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Anthony Scheben


Who I am
What I can tell you





How Drugs Work
Why we do drugs
Drugs of Concern
Some thoughts on how to help
What I can’t tell you


Not a lawyer
Governing law different for states and
locals

DRUGS ACT THROUGH EFFECTS ON
NATURAL BRAIN CHEMICALS

DRUG EFFECTS LAST LONGER THAN
THOSE PRODUCED NATURALLY


DRUGS OFTEN RELEASE MUCH MORE
BRAIN CHEMICAL THAN FATIGUE, FEAR,
EXCITEMENT
DRUGS CAN DISRUPT PROCESSES THAT
RECYCLE THESE BRAIN CHEMICALS
LEADING TO THEIR DEPLETION IN
NEURONS




STABLE SATIFICATION OCCURS WITH
FOOD, WATER, SEX BUT NOT WITH DRUGS
DRUGS PRODUCE EFFECTS ON DOPAMINE
VERY RAPIDLY
THE MORE OFTEN DRUGS ARE USED THE
MORE REINFORCING THEY BECOME
EVENTUALLY DRUGS CAN CONTROL LARGE
AREAS OF BEHAVIOR


DRUGS ACTIVATE THE REWARD SYSTEM
PRODUCING POWERFUL FEELINGS OF
PLEASURE & AN INCREASED DESIRE TO
REPEAT DRUG USING BEHAVIOR
DRUGS EXERT POWERFUL CONTROL
OVER BEHAVIOR BY ACTING DIRECTLY
ON THE MORE PRIMITIVE SURVIVAL
AREAS IN BRAIN



ACTIVATION of BRAIN REWARD
PROCESSES
ULTIMATELY REDUCES ACTIVITY IN
THESE PATHWAYS
LONG LASTING CHANGES IN BRAIN
STRUCTURES THAT UNDERLIE LEARNING
And Change our behavior




DEVELOP INTO LATE ADOLESENCE
DRUGS CAUSE RELEASE OF
DOPAMINE
TRIGGERS MEMORY ENCODING
LINKED TO THE DRUG EXPERIENCES
LINKED TO DRUG CRAVING
RX DRUG ABUSE



Drug overdose was the leading cause of
injury death in 2010. Among people 25 to 64
years old, drug overdose caused more
deaths than motor vehicle traffic crashes.
OVER HALF A MILLION EMERGENCY DEPARTMENT
VISITS IN 2010 WERE DUE TO PEOPLE MISUSING OR
ABUSING RX PAIN MEDS.
NON-MEDICAL USE OF RX PAIN MEDS COSTS
HEALTH INSURERS UP TO $72.5 BILLION ANNUALLY
IN DIRECT HEALTH CARE COSTS
• In the United States, drug overdose death rates more than
tripled since 1990. Every day, more than 100 people die from
drug overdoses. Most of these deaths are caused by
prescription drugs. According to the Centers for Disease
Control and Prevention (CDC), the recent surge in drug
overdose death rates is a result of increasing abuse and
misuse of prescription opioid painkillers.
• In 2010, prescription painkillers killed more than 16,500
people in the U.S., more than twice as many as cocaine and
heroin combined.
• In 2011, healthcare providers prescribed more than four
times as many painkillers as in 1999, and at the same time
prescription painkiller deaths increased.
• A small percentage of providers, roughly 20 percent, are
responsible for 80 percent of all prescription painkillers in
2010.
• In 2012, an estimated 12.5 million people reported using
prescription painkillers without a prescription

MANY

MIDDLE-AGED

PEOPLE

WHITES

MORE MEN THAN WOMEN DIE OF OVERDOSES FROM
PRESCRIPTION PAINKILLERS.
ADULTS HAVE THE HIGHEST
OVERDOSE RATES.
RX
PAINKILLER
IN RURAL COUNTIES ARE ABOUT 2X AS LIKELY TO
OVERDOSE ON RX PAINKILLERS AS PEOPLE IN BIG CITIES.
AND NATIVE AMERICANS ARE MORE LIKELY TO
OVERDOSE ON RX PAINKILLERS.
ABOUT 1 IN 10 NATIVE AMERICANS AGE 12 OR OLDER USED
RX PAINKILLERS FOR NONMEDICAL REASONS IN THE PAST
YEAR, COMPARED TO 1 IN 20 WHITES AND 1 IN 30 BLACKS.

CHEWING TABLETS

SNORTING CRUSHED TABLETS


DISSOLVING TABLETS IN WATER &
INJECTING
THESE METHODS CAUSE A FASTER,
HIGHLY DANGEROUS RELEASE OF
ACTIVE INGREDIENTS
“GRABBING A HANDFUL OF
PRESCRIPTION DRUGS AND
SWALLOWING THEM, A COMMON
PRACTICE AMONG ADOLESCENTS AND
TEENS”

HEROIN (SCHEDULE I)

OXYCODONE (PERCODAN®, OXYCONTIN®)

OXYMORPHONE (OPANA®)

NEWEST - ZOHYDRO

MORPHINE

CODEINE
THOSE DUE PRIMARILY FROM INPURITIES FOUND IN STREET
DRUGS & IN THE NON-STERILE PRACTICES OF INJECTING
SKIN, LUNG, AND BRAIN ABSCESSES
BACTERIAL INFECTION E.G. FLESH-EATING STREP C &
STAPH A
ENDOCARDITIS (INFLAMMATION OF THE HEART LINING)
HEPATITIS B,C
HIV/AIDS
THOSE DUE TO THE PHARMACOLOGICAL ACTIONS OF THE
DRUGS EVEN WITH MEDICALLY APPROPRIATE USE
NAUSEA
ITCHING
BOWEL OBSTRUCTION
RESPIRATORY DEPRESSION
XANAX AND RELATED
DRUGS

PHARMACEUTICAL NAMES
ATIVAN ®- LORAZEPAM
KLONOPIN® VALIUM ®
XANAX ®

CLONAZEPAM
- DIAZEPAM
- ALPRAZOLAM
STREET NAMES
CANDY; Z-BARS; ZANNIES
DOWNERS; SLEEPING PILLS; TRANKS

CLINICAL USES:
INSOMNIA
ANXIETY
ANESTHESIA
MUSCLE RELAXANTS

INTERACT WITH GABA RECEPTORS TO
PRODUCE CALM, SLEEP, & AMNESIA
CAUSES REDUCED INHIBITIONS & IMPAIRED JUDGEMENT
CONCURRENT ALCOHOL OR OTHER DEPRESSANT USE CAN
BE FATAL
HIGH ABUSE AMONG HEROIN & COCAINE ABUSERS
ALPRAZOLAM & DIAZEPAM ARE THE TWO MOST
FREQUENTLY ENCOUNTERED BENZODIAZEPINES ON THE
ILLICIT MARKET
PROVIGIL ®, METH,
AMPHETAMINES, RITALIN®

CLINICAL USES:
ANOREXIANTS (WEIGHT LOSS)
ATTENTION DEFICIT DISORDER
DECONGESTANTS



ENHANCE THE ACTIVITY OF
NOREPINEPHRINE & DOPAMINE
 HEART RATE & BLOOD PRESSURE
OFTEN USED/ABUSED TO BOOST
COGNITIVE FUNCTIONS




FIRST USED IN GERMANY & JAPAN
DURING WWII
WIDELY USED AS DIET PILLS DURING
1950s
“SPEED” IN 1960s
CHEAPER & MORE LONG LASTING
THAN COCAINE

“SPEED”, “CRYSTAL”, “CRANK”

Rx – METHEDRINE; DOSOXYN

USE: ORAL; IV; SMOKING; SNORTING


MORE POTENT BRAIN ACTIONS THAN
AMPHETAMINE
GREATER NEUROTOXICITY THAN
AMPHETAMINE

IRRITABLE; WIRED; JITTERY

MAY FEEL SUPER PRODUCTIVE

REPETITIVE TASK
METHYLPHENIDATE (RITALIN®, METHYLIN®, CONCERTA®)
STREET SLANG – PINEAPPLE; KIBBLES & BITS
TREATMENT OF EXCESSIVE DAYTIME SLEEPINESS
ASSOCIATED WITH NARCOLEPSY
TREAT ATTENTION DEFICIT HYPERACTIVITY DISORDER
(ADHD) IN CHILDREN.
DISSOLVE TABLETS IN WATER & INJECT THE MIXTURE
COMPLICATIONS DUE TO INJECTION OF THE INSOLUBLE
FILLERS USED IN THE TABLETS; THESE MATERIALS BLOCK
SMALL BLOOD VESSELS CAUSING SERIOUS DAMAGE TO THE
LUNGS AND RETINA OF THE EYE
BINGE USE CAUSE PSYCHOTIC EPISODES, CARDIOVASCULAR
COMPLICATIONS, & SEVERE PSYCHOLOGICAL ADDICTION
9 - TETRAHYDROCANNABINOL

MAJOR PSYCHOACTIVE INGREDIENT

PRODUCES THE “HIGH” FEELING

CHANGES BEHAVIOR & PERCEPTION

PHYSICAL RELAXATION

SEDATION

GIDDINESS

TIME SLOWS DOWN

SHORTENS ATTENTION SPAN

SHORT TERM MEMORY DEFICIT
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ANXIETY/PARANOIA



BINDS TO CB1&2 RECEPTORS; SAME AS
ANANDAMIDE, AN ENDOCANNABINOID
DECREASES GABA RELEASE
REDUCES ACETYLCHOLINE ACTIVITY IN
HIPPOCAMPUS, AFFECTING MEMORY &
COGNITIVE FUNCTIONING

INCREASES DOPAMINE RELEASE



A STUDY @ BETH ISRAEL DEACONESS MEDICAL
CENTER FOCUSED ON 4,000 PEOPLE WHO HAD
SUFFERED A HEART ATTACK
A PERSON'S CHANCE OF HAVING A HEART
ATTACK, ESPECIALLY FOR THOSE WHO ARE
ALREADY AT RISK FOR HEART DISEASE, 
NEARLY 5 FOLD DURING THE 1ST HOUR AFTER
SMOKING MARIJUANA
HEART ATTACK MAY BE DUE TO THE RUPTURE
OF CORONARY PLAQUES CAUSING A CLOT,
WHICH RESTRICTS BLOOD FLOW TO THE HEART

INCREASED RISK OF SCHIZOPHRENIA

INCREASED RISK OF DEPRESSION

INCREASED RISK OF SUICIDAL
IDEATION


INCREASED RISK OF PSYCHOSIS
ESPECIALLY IN THOSE GENETICALLY
PREDISPOSED
ABOUT 1 OUT OF 4 ARE PREDISPOSED
TO MARIJUANA-RELATED MENTAL
HEALTH CONSEQUENCES
© DALTERIO 2009

 T CELLS

 VIRAL RESISTANCE

 RESPIRATORY DISEASES

IMMUNOSUPPRESSIVE EFFECTS
MEDIATED BY CB2 RECEPTORS
© DALTERIO 2009



MARIJUANA IS THE MOST WIDELY USED DRUG BY
WOMEN AT REPRODUCTIVE AGE
STUDIES REPORT EITHER LOWER BIRTH WEIGHT OR
SHORTER LENGTH AT BIRTH FOR INFANTS EXPOSED
PRENATALLY
PATERNAL MARIJUANA USE DURING THE PERIODS
OF CONCEPTION & PREGNANCY & ALSO
POSTNATALLY WERE SIGNIFICANTLY ASSOCIATED
WITH INCREASED RISK OF SIDS
 EXPOSURE VIA BREAST MILK DURING THE FIRST
MONTH POSTPARTUM APPEARS TO BE ASSOCIATED
WITH A DECREASE IN INFANT MOTOR DEVELOPMENT
AT ONE YEAR OF AGE
© DALTERIO 2009

NOT FDA APPROVED FOR SAFETY & EFFECTIVENESS

CANNOT PROVIDE CONSISTENT DRUG DOSE OR DELIVERY
GUIDELINES
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CONTAMINATION ISSUES

SMOKING & PLANTS ARE NO LONGER ACCEPTED IN ANY
CURRENT TREATMENT SCENARIO IN THE US

ADVERSE EFFECTS OF SMOKING

SMOKING PRODUCES A QUICK”HIGH” MAKING THE PATIENT FEEL
“BETTER”

AN EXAMPLE OF THE PLACEBO EFFECT; IF PEOPLE “BELIEVE”
MARIJUANA IS A MEDICINE FOR THEM IT MAY WORK
© DALTERIO 2009


CAN BE EFFECTIVE TREATMENT FOR
SEVERAL CONDITIONS IN WHICH
PATIENTS DO NOT REPOND TO
OTHER THERAPIES
LIKE ANY Rx PRODUCT
CANNABINOIDS ARE ASSOCIATED
WITH ADVERSE EFFECTS WHICH
MUST BE CONSIDERED AS A BENEFIT
V RISK MEDICAL DECISION
© DALTERIO 2009

BLISS

BLACK MAMBA

BOMBAY BLUE

FAKE WEED

GENIE

SPICE

DEVELOPED BY JW HUFFMAN
THE MID 90’S

SPRAYING A SYNTHETIC THC LIKE COMPOUND
JWH-018 ONTO HERBAL PRODUCTS OR INCENSE

EASY

LEGAL

SOLD AS
KOREA
A PLANT GROWTH STIMULANT IN

BANNED
IN SOME LOCALITIES,

BANNED
AT
CLEMSON U
IN
TO GET ON THE INTERNET OR IN HEAD SHOPS,
SOME GAS STATIONS ETC.
STATUS IN QUESTION
BY US MILITARY
DRUG SCREENING TESTS
&
CHINA &
EUROPE & RUSSIA
DETECTED BY THEIR



REPORTS THAT SO FAR THIS YEAR THERE
HAVE BEEN 567 K2-RELATED CALLS, UP
FROM 13 IN 2009
INVESTIGATORS NOT REALLY CERTAIN WHAT
IS IN K2 LABELED PRODUCTS
PEOPLE ARE ARRIVING AT ERS WITH
SYMPTOMS NOT NORMALLY BE ASSOCIATED
WITH MARIJUANA


K2 AFFECTS THE BRAIN IN THE SAME WAY
AS MARIJUANA'S PSYCHOACTIVE THC
BOTH COMPOUNDS BIND TO THE CB1
RECEPTORS, WHICH PRIMARILY AFFECT THE
CENTRAL NERVOUS SYSTEM

JWH-018 ALSO BINDS TO THE PERIPHERAL
BRAIN (CB2) RECEPTORS, WHICH ARE
INVOLVED IN THE IMMUNE SYSTEM

VERY RAPID  IN HEART RATE

DANGEROUSLY ELEVATED BLOOD PRESSURE

PALE SKIN

SEVERE HALLUCINATIONS

EXTREME ANXIETY, AGITATION & SEIZURES
& VOMITING
ALTHOUGH THE DATA IS STILL BEING
UPDATED THE FOLLOWING REFLECTS
CLOSED CASES FOR SYNTHETIC
MARIJUANA EXPOSURES
 IN 2010 THERE WERE 2,906 CALLS
 FOR 2011 6,959
 AS OF JUNE 2012 THERE WERE 3,372


BATH SALTS' FIRST BECAME POPULAR WITH
THE CLUB SCENE IN EUROPE
IN 2010 OVER 2,000 CLUBBERS REPORTED
THAT 40% OR MORE HAD USED SOME FORM
OF BATH SALTS, AND MORE THAN 30% HAD
USED THEM WITHIN THE LAST MONTH


THEY ARE SYNTHETIC DERIVATIVES OF
CATHINONE, A SUBSTANCE THAT COMES
FROM AN AFRICAN PLANT CALLED “KHAT.”
CATHINONE IS A SCHEDULE I CONTROLLED
SUBSTANCE UNDER THE FEDERAL
CONTROLLED SUBSTANCES ACT




THE AMERICAN ASSOCIATION OF POISON
CONTROL CENTERS REPORT THAT IN 2009
U.S. POISON CONTROL CENTERS RECEIVED
NO CALLS ON INGESTION OF BATH SALTS.
IN 2010, THEY RECEIVED 303 CALLS
BY 2011 MORE THAN 6138 CALLS
AS OF MAY 2012 THERE WERE 1302
CALLS

DELUSIONS

HALLUCINATIONS

SEIZURES

PANIC ATTACK

INCREASED HEART RATE & BLOOD
PRESSURE
Hallucinogens

Lysergic Acid Amide (LSA):
 ergot and fungi infected plants and produce
 ten times less potent than LSD (Lysergic
Acid Diethylamide)
 Seeds are crushed and eaten or soaked in
water or alcohol and eaten.
 The effects last four to eight hours and can
include: auditory and visual hallucinations;
elevated blood pressure and heart rate;
memory loss; anxiety; panic attacks; acute
psychosis; and suicidal thoughts.
short
for molecule, is
considered to be pure
MDMA, unlike Ecstasy,
which generally is laced
with other ingredients,
such as caffeine or
methamphetamine.
Hallucinogenic
amphetamine
Similar effects to
MDMA and
methamphetamines
$50 - $100 per gram







synthesized in 1970’s -1980’s
psychedelic phenethylamine
taken orally
powerful hallucinogenic effects
high can last 6- 12 hours
sold through European sources
one death reported in MN on March 11, 2011





synthesized by Alexander Shulgin
popularized MDMA (Ecstasy)
2C-I another phenethylamine
available
2C-E is chemically related to other
2C phenethylamines
exact legal status is unclear - 2C-B
banned.
Access via the internet
“Legal ketamine” – ketamine analog
Discovered in 2010
Methoxetamine (also known as mexxy or
MXE). Although there is very little evidence about its
short and long term effects, we do know that it is
chemically related to ‘dissociative anaesthetics’
like ketamine and PCP, and has similar effects. From
anecdotal reports, MXE appears to be much stronger
than ketamine, so users should take extra care to avoid
overdosing by only using small amounts.



Amphetamine like – originally developed as an
antihelminthic
BZP, TMFPP – “legal ecstasy”
Schedule I in 2004

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
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

Antidepressant
Inhibits serotonin transporter
Pills/powder
Effect lasts 6 – 8 hours
Takes 2 hours to get first effect
Management:




Benzodiazepines
Fluids
Cooling
EKG
“Krokodil”
•Desomorphine
(Dihydrodesoxymorphine) is an
opiate analogue invented in 1932 in the United
States that is a derivative of morphine
•Desomorphine has attracted attention in Russia
due to its simple production, utilizing codeine,
iodine, gasoline, paint thinner, hydrochloric acid,
lighter fluid and red phosphorus.
•The street name in Russia for home-made
Desomorphine made in this way is "krokodil"
(crocodile), reportedly due to the scale-like
appearance of skin of its users
•Since the mix is routinely injected immediately
with little or no further purification, "Krokodil"
has become notorious for producing severe tissue
damage including injury to the veins (phlebitis)
and gangrene. Other consequences of use have
included severe withdrawal, spread of HIV
through the use of contaminated needles and
death.
Methylhexanamine
Source - found naturally in the geranium
plant
It is not scheduled by the DEA - legal
Banned in athletics
Stimulant
Not widely studied
Central nervous system (CNS) effects
are said to be less than amphetamine
and ephedra. Effects are dosedependent and include euphoria,
elevated mood, intense energy,
adrenaline rush, mental clarity and
increased confidence.



Embalming Fluid-Soaked Marijuana:
 The trend of smoking marijuana soaked in
embalming fluid is gaining popularity
throughout the United States. The syndrome
of intoxication looks nearly identical to that
seen following phencyclidine (PCP) use, with
agitation, disorganized speech and thoughts,
and diminished attention. The authors
believe that this new trend in drug use
involving marijuana also presents a
resurgence in PCP use.
Soaked in water – uneven burn
Mixed with THC: wet, fry, crystal joint,
supergrass

Fermentation of human
waste
Feces and urine stored in
tight container for several
days
Reaction produces
methane gas
Methane major
component of natural gas
“Huffed” by users

producing anoxia




What’s different today then in the
1970’s when the drug Ecstasy (MDMA)
was popularized?
What has changed to fuel the rapid
development and distribution of
designer drugs?
Supervisor Dos
• DO emphasize that you only are concerned with
work performance or conduct
• DO have documentation or performance in front of
you when you talk with the employee
• DO remember that many problems get worse
without assistance
• DO emphasize that conversations with an EAP, if
applicable, are confidential
• DO explain that an EAP, if applicable, is voluntary
and exists to help the employee
• DO call an EAP, if applicable, to discuss how to
make a referral
• DON’T try to diagnose the problem
• DON’T moralize; limit comments to job performance and conduct
issues only
• DON’T discuss alcohol and drug use
• DON’T be misled by sympathy-evoking tactics
• DON’T cover up; if you protect people, it enables them to stay the
same
• DON’T make threats that you do not intend to carry out
• DON’T try to be the police
Under the ADA, alcoholism is a disability, but
alcoholic employees may be held to the same
standards as other employees, even if
unsatisfactory performance is caused by the
alcoholism.
Neither the Americans with Disabilities Act (ADA)
nor the Rehabilitation Act of 1973 protect current
users of illegal drugs.
Absences due to substance abuse may be covered
under the Family and Medical Leave Act (FMLA)
if the abuse constitutes a serious health condition
which includes:
•
•
66
Any period of incapacity or treatment connected to inpatient care such as substance abuse
treatment; or
Continuing treatment by a healthcare provider, which includes any period of incapacity (i.e.,
inability to work) due to a health condition lasting more than 3 consecutive days (including
treatment thereof, or recovery from) and any subsequent treatment or period of incapacity
relating to the same condition.




PSYCHOACTIVE DRUGS ACT BOTH RAPIDLY
& DRAMATICALLY ON NEURONS THAT
RELEASE DOPAMINE
THIS CREATES STRONG & LONG-LASTING
MEMORIES ACTIVATING PRIMAL SURVIVAL
REWARD MECHANISMS
REWARD IS ACTIVATED BOTH BY DRUG
ACQUISITION & ACTUAL DRUG EFFECTS
THE NEED FOR REACTIVATE THESE
PATHWAYS ARE PERCEIVED AS NECESSARY
FOR SURVIVAL





DRUGS INTERFERE WITH LEARNING &
MEMORY ESPECIALLY IN ADOLESCENTS
AGE OF FIRST USE HAS A PROFOUND
EFFECTS ON ADDICTION PROBABILITY
DRUG AVAILABILITY INCREASES USE
LONG-TERM MEDICAL EFFECTS OF THE
LEGAL ALCOHOL & TOBACCO COST
BILLIONS
PSYCHOACTIVE DRUG USE HAS
PROFOUND IMPACT ON TRAFFICRELATED DEATHS, WORKPLACE
ACCIDENTS & ABSENTEISM, DOMESTIC
VIOLENCE & CRIMINAL BEHAVIORS
What is it and why is it so popular
right now?