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Kevin Leehey M.D. Child, Adolescent, and Adult Psychiatry Board Certified

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Title: Kevin Leehey M.D. Child, Adolescent, and Adult Psychiatry Board Certified


1
Kevin Leehey M.D.Child, Adolescent, and Adult
PsychiatryBoard Certified
  • 296-4280
  • leeheymd.com

2
University of ArizonaCampus Health Service
  • Update on Substance Use Among College Students
    1/6/09
  • Kevin Leehey M.D.
  • leeheymd.com
  • 296-4280

3
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4
  • Twenty-five is the best estimate for when the
    brain is reasonably fully mature.

5
The teen brain is more vulnerable to the
stimulating, damaging, and addicting effects of
nicotine, alcohol, and other drugs.
  • One in three teens who start smoking as a teen
    will die of a tobacco related disease.
  • 90 of adult smokers began as teens.
  • Almost 45 of kids who start drinking alcohol by
    13 will become alcoholic, while only 10 of those
    who wait till 21 will.
  • Substance use in youth thus becomes hard wired in
    as a tendency for life. This is in addition to
    any genetic predisposition.

6
  • Healthy Subject watching video of using
  • Substance abuser in remission watching video of
    using

7
Causes of death ages 15-24
8
Causes of death ages 15-24
  • Accidents -primarily motor vehicle, many are
    substance impaired.
  • Suicide
  • Homicide
  • These 3 account for 75 of all deaths in our
    kids. Suicide and homicide are mostly by guns and
    many are substance impaired.

9
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10
SSRI prescription rates in the United States
11
Suicide rates in children and adolescents (aged 5
19 years) in the United States
12
Case 1
  • 19 year old male c/o tired, cant sleep till 3
    am, drags getting up, and is irritable and moody.
    Friends referred him to Student Health concerned
    he has Bipolar d/o. Hes taking Adderall 20 mg
    tablets 4x/d prescribed by his hometown Dr. for
    ADHD at 20 mg BID. BTW, he needs more cuz his
    bottle was stolen at a party.

13
Prescription medicine abuse
  • From family, friends, stolen - often from peers,
    Mexico, online, or take more than prescribed
  • Youth think theyre safer, pure, legal
  • ADHD meds Adderall, Ritalin, MPH, Metadate CD,
    Dexedrine, Focalin, Vyvanse, Strattera
  • Benzodiazepines benzos, Bars (Xanax 2 mg),
    Klonopin (clonazepam), Ativan (lorazepam), Valium
    (diazepam), Roofies (rohypnol - Mexico), etc
  • Muscle relaxers Soma, etc
  • Pain pills Case 6

14
Case 2
  • 21 year old female soph who complains of sleep
    onset problems. Takes only afternoon classes and
    still oversleeps. She says her roommates Ambien
    really helps and heard theres a generic now I
    really want some.

15
Teens do best with 8 to 10 hours sleep, few get
it and phase shift. REM occurs about every 90
minutes. REMs get longer and deep sleep shorter
overnight. REM key for neurotransmitters and
memory. Naps lack REM.
16
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17
Other sleep aides
  • Sleep hygiene
  • CBT Cognitive Behavioral Therapy
  • Relaxation response
  • Melatonin, L-tryptophan
  • Valerian root, kava, chamomile, passion flower
  • Seroquel, Doxepin, amitriptyline

18
Case 3
  • An RA at Coronado insisted John, an 18 year old
    freshman from Chicago, go to Student Health after
    his roommates repeated complaints that John has
    passed out at his computer 3x and has a case each
    of dust, cracks, and Whipped Cream.

19
Inhalants
  • No, not Angel Dust Dust Off
  • No, cracks not crack. BB and Airsoft gun air
    cylinders
  • No, N.O. nitrous oxide, Whip-its
  • Amyl or butyl nitrate Poppers
  • Gas, glue, paint, ether, etc

20
Case 4
  • Sarah from Paradise Valley and Lisa from
    Foothills, both 20, like to party and live
    together off campus. Although by chance each had
    appts separately they mention each other and are
    unforgettably slender well, really too skinny
    showy, have suckers and c/o of crashes, downs
    and want Prozac.

21
Speed and extended family
  • Ecstasy- E, X, XTC, vitamin E, Thizz, happy
    meals, roll pills (rolling), skittles, tads,
    lovers speed
  • Methamphetamine- meth, ice, Glass, G, shards,
    yack, gack, crank, speed, crystal, tweak
  • Ephedrine- as supplement, yellow jacket online,
    in OTC Bronkaid
  • Cocaine- powder, coke, blow, yay-o, yay, crunk
    (coke when drunk)
  • Crack- rock, hard
  • energy drinks, supplements, weight loss
    caffeine, guarana, taurine, ephedrine

22
Hallucinogens
  • LSD- acid, Lucy, stamp
  • mescaline
  • Psilocybin- shrooms, silly
  • Salvia
  • Jimson Weed

23
Dissociatives
  • Phencyclidine- PCP, Angel Dust
  • Ketamine- special K, K hole
  • Dextromethorphan (opiate like)- DM, DXM, Triple
    Cs (Coricidin Cough and Cold also in lots OTC),
    skittles, Robo, Robo tripping
  • GHBgammahydroxybutarateXylem- grievious bodily
    harm, G, liquid ectasy

24
Body builders, bulk thencut
  • Steroids, HGH
  • Ephedrine- Bronkaid (OTC)
  • Energy drinks, caffeine, guarana, taurine
  • Protein supplements
  • Performance enhancing drugs
  • Diet pills, sibutramine, diuretics

25
Case 5
  • Blair denies its an issue but has increased
    weed to 24/7, is not making it to class,
    forgets assignments, and is not concerned. Blair
    was referred by the Dean after 2 years of 3.0
    GPA dropped to 2 Ds, 1 F, and 2 dropped this
    classes semester and paraphernalia possession on
    campus.

26
Marijuana
  • Weed, grass, pot, mary jane, ganja, green, joint,
    blunt, cannabis
  • 2 problem drug in college
  • Amotivational syndrome, apathy
  • short term swiss cheese memory d/o
  • Driving impaired
  • Dependence
  • Withdrawal
  • Increased rate of psychosis
  • 2 of adults over 40 smoke every day

27
Case 6
  • 19 year old Brandons desperate parents called
    his advisor and your office saying he is fine one
    day or for a few days and then is really moody,
    irritable, and ill. Then fine again. As he
    undresses for exam the nurse sees some foil fall
    on the floor. She picks it up and notices a
    sweet acetone like smell and scorch marks.

28
Opiates
  • Vicodin (hydrocodone)- Watsons, vics,
  • Percodan, Percocet (oxycodone)- percs,
  • Oxycontin (oxycodone ER)- use oral or crush and
    snort, 1/mg - oxy, o/cs, oxygen
  • Heroin- smoked in foil, 40-60/gm tar, BT,
    black tar, H, horse, smack, dope, junk
  • Speedball opiate with speed/coke/crack/meth
    killed John Belushi and Chris Farley
  • Death by respiratory suppression- Anna Nicole
    Smith, Heath Ledger and several local youth. 1
    or 2 behind alcohol OD or combo

29
Opiates 1 New Use
30
Case 7
  • This 20 year old tells you hes on probation and
    doing community service and random UAs my
    color is purple for MIP. He proudly shows his
    new 125 AZ DL with DOB showing hes 21. He says
    his occasional use of Triple Cs and Salvia is
    legal, no problem.

31
Drug Screens
  • You cant detect what you dont test for
  • Time frames matter
  • No unobserved urine test is worthwhile lots of
    scams !
  • Medical lab, J-2, OTC, etc
  • Standard urine test MJ, opiate, amphetamine,
    cocaine, benzodiazepine
  • Hair, eyes, blood, breathalyzer, saliva
  • Lots drugs and alcohol dont show
  • A negative test doesnt mean no problem !

32
Smoke and Head Shops
  • Sell smoking accoutrements, luxuries, and
    paraphernalia
  • Sell salvia, amyl and butyl nitrates
  • Sell fake urine and various items to block or
    falsify drug screens

33
Case 8
  • Ginger, a 22 year old 57 115 lb senior,
    sorority officer, was dropped off at the ER at 2
    am semi comatose after 7 double shots vodka in
    30 minutes at a party. This followed a couple
    hours of beer pong at a pre-party.

34
Alcohol
  • The 1 college age substance problem
  • Binge, games, pre-party, rituals
  • Accidents of all types, DUIs, fights, property
    damage, stupid and obnoxious embarrassing
    behavior, suicide, sexual assaults both
    perpetrators and victims

35
Case 9
  • Smokey, 25, a previously devout grad student from
    abroad comes in for a persistent cough and
    decreased endurance when exercising. You are
    concerned that his hookah shisha use has
    expanded to a pack of cigs a day.

36
Tobacco
  • 1 killer (and so much morbidity !) by far, just
    not so soon
  • ashline.org Arizona Smokers Helpline
    1-800-556-6222

37
Actual Causes of Preventable Deaths
38
Case 10
  • Alex attends classes, earns good grades, works
    part time, visits family, has friends, exercises,
    and has goals.

39
  • Most college age youth have no substance problems

40
Thank you and good luck
  • Kevin Leehey M.D.
  • leeheymd.com
  • 296-4280
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