What You Dont Know CAN Hurt You

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What You Dont Know CAN Hurt You!

• The Abuse of Prescription Drugs and Other Opiates

Serving Cumberland, Gloucester and Salem
Counties
The Southwest Council, Inc. Where the Science of
Prevention Meets the Needs of the
Community
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Prescription Drugs of Abuse 101
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Medical vs. Non-medical use

• Medical Use
• Taking a prescription or over-the-counter (OTC)
  medication as prescribed or recommended.
• Non-medical use
• Use that does not meet the definition of medical
  use.

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Who is Abusing Prescription Drugs?
Approximately 20 of the United States population
has used prescription drugs non-medically in
their lifetime.
National Institute on Drug Abuse (NIDA)
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Who is Abusing Prescription Drugs?
There were 9.0 million (3.7) people aged 12 and
older who were current users of illicit drugs
other than marijuana in 2005.
2005 National Survey on Drug Use and Health
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Who is Abusing Prescription Drugs?
Nationally, 6 of people aged 18-25 report misuse
of prescription drugs in the past year.
Gloucester County Times April 2, 2007
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Who is Abusing Prescription Drugs?
6.4 million of these people aged 12 and up
reported using prescription drugs non-medically
in the preceding month.

• 4.7 million used pain relievers
• 1.8 million used tranquilizers
• 1.1 million used stimulants
• 272,000 used sedatives

2005 National Survey on Drug Use and Health
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Who is Abusing Prescription Drugs?
In a 2005 survey, 4 of New Jersey residents
report abusing prescription drugs in the past
year.
Perspectives April, 2007
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Who is Abusing Prescription Drugs?
11 of New Jersey residents aged 18-25 reported
misuse of a prescription drug in 2005.
Gloucester County Times April 2, 2007
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Who is Abusing Prescription Drugs?
Prescription drugs were the most common first use
drug for people age 12 and older. Prescription
drug use rates are similar for men and
women. The majority of prescription drug abusers
are Caucasian.
2005 National Survey on Drug Use and Health, DAWN
2005
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Who is Abusing Prescription Drugs?
Average age for first time non-medical users of
psychotherapeutics was 22.2 years.

• 20.1 years for stimulants
• 21.2 years for pain relievers
• 22.9 for sedatives
• 25.7 for tranquilizers

2005 National Survey on Drug Use and Health
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How do People Get Prescription Drugs?
2005 Sources of Prescription Drugs for
Non-Medical Use

• Friend or Family Member
• Doctor
• Drug Dealer or Other Stranger
• Internet

2005 National Survey on Drug Use and Health
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Results of Prescription Drug Abuse

• In 2005, 598,542 emergency department (ED) visits
  involved the non-medical use of prescription or
  OTC pharmaceuticals or dietary supplements.

DAWN 2005
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Results of Prescription Drug Abuse

• The majority of these ED visits involved multiple
  drugs.
• 20 involved alcohol.
• 20 involved other illicit drugs.
• 6 involved alcohol and other illicit drugs.

DAWN 2005
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Results of Prescription Drug Abuse
The most frequently reported drugs in these ED
visits were Central Nervous System (CNS) agents
and psychotherapeutic agents.
DAWN 2005
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Results of Prescription Drug Abuse

• The most frequent CNS agents reported were
  opiate/opioid analgesics
• 51, 225 ED visits for
  Hydrocodone/combinations
• 42,810 ED visits for
  Oxycodone/combinations
• 41,216 ED Visits for Methadone

DAWN 2005
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Results of Prescription Drug Abuse
The psychotherapeutic agents most frequently
reported in ED visits were anti-anxiety agents,
sedatives and hypnotics (34).
DAWN 2005
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Results of Prescription Drug Abuse

• Benzodiazepines of Abuse
• 62,020 visits for Alprazolam
• 30,608 visits for Clonazepam
• 19,655 visits for Lorazepam
• 18,567 visits for Diazepam

DAWN 2005
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Results of Prescription Drug Abuse

• Cumberland County Treatment Admissions
• 
  (5-15-06 TO 5-15-07)
• Heroin Opiates 402 23
• Other Drugs 250 14

DAWN 2005
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Results of Prescription Drug Abuse

• Gloucester County Treatment Admissions
  (5-15-06 TO 5-15-07)
• Heroin Opiates 824 35
• Other Drugs 328 14

DAWN 2005
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Results of Prescription Drug Abuse

• Salem County Treatment Admissions
• (5-15-06 TO 5-15-07)
• Heroin Opiates 166 26
• Other Drugs 74 11

DAWN 2005
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Results of Prescription Drug Abuse

• ED visits related to non-medical use of
  pharmaceuticals increased 21 from 2004 to 2005.
• Benzodiazepines increased 19
• Opiates/Opioids increased 24
• Methadone increased 29

DAWN 2005
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Results of Prescription Drug Abuse
Treatment admissions in New Jersey for pain
killers increased 217 from 1999 through
2005.
Gloucester County Times April 2, 2007
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Important Terms

• USE
• MISUSE
• ABUSE
• ADDICTION
• TOLERENCE
• DEPENDENCE
• 1) PHYSICAL
• 2)PSYCHOLOGICAL
• WITHDRAWAL

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Controlled Substances Act

• CLASSIFICATION CRITERIA
• Abuse liability
• Value as a medication
• History of use and abuse
• Risk to public Health
• Possible political concerns

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Controlled Substances Act

• Schedule I
• The drug or other substance has a high potential
  for abuse.
• The drug or other substance has no currently
  accepted medical use in treatment in the United
  States.
• There is a lack of accepted safety for use of the
  drug or other substance under medical
  supervision.
• examples Heroin, Marijuana, LSD

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Controlled Substances Act

• Schedule II
• The drug or other substance has a high
• potential for abuse.
• The drug or other substance has a currently
• accepted medical use in treatment in the
• United States or a currently accepted medical
  
• use with severe restrictions.
• Abuse of the drug or other substances may lead to
  severe psychological or physical dependence.
• examples morphine, MPH, Cocaine

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Controlled Substances Act

• The drug or other substance has a potential for
• abuse less than the drugs or other
  substances in
• schedules I and II.
• The drug or other substance has a currently
• accepted medical use in treatment in the United
• States.
• Abuse of the drug or other substance may lead to
• moderate or low physical dependence or high
• psychological dependence.
• examples Tylenol w/codeine, some barbiturates

Schedule III
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Controlled Substances Act

• Schedule IV
• The drug or other substance has a low potential
  for abuse
• relative to the drugs or other substances
  in schedule III
• The drug or other substance has a currently
  accepted
• medical use in treatment in the United
  States
• Abuse of the drug or other substance may lead to
  limited
• physical dependence or psychological
  dependence relative
• to the drugs or other substances in
  schedule III
• examples benzodiazepines,
  phenobarbital, phentermine

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Controlled Substances Act
Schedule V

• The drug or other substance has a low potential
  for
• abuse relative to the drugs or other
  substances in
• schedule IV.
• The drug or other substance has a currently
  accepted
• medical use in treatment in the United
  States.
• Abuse of the drug or other substance may lead to
  limited physical dependence or psychological
  dependence relative to the drugs or other
  substances in schedule IV.
• examples Robitussin, Lomotil

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New Jersey Pharmaceutical Misuse Patterns

• New Jersey has the highest concentration of
• pharmaceutical and chemical firms in the
  country.
• Doctor shopping, prescription forgery, and
  organized
• script rings remain the prevalent source of
  diverted
• legitimate pharmaceutical drugs in the New
  Jersey.
• The most commonly abused pharmaceuticals
• are Percocet, OxyContin, Xanax,
• Vicodin/Vicodin ES, and
• Hydrocodone/Hydrocodone products.
• The most commonly abused chemicals are
• GBL, Pseudoepherdrine, and Ephedrine.
• DEA Fact sheet last updated 2/2007

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Heroin

• South American (Colombian) Heroin represents the
  most significant narcotic problem in New Jersey
• Accounts for more admissions to state treatment
  centers than cocaine, marijuana, and all other
  drugs combined.
• Heroins high purity (among the highest in the
  nation) and low price has attracted numerous new
  users over the last few years
• Heroin purity levels in the Newark area continue
  to be among the highest in the nation.
• Traditionally, black tar heroin has been very
  rare in the New Jersey area, however, recent
  seizures indicates that black tar heroin is
  becoming more readily available.
• Heroin routinely arrives in the New Jersey
  metropolitan area primarily from South America,
  with transshipment from Mexico, Aruba, Curacao,
  Puerto Rico and countries in Central America.

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Heroin - continued

• Heroin is routinely packaged in glassine
  envelopes with a brand name stamped on it. Ten
  glassine envelopes are referred to as a bundle
  and 50 glassines are a brick.
• Distribution points primarily remain open-air
  markets or street corners in lower income areas
  of urban cities such as Newark, Paterson, Camden,
  Jersey City, and Elizabeth.
• The majority of the heroin is smuggled in from
  Colombia via couriers arriving aboard various
  airlines.
• New information reveals that heroin traffickers
  are utilizing multiple couriers on flights with
  multiple connections. With this relay style
  method, couriers hand off packages to individuals
  waiting at the next connection point.
• Source DEA Fact sheet last updated 2/2007

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New Jerseys Most Wanted

• AHMAD, Ahmad Zuhdi Abdel Fattah
• CASTRILLON, Rodrigo D.
• LOPEZ, Juan Guillermo
• OCHOA, Javier
• OSORIO-SERNA, Maria Teresa
• SERNA, Maria Victoria
• VERGARA, Sylvio

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Adolescent Abuse

• Top Ten Drugs of Abuse
• Tobacco-400,000 deaths per year
• Alcohol-most widely used drug
• Marijuana-most widely used illicit drug
• Prescription drugs-rapidly rising in popularity
• Methamphetamine-becoming drug of choice
• Ecstasy-evolving from in Rave to Street Drug
• Crack/Cocaine-some popularity among illicit drug
  abusers
• Heroin-epidemic proportions in Mid Atlantic
  States
• Inhalants-continues to show huge increases
• Steroids-mostly with athletics physical
  appearance

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Dont Forget Over- The- Counter Drugs

• Believe they are safer because they are
• not illicit
• Antihistamines
• Cough Suppressants
• - 4 of 8th, 5 of 10th, 7 of 12 graders
  reported
• taking RX meds with DXM to
  get high (2006)
• Diet and Energy Aids
• Herbs Supplements

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Methods Of Abuse Among Adolescents

• Break down sustained release
• Oxycontin Tabs
• Fentanyl patches Per-a-pops
• Oral experimentation
• Grinding Snorting
• Stimulants (Ritalin/Adderall)
• Benzos (Xanax)
• Opioids (Oxycontin, Vicodin, etc)

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Trends In Prescription Abuse

• Polydrug approach
• Sedative-hypnotic potentiation
• Sedative-hypnotic opioid potentiation
• Sedative-hypnotic illicit drugs
• Sedative-hypnotic/opioid stimulant

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How Rx Drugs Are Obtained
Steal or divert from medicine cabinet
Buy on the street
Internet
Trade on street (Ritalin for Pot)
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How Rx Drugs Become Available On The Street

• 1) Theft from manufacturer, pharmacy, etc.
• Diversion by health-care workers
• Manipulate physicians others
• Clinics
• - diet clinics, stress clinics, pain clinics,
  etc.
• 5) Scams for ERs physician
• casting, blood in urine, X-rays, etc

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Availability And Accessibility

• 62 (14.6 million) say Rx pain relievers are easy
  to get from parents medicine cabinets
• 50 (11.9 million) say easy to get through other
  peoples Rx
• 52 (12.4 million) say Rx pain relievers are
  available everywhere
• Source PATS 2006

• 56 (13.4 million) agree that Rx drugs are easier
  to get than illegal drugs
• 14 year olds are 4X more likely then 13 year olds
  to be offered Rx drugs (CASA 2006)
• 39 of 14-20 year olds say it is easy to get Rx
  drugs online or by phone more girls(48) then
  boys(31) said it was easier
• Source TRU, 2006

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Cyber Shopping

• As easy as purchasing a book or CD
• Only require shipping address payment method
• May offer secretive shipping trial offers
• ½ of the sites are outside of U.S. jurisdiction
• Use pseudonyms, chat rooms, IM, bulletin boards,
  news groups, public internet, money wiring
  services, electronic encryption,etc.
• www.erowid.org
• www.pillwatch.com
• www.pharmacysources.com

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Prescription Drugs

• Common Rx Drugs of Abuse
• Stimulants
• Sedative hypnotics
• Opioids
• Sexual enhancers (E.D. drugs)
• Anesthetics
• Anabolic Androgenic Steroids

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Prescription Drugs

• Stimulants
• Amphetamines
• Adderall Dexedrine
  Desoxyn
• Methylphenidate (MPH)
• Ritalin Concerta
• Others
• Fastin Plegine Meridia
• Didrex Sanorex Tenuate

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30mg Adderall ovals
Stimulants are prescribed for ADHD Obesity
Narcolepsy Depression Non- responsive asthma
25mg Adderall caps
20mg Ritalin caps
10mg Ritalin tablets
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Prescription Drugs

• Stimulants
• Effects of short term use
• Increased BP Increased Pulse
• Increased respiration Suppress appetite
  Sleep deprivation
• Effects of long term use
• Addiction potential Malnutrition or
  wasting

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Prescription Drugs

• Stimulants
• Negative effects
• Hypothermiaseizures
• Arrhythmias
• Cardiovascular failure
• Paranoia
• Psychosis
• Hostility/aggression
• Overdose stroke toxic psychosis

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Prescription Drugs

• Stimulants
• Indicators
• Hyperactivity Euphoria
• Irritability
  Anxiety
• Anorexia Weight
  Loss
• Excessive talking Dilated
  Pupils
• Dry Mouth and Nose
• Contra-indications
• OTC stimulants (decongestants)
• Antidepressants
• Asthma Meds

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Prescription Drugs
Vicodin

• OPIOIDS
• Natural (known as opiates)-Morphine-Codeine
• Semi-Synthetic (known as opioids)-Heroin-Hydroc
  odone (Hycodan)-Hydromorphone (Dilaudid)-Meperid
  ine (Demerol)-Oxycodone (OxyContin,
  Percodan/Percocet, Vicodin)
• Synthetic (also known as opioids)
• -Fentanyl (Sublimaze)-Methadone
  (Dolophine)-Propoxyphene (Darvon)-Pentazocine
  (Talwin)

Buprenorphine
Oxycodone/Oxycontin
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Prescription Drugs

• OpioidsPrescribed for
• Relief of post surgical pain
• Management of acute chronic pain
• Relief of cough and diarrhea
• Treatment of opioid dependence
• Pain Relievers are most abused Rx drug by
  Teens
• (OxyContin and Vicodin)
• --Monitoring the Future, 2006

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Prescription Drugs

• Opioids
• OxyContin
• For higher levels pain
• Sustained, controlled release oxycodone
• Fentanyl
• Sustained, controlled release
• 30 times the potency of Morphine

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Prescription Drugs

• Opioids
• Effects of Short Term Use
• Drowsiness
• Depressed Respiration
• Analgesia
• Constipation

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Prescription Drugs

• Opioids
• Objective Symptoms of Influence
• Constricted Pupils
• Sleepiness (nodding off)
• Loss of appetite
• Twitching/Scratching
• Possible injection sites and related paraphernalia

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Prescription Drugs

• Sedative-Hypnotics
• Benzodiazepines Barbiturates
• -Diazepam (Valium) -Butalbital
• -Alprazolam(Xanax) -Secobarbital
• -Clonazepam (Klonopin) -Amobarbital
• -Flunitrazepam (Rohypnol)
• -Lorazepam (Ativan) Muscle
  Relaxants
• -Nimetazepam (Erimin) -Soma
• -Temazepam (Restoril) -Flexeril
• -Triazolam (Halcion)
• Hypnotics
• 
  -Dalmane
• 
  -Chloral Hydrate

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Prescription Drugs

• Sedative-Hypnotics--prescribed for
• Anxiety
• Panic Attacks
• Reduce Stress Reaction
• Seizure Treatment/Prevention
• Muscle Relaxant
• Anesthesia (high doses)
• Tension

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Prescription Drugs

• Sedative-Hypnotics Indicators
• Appears Drunk
• Slurred Speech
• Impaired Judgment
• Difficulty Concentrating
• Pupils usually dilated
• Difficulty Walking
• Sleepiness
• Clumsiness

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Prescription Drugs

• Sedative-HypnoticsContra-indications
• Alcohol
• Opioids
• Antihistamines
• Skeletal muscle relaxants

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Prescription Drugs

• Anesthetics
• Ketamine (liquid) Club/Rave Drug
• Effects specific to Ketamine
• Out of body experience Gumby Doll period
• 30-60 minute duration (vs. PCP, several hours)
• Nitrous Oxide (gas)
• Effects begin within secondsExhileration, loss
  of coordination, giddiness, floating feeling
• Adverse effectsHeadache, nausea, vomiting,
  permanent damage using tanks can cause frostbite
  damage

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w w w . s o u t h w e s t c o u n c i l . o r g
Serving Cumberland, Gloucester and Salem
Counties
The Southwest Council, Inc. Where the Science of
Prevention Meets the
Needs of the Community