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By Dennis Miller, BHC Senior Writer

While illicit drug and alcohol use have declined among the teen population in recent years according to the Substance Abuse and Mental Health Services Administration (SAMHSA), prescription drug abuse remains a serious concern. For teens, they're rapidly becoming today's 'drug of choice,' perhaps in part because they’re perceived to be safer and more socially acceptable owing to their legal, FDA-approved status. Easier access also plays a role since Rx medications are readily available either by prescription or from family medicine cabinets. In fact, prescription drugs are more misused today by teens than any illicit drug except marijuana.

In an effort to help combat this growing problem, a new initiative has just been launched by the National Council on Patient Education (NCPIE), in cooperation with SAMHSA and representatives from 15 nationally recognized prevention, health professional and child advocacy organizations. The program, entitled “Maximizing Your Role as a Teen Influencer: What You Can Do To Prevent Teen Prescription Drug Abuse,” is the latest in a long series of initiatives launched by NCPIE to help rein in prescription drug abuse in America.

NCPIE, a non-profit organization formed in 1982, is dedicated to educating consumers and health professionals on safe prescription drug use. “We have a very singular focus and we’ve had that for some time, since the inception of the council,” says NCPIE’s Executive Vice President Ray Bullman. “And that is to stimulate and improve communication of information on appropriate medicine use to the general public and to healthcare professionals.”

Previous NCPIE programs and campaigns to combat teen prescription drug abuse have focused their efforts mainly on parents and teens themselves. For this latest effort, the decision was made to target others who are also in a strong position to influence teens. This may includes parents, teachers, coaches, school officials, health professionals, guidance counselors and other adults in positions of respect for teens. “We hope that we can reach prescribers, be they physicians, nurse practitioners, physician assistants or dentists, for example. And those who are at the point of that interface with both adults and teens — at the point of making an informed decision about prescribing medications,” explains Bullman. “The other is anyone who has their feet on the ground in the educational community or environment. And that might be a teacher. It might be someone involved with Parent-Teacher Associations or school clubs for example. It might be a counselor. It might be a coach. We hope that it’s anyone that can have that opportunity where a student is either seeking to or interested in talking to adults in the educational setting.”

The program consists of a wide array of resources teen influencers can use to educate themselves, and in turn, teens on the dangers of prescription drug abuse. The resources range from background materials to help support informal, one-on-one conversations with teens, to a full PowerPoint slide presentation, replete with speaker’s notes presenters can use to deliver a ready-made presentation to audiences of teens. “We’re not trying to put words in anyone’s mouth but we did find through our Project Advisory Team that it’s effective to provide some key phraseology and messages to support each one of the slides, as a lay presenter or a healthcare provider for that matter uses the materials as a way of passing forward throughout their own community information to help support positive teen decisions to avoid prescription drug abuse,” says Bullman.

The full array of these materials can be accessed at www.talkaboutrx.org. The aim of the materials, according to an NCPIE press release [PDF], is to:

• Educate teen influencers about teen prescription drug abuse—the extent of the motivates teens to misuse or abuse prescription drugs, how they gain access to warning signs and symptoms of abuse.
• Dispel popular myths about prescription drug use and abuse.
• Reinforce the powerful role that teen influencers can play in educating teens about prescription drug abuse and helping to promote healthy alternatives.
• Provide tips for talking with teens and identifying teachable moments.
• Inspire participants to take action against prescription drug abuse, whether it's talk with teens they interact with, implementing efforts within their own schools or engaging other teen influencers or offering to give this presentation to others.

Behavioral Health Central recently spoke with NCPIE Executive Vice President Ray Bullman about the “Maximizing Your Role as a Teen Influencer” program, the thinking behind its inception, the planning and development process that went into it, and its strategies and goals. To hear our interview, click on the audio icon above. The following is a complete edited transcript of our conversation.

BHC: Tell us a bit about the National Council on Patient Information and Education and exactly what it’s all about.

RB: Sure. I’d be pleased to. The National Council on Patient Information and Education, NCPIE for short, is a 501(c)(3) non-profit coalition and we were organized back in October of 1982. And we have a very singular focus and we’ve had that for some time, since the inception of the council. And that is to stimulate and improve communication of information on appropriate medicine use to the general public and to healthcare professionals. And we hope that stimulating that kind of a dialogue between healthcare providers and patients can lead to safe and appropriate medicine use.

BHC: Great. Now give us an overview of this new program, “Maximizing Your Role as a Teen Influencer.”

RB: I’d be pleased to. I would want to point out that the program is currently designed and available as an online resource, as an online educational tool, or as a toolkit, I should say, and it’s located currently at www.talkaboutrx.org. And when listeners visit talkaboutrx.org, you’ll find the materials are actually divided into several components, the first of which are very comprehensive and we hope a very informative ‘how-to’ presenter’s guide that includes, from soup to nuts, everything that we think and that we hope a healthcare provider or a consumer who has a teachable moment opportunity, as it were, with teens can use. [They can use] the materials for setting up themselves and presenting a teen influencer workshop.

And the second component that you’ll find available on the website is an actual PowerPoint presentation with a suggested script. We’re not trying to put words in anyone’s mouth but we did find through our project advisory team that it’s effective to provide some key phraseology and messages to support each one of the slides, as a lay presenter — or a healthcare provider for that matter — uses the materials as a way of passing forward throughout their own community information to help support positive teen decisions to avoid prescription drug abuse.

BHC: Who is your target audience for these tools and resources and how do you hope they use them?

RB: Dennis, we have a very broad target audience for the resources. In particular, we are targeting healthcare providers or healthcare professionals, such as those in your listening audience, for example. We hope that we can reach prescribers, be they physicians, be they nurse practitioners, physician assistants or dentists, for example. And those who are at the point of that interface with both adults and teens — at the point of making an informed decision about prescribing medications. So that’s one particular and very critically important audience or subset of the overall audience for this teen influencer program.

The other is anyone who has their feet on the ground in the educational community or environment. And that might be, as you mentioned at the opening, a teacher. It might be someone involved with Parent-Teacher Associations or school clubs for example. It might be a counselor. It might be a coach. We hope that it’s anyone that can have that opportunity where a student is either seeking to or interested in talking to adults in the educational setting.

We hope that that teacher or coach or counselor, for example, will make themselves take advantage of these materials. And we hope these materials will help support that kind of a personal and perhaps, even if it’s short, but it’s a pointed and directed conversation with teens.

BHC: Tell us a little bit about how the project came together.

RB: The program came together real, Dennis, actually as a Phase II of a series of contractual agreements that NCPIE, the National Council, has developed with SAMHSA. And the initial program that NCPIE developed — and when I say NCPIE developed, I don’t mean that organizationally our non-profit group itself is responsible in and of itself in developing the educational content and the suggestions for outreach and program and program promotion, for example. What we did is we really, we tried to pull together the best available brain trust as it were. And we discussed with SAMHSA when we started developing Project I that we think that there are many, many high-caliber organizations out there with a vast knowledgebase and experience. And what we wanted to do is essentially bring them together under the, in this case. NCPIE/SAMHSA umbrella, and have them provide the advice and guidance that, collaboratively and collectively, we can then package and we then put out to the public and healthcare professionals.

Our first campaign that we developed was called “Not Worth The Risk Even If It’s Legal.” And that was more of your typical public awareness and outreach campaign where NCPIE developed a downloadable — I guess you could call it a brochure but it’s available as a downloadable PDF — and that’s “Talking To Teens About Prescription Drug Abuse.” And that’s very much more targeted to and directed at parents. And then the other brochure that we developed or downloadable piece for that initial campaign was directed very specifically at teens, to try and dispel some of the myths and misconceptions about prescription drugs and prescription drug abuse in particular.

Dennis, moving forward, the second campaign — this current one that we’re talking about here today, the teen influencer program — provided us the opportunity to bring together a cadre of organizations we call our Project Advisory Team. And surprisingly and pleasantly we were informed when we got a number of groups together that make up this Project Advisory Team of 15 organizations that it was the first time that they’ve had an opportunity to interact in one room as it were.

So we were very pleased and we look forward as we move forward to serve as that sort of a catalyst and convener again. But what those groups were, for example, were The National Association of Health Education Centers, The Partnership For a Drug Free America, The Community Anti-Drug Coalition and The American Academy of Pediatrics, to name just a few, and you’ll find those listed in our program materials on our website.

But what we did is we really started with a tabula rasa and we asked the creative energies of the groups in the room to help guide us in guiding the direction of the materials and the messaging.

BHC: Has the problem of teen abuse of prescription drugs getting worse, has it been lessening, or has it been staying about the same over the last decade?

RB: Well, prescription drug abuse is currently a significant problem among teens and I guess you can broaden that by actually the age 12-to-25 cohort. And there are a number of reasons that that’s a problem. But for people ages 12 to 25, they have among the highest rates of prescription drug abuse. And parents and others often underestimate teen abuse of prescription drugs. So while in certain areas the abuse of illicit substances has been trending downward, prescription drug abuse is still a very critical problem.

BHC: What are some of the challenges involved with teaching teens that prescription drugs, if misused, can be just if not more dangerous than street drugs?

RB: One of the problems or one of the challenges in trying to break through teen thinking is to have teens understand that prescription drugs, even though the prescription is written by a physician or a prescriber — a healthcare professional — and that the medicines are approved by the system as it were with the Food and Drug Administration, that they are still harmful and they can, if not written specifically for you and your particular condition they can cause a great deal of harm.

And the other challenge is that prescription drugs are essentially ubiquitous now and they’re available pretty much at any time. If you were to walk into anyone’s home, it’s very likely that prescription medications, while being used for either chronic conditions or acute self-limiting conditions, are very available to the teenage population through the medicine cabinet, for example.

BHC: What motivates teens to use prescription drugs? Are these basically the same driving forces that motivate them to use street drugs, or are they different?

RB: Well there’s some similarity, but there’s some distinctions as well. For example, teens tend to use and oftentimes abuse prescription drugs in an effort to enhance performance, and that might be academic performance in terms of cognitive improvement. Oftentimes, medications that are very specifically prescribed for that reason are also very available through peer influence or are oftentimes made available to those whom they are not prescribed.

Also, the prescription medicines are also being used by teens to help address some of their own life stressors, as it were. And the day-to-day pressures that are brought to bear on teens is significant and oftentimes through, whether it’s mimicking or word of mouth, teens tend to pass those medications forward.

BHC: How do you thread that needle of letting teens know that they do need to take the prescription drugs that have been prescribed to them in a safe manner while at the same time cautioning them about their possible misuse?

RB: That’s a great question, because it is a fine line, as it were. And it is also an opportunity and a teachable moment by parents and adults as well. One of the things that NCPIE has done throughout the teen influencer program and the precursor program I mentioned a few minutes earlier, Dennis, is that we remind students — as hackneyed as it might be in terms of education — we do call upon what we call the “three R’s” for safe and appropriate medicine use. And that is trying to get across to teens and have them buy into respecting the power of medicines and the value of medicines used properly. Prescription medicines are powerful chemicals, but if used appropriately and in the right way they can have tremendous value.

And then there is of course a flip side to that and that is recognizing — and that’s the second R — that all medicines including prescription drugs have risks, attended risks, along with that value or those benefits. And the risks tend to increase dramatically when medications are abused.

And the final one in terms of our three R’s is responsibility. And that is trying to impress upon teens to take responsibility for learning how to take prescription medicines safely and appropriately. And that also includes, if you think you’re having problems even the first time you’re taking a legally prescribed and dispensed medication, it’s important to seek help.

BHC: Ray, do you feel like maybe we could be over-prescribing drugs to kids today? Do you think there’s an element there of possibly implicitly communicating to them that drugs can make them feel better, and in kids’ minds. maybe that metastasizes into a more general attitude that they’re all safe for them, and that if one a day is good, heck, two might be even better?

RB: I think you raise a very important issue and this certainly is not just a medicated society but a medicated generation. And I think it’s incumbent upon parents — we as parents; myself included — to make sure that from the inception of introducing our children to the healthcare and medical system that it not be either raised or reinforced that there’s a pill for every ill. It’s important to engage in that very specific dialogue with the healthcare provider and the medical team, and when medicines are part of the treatment regimen, after that discussion has been held, that’s when it really is incumbent to start thinking about a whole other list of important steps that need to be taken to ensure not only that medicine works appropriately and safely, but also that the risk of that medicine being abused is diminished or disappears.

BHC: Is this primarily a problem of teens misusing drugs that have been prescribed to them? Or are they more frequently raiding their parents’ medicine cabinets or getting these drugs in other ways? Or is it really an equal mix of both?

RB: I think its a little bit of “D” — all of the above, Dennis. We do hope, though, that as teens actually engage in a dialogue, and as they become older and they enter into more of a self-reliant discussion and visit with their healthcare provider, that it’s impressed upon them and they realize the importance of the fact that if a medicine is prescribed, that medicine is very specifically prescribed for very specific reasons. And that even though a friend may sound like they have a similar kind of a problem or condition, there’s a big risk in making that available just on that assumption.

BHC: Why was the decision made to target adult teen influencers with this program and not the teens themselves? Is it just that you feel you’ve got sufficient programs that do that?

RB: No, I’m not sure there are sufficient programs. The decision to focus on the adult as a teen influencer really evolved over part of the discussion with the groups that we have involved or invited to be part of our Project Advisory Team. But in the first campaign that NCPIE conducted, “Not Worth The Risk Even If It’s Legal,” that focus was very specifically within that family unit on teens and parents. And so, really, it was somewhat evolutionary to think, “Now, if we take the next step up, how can we develop a very broad-brush program that’s designed as a pass-it-forward program?”

We hope can reach more and more adults and impress upon those adults that the same message and the same materials can be used not only in their own household but for those involved in either their clubs or community groups or on their campuses for example.

BHC: Well, Ray, fascinating! Where can people who are interested in learning more about the program or maybe getting their hands on resources go to get more information? Is it just that website you mentioned earlier?

RB: We would encourage them to visit www.talkaboutrx.org. And Dennis, they’ll find all the program materials available as free downloads right there.

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