Opioids & The Young Adult

Population

MARY-K O’SULLIVAN, LMFT, LADC, LPC

Capital Region Mental Health Center

Please Define The Difference Between

Mood Altering and Mind Altering

Adolescence & Young Adulthood

Developmental Stage that Transitions the Child to an Adult

Age Range is between 10 – 24 and referred to as “teenagers,”

“adolescents,” “youth,” and “young people”; The associated

age spans are variously 13-19, 10-19, 15-24, even 10-24.

Focus is Upon Developing Adult Coping Skills and Abstract

Problem Solving in Varying Situations

Young Adulthood Risk

Factors

• Exposure To Drug Users In

Social/Work Environments

• Relationship & Work Instability

• Unemployment

• Psychological/Psychiatric Symptoms

The Effective Brain

GROWTH: Potential for

Learning

PRUNING:

Efficiency

MYELINATION:

Speed

Nucleus Accumbens

• promotes the drive for new experiences

• seeks activities with low effort for high

yield

• enhances maturity

• pushes away from family to the outside

world

The peer group becomes

increasingly important to teenagers

because

1. They have a greater understanding of others

2. They have a great capacity for mutual

understanding

3. They have an increased capacity for intimacy

and true friendship

4. All of the above

Young Adults Have a Unique Culture of

Their Own With Peer Structures, Belief Systems, &

Developmental Goals

Young Adult Context

• What Role Do Peers Play in the Development Process of

Adolescents?

• What Role Does School Play in the Development

Process of Adolescents?

• What Role Does Community Play in the Development

Process of Adolescents?

• What Role Does Family Play in the Development

Process of Adolescents?

Peers tend to influence more ______,

parents tend to influence more _______.

1. Decision making; basic values

2. Superficial behavior; basic values

3. Basic values; superficial behavior

4. Basic values; cultural mores

` The Amygdala

Contributes to:

Impulsive Behavior

Inappropriate Behavior

Missed Social & Emotional Cues

Miscommunication

Contributes to Rapid & Highly

Emotional Reponses

Behaviors Not Outgrown With Aging

FRONTAL LOBE

Poor Organizational Skills

Poor Decision-making

Poor Processing of Abstract Concepts

Rule Breaking

Reckless Behavior

Emotional Outbursts

HIPPOCAMPUS

Difficulty with Memory

Difficulty Learning

The Washington Post Reviewed the

CDC Data for 2015 and Found:

• Heroin death rates were

highest in Ohio, West Virginia,

and Connecticut, where the

rates were between 10 and

13.3 deaths per 100,000

residents

• The analysis showed that

synthetic opioids—including

Fentanyl and Carfentanil—

almost exclusively affect the

East Coast

Narcotics

• OPIATES: Directly Derived From The Opium Poppy

• SEMI-SYNTHETIC OPIATES: Partially Derived From The Opium Poppy, Partially Man-made

• OPIOIDS: Completely Synthetic/Man-made

NARCOTICS

OPIATES

OPIUM - Schedule II or III (Diluted)

MORPHINE – Schedule II

CODEINE – Schedule III

THEBAINE – Schedule II

NARCOTICS

SEMI-SYNTHETIC OPIATES

Heroin: Schedule I

Hydrocodone: Schedule III (ex: Vicodin)

Hydromorphone: Schedule II (ex: Dilaudid)

Oxycodone: Schedule II (ex: OxyContin, Percodan, Tylox)

NARCOTICS

OPIOIDS – (Fully Synthetic)

Buprenorphine (Subutex,

Suboxone): Schedule V

Fentanyl: Schedule II

Meperidine (Demerol):

Schedule II

Methadone (Dolophine):

Schedule II

Pentazocine (Talwin):

Schedule IV

Propoxyphene (Darvon):

Schedule IV

Tramadol (Ultram, Ultracet):

(Not Yet Scheduled)

“Pharm-parties” are introducing adolescents and

young adults to the world of prescription drug

use at an alarming high rate. It is not considered

“drug use” by many of those engaged in the

behavior as the medication comes from a

pharmacy

Often unable to afford illicit sources of the

prescription medication, and now

physically addicted, individuals turn to

heroin

Heroin costs 1/3 to 1/2 that of Oxycodone

purchased illicitly on the street

Deaths Due To Narcotics • King George V – Monarch (cocaine and morphine)

• John Belushi – Actor/Musician (Speedball)

• River Phoenix – Actor (Speedball)

• Jim Morrison – Musician (Heroin)

• Chris Farley – Comedian/Actor (Speedball)

• Elvis Presley – Singer/Actor (Prescription Drugs)

• Janis Joplin – Singer (Heroin)

• Kurt Cobain – Musician (Heroin)

• Sigmund Freud – Physician (Morphine)

• DJ AM – Disc Jockey (Prescription Medications and Cocaine)

• Howard Hughes – Aviator (Codeine)

• Michael Jackson – Musician (Propofol and Other Prescription Meds)

• Heath Ledger – Actor (Prescription Medications)

• Sid Vicious – Musician/Sex Pistols (Heroin)

• Brad Renfro – Actor (Heroin and Morphine)

• Dana Plato – Actress (Lortab)

Emerging Trend – U-47700

• A synthetic opioid drug that

was developed in the 1970s

but never made available to

the public is being sold

online

• The designer drug has

gained popularity through

drug forums and websites,

where it is sold as a powder

or granules. One website

offers 1 gram for $40, or up

to 1 kilogram for $7,000.

Emerging Trend – Grey Death

• A new drug called "grey

death" has been linked

to a handful of lethal

overdoses in the South -

- but no one knows

exactly what's in it or

where it's coming from.

• The drug, a mix of

opioids, can kill in very

small doses and looks

like concrete mixing

powder.

Emerging Trend - Cheese

• A mixture of heroin and OTCs such as Tylenol PM

• The heroin-Tylenol PM combination of "cheese" sells for

approximately $2 a pill

• Users commonly take the powder by insufflation

("snorting") rather than by intravenous injection.

• This mixture is also known as "Tylenol With Smack"

Emerging Trend - Krokodile

• Krokodil (pronounced crocodile) is a homemade substitute for heroin, invented in rural Russia and

has recently been featured in news reports alleging its appearance in parts of the United States

although the DEA has not yet confirmed any krokodil in this country.

• The chemical name for the main ingredient is desomorphine.

• The drug is made from codeine mixed with household chemicals like paint thinner and gasoline.

It’s injected and can reportedly cause a high “ten times more powerful than morphine,” It’s also

three times as toxic.

• Krokodil gets its name from the scaly, gray-green dead skin that forms at the site of an injection.

The flesh destroyed by krokodil becomes gangrenous, and, in some cases, limb amputation has

been necessary to save a user’s life.

Emerging Trend - Hysingla ER

• Purdue Pharma has

announced that

its prescription opioid

medication Hysingla ER

(hydrocodone bitartrate) is

ready to hit the market.

• The drug is the first

hydrocodone product that

contains abuse-deterrent

properties

Emerging Trend W-18

• A new drug that is considered to be

10,000 times more powerful than

morphine has hit the market in the US

after being discovered in Canada

• The synthetic opiate-like W-18 is a

psychoactive substance and

opioid similar to heroin, but is 100 times

more powerful than fentanyl.

• W-18 is yet to be prohibited in Canada

or the US. It was made illegal in Sweden

on January 26, 2016.

• It was originally developed as a

painkiller by scientists at the University

of Alberta in 1981.

• After being deemed too strong, it was

never picked up by pharmaceutical

companies and was largely forgotten

about.

Current Trend - Zohydro

• The introduction of the powerful new opioid painkiller Zohydro has

spotlighted the nation’s growing prescription drug abuse problem.

• A powerful new prescription painkiller known as Zohydro ER hit the market

in March 2014 amidst widespread concern that the drug could trigger a

disastrous spike in overdoses and deaths. Zohydro is a potent extended-

release formulation of hydrocodone without the additives of aspirin or

acetaminophen and without anti-abuse formulation.

Current Trend - Opana

.

Opana (oxymorphone) is an opioid pain

medication. Opana is used to treat moderate

to severe pain.

The extended-release form of this medicine

is for around-the-clock treatment of severe

pain.

Law enforcement officials are alarmed by the rise of Opana abuse, which they

said started after Oxycontin was changed in late 2010 to make that drug more

difficult to snort or inject for a heroin-like high.

Opana abuse can be deadly because it is more potent, per milligram, than

Oxycontin, and users who are not familiar with how strong it is may be

vulnerable to overdosing.

Opana, known by such street names as "stop signs," "the O bomb," and "new

blues," is crushed and either snorted or injected up to four to ten times per day.

Current Trend - Carfentanil

• Carfentanil or

carfentanyl is an analog

of the synthetic opioid

analgesic fentanyl. It is

10,000 times more

potent than morphine,

making it among the

most potent

commercially used

opioids

Current Trend - Acetyl Fentanyl • Mixing fentanyl with heroin isn’t new; however, the development of a synthetic

fentanyl has just started to make headlines.

• Three overdose deaths in North Carolina have been linked to acetyl fentanyl, a

designer opioid drug closely related to the prescription pain killing opioid fentanyl.

Two deaths occurred in Jefferson Parish, La. due to the drug and the use of acetyl

fentanyl seems to be spreading throughout the country.

• Acetyl fentanyl is often marketed as heroin but it is five times more potent than

heroin, 16 times more potent than morphine. Therefore, it is leading to many

overdose deaths, particularly in Rhode Island and Pennsylvania. The pills are also

peddled as oxycodone.

• Acetyl fentanyl is difficult to detect and easy to miss in drug overdose cases.

• Acetyl fentanyl is not scheduled under the Controlled Substance Act.

Current Trend “Syrup,” “Purple Drank,” “Sizzurp,” “Lean”

• Drinking prescription-strength cough syrup containing codeine and promethazine

mixed with soda was referenced frequently in some popular 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.

• Demand for the syrup has sent its price soaring on the streets. Syrup that typically

costs $12 per pint is sold to street dealers for $300 per pint. Dealers sell it by the

ounce for $40-$80.

• The drink produces euphoria and causes motor skill impairment that make users

move slowly or lean over. Overdosing on the syrup is potentially fatal.

Current Trend P-Dope

• Often Called Designer Heroin

• Molecular Similarities to

Fentanyl in Some Areas of the

Country; Purer Heroin Mixed

With Procaine/Lidocaine in

Other Areas

• Over-rides Methadone

Allowing Users to Get High

• Users Call it the “Crack of

Heroin” due to its addictive

potential

Psychological

Effects of

Narcotics

• Mood swings

• Depression

• Anxiety

• Irritability

• Lethargy

• Exhaustion

• Sedation

• Memory

problems

• Hallucinations

• Delusions

• Paranoia

Heroin

Opium

Morphine

Codeine

Hydrocodone (ex: Vicodin,

Zohydro)

Hydromorphone (ex: Dilaudid)

Oxycodone (ex: OxyContin,

Percodan, Tylox)

Oxymorphone (Opana)

Buprenorphine (Subutex,

Suboxone)

Fentanyl

Meperidine (Demerol)

Methadone (Dolophine)

Pentazocine (Talwin)

Propoxyphene (Darvon)

Definitions of Mood vs. Mind Altering

• Mood- Altering: Client Becomes Their Own Pharmacist. Focus is on

a Temporary or Short-term Emotional or Feeling State; Can Involve

Perception of Outside Stimuli; Deregulates Brain Chemistry; Getting

High is the Goal

• Mind Altering: Medical Personnel are Pharmacists. Focus is on

Long-term Feeling or Emotional State; Targets Intellect, Judgment,

Cognition, Intellect; Re-regulates Brain Chemistry; Getting High Is

Not the Goal Nor Part of the Perception of the Client