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

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Kevin Leehey M.D.Child, Adolescent, and Adult
PsychiatryBoard Certified

• 296-4280
• leeheymd.com

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University of ArizonaCampus Health Service

• Update on Substance Use Among College Students
  1/6/09
• Kevin Leehey M.D.
• leeheymd.com
• 296-4280

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

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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.

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• Healthy Subject watching video of using

• Substance abuser in remission watching video of
  using

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Causes of death ages 15-24
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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.

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SSRI prescription rates in the United States
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Suicide rates in children and adolescents (aged 5
19 years) in the United States
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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.

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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

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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.

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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.
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Other sleep aides

• Sleep hygiene
• CBT Cognitive Behavioral Therapy
• Relaxation response
• Melatonin, L-tryptophan
• Valerian root, kava, chamomile, passion flower
• Seroquel, Doxepin, amitriptyline

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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.

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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

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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.

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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

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Hallucinogens

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

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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

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Body builders, bulk thencut

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

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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.

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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

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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.

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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

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Opiates 1 New Use
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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.

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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 !

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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

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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.

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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

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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.

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Tobacco

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

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Actual Causes of Preventable Deaths
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Case 10

• Alex attends classes, earns good grades, works
  part time, visits family, has friends, exercises,
  and has goals.

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• Most college age youth have no substance problems

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Thank you and good luck

• Kevin Leehey M.D.
• leeheymd.com
• 296-4280