Multi-pronged approach to teen drug use prevention

Last Saturday was National Drug Take-Back Day during which people could safely dispose of unused prescription drugs in an environmentally-friendly manner at local police precincts.  This is one activity that is part of a national strategy for preventing youth substance use.

Effective youth substance use prevention strategies need to include multiple activities targeting multiple risk factors conducted by multiple organizations.  This was made clear during a recent House of Representatives committee meeting about prescription drug and heroin abuse.


Many factors contribute to prescription drug abuse
The first person to testify was Joseph Rannazzisi from the Drug Enforcement Administration.  His testimony highlights the multiple factors contributing to prescription drug abuse:

The problem of prescription drug abuse has increased exponentially in the last 15 years due to a combination of excessive prescribing, drug availability through friends and family, Internet trafficking, rogue pain clinics, prescribers who prescribe pharmaceutical controlled substances without a legitimate medical purpose or outside the usual course of professional practice, pharmacies that dispense illegitimate prescriptions, and supply chain wholesalers and manufacturers that fail to provide effective controls and procedures to guard against diversion—all of which fueled illicit access at the expense of public health and safety.

Prevention activities address multiple factors
Rannazzisi goes on to describe a “holistic approach” to prevent diversion of prescription drugs and reduce availability for abuse.

Non-medical drug use cannot be addressed through law enforcement action alone. The Office of National Drug Control Policy’s 2011 Prescription Drug Abuse Prevention Plan, a multi-pronged approach that includes education, tracking and monitoring, proper medicine disposal, and enforcement is a science-based and practical way to address this national epidemic.

Preventing teen drug use prevents adult substance abuse problems
Michael Botticelli from the White House Office of National Drug Control Policy emphasized that most adults with substance abuse problems started using drugs before they became adults.

We also know that substance use disorders, including those driven by opioids, are a progressive disease. Most people who develop a substance use disorder begin using at a young age and often start with alcohol, tobacco, and/or marijuana. 

Multi-pronged prevention strategy
He then discussed the White House’s plan for preventing prescription drug abuse:

The Plan focuses on improving education for patients and healthcare providers, supporting the expansion of state-based prescription drug monitoring programs, developing more convenient and environmentally responsible disposal methods to remove unused medications from the home, and reducing the prevalence of pill mills and doctor shopping through targeted enforcement efforts.

Remarks from Daniel Sosin, representing the Centers from Disease Control and Prevention, supported previous testimony and outlined what his agency doing.   Nora Volkow from the National Institutes on Drug Abuse provided information about how prescription drugs and heroin affect the brain.

Westley Clark from the Substance Abuse and Mental Health Services Administration discussed prevention efforts conducted through his agency.  Among them:

SAMHSA also supports the “Not Worth the Risk, Even If It’s Legal” education campaign, which
encourages parents to talk to their teens about preventing prescription drug abuse. Another
educational program, “Prevention of Prescription Abuse in the Workplace,” is designed to
support workplace-based prevention of misuse and abuse of prescription drugs for employers,
employees, and their families.

Community forum about youth drug use prevention features local policymakers

Keeping It Real: Marijuana, Alcohol and the Effects on Our Youth
Thursday May 8th, 5:30-8:00pm

Rainier Beach High School Paul Robeson Performing Arts Theater
8815 Seward Park Ave S, Seattle WA 98118

Join Mayor Ed Murray, Councilmember Bruce Harrell, Liquor Control Board Member Ruthann Kurose, King County Judge Wesley Saint Clair, School Board Member Betty Patu, Drug Court Supervisor Josalyn Conley, Children's Hospital Dr. Leslie Walker,  and other community leaders to discuss what youth, parents, leaders, and the community can do to prevent and reduce youth marijuana, alcohol and other drug use.

Dinner provided from 5:30-6:00pm.  Program begins at 6:00pm.

Youth performances by the SE Seattle Community Youth Orchestra, the South Shore Steel Pan Ensemble and Dance 206.

Organized by the SE Seattle P.E.A.C.E. Coalition, in collaboration with Aki Kurose Middle School, RBHS PTSA, APICAT & WAPI Community Services.   

Tomorrow is Drug Take Back Day

Tomorrow between 10:00 a.m. and 2:00 p.m., Seattleites can dispose of unused and unwanted prescription drugs at Seattle Police precincts.

In NE Seattle, prescription drug abuse among our middle and high school students has steadily increased over the past few years.  Since home medicine cabinets are a major source of medications for teenagers who abuse prescription drugs, it is important to get rid of leftovers, especially if they are not locked up.

A National Rx Drug Abuse Summit was held in Atlanta earlier this week and one of the videos shared through the event's social media is this one:

Marijuana advertising milestone

A new legal marijuana system milestone may have been reached last week.  Though medical marijuana businesses and products have been advertised locally for a while, last week a Seattle newspaper may have run the first ad for a recreational marijuana business licensed by the Liquor Control Board.

As the marijuana industry grows and matures, expect more advertising aimed at promoting and normalizing use of the drug.  A recent KPLU news story includes this quote from a marketing expert: "[Businesses are] going to try to go beyond their core quote-unquote 'stoner user' to expand and have it be acceptable at cocktail parties."

Preventing underage use of nicotine and marijuana products through regulations

An article in the latest edition of the American Journal of Public Health suggests that it is important for pubic health policies for preventing youth marijuana use to be instituted as soon as possible in states like Washington.  Policies should be adopted before an industry with significant lobbying power is fully established.  The article states, “The lesson for marijuana may be to establish authorities’ rights to impose regulations from the outset because of how difficult it can be to expand regulator scope” after an industry is well established. 

Regulating e-cigarettes

The Food and Drug Administration’s recent announcement that they plan to regulate e-cigarettes, devices that vaporize liquid nicotine products, provides a perfect example.  As the Campaign for Tobacco Free Kids notes, “Three years after first announcing plans to do so, the Food and Drug Administration today has finally issued a proposed rule to begin regulating electronic cigarettes, cigars and other tobacco products not currently under its jurisdiction . . . It is inexcusable that it has taken the FDA and the Administration so long to act. This delay has had serious public health consequences as these unregulated tobacco products have been marketed using tactics and sweet flavors that appeal to kids, and their use has skyrocketed.”

Skyrocketing use of marijuana vaporizers

Just like the use of nicotine vaporizers has skyrocketed among teenagers, the use of marijuana vaporizers has also skyrocketed among teenagers according to state officials. "Right now in Washington, if you are in mid twenties and younger, you prefer hash oils and vaporization as opposed to smoking," said Randy Simmons, Program Director for I-502 for the Washington State Liquor Control Board in a recent KOMO News story. 

Regulating e-joints

Among the FDA’s proposed regulations is a ban on selling e-cigarettes to minors, a regulation that the King County Board of Health adopted in 2010.  The sale of marijuana vaporizers to minors should also be banned on a statewide level and online.  Like the ban on e-cigarette sales to minors, such a regulation would be one way to reduce the number of minors who try and regularly use what is erroneously seen as a safe way to use marijuana.

National Prevention Week 2014 is May 18-24

What is National Prevention Week?

National Prevention Week is an annual health observance dedicated to increasing public awareness of, and action around, substance abuse and mental health issues. The observance brings together individuals, organizations, coalitions, states, and communities through local events to promote substance abuse prevention and mental health. National Prevention Week 2014 will take place this year from May 18-24, 2014.

How can I get involved?

Commitment to National Prevention Week 2014 and its theme, Our Lives. Our Health. Our Future., starts with you and your organization. Here is how to get started:   

• Visit www.samhsa.gov/prevention-week to learn more about National Prevention Week 2014 and how you can get involved. 
• Get in the spirit: watch the National Prevention Week 2014 promotional video. Share the video link and spread the word!
• Browse the Participant Toolkit to start gathering ideas for your event.

Once you are familiar with National Prevention Week and tools you can use, you can:

INFORM.  Each day of National Prevention Week is dedicated to a specific health theme.

• Sunday, May 18: Prevention and Cessation of Tobacco Use
• Monday, May 19: Prevention of Underage Drinking
• Tuesday, May 20: Prevention of Prescription Drug Abuse and Marijuana Use
• Wednesday, May 21: Prevention of Alcohol Abuse
• Thursday, May 22: Prevention of Suicide
• Friday, May 23: Promotion of Mental Health

Provide information about these topics to friends, family, colleagues, clients, and others throughout the community. 

CONNECT.  Connect with your colleagues to collaborate on raising awareness about Prevention Week themes.   

PLEDGE.  Join others and take the Prevention Pledge on SAMHSA’s Facebook page. Let colleagues, friends, and family know about the Pledge and encourage them to take it, too. This year, the Prevention Pledge features a new, digital “brick wall” component. By taking the Pledge, individuals of all ages can add their pledge brick to the growing brick wall. They also have the option of sharing their prevention story or a personal message.

Public health regulations for marijuana

An article published in the April 17, 2014 edition of the American Journal of Public Health discusses why public health regulations are needed when establishing a legal commercial marijuana system. 

Based on research findings for preventing teen alcohol and tobacco use, the authors suggest implementing the following regulations for an emerging marijuana market:

• Keeping prices artificially high;
• Restricting and carefully monitoring licenses if a state monopoly is not established;
• Limiting the types of products sold;
• Limiting marketing;
• Restricting public consumption. 

Limiting outlet density: public health benefits

The Washington State Liquor Control Board marijuana rules limit the amount of marijuana retailers that may open in communities.  Twenty-one stores will be allowed in Seattle, which is in line with how many liquor stores were in Seattle prior to privatization.  Limiting outlet density is a proven way to reduce underage drinking and other public health harms associated with alcohol.  The article elaborates by stating, “ . . . studies from various disciplines converge in showing a strong positive relationship between alcohol outlet density and alcohol misuses as well as unintentional injuries and crime.  The evidence is so strong that several national and regional health organizations . . . have included recommendations related to licensing restrictions in prevention plans.”

Limiting outlet density: Saving tax dollars

The article goes on to say, “Keeping the number of licenses small also helps control the cost of regulating these new businesses and enforcing compliance (because there are fewer entities to oversee).  Fewer licenses make it easier for the government to keep close records on each licensee, making it easier to discover anomalies in their books that could indicate diversion to underground markets.”

Limiting products sold

Since it is difficult to expand regulations once a market is fully established, the authors suggest that products attractive to youth be strictly limited from the get-go.  “If governments wait to try to impose such product restrictions or leave the industry to regulate itself, the outcome could be problematic, as profit motive will likely dominate decisions rather than consumer safety.”  Both the alcohol and tobacco industries make products that are attractive to youth including sweet-flavored cigarettes, nicotine products, and alcohol.   Currently, marijuana rules in our state do not ban sweet-flavored or other products that may be attractive to youth. 

Restricting public consumption

The authors promote limiting public consumption of marijuana based on studies about youth tobacco use and restrictions on public tobacco use.  “ . . . Clean indoor air laws targeting public places that youths tend to congregate . . . are associated with reduced initiation and self-reported use of cigarettes among children and adolescents.  Even broad workplace clean indoor air laws . . . have been shown to influence the smoking behaviors of youths by influencing antismoking norms.”  While the use of marijuana “in view of the public” is against Washington State law, it remains to be seen how the law is interpreted by local jurisdictions and enforced.  In Seattle, public use of marijuana results in a verbal warning for the first violation and a $27 fine after that.  

Legislature addresses liquor privatization and increased youth access

Since hard liquor became available in grocery and other large retail stores, Prevention WINS coalition members have reported that it is easily stolen by minors.  During the coalition’s December 2012 general meeting, the North Precinct Liaison for the Seattle City Attorney’s Office reported:

~ All grocery stores, including all North Seattle groceries, are being hit by theft of liquor. 

~ Store security officers usually have a hands-off policy and are told to verbally discourage theft.

 

~ Many stores display alcohol near doors, making it easy for people to steal. 

~ When corporate offices are contacted, they state that, as a corporation, liquor theft is not affecting their profits and they do not plan to address the problem. 

~ Some South Seattle stores have begun to lock up their liquor. 

~ It is estimated that stores are losing up to $1,000 per day and the Roosevelt Safeway reports that they are losing about $30,000 per month due to liquor theft.  Stores are likely under-reporting their losses and that reported losses should be multiplied by 3 to get a more accurate picture. 

~ The King County Prosecutor’s Office does not prosecute any theft less than $1,000.  The Seattle City Attorney’s Office is working to track individual thieves so that when they steal an aggregate of more than $750 the City Attorney can refer them to the Prosecutor’s Office. 

Liquor theft is not unique to Seattle. In response, the state legislature passed a bill aimed at reducing theft.  KPLU broadcast a story about it today:

Grocery store owners who are losing liquor to shoplifters could pay a hefty price. Under a new law that takes effect June 13, the state can take away the store's license to sell liquor.

The crack down is aimed at keeping liquor out of the hands of underage drinkers.

Thefts Began With Privatization

As soon as liquor was privatized in Washington in 2012, Rep. Christopher Hurst, D-Enumclaw, began hearing stories from cops about juveniles being caught with hard liquor. Hurst says that wasn't the case with state-run liquor stores, which had a theft rate of about zero.

Almost always, he says, the bottle of whiskey or tequila had been “lifted” from a retail shelf.

While many store owners did begin locking the liquor away and putting up special security systems, Hurst was frustrated by how lax some stores remained.

“You know, there were stores that had, eight steps from the door at one o'clock in the morning, Jose Cuervo or Jack Daniels or Jaegermeister — stuff that kids, of course, love and like to steal,” Hurst said.

New Law Goes After Retailers

Under the new law, a store that doesn't secure its liquor could lose its license from the state Liquor Control Board.

The state will be able to take the license away if the store has, within six months, two shoplifting incidents that result in the alcohol ending up in a juvenile's hands.

Hurst, who sponsored the legislation, says he thinks it’s already making a difference. He says he recently returned to a store that had displayed its liquor next to the front door.

Take back your meds to police precincts April 26

On April 26 from 10 a.m. to 2 p.m. Seattle Police Department precincts and the Drug Enforcement Administration (DEA) will give the public its eighth opportunity in three years to prevent pill abuse by ridding their homes of potentially dangerous expired, unused, and unwanted prescription drugs.  Bring your pills for disposal to a SPD precinct.  (The DEA cannot accept liquids or needles or sharps, only pills or patches.)  The service is free and anonymous, no questions asked.

Community partners are called to publicize this event.  To help with publicity, a toolkit that includes flyers and web buttons is available online.  

Last October, Americans turned in 324 tons (over 647,000 pounds) of prescription drugs at over 4,114 sites operated by the DEA and its thousands of state and local law enforcement partners.  

This initiative addresses a vital public safety and public health issue.  Medicines that languish in home cabinets are highly susceptible to diversion, misuse, and abuse.  During the March Prevention WINS coalition meeting, members identified home medicine cabinets as the primary way NE Seattle students who abuse these drugs get them.   In addition, Americans are now advised that their usual methods for disposing of unused medicines—flushing them down the toilet or throwing them in the trash—both pose potential safety and health hazards.

Rates of prescription drug abuse in the U.S. are alarmingly high and prescription drug abuse rates have steadily increased among NE Seattle students since 2006. 

While the King County Board of Health approved a secure medicine return program last year, the program is not up and running, yet.

Liquor Control Board will hold lottery for marijuana retail licenses later this month

The Washington State Liquor Control Board (WSLCB) today announced that they will hold a lottery to select the apparent successful applicants for marijuana retail licenses April 21-25.  The lottery will produce a list of applicants that the agency will use to continue its retail licensing process. The WSLCB is expected to post the list of applicants for each jurisdiction in their website’s public records section on May 2 and they expect to begin issuing retail licenses no later than the first week of July.

Initiative 502 directed the WSLCB to limit the number of marijuana retail stores by county. In its rules, the WSLCB limited the number of stores statewide to 334. The City of Seattle is allocated 21 retail stores, similar to the number of liquor stores in the city prior to privatization. 

There are multiple requirements for licensure such as the applicant must have a business location that is not within 1,000 feet of a school, park or other area specified by Initiative 502 as places where children congregate.  The City of Seattle adopted zoning regulations that prohibit marijuana businesses from locating in residential areas, neighborhood business zones, and historical areas. 

Limiting how many retail outlets are allowed in a geographic area is a science-based method for preventing  youth substance use.  Multiple studies indicate that restricting the number of businesses that sell alcohol or tobacco in a neighborhood is one way to prevent youth access and use of the drugs.  The same is expected to hold true for marijuana.  

April is Alcohol Awareness Month, another opportunity for community members to talk about underage drinking

Each April, the National Council on Alcoholism and Drug Dependence, Inc. (NCADD) sponsors NCADD Alcohol Awareness Month to increase public awareness and understanding, reduce stigma and encourage local communities to focus on alcoholism and alcohol-related issues.

This April, NCADD highlights the important public health issue of underage drinking, a problem with devastating individual, family and community consequences.

Annually, over 6,500 people under the age of 21 die from alcohol-related accidents and thousands more are injured.  Additionally:

~ Alcohol is the number one drug of choice for America's young people, and is more likely to kill young people than all illegal drugs combined.

~ Each day, 7,000 kids in the United States under the age of 16 take their first drink.

~ Those who begin drinking before age 15 are four times more likely to develop alcoholism than those who begin at age 21.

~ Underage alcohol use costs the nation an estimated $62 billion annually.

Reducing underage drinking is critical to securing a healthy future for America's youth and requires a cooperative effort from parents, schools, community organizations, business leaders, government agencies, the entertainment industry, alcohol manufacturers/retailers and young people.

An integral part of Alcohol Awareness Month is Alcohol-Free Weekend (April 4-6, 2014), which is designed to raise public awareness about the use of alcohol and how it may be affecting individuals, families, and the community. During this seventy-two-hour period, Americans young and old are invited to participate in three alcohol-free days.  This is a good opportunity for parents to talk with their children about alcohol and to teach refusal skills.