Alcohol and Drug Abuse
Alcohol Related <ul><li>Alcohol is the oldest and most widely used drug in the </li></ul><ul><li>world. Nearly half of all...
Friend   or   Foe  ? <ul><ul><li>High levels of alcohol consumption can lead to physical illness and psychological and soc...
Signs and symptoms of Alcholism <ul><li>alcohol use and intoxication: </li></ul><ul><li>Smell of alcohol on breath </li></...
Alcoholism <ul><li>Alcoholism or alcohol dependence is a medical term with a deliberately more precise Meaning than the pr...
Signs   of   Alcoholism <ul><li>As alcohol levels increase with more drinking, there is poor control of muscles, poor coor...
Effects of Alcoholism  <ul><ul><li>Excessive and inappropriate alcohol consumption at work leads to accidents, absenteeism...
Serious   Intoxication   <ul><li>Serious intoxication results when a large amount of an alcoholic beverage is taken over a...
Alcohol Withdrawal <ul><li>Alcohol withdrawal occurs when a physiologically dependent person abruptly stops using alcohol....
Dependency   <ul><li>A short list of questions that can indicate if alcohol dependence is a possibility. Two or more posit...
Alcohol   Related   Problems <ul><li>Excess alcohol can lead to health problems including but not limited to: Depression, ...
Sudden Death May Occur  <ul><ul><li>When the individual has ingested so much alcohol that the brain center which controls ...
Binge Drinking <ul><li>Binge drinking is defined as drinking five or more standard alcohol drinks for males, and four or m...
Binge Drinking <ul><li>If you are 25 years or younger and you drink to excess even once a week, your brain may exhibit som...
Binge Drinking <ul><li>Heavy Drinking Pattern Affects Brain </li></ul><ul><li>Binge Drinkers, But Not Alcoholics </li></ul...
MIX Ecstasy and Alcohol
20 Questions <ul><li>Do you  lose time from work due to drinking? </li></ul><ul><li>Is drinking making your home life unha...
20 Questions Results <ul><li>According to the Office of Health Care Programs, Johns Hopkins University Hospital, developer...
Drug Abuse
Drug abuse <ul><li>Has a wide range of definitions related to taking a psychoactive drug or performance enhancing drug for...
Drugs and the Work Place <ul><li>A country with only 'five' percent (5%) of the entire world's population buys and consume...
Lowers productivity /  causes accidents and injuries. <ul><li>Problems related to alcohol and drug abuse cost American bus...
Increases Absenteeism, Turnover and  Employer’s medical costs . <ul><li>An estimated 500 million workdays are lost annuall...
What can your organization do to decrease the impact of substance abuse <ul><li>Implement a drug-free workplace program   ...
Drug-free workplace program may include: <ul><li>a written policy  </li></ul><ul><li>employee education  </li></ul><ul><li...
A good drug-free workplace program can lead to <ul><li>Decreases in:    </li></ul><ul><li>absenteeism  </li></ul><ul><li>a...
What are the Signs of Abuse? <ul><li>Substance abusers in the workplace can be difficult to identify. But there are some c...
Signs of Abuse <ul><li>Cocaine Users </li></ul><ul><li>Display increased energy and enthusiasm early in their drug involve...
How Can it Be Prevented? <ul><li>A written policy </li></ul><ul><li>Employee drug education </li></ul><ul><li>Training (Ma...
What Can Employees Do? <ul><li>Don’t be an &quot;enabler.&quot; </li></ul><ul><li>Don’t &quot;look the other way.&quot; </...
Types of Drugs <ul><li>Drugs can be categorized in many ways, hard or soft, uppers or downers, addictive or non-addictive,...
STIMULANTS <ul><li>Increase the activity of the central nervous system, some examples include, but are not limited to Amph...
DEPRESSANTS <ul><li>Reduce the activity of the central nervous system, some examples include but are not limited to Alcoho...
HALLUCINOGEN S <ul><li>Alter perceptions of reality and may result in hallucinations some examples include but are not lim...
ECSTASY
ECSTASY <ul><li>COMMON & BRAND NAMES </li></ul><ul><ul><li>Ecstasy; E; X; XTC; Rolls; Beans; Adam </li></ul></ul><ul><li>C...
PMA and MDMA <ul><li>Taken in tabs although inhalation and injection have been infrequently reported. </li></ul><ul><li>Ef...
MDMA/PMA how It Looks <ul><li>Powder </li></ul><ul><li>Pressed pills </li></ul><ul><li>Capsules (may not be full) </li></u...
MDMA/PMA Packaging <ul><li>Because of their small size, MDMA pills may be easily hidden.  They may simply be mixed in with...
Long Term effects <ul><li>More prolonged “burn out” or “crash periods” up to a week later </li></ul><ul><li>Dental Damage ...
Ecstasy Effects <ul><li>extreme mood lift  </li></ul><ul><li>increased willingness to communicate  </li></ul><ul><li>incre...
Ecstasy Effects <ul><li>appetite loss  </li></ul><ul><li>visual distortion  </li></ul><ul><li>rapid, involuntary eye jiggl...
Ecstasy Effects <ul><li>mild to extreme jaw clenching (trisma), tongue and cheek chewing, and teeth grinding (trisma)  </l...
ECSTASY
LSD
LSD <ul><li>COMMON & BRAND NAMES </li></ul><ul><ul><li>Acid; L; Tabs; Blotter; Doses; Trips </li></ul></ul><ul><li>EFFECTS...
LSD Effects <ul><li>increase in energy (stimulation)  </li></ul><ul><li>increase in associative & creative thinking  </li>...
LSD Effects <ul><li>general change in consciousness (as with  most psychoactive)  </li></ul><ul><li>pupil dilation  </li><...
LSD Effects <ul><li>over-awareness & over-sensitization to music and noise  </li></ul><ul><li>paranoia, fear, and panic  <...
Marijuana
Marijuana <ul><li>Cannabis has been around for centuries and the plant has been used to make rope, thread, clothes and eve...
Cannabis (Marijuana) <ul><li>COMMON NAMES </li></ul><ul><ul><li>Marijuana; Marihuana; Pot; Weed; Grass; Mary Jane; ... </l...
Some of the Hazards of Using Marijuana ? <ul><li>Some of the common discomforts found when using marijuana include dry mou...
Hazards of Marijuana Use <ul><li>Short Term </li></ul><ul><li>Anxiety and paranoia </li></ul><ul><li>Impaired memory </li>...
Marijuana Short Term Effects <ul><li>mood lift  </li></ul><ul><li>relaxation, stress reduction  </li></ul><ul><li>creative...
Signs of Marijuana Use <ul><li>Dilated (large) pupils  </li></ul><ul><li>Cigarette rolling papers  </li></ul><ul><li>Seeds...
Signs of Marijuana Use <ul><li>Distorted sensory perceptions  </li></ul><ul><li>Dry mouth  </li></ul><ul><li>Euphoria (tem...
Signs of Marijuana Use <ul><li>Temporary feelings of reduced anxiety or stress  </li></ul><ul><li>Sadness/depressed mood  ...
Marijuana
Marijuana
Marijuana
Marijuana Buds and Blount
Marijuana Blount
Marijuana Pipe
Marijuana Pipe
Cocaine Crack Cocaine
Cocaine (Crack Cocaine) <ul><li>COMMON & BRAND NAMES </li></ul><ul><ul><li>Coke; Crack; Blow; Snow; Nose  </li></ul></ul><...
Cocaine (Crack Cocaine) <ul><li>PSYCHOLOGICAL EFFECTS : </li></ul><ul><ul><li>Varies with dose and the tolerance of the us...
Cocaine Addiction <ul><li>Cocaine is a powerfully addictive central nervous system (CNS) stimulant. It has extremely poten...
Cocaine Addiction <ul><li>The effects of cocaine are immediate, extremely pleasurable, and brief. Cocaine produces intense...
Signs of Cocaine Addiction <ul><li>Red, bloodshot eyes  </li></ul><ul><li>Runny nose or frequent sniffing  </li></ul><ul><...
Common emotional signs of cocaine addiction  <ul><li>Change in eating or sleeping patterns  </li></ul><ul><li>Change in gr...
Common signs of cocaine addiction withdrawal <ul><li>depressed mood  </li></ul><ul><li>fatigue  </li></ul><ul><li>generali...
Cocaine Powder
Cocaine for Injecting
Cocaine for Snorting
Signs of Crack Addiction <ul><li>The signs of crack addiction are very similar to cocaine addiction. However, there are ma...
Crack Cocaine Addiction <ul><li>Crack is typically smoked in pipes constructed of glass bowls fitted with one or more fine...
Crack Cocaine Addiction <ul><li>Crack is a purified form cocaine. Two or three doses can cause addiction. Because this smo...
Signs of Crack Addiction <ul><li>Crack addicts have many tell tale signs of their addiction. A few physical signs of crack...
Crack Cocaine
Vial Crack Cocaine
 
 
 
Methamphetamine
Methamphetamine <ul><li>COMMON & BRAND NAMES </li></ul><ul><ul><li>Meth; Speed; Crystal; Glass; Crank;  </li></ul></ul><ul...
Methamphetamine High <ul><li>A methamphetamine-induced &quot;high&quot; artificially boosts self-confidence, many users ar...
Methamphetamine <ul><li>As a powerful stimulant, methamphetamine, even in small doses, can increase wakefulness and physic...
Methamphetamine Effects <ul><li>Hyperactivity  </li></ul><ul><li>Irritability  </li></ul><ul><li>Visual hallucinations  </...
Physiological effects of methamphetamine use include:  <ul><li>abnormally high blood pressure  </li></ul><ul><li>rapid and...
Methamphetamine Short Term <ul><li>increased attention  </li></ul><ul><li>decreased fatigue  </li></ul><ul><li>increased a...
Long-term effects of methamphetamine use <ul><li>Long-term methamphetamine abuse results in many damaging effects, includi...
Long-term effects of methamphetamine use <ul><li>dependence  </li></ul><ul><li>addiction psychosis  </li></ul><ul><li>para...
Meth Chronic Use <ul><li>With chronic use, tolerance for methamphetamine can develop. In an effort to intensify the desire...
Methamphetamine Addiction <ul><li>Methamphetamine is a highly addictive drug. Recovery and rehabilitation from methampheta...
Making Crank/Meth Made Easy <ul><li>Nazi  Method </li></ul><ul><li>Iodine </li></ul><ul><li>Red Phosphorus </li></ul><ul><...
GHB
GHB <ul><li>GHB may be made in homes by using recipes with common ingredients.  </li></ul><ul><li>&quot;Liquid Ecstasy,&qu...
Recognizing GHB <ul><li>AKA:  GHB, G, Jib, Scoop, Liquid E, Liquid X, Woman’s Viagra, Grievous Bodily Harm, Easy Lay, Gamm...
So Many Names…. <ul><li>Tranquili G, Midnight Blue, Verve, Rejoov, Somax, SomatoPro, Flower Power, Puritech, Alcover, G-ri...
GHB  How are they used? <ul><li>GHB can be produced in clear liquid, or a white powder, tablet, and capsule forms, and it ...
Other GHB Products
Efforts to Avoid Detection <ul><li>GHB & its analogs are  NOT  protected by the Dietary Supplement & Heath Education Act o...
GHB- No longer Just for Rapists <ul><li>Recreational Use </li></ul><ul><li>Muscle Gain </li></ul><ul><li>Those under manda...
What To Expect
Typical GHB Containers <ul><li>Typical bottles for hiding GHB-- film canisters, hair spray, liquid candy bottles, food col...
Recognizing Containers <ul><li>ANY  container that will hold a liquid.  </li></ul>GHB addicts have hidden it in engine com...
GHB analogs - What does it do <ul><li>At lower doses, GHB has sedative effects, but, as the dose increases, GHB effects ma...
GHB toxicity- mild <ul><li>Lethargy, easily aroused with repeated stimulation </li></ul><ul><li>Drowsiness, somnolence, di...
GHB Toxicity- Severe <ul><li>Frequent Vomiting,  </li></ul><ul><li>Respiratory depression or arrest </li></ul><ul><li>Seiz...
GHB <ul><li>ALCOHOL IS THE MOST COMMON DRUG CO CONSUMED IN GHB RELATED DEATHS </li></ul>
GHB Treatment <ul><li>Primary Supportive </li></ul><ul><li>Beware of positional Asphyxia, but soft restraints are a good i...
GHB Treatment <ul><li>Protect your self </li></ul><ul><li>VOMIT </li></ul><ul><li>Be cautious using respiratory depressant...
Difficulty in Prosecution <ul><li>Sort Duration </li></ul><ul><li>Amnesia clouds recall </li></ul><ul><li>Often pro-sexual...
GHB analogs- What does this mean to me? <ul><li>GHB analogs are unpredictable in clinical course, other than duration.  </...
Those who have Died <ul><li>More than 16,000 adverse reaction to GHB are documented. More than 72 deaths have been deemed ...
Field Testing This is what GHB/GBL does to a Styrofoam cup!
Raves
The Rave Culture <ul><li>Generally speaking, “Rave” applies not just to the parties but to an entire subculture </li></ul>...
Rave Culture <ul><li>Tend to be “Sponsored” (A.K.A. “Promoters”), limits liability on both sides </li></ul><ul><li>Sometim...
Rave Culture
Possible Rave Indicators <ul><li>Light Sticks </li></ul><ul><li>Water/Gatorade Bottles for sale </li></ul><ul><li>H2O shut...
Possible Rave Indicators <ul><li>Glow sticks of all sizes </li></ul><ul><li>Special mouth guards </li></ul><ul><ul><li>Pro...
Possible Rave Indicators <ul><li>The sensation of breathing is intensified by the menthol (eucalyptus) in vapor rub produc...
It’s About Sensation <ul><li>Many carry personal vibrators.  Notice the “x” & “e” & butterfly beads.  Butterfly is a commo...
Rave Paraphernalia <ul><li>MDMA causes “bruxism”—teeth grinding & involuntary jaw locking; damages teeth. </li></ul><ul><l...
Common Medical concerns <ul><li>Severe Dehydration and Hyperthermia </li></ul><ul><li>Poly-Pharm involvement </li></ul><ul...
Heroin
Heroin <ul><li>Also Known as </li></ul><ul><li>Black Tar </li></ul><ul><li>China White </li></ul><ul><li>Speed Ball </li><...
Methods of use:  <ul><li>Shooting: </li></ul><ul><li>Skin Popping: </li></ul><ul><li>Muscle Popping:  </li></ul><ul><li>Ch...
Signs and Systems of an Opiate Overdose <ul><li>Pin Point Pupils </li></ul><ul><li>Hypotension </li></ul><ul><li>N/V </li>...
Long Term problems <ul><li>HIV, HEP-A/B/C,  </li></ul><ul><li>BLOOD POISONING (Septicemia) “Cotton Fever” </li></ul><ul><l...
Some things that have been done with a Heroin OD by Junkies <ul><li>Injected someone with salt water or Milk  This is an o...
Signs of Drug Abuse <ul><li>There's no easy way to figure out if someone, especially a teenager, is using drugs or alcohol...
Personality:   <ul><li>Becomes disrespectful—is verbally and physically abusive  </li></ul><ul><li>Is angry a lot, acts pa...
Physical Appearance: <ul><li>Not taking care of hygiene and grooming  </li></ul><ul><li>Not sleeping or sleeping too much ...
Social Activity/School Performance:  <ul><li>Drops old friends and activities  </li></ul><ul><li>Is skipping school  </li>...
Should You Snoop ? <ul><li>It's a controversial topic. if you suspect a family member, especially your child is drinking o...
General Affects on the Public  <ul><li>Violent Crimes (Murder, Robberies) </li></ul><ul><li>Ingress in Burglaries (Mainly ...
Examples <ul><li>Person steals Check Book during burglary or from purse, Buys Large amount of meat at grocery store with s...
Drug Abuse <ul><li>It is not uncommon for Law Enforcement to recover stolen property from a Drug House during the executio...
Signs of Alcohol and Drug Addictions <ul><li>There are many signs that an individual may have a drug or alcohol addiction....
Signs / Indicators of Addication <ul><li>Increase or decrease in appetite; changes in eating habits, unexplained weight lo...
Signs / Indicators of Addication <ul><li>Unexplained moodiness, irritability, or nervousness.  </li></ul><ul><li>Violent t...
The Results of  Alcohol and Drug Abuse
 
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  • Hi, I work in substance misuse treatment and would greatly appreciate the use of this presentation as I am currently delivering intensive training to young people.
    If possible could you email me it to tim.murphy@lifeline.org.uk.
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  • oh wow over 100 slides! really good job
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  • sir pls can u mail me at drswamymv@gmail.com
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  • I agree with everyone, this is an excellent presentation. Thank you for taking the time to put this together!
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  • Outpatient Drug Addiction Center
    http://vegas1991.treatmentcenterpage.com/

    855-YES-REHAB outpatient Drug rehab
    736 n tenth street unit 5
    Las Vegas, NV 89101
    702-605-1991
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  • Street doses of MDMA generally run from 50mg. to 150 mg. 100mg. or 1/10th of one gram is considered an average single dose. Monks have used lower doses (40-60 mg) to assist meditation, and therapists(especially in Israel for PTSD) have sometimes taken similarly low doses to become more in tune with clients. A benchmark standard dose is often considered to be 2 mg of MDMA per kilogram of body weight (though response to the drug is not strictly proportional to body weight). Users will take 1/3-1/2 the original dose to maintain at approx 1 ½ hours after ward. Initial effects include a brief &amp;quot;rush&amp;quot; of energy, usually described as mild but euphoric. After this rush, the high levels off to a plateau which lasts 2-3 hours and is followed by a gradual &amp;quot;coming down&amp;quot; sensation, culminating in a feeling of fatigue in about 4-6 hours
  • Hangover and the Week After Many users report feeling extremely drained the day after MDMA use. This &apos;day after&apos; effect means for many MDMA users that they need to plan 2 days for the experience: one for the peak experience and one recovery day, with very little planned. Many users also experience some level of post-MDMA depression, often starting on the second day after the experience and lasting for up to 5 days. A small percentage of users report depressive symptoms for weeks afterwards. Alternately, some users report feeling better than normal for a week or so after taking MDMA. The negative after-effects of taking MDMA appear to be worse with higher frequencies of use, higher dosages, and perhaps total lifetime usage. Long-term users often describe increasingly uncomfortable and prolonged &amp;quot;burn-out&amp;quot; periods, sometimes lasting two or more days Sore throats, flu like s/s, and other symptom are reported, its MOA is poorly understood MDMA exerts amphetamine-like effects which include dilated pupils, dry mouth and throat, tension in the lower jaw, grinding of the teeth, and overall stimulation. These side effects are dose dependent and will vary depending on the health of the individual user
  • Very easy to make, no cooking is required. Since no longer commercially available, its potency in variable.GBL, GBH, BD &amp; One 4 B are just a few analogs The sodium salt of gamma-hydroxybutyric acid is known as sodium oxybate and has a number of other chemical names. Gamma-butyrolactone (GBL) is an industrial solvent which can be purchased from chemical distributors and is used in the clandestine manufacture of GHB. GHB is produced in clandestine laboratories using a relatively simple synthesis. GHB, itself, is a solid substance but is generally dissolved in a clear liquid. Confiscated samples have been found in &amp;quot;spring water&amp;quot; bottles or disguised as mouth-wash. GHB is abused to produce euphoric and hallucinogenic states, and for its alleged role as a growth hormone releasing agent to stimulate muscles. GHB can produce drowsiness, dizziness, nausea, visual disturbances, unconsciousness, seizures, severe respiratory depression and coma. Overdose usually requires emergency medical treatment. Illicit Uses GHB induces a sense of euphoria and intoxication. It is sometimes mixed with alcohol to intensify its effects resulting in respiratory depression and coma. The typical dose is 1 - 5 grams of powder (depending on the purity of the compound this can be 1-2 teaspoons mixed in a beverage). GHB has been sold already mixed in liquid and dispensed by the water-bottle cap to the user. The saturation and concentrations of these &amp;quot;home-brews&amp;quot; have varied so that the user is not usually aware of the actual dose they are drinking. The onset of effects occurs within 15-30 minutes, and lasts 3-6 hours.   User Population GHB is popular with high school and college students. GHB is found at &amp;quot;rave parties&amp;quot; and upscale &amp;quot;smart-drink&amp;quot; nightclubs. Body-builders also abuse GHB for its purported anabolic effects. GHB has been used to assist in the commission of sexual assaults. DEA has documented 15 sexual assault cases involving 30 victims under the influence of GHB. Urinalyses were conducted on samples submitted from victims of alleged sexual assault; of the 711 drug-positive urines 48 tested positive for GHB.   Illicit Distribution At bars or &amp;quot;rave&amp;quot; parties GHB is sold for $10 per capful or &amp;quot;swig&amp;quot;. The most typical route of administration is oral consumption. Major source to the street is through clandestine synthesis. The product has been disguised by adding food coloring, flavorings, and/or storing it in bottles. GBL, the solvent precursor for GHB, is also being abused due to its rapid conversion to GHB soon after ingestion. GBL is more biologically available than GHB. In January 1999 the FDA issued a request for a voluntary recall of all GBL-containing products sold in health food stores and warned the public of its abuse potential and danger to the public health. 1,4-butanediol (One 4 B), a chemical related to both GHB and GBL has also been declared a Class I Health Hazard. In 1999 the FDA issued another warning on 1,4 butanediol, GHB, and GBL stating that these pose a significant health hazard. To date, FDA investigators have investigated 124 cases involving large scale inter-state manufacture and distribution of GHB. Law enforcement agencies have encountered GHB on 850 occasions, including 150 clandestine laboratories, and 500 seized and analyzed laboratory exhibits.  Control Status The &amp;quot;Hillary Farias and Samantha Reid Date-Rape Prohibition Act of 1999&amp;quot; (Public Law 106-172) was signed on February 18, 2000. On that date, GBL became a List I chemical, subject to the criminal, civil and administrative sanctions of the Controlled Substances Act. On March 13, 2000, GHB was made a Schedule I controlled substance (65 FR 13235-13238).At the recommendation of the W.H.O., the Commission on Narcotic Drugs on 20 March 2001 added GHB in Schedule IV of the 1971 Convention of Psychotropic Substances. *(including federal, state and local cases of possession, trafficking, clandestine manufacturing, forensic analyses) sucol-B, an alternative name for 1,4-butanediol GBL: gamma-butyrolactone, furonone di-hydro dihydrofuranone Metabolizes to GHB. BD: 1,4-butanediol, tetramethylene glycol, sucol-B, butylene glycol Precursors for GBL , which then become GHB. GHV: gamma-hydroxyvalerate, Valeric Acic, methyl-GHB* Is its own separate metabolite, however clinically is almost exactly like GHB GVL: gamma-valerolactone, 4-pentanolide, Precursor to GHV
  • GHB or gamma-hydroxybutyrate is usually prepared in a form called sodium oxybate which is just the sodium salt of GHB hence its alternative name sodium gamma-hydroxybutyrate. Just to make things more complicated CAS refers to this salt as butanoic acid, 4-hydroxy, monosodium salt. In the earlier abstracts butyric replaces butanoic. GHB is listed in Merk Ed. 11,8603 under Sodium Oxybate.
  • GHB is usually abused either for its intoxicating, sedative, and euphoriant properties. GHB&apos;s intoxicating and depressant effects on the CNS begin 10 to 20 minutes after the drug is taken orally. The effects typically last up to 4-6 hours, depending on the dosage. At lower doses, GHB can relieve anxiety and produce relaxation; however, as the dose increases, the sedative effects may result in sleep and eventual coma or death. The line between achieving euphoric effects and toxicity resulting in life threatening side effects is very narrow. GHB is often used with alcohol potentate its effects and increasing the likelihood of side effects and toxicity. Dose Effect 10 mg/kg Amnesia, hypotonia 20 mg/kg Drowsiness, somnolence, dizziness, euphoria 50 mg/kg Vomiting, bradycardia, Cheyne-Stokes respirations, seizures, coma and death.
  • HOW MANY CLEANING SOLUTIONS COME IN 2-OZ BOTTLES WITH AN EYEDROPPER?
  • GHB is usually abused either for its intoxicating, sedative, and euphoriant properties. GHB&apos;s intoxicating and depressant effects on the CNS begin 10 to 20 minutes after the drug is taken orally. The effects typically last up to 4-6 hours, depending on the dosage. At lower doses, GHB can relieve anxiety and produce relaxation; however, as the dose increases, the sedative effects may result in sleep and eventual coma or death. The line between achieving euphoric effects and toxicity resulting in life threatening side effects is very narrow. GHB is often used with alcohol potentate its effects and increasing the likelihood of side effects and toxicity. Dose Effect 10 mg/kg Amnesia, hypotonia 20 mg/kg Drowsiness, somnolence, dizziness, euphoria 50 mg/kg Vomiting, bradycardia, Cheyne-Stokes respirations, seizures, coma and death.
  • GHB in pure form is clear &amp; thicker than water; it bubbles when shaken. But it can be dyed any color, watered down &amp; not all of its “analog” cousins bubble. It may also be seen in powder, capsule or a “putty” form.
  • Coma and seizures can occur following abuse of GHB and, when combined with methamphetamine, Alcohol, or MDMA there appears to be an increased risk of seizure. Combining use with other drugs such as alcohol can result in nausea and respiratory depression . ALCOHOL IS THE MOST COMMON DRUG CO CONSUMED IN GHB RELATED DEATHS GHB may also produce withdrawal effects, including insomnia, anxiety, tremors, and sweating. Because of concern about Rohypnol, GHB, and other similarly abused sedative-hypnotics, Congress passed the &amp;quot;Drug-Induced Rape Prevention and Punishment Act of 1996&amp;quot; in October 1996. This legislation increased Federal penalties for use of any controlled substance to aid in sexual assault. GHB is cleared from the body relatively quickly, so it is sometimes difficult to detect in emergency rooms and other treatment facilities. In fact, only about 2-5% of GHB is excreted renally. In those cases where it has been renally excreted, GHB can be found in urine samples that test specifically for the substance within 4-7 hours after ingestion. GHB is not part of routine urine toxicological testing.
  • There were some homicide cases linked to GHB, it is believed that the subject used GHB in a date rape type of scenario, and when the victim did not respond quickly enough, that more GHB was added to her drink, becoming toxic.
  • Dose Effect 10 mg/kg Amnesia, hypotonia 20 mg/kg Drowsiness, somnolence, dizziness, euphoria 50 mg/kg Vomiting, bradycardia, Cheyne-Stokes respirations, seizures, coma and death. Use with alcohol and stimulants (Meth, MDMA) are known to potentiate its effects. Seizures, Sudden onset of coma: Most often the cause of EMS notification
  • It is worth noting that alcohol severely exacerbates GHB’s effects. GHB analog Butanediol and Ethanol are metabolized through the same pathways, making concombant use of ETOH very dangerous.
  • As with other CNS depressants the emergency management is geared towards supporting a patient airway, supporting ventilation, oxygenation and adequate perfusion. There are no specific antidotes or completely safe reversal agents that can be administered. Although Physostigmine, a cholinergic drug, has been shown to reverse sedation, it is widely believed that the risks of bradycardia, seizures, AV block, cholinergic crisis, or asystole outweigh the potential benefits of reversal. Provide a patent airway. Suction sections as needed. Anticipate vomiting. Consider and assess for associated trauma or sexual assault that may have occurred. Position the patient for airway protection and to optimize perfusion. Oxygenate and ventilate if hypoventilation occurs. Reassess often for changes. Assess for concomitant problems such as hypoglycemia, opiate overdose, alcohol ingestion, other drugs. Monitor the cardiac rhythm. Bradycardia accompanies approximately 36% of ingestions. If bradycardia is present Atropine may be administered to hemodynamically unstable patients. Documented cardiac rhythms include first-degree heart block, atrial fibrillation, right-bundle branch block, and ventricular ectopy. Hypotension accompanies about 10% of GHB ingestions. This usually is associated with co-ingestion of GHB and alcohol or another drug and usually is mild. If hypotension is not resolved readily by stimulation or atropine administration, another ingestion or co-ingestion must be considered. When co-ingestion of another substance is suspected gastric decontamination by lavage with Activated charcoal with sorbitol is indicated. because GHB is rapidly absorbed from the GI system, lavage with an isolated GHB ingestion is probably not useful. Keep the patient warm. Mild hypothermia has been reported in about 70% of cases.
  • A recent study noted that two thirds of patients present with a GCS of less than 9, and a full third present with a GCS of 3. According to physician reports one peculiar characteristic of GHB toxicity is that patients often demonstrate extreme combativeness and agitation despite such profound CNS and respiratory depression. Several physicians have been surprised when the individual suddenly awakens during an intubation attempt. The coma usually lasts from 3 to 6 hours and spontaneously resolves. Those patients intubated for respiratory depression typically have a longer time to recovery, but extubation within 8-10 hours is common; extubation in the ED has been described. The resolution is characteristically rapid and usually accompanied by seizure-like movements, myoclonic jerks and agitation. (Cameron, e-medicine.com, 2001)
  • Soft fuzzy clothing or other interesting textured fabrics add to sensation &amp; are popular. Special clothing &amp; hats are sold with hidden compartments to hide their drugs at school &amp; parties. In the hat below, it is behind the emblem; it is sealed with Velcro under the hat band.
  • Severe Dehydration and Hyperthermia: from hyperdynmamic drug use (MDMA, METH, PMA), low availability of H2O Poly-Pharm involvement: (intentional and accidental) Date Rape: Multiple Patients (approach with a plan): drug use, violance, heat Volatile Crowds
  • Clockwise: Black tar heroin, various types of heroin and balloons, pure heroin…china white, and someone shooting up. Notice the dark color of the junk in the syringe. The typical heroin user today consumes more heroin than a typical user did just a decade ago, which is not surprising given the higher purity currently available at the street level. Until recently, heroin in the United States almost exclusively was injected either intravenously, subcutaneously (skin-popping), or intramuscularly. Injection is the most practical and efficient way to administer low-purity heroin. The availability of higher purity heroin has meant that users now can snort or smoke the narcotic. Evidence suggests that heroin snorting is widespread or increasing in those areas of the country where high-purity heroin is available, generally in the northeastern United States. This method of administration may be more appealing to new users because it eliminates both the fear of acquiring syringe-borne diseases such as HIV/AIDS and hepatitis, and the historical stigma attached to intravenous heroin use.  Howard Lotsof, a renowned researcher into ibogaine treatment of heroin addiction, has estimated that a &amp;quot;low end analgesic dose of heroin would be about 1mg.&amp;quot; Most users start with doses much higher than this. Insufflated doses of heroin probably start at between 5 and 20mg of pure heroin and intravenous doses probably start between 5 and 10 mg. As usage increases, however, the doses get much higher. Dr Lotsof wrote &amp;quot;In close to twenty years of research and involvement with the treatment of opioid dependence with ibogaine the highest dose I personally saw used of heroin in Europe was 2 grams [per day], that is 2,000 mgs.&amp;quot; 2 grams per day, however, is extremely high, much higher than most heroin addicts achieve. Heroin is very expensive and this dosage level would be fatal in most people who had not worked up their dosages slowly. When the Swiss government began allowing maintanence of heroin users, they were able to collect reliable data about exactly how much heroin was being used. The Swiss found that users offered unlimited quantities would, on average, max out at between 300 and 500 mg. of diacetylmorphine per day. One author writes &amp;quot;I&apos;ve known people prescribed a full gram per day, but they were quite unusual, and such habits on the street are impossible except for relatively high level dealers. Remember, I&apos;m talking about pure pharmaceutical or number 4 if on the street. There are certainly cases of pain patients receiving larger equivalent dosages of opioids, but I&apos;ve never heard of one of these beating a 1000/1 ratio.&amp;quot; The Swiss data was published in 1999 Prescription of Narcotics for Heroin Addicts: Main Results of the Swiss National Cohort Study Page 20 states that the mean daily dose of heroin IV ( when used alone, without methadone on the side) was 491.7mg. Page 22 states &amp;quot;A stable dose was achieved after 6 months at most; beyond this point, almost no further increases in dose were required
  • China White : Pure heroin is a white powder with a bitter taste. Most illicit heroin is a powder form which may vary in color from white to dark brown because of impurities left from the manufacturing process or the presence of additives. Pure heroin is rarely sold on the street.. This heroin may be smoked. “ black tar,&amp;quot; has also become increasingly available in the western United States. The color and consistency of black tar heroin results from the crude processing methods used to illicitly manufacture the substance in Mexico. Black tar heroin may be sticky, like roofing tar or hard like coal, and its color may vary from dark brown to black. It is often sold on the street in its tar-like state at purities ranging from twenty to eighty percent. This heroin is most frequently dissolved, diluted and injected.  Red Rum Heroin - is a highly potent form of heroin that was recently responsible for the overdose death of a rock musician in New York. Red Rum and other brands like it, including Fire Express, Green Honey, and Laundromat, are much more potent than brands of heroin a decade ago. They are designed to deliver a strong high by snorting or smoking instead of injecting. According to New York City police, a sample of the Red Rum heroin tested at a purity level between 60 and 70 percent. Red Rum&apos;s origins are believed to be South American. Speed Ball : Heroin mixed with cocaine Homicide, Buick, super Buick, twilight sleep: Mixed with scopolamine. Scopolamine, which causes amnesia, was introduced in 1902 and used up until the 1960s. Injected with morphine, this analgesic-amnesic technique known as &amp;quot;Twilight Sleep&amp;quot; provided painless birth. However, &amp;quot;Twilight Sleep&amp;quot; had its downside. Not only did it completely remove the mother from the birth experience, a growing concern in the 1950s, but it also caused neonatal depression.
  • A dirty hit can result in a fairly quick and intense reaction or might take days or weeks to produce an effect. Symptoms often include sweating, headache, fever, and trembling. While the effects of a dirty hit may pass by themselves,. Shooting: IV Injection Skin Pooping: SQ injection Muscle Pooping: IM Chasing the dragon: Smoking ( it&apos;s put on aluminum foil and heated from the bottom and allowed to run down the foil if possible while inhaling the smoke…) freebasing Dirty Hit: The result of a dirty process usually resulting in an abscess, cellulites, etc
  • “ This is the key to the heroin high: Nothing matters, hot or cold, fun or boring, big or small. When one is high on smack, one looks at the outside world and has only one thought: Who gives a f*ck? You feel as if you&apos;ve been wrapped in the most pleasing, warm, and comfortable blanket in the world. At high doses, you fall in and out of consciousness, and getting this &apos;nod&apos; is what the veteran user prays for everytime he shoots up; to sleep the sleep of angels is the ultimate goal of the heroin addict.” ..from erowid.com The bottom of a soda pop can is commonly used as a &amp;quot;spoon&amp;quot; to dissolve the heroin in because it is curved inward like a spoon. The bottom is torn off of a can as close to the bottom as possible. Polypharm OD may mask some s/s Oxycodone is a semi-synthetic opioid derived from the opium alkaloid thebaine. It is typically made into the salt form, oxycodone hydrochloride, a white, odorless crystalline powder that is highly soluble in water and slightly soluble in alcohol. It’s chemically known as 4, 5a-epoxy-14-hydroxy-3-methoxy-17– methylmorphinan-6-one hydrochloride. It has a high oral bioavailability relative to other opioids, between 60 and 87 percent, making it ideal for oral administration. Oral bioavailability is the percentage of active drug which reaches systemic circulation through oral administration relative to direct injection into the bloodstream. High oral bioavailability is desirable because it reduced the physical size of tablets, and gives the physician greater precision when titrating doses because of predictable pharmacokinetics. Oxycodone also has a high nasal bioavailability [5] , between 50 and 65 percent, which makes it a good candidate for a nasally administered formulation, but also for nasal abuse. It can also be given intramuscularly, intravenously, subcutaneously, and rectally.The serum half-life following oral administration (oxycontin) is 3.5 to 4 hours. Its effective duration of analgesic action is 3 to 4 hours. Subjective comments from users [9] [‘Oxy’ refers to OxyContin tablets whose active ingredient is oxycodone]: “ I’ve had some almost 99% pure Heroin and I have to say it’s definitely better than Oxy [10] , especially when considering the high price of Oxy.” “ Heroin has a very ‘narcotic’ feel to it, but oxy has a seriously ‘medical’ feel to it. It’s a very ‘clean’ high.” “ When you intravenously inject Oxy, the rush doesn’t last very long at all. The major part of it is over in about 20 minutes. Heroin lasts a lot longer.” “ Oxy is over quicker. Much cleaner [compared to heroin] though. Not as sleep and not so much of the itch. Oxy doesn’t make me as nauseated. Oxy makes everything beautiful.” “ All I can say is that I get a very giddy happy high from oxycodone while I get a knockout loaded feeling from heroin.” “ Morphine Sulfate is useless to me orally. It is extremely not well absorbed by this route. Morphine is not quickly absorbed even by injection compared to some others, and tends to cause more histemic and emetic reactions, not to mention more respiratory depression. It has a nice dreamlike quality though. Not at the top, but still very nice to have.” “ You get a lot more ‘nod [11] ’ with Heroin than with Oxy.” “ When you get that oxy buzz,” she says, “it’s a great feeling. You’re happy. Your body don’t hurt. Nothing can bring you down. It’s a high to where you don’t have to think about nothing. All your troubles go away. You just feel like everything is lifted off your shoulders.” [12]
  • BLOOD POISONING (Septicemia) Blood poisoning (septicemia) is a bacterial infection of the bloodstream that can be caused by injecting with contaminated water, re-using old cottons, or failing to clean the skin prior to injection. Early symptoms include chills, fever, and extreme fatigue. If you experience these symptoms, seek medical attention. Septicemia can be fatal! ENDOCARDITIS Endocarditis is an infection of the heart lining that is caused by bacteria, fungi, and other infection-causing microbes that enter the bloodstream during injection and build up around the valves of the heart, weakening them as well as other parts of the heart muscle. Endocarditis can eventually cause a heart murmur, as well as fever, chest pains, fainting spells, shortness of breath, and heart palpitations. It can be treated with antibiotics if detected early, but can be fatal if it goes untreated. TETANUS tetanus spores enter a wound and release tetanus bacteria, usually after a scab has already formed. The bacteria then enter the bloodstream and cause an infection, which is characterized by muscle spasms or rigidity, especially in the neck and jaw (tetanus is commonly called &amp;quot;lockjaw&amp;quot;). Tetanus is fatal if not treated. Tetanus spores live in the soil and on rust, which is why a tetanus shot is recommended if you step on an old nail or other rusty object. If your needle, syringe, or other injection equipment is contaminated with tetanus spores due to dirt or rust, you could infect yourself. Skin-poppers and muscle-poppers are particularly susceptible to tetanus infection and should always use new, sterile equipment. NECROTIZING FASCIITIS (Flesh-Eating Disease) Associated w/ black tar Necrotizing fasciitis is a bacterial infection commonly known as &amp;quot;flesh-eating disease&amp;quot; that enters the body through broken skin and then affects the surrounding tissue and nearby muscle. It can be transmitted by the exchange of blood during needle sharing, and has recently been traced to &amp;quot;black tar&amp;quot; heroin on the West Coast. Symptoms of necrotizing fasciitis include increasing redness and swelling and extreme pain at the wound or injection site accompanied by a fever. The flesh around the site of infection begins to decay and looks as if it had been &amp;quot;eaten&amp;quot; away. Since this infection is fatal, early treatment with antibiotics is crucial to survival, although even appropriate therapy does not prevent death in all cases. Wounds must be kept impeccably clean. WOUND BOTULISM Wound botulism is caused by a bacteria that produces a toxin on the skin where a puncture would is made and that eventually stops your breathing by paralyzing your muscles. Recent cases have been associated with the subcutaneous injection of &amp;quot;black tar&amp;quot; heroin on the West Coast. The source of the botulism could be the drug itself, a cut in the drug, dirty injection equipment, or contamination during the preparation process. Wound botulism can be prevented in the same ways as necrotizing fasciitis­by following excellent sterile technique when preparing and injecting your drugs. Symptoms of wound botulism include droopy eyelids, blurred or double vision, and a dry, sore throat which may progress into difficulty speaking and swallowing, a weakness of the neck, arms, and legs, and difficulty breathing.
  • Transcript of "Alcohol drug awareness"

    1. 1. Alcohol and Drug Abuse
    2. 2. Alcohol Related <ul><li>Alcohol is the oldest and most widely used drug in the </li></ul><ul><li>world. Nearly half of all Americans over the age of 12 are </li></ul><ul><li>consumers of alcohol. Most people don’t have a problem </li></ul><ul><li>with alcoholism but there are an estimated 10 to 15 million </li></ul><ul><li>alcoholics or problem drinkers in the United States, with </li></ul><ul><li>more than 100,000 deaths each year attributed to alcohol. </li></ul><ul><li>What most people don’t realize is that among the nation’s </li></ul><ul><li>alcoholics and problem drinkers are as many as 4.5 million </li></ul><ul><li>adolescents </li></ul>
    3. 3. Friend or Foe ? <ul><ul><li>High levels of alcohol consumption can lead to physical illness and psychological and social distress. </li></ul></ul><ul><ul><li>  </li></ul></ul><ul><ul><li>Small, regular amounts of alcohol also seem to have a positive effect on the heart and circulation. </li></ul></ul><ul><ul><li>  </li></ul></ul><ul><ul><li>But too much alcohol is often a recipe for disaster. </li></ul></ul><ul><li>The increasing use of alcohol, along with other drugs of abuse, is a serious public health problem across all age ranges, but especially so in the young. </li></ul>
    4. 4. Signs and symptoms of Alcholism <ul><li>alcohol use and intoxication: </li></ul><ul><li>Smell of alcohol on breath </li></ul><ul><li>Irritability </li></ul><ul><li>Euphoria </li></ul><ul><li>Loss of physical coordination </li></ul><ul><li>Inappropriate or violent behavior </li></ul><ul><li>Loss of balance </li></ul><ul><li>Unsteady gait </li></ul><ul><li>Slurred and/or incoherent speech </li></ul><ul><li>Loss of consciousness </li></ul><ul><li>Slowed thinking </li></ul><ul><li>Depression </li></ul><ul><li>Impaired short-term memory </li></ul><ul><li>Blackouts </li></ul><ul><li>alcohol withdrawal, experienced by alcoholics and problem drinkers: </li></ul><ul><li>Tremors </li></ul><ul><li>Agitation </li></ul><ul><li>Anxiety and panic attacks </li></ul><ul><li>Paranoia and delusions </li></ul><ul><li>Hallucinations (usually visual) </li></ul><ul><li>Nausea and vomiting </li></ul><ul><li>Increased body temperature </li></ul><ul><li>Elevated blood pressure and heart rate </li></ul><ul><li>Convulsions </li></ul><ul><li>Seizures </li></ul>
    5. 5. Alcoholism <ul><li>Alcoholism or alcohol dependence is a medical term with a deliberately more precise Meaning than the problems that can occur, sometimes as one-offs, through an uncharacteristic binge. In alcohol dependence a number of features come together in the behavior of the person affected. </li></ul><ul><ul><li>Drinking begins to take priority over other activities. </li></ul></ul><ul><ul><li>It becomes a compulsion. </li></ul></ul><ul><ul><li>Tolerance develops, it takes more alcohol to produce drunkenness. </li></ul></ul><ul><ul><li>Withdrawal symptoms such as anxiety and tremor develop after a </li></ul></ul><ul><ul><li>short period without a drink, and are reduced by taking more alcohol. </li></ul></ul><ul><li>Often alcohol dependence remains undetected for years </li></ul>
    6. 6. Signs of Alcoholism <ul><li>As alcohol levels increase with more drinking, there is poor control of muscles, poor coordination, double vision, flushing of the face, bloodshot eyes, and vomiting. </li></ul><ul><li>Behavior varies greatly. It is hard to predict what an intoxicated person will do next. He/she may cry bitterly, show unexplained happiness, change moods rapidly, or just pass out. </li></ul><ul><li>NOTE: “ Passing out ” or “ falling asleep ” can be a warning sign that the person is actually in a dangerous alcohol coma. </li></ul><ul><li>Get immediate help if you suspect alcoholic coma. </li></ul>
    7. 7. Effects of Alcoholism <ul><ul><li>Excessive and inappropriate alcohol consumption at work leads to accidents, absenteeism and lost revenue . </li></ul></ul><ul><li>25% people who die in road accidents have blood alcohol levels greater .08 (current legal limit) </li></ul><ul><ul><li>Aggressive and criminal behavior and the consumption of alcohol are linked. </li></ul></ul><ul><ul><li>Alcoholics and heavy drinkers are especially susceptible to the development of other diseases. </li></ul></ul><ul><ul><li>Alcoholics and problem drinkers also undoubtedly contribute to the deterioration of the mental health of other members of their families through verbal, physical, and sexual abuse. </li></ul></ul>
    8. 8. Serious Intoxication <ul><li>Serious intoxication results when a large amount of an alcoholic beverage is taken over a relatively short period of time (or for a longer period of time, when alcohol intake exceeds alcohol excretion). Memory is commonly lost for the events while intoxicated. Symptoms are drowsiness that can progress rapidly to coma; slow snoring breathing; blueness of the face, lips, and fingernail beds; involuntary passage of urine or feces; dilated pupils; and rapid weak pulse. A suspected alcoholic stupor or coma represents a medical emergency . </li></ul>
    9. 9. Alcohol Withdrawal <ul><li>Alcohol withdrawal occurs when a physiologically dependent person abruptly stops using alcohol. Physiologic dependence can develop after prolonged and heavy drinking. </li></ul><ul><li>Alcohol withdrawal can be a life-threatening emergency. Symptoms include increased sweating and pulse (greater than 100/min), hand tremor, insomnia, nausea or vomiting, hallucinations or illusions, agitation, anxiety, and grand mal seizures. </li></ul>
    10. 10. Dependency <ul><li>A short list of questions that can indicate if alcohol dependence is a possibility. Two or more positive answers to these questions suggests dependence. Have you ever: </li></ul><ul><ul><li>Thought you should Cut down on your drinking? </li></ul></ul><ul><ul><li>Felt A annoyed by others criticizing your drinking? </li></ul></ul><ul><ul><li>Felt bad or Guilty about your drinking? </li></ul></ul><ul><ul><li>Had a drink first thing in the morning to steady your nerves or get rid of a hangover ? </li></ul></ul>
    11. 11. Alcohol Related Problems <ul><li>Excess alcohol can lead to health problems including but not limited to: Depression, Liver cirrhosis, Heart failure, Damage to the brain and nervous system. </li></ul><ul><li>Along the way there is often damage to relationships, finances and jobs and problems with the law. </li></ul>
    12. 12. Sudden Death May Occur <ul><ul><li>When the individual has ingested so much alcohol that the brain center which controls breathing and heart action is fatally depressed. </li></ul></ul><ul><ul><li>When other depressant drugs (such as “sleeping pills”) are taken along with alcohol, magnifying the depressant effects. </li></ul></ul><ul><ul><li> During an accident (one-half of all fatal traffic accidents involve the use of alcohol); or </li></ul></ul><ul><ul><li>As a result of suicide or murder (many self-inflicted deaths as well as homicides involve the use of alcohol.) </li></ul></ul>
    13. 13. Binge Drinking <ul><li>Binge drinking is defined as drinking five or more standard alcohol drinks for males, and four or more for females within a two-hour interval. In the United States, up to 45% of college students report binge drinking or heavy drinking episodes at least once a week. </li></ul>
    14. 14. Binge Drinking <ul><li>If you are 25 years or younger and you drink to excess even once a week, your brain may exhibit some deficits as a result of your binge drinking. Your ability to pay attention and use your visual working memory could be compromised, according to researchers. </li></ul>
    15. 15. Binge Drinking <ul><li>Heavy Drinking Pattern Affects Brain </li></ul><ul><li>Binge Drinkers, But Not Alcoholics </li></ul><ul><li>Problems With Working Memory </li></ul><ul><li>Alterations In the Brain </li></ul>
    16. 16. MIX Ecstasy and Alcohol
    17. 17. 20 Questions <ul><li>Do you lose time from work due to drinking? </li></ul><ul><li>Is drinking making your home life unhappy? </li></ul><ul><li>Do you drink because you are shy with other people? </li></ul><ul><li>Is drinking affecting your reputation? </li></ul><ul><li>Have you ever felt remorse after drinking? </li></ul><ul><li>Have you had financial difficulties as a result of drinking? </li></ul><ul><li>Do you turn to inferior companions and environments when drinking? </li></ul><ul><li>Does your drinking make you careless of your family's welfare? </li></ul><ul><li>Has your ambition decreased since drinking? </li></ul><ul><li>Do you crave a drink at a definite time daily? </li></ul><ul><li>Do you want a drink the next morning? </li></ul><ul><li>Does drinking cause you to have difficulty in sleeping? </li></ul><ul><li>Has your efficiency decreased since drinking? </li></ul><ul><li>Is drinking jeopardizing your job or business? </li></ul><ul><li>Do you drink to escape from worries or trouble? </li></ul><ul><li>Do you drink alone? </li></ul><ul><li>Have you ever had a loss of memory as a result of drinking? </li></ul><ul><li>Has you physician ever treated you for drinking? </li></ul><ul><li>Do you drink to build up your self-confidence? </li></ul><ul><li>Have you ever been to a hospital or institution on account of drinking? </li></ul>
    18. 18. 20 Questions Results <ul><li>According to the Office of Health Care Programs, Johns Hopkins University Hospital, developers of this screening quiz, if you answered 3 of these questions with a Yes it is a definite sign that your drinking patterns are harmful and possibly considered alcohol dependent or alcoholic. You may want to seek an evaluation by a healthcare professional. </li></ul>
    19. 19. Drug Abuse
    20. 20. Drug abuse <ul><li>Has a wide range of definitions related to taking a psychoactive drug or performance enhancing drug for a non-therapeutic or non-medical effect . Some of the most commonly abused drugs include alcohol, amphetamines, barbiturates, cocaine, methaqualone, opium, and minor tranquilizers. </li></ul><ul><li>Use of these drugs may possibly lead to physical, social, and psychological harm, as well as criminal charges. </li></ul>
    21. 21. Drugs and the Work Place <ul><li>A country with only 'five' percent (5%) of the entire world's population buys and consumes sixty percent (60%) of the entire world's supply of illicit drugs. </li></ul>
    22. 22. Lowers productivity / causes accidents and injuries. <ul><li>Problems related to alcohol and drug abuse cost American businesses roughly $81 billion in lost productivity in just one year </li></ul><ul><li>Studies have shown that substance-abusing employees function at about 67% of their capacity </li></ul><ul><li>Up to 40 percent of industrial fatalities and 47 percent of industrial injuries can be linked to alcohol use and alcoholism. </li></ul><ul><li>Employees who use drugs are 3.6 times more likely to be involved in a workplace accident and 5 times more likely to file a workers’ compensation claim. </li></ul>
    23. 23. Increases Absenteeism, Turnover and Employer’s medical costs . <ul><li>An estimated 500 million workdays are lost annually due to alcoholism. </li></ul><ul><li>Employees who use drugs are 2.2 times more likely to request early dismissal or time off, 2.5 times more likely to have absences of eight days or more, and 3 times more likely to be late for work. </li></ul><ul><li>Illicit drug users are more than twice as likely than those who do not use drugs to have changed employers three or more times in the past year. </li></ul><ul><li>Employees who use drugs cost their employers about twice as much in medical claims as do non-drug-using employees. </li></ul>
    24. 24. What can your organization do to decrease the impact of substance abuse <ul><li>Implement a drug-free workplace program   </li></ul><ul><li>In a drug-free workplace, all employees adhere to a program of policies and activities designed to provide a safe Workplace. </li></ul><ul><li>The policies and activities discourage alcohol and drug abuse and encourage treatment, recovery and the return to work of those employees who have abuse problems. </li></ul><ul><li>Even if your organization is not required to have a drug-free workplace program, your organization can still benefit.   </li></ul>
    25. 25. Drug-free workplace program may include: <ul><li>a written policy </li></ul><ul><li>employee education </li></ul><ul><li>supervisor training </li></ul><ul><li>access to assistance </li></ul><ul><li>drug testing </li></ul>
    26. 26. A good drug-free workplace program can lead to <ul><li>Decreases in:    </li></ul><ul><li>absenteeism </li></ul><ul><li>accidents </li></ul><ul><li>downtime </li></ul><ul><li>turnover </li></ul><ul><li>workers’ compensation costs </li></ul><ul><li>employee discipline problems </li></ul><ul><li>Increases in: </li></ul><ul><li>productivity </li></ul><ul><li>profits </li></ul><ul><li>customer satisfaction </li></ul><ul><li>health status </li></ul><ul><li>employee morale </li></ul>
    27. 27. What are the Signs of Abuse? <ul><li>Substance abusers in the workplace can be difficult to identify. But there are some clues that signal possible drug and alcohol problems. </li></ul><ul><li>Here’s what to look for: </li></ul><ul><li>Frequent, prolonged, and often unexplained absences </li></ul><ul><li>Involvement in accidents both on and off the job </li></ul><ul><li>Erratic work patterns and reduced productivity </li></ul><ul><li>Indifference to personal hygiene </li></ul><ul><li>Overreaction to real or imagined criticism </li></ul><ul><li>Such overt physical signs as exhaustion or hyperactivity, dilated pupils, slurred speech, or an unsteady walk </li></ul><ul><li>Marijuana users may have bloodshot or glassy eyes and a persistent cough. </li></ul>
    28. 28. Signs of Abuse <ul><li>Cocaine Users </li></ul><ul><li>Display increased energy and enthusiasm early in their drug involvement. </li></ul><ul><li>Later they may be subject to extreme mood swings and can become paranoid or delusional. </li></ul><ul><li>Alcohol abusers </li></ul><ul><li>Find it hard to conceal morning-after hangovers. </li></ul><ul><li>Their productivity declines, and they may show signs of physical deterioration. </li></ul>
    29. 29. How Can it Be Prevented? <ul><li>A written policy </li></ul><ul><li>Employee drug education </li></ul><ul><li>Training (Managers, Front-line supervisors, Human Resource) </li></ul><ul><li>Identifying and dealing with substance abusers </li></ul><ul><li>Employee Assistance Program </li></ul>
    30. 30. What Can Employees Do? <ul><li>Don’t be an &quot;enabler.&quot; </li></ul><ul><li>Don’t &quot;look the other way.&quot; </li></ul><ul><li>Don’t intervene on your own </li></ul><ul><li>Don’t worry about jeopardizing a substance abuser’s job. </li></ul>
    31. 31. Types of Drugs <ul><li>Drugs can be categorized in many ways, hard or soft, uppers or downers, addictive or non-addictive, most harmful or least harmful, legal or illegal. However, we think a useful way of categorizing drugs is by dividing them into three categories based on the effect they achieve: </li></ul><ul><li>STIMULANTS </li></ul><ul><li>DEPRESSANTS </li></ul><ul><li>HALLUCINOGENS </li></ul>
    32. 32. STIMULANTS <ul><li>Increase the activity of the central nervous system, some examples include, but are not limited to Amphetamines, Steroids, Cocaine & Crack, Caffeine, Ecstasy and Tobacco. </li></ul>
    33. 33. DEPRESSANTS <ul><li>Reduce the activity of the central nervous system, some examples include but are not limited to Alcohol, Barbiturates, Heroin and Solvents. </li></ul>
    34. 34. HALLUCINOGEN S <ul><li>Alter perceptions of reality and may result in hallucinations some examples include but are not limited to LSD, Cannabis and Magic Mushrooms. </li></ul>
    35. 35. ECSTASY
    36. 36. ECSTASY <ul><li>COMMON & BRAND NAMES </li></ul><ul><ul><li>Ecstasy; E; X; XTC; Rolls; Beans; Adam </li></ul></ul><ul><li>CHEMICAL NAME </li></ul><ul><ul><li>3,4-methylenedioxymethamphetamine </li></ul></ul><ul><li>DESCRIPTION </li></ul><ul><ul><li>MDMA is one of the most popular recreational psycho actives, most commonly sold in the form of &quot;ecstasy&quot; tablets. It is known for its empathogenic, euphoric, and stimulant effects, and has also been used in psychotherapy. </li></ul></ul>
    37. 37. PMA and MDMA <ul><li>Taken in tabs although inhalation and injection have been infrequently reported. </li></ul><ul><li>Effects generally appear within 15-30 minutes (MDMA) or almost 60 minutes (PMA). </li></ul><ul><li>The usual dose ranges from 100 to 150 mg. Toxicity may be seen at doses as little as 175 mg </li></ul>
    38. 38. MDMA/PMA how It Looks <ul><li>Powder </li></ul><ul><li>Pressed pills </li></ul><ul><li>Capsules (may not be full) </li></ul><ul><li>Wide range of logos </li></ul><ul><li>Wide variety of colors & shapes </li></ul><ul><li>Nicknames reflect logos & colors </li></ul><ul><li>Designed to look “innocent” & thus “harmless.” </li></ul>“ Euros”
    39. 39. MDMA/PMA Packaging <ul><li>Because of their small size, MDMA pills may be easily hidden. They may simply be mixed in with other candies, such as Skittles, M&Ms, etc. Pez containers are common too. </li></ul>
    40. 40. Long Term effects <ul><li>More prolonged “burn out” or “crash periods” up to a week later </li></ul><ul><li>Dental Damage </li></ul><ul><li>Depression for weeks </li></ul><ul><li>Renal failure </li></ul>
    41. 41. Ecstasy Effects <ul><li>extreme mood lift </li></ul><ul><li>increased willingness to communicate </li></ul><ul><li>increase in energy (stimulation) </li></ul><ul><li>ego softening </li></ul>
    42. 42. Ecstasy Effects <ul><li>appetite loss </li></ul><ul><li>visual distortion </li></ul><ul><li>rapid, involuntary eye jiggling </li></ul><ul><li>mild visual hallucinations </li></ul>
    43. 43. Ecstasy Effects <ul><li>mild to extreme jaw clenching (trisma), tongue and cheek chewing, and teeth grinding (trisma) </li></ul><ul><li>Hangover the next day, lasting days to weeks </li></ul><ul><li>possible strong urge to repeat the experience, though not physically addictive </li></ul><ul><li>possible psychological crisis requiring hospitalization (psychotic episodes, severe panic attacks, etc) (rare </li></ul>
    44. 44. ECSTASY
    45. 45. LSD
    46. 46. LSD <ul><li>COMMON & BRAND NAMES </li></ul><ul><ul><li>Acid; L; Tabs; Blotter; Doses; Trips </li></ul></ul><ul><li>EFFECTS CLASSIFICATION </li></ul><ul><ul><li>Psychedelic </li></ul></ul><ul><li>CHEMICAL NAME </li></ul><ul><ul><li>d-lysergic acid diethylamide </li></ul></ul><ul><li>DESCRIPTION </li></ul><ul><ul><li>LSD is the best known and most researched psychedelic. It is the standard against which all other psychedelics are compared. It is active at extremely low doses and is most commonly available on blotter or in liquid form. </li></ul></ul>
    47. 47. LSD Effects <ul><li>increase in energy (stimulation) </li></ul><ul><li>increase in associative & creative thinking </li></ul><ul><li>mood lift </li></ul><ul><li>increased awareness & appreciation of music </li></ul>
    48. 48. LSD Effects <ul><li>general change in consciousness (as with most psychoactive) </li></ul><ul><li>pupil dilation </li></ul><ul><li>difficulty focusing </li></ul><ul><li>quickly changing emotions </li></ul>
    49. 49. LSD Effects <ul><li>over-awareness & over-sensitization to music and noise </li></ul><ul><li>paranoia, fear, and panic </li></ul><ul><li>unwanted and overwhelming feelings </li></ul><ul><li>unwanted life-changing spiritual experiences </li></ul>
    50. 50. Marijuana
    51. 51. Marijuana <ul><li>Cannabis has been around for centuries and the plant has been used to make rope, thread, clothes and even smoked for its psychoactive properties and medicinal purposes. The drug has been widely used in America for more than 40 years. It is estimated that close to 5 million Americans regularly use marijuana. </li></ul><ul><li>Marijuana is obtained from the dried leaves and flowers of the hemp plant. The potency of marijuana depends on the method of preparation. </li></ul><ul><li>Although marijuana is usually smoked, it can also be eaten or mixed in beverages like tea, coffee and in very rare cases, it is also injected. </li></ul><ul><li>THC is the primary psychoactive component of marijuana. The intoxicating effects of marijuana usually last 2-3 hours. </li></ul>
    52. 52. Cannabis (Marijuana) <ul><li>COMMON NAMES </li></ul><ul><ul><li>Marijuana; Marihuana; Pot; Weed; Grass; Mary Jane; ... </li></ul></ul><ul><li>EFFECTS CLASSIFICATION </li></ul><ul><ul><li>Intoxicant; Stimulant; Psychedelic; Depressant </li></ul></ul><ul><li>DESCRIPTION </li></ul><ul><ul><li>Cannabis, a fast-growing bushy annual with dense sticky flowers, produces the psychoactive THC. It is the most widely used illegal psychoactive and has a long history of medicinal, recreational, and industrial use. The fibrous stalks of the plant are used to produce clothing and rope. </li></ul></ul>
    53. 53. Some of the Hazards of Using Marijuana ? <ul><li>Some of the common discomforts found when using marijuana include dry mouth, swollen eyelids, bloodshot eyes, loss of coordination and an accelerated heart rate. </li></ul>
    54. 54. Hazards of Marijuana Use <ul><li>Short Term </li></ul><ul><li>Anxiety and paranoia </li></ul><ul><li>Impaired memory </li></ul><ul><li>Difficulty in thinking </li></ul><ul><li>Learning difficulties </li></ul><ul><li>Lack of attention and focus </li></ul><ul><li>Poor driving skills </li></ul><ul><li>Long Term </li></ul><ul><li>Respiratory problems </li></ul><ul><li>Poor short-term recall </li></ul><ul><li>Inability to shift attention normally </li></ul><ul><li>Inability to understand complex information </li></ul><ul><li>An increased risk of developing lung, head and neck cancers </li></ul><ul><li>Lack of motivation </li></ul>
    55. 55. Marijuana Short Term Effects <ul><li>mood lift </li></ul><ul><li>relaxation, stress reduction </li></ul><ul><li>creative, philosophical or deep thinking : ideas flow more easily </li></ul><ul><li>increased appreciation of music. More aware of, deeper connection to music. </li></ul>
    56. 56. Signs of Marijuana Use <ul><li>Dilated (large) pupils </li></ul><ul><li>Cigarette rolling papers </li></ul><ul><li>Seeds that have been cleaned from marijuana </li></ul><ul><li>Smell on clothing, in room, or in car </li></ul><ul><li>Bloodshot eyes </li></ul><ul><li>Sleepy appearance </li></ul><ul><li>Reduced motivation </li></ul><ul><li>Pipes, bongs, homemade smoking devices (you may see sticky residue from burned marijuana) </li></ul><ul><li>Anxiety </li></ul><ul><li>Difficulty thinking </li></ul>
    57. 57. Signs of Marijuana Use <ul><li>Distorted sensory perceptions </li></ul><ul><li>Dry mouth </li></ul><ul><li>Euphoria (temporary feelings of elation, energy and limitless power) </li></ul><ul><li>Feeling sluggish </li></ul><ul><li>Grandiosity (acting in a pompous or boastful manner) </li></ul><ul><li>Impaired judgment </li></ul><ul><li>Impaired short-term memory </li></ul><ul><li>Inappropriate laughter </li></ul><ul><li>Increased heart rate </li></ul><ul><li>Increased appetite, craving sweets </li></ul><ul><li>Reduced coordination </li></ul>
    58. 58. Signs of Marijuana Use <ul><li>Temporary feelings of reduced anxiety or stress </li></ul><ul><li>Sadness/depressed mood Sensation that time is passing slowly </li></ul><ul><li>Social withdrawal and isolation </li></ul><ul><li>Discolored fingers </li></ul><ul><li>Sleepiness </li></ul><ul><li>Generally it can be difficult to recognize the signs of marijuana addiction if you don't see the individual after smoking when they are still experiencing the effects of the drug . </li></ul>
    59. 59. Marijuana
    60. 60. Marijuana
    61. 61. Marijuana
    62. 62. Marijuana Buds and Blount
    63. 63. Marijuana Blount
    64. 64. Marijuana Pipe
    65. 65. Marijuana Pipe
    66. 66. Cocaine Crack Cocaine
    67. 67. Cocaine (Crack Cocaine) <ul><li>COMMON & BRAND NAMES </li></ul><ul><ul><li>Coke; Crack; Blow; Snow; Nose </li></ul></ul><ul><ul><li>Candy </li></ul></ul><ul><li>EFFECTS CLASSIFICATION </li></ul><ul><ul><li>Euphoric Stimulant </li></ul></ul><ul><li>CHEMICAL NAME </li></ul><ul><ul><li>benzoylmethyl ecognine </li></ul></ul><ul><li>DESCRIPTION </li></ul><ul><ul><li>Cocaine is a common stimulant derived from the Erythroxylum coca plant. It is best known for its massive popularity in powdered and freebase (crack) forms. </li></ul></ul>
    68. 68. Cocaine (Crack Cocaine) <ul><li>PSYCHOLOGICAL EFFECTS : </li></ul><ul><ul><li>Varies with dose and the tolerance of the user. Increases alertness, wakefulness, elevates the mood, mild to high degree of euphoria, increases athletic performance, decreases fatigue, clearer thinking, increases concentration, increases energy, increased irritability, insomnia, restlessness. With high doses may exhibit a pattern of psychosis with confused and disorganized behavior, irritability, fear, paranoia, hallucinations, may become extremely antisocial and aggressive </li></ul></ul><ul><li>WITHDRAWAL SYMPTOMS: </li></ul><ul><ul><li>Although cocaine does not cause dangerous physical addiction, discontinuing regular use can lead to a wide varieties of (very) unpleasant withdrawal and craving symptoms, including: intense cravings for more cocaine, hunger, irritability, apathy, depression, paranoia, suicidal ideation, loss of sex drive and more. </li></ul></ul>
    69. 69. Cocaine Addiction <ul><li>Cocaine is a powerfully addictive central nervous system (CNS) stimulant. It has extremely potent effects, and individuals who take cocaine can develop an addiction to cocaine after using the drug for a very short period of time. Cocaine is a crystalline, granular, or powder substance, having a saline, slightly bitter taste that numbs the tongue and lips. It heightens alertness, inhibits appetite and the need for sleep, and provides intense feelings of pleasure. Some users find that the drug helps them to perform simple physical and intellectual tasks more quickly, while others can experience the opposite effect. It is prepared from the leaf of the Erythroxylon coca bush, which grows primarily in Peru and Bolivia. </li></ul>
    70. 70. Cocaine Addiction <ul><li>The effects of cocaine are immediate, extremely pleasurable, and brief. Cocaine produces intense but short-lived euphoria and can make users feel more energetic. Like caffeine, cocaine produces wakefulness and reduces hunger. Psychological effects include feelings of well-being and a grandiose sense of power and ability mixed with anxiety and restlessness. As the drug wears off, these temporary sensations of mastery are replaced by an intense depression, and the drug abuser will then &quot;crash&quot;, becoming lethargic and typically sleeping for several days. </li></ul><ul><li>When cocaine use is stopped or when a binge ends, depression (crash) follows almost immediately. This is accompanied by a strong craving for more cocaine, fatigue, pleasurelessness, anxiety, irritability, sleepiness, and sometimes agitation or paranoia. </li></ul>
    71. 71. Signs of Cocaine Addiction <ul><li>Red, bloodshot eyes </li></ul><ul><li>Runny nose or frequent sniffing </li></ul><ul><li>Weight loss </li></ul><ul><li>Increased susceptibility to illness </li></ul><ul><li>Increased blood pressure </li></ul><ul><li>Constricted blood vessels </li></ul><ul><li>Dilated pupils </li></ul><ul><li>Increased heart rate </li></ul><ul><li>Increased temperature </li></ul><ul><li>Nosebleeds </li></ul><ul><li>Altered motor activities (tremors, hyperactivity) </li></ul><ul><li>Perspiration or chills </li></ul><ul><li>Nausea or vomiting </li></ul>
    72. 72. Common emotional signs of cocaine addiction <ul><li>Change in eating or sleeping patterns </li></ul><ul><li>Change in groups of friends </li></ul><ul><li>Change in school grades or behavior </li></ul><ul><li>Withdrawn, depressed, tired, or careless about personal appearance </li></ul><ul><li>Loss of interest in school, family, or activities </li></ul><ul><li>Frequently in need of money </li></ul><ul><li>Unusual energy followed by excessive sleeping </li></ul><ul><li>Depression </li></ul><ul><li>Irritability </li></ul><ul><li>Erratic behavior </li></ul><ul><li>Isolation </li></ul><ul><li>Strained relationships </li></ul><ul><li>Missed work </li></ul><ul><li>Increased time away from family </li></ul><ul><li>Stealing/Lying/Financial problems </li></ul><ul><li>Thoughts of suicide </li></ul><ul><li>Paranoia </li></ul><ul><li>Auditory hallucinations </li></ul><ul><li>Talking rapidly </li></ul>
    73. 73. Common signs of cocaine addiction withdrawal <ul><li>depressed mood </li></ul><ul><li>fatigue </li></ul><ul><li>generalized malaise </li></ul><ul><li>vivid and unpleasant dreams </li></ul><ul><li>agitation and restless behavior </li></ul><ul><li>slowing of activity </li></ul><ul><li>increased appetite </li></ul><ul><li>intense cravings for cocaine </li></ul>
    74. 74. Cocaine Powder
    75. 75. Cocaine for Injecting
    76. 76. Cocaine for Snorting
    77. 77. Signs of Crack Addiction <ul><li>The signs of crack addiction are very similar to cocaine addiction. However, there are many differences between how the drugs are used and the duration and types of effects experienced by the user. Crack, sometimes called &quot;Rock&quot;, is a purified form of cocaine that is smoked by inhaling the vapors of cocaine that are given off as the drug is heated. Crack is cocaine has been distilled form its familiar powder form of cocaine hydrochloride. Cocaine powder is put into a mixture with baking soda, heated, hardened and then broken into pieces. Crack is often more pure than sniffable cocaine (85%-90% pure). It is sold as light brown or beige pellets. Drug dealers distribute ready to smoke freebase cocaine packaged in small vials. </li></ul>
    78. 78. Crack Cocaine Addiction <ul><li>Crack is typically smoked in pipes constructed of glass bowls fitted with one or more fine mesh screens that support the drug. The user heats the side of the bowl (usually with a lighter), and the heat causes the cocaine base to vaporize. The user inhales the cocaine-laden fumes through the pipe. Alternatively, crack cocaine can be sprinkled in cigarettes and smoked. Usually the crack is ground up and sprinkled into a marijuana joint and smoked. These cocaine laced joints are referred to as primos. The vapors of the freebase are absorbed through the lungs into the bloodstream and transported to the brain within 10-15 seconds. One inhalation will produce a degree of intoxication usually lasting 10-15 minutes. The drug is said to take its name from the crackling noise it makes when it is smoked. </li></ul>
    79. 79. Crack Cocaine Addiction <ul><li>Crack is a purified form cocaine. Two or three doses can cause addiction. Because this smokable form of cocaine delivers 10 times the impact of &quot;snorting&quot; the powder, casual use can cause death from heart or respiratory failure. Crack smokers also run an increased risk of addiction and paranoid psychosis. The high from smoking crack lasts between 5 to 7 minutes and is followed by severe depression, feelings of worthlessness, and a craving for more of the drug. In a brief period of time, crack begins to control the user. This is the pattern of behavior that leads to addiction and dependence. The compulsion to continue to use crack has led to the &quot;binges&quot; that are often described by users. During a binge, Crack is smoked continuously until money and/or drug supplies are gone, or the user experiences physical collapse. The need for crack supersedes every other need, leading to crime and violence to acquire it. </li></ul>
    80. 80. Signs of Crack Addiction <ul><li>Crack addicts have many tell tale signs of their addiction. A few physical signs of crack addiction include dilated pupils, sweating, weight loss, irregular heartbeat, frequent upper respiratory infections, fits of coughing, coughing up black mucous, muscle tremors, severe headaches and a decline in personal appearance. Additionally, a few emotional signs of crack addiction include dramatic mood changes, and insomnia followed by exhaustion, loss of interest in friends, loss of interest in food, sex, or other pleasures, hearing voices and hallucinations. </li></ul>
    81. 81. Crack Cocaine
    82. 82. Vial Crack Cocaine
    83. 86. Methamphetamine
    84. 87. Methamphetamine <ul><li>COMMON & BRAND NAMES </li></ul><ul><ul><li>Meth; Speed; Crystal; Glass; Crank; </li></ul></ul><ul><ul><li>Tweak; Yaba </li></ul></ul><ul><li>CHEMICAL NAME </li></ul><ul><ul><li>d-N-methylamphetamine </li></ul></ul><ul><li>DESCRIPTION </li></ul><ul><ul><li>Methamphetamine is a strong physical and mental stimulant available widely in both prescription and street forms. It is relatively easy to synthesize which has contributed to its widespread use. </li></ul></ul>
    85. 88. Methamphetamine High <ul><li>A methamphetamine-induced &quot;high&quot; artificially boosts self-confidence, many users are overcome by a so-called &quot;superman syndrome.&quot; In this state, methamphetamine abusers ignore their physical limitations and try to do things which they are normally incapable of performing. Meth is highly addictive because people often continue using the drug to avoid an inevitable crash that comes when the drugs' positive effects begin to wear off. Even first-time users experience many of meth's negative effects. </li></ul>
    86. 89. Methamphetamine <ul><li>As a powerful stimulant, methamphetamine, even in small doses, can increase wakefulness and physical activity and decrease appetite. A brief, intense sensation, or rush, is reported by those who smoke or inject methamphetamine. Oral ingestion or snorting produces a long-lasting high instead of a rush, which reportedly can continue for as long as half a day. Both the rush and the high are believed to result from the release of very high levels of the neurotransmitter dopamine into areas of the brain that regulate feelings of pleasure. Short-term effects of methamphetamine: </li></ul>
    87. 90. Methamphetamine Effects <ul><li>Hyperactivity </li></ul><ul><li>Irritability </li></ul><ul><li>Visual hallucinations </li></ul><ul><li>Auditory hallucinations (hearing &quot;voices&quot;) </li></ul><ul><li>Suicidal tendencies </li></ul><ul><li>Aggression </li></ul><ul><li>Suspiciousness, severe paranoia </li></ul><ul><li>Shortness of breath </li></ul><ul><li>Increased blood pressure </li></ul><ul><li>Cardiac arrhythmia </li></ul><ul><li>Stroke </li></ul><ul><li>Sweating </li></ul><ul><li>Nausea, vomiting, diarrhea </li></ul><ul><li>Long periods of sleep (&quot;crashing&quot; for 24-48 hours or more) </li></ul><ul><li>Prolonged sluggishness, severe depression </li></ul><ul><li>Weight loss, malnutrition, anorexia </li></ul><ul><li>Itching (illusion that bugs are crawling on the skin) </li></ul><ul><li>Welts on the skin </li></ul><ul><li>Involuntary body movements </li></ul><ul><li>Paranoid delusions </li></ul>
    88. 91. Physiological effects of methamphetamine use include: <ul><li>abnormally high blood pressure </li></ul><ul><li>rapid and irregular heart rate and rhythm </li></ul><ul><li>seizures </li></ul><ul><li>damage to blood vessels in the brain (stroke) </li></ul><ul><li>accumulation of excess fluid in lungs, brain tissue and skull </li></ul><ul><li>continuous/excessive dilation of the pupils </li></ul><ul><li>impaired regulation of heat loss </li></ul><ul><li>hyperpyrexia (body temperatures higher than 104°) </li></ul><ul><li>internal bleeding; damage to other organs caused by disruption of blood flow </li></ul><ul><li>and breakdown of muscle tissue leading to kidney failure </li></ul>
    89. 92. Methamphetamine Short Term <ul><li>increased attention </li></ul><ul><li>decreased fatigue </li></ul><ul><li>increased activity </li></ul><ul><li>decreased appetite </li></ul><ul><li>euphoria and rush </li></ul><ul><li>increased respiration </li></ul><ul><li>hyperthermia </li></ul>
    90. 93. Long-term effects of methamphetamine use <ul><li>Long-term methamphetamine abuse results in many damaging effects, including addiction. Addiction is a chronic, relapsing condition, characterized by compulsive drug-seeking and drug use which is accompanied by functional and molecular changes in the brain. In addition to being addicted to methamphetamine, chronic methamphetamine abusers exhibit symptoms that can include violent behavior, anxiety, confusion, and insomnia. They also can display a number of psychotic features, including paranoia, auditory hallucinations, mood disturbances, and delusions (for example, the sensation of insects creeping on the skin, called &quot;formication&quot;). The paranoia can result in homicidal as well as suicidal thoughts. </li></ul>
    91. 94. Long-term effects of methamphetamine use <ul><li>dependence </li></ul><ul><li>addiction psychosis </li></ul><ul><li>paranoia </li></ul><ul><li>hallucinations </li></ul><ul><li>mood disturbances </li></ul><ul><li>repetitive motor activity </li></ul><ul><li>stroke </li></ul><ul><li>weight loss </li></ul>
    92. 95. Meth Chronic Use <ul><li>With chronic use, tolerance for methamphetamine can develop. In an effort to intensify the desired effects, users may take higher doses of the drug, take it more frequently, or change their method of drug intake. In some cases, abusers forego food and sleep while indulging in a form of binging known as a &quot;run,&quot; injecting as much as a gram of the drug every 2 to 3 hours over several days until the user runs out of the drug or is too disorganized to continue </li></ul>
    93. 96. Methamphetamine Addiction <ul><li>Methamphetamine is a highly addictive drug. Recovery and rehabilitation from methamphetamine addiction may require a treatment program ranging from certified addiction counseling to treatment at a residential alcohol and drug rehab center, depending on the extent of the addiction and a number of other factors </li></ul>
    94. 97. Making Crank/Meth Made Easy <ul><li>Nazi Method </li></ul><ul><li>Iodine </li></ul><ul><li>Red Phosphorus </li></ul><ul><li>Lithium </li></ul><ul><li>Anhydrous Ammonia </li></ul><ul><li>Red, White and Blue Method </li></ul><ul><li>Iodine </li></ul><ul><li>Red Phosphorus </li></ul><ul><li>Ether </li></ul><ul><li>Hydrochloric Acid </li></ul><ul><li>Sodium Hydroxide </li></ul><ul><li>Methanol </li></ul>
    95. 98. GHB
    96. 99. GHB <ul><li>GHB may be made in homes by using recipes with common ingredients. </li></ul><ul><li>&quot;Liquid Ecstasy,&quot; &quot;Georgia Home Boy,&quot; &quot;Grievous Bodily Harm, </li></ul><ul><li>“ Liquid ecstasy,&quot; do not confuse w/ MDMA </li></ul><ul><li>GBL, GBH, One 4 B </li></ul>
    97. 100. Recognizing GHB <ul><li>AKA: GHB, G, Jib, Scoop, Liquid E, Liquid X, Woman’s Viagra, Grievous Bodily Harm, Easy Lay, Gamma 10, Salty Water, GH Buddy, Aminos, Blue Nitro, Blue Thunder, Thunder Nectar, Renewtrient, Revivarant, Remforce, Firewater, Invigorate, Xyrem (research product), sodium oxybate, Fantasy & One4B (NZ) </li></ul>
    98. 101. So Many Names…. <ul><li>Tranquili G, Midnight Blue, Verve, Rejoov, Somax, SomatoPro, Flower Power, Puritech, Alcover, G-riffick, Eclipse, GHGold, Soap, Vita G, Dormir, Enliven, FX, Serenity, Inner G, Zen, White Magic Cleaner, Weight Belt Cleaner, Ink Jet Cartridge Cleaner, Plant Food, Fingernail Polish Remover, Paint Stripper. </li></ul><ul><li>There are more than 80 known names for GHB and its equally deadly analogs. </li></ul>
    99. 102. GHB How are they used? <ul><li>GHB can be produced in clear liquid, or a white powder, tablet, and capsule forms, and it is often used in combination with alcohol, making it even more dangerous </li></ul><ul><li>It is often carried in an eye dropper, or in water/Gatorade bottles and passed around. </li></ul><ul><li>Typically measured out in capfuls. </li></ul><ul><li>Occasionally blue food coloring is used to identify it at some raves. </li></ul><ul><li>It is occasionally used as a body building aid </li></ul>
    100. 103. Other GHB Products
    101. 104. Efforts to Avoid Detection <ul><li>GHB & its analogs are NOT protected by the Dietary Supplement & Heath Education Act of 1994. </li></ul><ul><li>Unapproved for human use. </li></ul><ul><li>“ Misbranded” drugs. </li></ul><ul><li>May be listed as “weight belt cleaner” or other solvent use or plant growth formula—trying to avoid detection </li></ul>
    102. 105. GHB- No longer Just for Rapists <ul><li>Recreational Use </li></ul><ul><li>Muscle Gain </li></ul><ul><li>Those under mandatory drug testing </li></ul><ul><li>Elderly </li></ul>
    103. 106. What To Expect
    104. 107. Typical GHB Containers <ul><li>Typical bottles for hiding GHB-- film canisters, hair spray, liquid candy bottles, food coloring, breathe mint containers (may be liquid LSD or G), vanilla bottles, Gatorade, pump hand lotion bottles. </li></ul>
    105. 108. Recognizing Containers <ul><li>ANY container that will hold a liquid. </li></ul>GHB addicts have hidden it in engine compartments, attics, etc .
    106. 109. GHB analogs - What does it do <ul><li>At lower doses, GHB has sedative effects, but, as the dose increases, GHB effects may result in sleep ,eventual coma, respiratory arrest, or death. </li></ul><ul><li>It is these effects that make it both a prime drug at Raves, and for Date Rape </li></ul>
    107. 110. GHB toxicity- mild <ul><li>Lethargy, easily aroused with repeated stimulation </li></ul><ul><li>Drowsiness, somnolence, dizziness, euphoria </li></ul><ul><li>Confusion (dazed and confused) </li></ul><ul><li>Amnesia, Susceptible to suggestion </li></ul>
    108. 111. GHB Toxicity- Severe <ul><li>Frequent Vomiting, </li></ul><ul><li>Respiratory depression or arrest </li></ul><ul><li>Seizures </li></ul><ul><li>Sudden onset of coma . Patients often demonstrate extreme SUDDEN combativeness and agitation despite such profound CNS and respiratory depression </li></ul><ul><li>Death (usually secondary to respiratory failure or aspiration) </li></ul>
    109. 112. GHB <ul><li>ALCOHOL IS THE MOST COMMON DRUG CO CONSUMED IN GHB RELATED DEATHS </li></ul>
    110. 113. GHB Treatment <ul><li>Primary Supportive </li></ul><ul><li>Beware of positional Asphyxia, but soft restraints are a good idea </li></ul><ul><li>Due to the risk of sudden airway failure, aspiration, and respiratory collapse, these patients need aggressive airway monitoring by ALS providers </li></ul>
    111. 114. GHB Treatment <ul><li>Protect your self </li></ul><ul><li>VOMIT </li></ul><ul><li>Be cautious using respiratory depressants </li></ul><ul><li>Making the decision to tube/not tube is tough, these patients do frequently vomit. </li></ul><ul><li>ETT placement is uncommon, but post ETT sedation/paralysis and restraint should be mandatory in the field </li></ul>
    112. 115. Difficulty in Prosecution <ul><li>Sort Duration </li></ul><ul><li>Amnesia clouds recall </li></ul><ul><li>Often pro-sexual appearing behavior </li></ul><ul><li>Lack of : </li></ul><ul><ul><li>Credible witness </li></ul></ul><ul><ul><li>Evidence </li></ul></ul>
    113. 116. GHB analogs- What does this mean to me? <ul><li>GHB analogs are unpredictable in clinical course, other than duration. </li></ul><ul><li>GHB analogs cause a rapid change in mental and respiratory status that makes it difficult to plan treatment and care </li></ul><ul><li>GHB’s presentation often mimics ETOH abuse and is often co-imbibed. </li></ul>
    114. 117. Those who have Died <ul><li>More than 16,000 adverse reaction to GHB are documented. More than 72 deaths have been deemed GHB related by the DEA (230 more are known), perhaps  just a tip of the iceberg since routine testing does not detect it. Deaths include a college student who took it as a &quot;safe&quot; sleep aid and died in his sleep. A 15 year- old in California's high desert who gulped GHB at a RAVE died. A 32 year-old male in Atlanta died from GHB only. A body builder in Ohio died, with only alcohol and GHB use. A 15 year-old female in Michigan died from GHB/GBL use. Death is even more likely when alcohol or other drugs are added </li></ul>
    115. 118. Field Testing This is what GHB/GBL does to a Styrofoam cup!
    116. 119. Raves
    117. 120. The Rave Culture <ul><li>Generally speaking, “Rave” applies not just to the parties but to an entire subculture </li></ul><ul><li>Not just “Night time” Parties at clubs </li></ul><ul><li>Can extend into multi-day events (Burning Man) </li></ul><ul><li>Hallmarked by techno/new age music and Psychedelic visual displays. </li></ul>
    118. 121. Rave Culture <ul><li>Tend to be “Sponsored” (A.K.A. “Promoters”), limits liability on both sides </li></ul><ul><li>Sometimes marketed as “Drug Free Teen Dance Parties” </li></ul><ul><li>If not at a formal club, they tend to be located in remote locations to limit outside interference. </li></ul><ul><li>Often will have a DJ instead of a band. Some DJ’s are celebrities, called the “A-List”, traveling a “Circuit ” </li></ul><ul><li>Remember, the overall event doesn't have to be a rave to have a strong Raver presence </li></ul>
    119. 122. Rave Culture
    120. 123. Possible Rave Indicators <ul><li>Light Sticks </li></ul><ul><li>Water/Gatorade Bottles for sale </li></ul><ul><li>H2O shut off in bathroom </li></ul><ul><li>Crash Rooms/Candles/Etc. </li></ul><ul><li>Have Dance Breaks/cool down periods </li></ul>
    121. 124. Possible Rave Indicators <ul><li>Glow sticks of all sizes </li></ul><ul><li>Special mouth guards </li></ul><ul><ul><li>Protect from swallowing mini glow sticks </li></ul></ul><ul><ul><li>Also less visible than the pacifiers </li></ul></ul>
    122. 125. Possible Rave Indicators <ul><li>The sensation of breathing is intensified by the menthol (eucalyptus) in vapor rub products. This will be slathered on their upper lips or in face masks. Or inhalers will be used. </li></ul><ul><li>Remember, many report things like “being burned by a cigarette feels good.” It’s all about sensation </li></ul>
    123. 126. It’s About Sensation <ul><li>Many carry personal vibrators. Notice the “x” & “e” & butterfly beads. Butterfly is a common emblem for Ecstasy. </li></ul><ul><li>Every touch feels good. </li></ul><ul><li>They may rub each other with things like Tiger Balm or with hair brushes or gloves with the “gripper dots” to intensify touch. </li></ul>
    124. 127. Rave Paraphernalia <ul><li>MDMA causes “bruxism”—teeth grinding & involuntary jaw locking; damages teeth. </li></ul><ul><li>Pacifiers, lollipops, mouthguards & other things to suck help reduce this. </li></ul><ul><li>Hidden compartments </li></ul>
    125. 128. Common Medical concerns <ul><li>Severe Dehydration and Hyperthermia </li></ul><ul><li>Poly-Pharm involvement </li></ul><ul><li>Date Rape </li></ul><ul><li>Multiple Patients (approach with a plan) </li></ul><ul><li>Volatile Crowds </li></ul>
    126. 129. Heroin
    127. 130. Heroin <ul><li>Also Known as </li></ul><ul><li>Black Tar </li></ul><ul><li>China White </li></ul><ul><li>Speed Ball </li></ul><ul><li>Homicide, Buick, super Buick, twilight sleep </li></ul>
    128. 131. Methods of use: <ul><li>Shooting: </li></ul><ul><li>Skin Popping: </li></ul><ul><li>Muscle Popping: </li></ul><ul><li>Chasing the dragon: Smoking </li></ul><ul><li>Freebasing </li></ul>
    129. 132. Signs and Systems of an Opiate Overdose <ul><li>Pin Point Pupils </li></ul><ul><li>Hypotension </li></ul><ul><li>N/V </li></ul><ul><li>Respiratory/CNS depression </li></ul><ul><li>Aspiration and Hypoxia </li></ul><ul><li>Hallucinations </li></ul><ul><li>Other s/s? Think poly-pharm involvement </li></ul><ul><li>Dirty Needles (“Diabetics”) </li></ul><ul><li>Cotton balls, Cig Filters </li></ul><ul><li>Spoons w/ residue or similar improvised device </li></ul>
    130. 133. Long Term problems <ul><li>HIV, HEP-A/B/C, </li></ul><ul><li>BLOOD POISONING (Septicemia) “Cotton Fever” </li></ul><ul><li>ENDOCARDITIS </li></ul><ul><li>TETANUS </li></ul><ul><li>NECROTIZING FASCIITIS (Flesh-Eating Disease) Associated w/ black tar </li></ul><ul><li>WOUND BOTULISM </li></ul><ul><li>TRACKING AND BRUISING </li></ul><ul><li>CONSTIPATION, BOWEL OBSTRUCTION </li></ul>
    131. 134. Some things that have been done with a Heroin OD by Junkies <ul><li>Injected someone with salt water or Milk This is an old junky myth sometimes still used. </li></ul><ul><li>Injected someone who overdosed on heroin with cocaine or speed, or vice versa . Another old myth. </li></ul><ul><li>Narcan Used PTA of EMS - Narcan is becoming more and more common among junkies for “emergencies” (some trials are being done in Seattle and Europe) </li></ul><ul><li>Put ice on their genitals (down their pants) . </li></ul><ul><li>Placed in a cold shower </li></ul>
    132. 135. Signs of Drug Abuse <ul><li>There's no easy way to figure out if someone, especially a teenager, is using drugs or alcohol. As you'll see, many of the signs and symptoms of substance abuse are also, at times, typical adolescent behavior. There are other causes for some of these behaviors. </li></ul><ul><li>But do not use this as an excuse to ignore the warning signs of drug abuse. If some of these signs, (not all in the same category), are present for a period of time, you should talk to the person you suspect of using illicit drugs. Remember don't be afraid to come right out and ask. Before you ask, Decide in advance, how you'll respond to a &quot;yes&quot; answer. </li></ul>
    133. 136. Personality: <ul><li>Becomes disrespectful—is verbally and physically abusive </li></ul><ul><li>Is angry a lot, acts paranoid or confused, or suffers from extreme mood swings </li></ul><ul><li>Seems depressed and less out-going than usual </li></ul><ul><li>Is secretive and lies about what he is doing and where he is going </li></ul><ul><li>Is stealing or “losing” possessions he used to value </li></ul><ul><li>Seems to have a lot of money, or is always asking for money </li></ul><ul><li>Withdraws from the family and family activities </li></ul>
    134. 137. Physical Appearance: <ul><li>Not taking care of hygiene and grooming </li></ul><ul><li>Not sleeping or sleeping too much </li></ul><ul><li>Loss of appetite </li></ul><ul><li>Weight loss or weight gain </li></ul><ul><li>Too hyperactive or too little energy </li></ul>
    135. 138. Social Activity/School Performance: <ul><li>Drops old friends and activities </li></ul><ul><li>Is skipping school </li></ul><ul><li>Loses interest in school work and is getting low grades </li></ul><ul><li>Sleeping in class </li></ul><ul><li>Loses concentration and is having trouble remembering things. </li></ul><ul><li>Not Doing Homework </li></ul><ul><li>Defiant of authority </li></ul><ul><li>Poor attitude toward sports or other extracurricular activities </li></ul><ul><li>Reduced memory and attention span </li></ul><ul><li>Not informing you of teacher meetings, open houses, etc </li></ul>
    136. 139. Should You Snoop ? <ul><li>It's a controversial topic. if you suspect a family member, especially your child is drinking or using drugs, snooping can help keep your children safe. If they’ve got something to hide, you need to know about it. You’re talking about their health and well-being. </li></ul>
    137. 140. General Affects on the Public <ul><li>Violent Crimes (Murder, Robberies) </li></ul><ul><li>Ingress in Burglaries (Mainly Residential, Home Invasions) </li></ul><ul><li>Thief’s in General </li></ul><ul><li>Any Thing for Quick Easy Cash </li></ul>
    138. 141. Examples <ul><li>Person steals Check Book during burglary or from purse, Buys Large amount of meat at grocery store with stolen checks, trades meat for drugs. </li></ul><ul><li>Steals anything of value trades for drugs </li></ul><ul><li>Street drug deal goes bad, buyer / seller gets shot. </li></ul>
    139. 142. Drug Abuse <ul><li>It is not uncommon for Law Enforcement to recover stolen property from a Drug House during the execution of a search warrant. </li></ul>
    140. 143. Signs of Alcohol and Drug Addictions <ul><li>There are many signs that an individual may have a drug or alcohol addiction. The drug addiction signs listed below are cues to look for when evaluating this matter. Be aware that possessing several of these signs does not always imply that there is a drug addiction present, but if one is suspected be supportive of the individual in their road to drug addiction recovery. </li></ul>
    141. 144. Signs / Indicators of Addication <ul><li>Increase or decrease in appetite; changes in eating habits, unexplained weight loss or gain. </li></ul><ul><li>Smell of substance on breath, body or clothes. </li></ul><ul><li>Extreme hyperactivity; excessive talkativeness. </li></ul><ul><li>Needle marks or bruises on lower arm, legs or bottom of feet. </li></ul><ul><li>Change in overall attitude / personality with no other identifiable cause. </li></ul><ul><li>Changes in friends: new hang-outs, avoidance of old crowd, new friends are drug users. </li></ul><ul><li>Change in activities; loss of interest in things that were important before. </li></ul><ul><li>Drop in school or work performance; skips or is late to school or work. </li></ul><ul><li>Changes in habits at home; loss of interest in family and family activities. </li></ul><ul><li>Difficulty in paying attention; forgetfulness. </li></ul><ul><li>Lack of motivation, energy, self-esteem, discipline. Bored, &quot;I don't care&quot; attitude. </li></ul><ul><li>Defensiveness, temper tantrums, resentful behavior (everything's a hassle </li></ul>
    142. 145. Signs / Indicators of Addication <ul><li>Unexplained moodiness, irritability, or nervousness. </li></ul><ul><li>Violent temper or bizarre behavior. </li></ul><ul><li>Unexplained silliness or giddiness. </li></ul><ul><li>Paranoia -- suspiciousness. </li></ul><ul><li>Excessive need for privacy; keeps door locked or closed, won't let people in. </li></ul><ul><li>Secretive or suspicious behavior. </li></ul><ul><li>Car accidents, fender benders, household accidents. </li></ul><ul><li>Chronic dishonesty; trouble with police. </li></ul><ul><li>Unexplained need for money; can't explain where money goes; stealing. </li></ul><ul><li>Unusual effort to cover arms, legs. </li></ul><ul><li>Change in personal grooming habits. </li></ul><ul><li>Possession of drug paraphernalia. </li></ul>
    143. 146. The Results of Alcohol and Drug Abuse
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