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Saturday, March 24 - Updates in Drugs of Abuse

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Updates in Drugs of Abuse
0006-0000-18-006-L01-P | .2 CEU |
Kimberly Hoffman, PharmD, BCPP, BCGP

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Saturday, March 24 - Updates in Drugs of Abuse

  1. 1. Updates in Drugs of Abuse Kimberly Hoffmann PharmD, BCPP, BCGP Clinical Professor of Pharmacy Practice Thomas J. Long School of Pharmacy and Health Sciences at the University of the Pacific; Stockton, California. khoffmann@pacific.edu or kim@pacificrx.net
  2. 2. There are no Conflicts of Interest to Declare for this Presentation
  3. 3. Goal of this Presentation •The goal of this presentation is to inform pharmacists of the widespread abuse of medications in the world today, to update them on new forms of substance dependence, so they will be able to recognize the problem and help the patient obtain proper treatment.
  4. 4. LEARNING OBJECTIVES: Define drug abuse and be able to recognize key factors in drug dependence. Identify the biological, social, and environmental causes of drug use. Discuss the consequences of drug abuse, and the role it plays over a lifetime (comorbidities) Outline the different classes of drugs of abuse concentrating on the newer medications being abused. Describe updated scientific information regarding cannabinoids and their use in different populations. Recognize new strategies to prevent drug abuse and the consequences of use for patients.
  5. 5. Is this problem getting any better? 1960’s
  6. 6. 1970’s
  7. 7. 1980’s 1988 Office of National Drug control Policy Created October 1986: Reagan signs the Anti- Drug Abuse Act of 1986, which appropriates $1.7 billion to fight the drug war.
  8. 8. 1990’S-RAVE! GRUNGE
  9. 9. 2000-The New Millenium… CRYSTAL METH
  10. 10. TODAY Heroin Highs
  11. 11. TODAY … Spice: BATHSALTS
  12. 12. Not in MY Neighborhood!Not in MY Neighborhood! • In 2013, an estimated 24.6 million persons in the United States aged 12 years or older (9.4% OF THE US population) were classified as having abused or been dependent on substances subject to addiction during the previous year. National Institute for Drug Abuse, 2013.
  13. 13. STATISTICS WHAT IS THE ECONOMIC COST OF DRUG ABUSE IN THE UNITED STATES? Abuse of tobacco, alcohol, and illicit drugs is costly to our Nation, exacting more than $740 billion annually in costs related to crime, lost work productivity and health care.¹ National Drug Intelligence Center. National Drug Threat Assessment. Washington, DC: United States Department of Justice; 2011. www.justice.gov/archive/ndic/pubs44/44849/44849p.pdf
  14. 14. MORE STATISTICS National Overdose Deaths—Number of Deaths from Prescription Drugs. The figure above is a bar chart showing the total number of US overdose deaths involving prescription drugs from 2001 to 2013. The chart is overlayed by a line graph showing the number of deaths by females and males. From 2001 to 2013 there was a 2.5-fold increase in the total number of deaths. Prescription Drugs include: anti-depressants, barbiturates, benzodiazepines and opioids. National Overdose Deaths— Number of Deaths from Prescription Drugs. The figure above is a bar chart showing the total number of US overdose deaths involving prescription drugs from 2001 to 2013. The chart is overlayed by a line graph showing the number of deaths National Overdose Deaths—Number of Deaths from Prescription Drugs. The figure above is a bar chart showing the total number of US overdose deaths involving prescription drugs from 2001 to 2013. The chart is over layed by a line graph showing the number of deaths by females and males. From 2001 to 2013 there was a 2.5-fold increase in the total number of deaths. Prescription Drugs include: anti-depressants, barbiturates, benzodiazepines and opioids.
  15. 15. What is Drug or Substance Abuse? The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), no longer uses the terms substance abuse and substance dependence, rather it refers to substance use disorders, Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. According to the DSM-5, a diagnosis of substance use disorder is based on evidence of impaired control, social impairment, risky use, and pharmacological criteria.
  16. 16. Drug Abuse vs. Drug Dependence? Definition of Dependence Syndrome: The Tenth Revision of the International Classification of Diseases and Health Problems (ICD-10) defines the dependence syndrome as being a cluster of physiological, behavioural, and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behaviours that once had greater value. A central descriptive characteristic of the dependence syndrome is the desire (often strong, sometimes overpowering) to take the psychoactive drugs (which may or not have been medically prescribed), alcohol, or tobacco. There may be evidence that return to substance use after a period of abstinence leads to a more rapid reappearance of other features of the syndrome than occurs with nondependent individuals. http://www.who.int/substance_abuse/terminology/definition1/en/
  17. 17. What Causes Substance Misuse?Biology. The genes that people are born with account for about half of a person's risk for addiction. Gender, ethnicity, and the presence of other mental disorders may also influence risk for drug use and addiction. Environmental and social causes: A person’s environment includes many different influences, from family and friends to economic status and general quality of life. Factors such as peer pressure, physical and sexual abuse, early exposure to drugs, stress, and parental guidance can greatly affect a person’s likelihood of drug use and addiction
  18. 18. What Causes Substance Misuse? Age: Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it will progress to addiction. This is particularly problematic for teens. Because areas in their brains that control decision-making, judgment, and self-control are still developing, teens may be especially prone to risky behaviors, including trying drugs.
  19. 19. Consequences of Drug Misuse oShort-term effects can range from changes in appetite, wakefulness, heart rate, blood pressure, and/or mood to heart attack, stroke, psychosis, overdose, and even death. These health effects may occur after just one use. oLonger-term effects can include heart or lung disease, cancer, mental illness, HIV/AIDS, hepatitis, and others. Long- term drug use can also lead to addiction. Drug addiction is a brain disorder. Not everyone who uses drugs will become addicted, but for some, drug use can change how certain brain circuits work. These brain changes interfere with how people experience normal pleasures in life such as food and sex, their ability to control their stress level, their decision- making, their ability to learn and remember, etc. These changes make it much more difficult for someone to stop taking the drug even when it’s having negative effects on their life and they want to quit.  NIDA. Health Consequences of Drug Misuse. National Institute on Drug Abuse website. https://www.drugabuse.gov/related-topics/health-consequences-drug-misuse. March 23, 2017. Accessed February 18, 2018.
  20. 20. Kids and Drugs oAccessibility - your medicine cabinet - Grandma’s purse - siblings (sharing and stealing) - friends - OTC preparations (DXM, cough and cold preps) oCost- the lower the better! Alco-pops! o“Pharming”
  21. 21. Adults in General:  Have Greater Accessibility to Drugs - Internet (No physical needed!) - Canada, Mexico, Great Britain, India etc - Mail order prescriptions :Less familiarity between Doctors and patients Have a wider variety of drugs available to them on the market
  22. 22. The Neurobiology of Addiction • Above the hindbrain is the mesencephalon or midbrain, which contains two important regions for substance abuse: 1. Ventral Tegmental Area (VTA): which is has many dopaminergic cell bodies that project to the limbic system and forebrain. 2. Nucleus Accumbens: spiny neurons in this area receive input from both the dopaminergic neurons of the VTA and the glutamatergic neurons of the hippocampus, amygdala, and medial prefrontal cortex. The end result is the release of dopamine.
  23. 23. Mesolimbic Dopamine System
  24. 24. More to the Story….. • Dopamine is not the only neurotransmitter involved with substance dependence. Many others play a role such as: • Serotonin • GABA • Glutamate • Norepinephrine
  25. 25. Males vs. Females oMales start using drugs at an earlier age. oMales abuse drugs more often and in larger amounts. oMales are more likely to abuse alcohol and tobacco. oClose to 12 percent of American males age 12 and older were currently using illegal drugs, compared with just over 7.3 percent of females in the same age group. Multi-drug use was also more common in males than in females. oFemales abuse benzodiazepines more often than males.
  26. 26. Commonly Abused Psychoactive Substances 1.Sedative/hypnotics (BZDS and Barbs) 2.Nicotine 3.Opioids 4.Cannabis 5.Alcohol 6.Cocaine 7.Amphetamines 8.Ecstasy 9.Volatile Solvents 10.Hallucinogens
  27. 27. Alcohol o Global Burden: In 2012, 3.3 million deaths, or 5.9 percent of all global deaths (7.6 percent for men and 4.0 percent for women), were attributable to alcohol use. o Alcohol contributes to over 200 diseases and injury-related health conditions, most notably alcohol dependence, liver cirrhosis, cancers, and injuries. o In 2013, 86.8 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime; 70.7 percent reported that they drank in the past year; 56.4 percent reported that they drank in the past month.
  28. 28. Alcohol (con’t) Prevalence of Drinking: According to the 2013 National Survey on Drug Use and Health (NSDUH), 35.1 percent of 15year-olds report that they have had at least 1 drink in their lives.17 About 8.7 million people ages 12–20 (22.7 percent of this age group) reported drinking alcohol in the past month (23 percent of males and 22.5 percent of females). Consequences of Underage Alcohol Use:Research indicates that alcohol use during the teenage years could interfere with normal adolescent brain development and increase the risk of developing an AUD. In addition, underage drinking contributes to a range of acute consequences, including injuries, sexual assaults, and even deaths—including those from car crashes. National Institute on Alcohol Abuse and Alcoholism (NIAAA). Alcohol Alert, No. 67 “Underage Drinking,” 2006. Available at: http://pubs.niaaa.nih.gov/publications/AA67/AA67.htm
  29. 29. Alcohol Toxicity is on the Rise In addition to alcoholic dementia, seizures,cirrhosis of the liver and Werneke-Korsakoff syndrome…..we now have drugs which are much more powerful and are metabolized by the Cytochrome P450 system producing more Drug-Drug Interactions and additive effects with alcohol. Benzodiazepines, opiates, stimulants, barbiturates, muscle relaxants, and anticonvulsants are all known to be very toxic when combined with alcohol
  30. 30. Alcohol • Increases the inhibitory activity mediated by GABA-A receptors and decreases excitatory activity mediated by glutamate receptors. • Reinforcing effects probably due to increased firing rate of the dopaminergic neurons of the VTA and the dopamine release into the nucleus accumbens.
  31. 31. Sedative/Hypnotics (Benzodiazepines and Barbiturates) Both types of drugs work on the GABA-A receptor complex and have very strong reinforcing effects. Many legal cases involving benzodiazepine use and driving. The new “drugged-driving” scenario. Tolerance develops to certain aspects of benzodiazepines leading people to believe they are not impaired.
  32. 32. Sedatives (continued) oNew “Z” hypnotics……thought to be the safe alternative…no tachyphylaxis…no dependence….is that really the case? oZolpidem….a new way to hallucinate? -night eating, driving, crazy sex? oWhat happens when you take four times the usual dose?
  33. 33. Nicotine (Tobacco) Potent agonist of nicotinic receptors of the cholinergic nervous system. Promotes dopamine synthesis by increasing tyrosine hydroxylase expression thru activation of somatodendritic acetylcholine receptors in the niagrostriatal and mesolimbic dopamine pathways. Potential for dependence surpasses all other psychoactive substances. (most like stimulants)
  34. 34. Statistics for Nicotine Use in America For people aged 18 years and older: Tobacco use remains the single largest preventable cause of death and disease in the United States. Cigarette smoking kills more than 480,000 Americans each year, with more than 41,000 of these deaths from exposure to secondhand smoke. In addition, smoking-related illness in the United States costs more than $300 billion a year, including nearly $170 billion in direct medical care for adults and $156 billion in lost productivity. In 2016, an estimated 15.5% (37.8 million) of U.S. adults were current* cigarette smokers. Of these, 76.1% smoked every day. https://www.cdc.gov/tobacco/campaign/tips/resources/data/cig arette-smoking-in-united-states.htm-accessed February 18, 2018
  35. 35. Statistics for Nicotine Use in America For Children under age 18: Cigarette smoking during childhood and adolescence causes significant health problems among young people, including an increase in the number and severity of respiratory illnesses, decreased physical fitness and potential effects on lung growth and function. Most importantly, this is when an addiction to smoking takes hold, often lasting into and sometimes throughout adulthood. Among adults who have ever smoked daily, 87 percent had tried their first cigarette by the time they were 18 years of age, and 95 percent had by age 21 In 2015, 9.3 percent of high school students reported smoking cigarettes in the last 30 days, down 74 percent from 36.4 percent in 1997 when rates peaked after increasing throughout the first half of the 1990s. www.lung.org/stop-smoking/smoking-facts/tobacco-use-among-children.html?referrer=https://ww
  36. 36. What is this New Craze called Vaping?E-cigarettes come in many shapes and sizes. Most have a battery, a heating element, and a place to hold a liquid. E-cigarettes produce an aerosol by heating a liquid that usually contains nicotine—the addictive drug in regular cigarettes, cigars, and other tobacco products—flavorings, and other chemicals that help to make the aerosol. Users inhale this aerosol into their lungs. Bystanders can also breathe in this aerosol when the user exhales into the air. E-cigarettes are known by many different names. They are sometimes called “e-cigs,” “e-hookahs,” “mods,” “vape pens,” “vapes,” “tank systems,” and “electronic nicotine delivery systems (ENDS).” Using an e-cigarette is sometimes called “vaping.” E-cigarettes can be used to deliver marijuana and other drugs. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/index.htm https://www.cdc.gov/tobacco/basic_information/e-cigarettes/index.htm
  37. 37. Types of e-cigarettes: In the United States, youth are more likely than adults to use e- cigarettes. In 2016, more than 2 million U.S. middle and high school students used e-cigarettes in the past 30 days, including 4.3% of middle school students and 11.3% of high school students. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/index.htm
  38. 38. “The Opioid Crisis” Opioids encompasses both the naturally occurring opiates such as heroin and morphine and the synthetic and semi-synthetic preparations. 3 receptor classes in the brain for opioids:mu, delta and kappa. Mu agonists have reinforcing properties. Delta agonists and endogenous enkephalins seem to produce reward, but at a lesser extent than mu agonists. Kappa receptors appear to have an opposing effect on reward, and are hypothesized to work with mu receptors in keeping a balance or control of mesolimbic dopaminergic neurons.
  39. 39. Opioid Tolerance and Dependence oOccurs rapidly oWithdrawal from opioids is extremely uncomfortable as is characterized by: watery eyes, runny nose, yawning, sweating, restlessness, irritability, tremor, nausea, vomiting, diarrhea, increased blood pressure and heart rate, chills cramps and muscle aches. “I wasn’t taking the drugs to get high anymore, I was taking the drugs to avoid withdrawal”.
  40. 40. Current Pharmacologic Treatment of Opioid Dependence o Methadone-unusual pharmacokinetics o Often patients still abusing other substances o Buprenorphine (Buprenex®, Suboxone®, Subutex®) combined with naloxone to discourage diversion. 3 times per week, expensive o Ofirmev™ is a new IV formulation of acetaminophen designed for it’s synergistic effects with opioids in post operative pain and in cancer patients. It is now being used in emergency departments with drug seekers. o Caldolor™ is a new formulation of ibuprofen in sterile water for injection.
  41. 41. Heroin Can be injected, snorted or even smoked. Black tar heroin is made primarily in Mexico. Names: Negro: the Spanish word for black Piedra: the Spanish word for stone Chiva: a Spanish word for a young goat, Nut Job , Muck, Frown, Slab Historically, NYC is the city with the highest rate of heroin use. Now that the governmental agencies are discouraging healthcare professionals from prescribing opioids, the number of heroin users is rising dramatically.
  42. 42. Other Opioids o Opioids are commonly crushed and snorted for a rush. o Upon examination, look for constricted “pinpoint pupils” o Hydrocodone/APAP (Norco™)-abuse at epidemic proportions. This drug is now a “Schedule II” drug. Mixing with alcohol gives intensified effect. Snorting may cause perforation of nasal septum. Names: "vics", "tabs", "hydros“ or “Watsons” o Oxycodone (Oxycontin™)-abuse at epidemic proportions. Sells for at least $1.00 per mg on the street. Snorting becoming very common. Names: Cotton, Hillbilly Heroin, Kicker, OCs, Ox, Os, Oxy, Pills, 40, 40-Bar,80.
  43. 43. Other Opioids (continued) Fentanyl (synthetic opioid) o20 times more powerful than morphine oUse is on the rise with teens. Many deaths reported. oSnorting, chewing patches etc oSmoking out of lightbulbs o100mcg patch sells for approximately $15.00 on the street Names: Apache, China girl, China white, Dance fever, friend, Goodfella, jackpot, murder 8, TNT, Perc-O-Pop, Lollipop, Tango, Cash
  44. 44. Fentanyl in Healthcare today o60% of all deaths in the US due to overdose are caused by fentanyl. oNever prescribe Fentanyl to a patient who is opiate naïve. oFentanyl is not prescribed in Emergency Departments anymore. oUsed primarily in surgery and hospice care. oFentanyl is sometimes the substance used to lace fake Xanax. oFentanyl is often stolen from hospice patients.
  45. 45. Opioids (continued) Tylenol #3 • Tylenol #3-still going strong. $5.00 for 2 tablets on high school campuses. Snorting. Some people mixing tylenol# 3 with snuff or spit tobacco and snorting. Gives both a calming effect while nicotine is stimulating. Street names: T-threes, Captain Cody, schoolboy.
  46. 46. “Cheese” oAimed at our children • Cheap high; sold for $2.00-$10.00 • Mixture of small amounts (2-8%) heroin and the rest is Tylenol- PM™(Acetaminophen/diphenhydramine) • Crushed into powder and snorted through hollowed-out ballpoint pens. oMimics the “speedball” (heroin and cocaine)
  47. 47. Opiates (con’t) Tramadol (Ultram™)Now a Controlled Substance. Many reports of dependence and withdrawal of the mu receptor type. Often crushed and snorted or diluted with liquid and injected. Drug inhibits the synaptic reuptake of both serotonin and norepinephrine Cases of serotonin serum sickness have been reported in patients with concomitant use of serotonergic antidepressants. Increases risk of seizures
  48. 48. Newest Approaches to Decreasing Opioid Use: Education of the Patient: 1. The Pain will not completely disappear. 2. Educating Patients on Hyper-analgesia 3. Referring patient to Cognitive Behavioral Therapy 4. Meditation 5. Using ice machines after surgery 6. Using heat to alleviate pain.
  49. 49. Newest Approaches to Decreasing Opioid Use (con’t) 7. A transcutaneous electrical nerve stimulation (TENS) unit is a device that sends small electrical currents to targeted body parts. These currents are used to relieve pain. Some TENS units are designed for use in a hospital or healthcare facility. Others are safe to use at home. TENS therapy subdues hyperalgesia, which is a high sensitivity to pain. The pain may be located anywhere on the body. 8. Trigger Point Injections using anesthetics 9. Reducing doses of pain medications and replacing with medications in lesser controlled category. 10. Surgery
  50. 50. Marijuana National Institutes of Health NEWS RELEASE Wednesday, October 21, 2015 “Prevalence of Marijuana Use Among U.S. Adults Doubles Over Past Decade”. Surveys show 9.5 percent of Americans use marijuana; 30 percent of users meet criteria for a disorder. o Long-term effects: Marijuana also affects brain development. When marijuana users begin using as teenagers, the drug may reduce thinking, memory, and learning functions and affect how the brain builds connections between the areas necessary for these functions. Two studies involving adolescents showed an eight point decrease in IQ for adolescents who used daily marijuana.
  51. 51. Cannabinoids: Marijuana Cannabis derivatives are the most widely used illicit drugs in the world. New studies have shown the damage to the lining of the lung is much worse than by cigarette smoking. Works on the endocannabinoid system. Three receptor ligands (cannabinoid agonists) have been identified. Euphoric effects thought to be from THC-9 acting on the mesolimbic dopamine reward system Street names: weed, MJ, pot, maryjane, hooch)
  52. 52. Cocaine Powerful stimulant which is snorted, smoked, ingested or injected (sympathomimetic) In the brain, cocaine acts as a monoamine transporter blocker for dopamine, serotonin and norepinephrine Cocaine also facilitates serotonin transmission in the nucleus accumbens-may account for more reinforcing effects Withdrawal not as severe as with opioids Street names: coke, snow, crack, rock
  53. 53. Cocaine (continued) Crack cocaine, crack or rock is a solid form of cocaine which is smoked. It is a freebase form of cocaine that can be made using baking soda (sodium bicarbonate) or sodium hydroxide, in a process to convert cocaine hydrochloride (powder cocaine) into methylbenzoylecgonine (freebase cocaine). Crack cocaine is used by the African American community at a very high rate.
  54. 54. Cocaine (continued) Long term use results in cognitive deficits. Executive functioning: decision-making and judgment affected EEG abnormalities detected in people recovering from cocaine dependence Anti-cocaine antibodies being developed for use peripherally to prevent cocaine from entering the brain The cocaine vaccine IPC-010 (TA-CD) is being tested on rats Both remedies have high variability, and thought to work best with highly motivated individuals
  55. 55. Amphetamines This group includes both delta and levo amphetamines, ephedrine, methamphetamine, methylphenidate, and (-)cathinone (Khat: leaves/bud of East African plant-chewed or brewed as tea). Used excessively in somalia. Only prescribed for medical use of ADHD, narcolepsy, weight loss Methylphenidate is crushed and snorted
  56. 56. Stimulants (continued) Ritalin and Adderall are the new “Dexedrine” of the 50’s and 60’s White college age males biggest abusers of stimulants. People using to stay awake and study Teens stealing siblings ADHD meds for a “high” School teachers and counselors “dipping in” to the children’s meds.
  57. 57. Methamphetamine Street names: meth, crank, crystal, ice Smoked, snorted, ingested, injected Crossing the country at an alarming rate Stimulates release of dopamine from nerve terminals via dopamine transporter-dopamine is released independently of neuronal excitation-this contrasts cocaine which blocks reuptake in the synapse only.
  58. 58. Methamphetamine (continued) New pseudoephedrine legislation has helped. Majority of meth now imported from Mexico. This has driven the price upward. Fewer children able to afford. Strawberry Quik Damage to dopaminergic neurons is severe- regeneration after 14 months of abstinence, but chemical transmission is still affected.
  59. 59. 3,4-methylenemethamphetamine (MDMA) Ecstasy….”The Love Drug” Street names: XTC, E, Adam, cloud 9, herbal bliss Most worrisome: youth do not perceive this drug as harmful. Club drug, used at rave parties Classified as a psycho-stimulant, but is also a hallucinogen in very high doses. New pharmacological class: entactogens-means “entering into contact with yourself”
  60. 60. Ecstasy (continued) Abuse of this drug is spreading across the world. In Asian countries, more ecstasy is consumed than heroin and cocaine combined. In Australia, 90% of all users inject the drug. In the US, the drug is primarily ingested or smoke, but maybe snorted or inhaled also. Most effects are serotonergic, but dopamine and NE are also released.
  61. 61. Ecstasy is neurotoxic Neurotoxicity is dose and frequency related-It is cumulative. Severe reductions in serotonin and its transporters and neurons. Impairment in regulation of body temperature Impairments in memory, decision-making, and self-control. Increased psychiatric symptoms such as: depression, panic attacks and paranoia.
  62. 62. Volatile Solvents (Inhalants) Scarcity of research-very little known regarding mechanism of action Most popular with children and adolescents due to availability Glue-sniffing, white-out, glade air freshener, paint stripper, nail polish remover, sharpies, whipped cream or anything “under the sink” Dizziness, disorientation, and euphoria with excitation minutes after inhalation.
  63. 63. Inhalants (continued) Withdrawal of these substances often results in convulsions. Damage is often severe. Psychiatric and neurologic problems are often irreversible, and include: severe paranoia, hallucinations, delusions, temporal lobe epilepsy, and lower IQ.
  64. 64. Hallucinogens Very popular with the youth of today LSD, ecstasy, ketamine, PCP and Salvia Divinorum- perceived as harmless. Cannabis is really a hallucinogen. These drugs produce distortions of the senses. Produces elevated heart rate and body temperature, unstable motor coordination and pupillary dilatation.
  65. 65. Phencyclidine (PCP) oDrug Class: Hallucinogen, dissociative anesthetic, psychotomimetic, sedative-hypnotic. oLiquid form used to dip “joints” into=Angel Dust oMedical and Recreational Uses: Formerly used as a surgical anesthetic, however, there is no current legitimate medical use in humans. Used as a veterinary anesthetic or tranquilizer. Recreationally used as a psychedelic and hallucinogen.
  66. 66. SPICE Synthetic marijuana Used to be purchased in smoke shops legally. Now illegal, but flourishing on the streets. Hallucinogenic Lasting effects including Psychotic symptoms Extremely addictive (psychologically) Causes extreme violence in some people.
  67. 67. Bath Salts o The term “bath salts” refers to an emerging family of drugs containing one or more synthetic chemicals related to cathinone, an amphetamine-like stimulant found naturally in the khat plant. o Reports of severe intoxication and dangerous health effects associated with use of bath salts have made these drugs a serious and growing public health and safety issue. The synthetic cathinones in bath salts can produce euphoria and increased sociability and sex drive, but some users experience paranoia, agitation, and hallucinatory delirium; some even display psychotic and violent behavior, and deaths have been reported in several instances.
  68. 68. Ketamine Street names: special K, Kit kat, Cat Valium, K, Purple, jet, etc….. Used in veterinary medicine and in conscious sedation in Emergency Depts. Effects are subjective-some feel euphoric and happy, and some have a “bad trip” referred to as a “Black Hole” Dissociative (like LSD)-can be injected, inhaled, mixed with ecstasy and smoked.
  69. 69. KRATOM THERAPY • Mitragyna speciosa, commonly known as kratom, grows naturally in Thailand, Malaysia, Indonesia and Papua New Guinea. • Serious concerns exist regarding the toxicity of kratom in multiple organ systems. Consumption of kratom can lead to a number of health impacts including, respiratory depression, vomiting, nervousness, weight loss and constipation. • Kratom has been indicated to have both narcotic and stimulant-like effects and withdrawal symptoms may include hostility, aggression, excessive tearing, aching of muscles and bones and jerky limb movements. • This drug has been sold in California as a natural botanical cure for many diseases. • The FDA and CA Dept. of Public health have placed an embargo on its import and sales.
  70. 70. What is Krokodil (desomorphine)? Desomorphine, known by thestreet name krokodil, is an opioid derivative of codeine Like heroin and other opioids it has a sedative and analgesic effect, is highly addictive, and potentially harmful. Those who inject these caustic agents into their veins can develop extreme skin ulcerations, infections, and gangrene- a discolored (green, black) scale-like skin that resembles a crocodile, hence the street name “krokodil”. The drug has been noted to be fast-acting and eight to ten times more potent than morphine. However, the half-life is short, and euphoric effects may last less than two hours. Due to the short “high”, many users find themselves in a rapid repetition of drug synthesis to avoid withdrawal symptoms that are typical of heroin.
  71. 71. Krokadil Effects
  72. 72. Side Effects of Krokodil Reported Blood vessel damage Open ulcers, gangrene, phlebitis Skin and soft tissue infections Skin grafts/surgery Limb amputations Pneumonia Blood poisoning Meningitis
  73. 73. Side Effects of Krokadil (con’t) • Rotting gums/tooth loss • Bone infections (osteomyelitis) • Speech and motor skills impairment • Memory loss and impaired concentration • Liver and kidney damage • Overdose • Death
  74. 74. Miscellaneous Drugs of Abuse •Ibuprofen in albuterol metered dose inhalers. (HFA won’t work!)Albuterol helped open the airways. •Seroquel crushed and snorted “S, Quel” •Wellbutrin crushed and snorted for a rush •Dextromethorphan “DXM, Robo-tripping, skittling, triple C”- dissociative effects in high doses. Abused by teens. Available in powder form on the internet. With alcohol, deaths have been reported.
  75. 75. Activity: Post Presentation Questions: 1. What neurotransmitter is thought to be predominant in the reinforcing effects of substance abuse? A. dopamine B. serotonin C. Glutamate D. norepinephrine 2. Which gender is found to become dependent on sedative/hypnotics at a rate of 4:1 over the other gender? A. Men B. Women
  76. 76. Post Presentation Questions: 3. Which prescription narcotic is 20 times more powerful than morphine and is being abused at an alarming rate among teens and other youth? A. hydromorphone B. tramadol C. meperidine D. fentanyl 4. Of the following illicit drugs, which one is the most widely abused in the world? A. cocaine B. cannabinoid derivatives C. heroin D. ecstasy
  77. 77. Post Presentation Questions: 5. What is the name of the new practice among teens where many types of prescription medications are ingested at the same time to see what feeling will result? A. scripting B. blasting C. pharming D. Rxing 6. Why do youth typically abuse dextromethorphan, alcohol, acetaminophen derivatives and diphenhydramine? A. less addictive B. more easily obtained C. no hangovers D. no legal consequences if caught
  78. 78. Post Presentation Questions: 7. Which area of the midbrain receives input from the hippocampus, amygdala and medial prefrontal cortex which results in the release of dopamine? A. nucleus accumbens B. pituitary gland C. thalamus D. chemoreceptor trigger zone 8. Which medication has a potential for dependence which surpasses all other psychoactive substances? A. haloperidol B. morphine C. nicotine D. Ketamine
  79. 79. Thank you for your time Questions?
  80. 80. Answers to Post Presentation Questions: 1. a 2. b 3. d 4. b 5. c 6. b 7. a 8. c

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