the therapeutic dose. like prescription drugs, the over-the-counter drugs are safe and effective when used as indicated but- and, also like prescription drugs when misused, you get a different effect, a different response. tim? you know, the other over-the-counter that we actually haven't touched on here is inhalants, which is a huge problem, especially in our younger grades. i mean, our monitoring the future survey shows that it's kind of the reverse, the 8th and 12th graders reversed. the 8th graders use more inhalants than the 12th graders do. and so that's some of the first and early exposure for these things that are readily available in the drugstore, art store. well, when we come back, i know that we've just scratched the surface on the over-the-counter because that is something that's even more accessible to the younger populations, and they can

just go up to the drugstore and acquire it. and so i want to talk about what some of the preventive measures we can take, you know, not only parents can take but pharmacies as well. we'll be right back. (music) it's important to be familiar with the proper terminology surrounding addiction and recovery. one of the terms you want to be familiar with is substance use disorder. substance use disorders involve the dependence on or abuse of alcohol and/or drugs, including the nonmedical use of prescription drugs.

for more information on this and other recovery jargon, visit the recovery month web site. (music) drug and alcohol addiction. you lose your way. but there is a way out. you can find direction. find support, treatment. find yourself, and your life. your direction home. for drug or alcohol treatment referral for you or someone you know, call 1 (800) 662-help. if someone you love has a problem with drugs and alcohol... "he's not expecting this." "yeah, but it's the right thing" ...there is something you can do. "you think he'll be ok with this?" "shhh, here he comes." "congratulations!" you can celebrate his recovery every chance you get.

for drug or alcohol treatment referral for you or someone you know, call 1 (800) 662-help. (music) today, we're a medicated society. and that means that prescription medicines and over-the-counter medicines are literally at arm's reach. in fact, people ages 65 and older, in any given year, are filling more than 30 different prescriptions. and one third of older adults are using

five different medicines at the same time. the mission of the national council on patient information education, ncpie, is to stimulate and improve communication of information on safe and appropriate medicine use to the general public and health care professionals. "thank you for inviting the national council on patient information education, ncpie; that's how i'm going to refer to us today." one of our key programs right now is called the "teen influencer" program. the full title is "maximizing your role as a teen influencer: what you can do to prevent teen prescription drug abuse." that program enables adults in the community to access and download and then use for community outreach purposes a whole range of materials to help get the word out in a consistent way about prevention and treatment options related to teen prescription drug abuse. as medication use becomes more prevalent in our society

for all ages, so too becomes the need to improve the communication about those medicines between the clinicians-the doctors, the pharmacists, other prescribers-and the patient and their support network. samhsa's been a tremendous resource support to ncpie. they've provided resources and also the intellectual information and data that have enabled ncpie to develop resource materials, such as our "teen influencer" program, materials that are available for the community and for teens and parents. ncpie makes sure that it embeds in all its messages and materials information for the general public, for adults and teens about where they can seek out treatment information, including, for example, samhsa's hotline and their "treatment locator." all the wonderful resources that we have, whether they're at aarp or the national council on patient information and education, all come down

to helping people get the most value from their medicines. so if i go to a gathering, it could be a party of one or it could be a party of a thousand, and people ask me what i do and i tell them, automatically that triggers "oh, my mother's taking a lot of medications," or "my son's having a problem with..." so it creates an opportunity to help and serve. so we've already established that over-the-counter medications are accessible and that youth are in particular risk of accessing these drugs. and, what has been done or what can be done to help us deal with this problem. beverly? we need to make sure parents are aware that this is really an issue and a concern for their youth and that we have community groups in schools and different organizations bring that up. because i think parents, it's kind of under their radar.

they're looking for illicit drugs; they're kind of thinking about that and watching for their children, but they're not paying attention to the packages of cough syrup coming into the house or the different things they might find around or maybe different shopping expeditions that their children are taking to the drugstores. and they can work with their local community pharmacies, too, to sort of increase that awareness and make people more aware that this is a prevalent issue and it is a problem, and i think its getting on parents' radar will help a great deal in that respect. we want to keep parents aware that just because, again, it's on the aisle doesn't mean that if it's misused, it's safe. for instance, between 1999 and 2004, there's a sevenfold increase in overdose due to over-the-counter cough medications, and most of those overdoses occur in the 15- to 16-year age range. so we're talking about, we're talking about the

young children in their families' household. and when you ask how much they took, it turns out that instead of taking one or two teaspoons or tablespoons of medications, our young people are taking 25 to 50 times the recommended therapeutic dose, which is clearly not what the pharmaceutical company intended. so it's an important thing to keep in mind that the age range that we're concerned about is everyone but particularly our young people when they take so much and they risk complications; overdose is a very real complication. and i think that we need to be very cognizant of the fact that the-a parent speaking to their teenager is extremely impactful. research states that the more understanding and education that the youth gets from the parent, the less likely that they're going to use the over-the-counter medications as, you know,

thrill-seeking or, you know, get into trouble that way. so parental education and information to their teenager is extremely important in prevention. beverly, you wanted to add something? yes, i did. i think we need to not stockpile our medications as well, so our parents can track how much cough syrup is in the house at any given time. you know, if you get to a point where the cold, the flu is gone, then throw that bottle away and then buy a new bottle when it comes in the next time. that way they can track and kind of keep an eye on what the medication levels are there in the house. we teach our parents to childproof their homes for toddlers, but we haven't really talked to them about doing the same types of things for their teens, as well. well, one of the things in terms of, if you can't- if you have to stockpile, keep the medication under lock and key; that's an alternative. the reason i mentioned that is because we also have to think about our rural citizens who have to travel long distances and that gets to be a problem,

or in communities like in northern alaska where everything has to be flown in. so if you have to stockpile, you stockpile under lock and key, and you keep an eye on what's going on in that cabinet. or a family may simply not be able to afford, i mean, if they don't have a lot of money, i mean, you really wouldn't want to throw something out. but as dr. clark mentioned, you really- and you did as well-you really do need to keep track of it. dr. condon? i think dr. clark's point is right on. a medicine cabinet in 2009 has a different connotation than it did with my parents' generation. and back then it was where you kept the medicines that were very, you know-you mentioned the word- we needed to respect them, but as the culture has changed with supplements and advertisements and, yes, we encourage people to get medications for their ailments, and we have many

more lifesaving medications available when appropriately-. the medicine cabinet's no longer that sacred place where you store things. in fact, i would maintain, personal observation, we don't even have a medicine cabinet. we have them all-we have medications in drawers, on counters. and i bet you most families, in fact, probably do the same thing. that's correct. and talking about what we keep in the medicine cabinet, i'm intrigued about an off-camera conversation we were having related to medical marijuana, that some states are allowing medical marijuana to come in, and dr. condon, you wanted to make some observations. well, again, we're talking about, we were talking earlier about prescription medications because they have the stamp of approval as safe and effective by the federal- the fda, they are prescribed by a physician, and, when used appropriately, they're lifesaving, just a as i said. but that does impart to that medication that it's safe.

and, again, it's only safe for the individual. but that stamp of approval is, i think, contributing to our young people saying, "well, it's safe for somebody else or it's safe for my parents, it must be safe for me." and that's what we talked earlier about. that's not the right message. so the attitudes have been changing because our monitoring the future survey we released earlier this week is actually tracking those attitudes, and we're finding a softening of attitudes about some prescription medications, the risks of harmfulness. at the same time we're seeing a softening of the attitudes about the perceived risks of marijuana, and so there's a softening of that or a decrease in its perceived harmfulness. and that may very well be a result of-we see 13 states and 1 jurisdiction with medical marijuana laws.

so if a physician's prescribing them, how can that be bad? and how can one combat that danger? what-again, i go back to the parent. what does the parent say to the child? it's still all about respecting medications and respecting the fact that a prescribed medication is safe for that particular individual, for that particular time, for that particular ailment. and then after that point in time, it's no longer safe anymore. so that's what we need to reinforce to the parents, and that message needs to come across, all the way across the board. if we get that message out to parents, they will also understand that applies to the senior population, that it applies to, you know, our very young population. it's the same message, no matter what. we've talked a lot about the problem. i want to start now a little bit diving into some of the solutions. and dr. krantz, particularly with the older americans, and please note to let us know when one

becomes older so that people can self-identify because we are quite the young generation of older americans that we're facing. i know i'll never start-stop using jeans or thinking that i'm older for heaven sakes. but indeed, i am. and so i want you to address that issue. what do the seniors need to be particularly cognizant of-and if they run into trouble, what type of programs are available? well, at hanley center, we have a prevention program, called aging to perfection. and actually our older adult unit, to answer your question, when you become old is 55 and above. so i qualify for the older adult program now. but what our aging to perfection program actually addresses is helping the older adult- first of all, you know, simple things-

write down the prescriptions that they're taking when they go to the doctor because, again, they're getting multiple prescriptions from different physicians, and there are drug-drug interactions that potentially can be lethal to them. so writing them down, understanding, you know, asking questions, throwing away their medication when it's, when they're finished, not saving it. and that's a hard thing in today's economy, you know, not saving the medication. so there's a list of prevention techniques that we teach the older adults so that they can use their medication in a more safe and effective manner. dr. condon? i wanted to echo that. i think we-for our older citizens, you know, their medications are oftentimes received via the mail, or they're standing in a long line in a retail pharmacy. so to ask questions is something that we just

want to get out of it. and we really need to really get the message out that there is a professional there, a pharmacist. there's usually a little window where you can have a consultation, and they will take the time to talk to individuals about drug interactions, about doses, and let them understand rather than it just being essentially a retail operation. let me go to dr. clark and ask him as a physician. does the physician bear some responsibility to explain to their patients what they're getting and how to use it? well, as dr. krantz would note, yes, the physician does, but, again, in a period when you've got multiple medications, sometimes from multiple practitioners, that's not as easily- that's more easily said than done. but one of the things you can do is, you go to a single pharmacy, and in the era of electronic records and electronic prescribing,

it's a lot easier for that single pharmacy to have their computer programs acknowledge when there are potential conflicts or adverse reactions. there are delivery models, like medical homes where you've got one entity that is the repository of all your medical information, so if there's a red flag, that can be easily tracked. when you get into the medicare age range, through e-prescribing, again, it's a lot easier to track the records. so we're moving in the direction of having personal health records and electronic medical or electronic health records where the computers can play a role. but, as dr. condon pointed out, the seniors themselves should understand, with multiple medications, it's possible to have these conflicts, as dr. krantz pointed out, and you should ask. and if you ask, the pharmacist will take

the time to discuss these matters with you. when we come back, i want to continue a little bit on this subject because i think there's a lot left unsaid still. we'll be right back. for more information on national alcohol and drug addiction recovery month, events in your town, and how you can get involved, visit the recovery month web site at recoverymonth.gov. they tell me i was there, but i don't remember. i don't know where i really was. i do not know what i had for breakfast. i do not know who won the game. i don't recognize this man. if you or someone you know is struggling with a drug or alcohol problem, there is a solution. recovery. call 1 (800) 662-help for information and for hope. through treatment, my life's a whole lot brighter now. brought to you by the u.s. department of health and human services.

people trapped by drug or alcohol addiction often feel like there's no hope, no way out. but for every lock, there's a key. and if you have a problem, it's good to know there are real solutions to help you get free. for drug or alcohol treatment referral for you or someone you know, call 1 (800) 662-help. brought to you by the u.s. department of health and human services. (music) if i can do it, anybody can do it. i'm no exception. i happen to be a professional, but i was also an inmate. upon studying for the bar exam, there was pressures as to your ability to concentrate and focus. i was dating someone whose father was a sports physician, and at their house were boxes of hydrocodone, sample boxes.

and i did go to their house, i took 2 of the sample boxes that had 40 pills in them. my theory at the time, although yes, it was absolutely wrong to take pills out of someone's house that are not prescribed to me and do not belong to me, was after the bar exam, i will stop taking them. i did not think, "what if," and what actually turned out to be my story. (music) being in recovery, we have the option to not only change our lives but to change other peoples' lives. i wouldn't change a thing. i wouldn't take the arrests off my record. i wouldn't do anything to change where i am today. and i think it's important to tell people the message that we do recover. i'm a five-time convicted felon. and today and for the past over six years, i haven't taken a drug. and the message is, we do recover. (music) dr. clark, are there any types of monitoring systems that are instituted that one can

look to that help to solve this problem? well, there are different types of monitoring programs. one of the ones that we at the substance abuse mental health services administration use in conjunction with the department of justice are what's called prescription monitoring programs. so these are programs that monitor at the pharmacy level, the use of prescription opiates and other scheduled drugs, and we're able to determine whether a physician is misprescribing or a patient is presenting in multiple systems if they use the same id numbers, so that we can address that. but there are other prescription strategies, and dr. krantz was talking about one. correct. the one that has been helpful to me as a family practitioner is when i get the message from the pharmacy that did i realize that this particular patient

was also taking this, this, and this drug. so that prescription monitoring program has been extremely helpful. the other thing i think we need to be mindful of with prescriptions, especially for talking about older adults, is that most of them can't read the directions on the prescription bottle. so, again, speak-as dr. condon has said, speaking with the pharmacist, speaking with their primary care physician is extremely important in understanding how to take the medication. and dr. condon, i mean, i think older americans sometimes are afraid to ask, afraid to inquire. why should we-you know, i mean, let's emphasize again the reasons why they should do this. well, again, we know that they're receiving more prescriptions than the last generation of elderly adults in the united states, and i think we even have a graph showing the number of prescriptions

on how they've gone up in the united states. we also know that most medications are tested in clinical trials, not using older adults but using middle-aged people or younger, healthy individuals, or if there's a chronic illness, not necessarily for children and not necessarily for seniors. and their metabolism, their pharmacokinetics, as we say, change dramatically as we age and as we get larger, as we put on weight, as we lose weight, all of those factors. so, yes, maybe seniors are reluctant to ask the pharmacists. i think the pharmacists are a key here because, in, just my personal experience in a retail pharmacy, actually one of the things that they really enjoy, and it's one of the reasons they became pharmacists, is to counsel patients and to let them

and to share the knowledge that they have rather than just arguing with insurance companies over the phone. beverly? yes, in regard to our seniors again, i want to point out that as far as the pharmacist is concerned, we can go back to the pharmacist and ask questions later on. they are there for us to make use of them, and they enjoy doing that, like you were speaking of earlier. don't be afraid that once you got your prescription and walk away that you can't come back the next day and ask questions of the pharmacist when you've looked at things a little bit more and looked at your other medications. and when it comes to our senior population, they have a lot of prescriptions, a lot of bottles lying around; we again want to encourage them to safeguard their medications, because they may not be aware that maybe their grandchildren or friends of their grandchildren might come in and be shopping for medications, or even some of the repair people coming in their homes might be looking for medications. they may not be using them, but they know they're valuable, and they might be interested in taking those to resell later on. so it's all about safeguarding those medications

and making people more aware; the pharmacist is there to help them; store your medications safely; use them properly. you know, it's some very basic principles that we need to get the messages out about. we had spoken earlier about some of the practices of people sharing their prescription, correct, dr. krantz? and how do we feel about that? well, prescriptions are not written to be shared, first of all. i mean, it's extremely important to use your own prescription. and that, i mean, dr. clark talked about the statistics, even of the teenagers, the youth, you know, 12 to 25 that are using prescription drugs that are from a relative or a friend. i mean, it's a significant problem in the united states today. beverly, talk to us about your programs. sure. in colorado we started a new campaign called rxdrugs.notsafe.notyours.o rg is the web site on that,

and it's a resource for parents, students, educators. they can go there and find different connections to materials that patients can learn how to dispose of their medications properly, students can learn what to do if they think some of their friends are starting to have issues with drugs. parents can go there to find other resources as well and how to address that issue within their home. the issue of getting help-we've talked about, a lot about the-what are the parameters of the problem, who are the targeted populations that are at risk, but if i've got a prescription misuse problem, dr. clark- what types of programs should i seek in terms of treatment? well, you should-first, we want to make sure that you're talking to your practitioner. if you are reluctant to talk to your practitioner, samhsa has a 1 (800) 662-help, 1 (800) 662-help line.

you can call that line, and they will direct you to a professional evaluator who can help determine whether you need outpatient assessment or inpatient assessment or what have you, but the key issue is the willingness to do that. one of the problems in our country is that most people don't perceive the need for assistance. our data indicates that 96 percent of the people who meet criteria for abuse and dependence don't perceive a need. and dr. krantz was talking about that, especially with prescription drugs, if you can start off with therapeutic use and if you're not careful, it creeps up and then you get embarrassed. if you're older or it's a lark if you're younger, nevertheless, it's the problem. so we encourage people to recognize that the misuse of prescription drugs is very dangerous, immediately to your health and potentially to other people. so you should call 1 (800) 662-help, you should talk to your practitioner, or you can talk to someone who is medically sophisticated enough

to assist you in finding the appropriate place. and as dr. clark was speaking, he's absolutely correct in the sense that one of the barriers to the treatment of this disease is the stigma where the people don't understand it as a disease. you know, addiction is just as much a disease as diabetes, cancer, heart disease. we need to look at it that way, and we need to have access to care and access to treatment because treating the disease changes the whole person's life. in your own case, dr. krantz, what was your "aha" moment when you realized that you really needed help? my aha moment was when i thought-i continued to have headaches, was taking the opioid, the medication, and it wasn't getting better, and i came to the conclusion that probably maybe i'm crazy

because i tried to stop, stopped but couldn't stay stopped, didn't understand, was not- even in medical school-i was not given the education or the amount of education that i needed to understand that chemical dependency addiction is a disease, and through the use and abuse of an addictive substance that the disease can kick in. so, again, that barrier that i had to deal with was the shame and the guilt and the stigma of being labeled a drug addict where i had no understanding. so when i walked into treatment, i thought, well, this is good because they'll give me a pill to help me because obviously i'm crazy- i'm doing things i would never do. i'm taking more medication. i'm a physician. i understand that i shouldn't be doing this. and then they said to me, no, you have the disease