Objectives New Trends in Street Drugs Upon completion of this program the learner will be able to: th September 14 , 2015 1. Identify new trends in street drug 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 Heroin as an alternative Cocaine, Meth and Heroin are regional Hallucinogenic: LSD (Acid) and MDMA (Ecstasy, Molly) Methamphetamine – Regional Marijuana use and dependence has risen (plus introduction of Wax/Dabs) Daily use of Synthetic cannabinoids (K2 and Spice) Marijuana remains Synthetic Cathinones (Bath Salts, Flakka) common Chemical Drugs – EG: 2C-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 • Mannitol 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 Confusion, Disorientation, Delirium was cut with Cold and clammy skin “Rush” feeling a surge of euphoria 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 Opioid OD triad (observed in Heroin and opiates) Drug craving Coma Restlessness, Insomnia Respiratory depression and failure Muscle and bone pain Vomiting and diarrhea Depression of CNS – Miosis - pin point pupils Cold flashes with Piloerection (goose bumps 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 alcohol or barbiturate 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 codeine 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 Norway, 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 United States an injection. Case reported in St. Louis - (Thekkemuriyi, John, & Pillai, 2014) 2 Krokodil 2015 Drug Trends: Cocaine Cocaine Powder Crack Cocaine 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 Medications and Cocaine Treatments: Tachycardia and Hypertension Arrhythmias, Widened QRS/Q and prolonged QT segment Charcoal - Oral ingestion (especially stuffers/packers) MI/ ACS/ Coronary artery spasms that cause MI Benzodiazepines 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), lidocaine (in combo Tremors, hallucinations and delirium with Benzodiazapines) and Magnesium Agitated (excited) delirium Medications to Avoid: Seizures and convulsions Avoid Beta-blockers - unopposed alpha 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: quinidine, procainamide, and disopyramide (Norpace) (class 1a) > QRS and QT intervals and Emboli may occur from injection slows the metabolism 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 Amphetamines Chalk Bikers Coffee Crank Yaba (pills) Uppers Yellow Bam Use/Route: Oral, Snorting, Smoking , 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 Anxiety, confusion, depression not a rush alzheimers Chronic fatigue, insomnia Heart failure Delusions, paranoia, aggression, hallucinations Brain damage Stroke Toxic psychosis 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 caffeine 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 Methylone: (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 Chills/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