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
1 10/4/2018
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
3 10/4/2018
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
4 10/4/2018
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
5 10/4/2018
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)
6 10/4/2018
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
7 10/4/2018
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
8 10/4/2018
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.
9 10/4/2018
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
10 10/4/2018
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
11 10/4/2018
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
12 10/4/2018
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
13 10/4/2018
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
14 10/4/2018
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
15 10/4/2018
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
17 10/4/2018
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
18 10/4/2018
Dangerously Potent • Tranquilizing agent for elephants and other large mammals – Drop can be lethal – 2 mg can tranquilize African Elephants in seconds
19 10/4/2018
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
20 10/4/2018
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
21 10/4/2018
“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
22 10/4/2018
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
23 10/4/2018
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
24 10/4/2018
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?
26 10/4/2018
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
28 10/4/2018
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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