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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.