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What You Dont Know CAN Hurt You

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Taking a prescription or over-the-counter (OTC) medication as prescribed ... examples: benzodiazepines, phenobarbital, phentermine. Controlled Substances Act ... – PowerPoint PPT presentation

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Title: What You Dont Know CAN Hurt You


1
What You Dont Know CAN Hurt You!
  • The Abuse of Prescription Drugs and Other Opiates

Serving Cumberland, Gloucester and Salem
Counties
The Southwest Council, Inc. Where the Science of
Prevention Meets the Needs of the
Community
2
Prescription Drugs of Abuse 101
3
Medical vs. Non-medical use
  • Medical Use
  • Taking a prescription or over-the-counter (OTC)
    medication as prescribed or recommended.
  • Non-medical use
  • Use that does not meet the definition of medical
    use.

4
Who is Abusing Prescription Drugs?
Approximately 20 of the United States population
has used prescription drugs non-medically in
their lifetime.
National Institute on Drug Abuse (NIDA)
5
Who is Abusing Prescription Drugs?
There were 9.0 million (3.7) people aged 12 and
older who were current users of illicit drugs
other than marijuana in 2005.
2005 National Survey on Drug Use and Health
6
Who is Abusing Prescription Drugs?
Nationally, 6 of people aged 18-25 report misuse
of prescription drugs in the past year.
Gloucester County Times April 2, 2007
7
Who is Abusing Prescription Drugs?
6.4 million of these people aged 12 and up
reported using prescription drugs non-medically
in the preceding month.
  • 4.7 million used pain relievers
  • 1.8 million used tranquilizers
  • 1.1 million used stimulants
  • 272,000 used sedatives

2005 National Survey on Drug Use and Health
8
Who is Abusing Prescription Drugs?
In a 2005 survey, 4 of New Jersey residents
report abusing prescription drugs in the past
year.
Perspectives April, 2007
9
Who is Abusing Prescription Drugs?
11 of New Jersey residents aged 18-25 reported
misuse of a prescription drug in 2005.
Gloucester County Times April 2, 2007
10
Who is Abusing Prescription Drugs?
Prescription drugs were the most common first use
drug for people age 12 and older. Prescription
drug use rates are similar for men and
women. The majority of prescription drug abusers
are Caucasian.
2005 National Survey on Drug Use and Health, DAWN
2005
11
Who is Abusing Prescription Drugs?
Average age for first time non-medical users of
psychotherapeutics was 22.2 years.
  • 20.1 years for stimulants
  • 21.2 years for pain relievers
  • 22.9 for sedatives
  • 25.7 for tranquilizers

2005 National Survey on Drug Use and Health
12
How do People Get Prescription Drugs?
2005 Sources of Prescription Drugs for
Non-Medical Use
  • Friend or Family Member
  • Doctor
  • Drug Dealer or Other Stranger
  • Internet

2005 National Survey on Drug Use and Health
13
Results of Prescription Drug Abuse
  • In 2005, 598,542 emergency department (ED) visits
    involved the non-medical use of prescription or
    OTC pharmaceuticals or dietary supplements.

DAWN 2005
14
Results of Prescription Drug Abuse
  • The majority of these ED visits involved multiple
    drugs.
  • 20 involved alcohol.
  • 20 involved other illicit drugs.
  • 6 involved alcohol and other illicit drugs.

DAWN 2005
15
Results of Prescription Drug Abuse
The most frequently reported drugs in these ED
visits were Central Nervous System (CNS) agents
and psychotherapeutic agents.
DAWN 2005
16
Results of Prescription Drug Abuse
  • The most frequent CNS agents reported were
    opiate/opioid analgesics
  • 51, 225 ED visits for
    Hydrocodone/combinations
  • 42,810 ED visits for
    Oxycodone/combinations
  • 41,216 ED Visits for Methadone

DAWN 2005
17
Results of Prescription Drug Abuse
The psychotherapeutic agents most frequently
reported in ED visits were anti-anxiety agents,
sedatives and hypnotics (34).
DAWN 2005
18
Results of Prescription Drug Abuse
  • Benzodiazepines of Abuse
  • 62,020 visits for Alprazolam
  • 30,608 visits for Clonazepam
  • 19,655 visits for Lorazepam
  • 18,567 visits for Diazepam

DAWN 2005
19
Results of Prescription Drug Abuse
  • Cumberland County Treatment Admissions

  • (5-15-06 TO 5-15-07)
  • Heroin Opiates 402 23
  • Other Drugs 250 14

DAWN 2005
20
Results of Prescription Drug Abuse
  • Gloucester County Treatment Admissions
    (5-15-06 TO 5-15-07)
  • Heroin Opiates 824 35
  • Other Drugs 328 14

DAWN 2005
21
Results of Prescription Drug Abuse
  • Salem County Treatment Admissions
  • (5-15-06 TO 5-15-07)
  • Heroin Opiates 166 26
  • Other Drugs 74 11

DAWN 2005
22
Results of Prescription Drug Abuse
  • ED visits related to non-medical use of
    pharmaceuticals increased 21 from 2004 to 2005.
  • Benzodiazepines increased 19
  • Opiates/Opioids increased 24
  • Methadone increased 29

DAWN 2005
23
Results of Prescription Drug Abuse
Treatment admissions in New Jersey for pain
killers increased 217 from 1999 through
2005.
Gloucester County Times April 2, 2007
24
Important Terms
  • USE
  • MISUSE
  • ABUSE
  • ADDICTION
  • TOLERENCE
  • DEPENDENCE
  • 1) PHYSICAL
  • 2)PSYCHOLOGICAL
  • WITHDRAWAL

25
Controlled Substances Act
  • CLASSIFICATION CRITERIA
  • Abuse liability
  • Value as a medication
  • History of use and abuse
  • Risk to public Health
  • Possible political concerns

26
Controlled Substances Act
  • Schedule I
  • The drug or other substance has a high potential
    for abuse.
  • The drug or other substance has no currently
    accepted medical use in treatment in the United
    States.
  • There is a lack of accepted safety for use of the
    drug or other substance under medical
    supervision.
  • examples Heroin, Marijuana, LSD

27
Controlled Substances Act
  • Schedule II
  • The drug or other substance has a high
  • potential for abuse.
  • The drug or other substance has a currently
  • accepted medical use in treatment in the
  • United States or a currently accepted medical
  • use with severe restrictions.
  • Abuse of the drug or other substances may lead to
    severe psychological or physical dependence.
  • examples morphine, MPH, Cocaine

28
Controlled Substances Act
  • The drug or other substance has a potential for
  • abuse less than the drugs or other
    substances in
  • schedules I and II.
  • The drug or other substance has a currently
  • accepted medical use in treatment in the United
  • States.
  • Abuse of the drug or other substance may lead to
  • moderate or low physical dependence or high
  • psychological dependence.
  • examples Tylenol w/codeine, some barbiturates

Schedule III
29
Controlled Substances Act
  • Schedule IV
  • The drug or other substance has a low potential
    for abuse
  • relative to the drugs or other substances
    in schedule III
  • The drug or other substance has a currently
    accepted
  • medical use in treatment in the United
    States
  • Abuse of the drug or other substance may lead to
    limited
  • physical dependence or psychological
    dependence relative
  • to the drugs or other substances in
    schedule III
  • examples benzodiazepines,
    phenobarbital, phentermine

30
Controlled Substances Act
Schedule V
  • The drug or other substance has a low potential
    for
  • abuse relative to the drugs or other
    substances in
  • schedule IV.
  • The drug or other substance has a currently
    accepted
  • medical use in treatment in the United
    States.
  • Abuse of the drug or other substance may lead to
    limited physical dependence or psychological
    dependence relative to the drugs or other
    substances in schedule IV.
  • examples Robitussin, Lomotil

31
New Jersey Pharmaceutical Misuse Patterns
  • New Jersey has the highest concentration of
  • pharmaceutical and chemical firms in the
    country.
  • Doctor shopping, prescription forgery, and
    organized
  • script rings remain the prevalent source of
    diverted
  • legitimate pharmaceutical drugs in the New
    Jersey.
  • The most commonly abused pharmaceuticals
  • are Percocet, OxyContin, Xanax,
  • Vicodin/Vicodin ES, and
  • Hydrocodone/Hydrocodone products.
  • The most commonly abused chemicals are
  • GBL, Pseudoepherdrine, and Ephedrine.
  • DEA Fact sheet last updated 2/2007

32
Heroin
  • South American (Colombian) Heroin represents the
    most significant narcotic problem in New Jersey
  • Accounts for more admissions to state treatment
    centers than cocaine, marijuana, and all other
    drugs combined.
  • Heroins high purity (among the highest in the
    nation) and low price has attracted numerous new
    users over the last few years
  • Heroin purity levels in the Newark area continue
    to be among the highest in the nation.
  • Traditionally, black tar heroin has been very
    rare in the New Jersey area, however, recent
    seizures indicates that black tar heroin is
    becoming more readily available.
  • Heroin routinely arrives in the New Jersey
    metropolitan area primarily from South America,
    with transshipment from Mexico, Aruba, Curacao,
    Puerto Rico and countries in Central America.

33
Heroin - continued
  • Heroin is routinely packaged in glassine
    envelopes with a brand name stamped on it. Ten
    glassine envelopes are referred to as a bundle
    and 50 glassines are a brick.
  • Distribution points primarily remain open-air
    markets or street corners in lower income areas
    of urban cities such as Newark, Paterson, Camden,
    Jersey City, and Elizabeth.
  • The majority of the heroin is smuggled in from
    Colombia via couriers arriving aboard various
    airlines.
  • New information reveals that heroin traffickers
    are utilizing multiple couriers on flights with
    multiple connections. With this relay style
    method, couriers hand off packages to individuals
    waiting at the next connection point.
  • Source DEA Fact sheet last updated 2/2007

34
New Jerseys Most Wanted
  • AHMAD, Ahmad Zuhdi Abdel Fattah
  • CASTRILLON, Rodrigo D.
  • LOPEZ, Juan Guillermo
  • OCHOA, Javier
  • OSORIO-SERNA, Maria Teresa
  • SERNA, Maria Victoria
  • VERGARA, Sylvio

35
Adolescent Abuse
  • Top Ten Drugs of Abuse
  • Tobacco-400,000 deaths per year
  • Alcohol-most widely used drug
  • Marijuana-most widely used illicit drug
  • Prescription drugs-rapidly rising in popularity
  • Methamphetamine-becoming drug of choice
  • Ecstasy-evolving from in Rave to Street Drug
  • Crack/Cocaine-some popularity among illicit drug
    abusers
  • Heroin-epidemic proportions in Mid Atlantic
    States
  • Inhalants-continues to show huge increases
  • Steroids-mostly with athletics physical
    appearance

36
Dont Forget Over- The- Counter Drugs
  • Believe they are safer because they are
  • not illicit
  • Antihistamines
  • Cough Suppressants
  • - 4 of 8th, 5 of 10th, 7 of 12 graders
    reported
  • taking RX meds with DXM to
    get high (2006)
  • Diet and Energy Aids
  • Herbs Supplements

37
Methods Of Abuse Among Adolescents
  • Break down sustained release
  • Oxycontin Tabs
  • Fentanyl patches Per-a-pops
  • Oral experimentation
  • Grinding Snorting
  • Stimulants (Ritalin/Adderall)
  • Benzos (Xanax)
  • Opioids (Oxycontin, Vicodin, etc)

38
Trends In Prescription Abuse
  • Polydrug approach
  • Sedative-hypnotic potentiation
  • Sedative-hypnotic opioid potentiation
  • Sedative-hypnotic illicit drugs
  • Sedative-hypnotic/opioid stimulant

39
How Rx Drugs Are Obtained
Steal or divert from medicine cabinet
Buy on the street
Internet
Trade on street (Ritalin for Pot)
40
How Rx Drugs Become Available On The Street
  • 1) Theft from manufacturer, pharmacy, etc.
  • Diversion by health-care workers
  • Manipulate physicians others
  • Clinics
  • - diet clinics, stress clinics, pain clinics,
    etc.
  • 5) Scams for ERs physician
  • casting, blood in urine, X-rays, etc

41
Availability And Accessibility
  • 62 (14.6 million) say Rx pain relievers are easy
    to get from parents medicine cabinets
  • 50 (11.9 million) say easy to get through other
    peoples Rx
  • 52 (12.4 million) say Rx pain relievers are
    available everywhere
  • Source PATS 2006
  • 56 (13.4 million) agree that Rx drugs are easier
    to get than illegal drugs
  • 14 year olds are 4X more likely then 13 year olds
    to be offered Rx drugs (CASA 2006)
  • 39 of 14-20 year olds say it is easy to get Rx
    drugs online or by phone more girls(48) then
    boys(31) said it was easier
  • Source TRU, 2006

42
Cyber Shopping
  • As easy as purchasing a book or CD
  • Only require shipping address payment method
  • May offer secretive shipping trial offers
  • ½ of the sites are outside of U.S. jurisdiction
  • Use pseudonyms, chat rooms, IM, bulletin boards,
    news groups, public internet, money wiring
    services, electronic encryption,etc.
  • www.erowid.org
  • www.pillwatch.com
  • www.pharmacysources.com

43
Prescription Drugs
  • Common Rx Drugs of Abuse
  • Stimulants
  • Sedative hypnotics
  • Opioids
  • Sexual enhancers (E.D. drugs)
  • Anesthetics
  • Anabolic Androgenic Steroids

44
Prescription Drugs
  • Stimulants
  • Amphetamines
  • Adderall Dexedrine
    Desoxyn
  • Methylphenidate (MPH)
  • Ritalin Concerta
  • Others
  • Fastin Plegine Meridia
  • Didrex Sanorex Tenuate

45
30mg Adderall ovals
Stimulants are prescribed for ADHD Obesity
Narcolepsy Depression Non- responsive asthma
25mg Adderall caps
20mg Ritalin caps
10mg Ritalin tablets
46
Prescription Drugs
  • Stimulants
  • Effects of short term use
  • Increased BP Increased Pulse
  • Increased respiration Suppress appetite
    Sleep deprivation
  • Effects of long term use
  • Addiction potential Malnutrition or
    wasting

47
Prescription Drugs
  • Stimulants
  • Negative effects
  • Hypothermiaseizures
  • Arrhythmias
  • Cardiovascular failure
  • Paranoia
  • Psychosis
  • Hostility/aggression
  • Overdose stroke toxic psychosis

48
Prescription Drugs
  • Stimulants
  • Indicators
  • Hyperactivity Euphoria
  • Irritability
    Anxiety
  • Anorexia Weight
    Loss
  • Excessive talking Dilated
    Pupils
  • Dry Mouth and Nose
  • Contra-indications
  • OTC stimulants (decongestants)
  • Antidepressants
  • Asthma Meds

49
Prescription Drugs
Vicodin
  • OPIOIDS
  • Natural (known as opiates)-Morphine-Codeine
  • Semi-Synthetic (known as opioids)-Heroin-Hydroc
    odone (Hycodan)-Hydromorphone (Dilaudid)-Meperid
    ine (Demerol)-Oxycodone (OxyContin,
    Percodan/Percocet, Vicodin)
  • Synthetic (also known as opioids)
  • -Fentanyl (Sublimaze)-Methadone
    (Dolophine)-Propoxyphene (Darvon)-Pentazocine
    (Talwin)

Buprenorphine
Oxycodone/Oxycontin
50
Prescription Drugs
  • OpioidsPrescribed for
  • Relief of post surgical pain
  • Management of acute chronic pain
  • Relief of cough and diarrhea
  • Treatment of opioid dependence
  • Pain Relievers are most abused Rx drug by
    Teens
  • (OxyContin and Vicodin)
  • --Monitoring the Future, 2006

51
Prescription Drugs
  • Opioids
  • OxyContin
  • For higher levels pain
  • Sustained, controlled release oxycodone
  • Fentanyl
  • Sustained, controlled release
  • 30 times the potency of Morphine

52
Prescription Drugs
  • Opioids
  • Effects of Short Term Use
  • Drowsiness
  • Depressed Respiration
  • Analgesia
  • Constipation

53
Prescription Drugs
  • Opioids
  • Objective Symptoms of Influence
  • Constricted Pupils
  • Sleepiness (nodding off)
  • Loss of appetite
  • Twitching/Scratching
  • Possible injection sites and related paraphernalia

54
Prescription Drugs
  • Sedative-Hypnotics
  • Benzodiazepines Barbiturates
  • -Diazepam (Valium) -Butalbital
  • -Alprazolam(Xanax) -Secobarbital
  • -Clonazepam (Klonopin) -Amobarbital
  • -Flunitrazepam (Rohypnol)
  • -Lorazepam (Ativan) Muscle
    Relaxants
  • -Nimetazepam (Erimin) -Soma
  • -Temazepam (Restoril) -Flexeril
  • -Triazolam (Halcion)
  • Hypnotics

  • -Dalmane

  • -Chloral Hydrate

55
Prescription Drugs
  • Sedative-Hypnotics--prescribed for
  • Anxiety
  • Panic Attacks
  • Reduce Stress Reaction
  • Seizure Treatment/Prevention
  • Muscle Relaxant
  • Anesthesia (high doses)
  • Tension

56
Prescription Drugs
  • Sedative-Hypnotics Indicators
  • Appears Drunk
  • Slurred Speech
  • Impaired Judgment
  • Difficulty Concentrating
  • Pupils usually dilated
  • Difficulty Walking
  • Sleepiness
  • Clumsiness

57
Prescription Drugs
  • Sedative-HypnoticsContra-indications
  • Alcohol
  • Opioids
  • Antihistamines
  • Skeletal muscle relaxants

58
Prescription Drugs
  • Anesthetics
  • Ketamine (liquid) Club/Rave Drug
  • Effects specific to Ketamine
  • Out of body experience Gumby Doll period
  • 30-60 minute duration (vs. PCP, several hours)
  • Nitrous Oxide (gas)
  • Effects begin within secondsExhileration, loss
    of coordination, giddiness, floating feeling
  • Adverse effectsHeadache, nausea, vomiting,
    permanent damage using tanks can cause frostbite
    damage

59
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Serving Cumberland, Gloucester and Salem
Counties
The Southwest Council, Inc. Where the Science of
Prevention Meets the
Needs of the Community
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