TAKING A WALK ON
THE WILD SIDE OF
SUBSTANCE ABUSE
Donna Lotzer
Clinical Pharmacist
UW Hospital & Clinics
WEBBED 2015
WHAT WE WON’T TALK ABOUT
• OR MUST WE…(We must)
• National Drug Threat Assessment 2007
and 2010 compared
• Great Lakes area “Big Five”
– Cocaine: 39.4%/29.5%
– Methamphetamine: 27.6%/16.0%
– Marijuana: 17.1%/15.0%
– Heroin: 8.6%/25.0%
– Controlled Prescription Drugs:
6.5%/13.6%
www.justice.gov/ndic
NATIONAL MAP OF ABUSE
2010 Stats
NATIONAL MAP OF ABUSE
2010 Stats
Percentage of State and Local
Agencies Reporting High Availability
Objective One:
Recognize Unusual
Substances of Abuse and the
Circumstances Under Which
They Can Be Used
Who needs drugs? The right mix of
espresso, chocolate and minced chicken
hearts gets me right where I need to be!!
METHODS/CHOICE OF
INHALANT ABUSE
• Sniffing
• Huffing
• Bagging
•
•
•
•
Propane, butane
Gasoline, paint thinner
Acetone, glues
Spray paint, correction
fluid, degreasers
SYMPTOMS OF
INHALANT ABUSE
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•
•
•
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Outward initial signs
Sxs of intoxication
Ongoing problems
Terminal events (SSDS)
Chronic effects
Multisubstance abuse
possible/common
GOING FOR THE GOLD
• This person has a
problem!
• Metallic spray paint
is a favorite of
solvent abusers
• Meet a repeat multistate offender
GLYBURIDE
•
•
•
•
Unintentional party drug?
Mistaken for Valium
Crushed, snorted
Resulted in severe
hypoglycemia!!
Football and Cough Syrup Don’t Mix
• Codeine cough syrup
• Caught shipping in
pint water bottles!
• Maybe using/abusing?
• Used to boost effect of
other drugs
AWOL
•
•
•
•
•
Alcohol With Out Liquid
21rst century “hookah”!
Popular at some clubs
Promoted for “home use”
Shot of booze mixed with
oxygen goes directly to
one’s bloodstream for
maximum effect
“EMBALMING FLUID”
• Start with tea, tobacco, MJ
• Is it real or PCP?
• Person may refer to smoking
“fry”, wet” or “amp”, “happy
sticks” or “sherm”
• Symptoms of smoking PCP
• Symptoms of smoking
formaldehyde (!)
HAWAIIAN BABY WOODROSE
VIAGRA & CRYSTAL METH
COCKTAIL
• Targets gay men
• Linked to HIV &
STD’s
• Crystal meth =
impotence
• Viagra solves that
problem for many
“Your career took up too much time anyway – a crystal
meth habit can suck up your job, your friends, your
home and your health in 18 months”
NUTMEG
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•
•
•
Users try because curious, unlikely to repeat
Symptoms delayed, long-lasting (>24 hrs)
Experience nausea, gagging, headache
Teens use looking for marijuana-like effects
SAY “CHEESE” PLEASE
• Heroin mixed with
Tylenol PM
• Crush, snort, get
high & hooked
• Affordable, deadly
• Ages 13 and up
• Nationwide alert by
DEA in 2006
RECOMMENDED BY:
Physicians,
Pharmacists
and ...
Dr.
Feelgood??
WHAT ARE THEY AFTER?
• Dextromethorphan
– Serotonergic activity can produce
visual & auditory hallucinations
• Antihistamines
– Antimuscarinic properties produce
visual and tactile hallucinations
• Decongestants
– Stimulant effects
– Replacement for pseudoephedrine
• Look for “PE” = phenylephrine
DEXTROMETHORPHAN (DXM)
• Availability
• Expected
symptoms
– Drowsiness
– GI upset
– Stimulant if
combos
Examples of Clandestine DXM Pills
• Symptoms of
abuse
– Nausea, vomiting
– Ataxia, slurred
speech
– Dizziness,
drowsiness
– Hallucinations,
psychosis
– Nystagmus, coma
– Withdrawal
syndrome
CRUNKING
• Briefly hit the news with
a fatal case in Hawaii in
2012
• Mixes a beverage with
cough syrup and
narcotic pills
• Used by kids to get high
• Combination of
depressants causes
respiratory failure
JIMSON WEED
Datura stramonium
• Seasonal “high” found in your garden!
• Usually seeds are chewed, sometimes smoked
• Hallucinatory, violent behaviors result
ANGELS TRUMPET (Datura inoxia)
• Teen victim brewed
and drank tea
• Same botanical
family as Jimson
weed
• Contains atropine,
scopolamine etc.
• Historically called
“Jamestown weed”
Patrick J. Alexander @ USDA-NRCS PLANTS Database
WHAT IS DMT?
• Psychoactive
chemical
• Causes intense
psychedelic effects
• Can be smoked,
injected, snorted, or
taken orally
• Source is many
plants – origin in
South America
• Related to
psilocybin
DMT DETAILS
• Extremely intense
visuals
• Short duration (20”)
DMT Duration If Smoked
Total Duration
6 - 20 mins
Onset
0 - 1 mins
Coming Up
0 - 30 secs
Plateau
3 - 15 mins
Coming Down
3 - 5 mins
After Effects
15 - 60 mins
Hangover / Day After
---
• Can interact with
many Rx drugs –
unpredictable
• Smoking causes
severe lung irritation
• Vomiting common
• Color-changing
vision, buzzing
sounds reported
• Triggers latent
psychiatric problems
SALVIA DIVINORUM
(Sage of the Seers)
Herb – Legal, abusable
Folks “grow their own”
• http://www.all4humor.com/videos/funny-videos/salvia-abuse.html
PRESCRIPTION DRUG ABUSE
PATTERNS AND TRENDS - 2012
• What are we talking
about?
– Narcotic pain relievers
– CNS depressants
– Stimulants
• Combine with illicit
drugs
• Falsely lowered
perception of risk
with Rx abuse
• Why abuse them?
–
–
–
–
Easy access
Cheap, pure
“Less harmful”
Less likely risk of
arrest
• How does one get
them?
– Family and friends
– Dealers
– Theft from
pharmacy
OXYCODONE: OxyContin®
True or False:
OxyContin® is the #1
misused narcotic for
illicit purposes.
False: Morphine
ABC NEWS:
“PAINKILLER PATCH ABUSE
BLAMED FOR DEATHS”
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•
•
•
Fentanyl Tea Bag – Brew up a cup?
Fentanyl Rectally – Shove it up where?
Fentanyl Chewed – Bite it!
Fentanyl Snorted – Up your nose!
FENTANYL MADNESS
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Fentanyl Dermal – Taking the Heat
Fentanyl Gel – Up in Smoke
Fentanyl IV – Shooting up the Patch
Fentanyl, Cocaine &/or Heroin –
Deadly Mix
• Fentanyl Oral – Lick your “Perc-o-Pop”
RITALIN GOES TO COLLEGE
• Indicated for attention deficit disorder
• Used to boost alertness and study longer
• Hit the news at UW Madison in 2004 and
Marquette in 2006
• Also being used by teens and adults
• Source? Diverted from legal prescriptions
• Adverse effects are stimulant
• Possible risk of cardiac arrhythmias
Objective Two:
Appreciate the Sources of
Information and the
Motivation for Abuse of
Unconventional Substances
in Teens and Adults
You know I don’t think
I can face the day today…
Motivation?
WHERE THEY GO – ”SOURCES”
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•
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Wikipedia – Kids & adults alike
Erowid – Users head here first!!!
Google any term for limitless options
You Tube, Twitter, etc.
TEEN-ORIENTED WEBSITE
www.whatisdxm.com
“PHARMING” PARTIES
• “Trail mix” of drugs available
• Social event for any age, especially
teens and college kids
• Pill-popping frenzy – all participants
donate
INHALANT ABUSE VIDEOS
• http://www.youtube.com/watch?v
=QXxBfmwExIA
• http://www.youtube.com/watch?v
=J618fx8Y2u0&feature=related
THIS WON’T HAPPEN!
Website
for
anyone
to
buy
WHAT?!?
Objective Three:
Understand and Utilize the
Best Approach to
Management of Patients With
Symptoms Due to Atypical or
Unknown Substance Abuse
Does anyone
think that this
would impress a
teenager or
addict?
Would be nice
but it is not that
easy…
Respect your creativity
for thinking outside the box....
• Remember all bets
are off when what
you think you are
dealing with is an
abusable substance.
• Let your training
and instincts lead
the way!
• Manage the patient,
not the history of
exposure…
MANAGEMENT OF INHALANT
ABUSE SITUATIONS
• We need to do what??
– Fresh air,
decontamination
– Do NOT stress person
– Observation (non-medical
OK?)
– Oxygen & EMS transport
– CPR/ACLS protocols
MANAGING PHARMING
• Unknown pills, in unknown amounts
leads to a management dilemma
• Unexpected, unpredictable for EMS
• Fear by medical staff of missing
something like acetaminophen
– Silent killer 36 - 48 hours out!
• Multiple patients from one party…
– MUST NOT assume drug exposure is
the same for all
TOXIC PLANTS MANAGEMENT
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•
•
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Woodrose
Nutmeg
Jimson Weed
Salvia
Used with permission
Jimson Weed Seedpod
NARCOTICS OD MANAGEMENT
• Symptoms
– Narcotic overdose
– Terminal event is
respiratory arrest
• Management
– Airway priority #1
– Naloxone in large
doses (but…)
– Supportive care
DEXTROMETHORPHAN
MANAGEMENT
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•
•
•
Symptomatic/supportive
Naloxone (rare)
Benzodiazepines
Caution for other
ingredients that may
need management(!)
ADDITIONAL RESOURCES
FOR HELP
• Poison Center at 1-800-222-1222
• National Drug and Alcohol Treatment Referral
Service: 800-662-HELP
• Wisconsin Clearinghouse for Prevention
Resources: 800-248-9244 or 608-263-2797
• National Inhalant Prevention Coalition:
800-269-4237
• National Clearinghouse for Alcohol and Drug
Information: 800-729-6686 or 800-788-2800
• My contact information: 608-265-8160
– www.uwhealth.org/poison
ONLINE RESOURCES
• Medical journals
• Websites:
– www.inhalants.org
– www.inhalant.org
– www.theantidrug.com
– www.mediacampaign.org
– www.samhsa.gov/
– www.drugfree.org
– www.backtoschool.drugabuse.gov
– www.nida.nih.gov
– www.erowid.org