Download DrugScopes | Winter 2014 - Cincinnati Children`s Hospital Medical

Drug and Poison Information Center
(DPIC)
DrugScopes
Winter 2014
In this issue:
 Sizzurp
 Monitoring the Future
 Gravel
 Start Talking
H T T P : / / W W W. C I N C I N N AT I C H I L D R E N S . O R G / S E R V I C E / D / D P I C / D E FA U LT /
“Sizzurp”
Sheila Goertemoeller PharmD, CSPI, ICPS
Have you heard of “Sizzurp”? How about its slang terms “purple drank”, “syrup”, or “lean” (as in it will
make you lean over)?
What is it?
“ Sizzurp” is a dangerous and potentially fatal concoction formulated to get people high. It typically
contains the active ingredients promethazine with codeine (a prescription, controlled substance used for
cough), a mixing agent – typically a fruit flavored soda, and a candy flavoring and coloring agent.
Why is it used?
“Sizzurp” has gained popularity especially in the hip-hop music culture. Its use has been glamorized in
songs, rap videos, public venues and on social media. “Sizzurp” abuse is popular at parties, especially
among the teen crowd, to produce a high. It may look harmless and taste sweet, but it has the potential to be
deadly.
What are the dangers?
Codeine is an opiate and is classified as a narcotic controlled substance. It is in the same family of drugs as
morphine and it has the potential to be addictive. It is used for its pain relief and cough suppressing
properties. It can slow down the central nervous and respiratory systems in overdose. Promethazine has
sedative properties and is used to help with nausea, vomiting, motion sickness, and pain. In overdose it can
affect the heart and cause seizures. Promethazine in combination with codeine can cause significant central
nervous system and respiratory depression, stopping the heart and lungs from working and be fatal.
What can you do to help?
While prescription drug abuse is an on-going and pervasive problem, the danger of having it in a tasty
formulation raises worry for parents and health care professionals. Talk to your child about the dangers of
“Sizzurp”. Knowledge is power, and as always if you have any questions about “Sizzurp” or any other drug
information related questions, please do not hesitate to call the experts at the Cincinnati Childrens Hospital’s
Drug and Poison Information Center at 1-800-222-1222. We are here 24/7 to help you.
Monitoring the Future
Sara K. Pinkston RN II, MSN, CSPI
Ever wondered what is on the minds of 8th, 10th, and 12th graders regarding cigarettes, alcohol, and
illicit drugs? We hear a lot on the news about cigarette use, alcohol use, and illicit drug use among
teens, but have you ever wondered what they believe and think about these topics? Fortunately,
Monitoring the Future (MTF) has not only wondered about this, but has also surveyed these groups
since 1975 (12th graders since 1975 and 8th and 10th graders since 1991). Each year they survey
approximately 50,000 8th, 10th, and 12th grade students to study their behaviors, values, and attitudes.
The results of these surveys are in for 2013. According to 2013 OVERVIEW: Key Findings on
Adolescent Drug Use (Lloyd D. Johnston, Patrick M. O’Malley, Richard A. Miech, and Jerald G.
Bachman), some key findings include: a modest increase in prevalence of marijuana use in 8th and 10th
graders; a decline in synthetic marijuana use; and a decline in inhalant use. Nonmedical use of
prescription drugs including Adderall, Ritalin, and Oxycontin held steady as well as use of cocaine,
amphetamines, MDMA, heroin, Rohypnol, Ketamine, steroids, and sedatives.
Cigarette smoking fell considerably in 8th, 10th, and 12th graders between 1996 and 2013. Nevertheless,
this decline in use has decelerated in recent years. Smokeless tobacco saw an increase in use from the
mid-2000s through 2010. However, all three grades have seen modest declines in use since 2010.
The report finds alcohol the most widely used substance by teenagers. Despite recent declining rates, 7
out of 10 students have consumed alcohol (more than just a few sips) by the end of high school, and 3
out of ten have done so by 8th grade. The report goes on to say that about half of 12th graders and 12%
of 8th graders in 2013 reported having been drunk at least once in their life.
The MTF Study has been funded under a series of investigator-initiated competing research grants
from the National Institute on Drug Abuse, a part of the National Institutes of Health. MTF is
conducted at the Survey Research Center in the Institute for Social Research at the University of
Michigan. Results of these surveys can be viewed at http://www.monitoringthefuture.org. In addition
many of their publications can be viewed and/or downloaded there.
Their program can also be followed throughout the year on Twitter at: https://twitter.com/ysi_news or
on Facebook at: https://www.facebook.com/youthandsocialissues.
“Gravel”: A New Drug of Concern
Kelly Smith PhD
What is it?
Gravel is not just fragmented rocks anymore. “Gravel” is slang for an illicit designer drug being marketed in the
U.S. The name comes from its crystalline or rock-like appearance, and lab analysis has identified the drug as
alpha-PVP (alpha-pyrrolidinopentiophenone). Alpha-PVP is a substituted cathinone in the beta-keto
amphetamine class. As such, alpha-PVP is a nervous system stimulant. The alpha-PVP in “gravel” may be pure
or laced with other drugs like clonazepam or methamphetamines.
How is it used?
“Gravel” can be smoked, snorted, or injected as well as taken orally, sublingually, or rectally. Insufflation and
injection appear to be preferred routes for delivery since it doesn’t require as much drug to get high. Users often
report tingling, burning, and numbness at the exposure site. Due to that some users report trying an initial
threshold or “allergy testing” dose of 5mg.
Alpha-PVP is typically imported from Asia via the Internet. It is generally sold in 100mg increments for $20$30. Dosing intervals are highly individualized, but may be as frequent as every hour during a binge.
What are the dangers?
Like other amphetamines, alpha-PVP is addictive. It creates a temporary euphoria for users, sustainable only
through repeated exposures.
Alpha-PVP causes cardiac effects like increased heart rate and blood pressure. Other side effects include anxiety,
agitation, panic, hallucinations, and suicidal ideation. Police and ED personnel report panic and paranoia
triggered by use of this drug is some of the worst they’ve seen with designer drugs. The dangerous effects may
last several days.
Treatment
Treatment focuses on supportive care, including hydration, cooling the body temperature, aggressive
benzodiazepine or anti-psychotic administration, physical restraint, and respiratory assistance.
References
Marinetti LJ, Antonides HM. Analysis of Synthetic Cathinones
Commonly Found in Bath Salts in Human Performance and Postmortem
Toxicology: Method Development, Drug Distribution and Interpretation
of Results. Journal of Analytical Toxicology 2013; 37:135–146.
Kaizaka A, Tanaka S, Numazawa S. New Recreational Drug 1-phenyl2-(1-pyrrolidinyl)-1-pentanone (alpha-PVP) Activates Central Nervous
System via Dopaminergic Neuron. J. Toxicol Sci. 2014: 39 (1): 1-6. .
Start Talking
Shannon Staton-Growcock RN, CSPI
Have you heard about StartTalking.Ohio.gov the new program to build a drug-free future? It’s a
website aimed to provide resources for parents, family members, teachers, friends and any community
members to learn about the dangers with drug abuse and where they can seek help for loved ones who
may be at risk.
http://www.deadiversion.usdoj.gov/nflis/2008annual_rpt.pdf
Did you know:
http://www.cnn.com/2010/OPINION/02/25/smith.k2.spice.law/index.h
tml
/fay.ban.k2/index.html
http://drug-abuse.suite101.com/article.cfm/teenagers-smoking-k2have-authorities-incensed
-Most teens who abuse http://www.cbp.gov/xp/cgov/newsroom/news_releases/archives/2009_
pain relievers
say they get them from family and friends.
news_releases/january_2009/01142009_3.xml
http://www.justice.gov/dea/programs/forensicsci/microgram/mg0309/
-Children of parents who
talk to their kids about drugs are 50% less likely to use.
-More Americans die from
drug overdoses mg0309.pdf
than in car crashes.
http://www.wavy.com/dpp/news/local_news/spice-incense-productused-to-get-high
The website contains toolshttp://www.deadiversion.usdoj.gov/nflis/2008annual_rpt.pdf
to start thehttp://www.k2-incense.com
conversation with Ohio’s youth about the importance of living
http://en.wikipedia.org/wiki/JWH-073
healthy, drug-free lives. There is even a link for a parental toolkit to help foster knowledge and the
http://en.wikipedia.org/wiki/HU-210
ability to have those crucial conversations
along with a tips newsletter that can be emailed at regular
intervals to promote continued involvement. Parents, mentors and peers can make a difference just by
talking to the young people in their lives about drug abuse. Please Start Talking!
For more information to: http://starttalking.ohio.gov/
© 2014 By the Cincinnati Drug & Poison Information Center (DPIC)
Topics, print and layout editor: Sheila Goertemoeller PharmD, CSPI, ICPS
Content editors: Alysha Behrman RN, MSN, CSPI, ICPS, CARN; Sheila Goertemoeller PharmD, CSPI, ICPS; Marsha Polk HPT, OCPS, ICPS; and Earl G.
Siegel PharmD, OCPS
The opinions expressed herein are those of the contributing authors and do not necessarily reflect the views of the editor, publisher or supporting institutions.
DPIC is a service of the Cincinnati Children’s Hospital Medical Center and Children’s Hospital Research Foundation. Services are also supported by: the US
Department of Health and Human Services (HRSA), the Ohio Department of Health, Hamilton County Mental Health and Recovery Services Board, and the
Ohio Department of Alcohol and Drug Addiction Services (ODADAS). Additional support for DPIC services is provided by Akron Children’s Hospital
Medical Center and additional member Hospitals.