Funded and supported by Plymouth County District Attorney Timothy J. Cruz & The Brockton Area Opioid Abuse Prevention Collaborative This curriculum was developed in May of 2014 with funding from the Massachusetts Department of Public Health’s Bureau of Substance Abuse Services and the Partnership for Success II grant for the city of Brockton. Updated June of 2016 with support from the Heroin Education Funds distributed by the Plymouth County District Attorney’s office. Table of Contents 1.) Science of Addiction Pg. 1 13.) Current Trends Pgs. 17-18 2.) Risk Factors of Addiction Pgs. 1-2 14.) Appendix A Pgs. 18-38 3.) Statistics Pgs. 2-7 15.) Appendix B Pgs. 39-43 4.) Perception of Harm Pg. 8 16.) Appendix C Pgs. 44-123 5.) Types of Prescription Drugs 17.) Appendix D Pgs. 124-130 Pgs. 8-10 18.) Appendix E Pgs. 131-150 6.) Additional Negative Side Effects of Prescription Drugs Pgs. 10-12 19.) Appendix F Pgs. 151-157 7.) Prescription Drugs to Heroin 20.) Appendix G Pgs. 158-162 Pgs. 12 21.) Appendix H Pgs. 163-171 8.) Difference between Misuse & Abuse Pgs. 12-13 22.) Appendix I Pgs. 172-174 9.) Identifiers and Signs of Abuse 23.) Appendix J Pgs. 175-180 Pgs. 13-14 24.) Appendix K Pgs. 181-187 10.) Most Common Myths Youth Believe Pg. 15 25.) Appendix L Pgs. 188-231 11.) Prescription Drug Curriculums 26.) Appendix M Pgs. 232-257 Pg. 15 27.) Appendix N Pgs. 258-264 12.) Pop Culture and Media Pgs. 16-17 Science of Addiction Drugs contain chemicals that tap into the brain’s communication system and disrupt the way nerve cells normally send, receive, and process information. There are at least two ways that drugs cause this disruption: (1) by imitating the brain’s natural chemical messengers and (2) by over stimulating the “reward circuit” of the brain. Some drugs (e.g., marijuana and heroin) have a similar structure to chemical messengers called neurotransmitters, which are naturally produced by the brain. This similarity allows the drugs to “fool” the brain’s receptors and activate nerve cells to send abnormal messages. Other drugs, such as cocaine or methamphetamine, can cause the nerve cells to release abnormally large amounts of natural neurotransmitters (mainly dopamine) or to prevent the normal recycling of these brain chemicals, which is needed to shut off the signaling between neurons. The result is a brain awash in dopamine, a neurotransmitter present in brain regions that control movement, emotion, motivation, and feelings of pleasure. The overstimulation of this reward system, which normally responds to natural behaviors linked to survival (eating, spending time with loved ones, etc.), produces euphoric effects in response to psychoactive drugs. This reaction sets in motion a reinforcing pattern that “teaches” people to repeat the rewarding behavior of abusing drugs. As a person continues to abuse drugs, the brain adapts to the overwhelming surges in dopamine by producing less dopamine or by reducing the number of dopamine receptors in the reward circuit. The result is a lessening of dopamine’s impact on the reward circuit, which reduces the abuser’s ability to enjoy not only the drugs but also other events in life that previously brought pleasure. This decrease compels the addicted person to keep abusing drugs in an attempt to bring the dopamine function back to normal, but now larger amounts of the drug are required to achieve the same dopamine high - an effect known as tolerance. (NIDA) [See Appendix A, B, C, and D for more information] Risk Factors for Addiction Biology – The genes that people are born with – in combination with environmental influences – account for about half of their addiction vulnerability. Additionally, gender, ethnicity, and the presence of other mental disorders may influence risk for drug abuse and addiction. Environment – A person’s environment includes many different influences, from family and friends to socioeconomic status and quality of life in general. Factors such as peer pressure, physical and sexual abuse, stress, and quality of parenting can greatly influence the occurrence of drug abuse and the escalation to addiction in a person’s life. Development – Genetic and environmental factors interact with critical developmental stages in a person’s life to affect addiction vulnerability. Although taking drugs at any age can 1 lead to addiction, the earlier that drug use begins, the more likely it will progress to more serious abuse, which poses a special challenge to adolescents. Because areas in their brains that govern decision making, judgment, and self-control are still developing, adolescents may be especially prone to risk-taking behaviors, including trying drugs of abuse. (NIDA) Other Risk Factors: Family history of addiction Abuse, neglect, or other traumatic experiences in childhood Mental disorders such as depression and anxiety Early use of drugs (HBO.com) [See Appendix A, B, and D for more information] Statistics Interventionstrategies.com 2 Cdc.gov 3 Drugabuse.gov Drugfree.org 4 5 Potentionalmagazine.com 6 Interventionstrategies.com 7 Perception of Harm Many teens think that prescription drugs are perfectly safe if not safer than illegal drugs because they are prescribed by well-educated doctors and are manufactured by large, well- known corporations. They are also under the wrong impression that these drugs have fewer side effects compared to recreational drugs. What they don’t realize is that these drugs are only safe when used as prescribed. In reality, these drugs are as dangerous, if not more so than illicit drugs as these can cause long term adverse health effects and in some cases, even result to fatalities. (Scripts Rehab) It is also a common misconception that abusing prescription drugs is safer than abusing illicit drugs like cocaine and heroin because the manufacturing of prescription drugs is regulated or because they are prescribed by doctors. These circumstances don't mean these drugs are safe for someone who was not prescribed them or when taken in ways other than as prescribed. Like illicit drugs, prescription drugs can have powerful effects in the brain and body. Opioid painkillers act on the same sites in the brain as heroin; prescription stimulants have effects in common with cocaine. These medications can sometimes be consumed in ways that can be very dangerous in both the short and long term (e.g., crushing pills and snorting or injecting the contents). Also, abusing prescription drugs is illegal—and that includes sharing prescriptions with friends. (NIDA for Teens) [See Appendix J and K for more information] Types of Prescription Drugs See chart on page 9. [See Appendix E and F for more information] 8 Sources: U.S. Department of Justice Drug Enforcement Administration, Drugs of Abuse, 2011 Edition/ The Medicine Abuse Project What are Examples: How are Negative Effects Withdrawal Overdose they? they Symptoms Effects abused? Opioids Pain OxyContin, Swallow, Drowsiness, apathy, Early: Watery Pinpoint relievers, Vicodin, smoke, inability to eyes, runny nose, pupils, cold chemically Morphine, sniff, concentrate. Slowed yawning, and clammy skim, similar to Codeine, inject physical activity, sweating. confusion, heroin Fentanyl, constriction of Later: extreme Perecet, pupils, flushing of restlessness, drowsiness, Methadone, face and neck, irritability, loss of slowed Suboxone constipation, appetite, tremors, breathing nausea, slow vomiting, severe breathing depression, increased heart rate and blood pressure, chill, and sweating Stimulants Speed up Adderall, Swallow, Agitation, hostility, High fever, the body’s Ritalin, Diet smoke, panic, aggression, convulsions, systems, aids like sniff, suicidal or homicidal cardiovascular chemically Didrex, inject thoughts, paranoia, collapse similar to Focalin, hallucinations, cocaine Concerta dizziness, tremors, headache, flushed skin, chest pain with palpitations, sweating, vomiting, abdominal cramps Benzodiazepines Depressants Valium, Swallow, Amnesia, hostility, Shallow that Xanax, sniff, irritability, respiration, produce Halcion, inject vivid/disturbing clammy skin, sedation, Ativan dreams, slow down dilated pupils, sleep, central nervous weak and relieve system, cause sleep rapid pulse, anxiety and coma, muscle possible death spasms, and prevent seizures Barbituates Depressants Amytal, Swallow Impairment of Shallow that Amobarbital, or inject memory, judgment, respiration, produce and Seconal, coordination; clammy skin, wide Secobarbitral irritability, paranoid dilated pupils, spectrum of and suicidal ideation, weak, rapid central slow down central pulse, coma, nervous nervous system, possible death system sleepiness depression 9 9 Drinking prescription-strength cough syrup containing codeine and promethazine mixed with soda was referenced frequently in rap 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 euphoria 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. Codeine and other opioids present a high risk of fatal overdose due to their effect of depressing the central nervous system, which can slow down or stop the heart and lungs. Mixing with alcohol greatly increases this risk. Deaths from prescription opioid medications now outnumber overdose deaths from all other drugs (including cocaine and heroin), and codeine- promethazine cough