Download What`s New on the Streets

From Heroin, Flakka, Spice,
Bath Salts, BHO and
Meth…What’s On the Streets?
Geoff Wilson, LCSW, CADC
The Ridge Behavioral Health System
Where have we been?
Alcohol
Marijuana
Cocaine/Crack Cocaine
Inhalants
LSD/Ectasy
Speed
MARIJUANA USE CONTINUES TO RISE
AMONG U.S. TEENS
Marijuana use among teens rose in 2012
for the fifth straight year. Daily marijuana
use among high school seniors is now at a
30 year peak among high school seniors.
"Put another way, one in every fifteen high
school seniors today is smoking pot on a
daily or near daily basis," said Lloyd
Johnston, the principal investigator of the
study, "And that's the highest rate that we
have seen over the past thirty years—
since 1981."
Source: Monitoring
the Future
Marijuana
Much more available
Much more potent
Much greater negative effect on short-term memory,
mood, leading to anhedonia and amotivational syndrome
Correlation to school functioning, truancy, etc.
What do we think???
Natural vs. Man Made
1%THC vs. 37.2%THC
Issues with Edible Marijuana!
Dr. Dan Hehir from the Telluride Medical Center
found high potency edible marijuana products
may also be related to the higher rate or ER
visits. Smoking the drug gives users a more
consistent and fast-acting dose of THC –
roughly 5 milligrams – whereas the THC in
edible marijuana products takes longer to go
into effect, leading many users to overeat and
ingest too much of the chemical.
"Eating just one 100mg edible would be like
smoking 20 hits of marijuana," Hehir wrote.
"This may be possible for a heavy user, but for
many it's enough to create problems. "
Which one is the real Reese’s
Cup??
Serious Issues with Edibles!!
Dr. Richard Zane, head of the Department of
Emergency Medicine at the University of
Colorado Hospital, says the increase coincides
with the legalization of recreational marijuana.
Dr. Zane says young, otherwise healthy adults
are showing up at his emergency room agitated
and anxious. He says some are hallucinating.
“They will say they see things or hear things that
aren’t there," Zane says. "They see things on the
wall or smell things.”
"This is not your grandma’s
marijuana," says Dr. Zane.”
"It’s [one] thing to say that one person who’s
used marijuana before is gonna smoke a
marijuana cigarette or eat one small piece of
chocolate," says Zane. "It’s another thing
when you have college students who are
pretty naive who are sucking on a THCinfused lollipop and are psychotic for two or
three days because they’ve never had this
level of THC or this strength."
Is Marijuana Addictive???
What percentage of the population develops
Marijuana Addiction, Abuse, Dependence, etc..??
NORML reported that “approximately 8% of
marijuana users develop a pattern of abuse and
dependence problems”.
(NORML, recorded testimony to Congress 1999 Cannabis Dependence: Its Nature,
Consequences and Treatment, Marlatt, 2006)
Research suggests that about 1 in 11 users
becomes addicted to marijuana (Anthony, 1994;
Lopez-Quintero 2011).This number increases
among those who start as teens (to about 17
percent, or 1 in 6) and among people who use
marijuana daily (to 25-50 percent) (Hall, 2009a;
Hall, 2009b).
Kush
Kush refers to a subset of strains of
Cannabis indica. The origins of Kush
Cannabis are from landrace plants mainly
in Afghanistan, Northern Pakistan and
North-Western India with the name coming
from the Hindu Kush mountain
Dabs-Butane Honey Oil (BHO)
Wax, Dabs, BHO
The term of the day seems to be “wax.”
“DEA warns about potent marijuana-based
"wax" substance in central Indiana” reads
one headline, explaining how a “highlypotent marijuana-based product is
becoming the new drug of choice for teens
and young adults.”
Wax, Dabs, BHO
Within the past four years, I’ve seen the concentrate
scene explode in popularity… and in the occasional
apartment complex. Here on the West Coast it seems
like there is a huge generational divide, with the older
folks like me eager for 4:20 and the younger folks waiting
for 7:10, like dinner times in Florida.
In Colorado, “concentrates constitute as much as 30 to
50 percent of all sales at most shops,” according to local
media reports . (High Times, Belville, 8/25/14)
Wax, Dabs, BHO
Dabs are concentrated doses of cannabis that are made
by extracting THC and other cannabinoids using a
solvent like butane or carbon dioxide, resulting in sticky
oils also commonly referred to as wax, shatter, budder,
and butane hash oil (BHO).
One of the most unsettling facts about dabs is that
thanks to the super-concentrated power of BHO, for the
first time it seems possible to “overdose” on cannabis.
While still not lethal, taking more than your personal limit
of dabs can lead to uncomfortable highs and, in some
cases, passing out. After all of the chanting that “you
can’t overdose on marijuana,” concentrates could be
undermining advocates’ message of safety. There have
also been reports of more intense withdrawal symptoms
for dabbers, but again, the information is limited. (Leafly,
Rachel Chambers, 10/28/13)
Why some folks are Pro Dabs
The biggest positive of concentrates are that
they give a powerful dose of medicine to those
who truly need it. Patients dealing with severe or
chronic pain or extreme nausea report that
dabbing can be one of the best ways to get
immediate and effective relief. The amount of
flowers that would have to be smoked or
vaporized to get the same effect is just
unfeasible for some patients who need potent
medicine quickly.
40 million prescriptions in 1991, up to 180 million in
2007.
In the US, 82.5 prescriptions written for Opioid
painkillers for every 100 Americans in 2012
In Kentucky, 128.4 Opioid Pain Reliever prescriptions
for every 100 people, 57.4 Benzodiazepines for every
100!! (Centers for Disease Control and Prevention, 2012)
US receives 99% of world’s supply of Hydrocodone.
US receives 71% of world’s Oxycodone.
Lot of access to opiates for all ages!!
Opiates
Drugs of Abuse
Prescription Opiates
Opiates
Oxycontin
Opiates
Oxycontin
Opana!!
“Opana abuse in USA overtakes
OxyContin”- USA Today, 7/11/12
Prescription Drugs
Opana-Oxymorphone (“Stop Signs, O-Bomb”)Use increased significantly after re-formulation
of Oxycontin, much more potent, Overdoses!!
Heroin
Touted As Both a Cough Suppressant and A ‘NonAddictive Substitute’ for Morphine - 1895
Heroin
Heroin
Heroin
Xalisco Networks (pronounced ha-LEESko) spreading across America. They have
avoided large cities with established
Heroin networks.
Pizza delivery model!!
Up to $50 a dose in the 90s-Now as little
as $6 gets you a high.
Six pack vs. Heroin
Kids in Northern KY- “Slamming”
Heroin
Heroin is an opioid drug that is synthesized
from morphine, a naturally occurring
substance extracted from the seed pod of the
Asian opium poppy plant.
Heroin usually appears as a white or brown
powder or as a black sticky substance,
known as “black tar heroin.”
It is from morphine that heroin is made.
Morphine is made into heroin with a chemical
reaction containing the chemical compound
acetic anhydride. The heroin is then purified
using chemical or mechanical means.
Kentucky
Snorting
Smoking
IV Use
Adolescents-“Slamming”
Potency ranges from 10% Heroin up to 60-70% now.
Dose depends greatly on the purity of the heroin and
level of tolerance. Common IV doses generally fall
between 5 and 10 mg; smoked heroin doses may
range from 15 to 25 mg. Heroin users typically use
small quantities of new material to determine
potency and reduce the risk of overdose.
Why is it so Addictive??
As a result of our use of endorphins are body
is filled with opiate receptors.
Heroin is basically a concentrated form of
endorphins…..it stimulates an endorphin
rush that is much more powerful than
natural.
Soon after using, heroin crosses the bloodbrain barrier. In the brain, heroin is converted
to morphine and binds rapidly to opioid
receptors.
Post Acute Withdrawal
For longer term users, that isn't the end of it! This
acute withdrawal is followed by a "protracted
abstinence syndrome" which can continue for up to
32 weeks afterwards. The symptoms that continue
over this time are: restlessness; disturbed sleep
patterns; abnormal blood pressure and pulse rate;
dilated pupils; feeling cold; irritability; change of
personality and feeling; as well as an intense craving
for the drug.
Must prepare for how best to help Youth get through
POW while maintaining sobriety.
Co-occurring Disorders need to be addressed asap!
“Cancer painkiller mixed with Heroin Blamed in 22 deaths:
PA Doctor says Fentanyl can be 10-100 times more potent
than Morphine?” Jan 28 2014
Fentanyl
Suboxone
Suboxone
Suboxone Strip
Suboxone
Buprenorphine: Suboxone and Subutex.
Two scheduled III, sublingual buprenorphine
table formulations (2mg and 8mg) approved for
use in opioid addiction treatment.
Subutex- (buprenorphine alone)
Suboxone- (buprenorphine + naloxone)
In contrast, methadone is a schedule II drug
Partial mu-opiod agonists
Benzodiazepines
“At Least 12 Overdose Deaths Tied To
Danville Doctor”
Documents indicate that in March 2012,
investigators with the Drug Enforcement and
Professional Branch of the Office of Inspector
General analyzed Dr. Melborne William’s
records and found he was the number one
prescriber of Xanax in the state with 1,351,745
dosage units on 12,622 prescriptions recorded
from April 2011 through March 2012.
Prescription Drugs
Benzodiazepines
ADHD Prescriptions
Amphetamine
ADHD Prescriptions
Amphetamine
Dextromethorphan
“Robo Tripping or Robing”
Dextromethorphan
SAMHSA: In 2006 national survey, 3
million people between age of 12 to 25
had used cough medications to get high.
Mix it with Vodka, Caffeinated beverages,
beer, etc.
Can lead to kidney failure, elevated blood
pressure, dizziness, and cardio problems!
“I Can’t Sleep!!!
Sleep Aids
Sleep Aids
Ambien-By far the best selling sleep medicine prescribed
in US, followed by Lunesta and Rozerem/Sonata,
Restoril.
2007-16 million Ambien prescriptions
2009-34.9 million
ER Visits: 2004 - 13,000 vs. 2008 - 28,000
Targets same brain networks as Xanax/Valium, which is
why in larger doses people like the anti-anxiety “feeling”.
Sanofi-Aventis-”Take Ambien only as prescribed”
When mixed with alcohol…..look out!!
Heath Ledger, Rachel Uchitel on Celebrity Rehab
“Molly”
MDMA in its purest state
Data compiled by Ecstasy Data, which test
pills as part of harm reduction program, lot
of what’s being advertised as Molly is
really formulated using Methylone, the
active ingredient found in “Bath Salts”
Molly
According to NIDA: “MDMA can cause a
dangerous increase in body temperature that
can lead to kidney failure. MDMA can also
increase heart rate, blood pressure, and heart
wall stress. Animal studies show that MDMA can
damage specific neurons in the brain. In
humans, the research is not conclusive at this
time; however, a number of studies show that
long-term, heavy MDMA users suffer cognitive
deficits, including problems with memory.”
Overdose and Death
EDC Rave Spurs MDMA Drug Use Among
UCF Students
Health, News, Night Life — By Staff on May 31,
2011 at 2:29 am
A rave with a controversial past came to Orlando
over the weekend — and with it came hundreds
of doses of the MDMA drug “Molly,” a
KnightNews.com investigation has concluded.
120 people hospitalized and 118 arrested! Fun
ehh!!
Molly
Is it Real???? 10 Kits for only $18.75!!!
Bath Salts
A very dangerous synthetic drug
Are NOT used in Baths!!
Deliberately miss-labeled
“Not for Human Consumption”
The presumption is that most Bath Salts
are MDPV or
methylenedioxypyrovalerone. However
formulas are altered every day!!
Bath Salts
Number of Poison Control Calls
2010
304
2011
6,136
2012
2,655
Through Feb. 28, 2013 179
Bath Salts
Bath Salts
Tailored for Youth!!
Bath Salts Banned in Kentucky
Kentucky banned Bath Salts in 2011
In May, 2012 Gov. Steve Beshear signed
House Bill 481, a mandate that “closes legal
loopholes by banning classes, not just
compounds of synthetic drugs”
The original 2011 law , House Bill 121,
“extends seizure and forfeiture laws to
retailers who sell the items, makes sells a
felony for a second or subsequent offense,
and makes simple possession a
misdemeanor”.
A similar law on synthetic marijuana became
law last year.
Anyone shop here???
“Police raided the Botany Bay on Winchester Road this summer, and the owner
was charged with trafficking in synthetic drugs and possession of
paraphernailia”
Synthetic Marijuana
Spice is NOT Marijuana, it is a dangerous
Hallucinogenic Drug!!
Intentionally mislabeled as “herbal
incense” or “potpourri”.
Marked “Not for human consumption”.
Synthetic Cannabinoids
•Spice
•K2
•Herbal Incense
Dangers of Spice
Unregulated and Untested on Humans
No long term studies , true effects are not
known.
It is physically addictive!!
Very Dangerous…..One time use has
resulted in death!!
Flavors are added to it to make it more
appealing to kids (Bubble Gum, Grape,
etc.)
Cannabinoid Compounds
From 1984 to 2011, John Huffman and his team
from Clemson created 460 synthetic
cannabinoid compounds for test on lab animals
Shown promise in treatment of nausea, pain,
inflammation, and some skin cancers.
Of the many cannabinoid compounds that are
now illegal, three bear his initials: JWH-018,
JWH-073, JWH-200
Neurontin (Gabapentin)
It was originally developed for the
treatment of epilepsy, and currently is also
used to relieve neuropathic pain.
Gabapentin provides significant pain relief
in about a third of people who take it for
fibromyalgia or chronic neuropathic pain.
New Home Made Drugs
"Krokodil“ – Desomorphine
Cooked up from codeine in a manner similar to
making Methamphetamine from pseudoephedrine
Word is a person who starts taking it loses a year of
life with each dose!! Most don’t make it 3 years.
Extremely toxic to tissues- resulting in frequent loss
of limbs and gangrene
The worst affects of the drug include total tissue
atrophy, essentially eating the skin and tissue away
and exposing bone, leading to loss of appendages.
Krokodil
“Dirty Cousin” of Morphine, Synthetic in
nature.
Average user dies after 2-3 years.
Three times cheaper, ten times more
potent then Heroin, easy to make.
Mixing codeine with gasoline, paint
thinner, hydrochloric acid, iodine, and red
phosphorous.
Currently tearing Russia apart!!!
Kratom
-Kratom, comes from a tree indigenous to
Thailand and Malaysia
-Kratom’s primary active constituents are
believed to be the indole alkaloids 7hydroxymitragynine and Mitragynine
-7-hydroxymitragynine and Mitragynine are
structurally similar to tryptamines
-Their pharmacology is quite different, acting
primarily as mu-opioid receptor agonists
-Used as an analgesic for pain relief, antidiarrhea, mild stimulant at lower dose, opiate
addiction treatment. However is addictive!!!!
Methamphetamine
Methamphetamine is a powerful, highly addictive stimulant that affects the
central nervous system. Also known as meth, chalk, ice, and crystal, among
many other terms, it takes the form of a white, odorless, bitter-tasting
crystalline powder that easily dissolves in water or alcohol.
Methamphetamine comes in several forms and can be smoked, inhaled
(snorted), injected, or orally ingested. The preferred method of abusing the
drug varies by geographical region and has changed over time.
Smoking or injecting methamphetamine puts the drug very quickly into the
bloodstream and brain, causing an immediate, intense “rush” and amplifying
the drug’s addiction potential and adverse health consequences.
Methamphetamine
Methamphetamine
Meth manufacturers adapt to restrictions via small- or large-scale
“smurfing” operations: obtaining pseudoephedrine from multiple
sources, below the legal thresholds, using multiple false
identifications.
Methamphetamine production also involves a number of other easily
obtained chemicals that are hazardous, such as acetone, anhydrous
ammonia (fertilizer), ether, red phosphorus, and lithium. Toxicity
from these chemicals can remain in the environment around a
methamphetamine production lab long after the lab has been shut
down, causing a wide range of damaging effects to health. Because
of these dangers, the U.S. Environmental Protection Agency has
provided guidance on cleanup and remediation of
methamphetamine labs.
Flakka
Flakka????
Flakka
Alpha-PVP, nicknamed "flakka" - is an illegal synthetic drug
that has made headlines across southern Florida.
Most recently it has been found in Lewis County, KY, about 90
miles northeast of Lexington. And some experts say it's likely
to spread.
On the street, users call it "gravel," sometimes "magic,"
because the high lasts so long. But it also makes them
paranoid, violent and can give users adrenaline-fueled
strength, a troublesome combination for law enforcement.
In 2014, the DEA placed the drug on the U.S. list of illegal
controlled substances. During two recent busts in Lewis
County, deputies found pounds of flakka, including one stash
worth more than $200,000.
Alcoholism
Hi….I’m an Alcoholic, remember me????
Questions, comments, concerns??
Thank You!!!
Geoff Wilson, LCSW, CADC
The Ridge Behavioral Health System
3050 Rio Dosa Drive
Lexington, KY 40509
859.268.6448
[email protected]