Kevin Leehey M.D. Child, Adolescent, and Adult Psychiatry Board Certified

1. Kevin Leehey M.D.Child, Adolescent, and Adult PsychiatryBoard Certified 296-4280 leeheymd.com

2. University of ArizonaCampus Health Service Update on Substance Use Among College Students 1/6/09 Kevin Leehey M.D. leeheymd.com 296-4280

4. Twenty-five is the best estimate for when the brain is reasonably fully mature.

5. The teen brain is more vulnerable to the stimulating, damaging, and addicting effects of nicotine, alcohol, and other drugs. • One in three teens who start smoking as a teen will die of a tobacco related disease. • 90% of adult smokers began as teens. • Almost 45% of kids who start drinking alcohol by 13 will become alcoholic, while only 10% of those who wait till 21 will. • Substance use in youth thus becomes hard wired in as a tendency for life. This is in addition to any genetic predisposition.

6. Healthy Subject watching video of using Substance abuser in remission watching video of using

7. Causes of death ages 15-24 :

8. Causes of death ages 15-24 : • Accidents -primarily motor vehicle, many are substance impaired. • Suicide • Homicide These 3 account for 75% of all deaths in our kids. Suicide and homicide are mostly by guns and many are substance impaired.

10. SSRI prescription rates in the United States*

11. Suicide rates in children and adolescents (aged 5 – 19 years) in the United States

12. Case 1 • 19 year old male c/o tired, can’t sleep till 3 am, drags getting up, and is irritable and moody. Friends referred him to Student Health concerned he has Bipolar d/o. He’s taking Adderall 20 mg tablets 4x/d prescribed by his hometown Dr. for ADHD at 20 mg BID. BTW, he needs more cuz his bottle was stolen at a party.

13. Prescription medicine abuse • From family, friends, stolen - often from peers, Mexico, online, or take more than prescribed • Youth think they’re safer, pure, legal • ADHD meds – Adderall, Ritalin, MPH, Metadate CD, Dexedrine, Focalin, Vyvanse, Strattera • Benzodiazepines – benzos, “Bars” (Xanax 2 mg), Klonopin (clonazepam), Ativan (lorazepam), Valium (diazepam), “Roofies” (rohypnol - Mexico), etc • Muscle relaxers – Soma, etc • Pain pills Case 6

14. Case 2 • 21 year old female soph who complains of sleep onset problems. Takes only afternoon classes and still oversleeps. She says her roommate’s Ambien really helps and heard there’s a generic now – “I really want some”.

15. Teens do best with 8 to 10 hours sleep, few get it; and phase shift. REM occurs about every 90 minutes. REMs get longer and deep sleep shorter overnight. REM key for neurotransmitters and memory. Naps lack REM.

17. Other sleep aides • Sleep hygiene • CBT – Cognitive Behavioral Therapy • Relaxation response • Melatonin, L-tryptophan • Valerian root, kava, chamomile, passion flower • Seroquel, Doxepin, amitriptyline

18. Case 3 • An RA at Coronado insisted John, an 18 year old freshman from Chicago, go to Student Health after his roommate’s repeated complaints that John has passed out at his computer 3x and has a case each of “dust”, “cracks”, and Whipped Cream.

19. Inhalants • No, not Angel Dust – Dust Off • No, “cracks” not “crack”. BB and Airsoft gun air cylinders • No, N.O. nitrous oxide, “Whip-its” • Amyl or butyl nitrate – “Poppers” • Gas, glue, paint, ether, etc

20. Case 4 • Sarah from Paradise Valley and Lisa from Foothills, both 20, like to party and live together off campus. Although by chance each had appts separately they mention each other and are unforgettably slender; well, really too skinny; showy, have suckers and c/o of “crashes”, “downs” and want Prozac.

21. “Speed” and extended family • Ecstasy- E, X, XTC, vitamin E, Thizz, happy meals, roll pills (“rolling”), skittles, tads, lover’s speed • Methamphetamine- meth, ice, Glass, G, shards, yack, gack, crank, speed, crystal, tweak • Ephedrine- as supplement, yellow jacket online, in OTC Bronkaid • Cocaine- powder, coke, blow, yay-o, yay, crunk (coke when drunk); • Crack- rock, hard • energy drinks, supplements, weight loss; caffeine, guarana, taurine, ephedrine

22. Hallucinogens • LSD- acid, Lucy, stamp • mescaline • Psilocybin- shrooms, silly • Salvia • Jimson Weed

23. Dissociatives • Phencyclidine- PCP, Angel Dust • Ketamine- special K, K hole • Dextromethorphan (opiate like)- DM, DXM, Triple C’s (Coricidin Cough and Cold also in lots OTC), skittles, Robo, Robo tripping • GHB=gammahydroxybutarate=Xylem- grievious bodily harm, G, liquid ectasy

24. Body builders, bulk then“cut” • Steroids, HGH • Ephedrine- Bronkaid (OTC) • Energy drinks, caffeine, guarana, taurine • Protein supplements • Performance enhancing drugs • Diet pills, sibutramine, diuretics

25. Case 5 • Blair denies it’s an issue but has increased “weed” to 24/7, is not making it to class, forgets assignments, and is not concerned. Blair was referred by the Dean after 2 years of > 3.0 GPA dropped to 2 D’s, 1 F, and 2 dropped this classes semester and paraphernalia possession on campus.

26. Marijuana • Weed, grass, pot, mary jane, ganja, green, joint, blunt, cannabis • #2 problem drug in college • Amotivational syndrome, apathy • short term “swiss cheese” memory d/o • Driving impaired • Dependence • Withdrawal • Increased rate of psychosis • 2% of adults over 40 smoke every day

27. Case 6 • 19 year old Brandon’s desperate parents called his advisor and your office saying he is fine one day or for a few days and then is really moody, irritable, and ill. Then fine again. As he undresses for exam the nurse sees some foil fall on the floor. She picks it up and notices a sweet acetone like smell and scorch marks.

28. Opiates • Vicodin (hydrocodone)- Watsons, vics, # • Percodan, Percocet (oxycodone)- percs, • Oxycontin (oxycodone ER)- use oral or crush and snort, $1/mg - oxy, o/c’s, oxygen • Heroin- smoked in foil, $40-60/gm – tar, BT, black tar, H, horse, smack, dope, junk • “Speedball” – opiate with speed/coke/crack/meth killed John Belushi and Chris Farley • Death by respiratory suppression- Anna Nicole Smith, Heath Ledger and several local youth. #1 or 2 behind alcohol OD or combo

29. Opiates #1 New Use

30. Case 7 • This 20 year old tells you he’s on probation and doing community service and “random UA’s – my color is purple” for MIP. He proudly shows his new $125 AZ DL with DOB showing he’s 21. He says his “occasional” use of Triple C’s and Salvia is legal, “no problem”.

31. Drug Screens • You can’t detect what you don’t test for • Time frames matter • No unobserved urine test is worthwhile – lots of scams ! • Medical lab, J-2, OTC, etc • Standard urine test – MJ, opiate, amphetamine, cocaine, benzodiazepine • Hair, eyes, blood, breathalyzer, saliva • Lots drugs and alcohol don’t show • A negative test doesn’t mean no problem !

32. Smoke and “Head” Shops • Sell smoking accoutrements, luxuries, and paraphernalia • Sell salvia, amyl and butyl nitrates • Sell fake urine and various items to block or falsify drug screens

33. Case 8 • Ginger, a 22 year old 5’7 115 lb senior, sorority officer, was dropped off at the ER at 2 am semi comatose after 7 “double shots” vodka in ~ 30 minutes at a party. This followed a couple hours of “beer pong” at a “pre-party”.

34. Alcohol • The # 1 college age substance problem • Binge, games, pre-party, rituals • Accidents of all types, DUI’s, fights, property damage, stupid and obnoxious embarrassing behavior, suicide, sexual assaults – both perpetrators and victims

35. Case 9 • Smokey, 25, a previously devout grad student from abroad comes in for a persistent cough and decreased endurance when exercising. You are concerned that his hookah “shisha” use has expanded to a pack of cigs a day.

36. Tobacco • # 1 killer (and so much morbidity !) by far, just not so soon • ashline.org Arizona Smoker’s Helpline 1-800-556-6222

37. Actual Causes of Preventable Deaths

38. Case 10 • Alex attends classes, earns good grades, works part time, visits family, has friends, exercises, and has goals.

39. Most college age youth have no substance problems

40. Thank you and good luck… Kevin Leehey M.D. leeheymd.com 296-4280