely Tips for preventing and treating substance misuse Addiction, dependence and withdrawal Helpful resources and answers to questions

LOOK INSIDE FOR YOUR FREE MEDICINE MANAGER CLING! MADE IN THE USA This book was printed on recycled paper.

ISBN: 978-0-9978570-8-5