Transcript Wasted? How Times Have Changed.

Become familiar with some of the new
drugs of abuse – how they are used,
expected toxidrome/symptoms, and
emergency treatment.
 Review some of the old drugs of abuse
and the new creative ways they may be
abused.
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Fake Drugs Seized in State College Drug Raid
By: Jeff Preval
Updated: February 23, 2012
STATE COLLEGE, CENTRE COUNTY - Fake drugs, recently banned
in Pennsylvania have been seized in Centre County.
In a raid Wednesday night, involving three State College
businesses, synthetic marijuana, bath salts and other narcotic
paraphernalia were reportedly seized. The charge for selling
these substances is considered a felony. The Centre County
district attorney says the joint investigation involved stores in
State College, as well as, Schuykill and Berks County.
Products were seized from Jamaica Junction, Dragon Chasers
Emporium and Grasshoppers in State College.
The investigation continues.
Wearecentralpa.com
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Drug-Deal Incident Preceded Fatal Stabbing in Lemont, Police
Documents Show
by Adam Smeltz on January 17, 2012 4:52 PM
A small-time drug transaction gone awry led to the fatal stabbing of a
College Township man late Monday, a State College police
investigation suggests.
The victim, identified as Tyler Vaughn Struble, 20, of 831 Henszey St., had
suffered a deep laceration to his neck area when police arrived at his
Lemont home shortly after 10 p.m. He was pronounced dead later at
Mount Nittany Medical Center.
Authorities have charged Tyler Steven Marlatt, 20, of 821 Southgate
Drive, State College, with first-, second- and third-degree murder in
connection with Struble's death. Marlatt also is charged with robbery
and aggravated assault.
Statecollege.com
Avicii on November 17, 2011 – 31 patients
transported from the Bryce Jordan Center
to the Emergency Department.
 Sebastian-Ingrosso on Feb. 23, 2012 – 10
patients transported from the BJC to the
Emergency Department.
 DayGlow on April 11, 2012 – 27 patients
transported and on April 12, 2012 - 31
patients transported from the BJC to the
Emergency Department
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October 2012, Calder Commons: Penn
State cheerleader Paige Raque falls from
balcony
December 2012, Sigma Alpha Mu: Female
falls from window
Nov. 16, 2013, Penn Tower: Student killed
after falling from ninth-floor balcony
Nov. 22, 2013, The Palmerton: Student falls
from second-floor balcony at The
Palmerton
Jan. 19, 2014, The Palmerton: Another
student falls from second-floor balcony
Synthetic derivatives of federally
controlled substances created by slightly
altering the molecular structure of
existing drugs.
 Produced illegally in clandestine labs for
illicit use.
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Common Names: K2,
Spice, Blaze
Cost: $30-$40 for a 3
gram bag
Route of
Administration:
smoking, snorting,
or swallowing
Emerged as a problem in 2009
 A blend of plant and herbal materials
that have been sprayed with chemicals
 One in nine high school seniors have
gotten high on synthetic marijuana
 Calls to poison control centers in 2011
about 7000, up from 2900 in 2010
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Desired Effects:
Marijuana-like high
and calming effect
Adverse Effects:
excessive sweating,
agitation,
tachycardia,
aggression,
restlessness,
confusion, inability to
speak, and STROKE
Strokes caused by Spice
 Thought to be embolic etiology
 Siblings in Florida
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› 26 year old male – slurred speech and
weakness to the right side of his body – given
TPA
› 19 year old female – severe aphasia with
weakness to the right side of her body – she
was left completely disabled with right
hemiparesis and expressive aphasia.
Intoxication?
 Neurological Signs?
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Synthetic Marijuana
Treatment:
• Supportive care
• Treatment of associated
symptoms
•Benzodiazepines for agitation,
aggression
•IV Fluids for dehydration
Common Names: White
Lightning, Cloud 9,
Ivory Wave, White
Dove
Cost: $40 for 500mg
Route of Administration:
Snorting, swallowing,
smoking, injecting
Desired Effects:
Increased alertness;
diminished
requirement for food
or sleep; regarded
as synthetic cocaine
Adverse Effects:
hypertension,
sweating, chest pain
tachycardia,
extreme paranoia,
increased suicidal
thoughts, necrotizing
fasciitis
Number of calls to poison control centers
in 2011 was about 6100, up from 304 in
2010.
 Bath Salts accounted for 23,000 of
2.5million drug-related visits to the ED in
2011.
 Evade FDA regulation by printing
warning label, “ Not for Human
Consumption.”
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Bath Salts
Treatment:
• Supportive care
• Treatment of associated symptoms
• Benzodiazepines for agitation,
paranoia, restlessness, and seizures
• Maintain patient and staff safety
•TIME
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Proper Name: 3, 4Methylenedioxymethamph
etamine
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Common Name: MDMA,
XTC, Adam, E
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Cost: $20 to $30 per
dosage unit retail
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Route of Administration:
Swallowing, snorting,
smoking, injecting
Desired Effects:
profoundly positive
feelings, empathy for
others, elimination of
anxiety, and extreme
relaxation; suppress
the need to eat, drink,
or sleep.
Adverse Effects:
diaphoresis, bruxism,
jaw clenching,
paresthesias,
hyperthermia, fatal
dysrythmia and
Hyponatremia which
can cause cerebral
edema, confusion,
and seizures.
 MDMA
causes massive serotonin
release. Coupled with dancing and
dehydration, the hyperthermia is
greatly exaggerated.
 Many users will have pacifiers in their
mouth because of bruxism
MDMA
Treatment:
• Supportive care
• Treatment of associated symptoms
• Hyperthermia – cooling with ice packs
and a fan, ice-lavage; antipyretics are not
useful
•Benzodiazepines for agitation or seizures
• Admission if evidence suggests presence
of significant hyperthermia, altered mental
status, seizures, severe hyponatremia,
respiratory depression, or acute renal failure
secondary to rhabdomyolysis.
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Molly’s Plant Food is a synthetic
hallucinogenic amphetamine marketed
as a “plant food” that contains
ingredients that produce highs similar to
Ecstasy.
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Acute onset of agitated behavior which
may result in death.
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Bizarre and violent behavior, most commonly violence
towards glass
Removal of clothing, public nudity (even in cold weather)
Aggression
Hyperactivity
No pain perception
Hyperthermia
Paranoia
Hallucination
Incoherent speech or shouting
Grunting or animal-like sounds
Incredible strength or endurance (typically noticed during
attempts to restrain victim)
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Other medical conditions that can
resemble excited delirium are panic
attack, hyperthermia, diabetes, head
injury, delirium tremens, and
hyperthyroidism.
Treatment Suggestions for Excited
Delirium:
 Cooled IV fluids
 Chemical Sedation (Ketamine)
 ECG Monitoring
 Pulse Oximetry
 Sodium Bicarbonate administration
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GHB and GBL
Proper Name: Gamma-hydroxybutyric acid, gammabutyrolactone
Common Name: GHB, GBL
Other Street Name(s): Grievous Bodily Harm,
scoop, liquid ecstasy, cherry meth, growth hormone
booster, liquid x, and Georgia homeboy.
Cost: $10 per bottle, which usually contain 10 “hits”
Desired Effects: Initially marketed as a fat-burner
and a growth hormone promoter; now used as a
hallucinogenic, euphoric, and sleep aid
GHB and GBL
Physical Characteristics:
• GHB generally comes in pure powder form or mixed
with water.
• GBL is a precursor to GHB. GBL is a solvent found in
floor cleaning products, nail polish, and superglue
removers.
• Described by users as, “alcohol-free, hang over free
high with potent prosexual effects.”
• FDA approved for treatment of narcolepsy.
• First used by body builders for the euphoric effect
during marathon weight lifting sessions.
GHB and GBL
Harmful Effects:
• GHB quickly produces moderate amnesia but does not produce analgesia
or muscle relaxation.
• Bradycardia, decreased systemic vascular resistance, and hypotension.
• CNS depression is the hallmark of GHB use.
• Myoclonic jerks often confused with seizure activity.
• Sporadic violent agitation.
• Hypotension occurs in 10% of GHB ingestions.
• Burns to lips and oropharynx may represent caustic injury from
concomitant lye ingestion.
Rohypnol
Proper Name: Flunitrazepam (Rohypnol)
Common Name: Roofies
Other Street Name(s): In South Florida, street names
include “circles,” “Mexican valium,” “rib,” “roach-2,”
“roofies,” “roopies,” “rope,” “ropies,” and “ruffies.” In
Texas, flunitrazepam is called “R-2,” or “roaches.”
Cost: $5 or less per tablet
Desired Effects: Produce profound intoxication, boost
the high of heroin, and modulate the effects of cocaine
Rohypnol
Physical Characteristics:
• Flunitrazepam—marketed under the trade name
Rohypnol—is manufactured worldwide, particularly
in Europe and Latin America to treat severe sleep
disorders
• However, the drug is neither manufactured nor
approved for medical use in the United States.
• Described as 10X more potent than valium.
Rohypnol
Harmful Effects:
• It has physiological effects similar to diazepam.
• Paradoxically, although the drug is classified as a depressant,
flunitrazepam can induce excitability or aggressive behavior in some users.
• Dizziness, confusion, drowsiness, blurred vision, unresponsiveness,
anxiety, agitation
Just New Flavors
Nearly half of all college students (44%)
report having been drunk in the prior 30
days.
 About one in eight college students
(13%) reported having 10 or more drinks
in a row at least once in the prior two
weeks, and one in twenty (5%) reported
15 or more drinks in a row.
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Over 48 hours…66 patients presented to
the ER with Alcohol intoxication or
Alcohol Overdose
AVERAGE BAC
282.9
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Ethanol Tampon: more alcohol
absorption without consuming a large
amount of fluid or calories
'Up to five deaths' caused by drinking
game Neknominate
22 February 2014 Last updated at 13:40
GMT
Only have to go to
the family
medicine cabinet!
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Stimulants
CNS Depressants
Opioids
Sexual Enhancers
2nd to only marijuana as the most
commonly used illicit drugs.
 Oxycontin or Vicodin are the most
commonly abused prescription
medication.
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 Household
survey on drug abuse
indicate that the most dramatic
increase in new prescription drugs for
nonmedical purposes occurs in 12-17
year-olds and 18-25 year-olds.
a class of drugs that enhance brain
activity which leads to increased
alertness, attention and energy.
 Prescribed for Narcolepsy, Attention
Deficit Hyperactivity Disorder (ADHD),
and depression.
 When misused, can become addictive.
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Desired Effects:
-Increased level of
alertness
-study aid
-weight loss
-increase focus and
attention
-performance
enhancement
Adverse Effects
-increased blood
pressure
-increased heart
rate
and
respiration
-dangerously high
body
temperatures
-irregular heartbeat
-seizures
34% of college students abuse adderall.
 Used orally or crushed and used
intranasal.
 Some users inject it – “West Coast”
 Some users mix it with heroin or cocaine
– “Speed Ball”
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Stimulant Abuse
Treatment:
• Supportive care
• Treatment of associated symptoms
• Hyperthermia – cooling with ice packs
and a fan, ice-lavage
• Benzodiazepines for seizures, shivering, or
painful cramps
Barbituates – Nembutal, Phenobarbital
 Benzodiazapines – Valium, Ativan, Xanax
 Sleep Medication –Lunesta, Ambien,
Sonesta
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Desired Effects:
Sedation/drowsiness,
reduced anxiety,
feelings of well-being,
lowered inhibitions,
sleep aid; mellow out
Adverse Effects:
lowered blood
pressure, slowed
breathing, tolerance,
withdrawal, addiction;
increased risk of
respiratory distress and
death when
combined with
alcohol
CNS Depressants
Treatment:
• Supportive care
• Treatment of associated
symptoms
• Airway management
•Blood pressure support
 OxyContin
 Demerol
 Lortab
 Dilaudid
 Vicodin
 Lomotil
 Percocet
 Hycodan
 Norco
 Tylenol
#3
Often prescribed to
treat pain.
 Often abused due
to the initial
euphoric effect.
 May produce
severe respiratory
distress and prove
to be fatal.
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Narcotics
Treatment:
• Supportive care
• Treatment of associated
symptoms
• Airway management
• Reversal - Narcan
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Sizzurp is an addictive concoction that
gets the user high, made by combining
prescription-strength cough syrup with
sugary sodas like Mountain Dew or Sprite,
to which hard candies like Jolly Ranchers
are added for more flavor.
Sildenafil alone.
 Sildenafil with amyl
nitrate to get a
head rush.
 Both drugs are
potent vasodilators
and can cause
coronary ischemia.
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Figure 7.2 Specific Illicit Drug
Dependence or Abuse in the Past Year
among Persons Aged 12 or older - 2012
Dextromethorphan
 Dimenhydrinate
 Ephedrine and Pseudoephedrine(or
behind the counter)
 Sniffing/Huffing
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Glue
Gasoline
White Out
Nitrous Oxide (Whip its)
Usually young people
 Easily available over-the-counter
 Cheap
 Easy to shop-lift
 Just look in mom and dad’s medicine
cabinet or even grandma’s.
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Opioid agent used as a cough
suppressant
 Available since the 1960’s – new interest
in abuse of this substance among
adolescents.
 Found in more than 140 non-prescription
products.
 The most frequently abused product is
Nyquil.
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Street Names:
Robo, Red Devils,
DXM, or Dex
 Described as an
“LSD-like” high.
 Teens can receive
guidance on the
internet on how to
best abuse
dextromethorphan.
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In high doses, it will produce a dream like
state with auditory, visual, and
sometimes olfactory hallucinations.
 Available in Dramamine and Gravol.
 School nurses report that teens are
taking 8-12 tablets for an 8-12 hour “trip.”
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Aka “ma huang and ephedra” –
BANNED
 Easily converted into methamphetamine
 Used by teens for weight loss, to stay
awake, and for an energy boost.
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Glue-sniffing and gasoline-sniffing are
perhaps the most commonly recognized
OTC abuse for the older generation.
 Today, even common products such as
Whiteout or keyboard cleaner are used
but fortunately they have been
reformulated to reduce the effects.
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Street Name:
NOZ,Whip-Its
 Frequently inhaled
and abused at
Raves.
 Propellants found in
Wizard Air
Freshener are
similar to nitrous
oxide but similar
potential dangers.
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Anxiousness
 Confusion
 Disorientation
 Disinhibition
 Perpetual cough
 Hypoxia
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Airway, Airway, Airway
 Recognize toxidrome
 Supportive care
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Salvia: herbal mint plant that can be
grown from a seed and has
hallucinogenic properties. It can be
smoked or made into tea.
 Morning Glory Seeds: contain a
hallucinogenic substance resembling
LSD.
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“Used in the
exploration of
consciousness.”
 Can be smoked,
snorted, used
sublingually, or
made into tea or
soup.
 Produces an
amnestic state if
enough is used
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Plant commonly
found in home
gardens or
landscape.
 The seeds of the
morning glory plant
(Ipomoea
Violacea) contain
a chemical similar
to LSD.
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Produce a strong hallucinatory effect.
 Most plants are coated with pesticides
which can cause liver and neurological
damage.
 Seeds available in garden shops.
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These drinks are packed with herbal
stimulants, sugar, and caffeine.
 They claim to “Enhances athletic
performance” and “Increases caloric
burn and mental sharpness.”
 Mixing energy drinks and alcohol can
have devastating consequences.
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Desired Effects:
-Increased energy
-improved weight
loss
- improved mental
sharpness
-decreased need
for sleep
Adverse Effects:
-Dehydration as
caffeine is a
diuretic
-Dysrythmias
-Seizures
John Jackson allegedly bought a tin of
Hero Instant Energy Mints, each of which
is said to have as much caffeine as a
can of Red Bull. Jackson had so much
caffeine in his system after consuming
the mints that his caffeine levels were
nearly double those reported in other
caffeine overdose deaths.
Available at convenience stores as of
January 12, 2012.
 Each puff contains 100mg of caffeine (as
much as a cup of coffee) and B
vitamins.
 $2.99 for 6 puffs – cheaper than a cup of
coffee.
DANGER: No volume to drink
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If taken with alcohol, may have the effects
of the caffeinated alcoholic beverages
such as Four Loko
 Risks include neurological and
cardiovascular problems as well as
exacerbation of asthma
 The caffeine is absorbed through the mouth
and digestive track and not through the
lungs according to the manufacturer
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Marijuana (the real stuff)
 LSD
 Heroin
 Cocaine
 Mushrooms
 PCP
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Two more cases of flesh-eating krokodil
suspected in Utah as killer drug spreads
through streets of U.S.
Read more:
http://www.dailymail.co.uk/news/article2465422/Krokodil-drug-2-cases-suspectedUS.html#ixzz2rKlbYDVk
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Self-brewed heroin substitute made from
readily available codeine and any
number of toxic contaminants such as
iodine, lighter fluid, gasoline, and various
other hydrocarbons.
Obtaining a detailed history of the
ingestion or exposure from all available
sources is important.
 Inspect bottles of ingested substances to
help identify possible alcohols.
 Follow standard protocols for treating
patients with airway obstruction,
unconsciousness, or altered mental
status
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HISTORY:
› How Much?
› When?
› Where?
› What Else?
 Drugs
› What else happened?
 Are you SURE they are only drunk?
 Trauma?
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Centredaily.com
Mollydrug.net
www.EM-News.com
www.whitehouse.gov
Yourlife.usatoday.com/health/story/2012-03-19
www.medscape.com
Bangordailynews.com/2011/12/23
www.higheredcenter.org
www.monitoringthefuture.org
www.campushealthandsafety.org
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www.drugabuse.gov
www.projectghb.org
www.emed-journal.com
Toxalert-Maryland Poison Center
www.schoolnurse.com
www.emedmag.com
Smart Drug News
www.samhsa.gov
ACEP News