Download RX Drugs-Heroin Power Point Show

Rx Drug Abuse,
A Nation’s
Epidemic
Monday, December 9th , 1:00-4:00 p.m.
Saratoga Springs Public Library, H. Dutcher Community Room
A presentation on the link between prescription drugs
and heroin, how these drugs are getting here, the science
behind it, and what we do now!
MSgt Candace L. Stefanik
New York National Guard Counterdrug Task Force
Overview
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The Epidemic, an overview
Where are they coming from?
Commonly abused drugs
What's the dangers, risk , signs and symptoms
and brain chemistry of opioid abuse
• Statistics
• Strategies
A Nations Epidemic
Prescription narcotics, often called narcotic analgesics, are the most
used and abused substances today. Misuse and abuse of prescription
opioids has reached epidemic proportions in the U.S. according to the
surgeon general
While much of the problem is attributable to illicit drug use,
appropriate use of medications for pain may also lead to unnecessary
adverse events, addiction, and death.
The "war on drugs" has focused nearly exclusively on dealers
trafficking drugs like cocaine, heroin, and marijuana, while most of the
“new drug dealers” live right next door to you. These new dealers are
your Doctors, lawyers, students, teachers, etc. Unwittingly and
unprepared we became a nation obsessively trying to feel good, succeed
and control behavior in our youth. By the time we questioned whether
these legal drugs would have a lasting effect on our nation the death
toll was rising along with the addition rates.
Pharmageddon
Pharmageddon' Is Upon Us
Pharmageddon is "the prospect of a world in which
medicines and medicine produce more ill-health than
health, and when medical progress does more harm
than good" -- and it is no longer a prospect but fully
upon us. Those most at risk from dying from this new
drug crisis are people you would least expect; the
analysis revealed the death toll is highest among
people in their 40s, but all ages, from teenagers to the
elderly, and all walks of life are being affected. In fact,
prescription drugs are now the preferred "high" for
many, especially teens, as they are typically used
legally, which eliminates the stigma of being a
"junkie.“- The Baltimore Sun
Where are they coming from?
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Pharm Parties
Friends/Family
Theft
Dr. Shopping
Drug Dealers
Internet
Legal Prescription
Where is it coming from?
And according to the
2012 Monitoring the
Future survey, about
50 percent of high
school seniors said
that opioid drugs
other than heroin
(e.g., Vicodin) would
be fairly or very easy
to get.
Drug Companies
WHEN THINKING OF STRATAGIES DON’T FORGET WHERE
THEY COME FROM! Here is just a sampling of what the top drug
companies are up to:
• Merck: More than $5.5 billion in judgments and fines levied
against it, it was five years before Merck made its $30-billion recall
of the painkiller Vioxxx.
• Baxter: Dozens of recalls of products that caused deaths and
injuries, at least 11 different guilty pleas to fraud and illegal sales
activity, more than 200 lawsuits – and more than $1.3 billion in
criminal fines and civil penalties.
• Pfizer: In the largest health care fraud settlement in history, Pfizer
was ordered to pay $2.3 billion to resolve criminal and civil
allegations that the company illegally promoted uses of four of its
drugs, including the painkiller Bextra, the antipsychotic Geodon, the
antibiotic Zyvox, and the anti-epileptic Lyrica
Internet - Silk Road
• The site was operated on an anonymous
network known as Tor, making activity
on Silk Road virtually untraceable. The
only money accepted on Silk Road was
the digital currency bitcoin, adding an
additional layer of anonymity to buyers
and sellers.
• The use of bitcoin helped Silk Road
become a giant money laundering
operation, according to the FBI. To
process bitcoin transactions, Silk Road
used what the FBI described as a
"tumbler," a complex system that used
countless dummy transactions to
digitally conceal where the money came
from.
• Over the past two and a half years, the
FBI said the site generated revenue
worth more than 9.5 million bitcoins -valued at $1.3 billion.
• The FBI said Ulbricht's net worth was
essentially his value in Silk Road's
commissions, which totaled more than
600,000 bitcoins ($85 million).
• Silk Road wasn't restricted to illegal
drugs. The FBI says it was also used to
trade firearms, hire assassins and
employ hackers.
NATIONAL / INTERNATIONAL THREATS IMPACTING
NEW YORK STATE
Mexican-based Transnational Criminal Organizations (TCO) and their associates
dominate the supply and wholesale distribution of most illicit drugs in the United
States. These organizations control much of the production, transportation, and
wholesale distribution of illicit drugs destined for and in the United States.
Currently, seven Mexican based TCOs (Sinaloa Cartel, Los Zetas, Gulf Cartel,
Juárez Cartel, BLO, LFM, and Tijuana Cartel) are in a dynamic struggle for
control of the lucrative smuggling corridors leading into the United States,
resulting in unprecedented levels of violence in Mexico. Numerous other types of
organizations and groups are present, active, and thriving. For example,
Colombian based TCOs operate primarily in the Northeast and in southern
Florida, while ethnic Asian, Dominican, and Cuban organizations are expanding
operations. In addition, various street gangs, prison gangs, and outlaw motorcycle
gangs (OMGs) make up the bedrock of retail drug distribution throughout the
country.
UNCLASSIFIED//FO OFFICIAL USE ONLY
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Latin American political leaders have long
argued that if the U.S. population did not
consume such large quantities of illegal
drugs and there were not so many
American drug addicts and users, then
Latin American and Caribbean countries
would not produce such large quantities of
illegal drugs like marijuana, cocaine, and
heroin for export. As a result the region
would not be plagued by the powerful and
well-financed drug trafficking
organizations that have sprung up
throughout the hemisphere over the last
twenty five years plus. The United States
has been for decades, and remains today,
the largest single consumer market for
illicit drugs on the planet. Although there
is no definitive estimate, the value of all
illicit drugs sold annually in the United
States may reach as high as $150 billion.
Some $37 billion per year may be spent on
cocaine alone.
UNCLASSIFIED//FOR OFFICIAL USE ONLY
10
NATIONAL / INTERNATIONAL THREATS IMPACTING
NEW YORK STATE
The Mexican-based organizations’ preeminence derives from a competitive
advantage based on several factors, including access to and control of smuggling
routes across the U.S. Southwest Border and the capacity to produce (or obtain),
transport, and distribute nearly every major illicit drug of abuse in the United
States. These advantages are unlikely to change significantly in the short term,
ensuring the dominance of Mexican-based TCOs for at least the next several
years. Mexican-based TCOs were operating in more than a thousand U.S. cities
during 2009 and 2010, spanning all nine Organized Crime Drug Enforcement
Task Force OCDETF regions. (New York and New Jersey have their own region)
UNCLASSIFIED//FOR OFFICIAL USE ONLY
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NATIONAL / INTERNATIONAL THREATS IMPACTING
NEW YORK STATE
Ethnic Dominican trafficking organizations are significant cocaine and heroin
distributors in the New York/New Jersey and New England Regions. They are
expanding their networks of suppliers and drug distribution operations.
Dominican TCOs obtain cocaine and South American heroin from Colombian
TCOs and smuggle the drugs into the United States for distribution, primarily in
Northeastern markets. They also distribute cocaine, heroin, and marijuana in the
Southeast Region. The involvement of ethnic Dominican organizations in
domestic drug trafficking will increase in the near term as they continue to
develop and expand trafficking connections. Dominican trafficking organizations
are unique in that they operate independently of one another. There exists no
national or regional leadership and no centralized direction of their activities.
Consequently, the expansion of these organizations will be contingent on the
exploitation of local opportunities.
UNCLASSIFIED//FOR OFFICIAL USE ONLY
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Drug availability in the united states
Heroin: The availability of heroin in the United States and the number of markets
in which it is available is increasing as a result of increased production in Mexico,
even as Colombian production declines. The level of illicit poppy cultivation in
Mexico was second only to that in Afghanistan in 2009, potentially producing an
estimated 50 metric tons of heroin. The overwhelming bulk of the heroin produced
in Mexico is destined for the United States. The increase in Mexican heroin
production coupled with increased transportation of South American heroin by
Mexican TCOs correlates with an increase in heroin seizures along the Southwest
Border, the primary pipeline for U.S. heroin supplies. In addition, these factors
have likely contributed to increased heroin availability in some U.S. markets,
including Illinois, Missouri, New York, North Carolina, Pennsylvania, and South
Carolina. Some cocaine distributors are switching to heroin sales because of the
continuing cocaine shortage and the higher availability of heroin. This trend has
increased the accessibility of heroin to existing users and created new users in
some markets, particularly in the Northeast and Mid-Atlantic regions. As a result,
some drug abusers have experimented with heroin when their primary drug of
choice crack or powder cocaine was not available, and some cocaine users seem
willing to switch to heroin despite significant differences between the two drugs.
UNCLASSIFIED//FOR OFFICIAL USE ONLY
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HEROIN TRANSPORTATION ROUTES
UNCLASSIFIED//FOR OFFICIAL USE ONLY
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MDMA TRANSPORTATION ROUTES
MDMA is generally transported from POEs
in Washington, Michigan, New York, and Vermont
to markets throughout the United States.
UNCLASSIFIED//FOR OFFICIAL USE ONLY
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Molly-MDMA
• Someone who buys or takes Molly now is probably ingesting dangerous
synthetic drugs that have not been tested and are produced in widely
varying strengths. The DEA says only 13% of the Molly seized in New York
state the last four years actually contained any MDMA, and even then it
often was mixed with other drugs. The drugs frequently found in Molly are
Methylone, MDPV, 4-MEC, 4-MMC, Pentedrone and MePP.
What does Molly do?
• The lab-created chemicals mimic the effects of MDMA; most of them are
central nervous system stimulants that cause euphoric highs. They can also
cause a rapid heartbeat, high blood pressure, blood vessel constriction and
sweating, and can prevent the body from regulating temperature. Some of
the chemicals have been reported to cause intense, prolonged panic attacks,
psychosis and seizures.
• After they wear off, the chemicals can cause devastating depression. Several
of these compounds have caused deaths.
(Drew Griffin. Nelli Black and Patricia DiCarlo, CNN Investigations)
CLANDESTINE LABORATORY
RESPONSES / INCIDENTS
(Incidents include: dumpsites & other
meth related incidents
indirectly related to production)
MET
H
ANHYDROUS
AMMONIA THEFT
2013
(as of November 7, 2013)
TOTAL LABS / INCIDENTS: 119
Commonly Abused Drugs
Benzodiazepines: Valium, Xanax
• Valium and Xanax
are examples of
benzodiazepines,
another type of
depressant. They may
be prescribed to treat
anxiety, acute stress
reactions, panic
attacks, convulsions,
and sleep disorders
(typically for shortterm use). Like other
depressants, they
have reasonable uses
but may be abused.
Withdrawal from
benzodiazepines "can
be problematic" but
is rarely lifethreatening, notes
the National Institute
on Drug Abuse
(NIDA).
Sleep Medicines
• Sleep
medicines are
depressants.
The sleep
drugs Ambien,
Sonata, and
Lunesta are
newer sleep
medicines
called
nonbenzodiaze
pines. These
drugs may
have less
potential for
addiction than
other
depressants.
Barbiturates
• Prescribed to ease
anxiety or promote sleep,
depressants slow the
brain's function.
• Barbiturates are a type of
depressant.
Phenobarbital is a
barbiturate; others are
Mebaral, Seconal, and
Nembutal.
• Though helpful when
used as prescribed,
barbiturates can be
addictive. If taken with
certain drugs, including
alcohol, the heart and
breathing can slow,
which can lead to death.
Slang for barbituates
includes "barbs," "reds,"
red birds," "phennies,"
"tooies," "yellows," and
"yellow jackets."
Codeine and Morphine
• Pain relievers are
another group of
prescription drugs
that are commonly
abused. They include
codeine and
morphine. Brands of
morphine include
Avinza, Kadian, MS
Contin, Oramorph,
and Roxanol.
Morphine is typically
prescribed for severe
pain; codeine, for
milder pain. Street
names for codeine
include "Captain
Cody" and "Cody."
Slang for morphine
includes "M" and
"Miss Emma
Vicodin, Lortab, Lorcet
• Vicodin, Lortab,
and Lorcet contain
the opioid
hydrocodone plus
acetaminophen.
Opioids can cause
drowsiness,
constipation, and
may depress
breathing,
depending upon
how much you take.
Vicodin's street
names include
"vike" and
"Watson-387."
Vicodin, or any
other prescription
drug, shouldn't be
shared; it's only for
the patient with the
prescription.
Amphetamines
• Stimulants increase
alertness, attention, and
energy. They're
prescribed for
narcolepsy, attention
deficit hyperactivity
disorder (ADHD), and
depression that doesn't
respond to other
treatments. The ADHD
drugs Dexedrine and
Adderall, are stimulants
called amphetamines,
which may be abused by
people looking for a
sense of euphoria. Risks
include fast or irregular
heartbeat, reduced
appetite, heart failure,
nervousness, insomnia,
and addiction.
Nicknames for
amphetamines include
"bennies," "black
beauties," and "speed.“
OxyContin, Percocet
• OxyContin,
Percocet, Percodan,
and Roxicodone
share an active
ingredient,
oxycodone, which is
an opioid pain
reliever. These drugs
aren't identical;
Percocet also
contains
acetaminophen,
while Percodan also
contains aspirin.
These drugs should
only be taken under
medical supervision.
Street names
include "oxy,"
"O.C.," and
"oxycotton" for
OxyContin and
"percs" for Percocet
or Percodan.
Dextromethorphan (DXM)
• Dextromethorphan
(DXM) is the active
ingredient in many
nonprescription
cough and cold
medicines. Those
products are safe
when taken as
recommended, but
very large doses can
lead to euphoria and
impaired judgment -as well as nausea and
vomiting, loss of
coordination, and
increased heart rate.
DXM's street names
include "Orange
Crush," "Triple Cs,"
"Dex," "Robo," and
"Skittles."
Methylphenidate
• Methylphenidate is a
stimulant found in the
ADHD drugs Ritalin,
Concerta, Metadate,
and Methylin. Its
nicknames include
"MPH," R-ball,"
"Skippy," "the smart
drug," and "vitamin
R." Taking high doses
of a stimulant can lead
to a dangerously high
body temperature, an
irregular heartbeat,
and the potential for
cardiovascular failure
or lethal seizures
Identifying a Suspicious Pill
• Found a random pill and
want to know what it is?
WebMD's Pill
Identification Tool
may help. But because
there are hundreds of
drugs and thousands of
pills and tablets of all
shapes, colors, and sizes,
try taking the pill to a
pharmacist to get help
identifying it.
Pseudoephedrine
• Pseudoephedrine
is commonly
found in
nonprescription
cold medicines.
It's used as an
ingredient for
making the
illegal drug
methamphetami
ne ("meth").
That's why there
are laws limiting
the amount of
pseudoephedrine
-containing drug
products that can
be bought at a
time.
WebMD Identifying tool
Identifying a
Suspicious Pill
Found a random pill
and want to know what
it is? WebMD's Pill
Identification Tool may
help. But because there
are hundreds of drugs
and thousands of pills
and tablets of all
shapes, colors, and
sizes, try taking the pill
to a pharmacist to get
help identifying it.
Heroin
Heroin’s History
• First synthesized from morphine in 1874, heroin was not extensively used in
medicine until the beginning of this century. Commercial production of the
new pain remedy was first started in 1898. While it received widespread
acceptance from the medical profession, physicians remained unaware of
its potential for addiction for years. The first comprehensive control of
heroin in the United States was established with the Harrison Narcotic Act
of 1914.
• The biggest global threat from the Taliban is, by far, the drugs created from
Afghan opium poppies, which the United Nations Office on Drugs and
Crime said is responsible for 100,000 deaths each year worldwide.
• The $65-billion global market for heroin, opium and morphine also helps
fund terrorist and insurgent operations, including up to $600 million
annually for the Taliban.
• Law-enforcement seizes only about 20 percent of illicit opiate traffic,
according to the report.
• Opium Wars broke out in the late 1850s. These wars gave the English
language the expression "gunboat diplomacy" and secured Hong Kong as a
British colony until 1997. Indeed, the import and export of opium was
crucial to the British economy until its prohibition in the early 20th century.
Opium-Heroin
• Opium grows in Southeast Asia, Southwest Asia,
and Western Hemisphere (Mexico, Guatemala,
and Colombia) Opium is converted into heroin
in laboratories. Opium grown in Afghanistan
and South West Asia is generally consumed in
Asian and European markets. North and South
America gets theirs from Columbia and Mexico.
Afghanistan had become the world leader in
supply of opium, producing about 92% of total
worlds supply.
Opium
• Opium consist of morphine, codeine, thebaine and
other substances. This is used to make heroin. Just
before reaching maturity the poppy plant produces a
flower. In a week these petals fall off leaving a
capsule. The surface of the capsule is “scored” with a
knife with 3-4 blades. Opium gum oozes from the
cuts. The next day it is “scrapped”. The plant can be
scored 3-5 times before being cut to dry and its
seeds are extracted for next years harvest. The
farmers allows to dry for several days then wraps the
gum in banana leaves or plastic.
Heroin
• Heroin, an illegal opiate drug known on the street as
smack, junk, brown sugar, dope, horse, skunk and
other names is derived from the resin of the poppy
plant which grows predominantly in southeast and
southwest Asia, Mexico and now in Colombia. It is
manufactured in remote laboratories using
rudimentary equipment which presses the powder
into bricks for bulk shipment to destination
countries like the United States. Smaller amounts
are smuggled by couriers who swallow heroin-filled
latex balloons before boarding commercial airlines.
Heroin
• Pure heroin is a white powder with a bitter taste. Most
illicit heroin is a powder form which may vary in color
from white to dark brown because of impurities left from
the manufacturing process or the presence of additives.
Pure heroin is rarely sold on the street. A "bag" --slang
for a single dosage unit of heroin--may contain 100 mg
of powder, only a small portion of which is heroin. The
remainder could be sugars, starch, powdered milk, or
quinine. Traditionally the purity of heroin in a "bag" has
ranged from one to ten percent. More recently, heroin
purity has ranged from one to ninety-eight percent, with
a national average of thirty-five percent.
Heroin
• Another form of heroin, "black tar," has also become
increasingly available in the western United States.
The color and consistency of black tar heroin results
from the crude processing methods used to illicitly
manufacture the substance in Mexico. Black tar
heroin may be sticky, like roofing tar or hard like
coal, and its color may vary from dark brown to
black. It is often sold on the street in its tar-like state
at purities ranging from twenty to eighty percent.
This heroin is most frequently dissolved, diluted and
injected.
Heroin
• The typical heroin user today consumes more heroin than a typical
user did just a decade ago, which is not surprising given the higher
purity currently available at the street level. Until recently, heroin in
the United States almost exclusively was injected either
intravenously (rapid onset 7-8 seconds), subcutaneous (skinpopping), or intramuscularly(slower onset 5-8 minutes). Injection is
the most practical and efficient way to administer low-purity heroin.
The availability of higher purity heroin has meant that users now
can snort or smoke the narcotic ( onset 10-15 min.). Evidence
suggests that heroin snorting is widespread or increasing in those
areas of the country where high-purity heroin is available, generally
in the northeastern United States. This method of administration
may be more appealing to new users because it eliminates both the
fear of acquiring syringe-borne diseases such as HIV/AIDS and
hepatitis, and the historical stigma attached to intravenous heroin
use.
Heroin
• Two types of heroin
being sold in the US
Midwest: a grey soft
powder of medium-low
potency, and a tan
rocked powder of
medium-strong to
strong potency. Both
were analyzed and both
were found to be cut
with quinine. The
greyer powder was also
cut with lactose.
• Photo by Hammilton.
© 2013 Erowid.org
• Heroin
What's the dangers, risk , signs and symptoms?
Opioids are narcotic, painkilling drugs produced naturally
from opium or made synthetically. This class of drugs
includes heroin, morphine, codeine, methadone and
oxycodone (OxyContin).
Signs of narcotic use and dependence can include:
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Reduced sense of pain
Sedation
Depression
Confusion
Constipation
Slowed breathing
Needle marks (if injecting drugs)
Effects of Heroin
PRESCRIPTION OPIOIDS
• Fractures from falls in patients
aged 60 years and older
• Fatal overdose from respiratory
depression. Opioids
suppress respiratory drive and
decrease respiratory rate.
Respiratory depression is more
common with use of alcohol,
benzodiazepines, antihistamines,
and barbiturates.
• Tolerance, physical dependence,
withdrawal, and opioid
dependence (addiction)
• Drowsiness
• Increased pain sensitivity
(hyperalgesia)
• Sexual dysfunction and other
endocrine effects
• Constipation
• Nausea/vomiting
• Chronic dry mouth
• Dry skin/itching/pruritus
Barbiturates and benzodiazepines
Barbiturates and benzodiazepines are prescription central
nervous system depressants. Phenobarbital, amobarbital
(Amytal) and secobarbital (Seconal) are examples of
barbiturates. Benzodiazepines include tranquilizers, such as
diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan),
clonazepam (Klonopin) and chlordiazepoxide (Librium)
Signs of use and dependence can include:
• Drowsiness
• Slurred speech
• Lack of coordination
• Memory problems
• Confusion
• Slowed breathing and decreased blood pressure
• Dizziness
• Depression
Club Drugs
Club drugs are drugs commonly used by teens and young adults at clubs,
concerts and parties. Examples include Ecstasy (MDMA), GHB, Rohypnol
("roofies") and ketamine. These drugs are not all classified in the same
category, but they share some similar effects and dangers.
Signs of club drug use and dependence can include:
• An exaggerated feeling of great happiness or well-being (euphoria)
• Reduced inhibitions
• A heightened or altered sense of sight, sound and taste
• Amphetamine-like effects (with ketamine and Ecstasy)
• Decreased coordination
• Poor judgment
• Memory problems or loss of memory
• Increased or decreased heart rate and blood pressure
• Drowsiness and loss of consciousness (with GHB and Rohypnol)
• GHB and Rohypnol are particularly dangerous. At high doses, they can
cause seizures, coma and death. The danger increases when these drugs are
taken with alcohol. Because they worsen consciousness and memory and
they're easy to give someone without his or her knowledge or consent, these
drugs are both commonly used as date-rape drugs.
Methamphetamine, cocaine and
other stimulants
This class of drugs includes amphetamines, methamphetamine, cocaine and methylphenidate
(Ritalin).
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Signs of use and dependence can include:
Euphoria
Decreased appetite
Rapid speech
Irritability
Restlessness
Depression as the drug wears off
Nasal congestion and damage to the mucous membrane of the nose in users who snort
drugs
Insomnia
Weight loss
Increased heart rate, blood pressure and temperature
Paranoia
Methamphetamine, also known as "meth," is a particularly dangerous drug. It's highly
addictive and causes a number of short-term and long-term health consequences.
Methamphetamine is relatively inexpensive and widely available.
Hallucinogens
Use of hallucinogens produces different signs and symptoms depending on the drug. The most
common hallucinogens are LSD and phencyclidine (PCP).
Signs of LSD use include:
• Hallucinations
• Greatly reduced perception of reality, for example, interpreting input from one of your
senses as another, such as hearing colors
• Permanent mental changes in perception
• Rapid heart rate
• High blood pressure
• Tremors
• Flashbacks, a re-experience of the hallucinations — even years later
Signs of PCP use include:
• Hallucinations
• Euphoria
• Delusions
• Panic
• Loss of appetite
• Depression
• Aggressive, possibly violent behavior
Brain Chemistry
Dr. Nora D. Volkow, the neuroscientist in charge of the National Institute on
Drug Abuse stated that “ it all boils down to pretty much the same thing,
addiction is all about the dopamine. The pleasure, pain and devilish problem of
control are simply the detritus left by waves of this little molecule surging and
retreating deep in the brain.”
Risk Factors
People of any age, sex or economic status can become addicted to a
drug. However, certain factors can affect the likelihood of your
developing an addiction:
• Family history of addiction. Drug addiction is more common in
some families and likely involves the effects of many genes. If you
have a blood relative, such as a parent or sibling, with alcohol or
drug problems, you're at greater risk of developing a drug
addiction.
• Being male. Men are twice as likely to have problems with drugs.
• Having another psychological problem. If you have a
psychological problem, such as depression, attentiondeficit/hyperactivity disorder or post-traumatic stress disorder,
you're more likely to become dependent on drugs.
• Peer pressure. Particularly for young people, peer pressure is a
strong factor in starting to use and abuse drugs.
• Lack of family involvement. A lack of attachment with your
parents may increase the risk of addiction, as can a lack of parental
supervision.
• Anxiety, depression and loneliness. Using drugs can become
a way of coping with these painful psychological feelings.
• Taking a highly addictive drug. Some drugs, such as heroin
and cocaine, cause addiction faster than do others.
• Age of first onset
• Generation “Y” brain priming
Master Control
The human brain is made up
about 100,000,000,000
information processing cells,
called neurons. The neurons are
connected by 'wires' that carry
electrical signals, rather like the
wires in a computer do. The total
length of these 'wires' in a
human brain is about 100,000
miles! That's half the distance
between the earth and the
moon.
Brain Chemistry
• There are approximately 50 neurotransmitters
identified. There are billions of nerve cells located in
the brain, which do not directly touch each other.
Nerve cells communicate messages by secreting
neurotransmitters. Neurotransmitters can excite or
inhibit neurons (nerve cells). Some common
neurotransmitters are acetylcholine, norepinephrine,
dopamine, serotonin and gamma aminobutyric acid
(GABA). Acetylcholine and norepinephrine are
excitatory neurotransmitters while dopamine,
serotonin, and GABA are inhibitory. Each
neurotransmitter can directly or indirectly influence
neurons in a specific portion of the brain, thereby
affecting behavior.
Brain Chemistry cont.
• in a structure called the postsynaptic membrane of another nearby neuron.
Once the neurotransmitter is picked up by receptors in the postsynaptic
membrane, the molecule is internalized in the neuron and the impulse
continues. This process of nerve cell communication is extremely rapid.
• Once the neurotransmitter is released from the neurotransmitter vesicles of
the presynaptic membrane, the normal movement of molecules should be
directed to receptor sites located on the postsynaptic membrane. However,
in certain disease states, the flow of the neurotransmitter is defective. For
example, in depression, the flow of the inhibitory neurotransmitter
serotonin is defective, and molecules flow back to their originating site (the
presynaptic membrane) instead of to receptors on the postsynaptic
membrane that will transmit the impulse to a nearby neuron.
• The mechanism of action and localization of neurotransmitters in the brain
has provided valuable information concerning the cause of many mental
disorders, including clinical depression and chemical dependency, and in
researching medications that allow normal flow and movement of
neurotransmitter molecules.
Brain Chemistry
Drug addictions
• Cocaine and crack cocaine are psychostimulants that affect neurons
containing dopamine in the areas of the brain known as the limbic and
frontal cortex. When cocaine is used, it generates a feeling of confidence and
power. However, when large amounts are taken, people "crash" and suffer
from physical and emotional exhaustion as well as depression.
• Opiates, such as heroin and morphine, appear to mimic naturally occurring
peptide substances in the brain that act as neurotransmitters with opiate
activity called endorphins. Natural endorphins of the brain act to kill pain,
cause sensations of pleasure, and cause sleepiness. Endorphins released with
extensive aerobic exercise, for example, are responsible for the "rush" that
long-distance runners experience. It is believed that morphine and heroin
combine with the endorphin receptors in the brain, resulting in reduced
natural endorphin production. As a result, the drugs are needed to replace
the naturally produced endorphins and addiction occurs. Attempts to
counteract the effects of the drugs involve using medications that mimic
them, such as nalorphine, naloxone, and naltraxone .
Brain Chemistry
Neurons can become sensitized or desensitized to dopamine
• One important aspect of drug addiction is how cells adapt to previous drug
exposure.
• For example, long-term treatment with dopamine antagonists increases the
number of dopamine receptors. This happens as the nervous system tries to
make up for less stimulation of the receptors by dopamine itself. Likewise,
the receptors themselves become more sensitive to dopamine. Both are
examples of the same process, called sensitization.
Brain Chemistry
• An opposite effect
occurs after
dopamine or
dopamine agonists
repeatedly stimulate
dopamine receptors.
Here
overstimulation
decreases the
number of
receptors, and the
remaining receptors
become less
sensitive to
dopamine. This
process is called
desensitization.
Brain Imaging
There tends to be several similarities seen among classes
of drugs when it comes to brain imaging. The most
common similarity among drug and alcohol abusers is that
the brain has an overall toxic look to it. In general, the
SPECT (Brain Images) studies look less active, more
shriveled, and overall less healthy. A “scalloping effect” is
common amongst drug abusing brains.
Normal brain patterns show smooth activity across the
cortical surface. Scalloping is a wavy, rough sea-like look
on the brain’s surface. This pattern is also seen in patients
who have been exposed to toxic fumes or oxygen
deprivation. www.studentdrugtesting.org/15.%20Chapter15.PDF
Brain Imaging SPECT
Normal brain view 39 y/o
top down surface view, full
symmetrical activity
39 y/o -- 25 yr. hx of frequent
heroin use, top down surface view
marked overall decreased activity
Brain Imaging SPECT
39 y/o -- 25 yrs. of frequent heroin use
40 y/o, 7 yrs. on methadone
heroin 10 yrs. prior
Statistics
NIDA, SAMHSA, PATS, DAWN
Drug Free. org
Statistics
• Nearly One-Third of
Parents Believe
Stimulants Can Improve
Academic
Performance, Even for
Teens Who Do Not Have
Attention Deficit
Hyperactivity Disorder ~
Overview
Rx Access Points—
Friends & Family Source of Concern
SAMHSA. (2008). Results from the 2007 National Survey on Drug Use and Health: National Findings
(Office of Applied Studies, NSDUH Series: H-34, DHHS Publication No. SMA 08-4343). Rockville, MD.
Available at: www.oas.samhsa.gov/nsduh/2k7nsduh/2k7Results.pdf
RX ABUSE PREVENTION TOOLKIT - from awareness to action
Concerning Trends in Teen Prescription Drug Abuse According
to the New PATS Data (Partnership Attitude Tracking Study
(2008-2012)
The new PATS data confirm that misuse and abuse of prescription drugs
is now a normalized behavior among teens:
• One in four teens (24 percent) reports having misused or abused a
prescription drug at least once in their lifetime (up from 18 percent in
2008 to 24 percent in 2012), which translates to about 5 million teens.
That is a 33 percent increase over a five-year period.
• Almost one in four teens (23 percent) say their parents don’t care as
much if they are caught using Rx drugs without a doctor’s prescription,
compared to getting caught with illegal drugs.
• Of those kids who said they abused Rx medications, one in five (20
percent) has done so before age 14.
• More than a quarter of teens (27 percent) mistakenly believe that
misusing and abusing prescription drugs is safer than using street
drugs.
• One-third of teens (33 percent) say they believe “it’s okay to use
prescription drugs that were not prescribed to them to deal with an
injury, illness or physical pain.”
Statistics
Rx stimulants are a key area of concern, with misuse and abuse of Ritalin and
Adderall in particular driving the noted increases in teen medicine abuse.
Stimulants are a class of drugs that enhance brain activity and are commonly
prescribed to treat health conditions including ADHD and obesity. The 2012 data
found:
• One in eight teens (about 2.7 million) now reports having misused or abused
the Rx stimulants Ritalin or Adderall at least once in their lifetime.
• 9 percent of teens (about 1.9 million) report having misused or abused the Rx
stimulants Ritalin or Adderall in the past year (up from 6 percent in 2008)
and 6 percent of teens (1.3 million) report abuse of Ritalin or Adderall in the
past month (up from 4 percent in 2008).
• One in four teens (26 percent) believes that prescription drugs can be used as
a study aid.
Statistics
Abuse of prescription pain medicine remains at unacceptably high levels among
teens, but the new PATS data show it may be flattening. Teen abuse of
prescription pain relievers like Vicodin and OxyContin has remained stable since
2011, with one in six teens (16 percent) reporting abuse or misuse of an Rx pain
reliever at least once in their lifetime and one in 10 teens (10 percent) admitting to
abusing or misusing an Rx painkiller in the past year.
Statistics
• Almost one-third of parents (29 percent) say they believe ADHD medication can
improve a child’s academic or testing performance, even if the teen does not
have ADHD.
• One in six parents (16 percent) believes that using prescription drugs to get high
is safer than using street drugs.
• Teens reported that during the last conversation they had with their parents
regarding substance abuse, only 16 percent said they discussed the misuse or
abuse of prescription pain relievers with their parents, and just 14 percent
indicate the same for discussions about any type of prescription drug. In
comparison, a majority of teens (81 percent) say they have discussed the risks of
marijuana use with their parents, 80 percent have discussed alcohol and nearly
one-third of teens (30 percent) have discussed crack/cocaine.
• More than half of teens (56 percent) indicate that it’s easy to get prescription
drugs from their parent’s medicine cabinet. In fact, about half of parents (49
percent) say anyone can access their medicine cabinet.
• More than four in 10 teens (42 percent) who have misused or abused a
prescription drug obtained it from their parent’s medicine cabinet. Almost half
(49 percent) of teens who misuse or abuse Rx medicines obtained them from a
friend.
Statistics
Teens are more likely to use
prescription drugs if they believe
that their parents are more
lenient toward prescription drug
misuse or abuse compared to
illegal drug abuse, and if their
parents use drugs themselves.
One in five parents (20 percent)
report that they have given their
teen a prescription drug that was
not prescribed for them.
The PATS survey also found that
17 percent of parents do not throw
away expired medications, and 14
percent of parents say that they
themselves have misused or
abused prescription drugs within
the past year.
PATS Methodology
The 24th annual Partnership
Attitude Tracking Study (PATS) of
3,884 teens in grades 9-12 and 817
parents is nationally projectable
with a +/- 2.1 percent margin of
error for the teen sample and +/3.4 percent for the parent sample.
Conducted for The Partnership at
Drugfree.org and MetLife
Foundation by GfK Roper Public
Affairs & Corporate
Communications, the 2012 PATS
teen survey was administered in
private, public and parochial
schools, while the parent survey
was conducted through in-home
interviews by deKadt Marketing
and Research, Inc.
Statistics
Between 2004 and 2009, the number of
emergency department visits for opioid
analgesic misuse and abuse in New York City
more than doubled, rising from approximately
4500 to more than 9000 visits.
• In 2009, 1 in every 4 unintentional drug
poisoning (overdose) deaths in NYC
involved prescription opioid analgesics,
excluding methadone.
• In NYC, one-third of unintentional drug
poisoning overdose deaths involve a
benzodiazepine the most common
is alprazolam (Xanax®).
Risks of unintentional poisoning may be
increased when opioids are taken with
benzodiazepines because both cause
respiratory depression.
NONOPIOID APPROACHES TO
MANAGING PAIN
Pharmacologic approaches include:
• Acetaminophen
• Selected anticonvulsants
• Selected antidepressants
• Capsaicin (for neuropathic pain)
• Corticosteroids
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Transdermal lidocaine
Nonpharmacologic approaches include:
• Behavioral management (eg, assessment for
depression/stress, chemical dependency)
• Physical therapy
• Self-management therapies (eg, relaxation,
cognitive behavioral therapy)
• Chiropractic care
• Acupuncture
• Bio-feedback
•
•
•
•
•
CPE’s
Educate!
Implement Trainings
De-stigmitize
Write!
Conclusion
It is shown that universal drug prevention
strategies have proven to be effective. Preventing
this abuse can improve quality of life, increase job
performance, academic performance, decrease
financial cost in the judicial system as well as
health care cost, military preparedness and the
cost of lives. It is important that we now do all we
can to educate and prevent any further damage.