Drugs, ETOH and K2

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Drugs, ETOH and K2

• Trauma Update
• June 13, 2012
• Carol Nierling, MS, RN
• Trauma Program Manager

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Objectives

• At the conclusion of this presentation, the
  learner will be
• Familiar with K2
• Able to identify signs of Methamphetamine use
• Able to recognize the long (and sometimes short
  term) use of Meth
• Familiar with other types of street drugs
• Familiar with ETOH and why the change

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K2

• What is K2?
• Why the concern?
• Its legal

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CANNABIS
Cannabis

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What is it?

• Genus of flowering plants that include 3 types
• Cannabis sativa
• Cannabis indica
• Cannabis ruderalis

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History Of

• Plant is believed to have originated in the
  Himalayas. Also known as hemp.
• Plant produces a group of chemicals called
  cannabinoids
• Created in mid 1990s
• Lab created
• Called JWH-018 (initials of chemist)
• First smoked in Europe

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K2 and Packaging
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Because K2 is sold in different flavors, grades
and prices, and because we wanted to be thorough,
we got two different kinds each sold in 3-gram
bags. One was the Standard, which cost 15. The
other, Blonde, was a citrus blend and cost twice
as much as the Standard. K2 looks like potpourri
stomped to dust and mixed with confetti, and it
smells about the same. We chose the reliable,
available-at-every-gas-station Zig Zag rolling
papers as our method of conveyence. All we wanted
to know was this "Does K2 really get you high
like marijuana does?"
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Properties

• 10X more potent than THC
• Effects are more similar to meth than to
  marijuana

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Physical Symptoms

• Hallucinations
• Increased agitation
• ? blood pressure and HR

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ISSUES

• Hasnt been studied
• No quality control or regulation
• Never tested on humans
• Effects long term not known
• States regulating
• Like playing Russian Roulette

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St. Louis Pediatrician Experience

• Dr. Anthony Scalzo pediatrian and toxicologist
  at SLU- 30 teens in last 6 weeks
• Alert sent to Missouri ERs advising them that
  local K2 may be tainted
• Asked to collect urine samples however, most
  patients dont want to cooperate

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Many States Have Banned

• News clip from New York News station on May 12,
  2010

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Alcohol
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ETOH and Fatalities
Table 1113. Alcohol Involvement for Drivers in Fatal Crashes 1999 and 2009 Table 1113. Alcohol Involvement for Drivers in Fatal Crashes 1999 and 2009 Table 1113. Alcohol Involvement for Drivers in Fatal Crashes 1999 and 2009 Table 1113. Alcohol Involvement for Drivers in Fatal Crashes 1999 and 2009 Table 1113. Alcohol Involvement for Drivers in Fatal Crashes 1999 and 2009 Table 1113. Alcohol Involvement for Drivers in Fatal Crashes 1999 and 2009 Table 1113. Alcohol Involvement for Drivers in Fatal Crashes 1999 and 2009
BAC blood alcohol concentration BAC blood alcohol concentration BAC blood alcohol concentration BAC blood alcohol concentration BAC blood alcohol concentration BAC blood alcohol concentration BAC blood alcohol concentration
Age, sex, and vehicle type 1999 1999 1999 2009 2009 2009
Age, sex, and vehicle type Number of drivers BAC of .08 or greater Percentage with BAC of .08 or greater Number of drivers BAC of .08 or greater Percentage with BAC of .08 or greater
Total drivers involved in fatal crashes \1 56,502 11,447 20.3 45,230 10,102 22.3
Drivers by age group    
..Under 16 years old 333 32 9.6 181 13 7.2
..16 to 20 years old 7,985 1,346 16.9 5,051 951 18.8
..21 to 24 years old 5,639 1,768 31.4 4,597 1,588 34.5
..25 to 34 years old 11,763 3,245 27.6 8,610 2,722 31.6
..35 to 44 years old 11,059 2,748 24.8 7,757 2,006 25.9
..45 to 54 years old 7,708 1,321 17.1 7,664 1,694 22.1
..55 to 64 years old 4,608 496 10.8 5,276 669 12.7
..65 to 74 years old 3,251 224 6.9 2,868 199 6.9
..75 years old and over 3,346 124 3.7 2,547 85 3.3
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Whos At Most Risk

• Young People
• Motorcyclists fatalities 30 BAC gt 0.08
• Nearly 75 of all drunk drivers were not wearing
  seatbelts
• Drivers with prior DWI convictions
• Those involved in fatal crashes were 8X more
  likely to have a prior conviction for DWI

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Whos Most at Risk

• Weekend drivers (2x more likely to be involved in
  drunk driving fatal crashes.
• Nighttime drivers were 4x as likely to die in
  drunk driving crashes as those during daytime

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2008 Missouri

• 960 fatal crashes
• 310 fatalities alcohol
• 33
• US 32
• Underage drinkers accounted for 14 of drunk
  driving deaths

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Prevention

• Enforcing the 0.08 BAC laws
• Enforce legal drinking age
• Zero tolerance for drivers lt 21
• Sobriety checkpoints
• Health promotion efforts
• Mandatory substance abuse assessment and
  treatment for DWI offenders (ACS requirement)

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What is Methamphetamine?
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Methamphetamine

• Highly addictive central nervous system.
• Chemically related to amphetamine
• Effects on CNS are gt amphetamine
• Can be injected, smoked or snorted

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Magnitude of Problem

• Est. 10.4 million Americans gt 12 have used Meth
  at least once
• 4.3 of population (2005 )

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What does it look like?

• Clear, chunky crystals resembling ice
• Powder

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Crystal Meth
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Methamphetamine Pipe
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Street Names for Meth
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Other Names for Methamphetamine

• Speed Bikers Coffee
• Meth Crank
• Chalk Stove Top
• Ice Crystal or Crystal Meth
• Glass Trash
• Tina Yellow Barn
• Go-Fast

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Symptoms of Use

• ? Wakefulness
• ? Physical Activity
• ? Appetite
• ? Respiration
• Hyperthermia
• Euphoria

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Other Symptoms

• Irritability
• Insomnia
• Confusion
• Tremors
• Convulsions
• Anxiety
• Paranoia

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Physical Symptoms

• ? Heart Rate and BP
• Can cause irreversible damage to blood vessels in
  the brain (producing strokes)
• Irregular heartbeat
• Extreme anorexia

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Effects of Long Term Use

• Fatal kidney and lung disorders
• Brain damage
• Liver damage
• Blood clots
• Chronic depression
• Violent and aggressive behavior
• Malnutrition

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Long Term Effects - cont

• Deficient immune system
• Methamphetamine psychosis

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Pregnancy and Meth Use

• Babies can be born meth addicted
• Low birth weight
• Excessive crying
• Attention deficit disorder
• Behavior disorders
• ?risk of Shaken Baby Syndrome

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How Obtained

• Easily manufactured in clandestine labs using
  store bought material such as
• Red phosphorus
• Hydrochloric acid
• Drain cleaner
• Battery acid

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Ingredients cont

• Over the counter cold and asthma meds containing
  ephedrine or pseudoephedrine
• Lye
• Lantern Fuel
• Antifreeze
• Anhydrous ammonia

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Meth Ingredients
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Meth Recipe
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Clandestine lab Indicators

• Lrg amt of cold tablet containers
• Jars containing clear liquid with a white or red
  colored solution on the bottom
• Jars labeled as containing iodine or dark shiny
  metallic purple crystals in jars
• Jars labeled as containing Red Phosphorus

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Clandestine Labs

• Bottles or jars cont sulfuric, muriatic or
  hydrochloric acid
• Bottles with rubber tubing attached
• Glass cookware with a powdery residue
• Lamp fuel, paint thinner, acetone
• Lrg amts of lithium batteries
• Soft silver or gray metallic ribbon
• Propane tanks with fittings that have turned blue

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Other Indicators

• Brown or dead spots in yard
• Orange-brown or rust colored stains
• Constant seclusion from rest of neighborhood
• No trespassing signs
• Windows are always darkened
• Extreme security
• Windows always darkened

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Indicators Cont

• Frequent visitors at all time of day or night
• Large amounts of garbage

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Smells Assoc with Meth Labs

• Strong smell of urine
• Unusual chemical smells like ether, ammonia or
  acetone

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Anhydrous Ammonia- Steps to prevent theft

• Educate employees
• Store tanks in well lit areas
• Visually inspect tanks daily
• Create valve-protection plan for critical valves
• Consider theft deterrent additives for ammonia

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Meth Labs
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Meth Labs
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Meth Labs
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Labs Can Be Mobile
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Cost of Cleanup

• Clean up averages 5000 per site although
  individual costs may run in excess of 150,000

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Infectious Diseases

• Linked to HIV
• Hepatitis C
• Sexually transmitted diseases

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2009 Data
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Top Meth Bust States 2011
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Methamphetamine in Missouri
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Jan 2010 Battling Meth Fire in Union, MO
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Meth Incidents in MO by Year
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Top 8 Meth Counties 2010
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Article in USA Today

• Drug is uniquely destructive
• Restrictions approved on sale of cold medicines
  that can be used to manufacture (Part of Patriot
  Act)
• Requires retailers to keep cold medicines
  containing pseudoephedrine behind counter and
  customers would have to sign log book. Goes to
  HR week of March 6

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Treatment

• Difficult long term
• Short term relatively quick however
• wall period lasts 6-8 months in casual users
  and 2-3 years in regular users
• Some never able to recover

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Newer Treatment Methods

• Behavioral therapies
• Promising medications
• Depression is factor in withdrawal
• Anti-epileptic medication (TOPAMAX)
• Preliminary study with gamma-vinyl (GABA)
• New generation of monoclonal antibody based
  medications

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Matrix Model

• Initially developed for cocaine addiction
• 16 week program
• Group and individual therapy
• Results meth free urine samples at program
  completion and 6 month follow up (sizeable )

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Meth Withdrawal

• Length and severity of symptoms depend on amount
  of damage done
• Drug craving
• Extreme irritability
• Loss of energy
• Depression
• Fearfulness

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Withdrawal Signs

• Excessive Drowsiness
• Shaking
• Nausea
• Sweating
• ? Appetite

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Methamphetamine Bust
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The Many Faces of Methamphetamines
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Classic Teeth Signs
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Meth Mouth
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Effects of Meth
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Children and Meth
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Effects on Children

• Injury from fire or explosion
• Overdose on meth left out by parents
• Exposure to toxic chemicals
• Physical abuse
• Sexual abuse
• Behavior problems
• Malnutrition
• Substance abuse

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More Local Look

• 12 (1300) of the Children in the State of
  Missouri who are in foster care are there because
  of their parents methamphetamine related
  activities.

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Childs Room
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A Victim
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Give Kids a Chance
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References

• Office of Legislative Policy and Analysis (June
  2006)
• Missouri Foundation for Health
• www.nometh.org
• www.alcoholalert.com/drunk-driving-statistics-miss
  ouri.html
• www.cdc.gov/MotorVehicleSafety/Impaired_Driving/im
  paired-drv_factsheet.html

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References (cont)

• www.thecommunityguide.org/mvoi/AID/mlda-laws.html
• http//www-nrd.nhtsa.dot.gov/Pubs/811155.PDF
• http//en.wikipedia.org/wiki/Cannabis
• http//news.yahoo.com/s/livescience/20100304/sc_li
  vescience/fakeweekrealdrugk2causin..