Silver Cross EMSS
EMD CE
March 2014
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According to the National Survey on Drug
Use, 8.9% of the US population (2.2 million
people) are substance abusers.
Substance abuse results in an increased
incidence of injuries and illness.

Even if the primary reason for the call is not
substance abuse, it can still be a contributing factor.

Most commonly abused drug in the United
States today
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Involved in a significant number of traffic fatalities,
murders, and suicides
Symptoms of alcohol intoxication are similar
to those of other medical illnesses or severe
injuries.
*Don’t assume alcohol is causing the patient's signs &
symptoms until other chief complaints are ruled
out.

Alcohol is an addictive, depressant
drug.

Persons physically dependent on
alcohol can develop severe withdrawal
symptoms.

The most severe symptoms are
delirium tremens (DTs).
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Signs and symptoms of DTs
Confusion
 Hallucinations
 Gastrointestinal distress
 Chest pain
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Fever
Shaking
Restlessness
DTs is a serious medical emergency that can
be fatal.
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Courtesy of DEA
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May be ingested,
inhaled, injected, or
absorbed into the
body
Look for clues that
indicate the type of
drug and the way it
was administered.
Abuse of prescription
drugs has increased
in recent years.

Amphetamines

Stimulate the central nervous system

Includes speed, ice, crystal, cocaine (coke)

Signs of amphetamine use include:
 Restlessness
 Irritability
 Talkativeness
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Barbiturates

Depressants (drugs that depress the nervous
system)

Include tranquilizers, opiates, and marijuana

An overdose can result in respiratory depression or
arrest.
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Hallucinogens

PCP, LSD, peyote, mescaline, mushrooms

Chemicals that cause people to see things that are
not there

Signs and symptoms of PCP overdose
 Convulsions
 Coma
 Heart and lung failure
 Stroke
 Try to reduce auditory and visual stimulation.

Abused inhalants

Intentional inhalation of volatile chemicals

Many of these substances can be bought in
hardware stores.

May cause drowsiness, unresponsiveness, seizures,
or sudden cardiac death

Try to keep the patient from struggling.

Support the patient’s ABC’s
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Toxic injection from drugs

The patient’s reaction depends on the quantity and
type of drug injected.

Signs and symptoms include:
 Weakness
 Dizziness
 Fever
 Chills
This is the quickest and most difficult route
to treat.


Methamphetamine
Common Club Drugs:
 MDMA (Methylenedioxymethamphetamine)
 GHB (Gamma-hydroxybutyric acid)
 Heroin
Methamphetamine
Other
names for
methamphetamine:
 Ice
 Meth
 Tina
 Geep
 Chalk
Dust
 Ice Cream
 LA Glass
Methamphetamine
is a highly addictive
stimulant.
Generally lasting 12 hours, this high is 250
times more stimulating to the dopamine
receptors in the brain than the high from
endorphins from exercise, eating, and even sex.
These receptors wear out after a period of time,
becoming damaged. The person has no way to
feel good from eating, sex, or anything
pleasurable and seeks out more of the drug.
These
people may go into a deep sleep for
two to four days, appearing to be deceased.
This puts them at risk for rhabdomyolosis, a
break down of muscle tissue. The proteins
floating in the bloodstream from this
breakdown clog the kidneys and cause kidney
failure. Depending on the extent of the
damage, the patient could end up on
permanent dialysis.
Swallowing
-20-30 Minutes to feel the effects
-This method has the least risks due to the vomiting
mechanism when toxins are ingested
-Meth can be put in water, juice, and commonly is
placed in gel caps and taken orally.
-“Parachuting” is wrapping the meth in toilet paper
and swallowing it. This delays the onset, and makes
the high come on more slowly and evenly. This can
also be done with a baggie and a small puncture.
Considered a “harm reduction technique.”
Smoking
7-10
Seconds to feel the effects
Entered through the lungs which may lead to
breathing difficulties
Usually crystal meth is smoked in glass pipes,
similar to how crack cocaine is used.
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Shooting Up
15-30 seconds to feel the effects
Injected into the veins, or “the works.”
This is where abscesses and skin infections begin to develop.
Injection bypasses the filtering mechanism by the body: the
vomiting mechanism is bypassed and this directly circulates in the
bloodstream.
The sharing of needles spreads diseases such as Hepatitis, HIV, and
many antibiotic-resistant bacteria.
Improperly drawn-up meth can create an air bubble in the syringe
and subsequently cause an air embolus resulting in cardiac arrest.
“Bumping” or snorting
Onset of 3-5 minutes
Most common ingestion method
Can cause nose bleeds, respiratory problems,
and abscesses can form on the nose and face.
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“Booty Bump”
Onset of 10-15 seconds
Needleless syringe is used to administer liquid
meth into the rectum.
The drug is absorbed by the blood vessels in the
lining of the rectum.
Sometimes used in conjunction with prostitution,
this can cause injury and disease when used as a
“professional adjunct” for these patients for
alternate routes of intercourse.
Often used in patients who have septum issues
from snorting or loss of veins from injecting.
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“Hot Rail”
Onset of 7-10 seconds.
A glass stem is heated until the tip is red hot, then placed over a
bump (a small pile of the drug) and the vapor is inhaled
through the nose.

Immediate
Elation
High
Effects
energy and feeling of acuity, insomnia
GI distress (vomiting/ diarrhea)
Sweating
Anorexia
Agitation, irritability, talkativeness, panic, compulsive
fascination with repetitive tasks, violence, confusion
Increased sex drive, making this a popular club drug
Hypertension, hyperthermia, tachycardia, glucose level
instability, bronchodilation
Vasoconstriction
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Faces of Meth is an internet finding with hundreds
of results.
Meth causes muscle wasting and anorexia, and in
combination with the toxins it is “cut” with, causes a
severe result in the aging process and is often the
cause of sores on the face and skin. Tooth loss is
also a common side effect of meth use…
Here are some “before and after” photos.
Most of these photos are taken within a six-month
to two-year period:

http://photos.oregonlive.com/o
regonian/2011/05/faces_of_met
h_7.html

http://photos.oregonlive.com/o
regonian/2011/05/faces_of_met
h_7.html

Meth affects the
top teeth first,
and subsequent
damage spreads
to the gum tissue,
dissolving the
roots.
9
million users
worldwide
Most
drug
common club
Often
seen at raves
and industry parties
ECSTASY
Elephants
Adam
Eve
Beans
Hug
California
Hug
Sunrise
Clarity
E
Essence
Drug
Love Drug
Love pill
Lover’s speed
Molly
Scooby
snacks
Snowball
X
XE
XTC


“Ecstasy
was originally developed by Merck
pharmaceutical company in 1912. In its original
form, it was known as “MDMA.” It was used in
1953 by the US Army in psychological warfare
tests, and then resurfaced in the 1960s as a
psychotherapy medication to “lower inhibitions.”
It wasn’t until the 1970s that MDMA started being
used as a party drug.
By the early 1980s, MDMA was being promoted as
“the hottest thing in the continuing search for
happiness through chemistry,” and the “in drug”
for many weekend parties. Still legal in 1984,
MDMA was being sold under the brand name
“Ecstasy,” but by 1985, the drug had been banned
due to safety concerns.”
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Onset form pill ingestion is roughly 20 minutes to one
hour.
Duration is anywhere from 3 to 6 hours.
Patient has feeling of well-being, extreme euphoria,
significantly enhanced sense of touch and other senses
such as sound perception, along with a boost in energy.
Some individuals even experience mild hallucinogenic
effects while on the drug. The enhanced tactile
experiences individuals experience while on the drug
has earned it the nickname "the love drug".
Some Ecstasy users feel ill and experience stiff joints
and muscles, a stiff jaw, extreme thirst, sleep
disturbances, depression and paranoia.
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Rohypnol
It has been a concern for the last few years because of its
abuse as a "date rape" drug.
People may unknowingly be given the drug that, when mixed
with alcohol, can incapacitate victims and prevent them from
resisting sexual assault.
Also, Rohypnol can be lethal when mixed with alcohol and/or
other depressants.
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This drug is a sedative-hypnotic, causing amnesia.
It can cause respiratory depression in large amounts.
GHB is usually taken orally.
It is sold as a light-colored powder that easily dissolves in
liquids or as a pure liquid packaged in vials or small bottles.
In liquid form, it is clear, odorless, tasteless, and almost
undetectable when mixed in a drink. GHB is typically
consumed by the capful or teaspoonful at a cost of $5 to $10
per dose.
The average dose is 1 to 5 grams and takes effect in 15 to 30
minutes, depending on the dosage and purity of the drug. Its
effects last from three to six hours.
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Side effects of mild to severe overdose:
Nausea
Vomiting
Delusions
Depression
Vertigo
Hallucinations
Seizures
Respiratory distress
Loss of consciousness
Slowed heart rate
Lowered blood pressure
Amnesia
Coma
GHB can become addictive with sustained use.
Heroin
use is on the rise!
Has
a “city drug” stigma,
however many suburban
departments are seeing huge
increases of the drug in
higher socioeconomic areas
30
Deaths are accounted to
heroin in Will County in 2011
Chicago
and the metro
surrounding areas have the
highest rate of ER visits due
to heroin abuse
Symptoms
Airways



and lungs
Apneic
Shallow breathing
Slow and labored breathing
Eyes,
ears, nose, and throat
Skin


Cyanosis
Notable track marks/difficulty
establishing an IV
Stomach
and intestines
 Constipation
Dry mouth
 Spasms of the stomach and intestinal
 Extremely small pupils, sometimes as
tract
small as the head of a pin ("pinpoint
Nervous system
pupils")
 Coma
 Tongue discoloration
 Delirium
Cardiac
 Disorientation
 Hypotension
 Drowsiness
 Weak pulse
 Muscle spasticity
 Bradycardia


Provide basic life support.

Keep the patient from hurting self and others.

Provide reassurance and psychological
support.

Arrange for prompt transport.

Avoid classifying or judging the patient.
KEY QUESTIONS
1. What did the patient ingest?
How much did they take?
When did they take it?
2. Did the patient vomit?
YES? - Did it include any of the
ingested substance?
3. Is the patient violent or acting strangely?
PRE-ARRIVAL
INSTRUCTIONS
1. Notify police to respond
2 . If patient vomits, turn patient onto their side
3. Keep the patient calm
4. Do not leave patient alone
5. Save all medicine or other containers for
medical personnel
6. Call back if patient’s condition worsens prior to
the arrival of medical personnel
USEFUL INFORMATION
4. Does patient have a history of drug use?
If patient vomits, contents of vomit may be useful
5. Could this possibly be a suicide attempt?
Contact Poison Control for additional information:
(800) 222-1222
January 2014 Silver Cross EMSS 1st Trimester EMS
CE packet with information from the
following:
Crystal Meth Recovery Services, Meth Memo 2013
www.k-state.edu
FACES OF METH
Additional Information Provided by:
AAOS Emergency Medical Responder, 5th Edition
Will County 9-1-1 EMDPRS, June 2012