Addiction: What you need to know about current

Drug Trendsand Treatment

Dori Haddock, LCSWAdministrator

501-725-8008

Pain + DOC = Relief

Cerebellum

Neurotransmitter Pathway

Prefrontal Cortex

Our Brain Prefrontal Cortex: Higher Reasoning, creativity, moral

compass.

Hippocampus: Decision maker. Makes decisions based of off logical rational thinking

Amygdala: Emotional processor, where our emotions live

Cerebellum: keeps you alive on the most basic level

Neurotransmitter Pathway: Transmit signals across a chemical synapse, from one neuron to another where they are received by receptors. Serotonin, endorphins, melatonin, norepinephrine

Your brain on Drugs:

Sex and food create surges of dopamine at 200% the amount our body naturally produces.

When a neurotransmitter pathway is disregulated dopamine levels are already diminished.

When you experience a “connection” in the pleasure pathway (neurotransmitter pathway) you experience a surge of dopamine.

DOC can create up to 1,000% of dopamine the amount the body naturally produces.

Stores in the part of your brain you can’t communicate with.

Your brain is broken

When dopamine is surged, glutamate forms back to the cerebellum and is stored and locked in your memory

Over time your natural dopamine stops producing

Your Amygdala shuts down

Negative emotions= short term memory

Positive emotions = long term memory

Make decisions based on emotion and thoughts

Setting the stage…

Drug use changes brain chemistry in adolescents (whose brains are still developing)…hijacks the brain

Most commonly used = alcohol and marijuana

Biggest increase in use = Rx drugs

Synthetic use has increased

IV drug use and heroin use have increased

Addiction is a

pediatrically-acquired disease.

90% of addicted Americans begin use before age 18.

Addiction Risk Factors Two main questions: Does the adolescent smoke? & Is

there a family history of addiction?

Age of first use (younger, higher risk)

Learning disabilities, behavioral problems, psychological disorders

Trauma (abuse, divorce, bullying)

Stress (feelings of inadequacy & insecurity…little life experience to help them cope, turn to destructive behaviors)

Quality of parenting (parents who use…or sanction use… have kids who use)

Genetic history = 4x more likely to become addicts

Protective Factors

High self-esteem Emotional self-control and regulation Resiliency (coping skills and problem-solving

skills) Family structure and supervision Clear family expectations of behavior and

values Opportunities for positive connections: peer,

school, athletics, religious, community

Progression of Addiction Stress, anxiety, depression, other undesirable feelings

Drugs and alcohol create euphoria and numb these negative emotions (*Addiction for many begins with nicotine…cigs, dip, e-cigs)

Difficult for teens to delay rewards; they understand but don’t fear consequences

Consequences start slowly for many, making it difficult to connect the dots

Parental attitudes/beliefs can interfere with detection

(Not my child…as long as it’s ONLY pot and/or alcohol)

As use continues there are more things to escape from, creating vicious cycle of

use and increased consequences

Addiction sets in with teens who continue to use despite the negative consequences (increased tolerance, trying more dangerous and higher

quantities of drugs)

The good new is most kids respond to negative consequences.

For those who continue to use, early intervention is key!

Drug Trends

The great escape…

Nicotine

Nicotine

First drug of abuse for most adolescents

Effect: Central nervous system stimulant, makes you feel energized, then not, making one want to use again to get energized effect

Causes brain cell damage and loss at any age

Worse for an adolescent’s hippocampus (the mind’s memory bank)

Also causes more cases of depression when compared to adult smokers

Alcohol

Alcohol

Binge drinking (availability issues), combining with Rx and OTC drugs

Household items with alcohol: mouthwash, cold medication, cooking sherry, vanilla extract, hand sanitizer

Vodka-soaked tampons (male & female), vodka in eye dropper

Dewshine-mixing Mountain Dew and racing fuel (methanol); 2 deaths reported in Tennessee as of 1/26/16, TN Poison Control reports additional cases

Urine = 6-24 hrs, Hair = up to 90 days, Blood = 12-24 hrs

Slang: handle, yack, krunk = high on alcohol and chronic (mj)

Marijuana

Marijuana More potent than 20 years ago

Universal smoke time “420”; look for related paraphernalia

Gas pump emoji = I’ve got weed or I need weed

Finger hands = roach clip

Cost per ounce can be $250 or more for high-quality

Many kids deal or serve as middle-man to support use

Slang: skunk weed, cookie, moonshine haze, sour diesel, blueberry OG, krunk = high on alcohol and chronic (mj)

Synthetic Marijuana

Synthetic Marijuana “Fake Marijuana” (but not really…)

Illegal in all 50 states

Agitation, vomiting, hallucinations, paranoia, tremors, seizures, chest pain, stroke, kidney damage, acute psychosis, brain damage, death

Drug test doesn’t detect all formulations

Over 400 different brand names; ex. Spice, K-2, Jwh-018, Crazy Clown, Atomic Bomb, Baby J, Krunk Max, K-bomb, Nightmare, Purple Haze, Rasta Spice, Scooby Snax

Prescription Opioids

Pain relievers with an

origin similar to that of heroin

Hydrocodone(Vicodin, Lortab, Lorcet)

Street NamesVike, Watson-387

Common FormsCapsule, tablet, liquid

Methods of UseSwallowed, snorted, injected

Oxycodone(OxyContin, Percodan, Percocet)

Street NamesOC, oxycet, oxycotton, oxy, hillbilly heroin, percs

Common FormsTablet, capsule, liquid

Methods of UseInjected, swallowed, snorted

Oxymorphone(Opana)

Street NamesBiscuits, blue heaven, blues, Mrs O, O bomb, octagons,

stop signs

Common FormsTablet

Methods of UseInjected, swallowed, snorted

Hydromorphone (Dilaudid)

Street NamesD, dillies, footballs, juice, smack

Common FormsLiquid, suppository

Methods of UseInjected, rectal

Codeine

Street NamesCaptain Cody, Cody, Schoolboy, Doors and Fours,

Loads, Pancake and Syrup

Common FormsTablet, capsule, liquid

Methods of UseInjected, swallowed (often mixed with soda and

flavorings)

Meperidine(Demerol)

Street NamesDemmies, pain killer

Common FormsTablet, liquid

Methods of UseSwallowed, snorted, injected

Morphine(Duramorph, Roxanol)

Street NamesM, Miss Emma, monkey, white stuff

Common FormsTablet, capsule, liquid, suppository

Methods of UseInjected, swallowed, smoked, rectal

Fentanyl

Street NamesApache, China Girl, China White, Dance Fever, Friend, Goodfellas, Jackpot, Murder 8, Tango and Cash, TNT

Common FormsLozenge, sublingual tablet, film, buccal tablet

Methods of UseInjected, smoked, snorted

Fentanyl/Carfentanil-Laced Heroin

Fentanyl-100x more potent than morphine, 30-50x more potent than heroin

Carfentanil-an analogue of the synthetic opioid analgesic fentanyl, which is 100 times more potent than fentanyl; animal tranquilizer for elephants and other large mammals (not approved for human use)

Federal drug agents say in the last two years Mexican cartels have increased production of a variant of fentanyl called acetyl fentanyl, and are smuggling it into the United States

Mixtures are responsible for spike in overdoses in many communities

National Opioid Overdose Epidemic

Drug overdose is the leading cause of accidental death in the US, with 47,055 lethal drug overdoses in 2014. Opioid addiction is driving this epidemic, with 18,893 overdose deaths related to prescription pain relievers, and 10,574 overdose deaths related to heroin in 2014

In 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills

Four in five new heroin users started out misusing prescription painkillers

94% of respondents in a 2014 survey of people in treatment for opioid addiction said they chose to use heroin because prescription opioids were “far more expensive and harder to obtain.”

Epidemic Impact on Special Populations

Adolescents & Young Adults

In 2014, 467,000 adolescents were current nonmedical users of pain relievers, with 168,000 having an addiction to prescription pain relievers

In 2014, an estimated 28,000 adolescents had used heroin in the past year, and an estimated 16,000 were current heroin users. Additionally, an estimated 18,000 adolescents had a heroin use disorder in 2014

People often share their unused pain relievers, unaware of the dangers of nonmedical opioid use. Most adolescents who misuse prescription pain relievers are given them for free by a friend or relative

The prescribing rates for prescription opioids among adolescents and young adults nearly doubled from 1994 to 2007

HeroinAn opioid drug made from morphine,

a natural substance extracted from

the seed pod of the

Asian opium

poppy plant.

Heroin

Street NamesBrown sugar, China White, Dope, H, Horse, Junk, Skag, Skunk,

Smack, White Horse, Cheese (With OTC cold medicine and

Antihistamine)

Common FormsWhite or brownish powder, or black sticky substance known as

"black tar heroin“, newest is pill form

Heroin Mexican Brown Power, Black Tar; 98.6% pure Cost $15 for 100mg (same high as $100-$120 worth of opiates) Can be injected, smoked, or inhaled; IV has become normalized

Liquid O=black tar heroin/warm water, eyedropper vial-inhaled through nose, costs $5-$10/drop

Baby Heroin = Crush Tylenol PM snorted with H for first time to make snorting easier

Heroin in pill form: Originating in Mexico, appear to be Oxy Narcan (Naloxone)-Opiate antagonist (nasal spray, injection);

intubation is being used frequently now due to potency of drug; od reversal is temporary, must get patient to ER asap

Urine = 3-4 days, Hair = up to 90 days, Blood = 1-2 days Slang: Aunt Hazel, Dirt, Salt, H

Black Tar Heroin

Brown Heroin

White Heroin

Heroin in Pill Form

Synthetic Heroin

Synthetic Heroin Vivazen, Pegasus-liquid, sold in convenience stores

Currently legal in majority of states as of 1/2016

Also known as Mr. Smiley, Black Flame Kratom

Kratom-Sold as a tea (natural tea extract), currently not illegal unless head shop owner refers to it as a drug; sold as liquid and capsules

Made from leaves of tree grown in southeast Asia (mitragyna speciosa)

In small doses, stimulant; high doses, sedative

30 pills for $30; $4.99-11.99 per bottle liquid

Nervousness, aggression, sleeplessness, tremors

Illegal in our state (and 5 others) as of May 2016

Imodium (Loperamide)

Imodium (Loperamide) Used as both an alternative to opiate pain

prescriptions and as a self-detox medication for opiate withdrawals

Loperamide is safe in low doses (as directed on packaging) but is dangerous at high doses

Loperamide is an opioid agent, helps to bind receptors in the brain

Its accessibility, low cost OTC status, and lack of stigma contribute to its potential for abuse

Dosage needed for euphora 50-300 pills per day

Signs and Symptoms

Paraphernalia

Burnt spoons: “Pretty Spoons”

Tiny baggies

Rx bottles (labeled and unlabeled)

Tan or whitish powdery residue

Dark, sticky residue

Small glass pipes

Syringes

Rubber tubing

Laxatives and stool softeners

Mood/Psychological Symptoms

Increased general anxiety

Anxiety attacks

Euphoria

Psychosis

Improved self-esteem

Depression

Irritability

Lowered motivation

Physical Symptoms

Improved alertness

Increased sensitivity to sensory stimuli

Constricted blood vessels

Increased heart rate

High blood pressure

Increased energy

Decreased appetite

Increased sexual arousal

Physical agitation

Difficulty sleeping

Over arousal and hyper-vigilance

Tiny pupils

Sleepy eyes

Tendency to nod off

Slow breathing

Flushed skin

Runny nose

Restless legs

Physical Symptoms

Additional Side Effects Fatigue

Constipation

Breathlessness

A sense of elation

Bronchospasm

Physical and psychological dependence

Nausea

Confusion

Depressed respiration and difficulty breathing

Death (often due to use of more than one substance)

Chest pain

Signs of Overdose-

High Risk(IV increases risk)

Awake, but unable to talk Body is very limp Face is very pale or clammy Fingernails and lips turn blue or purplish black For lighter skinned people, the skin tone turns bluish

purple, for darker skinned people, it turns grayish or ashen.

Breathing is very slow and shallow, erratic, or has stopped Pulse (heartbeat) is slow, erratic, or not there at all Choking sounds, or a snore-like gurgling noise

(sometimes called the “death rattle”) Vomiting Loss of consciousness Unresponsive to outside stimulus

Overdose ReversalNarcan (Naloxone)

Opioid antagonist Works within 5 minutes; begins to wear off at 30

minutes, completely out of bloodstream at 90 minutes

Preferred route of administration is injection Nasal mist can be used secondarily (once respiration

has resumed) Intubation is being used frequently now due to

potency of drug Many communities have equipped first responders with

Narcan Legislation allowing civilians to purchase/carry to

administer, including school faculty (alongside defibrillators and quick clot kits)

The Cough and Cold Aisle

The Cough and Cold Aisle

•Any cough/cold remedy that contains DXM (dextromethorphan)

•Hallucinations, sense of dissociation

•Often shop-lifted

•Often taken in very large dosages (up to 40 at a time)

•Dex Slang: Triple C’s, Cordies, Skittles, Orange Crush, Robo-Trippin’, Robofizzing, rojo, velvet, dexing

•Crunk = Drink made from cough syrup and Rx pain pills, sometimes also mixed with grape or orange soda

•Two Styrofoam cups stacked = dex/syrup

Prescription Medications

Opiates/Narcotic pain relievers

Stimulants/Study Drugs

Tranquilizers/Benzos

Stimulants/Study Drugs Adderall, Ritalin, Concerta; Vyvanse considered least

abusable

Increase in alertness, attention, and energy

Increases blood pressure, heart rate, respiration and blood glucose and constricts blood vessels

Cost $3-6 per pill

Slang: The A Train, Bennies

Tranquilizers/Benzodiazepines Klonopin, Xanax, Valium, Ativan

Used to treat anxiety, panic attacks, and sleep disorders

Produces a drowsy or calming effect

Withdrawal can cause seizure and death

Xanax-injected gummy bears

Cost $1-5 per mg

Urine = therapeutic use 7 days/chronic use 4-6 wks, Hair = up to 90 days, Blood = 6 to 48 hours

Slang: Tranx, Bars, Valley Girls, School Buses

Treatment

Residential Partial Hospitalization Sober Living Intensive OutpatientOutpatient Medically Assisted Treatment Co-occuring treatment for Dual Diagnosis

Twelve Step Programs AA

NA

Celebrate Recovery

Working the steps

Getting a sponsor

Not just “attending meetings”

Service work

Medication

Yoga

Bradford Health Services

We’re here to help!

Emergency Consultation Service: Available for on-site consultations 24/7

Crisis Response: Available for in-office consultations 24/7

Our consultation services are available to the community at no charge. If we are unable to help the patient through a

Bradford program, we will do our best to connect them to the appropriate community resources.

For more information or to schedule a free consultation:

1-501-725-8008