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Alcohol and Drug Abuse
Alcohol Related ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Friend   or   Foe  ? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Signs and symptoms of Alcholism ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Alcoholism ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Signs   of   Alcoholism ,[object Object],[object Object],[object Object],[object Object]
Effects of Alcoholism  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Serious   Intoxication   ,[object Object]
Alcohol Withdrawal ,[object Object],[object Object]
Dependency   ,[object Object],[object Object],[object Object],[object Object],[object Object]
Alcohol   Related   Problems ,[object Object],[object Object]
Sudden Death May Occur  ,[object Object],[object Object],[object Object],[object Object]
Binge Drinking ,[object Object]
Binge Drinking ,[object Object]
Binge Drinking ,[object Object],[object Object],[object Object],[object Object]
MIX Ecstasy and Alcohol
20 Questions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
20 Questions Results ,[object Object]
Drug Abuse
Drug abuse ,[object Object],[object Object]
Drugs and the Work Place ,[object Object]
Lowers productivity /  causes accidents and injuries. ,[object Object],[object Object],[object Object],[object Object]
Increases Absenteeism, Turnover and  Employer’s medical costs . ,[object Object],[object Object],[object Object],[object Object]
What can your organization do to decrease the impact of substance abuse ,[object Object],[object Object],[object Object],[object Object]
Drug-free workplace program may include: ,[object Object],[object Object],[object Object],[object Object],[object Object]
A good drug-free workplace program can lead to ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What are the Signs of Abuse? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Signs of Abuse ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How Can it Be Prevented? ,[object Object],[object Object],[object Object],[object Object],[object Object]
What Can Employees Do? ,[object Object],[object Object],[object Object],[object Object]
Types of Drugs ,[object Object],[object Object],[object Object],[object Object]
STIMULANTS ,[object Object]
DEPRESSANTS ,[object Object]
HALLUCINOGEN S ,[object Object]
ECSTASY
ECSTASY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PMA and MDMA ,[object Object],[object Object],[object Object]
MDMA/PMA how It Looks ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],“ Euros”
MDMA/PMA Packaging ,[object Object]
Long Term effects ,[object Object],[object Object],[object Object],[object Object]
Ecstasy Effects ,[object Object],[object Object],[object Object],[object Object]
Ecstasy Effects ,[object Object],[object Object],[object Object],[object Object]
Ecstasy Effects ,[object Object],[object Object],[object Object],[object Object]
ECSTASY
LSD
LSD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
LSD Effects ,[object Object],[object Object],[object Object],[object Object]
LSD Effects ,[object Object],[object Object],[object Object],[object Object]
LSD Effects ,[object Object],[object Object],[object Object],[object Object]
Marijuana
Marijuana ,[object Object],[object Object],[object Object],[object Object]
Cannabis (Marijuana) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Some of the Hazards of Using Marijuana ? ,[object Object]
Hazards of Marijuana Use ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Marijuana Short Term Effects ,[object Object],[object Object],[object Object],[object Object]
Signs of Marijuana Use ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Signs of Marijuana Use ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Signs of Marijuana Use ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Marijuana
Marijuana
Marijuana
Marijuana Buds and Blount
Marijuana Blount
Marijuana Pipe
Marijuana Pipe
Cocaine Crack Cocaine
Cocaine (Crack Cocaine) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cocaine (Crack Cocaine) ,[object Object],[object Object],[object Object],[object Object]
Cocaine Addiction ,[object Object]
Cocaine Addiction ,[object Object],[object Object]
Signs of Cocaine Addiction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Common emotional signs of cocaine addiction  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Common signs of cocaine addiction withdrawal ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cocaine Powder
Cocaine for Injecting
Cocaine for Snorting
Signs of Crack Addiction ,[object Object]
Crack Cocaine Addiction ,[object Object]
Crack Cocaine Addiction ,[object Object]
Signs of Crack Addiction ,[object Object]
Crack Cocaine
Vial Crack Cocaine
 
 
 
Methamphetamine
Methamphetamine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Methamphetamine High ,[object Object]
Methamphetamine ,[object Object]
Methamphetamine Effects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physiological effects of methamphetamine use include:  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Methamphetamine Short Term ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Long-term effects of methamphetamine use ,[object Object]
Long-term effects of methamphetamine use ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Meth Chronic Use ,[object Object]
Methamphetamine Addiction ,[object Object]
Making Crank/Meth Made Easy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
GHB
GHB ,[object Object],[object Object],[object Object],[object Object]
Recognizing GHB ,[object Object]
So Many Names…. ,[object Object],[object Object]
GHB  How are they used? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Other GHB Products
Efforts to Avoid Detection ,[object Object],[object Object],[object Object],[object Object]
GHB- No longer Just for Rapists ,[object Object],[object Object],[object Object],[object Object]
What To Expect
Typical GHB Containers ,[object Object]
Recognizing Containers ,[object Object],GHB addicts have hidden it in engine compartments, attics, etc .
GHB analogs - What does it do ,[object Object],[object Object]
GHB toxicity- mild ,[object Object],[object Object],[object Object],[object Object]
GHB Toxicity- Severe ,[object Object],[object Object],[object Object],[object Object],[object Object]
GHB ,[object Object]
GHB Treatment ,[object Object],[object Object],[object Object]
GHB Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object]
Difficulty in Prosecution ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
GHB analogs- What does this mean to me? ,[object Object],[object Object],[object Object]
Those who have Died ,[object Object]
Field Testing This is what GHB/GBL does to a Styrofoam cup!
Raves
The Rave Culture ,[object Object],[object Object],[object Object],[object Object]
Rave Culture ,[object Object],[object Object],[object Object],[object Object],[object Object]
Rave Culture
Possible Rave Indicators ,[object Object],[object Object],[object Object],[object Object],[object Object]
Possible Rave Indicators ,[object Object],[object Object],[object Object],[object Object]
Possible Rave Indicators ,[object Object],[object Object]
It’s About Sensation ,[object Object],[object Object],[object Object]
Rave Paraphernalia ,[object Object],[object Object],[object Object]
Common Medical concerns ,[object Object],[object Object],[object Object],[object Object],[object Object]
Heroin
Heroin ,[object Object],[object Object],[object Object],[object Object],[object Object]
Methods of use:  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Signs and Systems of an Opiate Overdose ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Long Term problems ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Some things that have been done with a Heroin OD by Junkies ,[object Object],[object Object],[object Object],[object Object],[object Object]
Signs of Drug Abuse ,[object Object],[object Object]
Personality:   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physical Appearance: ,[object Object],[object Object],[object Object],[object Object],[object Object]
Social Activity/School Performance:  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Should You Snoop ? ,[object Object]
General Affects on the Public  ,[object Object],[object Object],[object Object],[object Object]
Examples ,[object Object],[object Object],[object Object]
Drug Abuse ,[object Object]
Signs of Alcohol and Drug Addictions ,[object Object]
Signs / Indicators of Addication ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Signs / Indicators of Addication ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Results of  Alcohol and Drug Abuse
 

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Editor's Notes

  1. 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 "rush" 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 "coming down" sensation, culminating in a feeling of fatigue in about 4-6 hours
  2. Hangover and the Week After Many users report feeling extremely drained the day after MDMA use. This 'day after' 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 "burn-out" 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
  3. Very easy to make, no cooking is required. Since no longer commercially available, its potency in variable.GBL, GBH, BD & 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 "spring water" 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 "home-brews" 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 "rave parties" and upscale "smart-drink" 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 "rave" parties GHB is sold for $10 per capful or "swig". 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 "Hillary Farias and Samantha Reid Date-Rape Prohibition Act of 1999" (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
  4. 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.
  5. GHB is usually abused either for its intoxicating, sedative, and euphoriant properties. GHB'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.
  6. HOW MANY CLEANING SOLUTIONS COME IN 2-OZ BOTTLES WITH AN EYEDROPPER?
  7. GHB is usually abused either for its intoxicating, sedative, and euphoriant properties. GHB'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.
  8. GHB in pure form is clear & thicker than water; it bubbles when shaken. But it can be dyed any color, watered down & not all of its “analog” cousins bubble. It may also be seen in powder, capsule or a “putty” form.
  9. 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 "Drug-Induced Rape Prevention and Punishment Act of 1996" 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.
  10. 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.
  11. 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
  12. 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.
  13. 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.
  14. 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)
  15. Soft fuzzy clothing or other interesting textured fabrics add to sensation & are popular. Special clothing & hats are sold with hidden compartments to hide their drugs at school & parties. In the hat below, it is behind the emblem; it is sealed with Velcro under the hat band.
  16. 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
  17. 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 "low end analgesic dose of heroin would be about 1mg." 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 "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." 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 "I'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'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've never heard of one of these beating a 1000/1 ratio." 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 "A stable dose was achieved after 6 months at most; beyond this point, almost no further increases in dose were required
  18. 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," 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'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 "Twilight Sleep" provided painless birth. However, "Twilight Sleep" 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.
  19. 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'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
  20. “ 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'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 'nod' 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 "spoon" 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]
  21. 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 "lockjaw"). 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 "flesh-eating disease" 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 "black tar" 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 "eaten" 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 "black tar" 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.