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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]