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New Trends in Street Drugs Upon Completion of This Program the Learner Will Be Able To

New Trends in Street Drugs Upon Completion of This Program the Learner Will Be Able To

Objectives New Trends in Street Upon completion of this program the learner will be able to:

th September 14 , 2015 1. Identify new trends in street use and legal Rochester, New York highs 2. Discuss some of the geographic, demographic and Dr. Andrea Efre cultural factors of drug use DNP, ARNP, ANP-BC, FNP-C 3. Review signs, symptoms and treatment options of Nurse Practitioner suspected drug use, withdrawal or overdose and Professor in Graduate Nursing

NIH: Monitoring the Future 2014 New Trends in Street Drugs National Trends: Prescription drugs are still a problem but turning to as an alternative , Meth and Heroin are regional Hallucinogenic: LSD (Acid) and MDMA (Ecstasy, Molly) – Regional Marijuana use and dependence has risen (plus introduction of Wax/Dabs)

Daily use of Synthetic (K2 and Spice) Marijuana remains Synthetic (, Flakka) common Chemical Drugs – EG: -I, N-Bomb, B-Fly, Internet Purchases – “Legal Highs”

Old Drug – New Trends… Rochester Trends Heroin Heroin: May be smoked snorted or injected Dr. Jeremy Cushman, Recently used as an alternative to Rx drugs Monroe County Interim Health Commissioner: Cutting Heroin: When other substances are used to increase the bulk: There were 94 heroin- • Talcum powder related deaths in 2014 (triple that of 2012) • Dextrose • Flour • More than 180 doses of Naloxone were given in last year to reverse heroin overdose

1 Symptoms of Heroin Use Long Term Effects of Heroin Pulmonary complications - Including pneumonia Short Term Effects Organ complications (including Liver disease) and vessel damage due to the additives that the heroin , Disorientation, Delirium was cut with Cold and clammy “Rush” feeling a surge of Needle Users Long Term Effects Endocarditis Accompanied by a warm flushing of the skin Collapsed veins Dry mouth, and heavy extremities Abscesses Cellulites “On the Nod" following the initial euphoria, this is a wakeful and drowsy state Infected sites HIV, Hep B and C in needle users

Signs of Overdose Withdrawal OD triad (observed in Heroin and ) Drug craving Coma Restlessness, Respiratory and failure Muscle and bone and diarrhea Depression of CNS – Miosis - pin point pupils Cold flashes with Piloerection ( know as Convulsions (Seizures) "cold turkey") Hypoxia and Cynosis Kicking movements ("kicking the habit") Hypotension Withdrawal symptoms peak between 48 and 72 hours and subside after about a week. Bradycardia Sudden withdrawal by heavily dependent users in poor Respiratory depression – Prepare to intubate health is occasionally fatal (less dangerous than or withdrawal) If found in community: Call 911 - Must go to ER – Even if Naloxone (Narcan) given (short 1/2 life) Use in pregnancy leads to Neonatal abstinence Syndrome (NAS) in the baby

Krokodil Krokodil “Krokodil,” a toxic homemade opioid Made by combining tablets with The flesh destroyed by krokodil various toxic chemicals including lighter becomes gangrenous, and, in fluid and industrial cleaners some cases, limb amputation has been necessary to save a Used as cheap heroin substitute in poor rural areas of Russia – user’s life. In 2011, it was estimated that as many as 2 million Russians Users often present with were addicted multiple scabs and skin Has similar effects in the brain as heroin, but more powerful infections. and has a shorter duration. Users often smell of iodine Spread into Europe - Germany, France, Belgium, Sweden, Krokodil gets its name from , Czech Republic, and Ukraine the scaly, gray-green dead Has recently been featured in news reports alleging its skin that forms at the site of appearance in parts of the an injection. Case reported in St. Louis - (Thekkemuriyi, John, & Pillai, 2014)

2 Krokodil 2015 Drug Trends: Cocaine Cocaine Powder Cocaine is a White All you need is: crystalline powder • Cocaine, Baking Soda, Freely soluble in water Water, Heat Popular method: ‘Free' the cocaine “Snort" lines with a alkaloid 'base' from the straw, rolled up paper salt U.S., many are hoping that the or $ bill pictures of flesh rotting off the No salt =  combustion = bone like the following will be  Smoke enough to discourage any potential Not soluble Krokodil users from ever trying this devastating drug. Intense high lasts 5-30 mins

Signs of Overdose of Cocaine and Cocaine Treatments: and Arrhythmias, Widened QRS/Q and prolonged QT segment Charcoal - Oral ingestion (especially stuffers/packers) MI/ ACS/ Coronary artery spasms that cause MI and vasodilators for HTN (nitroprusside and NTG) V-Fib/Cardiac arrest (High doses) Ventricular arrhythmias may respond to sodium bicarbonate (effects of cocaine on the Na+ Channels), (in combo Tremors, and delirium with Benzodiazapines) and Magnesium Agitated (excited) delirium Medications to Avoid: Seizures and convulsions Avoid Beta-blockers - unopposed responses (BP, Hyperthermia (Dopaminergic regulation of core temperature) Coronary blood flow, CO) Rhabdomyolysis (from Dopaminergic changes) Avoid Calcium Channel blockers ( ingested cocaine from GI, Respiratory arrest and may  ICP). Avoid Nifedipine (Procardia, Adalat)  seizures Aortic Dissection Avoid some antiarrhythmics: , procainamide, and disopyramide (Norpace) (class 1a) > QRS and QT intervals and Emboli may occur from injection slows the of cocaine

Methamphetamine What does Meth look like? . A white odorless powder that easily dissolves in water or alcohol and bitter- tasting

Street terms are: Speed Black Beauties Meth Tweak Poor man’s Cocaine Glass Crystal meth Ice Crystal Chalk Bikers Crank Yaba (pills) Uppers Yellow Bam Use/Route: Oral, Snorting, , IV or Rectal (Bootie bump)

3 Short Term Long Term Signs of Overdose of Effects Effects Methamphetamine Smoking or IV provides an intense sensation, called a Skin abscesses appear as Symptoms of use and signs of overdose are very “rush” or “flash,” chemicals rise to the surface similar to cocaine and Teeth rot from gum line Lasts only a few minutes and is Hyperthermia described as extreme pleasure Acute lead poisoning is a potential risk for Convulsions/seizures Oral, intranasal or rectal use methamphetamine abusers Produces euphoria - a high, but Risk of Parkinson's and , confusion, depression not a rush alzheimers Chronic fatigue, insomnia Heart failure Delusions, , aggression, hallucinations Toxic

Epilepsy Treatment discussed later

Street terms: 3,4 Methylenedioxymethylamphetamine, (MDMA) Ecstasy (pill) Invented in 1912 for medicine, Patented by Merck 1914 Molly (powder) In the 1970’s, it was used in psychotherapy

Also known as: Mid 1980’s used as a street and illicit drug XTC, X Schedule I drug with no current acceptable medical use Adam MDMA tablets are usually sold with logos, creating brand Hug drug names for users to seek out MDMA or MDA Dove Colorful pills may be hidden among colorful candies Love, E

Molly - MDMA Molly—slang for “molecular” How is MDMA Used? Usually contains Pure MDMA Can be snorted, injected, and rectally inserted, but is usually taken orally in tablet form Ecstasy often has additives such as or Methamphetamine Effects last approximately 4 to 6 hours Pure crystalline powder, or can Considered a “party drug.” be capsules containing powder Rarely used alone, Commonly mixed with alcohol and Molly = street term to describe some “Bathsalts” such as marijuana : (bk-MDMA) or Mephodrone (meow meow) “Candy flipping” is the combination of MDMA and LSD (especially in the UK) “Stacking” is taking three MDMA or more tablets at once Molly = street term for Methampetamine/meth combos “Piggy-backing” is taking a series of tablets over a short User may not get what they expected with Molly period of time

4 Molly - MDMA

Molly can be purchased in capsules for $8 to Uses (why people use) $40 per pill depending on location Molly had a surge in interest in the past few MDMA in any form Reduces inhibitions years, being celebrated frequently by actors produces energy and euphoria Produces feelings of and musicians empathy/affection for others Suppresses the need to Molly also comes in the form of high-priced, eat, drink, or sleep Talking excessively specially branded water, called Mollywatr (glow-in-the-dark container). Enables club-scene users Enjoying touching to endure all-night / 2-3 day parties Enjoying being touched

Eliminates anxiety Making it a Rape Drug Giggling uncontrollably

Side Effects Side Effects: Overheated/Increased core temperature Jaw muscle tension Dry mouth Hyperthermia 107-109°F Teeth grinding and Dilated pupils involuntary clenching Blurred vision Loss of consciousness Users will often suck on Seizures pacifiers and candy to Nausea help relieve the tension Faintness Confusion & Panic attacks Muscle tension /Sweating Tachycardia Tremors Problems sleeping Hypertension Muscle cramps Depression Hepatic/Renal failure Twitching Dehydration is common Death

Lysergic Acid Diethylamide (LSD) Signs of Use/Side Effects of LSD

Street terms: "acid”, Dots, Mellow Yellow, Elevated BP Flashbacks are a Loony toons, Blotter Tachycardia, Palpitations unpredictable and First discovered in 1938 dangerous side effect Produced in the US - on the West Coast, Hyperthermia particularly San Francisco Elevated blood sugar Occur spontaneously Effects are unpredictable from 30 mins to 12 hrs Dilated pupils Vary in frequency and Schedule I - No currently accepted medical use in Tremors duration treatment in the United States May occur days up to Odorless Gooseflesh months after use Colorless Perfuse Slightly bitter taste Hallucinations, delusions Increase occurrence Usually taken by mouth and paranoia during times of Found as a liquid, microdot, sugar cubes, gelatin Panic reactions squares and blotters (soaked paper)

5 Management of overdose for Cocaine, Methamphetamine, MDMA, Molly, or LSD and Treat as a Medical Emergency – Stabilize (ABC’s), Oxygen, Monitor, IV (K2, K9, Spice, and ‘Herbal Incense‘) Code Cart –May need defibrillator Prepare to intubate No specific antidote is known Benzodiazepines for seizures and muscle spasms Treat Hyperthermia - use cold water, fans, cooling blankets, and anti-pyretics (Tylenol) Additional treatment depends on the presenting complaint and organ system involved

THC – Wax/Dab - “dabbing” THC – Wax/Dab - “dabbing” Potent - high level of THC Known as: psychoactive compound: up to How is it used: Hash () oil 80% THC, (range 50-75%) Smoked in vaporizers and water pipes Wax Marijuana joint average 20% TCH e-cigarettes BHO Edibles, drinks and liquids Obtained from the cannabis Honey Oil Marijuana leaves and stems are Budder or shatter soaked in a such as Side Effects: which extracts the cannabinoids Scary vision/Halucinations The residue is then dried out, Psychosis/Mental health issues resulting in a sticky paste Tachycardia and Hypertension Produced into : Viscous oil, Increase in stomach acid hardened waxy substance, or brittle/glassy pieces

E-Cigarettes and THC K2, Spice Gold, and Herbal 'Incense' Biggest trends upward in Plant material and herbs Sprayed/ laced with teenage use synthetic cannabinoids Compounds chemically similar to THC Mimics the Psychoactive ingredients in marijuana (THC) The chemical compounds typically include HU-210, HU-211, JWH-018, and/or JWH-073 >100 such substances have been synthesized and identified to date Act on receptors found throughout the body (just like THC) Not generally detectable by current drug screening methods (that look for THC)

6 Scooby Snax K2, Spice Gold, and Herbal 'Incense' Herbal Incense How is it used: One of the original most popular herbal Most often smoked incense blends on the market Original, Hydro, and flavored Sometimes made into a New 2nd Generation Intravenously Available for next day shipping $20.99 for 4 grams (16.99 for original) Why: Mimic delirious effects of THC $34.99 for 10 grams (as of 4/2/15) Street Names: Hundreds of brands: Aroma, Banana Cream, Black Mamba, Bombay Blue, Fake Weed, Genie, K2, Nuke, Scooby Snax, SpicyXXX, Spice, Zohai

K2, Spice Gold, and Herbal 'Incense' Synthetic Cannabinoids K2, K9, Spice, and ‘Herbal Incense' Commonly purchased in head shops, shops, gas stations, retail Desired Affect: Euphoria & giddiness outlets, and the Internet Side Effect: Often marketed as Herbal Incense, Tachycardia, bradycardia, palpitations, Potpourri, or “fake weed.” chest pain, and Elevated BP Dyspnea and diaphoresis Users consider it a “Legal high” Anxiety, irritability, suicidal thoughts Many states have banned some Paranoia, Panic attacks, and psychosis substances involved in making it Seizures An example of deceptive language used on Spice labels ‘not for human consumption’ Appetite changes, nausea, vomiting Once banned, compound is modified to avoid laws It appears to be stored in the body for long periods of time, and therefore the long-term effects are not fully known.

Synthetic Cannabinoids: New Compounds Send Users to Treat the Symptoms Hospital (Per NIH/NIDA) Chest pain Severe agitation “Cloud 9,” “Relax,” or “Mojo,” “Spice,” “K2,” and “Crown” Tachycardia and Anxiety and Irritability “Scooby Snax” Bradycardia Hospitalizations, especially in > 150 hospital visits in Baton Confusion Michigan = county ban on sales Nausea and vomiting Rouge and Lafayette, Louisiana Somnolence Muscle spasms Updated April 20, 2015 Memory changes Recent surge in hospitalizations linked synthetic cannabinoids Seizures Paranoia Some states, including Mississippi, Alabama, and , have Tremors prompted health warnings from officials. New York Governor issued Intense hallucinations an alert after more than 160 patients were hospitalized in less than Dilated pupils Psychotic episodes: two weeks in mid April, 2015. Brisk reflexes including suicidal fixations Recent reports r/t names Geeked Up, Ninja, Caution, Red Giant, and Keisha Kole Reference: Seely, K. A., et al (2012) http://www.drugabuse.gov/drugs-abuse/emerging-trends

7 Cathinones – Cathinones - Natural vs Synthetic

Natural vs Synthetic Natural Synthetic Cathinone (Quat, Cot, Tea) Bath salts (Group name) Khat natural Cathinone Cathinone is an alkaloid Chemically structurally “Bath salts” chemical Leaves of the khat bush Cathinone formulas Grows in East Africa and in Like Amphetamines, they southern Arabia stimulate the CNS and have sympathomimetic features. Used for its euphoria and stimulating - Emerged in the recreational like properties drug markets as legal alternatives (‘legal highs’) to Hallucinogenic and amphetamine, ecstasy, or entactogenic cocaine DEA reports that 10 million people worldwide chew khat (Valentine et al, 2013)

Effects: and Side Effects Synthetic Cathinones (Bath Salts) Khat contains a number of chemicals Synthetic chemical - two are controlled substances: Derivatives of cathinone Cathinone (Schedule I) effects similar to cocaine, (Schedule IV) amphetamines, Khat, LSD, and MDMA Increases , serotonin, and Desired effects: in synapses Excitement, Euphoria, Hyper-manic Marketed as “bath salts” to evade states, Hyperactivity, talkative detection by authorities Side Effects: Not to confuse with bath products Insomnia Delusions of Grandeur or Epsom salts Extreme thirst, Loss of appetite Paranoia Originally synthesized in the 1920s Constipation Hallucinations Recreationally in UK in 2009, then Manic behavior Dilated pupils () Europe, then USA in 2010 Tachycardia + Hypertension Irritability and anger

Synthetic Cathinones (General) Synthetic Cathinones (General) Duration: 4 to 8 hours User Reports: Highly Higher doses/Overdose: Route: addictive with intense Severe Hyperthermia Sniffing/snorting (Most common) cravings Rhabdomyolysis Oral ingestion Hepatic and renal failure Smoking, vaporization, Side Effects: Cardiac injury Intravenous, intramuscular Tachycardia Death Rectal insertion Hypertension MDPV (bath salts) loses potency when Dissolved, rarely used IV/IM Feeling extreme heat Diaphoresis Desired effects: Prolonged panic attacks Reported by users: Agitation, Psychosis Increased energy Paranoia, Hallucinations Empathy, Openness Smoked bath salts in the maternity Seizures ward, was found running naked, kicked a Increased libido, Enhanced Sexual nurse and bit a police officer

8 Usually marketed with the Methylenedioxypyrovalerone (MDPV) warning Street Names: “Not intended for human consumption.” Bath salts  Energy-1 Ivory Wave  Plant food Most often found in college Plant fertilizer  Vanilla Sky MDPV: Bath salts towns in head shops Avalanch Bonsai Fertilizer More common to USA novelty stores, convenience Shock Wave  Purple Wave stores, and gas stations. : Meow-Meow Jewelry Cleaner More popular UK/Europe Sold over the Internet Psychological effects duration approx 3 to 4 hours Methylone: bk-MDMA Not to Users want to get high Mild stimulation lasts from 6 to 8 hours be confused MDMA = Ecstasy without engaging in criminal MDPV has 4x times the potency of Alpha PVP - Flakka activity (Ritalin, Concerta)

4-methylmethcathinone - Methylone: (bk-MDMA) Mephedrone N-methy-3,4- Street terms:, Like with MDVP: Methylone: Currently encouraged as a M-Cat, Meow Meow, drone, Mephedrone producing “safe” alternative to amphetamines bounce, mad cow, Bliss similar effects to MDMA, Available in US in powder and crystal form Amphetamines and Mephedrone mixed with Purchase on the internet methylone = bubbles Cocaine Delivered in 3-5 days (Dr. Synthetic Used: A white powder, ships from Bulgaria and China) capsules, or tablets $100 for 10 gms Generally the Same desired Europe: Sold in plastic tubes containing effects, side effect as MDPV 5 mL of liquid. Most common side effect: "room odorizer“ or "Explosion" teeth grinding - also found in MDMA (Ecstasy, X, Molly) Also may be sold as Molly

Alpha PVP - Flakka Alpha PVP - Flakka Alpha-Pyrrolidinopentiophenone, α-PVP, alpha-PVP, O-2387, β- -, Prolintanone Flakka, which comes in crystalline rock form Second generation synthetic cathinone It can be swallowed, snorted, Stimulant compound developed in the 1960s injected, or used in an e- The mechanism of action is unknown - believed to act similarly to cigarette and vaped. the MDPV, The duration last as few as 3-4 May act as a norepinephrine-dopamine reuptake inhibitor (NDRI) hours, but can also linger for several days Street terms: Flakka/Flocka/Flocca (Florida) Deadly Side Effect: Hyperthermia 105-106 f Gravel (other parts of the US) Leading to kidney failure, and rhabdomyolysis DEA Schedule I, but chemical manipulation changes are made – The drug is highly addictive, both from a physical as well making new versions of the drug as a psychological perspective.

9 Chemical Drugs 2C-I (India) Chemical: 4-Iodo-2,5-Dimethoxyphenethylamine Drugs in the “Bath salts” group usually contain hallucinogenics biochemically characterized as analogs of or LSD Psychedelic Produce LSD-like hallucinations and visual The fluffy white powder is distortions, and MDMA-like Naturally found in the , but synthetic versions usually pressed into pill form are made under the name of “research chemicals” empathy Oral doses (usually) 3 - 25 mg Phenethylamine are similar to the effects Users report delayed effects, Powder - snorting of Mecaline resulting in additional doses Small squares of blotter paper or more drugs, then risk of Eg: 2C-I (India) and Bromo DragonFly (B-Fly) and similar to LSD – oral toxicity or accidental over Injected = immediate onset of dosage hallucinogens are similar to LSD hallucinations may begin before the injection is complete EG: N-Bomb (Smiles) Schedule I, but still found on The LSD analog 25I-NBOMe was the most common internet sales detected as part of our 4-year surveillance program in Arkansas

Bromo DragonFly Ethylone More Street Term: B-Fly, Fly or 2C-B-fly Nexus, 2’s, Toonies, Bromo, Spectrum, Venu Ethylone, also known as 3,4-methylenedioxy-N- Chemical: 4-Bromo-2,5dimethoxyphenethylamine ethylcathinone (MDEC, bk-MDEA) – Related to phenethylamine Recreational designer drug classified as an entactogen, (Mescaline) family stimulant, and psychedelic of the phenethylamine, Extremely potent hallucinogen amphetamine, and cathinone chemical classes. Psychedelic effects that last 6–8 hours, or up to It is the β-keto analogue of MDEA ("Eve"). 12 hours in larger doses. Sometimes up to 3 days USA: Schedule I Ethylone has only a short history of human use and is Drug of choice for in Colombia reported to be less potent than its relative methylone. Vasoconstriction: extremity tissue necrosis In the United States, it began to be found in cathinone Seizures, products in late 2011 Respiratory distress Schedule I Controlled Substance Hepatic and renal failure

Butylone N-bomb N-Bomb: Smiles, 25I, 25C, 25B and “legal acid” Butylone, also known as β-keto-N- Chemical: 25I-NBOMe, 25C-NBOMe, and 25B-NBOMe methylbenzodioxolylbutanamine (bk-MBDB) Almost exclusively in Made in China – marketed as a “safe It is an entactogen, psychedelic, and stimulant of the alternative to LSD” phenethylamine chemical class. Sublingual/Buccal last 6–10 hours It is the β-keto analogue of MBDB. Last 4–6 hours when inhaled Duration up to 12 hours Butylone is produced as a white crystal Small amounts can cause: Butylone has similar effects as like Seizures, MI, Cardiac or Respiratory Arrest and death MDMA and MDBD. Deaths are recorded in USA It causes an increase in the levels of extracellular Prices: $10-15 per hit serotonin and dopamine. Bulk: 100mg=$100, 250mg=$225, 500mg=$400, 1000mg=$750 Schedule I Controlled Substance

10 Severe clinical toxicity associated with Additional Chemical Drugs you analytically confirmed recreational use of may hear about in this group 25I–NBOMe: case series 2,5-Dimethoxy-4-(n)- Study: Seven patients, all young adult males, presented propylthiophenethylamine (2C-T-7) to hospitals in the northeast of England with clinical Street Names: Blue Mystic, T7, toxicity after of 25I-NBOMe in Beautiful, Tripstay, Tweety-Bird, January 2013 Mescaline psychedelic phenethylamine Side effects: tachycardia (n = 7), hypertension (4), agitation (6), aggression, visual and auditory hallucinations (6), seizures (3), hyperpyrexia (3), clonus 5-Methoxy-N,N- (2), elevated white cell count (2), elevated creatine kinase (5-MeO-DIPT) (7), metabolic acidosis (3), and acute kidney injury (1). Street Names: Foxy, or Foxy Methoxy psychedelic tryptamine Hill et al, 2013

New Drug Trends – Legal Highs New Drug Trends – Legal Highs

New synthetic or herbal products are emerging Users believe they are a “legal” substitute for popular street drugs and are more readily available Marketed along the same pathways: Gas stations The Internet has made it easier to buy the drugs Convenience stores The internet also offers users information on how to use the drugs and how to share their highs and other drug- Gardening/plant stores related online Online You can seek questions like: “How will taking a dose of Google search for “legal high” About 502,000,000 results this product affect me?” (0.21 seconds) The Names are deceiving These drugs are not yet targeted yet by law enforcement. The results are unpredictable

Legal High’s are on Sale – online Benzo Fury or 6-APB Colorless stimulant, sold in powder and pellet or tablet form for oral consumption Can also be snorted Compound of the phenethylamine and amphetamine classes Marketed as a “research drug” , “not suitable for human consumption” Currently unscheduled in the U.S. $15-16 U.S. dollars) per pill/pellet

Effect within 30 to 60 minutes Effects plateau after approx 2 hours May last up to 10 hours

11 Sold primarily Red Dawn Vector Unbelievable Bliss through websites claiming to be Advertised as: suppliers of research “OUR customers tell us this is chemicals our best herbal pill product” There are multiple BLISS is a mood enhancer websites – Biggest composed of natural herbs supplier in UK Effects include extreme aphrodisia and mood User Notes: Use strictly enhancement. Affects are the similsr to MDMA (Ecstasy): one capsule at a time; though you can take Website Review: Our team and Alertness, increased energy, euphoria, feelings of peace and love another 1 1/2 hrs later, many satisfied repeat customers toward others, tingling feelings, and intense sexual responses if desired agree this is the best herbal Dilated pupils, tightening of jaw muscles, raised body energizer and mood temperature, tachycardia, anxiety/panic attacks and Contains 2 Capsules enhancement product available paranoid/confused states. $11.95

Smoking Alcohol Smoking Alcohol

Become drunk without the How is this done? Risk of overdose: extra calories Use a plastic bottle, fill with alcohol When a person drinks too much Vapor inhalation takes the and seal with a cork alcohol, the body induces vomiting to eliminate it. This does person from sober to drunk A hand tire pump is then used to not happen with smoking alcohol. within seconds pump air into the bottle to increase may be reduced the pressure Smoke alcohol bypasses the stomach and intestines and is not A vapor develops when the pressure broken down in the liver. mixes with the alcohol The person does not have this Once the vapor is seen, the cork is safety net to prevent alcohol pulled off and the vapors are inhaled poisoning. though the mouth and nose Overdose risk is much higher due Sometimes used with dry ice: Once to the fact that the body has not the dry ice mixes with the alcohol, a broken down the alcohol. vapor will develop

Powdered Caffeine Powder

Alcohol Overdose lead to the death of an Ohio high school

Coming soon to a store Prompted the FDA to issue a near you: Currently available safety advisory about caffeine online powders Arrhythmias, seizures, Legal, but banned in some states Bulk bags of pure caffeine powder vomiting, diarrhea, and are readily available online, and disorientation, death Manufactured with Dextrin to be attractive to young people for diluted in water to make energy/stimulation or for help The FDA recommends alcoholic beverages losing weight that consumers avoid caffeine powder and Abused by snorting Just a teaspoon of pure caffeine parents be alert to their powder is equivalent to about 25 hazards cups of coffee—a lethal amount

12 “Beezin’ - Usually while High”

Determining Use and Overdose

Look for clues – Paraphernalia Does anything look like a pipe? Shake a bottle of water to test for GHB Look for empty soda cans (with holes in) Candy, Bubbles, glow-sticks

Smuggling

Questions?

[email protected]

Please see reference list for further reading Smuggling Trick: Using plastic water bottles with a hidden compartment for drugs.

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