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Home , Brad Renfro, Speedball (drug), Thebaine

& The Young Adult Population

MARY-K O’SULLIVAN, LMFT, LADC, LPC Capital Region Mental Health Center Please Define The Difference Between Mood Altering and Mind Altering

Adolescence & Young Adulthood

Developmental Stage that Transitions the Child to an Adult

Age Range is between 10 – 24 and referred to as “teenagers,” “adolescents,” “youth,” and “young people”; The associated age spans are variously 13-19, 10-19, 15-24, even 10-24.

Focus is Upon Developing Adult Coping Skills and Abstract Problem Solving in Varying Situations Young Adulthood Risk Factors

• Exposure To Drug Users In Social/Work Environments • Relationship & Work Instability • Unemployment • Psychological/Psychiatric Symptoms

The Effective Brain

GROWTH: Potential for Learning

PRUNING: Efficiency

MYELINATION: Speed Nucleus Accumbens

• promotes the drive for new experiences

• seeks activities with low effort for high yield

• enhances maturity

• pushes away from family to the outside world

The peer group becomes increasingly important to teenagers because

1. They have a greater understanding of others 2. They have a great capacity for mutual understanding 3. They have an increased capacity for intimacy and true friendship 4. All of the above Young Adults Have a Unique Culture of Their Own With Peer Structures, Belief Systems, & Developmental Goals

Young Adult Context

• What Role Do Peers Play in the Development Process of Adolescents? • What Role Does School Play in the Development Process of Adolescents? • What Role Does Community Play in the Development Process of Adolescents? • What Role Does Family Play in the Development Process of Adolescents?

Peers tend to influence more ______, parents tend to influence more ______.

1. Decision making; basic values 2. Superficial behavior; basic values 3. Basic values; superficial behavior 4. Basic values; cultural mores ` The Amygdala Contributes to:

Impulsive Behavior

Inappropriate Behavior

Missed Social & Emotional Cues

Miscommunication

Contributes to Rapid & Highly Emotional Reponses

Behaviors Not Outgrown With Aging

FRONTAL LOBE Poor Organizational Skills Poor Decision-making Poor Processing of Abstract Concepts Rule Breaking Reckless Behavior Emotional Outbursts

HIPPOCAMPUS Difficulty with Memory Difficulty Learning

The Washington Post Reviewed the CDC Data for 2015 and Found:

• death rates were highest in Ohio, West Virginia, and Connecticut, where the rates were between 10 and 13.3 deaths per 100,000 residents

• The analysis showed that synthetic opioids—including and — almost exclusively affect the East Coast

Narcotics

• : Directly Derived From The Poppy

• SEMI-SYNTHETIC OPIATES: Partially Derived From The Opium Poppy, Partially Man-made

• OPIOIDS: Completely Synthetic/Man-made OPIATES

OPIUM - Schedule II or III (Diluted) – Schedule II – Schedule III THEBAINE – Schedule II

NARCOTICS SEMI-SYNTHETIC OPIATES

Heroin: Schedule I : Schedule III (ex: Vicodin) : Schedule II (ex: Dilaudid) : Schedule II (ex: OxyContin, Percodan, Tylox)

NARCOTICS OPIOIDS – (Fully Synthetic)

Buprenorphine (Subutex, Suboxone): Schedule V Fentanyl: Schedule II Meperidine (Demerol): Schedule II (Dolophine): Schedule II (Talwin): Schedule IV Propoxyphene (Darvon): Schedule IV (Ultram, Ultracet): (Not Yet Scheduled)

“Pharm-parties” are introducing adolescents and young adults to the world of prescription drug use at an alarming high rate. It is not considered “drug use” by many of those engaged in the behavior as the medication comes from a pharmacy

Often unable to afford illicit sources of the prescription medication, and now physically addicted, individuals turn to heroin Heroin costs 1/3 to 1/2 that of Oxycodone purchased illicitly on the street Deaths Due To Narcotics • King George V – Monarch ( and morphine) • – Actor/Musician (Speedball) • – Actor (Speedball) • Jim Morrison – Musician (Heroin) • – Comedian/Actor (Speedball) • Elvis Presley – Singer/Actor (Prescription Drugs) • Janis Joplin – Singer (Heroin) • – Musician (Heroin) • Sigmund Freud – Physician (Morphine) • DJ AM – Disc Jockey (Prescription Medications and Cocaine) • Howard Hughes – Aviator (Codeine) • Michael Jackson – Musician ( and Other Prescription Meds) • Heath Ledger – Actor (Prescription Medications) • Sid Vicious – Musician/Sex Pistols (Heroin) • Brad Renfro – Actor (Heroin and Morphine) • Dana Plato – Actress (Lortab)

Emerging Trend – U-47700

• A synthetic drug that was developed in the 1970s but never made available to the public is being sold online

• The designer drug has gained popularity through drug forums and websites, where it is sold as a powder or granules. One website offers 1 gram for $40, or up to 1 kilogram for $7,000.

Emerging Trend – Grey Death

• A new drug called "grey death" has been linked to a handful of lethal overdoses in the South - - but no one knows exactly what's in it or where it's coming from. • The drug, a mix of opioids, can kill in very small doses and looks like concrete mixing powder.

Emerging Trend - Cheese

• A mixture of heroin and OTCs such as Tylenol PM • The heroin-Tylenol PM combination of "cheese" sells for approximately $2 a pill • Users commonly take the powder by insufflation ("snorting") rather than by intravenous injection. • This mixture is also known as "Tylenol With Smack" Emerging Trend - Krokodile

• Krokodil (pronounced crocodile) is a homemade substitute for heroin, invented in rural Russia and has recently been featured in news reports alleging its appearance in parts of the United States although the DEA has not yet confirmed any krokodil in this country.

• The chemical name for the main ingredient is .

• The drug is made from codeine mixed with household chemicals like paint thinner and gasoline. It’s injected and can reportedly cause a high “ten times more powerful than morphine,” It’s also three times as toxic.

• Krokodil gets its name from the scaly, gray-green dead skin that forms at the site of an injection. The flesh destroyed by krokodil becomes gangrenous, and, in some cases, limb amputation has been necessary to save a user’s life.

Emerging Trend - Hysingla ER

• Purdue Pharma has announced that its prescription opioid medication Hysingla ER (hydrocodone bitartrate) is ready to hit the market. • The drug is the first hydrocodone product that contains abuse-deterrent properties

Emerging Trend W-18

• A new drug that is considered to be 10,000 times more powerful than morphine has hit the market in the US after being discovered in Canada • The synthetic -like W-18 is a psychoactive substance and opioid similar to heroin, but is 100 times more powerful than fentanyl. • W-18 is yet to be prohibited in Canada or the US. It was made illegal in Sweden on January 26, 2016. • It was originally developed as a painkiller by scientists at the University of Alberta in 1981. • After being deemed too strong, it was never picked up by pharmaceutical companies and was largely forgotten about.

Current Trend - Zohydro

• The introduction of the powerful new opioid painkiller Zohydro has spotlighted the nation’s growing prescription drug abuse problem. • A powerful new prescription painkiller known as Zohydro ER hit the market in March 2014 amidst widespread concern that the drug could trigger a disastrous spike in overdoses and deaths. Zohydro is a potent extended- release formulation of hydrocodone without the additives of aspirin or acetaminophen and without anti-abuse formulation. Current Trend - Opana

Law enforcement officials are alarmed by the rise of Opana abuse, which they said started after Oxycontin was changed in late 2010 to make that drug more difficult to snort or inject for a heroin-like high.

Opana abuse can be deadly because it is more potent, per milligram, than Oxycontin, and users who are not familiar with how strong it is may be vulnerable to overdosing.

Opana, known by such street names as "stop signs," "the O bomb," and "new blues,". is crushed and either snorted or injected up to four to ten times per day.

Opana () is an opioid pain medication. Opana is used to treat moderate to severe pain.

The extended-release form of this medicine is for around-the-clock treatment of severe pain. Current Trend - Carfentanil

• Carfentanil or carfentanyl is an analog of the synthetic opioid analgesic fentanyl. It is 10,000 times more potent than morphine, making it among the most potent commercially used opioids Current Trend - Acetyl Fentanyl

• Mixing fentanyl with heroin isn’t new; however, the development of a synthetic fentanyl has just started to make headlines. • Three overdose deaths in North Carolina have been linked to acetyl fentanyl, a designer opioid drug closely related to the prescription pain killing opioid fentanyl. Two deaths occurred in Jefferson Parish, La. due to the drug and the use of acetyl fentanyl seems to be spreading throughout the country. • Acetyl fentanyl is often marketed as heroin but it is five times more potent than heroin, 16 times more potent than morphine. Therefore, it is leading to many overdose deaths, particularly in Rhode Island and Pennsylvania. The pills are also peddled as oxycodone. • Acetyl fentanyl is difficult to detect and easy to miss in cases. • Acetyl fentanyl is not scheduled under the Controlled Substance Act. Current Trend “Syrup,” “Purple Drank,” “Sizzurp,” “”

• Drinking prescription-strength cough syrup containing codeine and promethazine mixed with soda was referenced frequently in some popular music beginning in the late 90s and has now become increasingly popular among youth in several areas of the country, according to recent CEWG data. Codeine is an opioid that can produce relaxation and when consumed in sufficient quantities. Promethazine is an antihistamine that also acts as a sedative. Users may also flavor the mixture with the addition of hard candies. • Demand for the syrup has sent its price soaring on the streets. Syrup that typically costs $12 per pint is sold to street dealers for $300 per pint. Dealers sell it by the ounce for $40-$80. • The drink produces euphoria and causes motor skill impairment that make users move slowly or lean over. Overdosing on the syrup is potentially fatal. Current Trend P-Dope

• Often Called Designer Heroin • Molecular Similarities to Fentanyl in Some Areas of the Country; Purer Heroin Mixed With Procaine/Lidocaine in Other Areas • Over-rides Methadone Allowing Users to Get High • Users Call it the “Crack of Heroin” due to its addictive potential Psychological

Effects of Narcotics • Mood swings Heroin • Depression Opium • Morphine • Irritability Codeine Hydrocodone (ex: Vicodin, • Lethargy Zohydro) • Exhaustion Hydromorphone (ex: Dilaudid) • Sedation Oxycodone (ex: OxyContin, Percodan, Tylox) • Memory Oxymorphone (Opana) problems (Subutex, • Hallucinations Suboxone) • Delusions Fentanyl Meperidine (Demerol) • Paranoia Methadone (Dolophine) Pentazocine (Talwin) Propoxyphene (Darvon)

Definitions of Mood vs. Mind Altering

• Mood- Altering: Client Becomes Their Own Pharmacist. Focus is on a Temporary or Short-term Emotional or Feeling State; Can Involve Perception of Outside Stimuli; Deregulates Brain Chemistry; Getting High is the Goal

• Mind Altering: Medical Personnel are Pharmacists. Focus is on Long-term Feeling or Emotional State; Targets Intellect, Judgment, Cognition, Intellect; Re-regulates Brain Chemistry; Getting High Is Not the Goal Nor Part of the Perception of the Client