370 likes | 604 Views
adolescent abuse of prescription and over-the-counter drugs michael nerney and associates PO Box 93 long lake, NY 12847-0093 518-624-5351 mcnerneyll@frontiernet.net. Prescription drugs. In the United States: Food and Drug Administration Sole agency responsible
E N D
adolescent abuse of prescription andover-the-counter drugsmichael nerney and associatesPO Box 93long lake, NY 12847-0093518-624-5351mcnerneyll@frontiernet.net
Prescription drugs • In the United States: • Food and Drug Administration • Sole agency responsible • Center for Drug Evaluation and Research • Ten to Twelve Years Average • 5 out of 5000 go to clinical trials • 1 out of 5 is approved
Prescription drugs • Investigational New Drug Application • Preclinical, lab, animal, safety • Phase 1 • Healthy subjects, 20-80 • ED(50), TD(50), LD(50) • Phase 2 • Target subjects, 100-300 • Effective against disease or disorder
Prescription drugs • Investigational New Drug Application • Phase 3 • Large randomized double blind • 1000-3000 patients • Minimum/maximum doses • Combinations • Adverse effects/Contraindications • IND vs. Placebo
Prescription drugs • Investigational New Drug Application • New Drug Application • Filed with FDA • 100,000 pages of data • Review time, 8-12 months • Up to 2 years • Phase 4 • Post marketing
Prescription drugs • 3 Basic Outcomes • Intended effect • Adverse effect • Idiosyncratic effect
Overview • Perceptions • GRASE • ACCESS
overview • Motivations • Bio-Psycho-Social • Dynamics • Dose, Contaminants
sources • Doctor Shopping • Home Visits • The Streets • The Internet
patterns • As Needed • Medication for Feelings • 4 out of 10 • Negative Emotions
patterns • Recreation • Disinhibition • Anxiety Reduction • Euphoria
patterns • Cross-generational • 3 generations • Parents use children's drugs • Kids use grandparents’ drugs
Drug combinations • Enhance Primary Drug Effect • Boost the initial drug • Slow metabolism • Grapefruit juice
Drug combinations • Alleviate Withdrawal • Mask the withdrawal symptoms • Two separate systems • One system suppression
Drug combinations • Reduce Negative Side Effects • Minimize unpleasant effects
Systems Investigated • Structural • Gray Matter • White Matter
concerns • New Research on the Brain • Glutamate System Suppression • Too much DA • Chemical/Structural Changes • Protein interference • Loss of flexible learning
CONCERNS • New Research on the Brain • Reward System Shutdown • Too much DA • CREB • Gene code • Synthesize Dynorphin
Concerns • New Research on the Brain • Embedded Memory • Too much DA • Delta FosB • Chemical Changes • Protein shift • PKMzeta • Stores the high
Abuse of Prescription Drugs • Prescription Stimulants Brief History • Mechanism of action • Reuptake • Site of activity • PFC, Limbic • Neurotransmitters • DA, NE, 5HT
Prescription Stimulants • Potential for Abuse/Addiction • High • Risks • Physical, Behavioral • Psychological
Abuse of Prescription Drugs, continued • Prescription Tranquillizers Brief History • Mechanism of action • Second Messenger • Site of activity • Limbic • Neurotransmitters • GABA
Prescription tranquillizers • Potential for Abuse/Addiction • Risks
Abuse of Prescription Drugs, continued • Prescription Narcotics Brief History • Mechanism of Action • Direct • Site of activity • Limbic, Brain Stem • Neurotransmitters • Endorphin Receptors
Prescription narcotics • Potential for Abuse/Addiction • High • Risks • Multiple
Abuse of Prescription Drugs, continued • Other Drugs
Interactions with other drugs • Alcohol • Marijuana
Interactions with other drugs, continued • Ecstasy • Over-the-Counter • Aeroshots • Allergy Meds
Over the counter • Robo-shots • Dextromethorphan • Opioid cough suppressant • Plus alcohol • Rapid and powerful intoxication • Motor control • Impulse control • Delusional
Treatment Issues • Detoxification/Withdrawal
Treatment issues • Treatment Model
Current and Experimental Medications as Treatment Adjuncts • For Opioid Dependency: Trexan Vivitrol Buphenex
Current and Experimental Medications as Treatment Adjuncts • For Cocaine/Methamphetamine/Stimulant Dependency: • Selegiline • Amantidine • Baclofen • Modafinil • Disulfiram
The Practice of Recovery • The Clinical Connection • Access to Qualified Treatment Providers • Therapeutic Alliance • Multiple Models • Access to Support • 12 Step Programs
Emotional Competencies • Self Awareness • Verbal Access • Emotional Regulation • Empathic Response • Passionate Interest
Key Aspects • Fluid Intelligence • Monitoring Performance • Managing Emotions
The Practice of Recovery • Practice and Repetition • Learn from Failure