Prescription and Over-The-Counter Drug Abuse

You may remember the days of childhood. It was common to get a cold, flu bug, or other type of illness. Trips to the doctor were never fun, but you knew that the word medicine meant a way to get better. Medicine helped get over the illness and back to school, back to the playground, and back with your friends. You knew that a doctor was prescribing you with the medication to help you recover. However, as you get older, you start to realize that some people abuse these same medications.

According to drugs.com, drugs that are safe and effective for use by the general public, without a prescription, are defined as over-the-counter (OTC) drugs. These drugs are often located on shelves in pharmacies, as well as non-pharmacy outlets. A few examples include grocery stores, convenience stores, and large discount retailers. In the U.S., there are more than 80 classes of OTC drugs. These range from allergy medications, to pain relievers, to weight loss products.

Some medications have psychoactive (mind-altering) properties and, because of that, they are sometimes abused. You could define abusing medications as someone taking a medication in ways or amounts other than what has been instructed in directions or by a doctor, or taken by someone other than the person for whom they are prescribed to. In fact, prescription and over-the-counter (OTC) drugs are, after marijuana (and alcohol), the most commonly abused substances by Americans, ages 14 and older. This is according to the National Institute on Drug Abuse.

 According to a study conducted by the University of Michigan, the most commonly abused prescription drugs are: opioid pain relievers, stimulants for treating ADHD (Attention Deficit Hyperactivity Disorder), and CNS (Central Nervous System) depressants for relieving anxiety. The most commonly abused OTC drugs are cough and cold remedies containing dextromethorphan.

Many people believe that prescription drugs and OTC drugs are safer to use than illicit drugs. This is only true when they are taken exactly as prescribed and for the purpose intended. When these prescription and OTC drugs are abused, they can become addictive and put abusers at risk for other adverse health effects. This includes overdose, especially when taken along with other drugs or alcohol.

There is more than one way for prescription and OTC drugs to be abused. These include taking a medication that has been prescribed for somebody else, taking a drug in a higher quantity or another manner than prescribed, and taking a drug for another purpose than prescribed.

We usually think of drug abuse issues as illicit drugs. However, licit drugs (legal for prescription) are a huge abuse issue. Whether they are being deliberately abused, or accidentally abused while taking them for a medical purpose, the results are disturbing.  People abuse over-the-counter (OTC) products to get high, zone out, hallucinate, etc.  Often times this abuse involves youth since these products are so readily available, either in the home medicine cabinet or simply for purchase.

The importance of educating our youth about the risks associated with the use and abuse of prescription and over-the-counter drugs need not go overlooked. Some of the same “medicines” that we have come to lean on during periods of illness, can harm our kids, family, and friends.

Drug Abuse and Addiction

As a student-athlete, you may know of someone who is struggling with drug abuse and addiction. It may be a close friend, a teammate, classmate or family member. Substance abuse and addiction can cause problems in the classroom, on the playing field and at home. It can often times leave individuals feeling alone and helpless, a potentially dangerous combination. It is for these reasons, that it is important to have a good understanding of the signs and symptoms of drug abuse and addiction.

Common signs of drug abuse and addiction:

-          Skipping class or flunking class, missing practice, and neglecting other day-to-day responsibilities

-          The use of drugs and/or alcohol during high risk situations (drinking and driving, before practice or a game)

-          Mood swings (fights with friends and/or family members, partners)

-          Legal issues (DUI, selling of drugs, possession charges)

-          A built up tolerance to drugs

-          Withdrawal symptoms

-          Constantly thinking about drug use

-          Understanding the risks of drug use, but continuing to participate

-          Losing interest in sports, socializing and other hobbies

Physical, behavioral and psychological warning signs:

-          Deterioration of physical appearance, grooming habits

-          Tremors, slurred speech

-          Bloodshot eyes, larger than normal pupils

-          Changes in appetite or sleep patterns

-          Sudden weight loss or gain

-          Always a need for extra money

-          Acting secretive about everything

-          Sudden change in friends

-          Lack of motivation

-          Anxious, fearful and paranoid

-          Angry outbursts and easily agitated

Recognizing that you or someone you know has a drug abuse or addiction problem is the first step, and often the most difficult step, on the road to recovery. Seeking help and finding support is crucial to any addiction recovery, and it takes a tremendous amount of courage to recognize that you or someone you know may need help.

If you feel that you or someone you know has an addiction problem, be proactive and contact any of the following individuals for support:

-          Family member

-          A close friend

-          A therapist or counselor

-          Your health care provider

-          Your athletic trainer, coach and/or another administrator

 Always remember, you are not alone and there are individuals that are willing to help!

 For more information on drug abuse and addiction, please visit the following resources:

http://www.mayoclinic.com/health/drug-addiction/DS00183 

http://www.drugabuse.gov/publications/drugfacts/understanding-drug-abuse-addiction

http://www.nlm.nih.gov/medlineplus/drugabuse.html

NCAA Championship Drug Testing

Drug-testing in the NCAA began in 1986 when testing at championship events began.  In 1990, it expanded to a year-round program in Divisions I and II and today, 90 percent of Division I, 65 percent of Division II and 21 percent of Division III schools conduct their own drug-testing programs in addition to the testing that occurs at the NCAA.  

Each year, approximately 13,500 samples are collected and analyzed through the NCAA's national drug-testing program, with the bulk of those tests focused primarily on performance-enhancing drugs (NCAA year-round testing). The NCAA tests at championship events in all three divisions at least once every five years and with some championships tested every year. During championship events, student-athletes are screened for steroids, diuretics and masking agents, stimulants, peptide hormones, anti-estrogens, beta-2 agonists, beta-blockers and street drugs. 

Recently, the NCAA’s Committee on Competitive Safeguards and Medical Aspects of Sports (CSMAS) voted to adjust the threshold for a positive marijuana test at NCAA championships to a level that is consistent with current best practices in drug testing, which will more accurately identify usage among student-athletes.

Beginning August 1, 2013, the threshold level for marijuana will change from 15 ng/mL to 5 ng/mL.  For years, Drug Free Sport has provided institutional clients the 5 ng/mL threshold in testing for marijuana.  Drug Free Sport has recognized testing at lower thresholds as a best practice for deterrence and we continue to provide our clients the best drug-prevention methods possible.

The CSMAS has also established a testing standard for synthetic cannabinoids (K2, Spice, etc.), which have not previously been tested for at NCAA championship events. The committee approved testing for those substances using the World Anti-Doping Agency (WADA) laboratory testing standard for level of detection.  Testing for synthetic cannabinoids will begin with the 2013 fall championships.

Drug Free Sport also has the ability to test for multiple metabolites of synthetic cannabinoids.  To learn more about testing for synthetic cannabinoids please contact Drug Free Sport at 816-474-8655.

Binge Drinking: Who is at risk and why should we be concerned?

According to the Centers for Disease Control and Prevention (CDC), binge drinking is “the most common pattern of excessive alcohol use in the United States.” Visit almost any campus, on any weekend, and I would be willing to bet that you will find students and student-athletes participating in binge drinking.

Let’s look at a few facts:

-          Binge drinking is said to be more common amongst young adults aged 18-34

-          The prevalence of binge drinking among men is twice as much as women

-          90% of alcohol consumed by youth under the age of 21 in the United States is in the form of binge drinking

We also know, according the 2009 NCAA Study of Substance Use of College Student-Athletes:

-          83.1% of respondents indicated drinking within the year (male and female)

-          47% of those reporting alcohol usage reported drinking six to ten plus drinks in a sitting (binge drinking)

-          54% of the respondents indicated drinking both during their competitive and off season

-          Student-athletes are at a higher risk for such behaviors

As you can see, it’s no mystery that student-athletes are at risk for, or are participating in the act of, binge drinking. Alcohol consumption has been and continues to be an issue at the collegiate level.

So what is “binge drinking” and why should we be concerned?

Binge drinking is typically defined as, for men, consuming five or more drinks within a period of two hours. For women, four or more drinks within the same time period is typically classified as binge drinking.

Some of the common issues that we see associated with binge drinking include:

-          Memory issues – disrupting sleep cycles and prohibiting one’s ability to retain information.

-          Hydration issues – decreasing the body’s state of hydration, which can be a real problem for student-athletes that are trying to perform at the highest level.

-          Injury issues – poor food choices, dehydration and depletion of nutrients can all lead to injuries.

-          Alcohol poisoning – always dangerous and can sometimes lead to death.

-          High blood pressure, stroke or other cardiovascular issues – it can and does happen.

-          Unintended pregnancy and sexually transmitted diseases – it can be prevented.

As you can see, none of the above issues associated with binge drinking is conducive to a student-athletes career. It is our job as educators to make sure that student-athletes are aware of the risks associated with the use of alcohol, and in particular, binge drinking. There is no one method that is a cure-all to this issue, but here are a few links that may be helpful.

myPlaybook

Expert Speakers

Prevention Strategies

Student-Athletes Speak Against Binge Drinking

APPLE Conferences

Following up this week on our May 8th 2012 blog titled "10 reasons why drugs, alcohol and/or supplements are still an issue in athletics," we explore:

           "The NCAA reported a 5.6 percent rise in alcohol consumption since 2005, with 83.1 percent of respondents reporting drinking alcohol in the past 12 months.."

This blog is titled 10 Reasons why drugs, alcohol and/or supplements are still an issue in athletics: Alcohol and it can be found on our myPlaybook blog at: http://myplaybook.drugfreesport.com/?p=717

"We are what we repeatedly do. Excellence then, is not an act, but a habit." Aristotle  

10 reasons why drugs, alcohol and/or supplements are still an issue in athletics: Marijuana 101

Following up this week on our May 8th 2012 blog titled "10 reasons why drugs, alcohol and/or supplements are still an issue in athletics," we explore our first reason:

           "In a 2009 study, the use of Marijuana amongst NCAA student-athletes had increased by   

            nearly 2 points over a period of 4 years. 22.6 percent of respondents claimed to have used 

            Marijuana within the last 12 months."

This blog is titled Marijuana 101 and can be found on our myPlaybook blog at: http://myplaybook.drugfreesport.com/uncategorized/marijuana-101/

"Tell me and I'll forget. Show me, and I may not remember. Involve me, and I'll understand."
-Native American Saying-

 

My first week at Drug Free Sport: Dietary Supplements

Well… My first week at Drug Free Sport was anything but typical. I have been in the Anti-Doping industry for three years now, working primarily with collection protocols, field staff training and athlete testing plans. I have developed a solid foundation in the Anti-Doping movement, but have to admit that I feel like a rookie when it comes to the complex world surrounding dietary supplements, drugs, alcohol and other doping methods in sport.

Barely scratching the surface on information related to the topics presented above now seems like an understatement after a week’s worth of work at Drug Free Sport. For instance, who would have thought that someone could make a dietary supplement out of the back of their car and sell it to consumers like you or I? Wait… What? dietary supplements that I’m putting into MY body could potentially be manufactured in the trunk of a car? According to the U.S. Food and Drug Administration, dietary supplements are regulated under the 1994 Dietary Supplement Health and Education Act (DSHEA). Under this act, manufacturers of dietary supplements or their ingredients “DO NOT need to register their products with the FDA nor get FDA approval before producing or selling dietary supplements” (FDA, http://www.fda.gov/Food/DietarySupplements/default.htm).

Regardless, these supplement companies or manufactures have to be regulated at some point, right? Well that’s actually correct. These companies must comply with cGMPS, which means “Current Good Manufacturing Practices.” These practices are in place essentially for quality control purposes. They act as a measure to ensure that companies are processing supplements in a consistent manner and meeting standards. Under what the FDA calls the “Final Rule,” supplement manufacturers must adhere to the following conditions (not limited to these conditions):

-          The design and construction of physical plants that facilitate maintenance

-          Cleaning

-          Proper manufacturing operations

-          Quality control procedures

-          Testing final product or incoming and in process materials

-          Handling consumer complaints

-          Maintaining records

(FDA, http://www.fda.gov/Food/DietarySupplements/default.htm)

The FDA deploys inspectors to ensure these rules are being followed, but on average, only about 5 inspections take place during a given month. Just go to your local supplement store and see how many different supplements and manufacturing companies there on the shelves; 5 inspections a month doesn’t even make a dent!

Taking this into consideration, how could a supplement that I put into MY body be created in the back of a trunk? Dietary supplements do not have to be approved, show effectiveness or be proven safe before being marketed, as long as they avoid health claims and ingredients that are not GRAS (I also, learned that this means Generally Recognized As Safe).

The point is that dietary supplements are under-regulated and in some cases, we have no idea where these dietary supplements and their ingredients are coming from. I would recommend watching this clip from Dateline’s Chris Hanson on dietary supplements:

(http://www.msnbc.msn.com/id/3032600/vp/46766278#46766278)

It’s only been one week and I could go on and on about some of the things that I’ve learned thus far. If there is one thing to take away from my first week with Drug Free Sport, it’s that no matter how much I’ve learned in my three years of Anti-Doping experience, it’s not enough and every day brings new surprises!

Until next time!

The all night cocktail – Adderall/Caffeine/Energy Drinks

There is no way around it, if you are in college you are probably going to do some  studying  to avoid failing a class, or to pass those dreaded finals to graduate.  Of course, the best method is a consistent nightly routine dedicated to specific classes and projects.  That would allow you to avoid cramming and make adequate time for rest (especially needed by collegiate athletes). From my personal experiences however, I know that “some” people may procrastinate and wait to study until the last minute before an exam.

What we know

College students cram for academic finals and student-athletes cram for academic and sport finals, but student-athletes have a great deal to lose when cramming.  Students and student-athletes alike are turning to caffeine (pill form), energy drinks (beverages that contain modest to relatively high levels and concentrations of caffeine; range: 50-505 mg caffeine/serving; 2.5-35.7 mg caffeine/oz) and Adderall to stay awake.  A scary trend is the combination of all three (more is not better…) to get the “best” effect.  It is estimated that 34% of students have used Adderall not prescribed to them to aid their studying.  A University of Kentucky study revealed that an estimated 75 % of students know someone who takes Adderall without a prescription.  All three include or are central nervous system stimulants and carry individual adverse reactions that increase in severity when combined.

Adderall (amphetamine and dextroamphetamine)

·         Can be habit-forming

·         If you are taking other drugs (prescribed or not) or supplements you should consult your doctor before taking Adderall.

·         Overusing Adderal may cause sudden death or serious heart problems such as heart attack or stroke.

·         Bottom line if you don’t have a prescription, don’t take the drug.

Energy drinks and caffeine

·         Caffeine has been clearly associated with adverse health effects in susceptible individuals.

·         Energy drinks frequently contain high and unregulated amounts of caffeine

·         Energy drinks have no therapeutic benefit and many ingredients are understudied and not regulated

Adverse reactions

Increased heart rate, increased blood pressure, insomnia and nervousness, headaches and tremors, and GI distress.

Easy Study Tools

Plan ahead and try to avoid cramming for your finals!!!  If that doesn’t work keep these tips handy for increased productivity.

·         Location - Avoid your couch, bed, dimly lit rooms, bean bags, etc...You want a good firm chair, strong lighting and a desk for all those books. 

·         Hydration - You are an athlete and this should be a staple in your daily routine.

·         Fuel – Just like you feed the body for on field/court workouts your mental workouts require that you fuel your body for success.  Avoid the junk food and try an apple or cereal to give you energy.

·         Breaks - Short 10-15 minutes, watch TV, text or talk on the phone, music, get creative.

·         Exercise - The last thing an athlete wants to hear I know…so try dancing, or take a short walk and after hop in the shower for some additional alertness!

If you can’t keep your eyes open no matter what you do, then it is time to go to bed.  Remember, your body recovers while you sleep and without sleep your muscles will not fully recover for your next workout or competition.

References

·         Mayo Clinic (accessed 5/5/2011) Energy Drinks Can Have a Variety of Adverse Effects on the Body http://www.mayoclinic.org/medical-edge-newspaper-2009/may-29b.html

·         Arria, A PhD; O’Brien, M, The “High” risk of Energy Drinks The Journal of the American Medical Association (JAMA). 2011; 305(6): 600-601(accessed online 5/5/2011)

·         Juliano, L, Griffiths, R, A critical review of caffeine withdrawal: empirical validation of symptoms and signs incidence, severity, and associated features. (2004) Psychopharmacology; 176: 1-29

·         Pubmed Health (accessed 5/5/2011) Dextroamphetamin and Amphetamine http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000166/

Substance Abuse Prevention

The year was 2000 and I was a junior in college, I was in the best shape of my life having completed football season and in the midst of a track season that would prove to be my best collegiate year of competition.  I was on top of the world, school was going great, sports were stellar and to top it all off I was a bachelor that lived alone!  I lived next door to a great girl that would always wave when we saw one another, and if given the chance she could talk for hours.  She seemed to have the perfect life, nice car, great style, plenty of friends, and what seemed to be a good boyfriend.  One evening, I got a knock on my door and my neighbor was standing in front of me crying.  I instinctively invited her in and tried to console her, but noticed immediately that something was not right.  Her speech was slowed, she was stumbling, and she seemed distant.  I didn’t think she was drunk, but still asked if she was drunk, she said no and I proceeded to ask what she had done immediately before coming to my apartment, and she nonchalantly answered “trying to end my life”…Thankfully, I was somewhat knowledgeable about how to handle a toxic agent being ingested or an overdose.  I immediately gave her milk to drink and sat her upright in a chair.  I grabbed the pill bottle she had ingested, and took her to the emergency room, where they pumped her stomach and checked her into the psychiatric ward of the hospital.  This story has a happy ending because she was released days later, and started receiving the help and attention that she needed and had been calling for, for so long.  She later told me that she suffered from depression, substance abuse (oxycotin), and Anorexia Nervosa.  To say the least I was utterly surprised!  I tell you this story, to help you understand that perceptions are not always reality, and as the old adage goes, you cannot always judge a book by its cover, so don’t be afraid to ask for help or offer help, we all need a ear, shoulder and kind heart from time-to-time.

Have you ever had a family member, friend or even neighbor that had issues with abusing drugs?  How about someone that had a body image disorder, anger management issues or the desire to end their life?  Well these are just a few of the topics that we covered the last two weekends with the APPLE Conference (1/21 -1/23 and 1/28 – 1/30.  The APPLE Conferences are led by the University of Virginia Gordie Center for Alcohol and Substance Education with assistance from the NCAA, Drug Free Sport, the Bacchus Network and the Gordie Foundation.  The great thing about the APPLE conferences is that they are focused solely on the student-athlete and the prevention of substance abuse and promoting health for student-athletes and athletics department administrators.  From the APPLE website,

“The goal of the APPLE conference is to assist colleges in promoting student athlete health and wellness by empowering teams of student- athletes and administrators to create an institution-specific action plan. “

There are individuals in our lives right now that could be experiencing or fighting and addiction, having trouble managing anger or image issues, and we could have no idea.  This is a problem, but we can do something to help, there are professionals at your schools, in your community and at the government level that can help you prevent substance abuse, but also recognize the signs of potential problems. 

I heard a number of wonderful presentations at the APPLE Conferences, and here are just a few of the professionals that spoke (power point presentations available to view here):

Linda Hancock is Director of the Wellness Resource Center at Virginia Commonwealth University (VCU) and a Family Nurse Practitioner.

Doug Everhart serves as the Manager of Alcohol Programs at the University of California-Irvine

Scott Goldman, Ph. D. is the clinical and performance psychologist for the University of Arizona's athletic department.

Matt Vogel works at the University of Wisconsin – La Crosse as a Health Educator and an adjunct Instructor for the Department of Health Education and Health Promotion. 

Erica Upshaw travels the country speaking to high school and college audiences and has reached more than 50,000 students with her program Keep Friendship Alive.

Craig Littlepage is in his eighth year as the Athletic Director of the University of Virginia.

Dr. Kelli Moran-Miller provides clinical and performance enhancement services at Virginia Tech, servicing the Athletic Department and Cook Counseling Center.

Resources:

Professional Organizations

American Academy of Pediatrics:  http://www.aap.org/  

American College of Sports Medicine:  http://www.acsm.org/  

American Dietetic Association:  http://www.eatright.org/  

American Society for Nutrition:  http://www.nutrition.org/about-asn/  

American Medical Association:  http://www.ama-assn.org/  

American Public Health Association:  http://www.apha.org/  

Institute of Medicine of the National Academies- Food and Nutrition Board:  http://www.iom.edu/About-IOM/Leadership-Staff/Boards/Food-and-Nutrition-Board.aspx  

Keep Friendship Alive:  http://www.keepfriendshipalive.com/

National Research Council:  http://sites.nationalacademies.org/nrc/index.htm  

National Institutes of Health:  http://www.nih.gov/  

National Library of Medicine:  http://www.nlm.nih.gov/  

National Eating Disorders Association: http://www.nationaleatingdisorders.org/

The National Center for Drug Free Sport Inc.:  http://www.drugfreesport.com/

College Drinking – Changing the Culture:  http://www.collegedrinkingprevention.gov/StatsSummaries/snapshot.aspx

Consumer Lab (subscription needed):  http://www.consumerlab.com/

National Institute of Health:  http://www.nih.gov/  

Mayo Clinic:  http://www.mayoclinic.com/

myPlaybook:  http://myplaybook.drugfreesport.com/ 

Healthfinder:  http://www.healthfinder.gov/  

Partnership for a Drug-Free America:  http://www.drugfree.org/

The Resource Exchange Center:  http://www.drugfreesport.com/rec/

Supplement Safety Now:  http://www.supplementsafetynow.com/

The Cleveland Clinic:  http://my.clevelandclinic.org/default.aspx

Taylor Hooton Foundation:  http://taylorhooton.org/

Journals

American Journal of Clinical Nutrition:  http://www.jneb.org/  

American Journal of Sports Medicine:  http://ajs.sagepub.com/  

American Society for Nutritional Sciences:  http://www.nutrition.org/  

Journal of American College of Nutrition:  http://www.am-coll-nutr.org/  

Journal of Applied Physiology:  http://jap.physiology.org/  

Journal of Nutrition Education and Behavior:  http://www.jneb.org/

Journal of the American Dietetic Association:  http://www.adajournal.org/

Physician and Sports Medicine:  http://www.physsportsmed.com/   

Nutrition Action:  http://cspinet.org/nah/index.htm  

News Letters

Insight Newsletter:  http://www.drugfreesport.com/newsroom/insight.asp

Nutrition Action Health Letter:  http://www.cspinet.org/