Nonmedical Use of Prescription Drugs

1. Nonmedical Use of Prescription Drugs Drug Statistics, Facts & Consequences

2. What is Nonmedical use of Prescription Drugs? • What are the Myths about Prescription Drug Use? • What are Stimulants? • What are Depressants (Narcotics & Sedatives)? • Are Over-the-Counter Drugs Dangerous? • What is the reality of prescription drug misuse?

3. 1. What is the meaning of Nonmedical Use of Prescription Drugs (Rx)? “Not prescribed for you” OR“You took the drug only for the experience or feeling it caused” (excludes Over-the-Counter medicine) Office of Applied Studies, SAMHSAAnesthetic and Life Support Drugs and Drug Safety and Risk Management Advisory Committees November 13, 2008 3

4. Where do nonmedical users get pain reliever prescription drugs? http://www.theantidrug.com/pdfs/prescription_report.pdf

5. Which prescription drugs are being abused? In 2005, 6.4 million Americans Age 12+ used a Rx for nonmedical purposes in past month 0.3 million Sedatives 1.1 million Stimulants 1.8 million Anti-Anxiety Medication 4.7 million Narcotic Pain Relievers Depressants Stimulants http://www.google.com/search?hl=en&rlz=1G1GGLQ_ENUS310&q=In+2005%2C+6.4+million+Americans+Age+12%2B+used+a+prescription+drug+for+nonmedical+purposes+in+past+month&btnG=Search&aq=f&oq=&aqi= SOURCE: 2005 National Survey on Drug Use and Health (NSDUH), published Sept 2005 by Dept of HHS / Substance Abuse and Mental Health Services Administration (SAMHSA)

6. Nonmedical use of prescription drugs ranks 2nd only to marijuana as the most prevalent category of drug abuse. Depressants Stimulants http://www.oas.samhsa.gov/2k6/pain/pain.cfm SOURCE: 2004 National Survey on Drug Use and Health (NSDUH) published Sept 2005 by the Dept of HHS / Substance Abuse and Mental Health Services Administration (SAMHSA)

7. 2. What are some Myths about Rx Use? • Prescription Drugs are “much safer” to use than illegal drugs. • “I think prescription drugs sound safer, even if they're not, just because they came from a company, and they were prescribed to someone for a legitimate reason.” • Gilbert Quintero. Journal of American College Health.  July-August 2009 v58 i1 p64(7). • There’s “nothing wrong” with using prescription medicines without a prescription “once in a while.” • Prescription Drugs are not addictive. • There are fewer side effects than street drugs. 2005 Partnership and Attitude Study (PATS) www.usdoj.gov/dea/concern/hydrocodone.ppt http://www.theantidrug.com/pdfs/prescription_report.pdf 7

8. Stimulant Medication

9. 3. Prescription Drug: STIMULANTS Amphetamines, MethamphetaminesAmphetamine Congeners & Diet Pills Intended Use:Narcolepsy, Obesity, Attention-deficit hyperactivity disorder (ADHD), Milder stimulants to lose weight. Nonmedical use:Surge of pleasure, rush or flash, burst of energy, to stay awake, Anorexia, Euphoric Effect Physical effects: include increased blood pressure, heart rate and pulse rates, insomnia, loss of appetite, and physical exhaustion. Drugs causing similar effects cocaine, crack, methamphetamine, khat http://www.getsmartaboutdrugs.com/drugs/amphetamines.html?v=0&t=0&p=1&f=0&df=0&dt=0 http://www.drugabuse.gov/ResearchReports/Prescription/prescription4.html#HowDo

11. Prescription Drug STIMULANTS Signs of AbuseNervousness, insomnia, over confident, aggressive, paranoid, loss of appetite, violent, euphoria, increased blood pressure. Signs of WithdrawalApathy, long periods of sleep, irritability, depression, disorientation. Signs of an Overdose Agitation, increased body temperature, hallucinations, convulsions, apathy, long periods of sleep, depression, disorientation & possible death. Signs of Long-term UseHeart disease, mental imbalances, paranoid, aggressive, twitching, malnutrition, dehydration & psychotic, deplete energy sources & severe depression. http://www.usdoj.gov/dea/pubs/abuse/chart.htm

12. Prescription Drug STIMULANTS How Stimulants can Kill: 1-Brain damageIncreased blood pressure increases the risk of a ruptured blood vessel in the brain. Narrowing of blood vessels reduces blood flow around the brain. 2-Heart attackIncreased oxygen demand by the heart (because of increased motor activity) accompanied by reduced blood supply (narrowing of blood vessels) can lead to heart attack. 3-OverheatingOne function of dopamine is to regulate body temperature. Altering dopamine levels with stimulants can affect the body's ability to cool itself. Combined with increased motor activity, this can lead to a dangerous increase in body temperature, resulting in organ failure and death. http://learn.genetics.utah.edu/content/addiction/drugs/overdose.html

13. Rates of Emergency Department visits, by drug, type of use and age- ADHD Stimulant Medicine 2008 DATA

14. ADHD Stimulant Medicine- Adderall® and Ritalin® While students feel smarter and more intelligent, the use of stimulants doesn't make them "smarter" or "better", it just makes their body's organs worker harder and can actually lead to the inability to concentrate or think clearly for any length of time. See Adderall Misuse on College Campuses

15. Illegal Comparisons and/orNot considered legitimate for medical use: STIMULANTS Cocaine- Slangs: Coke, Blow, Toot, Snow, Nose, Big C, Methamphetamine- See next slide Methyldioxymethamphetamine- MDA,MDMA Slangs: Ecstasy, rave, love drug, XTC, Adam *No one other drug is quite like MDMA, but MDMA produces both amphetamine-like stimulation and mild mescaline-like hallucinations. *tweaking- severe paranoid, hallucinatory, hyper vigilant thinking, & greater suicidal depression Ecstasy Crack Pipe Cocaine Crack Cocaine Paraphernalia http://www.whitehousedrugpolicy.gov/streetterms/ByType.asp?intTypeID=3http://www.usdoj.gov/oig/special/9712/appb.htm

16. Methamphetamine (Desoxyn®) vs. Methamphetamine (Meth) pg. 2 • Desoxyn®: • There is only one product currently marketed in 5 mg tablets. Desoxyn® has very limited use in the treatment of obesity, and attention deficit hyperactivity disorder. Slangs: Yaba (pill form) • Meth Illicit Use: • Meth abuse is also manifested by extreme anorexia, memory loss and severe dental problems. • Slangs: Batu, Black Beauties, Chalk, Chicken Feed, Tina, Crank, Crystal, Glass, Go-Fast, Hiropon, Ice, Meth, Trash, Methlies Quick, Shabu, Poor Man's Cocaine, Shards, Speed, Stove Top, Tweak, Ventana, Vidrio, Yellow Bam Meth speed ball- Methamphetamine combined with heroin Desoxyn® Meth Powder Crystal Meth http://www.oas.samhsa.gov/2k8/methamphetamineTX/meth.pdfhttp://www.deadiversion.usdoj.gov/drugs_concern/meth.htm http://www.getsmartaboutdrugs.com/drugs/methamphetamine.html?v=0&t=0&p=2&f=0&df=0&dt=0

17. Methamphetamine (Desoxyn®) vs. Methamphetamine (Meth) pg. 2 • Currently, methamphetamine is primarily produced by utilizing diverted pseudoephedrine combination products. (Now behind the counter at stores.) • Meth changes brain chemistry, and after extended use, the brain can no longer respond to dopamine (feel-good chemical produced by the brain). • Psychotic symptoms can persist for months and even years after use of these drugs has ceased and may be related to their neurotoxic effects. http://www.deadiversion.usdoj.gov/drugs_concern/meth.htmhttp://www.tcada.state.tx.us/http://www.kalispell.com/stopmeth/what_is_methamphetamine.htmhttp://www.drugfree.org/Files/Meth_Fact_Sheets

18. Tolerance and Cross-Tolerance Tolerance- Decrease in susceptibility to the effects of a drug due to its continued administration. (An increase in the amount of drug is necessary to get a similar high… the original “high” is almost impossible to feel again.) Cross-tolerance- Tolerance or resistance to a drug that develops through continued use of another drug with similar pharmacological compound. These factors increase the health risk when using drugs. http://www.merriam-webster.com/medical/cross-tolerance

19. Depressant Medication

20. 4. Prescription Drug Depressants Sedative-Hypnotics &Narcotics/Opioids Similarities- Slowed breathing, high potential for tolerance & dependence (addiction). ** Alcohol is a depressant and illegal for people under the age of 21 in the United States. http://www.getsmartaboutdrugs.com/drugs/narcotics.html?v=0&t=0&p=2&f=0&df=0&dt=0

21. 4. Prescription Drug Depressants- Sedative/Hypnotics • Intended Use- • To relieve Anxiety, Tension, Panic attacks, Acute stress reactions, Seizures, Sleep disorders, Epilepsy, Anesthesia (at high doses). • Muscle Relaxants- overall suppresses the Central Nervous System. • Nonmedical Use- • To relieve agitation, induce mild euphoria, lower inhibitions. • Often use in conjunction with other drugs. • Very similar to the emotional and physical effects of alcohol. • Blackout, brownouts, suicide attempts. • Date Rape Drug http://www.drugabuse.gov/ResearchReports/Prescription/prescription3.html#HowDo

23. 4. Prescription Drug Depressants- Sedative/Hypnotics Signs of Abuse-Slurred speech, disorientation, drunken behavior without odor of alcohol, impaired memory of events, interacts with alcohol. Signs of Withdrawal- Headaches, tremors, muscles twitching, nausea and vomiting, anxiety, restlessness, yawing, inability to focus, sleep disturbance, dizziness, delirium, convulsions, possible death. Can be fatal and should be medically supervised. Signs of an Overdose- Shallow respiration, clammy skin, dilated pupils, weak and rapid pulse, coma, possible death. http://www.usdoj.gov/dea/pubs/abuse/chart.htm

24. Prescription Drug Depressants- Sedative/Hypnotics • Signs of Long-term Use-Disrupt the transfer of information from short to long-term memory. Benzodiazepines: impair the ability to learn new information. • Alcohol- a CNS depressant, overdose is common, has damaging effects on every organ system, most dangerous psychoactive drug. ( Also, tolerance to alcohol results in tolerance to minor tranquilizers.) Sign of Abuse by Gary Fisher & Thomas Harrison

25. Illegal Comparisons and/orNot considered legitimate for medical use: Depressant- Sedative/Hypnotics • Benzodiazepines: Flunitrazepam- Rohypnol® • (banned in the US but legal in over 60 countries) • A small white tablet with no taste or odor when dissolved in a drink. • Slangs- Forget-me pill, Mexican Valium, R2, Roche, roofies, roofinol, rope, rophies, date rape drug • Short Term effects: The drug creates a sleepy, relaxed, and drunk feeling that lasts 2 to 8 hours. Other effects may include blackouts, with a compete loss of memory, dizziness and disorientation, nausea, difficulty with motor movements and speaking. http://www.drugfree.org/Portal/Drug_guide/Rohypnol#

26. Prescription Drug Depressants- Narcotic/Opioids • Intended Use- • Postsurgical pain relief, Management of acute or chronic pain, Relief of cough and diarrhea • Nonmedical Use- • Deaden emotional pain • Get a rush • Induce euphoria • Prevent withdrawal symptoms • There is no limit to the development of opiod tolerance. http://www.drugabuse.gov/tib/bupren.html

27. Lifetime Nonmedical Use of Selected Pain Relievers, Age 12 or Older: 2007 Vicodin®, Lortab®, or Lorcet® Hydrocodone Darvocet®, Darvon®, or Tylenol® with Codeine Propoxyphene (Darvocet and Darvon) Percocet®, Percodan®, or Tylox® Oxycodone Hydrocodone Hydrocodone Codeine OxyContin® Oxycodone Demerol® Morphine Methadone Ultram® Percent Using in Lifetime Office of Applied Studies, SAMHSAAnesthetic and Life Support Drugs and Drug Safety and Risk Management Advisory Committees November 13, 2008 27

28. Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older, by Sub state Region: Percentages, Annual Averages Based on 2004-2006 Office of Applied Studies, SAMHSAAnesthetic and Life Support Drugs and Drug Safety and Risk Management Advisory Committees, November 13, 2008 28

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30. Prescription Drug Depressants- Narcotic/Opioids Signs of AbusePinpoint pupils, sluggishness, shallow breathing and suppressed cough, slow pulse, low blood pressure, constipations, dryness of mouth, euphoria, numbness, slurred speech, sunken eyes. Signs of WithdrawalFlu-like symptoms, muscle cramps, dilated pupils, coughing, high blood pressure, rapid pulse, diarrhea, sweating, runny nose, anxiety, severe depression, loss of appetite, irritability, tremors, panic and vomiting. Symptoms are unpleasant and uncomfortable but rarely dangerous. Signs of an Overdose Slow and shallow breathing, clammy skin, convulsions, coma, possible death. A single dose can be lethal to an inexperienced user. http://www.getsmartaboutdrugs.com/drugs/narcotics.html?v=0&t=0&p=2&f=0&df=0&dt=0

31. Prescription Drug Depressants- Narcotic/Opioids ToleranceDevelops physical tolerance rapidly when the drugs are repeatedly administered and psychological tolerance is exhibit later at a slower rate. This tolerance results in the individual’s using doses that would kill a nontolerant person. Cross-ToleranceOccurs between natural and synthetic opioids but there is no cross-tolerance to CNS depressants (sedative/hypnotics). Signs of Long-term Use Severe constipation, women’s period delayed, sexual desire dulled. Heavier users- eyelids droop and the head nods forward, coordinating slowed. High tolerance and addiction.

32. How can one OxyContin pill kill you? Taking a large single dose could cause severe respiratory depression or death. Typically, opioids should not be taken with alcohol, antihistamines, barbiturates, or benzodiazepines. These other substances also suppress breathing and their effects in combination with opioids could lead to life-threatening respiratory depression. *There is always the possibility of a lethal reaction to any drug. http://www.drugabuse.gov/ResearchReports/Prescription/prescription8.html http://www.nida.nih.gov/infofacts/PainMed.htmlhttp://www.drugabuse.gov/infofacts/PainMed.html

33. Neurotransmittersbrain's major "workhorse" Many of the drugs being abused affect either glutamate or GABA or both to exert tranquilizing or stimulating effects on the brain. (gamma-amino butyric acid) Excitatory signal Inhibitory signal Under normal conditions, excitatory and inhibitory signals are in balance, resulting in controlled, regular breathing. A combination of heroin and alcohol can be especially dangerous. Opioids and alcohol both suppress breathing, but by different mechanisms. Heroin increases the inhibitory effects of GABA. (Increases the calming effect.) Alcoholdecreases the excitatory effects of glutamate Under the influence of alcohol or opioids, excitatory and inhibitory signals are out of balance, suppressing the impulse to breath http://learn.genetics.utah.edu/content/addiction/reward/pathways.html

34. Illegal Comparisons and/orNot considered legitimate for medical use: Opioids • Heroin • Heroin is processed from morphine (a naturally occurring substance extracted from the seed pod ). It comes in several forms, the main ones being "black tar" from Mexico (primarily sold in the western United States) and white heroin from Colombia (primarily sold on the East Coast.) • Slangs: Smack, junk, tar, Mexican brown, cheese, Harry, skag, Rufus, Perze,”H”, horse, dava, boy Vick, Watson 387 • Following this initial euphoria, the user goes "on the nod," an alternately wakeful and drowsy state. Mental functioning becomes clouded due to the depression of the CNS. http://www.drugfree.org/portal/drug_guide/heroin#http://www.tcada.state.tx.us/research/slang/terms.pdf http://www.getsmartaboutdrugs.com/content/drugs.aspx?duid=27eccf9b-2ceb-4f72-9076-25a11387c2f2&v=1&t=0&p=1&df=1&f=0&dt=0

35. Narcotic Prescription Drugs Only -Unintentional Overdose Deaths According to the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics, unintentional overdose deaths* involving prescription opioids increased 114 percent from 2001 (3,994) to 2005 (8,541), the most recent nationwide data available. *Does not include people prescribed drugs who died nor intentional overdoses (suicides). http://www.usdoj.gov/ndic/pubs33/33775/execsum.htm#Figure1

36. Over-the-Counter Medicine

37. 5. Are Over-the-Counter Drugs Dangerous? • Some over-the-counter (OTC) drugs, primarily cough and cold remedies that contain dextromethorphan (DXM), a cough suppressant, are used to get high. Products with DXM include NyQuil®, Coricidin®, and Robitussin®, among others. • Slangs: CCC, Dex, DXM, Poor Man's PCP, Robo, Rojo, Skittles, Triple C, Velvet • Illicit use of DXM is referred to on the street as "Robo-tripping," "skittling” or “dexing." • In 2006, about 3.1 million people aged 12 to 25 had used an OTC cough and cold medication at least once to get high, and nearly one million had done so in the past year. (SAMHSA, 2008) http://www.theantidrug.com/pdfs/prescription_report.pdfhttp://www.nida.nih.gov/infofacts/PainMed.htmlhttp://www.getsmartaboutdrugs.com/drugs/dextromethorphan_dxm.html?v=0&t=0&p=1&f=0&df=0&dt=0

38. 5. Are Over-the-Counter Drugs Dangerous? (con’t.) • Retailers are required of non-prescription products containing pseudoephedrine, ephedrine and phenylpropanolamine to place these products behind the counter or in a locked cabinet. (Methamphetamine is primarily produced by utilizing diverted pseudoephedrine combination products.) • Pseudoephedrine products include- Drixoral, Zyrtec-D 12-Hour, Advil Allergy Sinus, Mucinex D, Children’s Motrin Cold, Sine-Aid IB, Claritin-D 24 Hour, Sudafed 24 & 12 Hours, Afrinol. Photo shows chemicals, waste materials, & empty pseudoephedrine blister packs. http://www.usdoj.gov/ndic/pubs1/1837/1837p.pdf http://www.usdoj.gov/ndic/pubs36/36407/index.htm#foota

39. 7. What is the Reality of Prescription DrugMisuse?

40. The reality is that brothers, grandparents, friends, moms, uncles… are dying everyday due to misuse of prescription drugs. In 2009, Florida’s Medical Commission reported prescription drugs such as oxycodone, Xanax and Valium were present in 79 percent of the 8,653 drug-related deaths. Don’t regret ignoring the problem.

41. At the age of 22, Josh was prescribed OxyContin after a back injury. He got hooked and overdosed three times, before a he took a combination of three prescribed drugs that killed him -one day before his 25th birthday. Josh’s doctors were aware of his addiction problem and continued to prescribed him narcotic drugs.

42. On August 18th, 2006, Emily, only eighteen years of age and three days from her first day in college, was killed accidentally when she consumed OxyContin that had been prescribed for a relative.  Emily was not an experienced drug user, and all it took was one encounter with this drug. She had no chance to learn from this one-time experience.  Had she any idea how deadly this drug was, she would still be alive.

43. Patrick Stewart died on July 9, 2004 at 24 years of age after ingesting just one OxyContin®. He had no other drugs in his system and only a small amount of alcohol. He was a SDSU graduate, a graphic designer and a certified personal trainer. His friends described Patrick as "the one who puts you back on your bicycle after you fall off". He made the tragic mistake of believing someone at a 4th of July celebration when he was told that OxyContin was "sort of like a muscle relaxant, that it was prescription and FDA approved, so therefore safe". Close friends say that Patrick had never before taken an OxyContin, did not know it was equivalent to "heroin in a pill".

44. Robby L. Garvin 24 years old Died 6-11-2006 Death caused by Methadone toxicity. Robby died 40 hours after he took his first dose of this drug that was prescribed to him for pain. Robby was never informed by the prescribing doctor or the pharmacy that filled this prescription of the dangers and possible death that Methadone may cause.

45. If you suspect someone is abusing and/or addicted to drugs be proactive and persistent… addicts tend to lie and be dishonest as a means of continuing their habit, and as a defense mechanism. They are often even lying to themselves that they have a problem. Seek Professional and Medical advice. Don’t regret ignoring the problem. For additional information on prescription drug abuse, addiction, support groups, and recovery please visit www.StopRxDrugAbuse.org