21st Century Drugs A Quick, Yet Complete, Crash Course

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Frank L. Greenagel Jr. LCSW, LCADC, ACSW, CJC

Recovery Counselor - Rutgers

NJ Governor's Council on Alcoholism & Drug Abuse

Adjunct Professor - School of Social Work, Rutgers

Chairman – NJ Task Force on Heroin & Other Opiates

Program Coordinator/Health Educator - School of Communications & Information, Rutgers

ADAP - 2011 NAADAC Organization Achievement Award

Greenagel Counseling Services, LLC

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Tell ‘Em What You’re Going to Tell’Em

• Process Matrix

• Substance abuse &

dependence

• 21st Century Drugs

• Best Referrals

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Process Matrix

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2 rules for diagnosing out of the DSM-IV-TR

(1) when substance use or a medical condition

can account for the symptoms, it preempts the diagnosis of any other disorder that could produce the same symptoms

(2) the more pervasive disorder that has the symptoms gets diagnosed (do not put down a lesser disorder with the same symptoms)

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Substance Abuse Spectrum

I-----------------I-------------------I--------------------- Non-use use abuse dependence

1 of 4 3 of 7

1 year life-time

No role failure - role failure - role failure

- mv/machinery - tolerance

- recurring legal issues - withdrawal

- confrontation x2 - 30 hrs/wk

- previous attempts to quit

- more use/time than planned

- phys/psych problems

caused by or made worse

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Misdiagnoses • Substance Abuse, Substance Dependence &

Early Recovery often look like

– Depression

– Anxiety

– ADHD

– Bi-polar disorder

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New Trends • Energy drinks w/alcohol

• Synthetic Marijuana - K2, Spice, Space

• Synthetic Speed - Bath Salts

• Adderall

• Soma

• Molly

• Hydrocodone

• The Ascension of Oxycodone

• Opana

• Fentanyl Gree

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Energy Drinks + Alcohol Most are 6% to 12% alcohol (12 to 24 proof)

- 24/7 - Four Loko (4 main ingredients) - Sparks - Joose - 3 Sum - B E (Budweiser Energy) - Liquid Charge - Rock Star 21 - Spike - Tilt - Torque

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Energy Drinks + Alcohol: 4 Biggest Problems

1. Mixing caffeine and alcohol can increase the risk of alcohol poisoning.

2. Mixing alcohol and caffeine can make your heart rate and blood pressure rise.

3. Caffeine can make you feel energetic even if you’re drunk. Caffeine hides the depressive effects of alcohol. People can be “tricked” into thinking they are alert enough to do things like drive a car, when they really aren’t

4. Caffeine and alcohol are both diuretics, leading to dehydration (and really bad hangovers).

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Energy Drinks + Alcohol • Banned on NJ College Campuses Fall 2010

- Ramapo (Oct, 2010 – 17 students & 6 visitors hospitalized)

- Farleigh Dickinson - Drew - Rider

• FDA issued warning, and most companies took out the caffeine

• Drinks still sold with flashy cans and sweet flavors • One can still buy energy drinks + alcohol in some

states, as well as online • Mixing Red Bull & Vodka is still popular • Hard liquor + Rock Star or Monster continues Gree

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Synthetic Marijuana • Most likely to be used by

– Young teens

– People on probation

– Others that are being drug tested

– Marijuana smokers who can’t find it that day

• Still can be found

– Online, Canada

• Illegal in: UK, Ireland, Germany, France, Romania, Sweden, Switzerland, Chile, NZ

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K2, Spice, Space These terms refer to commercially available

products that have been sprayed with research

chemicals called synthetic cannabinoids but does not

contain any cannabis components.

These synthetic products are

usually made in Asia and then sold in local markets

throughout the US, including gas stations, liquor stores, convenient stores, smoke shops or on the Internet.

It is being sold as incense

and the content (and websites) usually have

warning labels: “NOT FOR HUMAN

CONSUMPTION”

K2, Spice, Pep Spice, Spice Gold, Spice Silver , Sence, Yucatan Fire, Skunk, Orange Dragon Smoke, Black Mamba, RedX Dawn, Zohai, Mr. Nice Guy, Bayou Blaster, Euphoria, Home Spice, Ultra

Cloud Ten, Genie, etc…..

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Synthetic Marijuana • Illegal in USA as of 3/1/2011: JWH-018, JWH-073, CP-

47,497, JWH-200, and cannabicyclohexanol

(banned for 1 year) (DEA pushing for an extension)

• JWH-018 can be detected in a special urine screen. A few tests for other chemicals at this time (Redwood)

• More likely to induce delusions and/or hallucinations than marijuana

• Banned by the US Military

• Headaches, agitation, vomiting

• Likely to be schedule I

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Synthetic Speed •sold as “Bath Salts” • designer stimulant out of Germany •illegal in NJ: 4/28/11 •chemical components banned in NJ: 8/23/11 •banned for 1 year by FDA

10/21/2011

•schedule I drug

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Synthetic Speed

• Methylenedioxypyrovalerone (MDPV)

• Can be smoked, snorted or injected

• Aura, Ivory Wave, Vanilla Sky, Ivory Soft, Loco-motion are some common names

• 3 – 20 mg dose

• Lasts 3-4 hours

• Racing thoughts, hallucinations, can induce panic attacks

• High body temperature, high blood pressure, high heart rate, kidney problems

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Adderall • Drugforum

• Introduced in 1996

• schedule II drug

• amphetamine

• Ritalin and Concerta are also abused

• overly prescribed for ADHD

• Sometimes prescribed for narcolepsy

• Stronger and longer lasting than Ritalin

• Adderall IR(immediate release)

• Adderall XR (extended release)

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Adderall • “study drug” for staying awake, increased energy and

improved concentration

• $5 to $40 at Rutgers

• increased blood pressure

• insomnia

• chronic use can cause birth defects

• chronic use can cause delusions

• moderate level of dependence

• hurts natural ability to concentrate

• banned by NFL, UFC & NCAA w/o a prescription

• banned in Japan, Korea & Thailand

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Soma • Created in 1959

• Carisoprodol

• Muscle relaxant

• January 11, 2012 – Schedule IV Drug

• Recreational use: sedative, euphoria

• Side effects: drowsiness, decreased reaction

• Potentiating effects on alcohol & synthetic opiates Gree

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Molly

• Schedule I drug in 1988

• Pure, uncut MDMA (ecstasy)

• Legal or illegal?

• Legal ecstasy – stimulant & hallucinogen

• Sold as “Molly’s Plant Food”

• Sold online

• Bluelight MDMA drug info & forum

• College, suburban and club drug

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Molly • 30 minute onset, lasts several hours

• Euphoria, psychedelia, stimulation, energy, desire

• Massive dopamine rush

• Insomnia, aches, nausea, stiff jaw, fatigue

• Anxiety, depression, irritability, gi problems

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Hydrocodone • Schedule III drug

• Germany, 1920

• Semi-synthetic opiate, used to treat pain

• Tablet, capsule or syrup

• Usually paired with acetominapine or ibuprofen

• Vicodin, Hycodan, Norco, Lorcet

• Respiratory problems when combined with alcohol

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Oxycodone • Opiate – painkiller • Schedule II Drug • Germany, 1916 • overly prescribed for pain management • Purdue Pharma in 1996. • Oxycontin 10, 15, 20, 30, 40, 60, 80 mg $1/mg at Rutgers • Oxycontin 160 mg discontinued in 2001 • Percodan 4.8355 mg w/ 325 mg aspirin • Percocet 2.5, 5, 7.5 & 10 mg w/ acetaminophen • Roxicodone, “Blues” 15 & 30 mg, immediate release • oral, intranasal, intravenous, intramuscular • bad interactions with numerous other drugs • high level of dependence • More than 50% of RX in USA come from FLA • Oxycontin Express documentary

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Oxycodone • memory loss, constipation, diarrhea, loss of appetite,

stomach pain, fatigue, nausea, lightheadedness, dizziness, headache, dry mouth, anxiety

• withdrawal symptoms: anxiety, nausea, insomnia, muscle aches, weakness, fever, panic attacks, and vomiting

• gateway to heroin • Far more young people are abusing opiates due to Oxycodone • opiates were #1 for DMHAS funded facilities in NJ in 2011.

Replaces alcohol, which had been #1 forever before that • Older adults are also abusing and becoming addict in high

numbers • OxyNeo – released in 2012 due to lawsuits & criticisms

– Too sticky to chew – Can’t crush – Turns to thick gel when put in water Gree

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Oxycodone – Where To Get It • Medicine Cabinets • Grandparents • Pain management clinics • Emergency Rooms • Online Pharmacies • Dentists

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Opana • Oxymorphone

• Germany, 1914

• Moderate to severe pain relief

• Less euphoria than heroin or oxycodone & wears off faster

• Octagon, stop sign, new blues

• Opana 5 & 10 mg

• Opana ER 5, 10, 20, 30, 40 mg

• Generic Opana ER 7.5 & 15 mg

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Fentanyl • Created in 1959

• Schedule II Drug

• Synthetic opiate

• 100x stronger than morphine

• Used as anesthesia or as a painkiller

• Quick onset – dissolves in fat really well

• Other medical forms: transdermal patch, lollipop, tab and spray

• Illegal use: snort, smoked, iv

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Fentanyl Patches • Transdermal patch is used for chronic pain

management

• 12, 25, 50, 75 and 100 mcg doses

• 8-12 hours to take effect

• Lasts 48 to 72 hours

• Can cause nausea, diarrhea, dry mouth, fatigue, headaches, depression, anxiety, and significant respiratory problems

• High chance for overdose

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NJ Other Opiate Treatment Admits SAMHSA Data

Other

opiates 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

0-11 yrs 0 1 0 0 0 0 0 0 0 0 0 0

12-17 yrs 7 11 13 21 19 20 27 59 74 74 80 95

18-20 yrs 18 29 63 58 100 144 210 271 451 610 956 993

21-25 yrs 47 63 144 158 290 471 550 783 1080 1488 2304 2790

Other

Opiates

Total 0-

25 yrs 72 103 220 237 409 635 787 1113 1605 2172 3339 3878

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New Treatments For Opiate Problems

• Buprenorphine

– Suboxone

– Subutex

• Naltrexone

– Naltrexone pill

– Vivitrol

• Naloxone

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Buprenorphine

Subutex - Schedule III drug - DATA 2000 – allowed for detox, short-term and long-term

maintenance as a form of medical treatment - FDA approval 2002 - MD’s must take a 3-day training, can treat 100 patients at a

time; law suggests MD recommends weekly therapy - Semi-synthetic opiate

- Helps physical withdrawal, helps with cravings - Used for pregnant women - White, oval shaped, bitter - Transdermal patches available

- Butrans, 7 day patch: 5, 10, 20 mcg (Purdu Pharma) Greena

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Buprenorphine

Suboxone - Schedule III drug

- DATA 2000; FDA 2002 - Semi-synthetic opiate - Orange color, hexagon shape, Lime or Orange taste - Also has Naloxone in it (4 B/1 N ratio) - 1, 2, 4, 8, 16 & 32 mg tablets - Helps physical withdrawal, helps with cravings - Ceiling effect regular users can’t OD, above 32 mgs does

nothing - Suboxone film 16/4 mgs, 8/2, 4/.5 - Better than methadone easier to withdraw, more

convenient, much less euphoric effect - Irony: Off-label use for pain management - Negatives: Can mask opiate use; expensive Gree

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Naltrexone • Naltrexone (Revia or Depade)

• Standard is 50 mg tablet

• Works for alcohol & opiate dependence

• Reduces cravings; blocks opiate euphoria

• Vivitrol (injectable Naltrexone)

• Muscle injection every 4 weeks

• Should accompany therapy

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Naloxone • Opiate antagonist

• Used in case of opiate overdose

• Available in generic form

• Takes 1 minute to take effect

• Stop Opiate Overdose in Washington State, as a result of Good Samaritan law 6/10/10

• Used in the movie Pulp Fiction (6:45 in clip)

• Some parents and public health officials pushing for more widespread availability

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My Favorite Referrals

• Detox Carrier - Belle Meade

• Rehab Sunrise House - Lafayette

• Long Rehab Integrity House - Secaucus & Newark

• $$$ Rehab Caron - Wernersville, PA

• ½ Half – W Anderson House - Flemington

• Sober House Oxford House - many NJ locations

• IOP Hunterdon Drug Awareness - Flemington

• MD - ASAM Dr. Lou Baxter - Princeton

• High School Association of Recovery Schools - USA

• University Rutgers - New Brunswick

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Frank L. Greenagel Jr. LCSW, LCADC, ACSW, CJC

Recovery Counselor - Rutgers

NJ Governor's Council on Alcoholism & Drug Abuse

Adjunct Professor - School of Social Work, Rutgers

Chairman – NJ Task Force on Heroin & Other Opiates

Program Coordinator/Health Educator - School of Communications & Information, Rutgers

ADAP - 2011 NAADAC Organization Achievement Award

Greenagel Counseling Services, LLC

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