The document discusses trends in adolescent drug use, highlighting reduced use of traditional street drugs but increased use of prescription and over-the-counter medications. It outlines various classes of opiates, their effects, and the risks associated with new drugs, particularly focusing on the misuse of ADHD medications like Adderall and the dangers of substances like dextromethorphan. Additionally, it reviews the addictive potential and side effects of common sedatives and hypnotics such as Ambien, Lunesta, and Rozerem.

1. NEW DRUGS OF ABUSE & NEW MEDICATIONS FOR THE TREATMENT OF ADDICTION Randall Webber, M.P.H. Director of External Training TASC, Inc.

2. Trends in Adolescent Drug Use: 2008 Update Randall Webber, M.P.H. Director of External Training TASC, Inc of Illinois

3. Overall Trends for Adolescents Less use of cocaine, PCP, LSD and other street drugs More use of both Rx drugs and over-the-counter (OTC) medications Greater “recreational” use of Adderall Marijuana use relatively unchanged Younger age of first use

4. The Problem with Pill Identifications: New York City May 2000 Amphetamine Chicago May 2000 MDMA Tucson AZ July 2000 PMA Portland Oct 2000 MDMA

5. PMA Effects - Sudden blood pressure rise (> 55mm) Hyperthermia usual cause of death Brain hemorrhage can occur Does NOT produce the pleasant Ecstasy effects so users take more causing an overdose. No hospital tests available for PMA.

6. Major Neurotransmitters Inhibitory Endorphins Excitatory Acetylcholine Inhibitory GABA Excitatory Glutamate Inhibitory Serotonin Inhibitory/Excitatory Dopamine

7. Methamphetamine Methamphetamine

8. Methamphetamine and MDMA A hydrogen atom shifts position   two oxygen atoms are added MDMA Methamphetamine

9. DXM Examples – No Urine Test Available Produces Olney’s Lesions On Lower Cortex “ Pink Molly” Buffalo NY “ Star” Indianapolis IN “ Clover” Wide spread across US “ Orange Julius” Seattle WA “ Green Triangle” Wide spread

10. Age of First Non-Medical Use of Rx Drugs & Lifetime Diagnosis of Substance Abuse

11. Annual Numbers of New Non-medical Users of Opiate Pain Relievers: 1965–2002

12. Number of New Users of Illicit Drugs: 2006

13. Number of Rx Opiate Users: 2005 Vs 2006

14. Source of Rx Opiates

15. Number of American 12+ y.o. who have used OxyContin VS Heroin (In Millions)

16. % of Youth Who Believe that Trying Heroin Once or Twice Does NOT pose a “Great Risk”

17. Types of Opiates Naturally Occurring Opiates Opium Morphine Codeine Thebaine Semi-Synthetic Opiates • Vicodin • Heroin

18. Brown & White Heroin

19. Black Tar Heroin (“El Chicle”)

20. Vicodin

21. Vicodin

22. Generic Hydrocodone

23. Types of Opiates Synthetic opiates Demerol (meperidine) Dilaudid (hydromorphone) Percodan/OxyContin (oxycodone) Numorphan (oxymorphone) Sublimaze (fentanyl) Methadone (dolophine) diphenoxylate/atropine (Lomotil)

24. OxyContin

25. OxyContin

26. Types of Opiates Karachi (Chicago area only) No as common now as in 1990s Drug composition varies. Usually includes an opiate (ex: Methadone) and at least one sedative (ex: CNS diazepam, phenobarbital).

27. Opiate Withdrawal Drug hunger (craving) Dilated pupils Yawning Lacrimation (eyes tear) Rhinitis (runny nose) Restlessness Anxiety Depression Muscle and bone pain

28. Opiate Withdrawal Stomach, leg and back cramps Nausea Insomnia Diarrhea Vomiting Chills/cold flashes with goose bumps ("cold turkey") Sweating Leg spasms (“kicking the habit”)

29. ADHD Medications

30. Two Major ADD Medications Ritalin Adderall (dextroamphetamine)

31. Ritalin

32. Reported Sources of Rx ADHD Medications Among Past-Year Non-medical Users, 2005* * Among adults ages 18 to 49 without a prior diagnosis of or prescription for ADHD

33. Consequences of Long-Term ADHD Medication Use (One Study ) Prescribed use of Ritalin among preadolescents Depression Anxiety Decreased ability to derive pleasure from alcohol and other drugs (AOD) Decreased ability to derive pleasure from natural rewards (food, sex, etc.) Potential outcome: Increased use of AOD

34. “ NEW” DRUGS Ambien (zolpidem tartrate) Lunesta (eszopiclone ) Rozerem (Ramelteon) DXM- Dextromethorphan

35. DEXTROMETHORPHAN

36. Dextromethorphan Coricidin Cough and Cold “ 3-C”, “triple C”, “Skittles”

37. Dextromethorphan Robitussin DM (‘Tussin”)

38. Medicines containing DXM may also contain other substances

39. DXM- Dextromethorphan May be mixed with or substituted for MDMA (“ecstasy”) In one study, 21% of “ecstasy” contained DXM Common cough suppressant drug In therapeutic doses, is sedating In larger doses, behaves like PCP

40. DXM Plateaus Abusers describe the DXM experience as occurring on four different plateaus.  First Plateau: Mild inebriation. Second Plateau: ♦ Effects similar to alcohol intoxication (slurred speech) ♦ May be mild hallucinations. ♦ Sh ort-term memory may be temporarily impaired.  Third Plateau: ♦ Impaired sense, particularly vision

41. DXM Plateaus Fourth Plateau: ♦ Mind and body dissociation/"out-of-body" experience ♦ Loss of some or all of senses ♦ Ef fects at this plateau to ketamine or PCP. detachment disorientation nystagmus stupor vomiting “ Robo Rash” itching.

42. SEDATIVE/HYPNOTICS

43. Ambien: Regular Release

44. Ambien: Sustained Release

45. Ambien (zolpidem tartrate ) Non-benzodiazepine hypnotic Available in 5-mg and 10-mg tablets Schedule IV substance Effect of 40 mg similar to Valium 20 mg

46. Ambien Mechanism of action: Subunit modulation of the GABA-A receptor chloride channel macromolecular complex GABA-A receptor complex: Is located on GABA alpha subunit Referred to as the benzodiazepine (BZ) or Ω (omega) receptor. At least three subtypes of this receptor have been identified.

47. Ambien Indicated for the short-term treatment of insomnia Use should be limited to 7 to 10 days Abnormal thinking and behavior changes have been reported: decreased inhibition (e.g., aggressiveness and extroversion that seems out of character) Sleep walking, driving, eating, cooking...

49. Ambien: Abnormal thinking and behavior agitation hallucinations depersonalization amnesia In primarily depressed patients-worsening of depression including suicidal thinking

50. Ambien: Withdrawal Symptoms Dysphoria Panic attack & nervousness Insomnia Abdominal and muscle cramps Nausea & Vomiting Sweating Lightheadedness Tremors Convulsions

51. Lunesta (eszopiclone )

52. Lunesta (eszopiclone ) Thought to also work through various GABA subreceptors. Addiction potential unclear.

53. ZIMOVANE (Zopiclone) First introduced in 1988 as hypnotic agent Marketed in 85 foreign countries as Imovane®, but has never been registered in the U.S. Closely related to eszopiclone (Lunesta) Abuse and dependency has been documented

54. ZIMOVANE (Zopiclone) Rarely seen as a street drug in the U.S., but common in Canada

55. Rozerem (Ramelteon ) Appears to work through MT 1 and MT 2 (melatonin) receptors. Has an addiction potential, but the degree of this potential is unclear. A highly unusual hypnotic, which appears to work through melatonin receptors. Melatonin A neurotransmitter that is manufactured from serotonin Involved in regulating circadian rhythms, and physical responses to changes in seasons.

56. Rozerem (Ramelteon )

57. Rozerem (Ramelteon )

58. Rozerem (Ramelteon ) In clinical testing has shown no potential for abuse. Does not bind or attached to receptors that affect memory, balance, cognition, or respiratory depression.

59. Nystagmus