10/4/2018

Emerging Drug Trends

Workforce ER Visits Cocaine School health Meth problems and Crime Local‐874 opioid dropouts Mental overdoses leading to Addiction health 27 deaths in 2016 Younger age of initiation‐11 Violence and Synthetic Drugs domestic abuse Heroin Regular use Marijuana “PINK”

Kratom Alcohol Tobacco/nicotine Prescription Drugs Experimentation

Access Perception of HARM

Choice to medical issue Parents are the #1 influence on choice

Electronic Smoking Devices

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Growing trend in “stealth use:”

“With no odor or smell, you can get away with vaporizing pretty much anywhere without anyone ever thinking any wrongdoing.” Quote from Leaf Science article “Portable Marijuana Vaporizers Worth Investing In”

Welcome Juul

Use is referred to as “juuling”

Juuling has shown a 270% jump among youth over the last year

Use of the Juul

2 10/4/2018

“mission is preventing the illegal sale of our products to youth”

Kit and Accessories

$6‐$12 $12‐13

$48.95

Look alike?

Pax Era • Micro USB • Similar pod • Temp adjust • THC concentrates

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Growing list of chemicals that can be “vaped”:

• Nicotine- most common • Tobacco • Alcohol •Caffeine • Synthetic Drugs – Flakka – Opioids • Heroin •Meth • Cocaine • Marijuana • THC Oil • THC Concentrates- quickly rising

“Dripping” Dripping involves multiple drops of “e-juice” going right to the atomizer (no filter)

Increased heating to: • Produce more “vapor” • Stronger “throat hit” • Improve flavors • Higher concentration of chemicals More carcinogens???

Policies: • Location examples: school districts, community center, libraries, government buildings, restaurants, businesses, churches and other organizations – Smoke‐free – Tobacco‐free – Nicotine‐free – SF with ESD add on

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OTC & Rx Drugs of Abuse

Dextromethorphan

Triple C Lemon Drop

Dextromethorphan (DXM)

DXM is a common cough suppressant found in cold/cough medications • Medical doses: 10 to 29 milligrams • Abuse doses: 250 to 1,500 milligrams

Narconon.org

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Stages of impairment

1. Inebriation similar to drunkenness 2. Inebriation plus slurred speech and possibly mild hallucinations 3. Altered state of consciousness, vision or other senses may be impaired 4. lose contact with their body, all senses shut off, similar to that of ketamine or PCP

Impact of Abuse

Damage from abuse: • Bone marrow and nerve cell damage • High blood pressure • Heart damage • Permanent brain damage • Liver failure • Tachycardia (rapid heart rate) •Seizures • Hyperthermia • Respiratory depression •Coma

Side Effects

• Euphoria • Double vision • Feelings of detachment • Drowsiness from the body • Impaired ability to walk. • Blotchy skin • Itching • Depression • Numbness of fingers • Difficulty speaking and toes • Dilated pupils • Symptoms of psychosis • Dizziness • Racing heart • Hallucinations • Vomiting • Involuntary movements (ataxia)

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Slang Terms Related to DXM

• “Skittling,”- Triple C • “Robo,” • “Dexing” • “Tussin”

Lemon Drop

Lemon Drop • Made by mixing painter’s solvent or lighter fluid with over-the-counter cough syrup • Lemonade Powder is mixed in to cover the bitter taste • Active ingredient is Dextromethorphan (DXM)

• DXM Gel Caps

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Lemon Drop Effects and Dangers

• Psychedelic drug that produces strong hallucinations • Can cause anxiety or panic that can last for hours • High amounts of DXM can stop the heart, slow breathing and cause fatal liver injury • Nausea, vomiting and stomach pain • Extreme sedation or drowsiness, confusion and dizziness • Blurred vision, slurred speech and poor physical coordination • Numbness in extremities

Lean/Purple Drank/Sizzurp/ Dirty Sprite

What is it?

• A combination of the following: – Prescription‐strength cough medicine. – Soft drinks. – Hard, fruit‐flavored candy • The prescription cough syrups used to make lean drink present the most danger because they often contain codeine, a powerful opioid drug • Another active ingredient in some prescription cough syrups is promethazine, an antihistamine that causes sedative effects and can impair motor functioning

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Short Term Side Effects

• Dizziness • Blurred vision • Nausea • Memory problems

Effects of Regular Users • Widespread health issues including – Dental decay. – Constipation. – Weight gain. – Urinary tract infections – May suffer from life‐threatening effects, which may be exacerbated when it is used in combination with other drugs • Some cases of coma and death have been reported • The risk of death is highest when combined with other sedative drugs or depressant substances such as alcohol

Large in Teen Culture • The U.S. Drug Enforcement Administration’s figures show that one in ten American teens have sipped either over-the-counter or prescription syrup. • Huge in the Hip Hop Culture – Known has “Hip Hop’s Heroin” – Referenced in over 30 percent of rap songs that reached the top ten of Billboard’s Hot 100 in 2017 – 2014 Study found that codeine references more than tripled in rap songs between 2000 and 2007.

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Triple C

What is Triple C • Slang term for the over-the-counter medication Coricidin HBP Cough & Cold – Contains Dextromethorphan, or DXM • The directions on a box of the medicine recommend one tablet every four hours to relieve cold symptoms – To achieve a high and to feel psychedelic effects, may take 10, 20, and even 30 pills at a time

Other Forms of Triple C

• Triple C (Coricidin Cough & Cold) = 30 milligrams of Dextromethorphan. • Coricidin Chest Congestion & Cough = soft gels containing 10 milligrams • Coricidin HBP Maximum Strength Flu = tablets containing 15 milligrams

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Street Names for Triple C

• Orange Crush • C-C-C • Red Devils • Skittles

Who Uses Triple C

• Law enforcement sources indicate that teenagers and young adults are the principal abusers •Why: – Usually stocked on open shelves – Susceptible to shoplifting, which has caused some stores to place it behind the counter – Relatively low price

Side Effects

• Nausea •Seizure • Abdominal pain • Brain damage • Vomiting • Possibly death. • Irregular heartbeat • Confusion • High blood pressure • Agitation • Headache • Paranoia • Numbness of fingers • inappropriate laughter and toes • Loss of consciousness

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Side Effects • You can also experience sensory changes like unusual sounds, a weird sense of touch, or a feeling of floating in midair • About five to ten percent of Caucasian people do not metabolize DXM very quickly, and this demographic is especially at risk of overdosing • Taking it with antidepressants can be deadly

Adderall

Adderall

• Used primarily to treat the symptoms of attention-deficit hyperactivity disorder (ADHD). • It has benefits with sleep disorders and reported, off-label utility in managing some forms of severe depression as well. • Central nervous system stimulant

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Short Term Signs of Abuse

• Headache •Anxiety • Dry mouth • Restlessness • Hoarseness • Pounding or fast • Nausea heartbeat • Stomach upset • Shortness of breath • Digestive issues • Difficulty sleeping and • Reduced appetite staying to sleep • Diarrhea or • Excessive fatigue constipation • Changes in sex drive

Long Term Signs of Abuse

• Weakness or • Blistering or peeling numbness in the arms skin or legs • Changes in vision • Dizziness • Aggressive behavior • Slowed or difficult • Paranoia speech • Mania • Chest pain • Seizures • Hives or rash

Long Term Abuse Health Issue

• Large Cardiovascular Issues – Increasing your blood pressure. – Increasing your heart rate. – Increasing your body temperature to dangerous levels. Linked to higher risks of Heart Attack & Stroke

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Larger Issue-Mixing with Alcohol

• Adderall has the ability to mask certain indicators of intoxication that people would otherwise use to slow or stop their consumption. If these signs go unnoticed, the user is at risk of continued drinking— potentially leading to alcohol poisoning, coma, or death.

Teen Adderall Abuse

• According to SAMHSA's National Survey on Drug Use and Health – 425,000 teens and adolescents between the ages of 12 and 17 reported misuse Adderall. – Approximately 2.5 million among young adults age 18 to 25 • Teens who misuse Adderall are also – 3 times as likely to have used marijuana. – 8 times as likely to have used cocaine or prescription tranquilizers like Xanax and Klonopin recreationally. – 5 times more likely to have misused prescription pain relievers.

Xanax

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Xanax

• Used to treat anxiety and panic disorders • Also called: – Xannies/Zannies – Handlebars/Bars – Blue footballs Drugabuse.com

Xanax Dosing

• Medical doses of .25mg, .5 mg, 1 mg, & 2 mg

• Abuse dose of 2-12.5 mg

Signs of abuse • Feelings of elation • Drowsiness • Sleeping for extended periods of time • Light-headedness • Difficulty concentrating • Problems with memory • Sluggishness • Nausea • Headache • Lack of coordination • Slurred speech • Confusion

• Disorientation Drugabuse.com • Respiratory depression

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User Experience

“Xanax makes you extremely sleepy and stupid. Kinda like being drunk. It also has a reputation of zapping your memory. You'll wake up the next day after 2mg of Xanax and wonder what the @#%& happened the night before”

Bluelight.org

Opioids

16 10/4/2018

What Happened With Opioids?

• Misperceptions about their safety. – Because these medications are prescribed by doctors, many assume that they are safe to take under any circumstance

• Increasing environmental availability – Prescribing rates are highest among pain medicine (49%), surgery (37%), and physical medicine/rehabilitation (36%). However, primary care providers account for about half of opioid pain relievers dispensed

• Varied motivations for their abuse. – Underlying reasons include: to get high; to counter anxiety, pain, or sleep problems; or to enhance cognition

Fentanyl

What About It? • Street Names – Apache, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpost, Murder 8, TNT, Tango & Cash • When used for abuse, usually in powder

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Short Term Effects • Works by binding to • Confusion Opiate Receptors • Constipation Brain -increasing • Sedation Dopamine • Unconsciousness • Increase desire to talk •Coma to people • Increased Tolerance • Drowsiness • Addiction • Respiratory Depression & Arrest • Most intrinsically euphoric drugs • Nausea

Carfentanil

Carfentanil

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Dangerously Potent • Tranquilizing agent for elephants and other large mammals – Drop can be lethal – 2 mg can tranquilize African Elephants in seconds

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State of Iowa Crime Lab Results

2015

Substance Cases Weight

Heroin 175 2967 grams

Heroin/Fentanyl 21 4.5 grams mixture

Fentanyl 3 2 patches, 1 residue

2016

Substance Cases Weight

Heroin 231 352 grams

Heroin/Fentanyl mixture 16 13 grams

Fentanyl 10 1.6 grams, 13 patches

Heroin/Acetyl Fentanyl 17grams mixture Acetyl Fentanyl 1 0.1 grams

Heroin/Furanyl Fentanyl 91.6 grams mixture

Furanyl Fentanyl 10 24 grams

U‐47700 5 39 grams

2017 (Jan Substance Cases Weight – Sep) Heroin 216 684 grams Heroin/Fentanyl mixture 50 41 grams Fentanyl 13 11 grams Heroin/Furanyl Fentanyl 16 4.8 grams mixture Furanyl Fentanyl 7 20 grams Heroin/Carfentanil mixture 2 trace Carfentanil 2 951.5 counterfeit oxycodone tablets Heroin/Acryl Fentanyl mixture 20 20 grams Acryl Fentanyl 3 0.03 grams Heroin/4‐fluoroisobutryl 2 28 grams fentanyl mixture Cyclopropyl Fentanyl 1 46 counterfeit oxycodone tablets Heroin/U‐47700 mixture 2 27.75 grams U‐47700 5 0.06 grams

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New Marijuana

Marijuana Trends

1. Decriminalization or Reduction 2. Medicinal 3. Retail 4. Positive Legislation

Legalization generally lowers perception of harm and increases access.

Not the same plant

THC: Psychoactive Ingredient

CBD: NON-Psychoactive Ingredient

• Source: Mehmedic et al., 2010

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“Concentrates are the Future of Cannabis” Average of plant: • 1960’s was 2-4% • 2017 is 15-20% Current concentrates are 60-90% Industry reached 98% THC

“Concentrates are used in probably 95 percent of the branded products” (ie: vape oils, the vape cartridges, the edibles) (aka: Dabs, budder, shatter, wax, oil, BHO) Engadget.com

Concentrates contain up to 98% THC

THC Products

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THC Products

2014 RAPID INCREASE IN DRUG OVERDOSE DEATH RATES

Designed by L. Rossen, B. Bastian & Y. Chong. SOURCE: CDC/NCHS, National Vital Statistics System

MJ and Opioid Deaths

• Project SAM

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Changes in use since legalization

Percentage of population ages 12 and up who Percentage of population ages 18 to 25 who used used marijuana in the past month marijuana in the past month

• Source: NSDUH state estimates

Marijuana and ER visits • 29% increase in ER visits related to cannabis

use (National Institute on Drug Abuse (NIDA)) • Cannabinoid Hyperemesis Syndrome – Causes stomach pain/vomiting due to THC toxicity – In Colorado, 2004 to 2009‐rare 2009‐41 cases 2011‐87 cases 2015‐still increasing, but no exact numbers available Colin Fernandez, Science Correspondent For The Daily Mail , August 2015 Remember, use and potency has increased

Marketing and local impact

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Pro-Marijuana Industry Wants to shake the past and gain acceptance 1. Establish a brand/logo 2. Increase favorability – Promote benefits, dismiss negatives, create confusion 3. Increase visibility 4. Develop products Has any of this occurred?

Marijuana’s brand?

What is this? How many would recognize it? What colors are often paired with it? Celebrity support? TV and Movies?

Normalizing through TV

“cannabis guest starring more often on television shows as a casual or medicinal product, rather than a taboo”

This is tobacco 101: Confuse, normalize, expand, protect Celebrities, music, movies and TV

25 10/4/2018

New Marijuana magazines

• Broccoli • Gossamer • Push Mag • Kitchen Toke

Shirts

Who is the target?

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Concealment

Hidden Beverage

Fake tampon stashes

27 10/4/2018

Paraphernalia sold for tobacco use?

OK?

General Drug Prevention Strategies • Educating the community on trends • Gaining community support by coalition work and other collaborations • Increasing Community Readiness Levels • Increase capacity of those who can be advocates

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Prevention • Share these truths with others • Support prevention efforts: – Tobacco Free Parks – Social Host – Paraphernalia sales restrictions – Pro‐drug marketing restrictions – Dispose of unneeded medications – Improve policies • Talk with youth (90%) • Stay informed…

Drug Prevention Info To Go…

• Drug use is a preventable behavior, & drug addiction is a treatable disease. Key influencers do make a difference.

• Teens who learn about drug dangers through ongoing dialogue at home are up to 50% less likely to ever use them.

• A frequent reason cited by drug free teens for deciding to not use drugs is the fear of disappointing their parents.

• Building skills and values can decrease the likelihood of substance use.

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