Fentanyl, Sizzurp, Vaping and Other Current Drug Trends

Overall Substance Abuse In America

DID YOU KNOW?

1 in 10 American adults and teenagers have a drug and/or alcohol

dependence problem?

…Yet only 11% of those who need treatment received it at a specialty facility

All drugs of abuse mimic neurotransmitters that exist

naturally in the brain.

Sugar & Spice and Everything…

•

• Cinnamon Challenge

• Kids are getting high on cinnamon and nutmeg.

• “Myristicin (like LSD) is a hallucinogenic

- Snorted, smoked and eaten in large quantities to produce a

marijuana-like high.

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Whipping cream, cooking oil spray and hand sanitizer are also being used by young children to get high.

Kratom

• Promoted as legal, undetectable and safe.

• Plant crushed up into a capsule that includes a plant and synthetic ketamine (cat tranquilizer), mephedrone and other additives.

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Synthetic Marijuana

According to Gateway research, those in treatment for abusing K2 report the following:

• K2 can induce a limitless high.

• Significant agitation and aggression.

• Overdose victims experience blacking out, seizures, vomiting.

• Hallucinations, paranoia, seizures, anxiety and over-activation of the central nervous system are common.

You won’t find this spice in your kitchen cabinet!

Spice

• Imitates marijuana, laced with 3 cannabinoids.

• A northern Illinois suburban public high school reported the first Illinois school drug overdose involving “Spice” in 2008

• Banned by US Custom Service

• Illegal in Illinois as of January 1, 2011

How Does it Effect You?

• Mimics effects of pot by triggering the cannabinoid receptors in the brain.

• Synthetic cannabinoids more potent than natural marijuana and remain in body much longer. Users experience rapid heart rate, vomiting, agitation, confusion, and hallucinations which do not always subside after use.

Not Your Average Bubble Bath!

Bath salts are a powder-like substance described as “fake cocaine”

and it is snorted, injected and smoked.

• The substance most commonly added to the bath salt compound is the stimulant mephedrone (MDVP)

• Powder-like substance described as “fake cocaine”

• Snorted, injected and smoked

• Effects are similar to methamphetamine, ecstasy, and cocaine

• Causes hallucinations, paranoia, rapid heart rate which may not stop after initial use. Linked to accidents due to risk taking, violent behavior and suicide.

• 200 times more potent than THC.

Illinois banned the sale of bath salts in July 2011

(28 states have banned bath salts as of July 2011)

“Flakka” or “Gravel” • More potent average Bath Salts (rocky looking Bath Salts).

• Looks like crystals or called gravel in some parts of the country.

• Produces dangerous hallucinations - can cause serious medical issues (lifelong heart and kidney problems), paranoia, panic attacks, death as a result of excited delirium.

• Sometimes synthetic other times meth mixed with heroin and cocaine.

• Snorting 20-30 mg = 6 hr. high, but re-dosing can cause death.

• 30x more potent than cocaine!

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Sample Pictures

Sample Pictures

Sample Pictures

History of MDMA (Ecstasy)

1912

MDMA

Merck Pharmaceutical

1953

Used by the US government for psychological

warfare

1960s

Psychotherapy med to help

lower inhibitions

1970s & 80s

Introduced at parties

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MDMA (Ecstasy/Molly) • Synthetic form of the original amphetamine.

• Amphetamine-like and hallucinogenic properties.

• Cut now with “LSD, Cocaine, heroin, amphetamine, and methamphetamine, to rat poison, caffeine, dog deworming substances, etc.” (Drugfreeworld.org)

• Feelings of euphoria, empathetic

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Ecstasy today may or may not contain any MDMA at all and is dangerous because users have no idea what is in the pills they take.

Green Turtles/Ninja Turtles

• Believed to be MDMA (Ecstasy). Shaped like a turtle with red and white specks or red TMT heads.

• Blog ratings: – Euphoria-8/10

– Eye wiggles-8/10

– Jaw clinching-10/10

– Empathy-8/10

• High lasts 4-6 hrs.

• Can still sleep after taking them

Some bloggers swear by them and have replaced all other pills Green Turtles.

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What is Molly?

• Powder form of MDMA, but and is synthetic and in pill form.

• Most often methanol, MDPV, mephedrone or “bath salts”. Made with cheaper products and very dangerous.

• Causes hyperthermia, seizures, high BP, depression and psychosis. Death occurs from kidney failure, toxicity or acidosis. (Talbot, 2015)

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Vapo Masks

Wearing masks with VapoRub on while rolling on Molly to enhance the high.

• Problematic when Molly elevates body temperature and drinking heavily.

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Sizzurp

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OTC Medications “Sizzurp”, “Purple Drank”, “Syrup”, “Drank”,

“Lean” • Narcotic drink that makes the user feel

extremely drowsy and often euphoric.

• Making a comeback from the 1960’s

• Codeine found in Rx cough syrup is a dissociative drug in which the mind & body have a feeling of separation. A narcotic drink that makes the user feel extremely drowsy and often euphoric.

• “Leaning on syrup”

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OTC Medications Lean or Syrup Mixes Recipes:

Lean= Prescription cough syrup (promethazine+codeine) + Sprite + a Jolly Rancher. Only about 4 teaspoons can be very effective.

Robotrip or Purple= Robitussin (dextromethorphan) + Skittles + Arizona Watermelon juice

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Abuse of OTC medication

• Cough and cold medicines, which come in tablets, capsules, gel caps, and lozenges as well as syrups, are swallowed. DXM is often extracted from cough and cold medicines, put into powder form, and snorted.

• Small doses help suppress coughing, but larger doses can cause fever, confusion, impaired judgment, blurred vision, dizziness, paranoia, excessive sweating, slurred speech, nausea, vomiting, abdominal pain, irregular heartbeat, high blood pressure, headache, lethargy, numbness of fingers and toes, redness of face, dry and itchy skin, loss of consciousness, seizures, brain damage, and even death.

AUDIENCE POLL

Have you ever “borrowed” a prescription medication from a family member or friend?

A) YES

B) NO

Trends – Prescription Drug Consumption

DID YOU KNOW?

• After marijuana, prescription and OTC medications account for most of the top drugs abused by 12th graders in the past year

• Of the 22,767 deaths relating to prescription drug overdose in 2013, 16,235 (71.3%) involved opioid painkillers, and 6,973 (30.6%) involved benzodiazepines

Is Prescription Drug Abuse the Road to Heroin?

• Heroin acts in the body almost identically to opiate pills, but when injected produces even greater euphoric effects.

• More common older users-start on opiates after survey find themselves addicted to heroin.

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Do you believe prescription meds are the real Gateway drug?

A) YES

B) NO

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AUDIENCE POLL

Commonly Abused Prescription Drugs Three classes:

• Benzos (Xanax, Valium, Klonopin, Ativan) & Benzo-

like (most common: Lunesta, Ambien, Lyrica, Neurontin,

etc): Used to treat anxiety and sleep disorders

CNS Depressants

• Most often used to treat ADHD (Ritalin, Concerta, Adderall, Vivanse)

Stimulants

• Used to treat pain (Norcos, Soma, Morphine,

methadone, Buprenorphine, hydrocodone, oxycodone, more common names: Percocet, Vycodin, Demerol, etc)

Opioids

Death Salad: Recipe for Disaster

CNS depressant/Opiate + alcohol + Anxiety/Depression/Bipolor = Death

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Abuse of Stimulants ADHD Medications

Stimulant medications increase alertness, attention and energy

• These drugs, (Ritalin, Adderall, Concerta), act on norepinephrine and dopamine systems in the brain and can produce feelings of euphoria

• Can be taken orally or crushed and snorted for greater effect

• Many youth, more commonly girls, abuse stimulant medications to aid in weight loss or maintaining low weight-stimulant abuse highly correlated with eating disorders

• Taken to recover from other drug use (depressants)

Opioids Use

• Opioid medications are prescribed to treat pain

• Highly addictive and dangerous risks of fatal overdose

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Abuse of Opioids

Overdose deaths increasing

A Different Kind of “Farming”

POLY PHARMING- The term “poly-pharming” has sprung up to describe the cultural trend of combining various prescription pharmaceutical drugs to alter a person’s mental and or physical state

WHERE A CLIENT BECOMES A CHEMIST

Treatment Issues- Pain Control

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“When I get a headache I . . .

A) drink some water and rest for a few minutes, it will pass”

B) take an OTC pain reliever (Tylenol, Advil) immediately”

C) take an OTC pain reliever (Tylenol, Advil) after an hour with no improvement”

D) tear up the house looking for the Vicodin left over from a past surgery”

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AUDIENCE POLL

Prescription Drug Abuse

According to the NIDA (National Institute of Drug Abuse), “20% of those in the U.S. aged 12 and older have used

prescription drugs for nonmedical reasons at least once in their lifetimes."

Heroin Metabolized

Heroin

Heroin rapidly (within moments) metabolizes

6-MAM

Into 6-MAM which is 6 times more potent than morphine

Morphine

Then finally metabolizes into morphine

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Heroin Use

• Heroin is extremely addictive and easy to overdose on (which can cause death). Withdrawal is intense and symptoms include insomnia, vomiting, and muscle pain-detox not fatal.

• Infection-sites related to use can require draining of the wound, plastic surgery and infections can get into the bloodstream and cause death.

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Overdose Deaths in America

• An average of 44 Americans die every day from prescription opioid overdoses (2014)

• An average of 22 Americans die every day from heroin overdoses (2013)

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Understanding Opioid Dependent Brain

Opiate addiction leads to an increased number of opioid receptors in the brain Normal levels of brain chemicals are not able to fully activate this increased number of opiate receptors When opioid receptors are left vacant (inactivated) a person will feel symptoms of opiate withdrawal

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How much is TOO much?

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• Street names: TNT and Tango & Cash

• Adding fentanyl is 100 times stronger than morphine (Chicago Tribune, 2016) and 50 times more deadly than heroin

• Often users believe they are taking oxycodone or heroin; not fentanyl.

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Fentanyl

Now 6 major different derivatives of Fentanyl

– Sometimes purchased separately

– Most often mixed and the user does not know it is in their heroin

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Understanding Fentanyl

Fentanyl Changes

• Acetyl Fentanyl is uprising and is part of the supply.

• Testing sites were aware of cycling in and out of Fentanyl with wide gaps with seemingly no presence of Fentanyl on the streets, but now are noticing something new. Consistent upward spike indicating it is here to stay.

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Carfentanli

• 100 times more potent than Fentanyl

• 10,000 times more potent than morphine

• Synthesized in 1974 as an anesthetic agent for large animals

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Carfentanil

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• Pressed into pill form and sold as prescription meds or mixed with heroin.

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• 2002 used in Moscow after a terrorist group held hostages in a movie theater. Made into aerosol-results backfired.

Carfentanil

Ohio…

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Over 230 overdoses with 20 resulting in death in ONE month – July! 174 overdoses estimated and three deaths during the week of August 20-26th – approximately 8 per day!

Availability?

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• Some of the Carfentanil is brought in by Mexican drug traffickers and sold for a HUGE profit.

• Establish an anonymous account & order directly from China on the internet.

• Highly restricted for veterinarians to use with large animals.

• Much easier to make this in a lab than grow poppies.

Says DEA spokes person Russ Baer

Special Considerations

• 5 times the amount of Narcan to counteract Carfentanil than heroin

• Calling in specialists to support reviving victims

• Appear better than 2-3 days experience repeat of symptoms

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Understanding Buprenorphine - BUP

Activates opioid receptors in the brain and will keep an opiate addicted person from feeling withdrawal. Stickier than other opiate drugs – even if a person tried to use heroin at the same time as buprenorphine, the heroin would have no effect. Partial opiate agonist. It will not create much of a

high and it is less dangerous than full agonist drugs

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Medication Assisted Treatment

• Naltrexone-Tx alcohol and opiates, non-opiate, 1 pill daily, blocks receptors, cannot get high and helps with cravings.

• Vivitrol- same as Naltrexone but IM every 28 days.

• Subutex-Tx opiates (purer Bup), used for pregnant women, liver issues, acute detox if recent opiate use.

• Bunavail-Bup & Naltrexone (Check-binded differently). For those who feel they need an small, regimented daily to avoid relapse.

• Suboxone-Bup & Naltrexone (Under tongue).

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Fills/Blocks Opiate Receptors

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Suboxone Considerations

Potency of 2mg=60mg of Morphine

Suboxone Misuse:

– Street value

– Use it to ensure they do not go into withdrawals until the next high

– IV for high or to help extend the script because it is expensive

– Accused of causing overdoses

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Special Benefits of Suboxone

• Beneficial for those with multiple relapses because their lifestyle of brief sobriety and using large amounts will prove to be fatal. They cannot get sober if you are dead.

• ADHD/Anxiety/Chronic Pain.

• Coordination of care with Strongly recommend good aftercare with trusted professionals who closely monitor as well as a strong support system.

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Warning Signs of Opioid Overdose

• Slow and shallow breathing

• Over sedated, cannot stay alert

• Unable to talk

• Person appears unconscious

• Blue or gray skin color

• Dark lips and fingernails

• Making snoring or gurgling sounds

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Naloxone

• Narcan®/Naloxone has been used in the medical field, such as in emergency rooms, in emergency medical services for the last thirty to forty years as an antidote for opiate reversals.

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Methods of Administration..

Evzio Intramuscular

auto-injector 0.4

$500 cash pay

s

Talks to you

Intramuscular

injection

Manual

Inexpensive

$30.00 - $40.00 Lay people may be

hesitant to use

Nasal MistMist

$75.00 cash pay

Teens Trends – Alcohol Consumption

Alcohol is the most widely used substance of abuse among America’s youth.

A greater proportion of teens use alcohol more than tobacco or other drugs.

What are Underage Youth Drinking? Distilled spirits are becoming more popular among teens (it’s challenging beer as the leader!) There is Good News! Even though alcohol is the most widely abused substance, use has continued to decline among high school seniors with past year use falling from 43.5 to 41.2% and alcohol binge drinking declining from 25.2 to 23.%.

Facts about Alcohol Use

Let’s talk depressant, dangerous intoxication and alcohol poisoning.

Recipe or Disaster = Alcohol + Comorbid mental health challenges

Marijuana in Pop Culture

Changing Attitudes in America

1992: “I did not inhale.” 2008: “I inhaled frequently. That was the point.”

Is marijuana addictive? A) YES

B) NO

C) I’m not sure.

AUDIENCE POLL

FACTS:

• Originally thought to be non- addicting.

• Mounting evidence over the last 40 years.

– Tolerance

– Withdrawal

– Compulsive use and inability to stop, despite consequences

• 17% of those who have used more than 5 times are at risk for dependence.

SUPER POT? • THC is much more potent than previously. Pot

has gone up from 3% THC to up to 27% THC. That is 275% more potent that weed only 10 years ago.

• 2009 Chicago news report documented the recent trend of “Super Pot” also called “Kush”, “Chronic”, “Hydro”.

• THC is a hallucinogen in larger quantities.

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Marijuana and Co-occurring Disorders

• Many clients with co-occurring disorders use marijuana and believe it helps their symptoms. Research to the contrary.

• Persons with mental illness are more likely to experience negative effects when using marijuana: anxiety, depression and paranoia while “high.”

• Persons with schizophrenia and other psychotic illness who use marijuana experience more frequent hospitalizations and increased symptoms.

)

Consequences of Illegal Use • 242,200 emergency room visits in the U.S. involved marijuana

use in 2005

• Second most frequent substance (after alcohol) found in the bodies of drivers involved in fatal vehicle accidents.

• Marijuana remains in body for approximately 14-30 days.

• Businesses drug test job applicants and employees to promote drug-free workplace.

• Drivers testing positive for THC can be

charged with DUI and subject to fines

and jail time. Testing limits and

technology evolving.

Types of Legislation

• Medical Use

• Decriminalization

• Recreational Use

Medical Marijuana • Medical use legal in 23 States & Washington D.C.

• Locally: Minnesota, Michigan & Illinois. Laws vary by State.

• Patients may possess, carry/transport, and even grow regulated amounts.

• Pending legislation in Wisconsin and other states.

Loopholes of Medicinal Cannabis

• No way to identify what weed is in the prescription bottle.

• Reports indicate the totally organic weed is more potent than street weed.

• Breaking through the abyss that occurs when prescriptions are involved with education and communication with other providers.

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Impact of Legalization in Colorado 2006-2014 Rocky Mountain HIDTA August 2014

• Traffic fatalities involving drivers testing positive for marijuana increased 100%.

• 10.47% of Colorado teens aged 12-17 use marijuana compared to 7.55% nationally.

• 7.63% of Colorado adults aged 18+ use marijuana, compared to 5% nationally.

Legalization Outcomes in Colorado

According to the National Survey on Drug Use and Health (NSDUH), SAMHSA’s annual survey revealed:

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• Youth ages 12-17 years have a 20% increase of use since legalization.

• Colorado is now ranked #1 up from #4 in country for youth use.

• Of those surveyed 18% get their marijuana from the street and 81% get it legally from parents or marijuana businesses.

• Colorado use of high school Juniors increased by 19% and Seniors by 14% from 2013 to 2015.

Honey Hash Oil Increasing THC Potency

• Process for extracting concentrated THC using butane or other chemicals.

• 80% PURE THC. Regular street weed is about 13%

• Hash oil can then be smoked, vaped or used in edibles

• Increases overdose risk, risk of negative side effects

• Extensive process involving hanging individual leaves and the sun.

Hash Oil-Shatter

Rock hard version of hash oil called “Shatter”; most potent and expensive

Can be produced in any kitchen with available supplies; “how to” videos on YouTube

The truth is scary…

• There are so many makers, mixers, chemist and cuts that we have no idea what the substance is made up of.

– Heroin

– Cannabis

– Pills

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What do the eyes tell you?

Opiates: Pinpoint pupil, very, very small and eyelid covering up half of the eye. Eyelids appear very heavy and drooped down. Narcotics: Heroin and prescription opiates/opiates (Vicodin, Percocet, Morphine, Codeine, OxyContin.

Stimulants: Very large, blown out pupil. Stimulant (Molly), Hallucinogens, K2, Spice, Cocaine.

Cannabis: Very large pupil like with Stimulant, BUT red veins one white part of eye to the point that the white looks pink.

Depressants Normal looking pupil, but eye lid weighted down. Alcohol, Valium Xanex, Soma, Ambien, etc.

Resource information: Bruce R Talbot Associates Inc. & Modified by Rachel Obafemi Gateway Foundation

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New Prevention Research

• Study found that there is a negative correlation between social activities and marijuana use in teens (Watkins, Johns, & Hossain, 2015)

• Study found that children of parents who practice an AUTHORITATIVE parenting style have significantly lower rates of marijuana use (King, Vidourek & Merianos, 2015).

New research presented at the 2015 APHA Conference in Chicago (Nov. 2015).

Treatment Issues • Patients require individualized assessment to determine

detox needs, and level of care

• Coordination of care involving community providers, PCP’s, specialty doctors, dentists, psychiatrists, insurance companies, pharmacists, is critical for success with prescription drug abusers

• Family support

• Twelve Step support

• “Just Pills”

• Get rid of all prescription medication

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• Treating the underlying co-occurring disorder, trauma, physical and emotional pain that drives addictive behavior. 90% of all clients in treatment have experienced trauma.

• Medication Assisted Treatment can help opioid abusers: Vivitrol, Suboxone, Bunavail, Naltrexone and others.

• Help client develop coping skills and behavioral strategies to deal with symptoms of pain, depression, anxiety, sleep problems, and attention issues without relying on medication intervention alone

• Awareness: Opiate Orphans, Doctors evaluate for signs and symptoms, collaboration of healthcare professionals (individual and group therapy, assessments and referrals).

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Treatment Consideration

Addiction is a disease!

• Identify the disease

• Healthcare providers collaborate to best treat the patient.

• Educate client

• Medication to assist symptoms if needed.

• Connect with support system (family, meetings, treatment, etc).

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Sources • Gateway Foundation’s Website www.recovergateway.org

• Moore & Budney, 2003, Journal of Substance Abuse Treatment

• www.drugfreeworld.com

• www.nami.org

• http://www.huffingtonpost.com/2014/08/06/dc-marijuana-legalization_n_5654826.html

• Marijuana Policy Project www.mpp.org

• The Legalization of Marijuana in Colorado: The Impact, 2014, Rocky Mountain High Intensity Drug Trafficking Area www.rmhidta.org/reports

• The Leafly www.leafly.com

• www.wikipedia.org “Legality of Cannabis by Jurisdiction”

• http://learnaboutmarijuanawa.org/factsheets/workplace.htm

Sources • National Institute of Health-Research Report Series- “Prescription Drug Abuse”

• www.nih.org

• www.samhsa.gov

• www.mayoclinic.org

• www.drugfreeworld.org

• www.cdc.gov

• “Prescription Drug Abuse is Lower, But Heroin Use Up” Ferris (2015), review of M. Larochelle, et. al., Harvard Medical School (2015) reported by www.cnbc.com

• “Prescription Drugs Could Be Gateway to Heroin” Fox (2015) www.nbcnews.com

• National Council on Alcoholism and Drug Dependence

• “Unintended Consequences: Why Painkiller Addicts Turn to Heroin”

S. Gupta (2015) www.cnn.com

• Chicago Health-Fall 2015 www.chicagohealthonline.com

• National Institute of Health-Research Report Series- “Prescription Drug Abuse”

• www.nih.org

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Sources • www.kidshealth.org/teen

• www.mayoclinic.org

• www.drugfreeworld.org

• www.cdc.gov

• “Prescription Drug Abuse is Lower, But Heroin Use Up” Ferris (2015), review of M. Larochelle, et. al., Harvard Medical School (2015) reported by www.cnbc.com

• http://www.crchealth.com/addiction/heroin-addiction-treatment/heroin-detox/buprenorphine-suboxone-vs/

• http://www.integration.samhsa.gov/clinicl-practice/trauma#bmb=1

• http://harmreduction.org/our-work/overdose-prevention/new-york-skoop/

• http://www.stopoverdoseil.org/

• http://www.anypositivechange.org/menu.html

Sources • https://www.networkforphl.org/_asset/qz5pvn/network-naloxone-10-4.pdf

• “Prescription Drugs Could Be Gateway to Heroin” Fox (2015) www.nbcnews.com

• National Council on Alcoholism and Drug Dependence

• “Unintended Consequences: Why Painkiller Addicts Turn to Heroin”

S. Gupta (2015) www.cnn.com

• Chicago Health-Fall 2015 www.chicagohealthonline.com

• https://www.drugabuse.gov/videos/emerging-trends-syrup-purple-dranksizzurp-lean

• http://getmedicil.biz/1940/robitussin_sizzurp/4.htm

• “Colorado Youth Marijuana Use: Up – Down – Flat? Examine the Data and You Decide!“ Press Release: Rocky Mountain High Intensity Drug Trafficking Area (RMHIDTA) (2015).spiceaddictionsupport.org

• “What Drug is My Client On?” Talbot (2015). www://DrugRecognition.com

Pill reports.net, Ecstasy Test Results Database by

Enlighten, “Ninja Turtle”.

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• Foundation for a Drug-Free World “What is Ecstasy”. Drugfreeworld.org

• Interactivefusion.net “Death by Fentanyl”

• Chicagotribune.com “Fentanyl and heroin overdose deaths increasing at alarming rate, DuPage officials warn”.

• Pubchem.ncbi.nlm.nih.gov

• Narconon.org

• Mayomedicallaboratories.com

• Sobernation.com “One City, Two Days, 78 Overdoses”.

• Nprillinois.org “An Even Deadlier Opioid, Carfentanil, Is Hitting The Streets” Sept 2, 2016.

• http://www.thehealthsite.com/news/children-now-getting-high-on-cinnamon/

• http://www.thehealthsite.com/news/children-now-getting-high-on-cinnamon/

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Sources

Thank you!

Questions?

Rachel Obafemi, LCPC, MISA, CADC

Gateway Foundation Lake Villa

25480 W. Cedarcrest Ln. Lake Villa, IL 60046

847-356-8205 x 3202 rmobafem@gatewayfoundation.org

RecoverGateway.org

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