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Understanding Polydrug Use and Effects on Impairment

Learn about the prevalence of polydrug use, common drug combinations, and the effects on major indicators of impairment. Explore null, overlapping, additive, and antagonistic effects of drug combinations.

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Understanding Polydrug Use and Effects on Impairment

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  1. Session 24 110 Minutes Drug Combinations

  2. Learning Objectives • Explain the prevalence of polydrug use among drug impaired subjects and identify common combinations of drugs abused by those subjects • Describe the possible effects that combinations of drugs can produce on the major indicators of drug impairment

  3. Learning Objectives (Cont.) • Define the terms “Null”, “Overlapping”, “Additive” and “Antagonistic” as they relate to polydrug effects • Identify specific effects that are most likely to be observed in persons under the influence of particular drug combinations

  4. What is Polydrug Use? Ingesting drugs from two or more drug categories

  5. Prevalence of Polydrug Use Los Angeles Field Validation Study (1985) • 72% of suspects had two or more drug categories in them (including alcohol) • 45% had two or more drugs other than alcohol

  6. Prevalence of Polydrug Use The National DRE database indicates that approximately 35% of all DRE reported cases revealed two or more drug categories detected Source: NHTSA/IACP DRE Database (2012)

  7. Common Combinations of Drugs Cocaine and Heroin Cocaine and Cannabis PCP and Cannabis Alcohol and practically anything else

  8. Drug Combinations • Cocaine and Heroin - “Speedball” • PCP and Heroin - “Fireball” • Crack and PCP - “Space base” • Crack and Marijuana - “Primo” • Crack and Methamphetamine - “Croak”

  9. The Effects of Drug Combinations on Major Indicators of Impairment • Null Effect • Overlapping Effect • Additive Effect • Antagonistic Effect

  10. Null Effect • If neither drug affects a particular indicator of impairment, their combination also will not affect that indicator • No action plus no action equals no action

  11. Null Effect (Cont.) Example #1: HGN • If neither drug affects HGN… Example: Narcotic Analgesic and Cannabis • (Neither category affects HGN) • …the combination should also not affect HGN, so HGN will not be present in this combination

  12. Null Effect (Cont.) Example #2: Reaction to Light • If neither drug affects reaction to light… Example: Dissociative Anesthetics and Cannabis • (Neither category affects the reaction to light) • …the combination will also not affect reaction to light, so reaction to light will be a normal response

  13. Null Effect (Cont.) Example #3: Body Temperature • If neither drug affects body temperature… Example: CNS Depressants and Cannabis • (Neither category affects the body temperature) • …the combination should also not affect body temperature, so body temperature will be in the DRE average range

  14. Overlapping Effect • If one drug affects a particular indicator of impairment, and another drug has no effect on that indicator, the combination of those two drugs will affect the indicator, in the same way as the first drug alone • Action plus no action equals action

  15. Overlapping Effect (Cont.) Example #1: Pupil Size • One drug affects the pupil size, but the other does not Example: CNS Stimulants and Dissociative Anesthetics • (CNS Stimulants dilate pupils, Dissociative Anesthetics don’t affect pupil size) • Pupils should be dilated

  16. Overlapping Effect (Cont.) Example #2: HGN • One drug causes HGN, but the other does not Example: CNS Depressants and Narcotic Analgesics • (CNS Depressants cause HGN but Narcotic Analgesics don’t) • HGN should be present

  17. Overlapping Effect (Cont.) Example #3: Lack of Convergence • One drug causes lack of convergence, but the other does not Example: Dissociative Anesthetics and Hallucinogens • (Dissociative Anesthetics cause lack of convergence, Hallucinogens don’t) • Lack of Convergence should be present

  18. Additive Effect • If two drugs independently affect some indicator in the same way, their use in combination will also affect the indicator and the effect may be reinforced • Action plus the same action produces reinforced action

  19. Additive Effect (Cont.) Example #1: Pulse Rate • Both drugs affect pulse rate in the same way Example: Cannabis and Inhalants • (Cannabis and Inhalants both elevate pulse rate) • Pulse rate should be elevated

  20. Additive Effect (Cont.) Example #2: Pupil Size • Both drugs affect pupil size in the same way Example: CNS Stimulants and Hallucinogens • (CNS Stimulants and Hallucinogens both dilate pupils) • Pupils should be dilated

  21. Additive Effect (Cont.) Example #3: Blood Pressure • Both drugs affect Blood Pressure in the same way Example: CNS Depressants and Narcotic Analgesics • (CNS Depressants and Narcotic Analgesics both depress blood pressure) • Blood Pressure should be depressed

  22. Antagonistic Effect • If two drugs affect some indicator in exactly opposite ways, their use in combination could affect that indicator in any possible way • Action versus opposite action yields you can’t predict the outcome

  23. Antagonistic Effect (Cont.) Whichever drug is more psychoactive at the time determines what we’ll see There is not an Antagonistic Effect for: • HGN • VGN • Lack of Convergence • Reaction to Light

  24. Antagonistic Effect (Cont.) Example #1: Pulse Rate • One drug affects pulse rate one way, the other drug affects pulse rate in the opposite way Example: CNS Stimulants and CNS Depressants • (CNS Stimulants elevate pulse rate, CNS Depressants depress pulse rate) • Pulse Rate will be up, down or within the DRE average ranges

  25. Antagonistic Effect (Cont.) Example #2: Pupil Size • One drug affects pupil size one way, the other drug affects pupil size in the opposite way Example: CNS Stimulants and Narcotic Analgesics • (CNS Stimulants dilates pupils, and Narcotic Analgesics constricts pupils) • Pupils will be dilated, constricted or within the DRE average ranges

  26. Antagonistic Effect (Cont.) Example #3: Body Temperature • One drug affects body temperature one way, the other drug affects body temperature in the opposite way Example: Hallucinogens and Narcotic Analgesics • (Hallucinogens elevate body temperature, Narcotic Analgesics depress body temperature) • Body Temperature will be up, down or within the DRE average ranges

  27. Cannabis and CNS Stimulant

  28. Cannabis and CNS Stimulant

  29. Cannabis and CNS Stimulant

  30. Cannabis and CNS Stimulant

  31. Cannabis and CNS Stimulant

  32. Cannabis and CNS Stimulant

  33. Cannabis and CNS Stimulant

  34. Cannabis and CNS Stimulant (6) Pupil Size Possibly Normal.

  35. Cannabis and CNS Stimulant (6) Pupil Size Possibly Normal.

  36. Cannabis and CNS Stimulant (6) Pupil Size Possibly Normal.

  37. Cannabis and CNS Stimulant

  38. Cannabis and CNS Stimulant

  39. Cannabis and CNS Stimulant

  40. Cannabis and CNS Stimulant

  41. Cannabis and CNS Stimulant

  42. Cannabis and CNS Stimulant

  43. Cannabis and CNS Stimulant

  44. Dissociative Anesthetic and Narcotic Analgesic

  45. Dissociative Anesthetic and Narcotic Analgesic

  46. Dissociative Anesthetic and Narcotic Analgesic

  47. Dissociative Anesthetic and Narcotic Analgesic

  48. Dissociative Anesthetic and Narcotic Analgesic

  49. Dissociative Anesthetic and Narcotic Analgesic

  50. Dissociative Anesthetic and Narcotic Analgesic

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