Substance Abuse, STREET DRUGS & OVERDOSE

Substance Abuse, STREET DRUGS & OVERDOSE Silver Cross EMSS EMD CE March 2014

Substance Abuse • According to the National Survey on Drug Use, 8.9% of the US population (2.2 million people) are substance abusers. • Substance abuse results in an increased incidence of injuries and illness. • Even if the primary reason for the call is not substance abuse, it can still be a contributing factor.

Alcohol • Most commonly abused drug in the United States today • Involved in a significant number of traffic fatalities, murders, and suicides • Symptoms of alcohol intoxication are similar to those of other medical illnesses or severe injuries. *Don’t assume alcohol is causing the patient's signs & symptoms until other chief complaints are ruled out.

Alcohol • Alcohol is an addictive, depressant drug. • Persons physically dependent on alcohol can develop severe withdrawal symptoms. • The most severe symptoms are delirium tremens (DTs).

Alcohol • Signs and symptoms of DTs • Confusion • Hallucinations • Gastrointestinal distress • Chest pain • Fever • Shaking • Restlessness • DTs is a serious medical emergency that can be fatal.

Drugs • May be ingested, inhaled, injected, or absorbed into the body • Look for clues that indicate the type of drug and the way it was administered. • Abuse of prescription drugs has increased in recent years. Courtesy of DEA

Drugs • Amphetamines • Stimulate the central nervous system • Includes speed, ice, crystal, cocaine (coke) • Signs of amphetamine use include: • Restlessness • Irritability • Talkativeness

Drugs • Barbiturates • Depressants (drugs that depress the nervous system) • Include tranquilizers, opiates, and marijuana • An overdose can result in respiratory depression or arrest.

Drugs • Hallucinogens • PCP, LSD, peyote, mescaline, mushrooms • Chemicals that cause people to see things that are not there • Signs and symptoms of PCP overdose • Convulsions • Coma • Heart and lung failure • Stroke • Try to reduce auditory and visual stimulation.

Drugs • Abused inhalants • Intentional inhalation of volatile chemicals • Many of these substances can be bought in hardware stores. • May cause drowsiness, unresponsiveness, seizures, or sudden cardiac death • Try to keep the patient from struggling. • Support the patient’s ABC’s

Drugs • Toxic injection from drugs • The patient’s reaction depends on the quantity and type of drug injected. • Signs and symptoms include: • Weakness • Dizziness • Fever • Chills • This is the quickest and most difficult route to treat.

Common “Street Drugs” • Methamphetamine • Common Club Drugs: • MDMA (Methylenedioxy-methamphetamine) • GHB (Gamma-hydroxybutyric acid) • Heroin

Methamphetamine • Other names for methamphetamine: • Ice • Meth • Tina • Geep • Chalk Dust • Ice Cream • LA Glass

Methamphetamine • Methamphetamine is a highly addictive stimulant. • Generally lasting 12 hours, this high is 250 times more stimulating to the dopamine receptors in the brain than the high from endorphins from exercise, eating, and even sex. • These receptors wear out after a period of time, becoming damaged. The person has no way to feel good from eating, sex, or anything pleasurable and seeks out more of the drug.

Methamphetamine • These people may go into a deep sleep for two to four days, appearing to be deceased. • This puts them at risk for rhabdomyolosis, a break down of muscle tissue. The proteins floating in the bloodstream from this breakdown clog the kidneys and cause kidney failure. Depending on the extent of the damage, the patient could end up on permanent dialysis.

How is Meth ingested? • Swallowing -20-30 Minutes to feel the effects -This method has the least risks due to the vomiting mechanism when toxins are ingested -Meth can be put in water, juice, and commonly is placed in gel caps and taken orally. -“Parachuting” is wrapping the meth in toilet paper and swallowing it. This delays the onset, and makes the high come on more slowly and evenly. This can also be done with a baggie and a small puncture. Considered a “harm reduction technique.”

How is Meth Ingested? • Smoking • 7-10 Seconds to feel the effects • Entered through the lungs which may lead to breathing difficulties • Usually crystal meth is smoked in glass pipes, similar to how crack cocaine is used.

How is Meth Ingested? • Shooting Up • 15-30 seconds to feel the effects • Injected into the veins, or “the works.” • This is where abscesses and skin infections begin to develop. • Injection bypasses the filtering mechanism by the body: the vomiting mechanism is bypassed and this directly circulates in the bloodstream. • The sharing of needles spreads diseases such as Hepatitis, HIV, and many antibiotic-resistant bacteria. • Improperly drawn-up meth can create an air bubble in the syringe and subsequently cause an air embolus resulting in cardiac arrest.

How is Meth Ingested? “Bumping” or snorting • Onset of 3-5 minutes • Most common ingestion method • Can cause nose bleeds, respiratory problems, • and abscesses can form on the nose and face.

How is meth ingested? • “Booty Bump” • Onset of 10-15 seconds • Needleless syringe is used to administer liquid meth into the rectum. • The drug is absorbed by the blood vessels in the lining of the rectum. • Sometimes used in conjunction with prostitution, this can cause injury and disease when used as a “professional adjunct” for these patients for alternate routes of intercourse. • Often used in patients who have septum issues from snorting or loss of veins from injecting.

How is Meth Ingested? • “Hot Rail” • Onset of 7-10 seconds. A glass stem is heated until the tip is red hot, then placed over a bump (a small pile of the drug) and the vapor is inhaled through the nose.

Effects of Meth… • Immediate Effects • Elation • High energy and feeling of acuity, insomnia • GI distress (vomiting/ diarrhea) • Sweating • Anorexia • Agitation, irritability, talkativeness, panic, compulsive fascination with repetitive tasks, violence, confusion • Increased sex drive, making this a popular club drug • Hypertension, hyperthermia, tachycardia, glucose level instability, bronchodilation • Vasoconstriction

“Faces of Meth” • Faces of Meth is an internet finding with hundreds of results. • Meth causes muscle wasting and anorexia, and in combination with the toxins it is “cut” with, causes a severe result in the aging process and is often the cause of sores on the face and skin. Tooth loss is also a common side effect of meth use… • Here are some “before and after” photos. • Most of these photos are taken within a six-month to two-year period:

http://photos.oregonlive.com/oregonian/2011/05/faces_of_meth_7.htmlhttp://photos.oregonlive.com/oregonian/2011/05/faces_of_meth_7.html “Faces of Meth”

Meth and the teeth… • Meth affects the top teeth first, and subsequent damage spreads to the gum tissue, dissolving the roots.

MDMA • 9 million users worldwide • Most common club drug • Often seen at raves and industry parties

MDMA A.K.A. • ECSTASY • Adam • Beans • California Sunrise • Clarity • E • Essence • Elephants • Eve • Hug • Hug Drug • Love Drug • Love pill • Lover’s speed • Molly • Scooby snacks • Snowball • X • XE • XTC

MDMA • “Ecstasy was originally developed by Merck pharmaceutical company in 1912. In its original form, it was known as “MDMA.” It was used in 1953 by the US Army in psychological warfare tests, and then resurfaced in the 1960s as a psychotherapy medication to “lower inhibitions.” It wasn’t until the 1970s that MDMA started being used as a party drug. • By the early 1980s, MDMA was being promoted as “the hottest thing in the continuing search for happiness through chemistry,” and the “in drug” for many weekend parties. Still legal in 1984, MDMA was being sold under the brand name “Ecstasy,” but by 1985, the drug had been banned due to safety concerns.”

MDMA • Onset form pill ingestion is roughly 20 minutes to one hour. • Duration is anywhere from 3 to 6 hours. • Patient has feeling of well-being, extreme euphoria, significantly enhanced sense of touch and other senses such as sound perception, along with a boost in energy. Some individuals even experience mild hallucinogenic effects while on the drug. The enhanced tactile experiences individuals experience while on the drug has earned it the nickname "the love drug". • Some Ecstasy users feel ill and experience stiff joints and muscles, a stiff jaw, extreme thirst, sleep disturbances, depression and paranoia.

GHB • Rohypnol • It has been a concern for the last few years because of its abuse as a "date rape" drug. • People may unknowingly be given the drug that, when mixed with alcohol, can incapacitate victims and prevent them from resisting sexual assault. • Also, Rohypnol can be lethal when mixed with alcohol and/or other depressants.

GHB • This drug is a sedative-hypnotic, causing amnesia. • It can cause respiratory depression in large amounts. • GHB is usually taken orally. • It is sold as a light-colored powder that easily dissolves in liquids or as a pure liquid packaged in vials or small bottles. • In liquid form, it is clear, odorless, tasteless, and almost undetectable when mixed in a drink. GHB is typically consumed by the capful or teaspoonful at a cost of $5 to $10 per dose. • The average dose is 1 to 5 grams and takes effect in 15 to 30 minutes, depending on the dosage and purity of the drug. Its effects last from three to six hours.

GHB Overdose • Side effects of mild to severe overdose: • Nausea • Vomiting • Delusions • Depression • Vertigo • Hallucinations • Seizures • Respiratory distress • Loss of consciousness • Slowed heart rate • Lowered blood pressure • Amnesia • Coma • GHB can become addictive with sustained use.

Heroin • Heroin use is on the rise! • Has a “city drug” stigma, however many suburban departments are seeing huge increases of the drug in higher socioeconomic areas • 30 Deaths are accounted to heroin in Will County in 2011 • Chicago and the metro surrounding areas have the highest rate of ER visits due to heroin abuse

Heroin Overdose • Symptoms • Airways and lungs • Apneic • Shallow breathing • Slow and labored breathing • Eyes, ears, nose, and throat • Dry mouth • Extremely small pupils, sometimes as small as the head of a pin ("pinpoint pupils") • Tongue discoloration • Cardiac • Hypotension • Weak pulse • Bradycardia • Skin • Cyanosis • Notable track marks/difficulty establishing an IV • Stomach and intestines • Constipation • Spasms of the stomach and intestinal tract • Nervous system • Coma • Delirium • Disorientation • Drowsiness • Muscle spasticity

General Treatment for a Drug Overdose • Provide basic life support. • Keep the patient from hurting selfand others. • Provide reassurance and psychological support. • Arrange for prompt transport. • Avoid classifying or judging the patient.

Drug Overdose & Poisoning Protocol Key Questions Pre-Arrival Instructions 1. What did the patient ingest? How much did they take? When did they take it? 2. Did the patient vomit? YES? - Did it include any of the ingested substance? 3. Is the patient violent or acting strangely? 4. Does patient have a history of drug use? 5. Could this possibly be a suicide attempt? 1. Notify police to respond 2 . If patient vomits, turn patient onto their side 3. Keep the patient calm 4. Do not leave patient alone 5. Save all medicine or other containers for medical personnel 6. Call back if patient’s condition worsens prior to the arrival of medical personnel USEFUL INFORMATION If patient vomits, contents of vomit may be useful Contact Poison Control for additional information: (800) 222-1222

Sources January 2014 Silver Cross EMSS 1st Trimester EMS CE packet with information from the following: Crystal Meth Recovery Services, Meth Memo 2013 www.k-state.edu FACES OF METH Additional Information Provided by: AAOS Emergency Medical Responder, 5th Edition Will County 9-1-1 EMDPRS, June 2012

Substance Abuse, STREET DRUGS & OVERDOSE