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SUBSTANCE ABUSE DRUGS. Sultana Poonja University of the Sciences in Philadelphia, Philadelphia College of Pharmacy Doctor of Pharmacy Candidate February 2005 PP495 Project in Pharmacy Instructor: Grace Earl, Pharm.D. Use of this Presentation.

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SUBSTANCE ABUSE DRUGS

Sultana Poonja

University of the Sciences in Philadelphia, Philadelphia College of Pharmacy

Doctor of Pharmacy Candidate

February 2005

PP495 Project in Pharmacy

Instructor: Grace Earl, Pharm.D.


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Use of this Presentation

  • This presentation may be used for educational purposes.

  • Please obtain permission by using contact information on the next page


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Acknowledgement

  • Contact Grace Earl, Pharm.D. at [email protected]

  • Instructor: Grace Earl, Pharm.D., Assistant Professor, University of the Sciences in Philadelphia, Philadelphia College of Pharmacy, Box 8, 600 South 43rd Street, Philadelphia, PA 19104


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Reviewed by

  • Laura Mandos, Pharm.D.

  • Associate Professor

  • University of the Sciences in Philadelphia

  • Philadelphia College of Pharmacy and Science


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Purpose of this Presentation

  • This presentation was designed to be used for educational purposes.

  • The information describes general information on drugs and substances that are abused.

  • Each section gives information on pharmacology, explanation of methods used to administer substances, symptoms, statististics.


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DEA DEFINITIONS

  • I highest potential abuse, unpredictable,

    psychological & physical dependence, death, NO

    medical use

  • II high potential abuse, severe psychological/physical

    dependence, medical use accepted with restrictions

  • III medium potential abuse, moderate or low physical,

    high psychological dependence, accepted medical

    use

  • IV low potential abuse, limited physical/psychological

    dependence, accepted medical use

  • V lowest potential abuse, limited physical /

    psychological dependence, accepted medical use


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Featured Illicit Drugs

  • Gamma Hydroxybutyrate (GHB)

  • Flunitrazepam (Rohypnol)

  • Amphetamines (Ecstasy)

  • Cocaine

  • Marijuana

  • Lysergic Acid Diethyl-amide (LSD)

  • Volatile Inhalants

  • Heroin

  • Oxycodone

  • Ketamine

  • Dextromethorphan


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Gamma Hydroxybutyrate (GHB)

Definition

  • Central Nervous System depressant.

  • A sedative-hypnotic, was originally developed as a sleep-aid.

  • A similar drug, “GBL,” turns into GHB in the body, having the same effect.

  • DEA SCHEDULE I

  • No known medical use.


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GBH

Grievous Bodily Harm

“G”

Liquid Ecstasy

Easy Lay

Energy Drink

Liquid E

GHB STREET NAMES


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GHB DOSAGE FORMS

  • A teaspoon or capful →normal dose.

  • Proper dose is unknown. A teaspoon could also be an overdose.


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LOW DOSES

Euphoric effect~ (alcohol)

Relax

Happy

Sociable

HIGH DOSES

Dizziness

Sleepiness

Vomiting

Muscle spasms

Loss of consciousness

GHB POSSIBLE EFFECTS


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GHB OVERDOSE EFFECTS

  • Cause loss of consciousness (temporary coma)

  • Slow breathing.

  • With alcohol, slows breathing to a dangerously low rate, which causes deaths.

  • Overdose occurs because the onset is delayed for up to two hours.


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GHB APPEARANCE

  • Powder and capsule form.

  • A clear liquid form that is colorless and odorless. (most common)

  • Produced as a white crystalline powder.

  • Slightly salty to the taste, and sold in small bottles.


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GHB 2002 STATISTICS1

  • 5 fatal cases reported

  • Ages: 19-36 years of age

  • 2 of the 5 cases were single ingestions.

  • 3 cases were multiple ingestions (GHB with other substance abuse drugs.

  • Acute type ingestions


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FLUNITRAZEPAM (ROHYPNOL)

  • Definition

  • Brand for flunitrazepam, a benzodiazepine drug, family of Valium & Xanax.

  • “Date rape” drug

  • DEA SCHEDULE IV

  • Not approved in the U.S. , used in the rest of the world as a tranquilizer, insomnia treatment & a sedative prior to surgery.

  • No statistical data reported.


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Roofies

Rophies

Lunch Money (referring to the drug's low price on the street)

Pappas or Potatoes (refers to mental capacity of someone under the influence of the drug)

Mind-Erasers

Mexican Valium

ROHYPNOL STREET NAMES


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ROHYPNOL DOSAGE FORMS

  • Orally in pill form, crushed and snorted.

  • Ingested orally, usually with alcohol or other drugs, including heroin.

  • 1 and 2 milligram dose


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ROHYPNOLPOSSIBLE EFFECTS WITHOUT ALCOHOL

  • Disorientation and confusion

  • Drowsiness

  • Dizziness

  • Slurred speech

  • Impaired judgement

  • Lack of coordination (difficulty walking)

  • Amnesia (impairs memory of events)


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ROHYPNOL POSSIBLE EFFECTS WITH ALCOHOL

  • Low blood pressure

  • Difficulty breathing

  • Death

  • Coma


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ROHYPNOL EFFECTS OF OVERDOSE

  • Rapid mood swings

  • Violent outbursts of temper

  • Can be life-threatening when mixed with alcohol

  • Development of physical and psychological dependence


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ROHYPNOL APPEARANCE

  • White & round pill, smaller than a dime.

  • Pills may be ground up or crushed into a powder.

  • Liquid form.

  • Dropped into a drink, it may dissolve & become "invisible."

  • Currently supplied with a 1-milligram dose in an olive green, oblong tablet, imprinted with the number 542.


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AMPHETAMINES (ECSTASY)

DEFINITION

  • A MDMA/3,4-Methylenedioxymethamphetamine. Belongs to “entactogens,” drug family, meaning “touching within.”

  • Other drugs: MDA,MDE and MBDB.

  • DEA SCHEDULE I

  • Appearance : N/A

  • No Medical Use

http://www.usdoj.gov/dea/photo_library.html accessed May 6, 2005


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AMPHETAMINES (ECSTASY)

http://www.usdoj.gov/dea/photo_library.html accessed May 6, 2005


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E

X

XTC

Adam

Clarity

Lover’s Speed

ECSTASY STREET NAMES


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ECSTASY DOSAGE FORMS

  • Tablet or capsule.

  • Usual dose is 100-125 mg

  • Black market "ecstasy" tablets vary widely in strength, and often contain other drugs.


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ECSTASY POSSIBLE EFFECTS

  • MDMA is a "mood elevator"

  • Relax, euphoric state.

  • It does NOT produce hallucinations.

  • Increased chances of dehydration,

    hypertension, & heart or kidney failure

  • Increased body temperature leads to death.


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ECSTASY EFFECTS OF OVERDOSE

  • Linked to neurotoxic damage in laboratory animals.

  • It is still unknown whether such damage occurs in humans or, if it does, whether this has any long-term, negative consequences.


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ECSTASY 2002 STATISTICS 1

  • 9 fatal cases

  • 1 of the 9 cases was by inhalation.

  • The 8 cases were by ingestion with multiple means such as cocaine, LSD, marijuana, ethanol, propranolol, benzodiazepine, etc.

  • Acute type ingestions/inhalations.

  • 3 of the cases were suicides.


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LYSERGIC ACID DIETHYL AMIDE (LSD)

DEFINITION

  • A hallucinogenic or psychedelic drug.

  • Found absorbed into tiny pieces of paper called “blotter”.

  • Found as a pure liquid or absorbed into a sugar cube.

  • LSD costs about $5 for a "hit."

  • DEA SCHEDULE I


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LSD

http://www.usdoj.gov/dea/photo_library.html accessed May 6, 2005


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Acid- (battery, black, blotter, blue, lime, paper, vodka)

Electric Kool-Aid

Mind detergent

Caps (blue, brown, green, pink, purple, yellow)

Sunshine (black, California, Hawaiian, Yellow)

Crystal tea

LSD STREET NAMES


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LSD DOSAGE FORMS

  • The form or derivative found in the seeds of the morning glory family plant.

  • Four to eight of these seeds are equal to 10,000 micrograms of LSD

  • Believed to be the ingredient in the parasitic fungus Claviceps purpurea and in the Convolvulaceae plant family, both of which were used in religious rites


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LSD POSSIBLE EFFECTS

DESCRIBED AS A TRIP WITH 4 PHASES:


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ONSET

Approximately 30 minutes after ingestion, colors appear sharper, moving objects leave "trails" behind them, and flat surfaces may appear to "breathe."


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THE PLATEAU

Over the second hour, the effects become more intense. Imaginary visions can appear from nowhere--from shapes in smoke, to lines on the palms of the hand.


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PEAK

Time is slowed almost to a standstill. Users

may feel like they are in a different world,

or a movie. For some this is profound and

mystical, but it can be very frightening for

others.


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COMEDOWN

Five or 6 hours after taking the drug the

sensations begin to subside, then after 8

hours the trip is usually over. The residual

effects may last until after sleep


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LSD OVERDOSE EFFECTS

  • Longer, more intense “trip” episodes

  • Psychosis

  • Possible death


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LSD APPEARANCE

  • Powder, tablet, capsule

  • Sugar cube

  • Drop of LSD solution evaporated on filter or blotting paper.

  • Incorporated into a square of gelatin ("windowpane")


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LSDMEDICAL USES

  • Once proposed as an analgesic in terminal patients.

  • An aid in psychotherapy

  • An adjunct to the treatment of alcoholism, opioid addiction, sexual abnormalities, autism, and sociopathy.


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LSD 2002 STATISTICS 1

  • Only one fatal case was reported.

  • Age of the person was 16 years old

  • Acute type

  • Usage way was unknown

  • Used in abuse


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MARIJUANA

DEFINITION

  • Cannabis, an ancient hallucinogenic drug derived from hemp plant

  • Can grow wild almost everywhere

  • Consists of dried, chopped, plant parts.

  • THC: active ingredient to cause damage.

  • Other types: Hashish, Bhang, Ganja, & Sinsemilla

  • Dea Schedule I   


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MARIJUANA

http://www.usdoj.gov/dea/photo_library.html accessed May 6, 2005


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Pot

Grass

Weed

Mary Jane

Dope

Reefer

Skunk

Boom

MARIJUANA STREET NAMES


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MARIJUANA DOSAGE FORMS

  • Smoked as a cigarette or joint, or in a pipe or bong.

  • Appeared in "blunts" =>cigars that have been emptied of tobacco and re-filled with marijuana, sometimes in combination with another drug, such as crack


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MARIJUANA POSSIBLE EFFECTS

  • Affects learning & social behavior

  • Affects memory & concentration

  • Drowsiness

  • Some experience insomnia

  • Feeling unmotivated

  • Feeling giddy

  • Uneasiness & anxiety

  • Thirst & hunger

  • Smoke can affect breathing


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MARIJUANA OVERDOSE EFFECTS

  • Impairs memory and may cause delusions, hallucinations and disorientation.

  • There is NO documented case worldwide of a fatal overdose from taking marijuana.


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MARIJUANA APPEARANCE & MEDICAL USES

  • It is a plant that is crushed into powder form to be able to sniff.

  • Legally there are no medical uses in America for marijuana. However, it has been used for patients who have AIDS & cancer because it helps them to control pain & nausea & other symptoms. Further research is needed for this drug to be legalized as a medicinal use.

  • No statistics reported


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COCAINE

DEFINTION

  • A powerful addictive stimulant directly affecting the brain.

  • The pure chemical, cocaine HCL, has been an abused substance for more than 100 years, & coca leaves, the source of cocaine, have been ingested for 1000 years.

  • DEA SCHEDULE II


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COCAINE

http://www.usdoj.gov/dea/photo_library.html accessed May 6, 2005


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Coke

“C”

Snow

Flake

Blow

Speedball (when linked with Heroin)

COCAINE STREET NAMES


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COCAINE DOSAGE FORMS

  • 2 chemical forms of cocaine: the hydrochloride salt & the "freebase.“

  • Hydrochloride salt, or powdered form of cocaine, dissolves in water &, if abused, can be taken intravenously (by vein) or intranasal (in the nose).

  • Freebaserefers to a compound that has not been neutralized by an acid to make the hydrochloride salt. The freebase form of cocaine can be smoked.


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COCAINE POSSIBLE EFFECTS


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COCAINE OVERDOSE EFFECTS & COMMENTARY

  • DEATH IF ANY OF THE EFFECTS CROSS THEIR LIMITS

  • Pure cocaine first extracted from leaf of the Erythroxyloncoca bush, grows in Peru & Bolivia, in the mid-19th century. In the early 1900s, it was the main stimulant drug used in most of the tonics/elixirs developed to treat a variety of illnesses.


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COCAINE APPEARANCE

  • Sold on the street as a fine, white, crystalline powder.

  • Diluted with such inert substances as cornstarch, talcum powder, and/or sugar, or with such active drugs as procaine (a chemically-related local anesthetic) or with such other stimulants as amphetamines.


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COCAINE MEDICAL USES

  • High potential for abuse (CII), can be administered by a doctor for legitimate medical uses, such as a local anesthetic for some eye, ear, and throat surgeries.

  • Local vasoconstriction, ophthalmologic impurity signature profiles analysis (CISPA).


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COCAINE 2002 STATISTICS 1

  • 45 fatal reported cases involving Cocaine.

  • Age ranges: 19 to 51 years old

  • 26 single types reported

  • 19 multiple types reported which included marijuana, opium, heroin, diazepam, amphetamines, salsalate, and codeine.

  • Majority of the 45 cases were acute type of death.

  • Majority of the cases were due to inhalation and ingestion. Some were unknown and 1 case was due to rectal cause.

  • Most of the cases were from misuse and abuse reason. Couple of the reasons were suicide.


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HEROIN

  • Highly addictive drug

  • Opiate

  • Processed from morphine, a naturally occurring substance extracted from the seed pod of certain varieties of poppy plants.

http://www.usdoj.gov/dea/photo_library.html accessed May 6, 2005


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HEROIN STREET NAMES

  • Aunt Hazel

  • Black Tar

  • Big H

  • Bozo

  • Dead President

  • Crown Crap

  • Diesel


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HEROIN DOSAGE FORMS

  • Injected

  • Sniffed/snorted/smoked


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“Rush”

Depressed respiration

Clouded mental functioning

Nausea & vomiting

Suppression of pain

Spontaneous abortion

Addiction

HEROIN POSSIBLE CONSEQUENCES


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Infectious diseases

Viral

HIV/AIDS

Hepatitis B & C

Bacterial Infections

Abscesses

HEROINPOSSIBLE CONSEQUENCES OF IV USE


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HEROIN OVERDOSE EFFECTS

  • Muscle spasticity

  • Pinpoint pupils

  • Bluish colored fingernails and lips

  • Tongue discoloration


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HEROIN APPEARANCE

  • White or brownish powder

  • Black sticky substance known on the streets as "black tar heroin."

  • Purer heroin is becoming more common, most street heroin is "cut" with other drugs or with substances such as sugar, starch, powdered milk, or quinine.

  • Street heroin can also be cut with strychnine or other poisons.


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HEROIN 2002 STATISTICS 1

  • Total of 40 cases were reported.

  • 15 of the cases were by the drug itself.

  • 25 of the cases were with other drugs, such as cocaine, marijuana, ethanol, alprazolam, & acetaminophen.

  • 27 cases were with inhalation or ingestions, 13 cases were unknown.

  • 5 were suicidal cases, 35 were cases of abuse.


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VOLATILE INHALANTS

  • Volatile substances that produce chemical vapors, which can be inhaled to induce a psychoactive, or mind-altering effect.

  • Mind-altering (inhaled into lungs)

    • fumes

    • vapors

    • gases


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VOLATILE INHALANTS STREET NAMES

  • Huff

  • Poor man’s pot

  • Satan’s Secret

  • Texas shoe shine

  • Spray

  • Toilet water

  • Bullet Bolt


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VOLATILE INHALANTS DOSAGE FORMS

  • Volatile solvents

  • Aerosols

  • Gases

  • Nitrites


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VOLATILE INHALANTS POSSIBLE EFFECTS

  • Blurred vision

  • Stupor or coma

  • “Fetal solvent syndrome” if inhalant used during pregnancy


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VOLATILE INHALANTSOVERDOSE EFFECTS

  • “Sudden sniffing death syndrome”

  • Accidental suffocation

  • Red, glassy or watery eyes; nosebleeds

  • Some products are carcinogens

  • Asphyxiation (displacing of available oxygen in lungs.)


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VOLATILE INHALANTSMEDICAL USE

  • Mild anesthetic used in medicine and dentistry

  • Nitrites used to enhance orgasm

  • Nitrites also used to dilate blood vessels and relax muscles.


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VOLATILE INHALANTS 2002 STATISTICS 1

  • In general, many cases were reported with selective inhalants.

  • Carbon monoxide caused 31 deaths.

  • Hydrogen sulfide caused 6 deaths.


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OXYCODONE

  • Narcotic pain medication.

  • Raises your pain threshold and blunts your brain’s perception of pain.

  • Analgesic


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OXYCODONE STREET NAMES & BRAND NAMES

  • M-Oxy

  • Oxycontin (Brand Name)

  • Oxyir

  • Percolone

  • Roxicodone


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OXYCODONE DOSAGE FORMS & MEDICAL USES

  • Tablets: 10, 20, 40, 80, or 160 mg

  • Higher doses ( 80 & 160 mg) only for use in opioid-tolerant patients onlyfor pain relief

  • Relief of moderate to severe pain.


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OXYCODONE POSSIBLE EFFECTS

  • Upset stomach

  • constipation

  • dry mouth,

  • hives

  • skin rash

  • yellowing of the skin or eyes


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OXYCODONEOVERDOSE EFFECTS

  • Skeletal muscle flaccidity, cold and clammy skin, constricted pupils, bradycardia, hypotension, and death.


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OXYCODONE 2002 STATISTICS 1

  • 27 cases were reported.

  • Age range was 14-75 years old.

  • 3 cases were with oxycodone.

  • 24 cases were oxycodone with other drugs such as marijuana, cocaine, heroin, & methadone.

  • 12 cases were suicidal, 8 cases were abuse, 2 cases were misuse, 5 cases were unknown.


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KETAMINE

  • Also known as ketamine hydrochloride.

  • A non-barbiturate

  • Rapid-acting disassociative anesthetic used on both animals and humans; used primarily for veterinary anaesthesiology.

  • It is being abused by an increasing number of young people as a "club drug," and is often distributed at "raves" and parties

  • Schedule III


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KETAMINE STREET NAMES

  • K

  • Special K

  • Vitamin K

  • Kit Kat

  • Blind squid

  • Cat valium


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KETAMINE DOSAGE FORMS

  • A liquid and the most potent ways of using it are by injecting it intramuscularly or intravenously.

  • tablet or a powder by evaporating the liquid and reducing it to a fine white powder that can be smoked or snorted.

  • Recreational doses = 30-300mg

  • Snorted dose = 15-200 mg

  • IM = 25 – 125 mg

  • Oral dose = 75- 300 mg


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KETAMINE POSSIBLE EFFECTS

  • Loss of motor control before injection is completed.

  • lower doses= hallucinogenic effect, clumsy, or 'robotic' movement, decrease in sensations, vertigo.

  • At higher doses= difficulty moving, nausea, dissociated from environment, Near Death Experiences (NDEs), loss of visions, black outs.

  • Psychologically addictive


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MEDICAL USE OF KETAMINE

  • Used in human medicine for pediatric burn cases and dentistry

  • Used in experimental psychotherapy.


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DEXTROMETHORPHAN

  • An antitussive

  • Used to relieve a nonproductive cough caused by a cold, the flu, or other conditions.


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DEXTROMETHORPHAN STREET NAMES

  • DXM

  • DM

  • CCC

  • Triple C

  • Candy

  • Robo

  • Velvet

  • Rojo


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DEXTROMETHORPHAN DOSAGE FORMS

  • Adult

    • Oral dose of either 10 to 20 mg every four hours or 30 mg every 6 to 8 hours not to exceed 120 mg daily.

  • Children

    • Oral dose of either 5 to 10 mg every 4 hours or 15 mg every six to eight hours, not to exceed 60 mg daily.


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DEXTROMETHORPHAN OVERDOSE EFFECTS

  • Slurred speech

  • Restlessness

  • A feeling of poor coordination

  • Difficulty breathing

  • Seizures


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DEXTROMETHORPHAN APPEARANCE

  • Liquid

  • Lozenges

  • Powder

  • Syrup

  • Tablets


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Summary

  • Respiratory failure: GHB, Rohypnol, Marijuana, Cocaine, Heroin & Volatile Inhalants

  • Hallucinations: Rohypnol, LSD & Marijuana

  • Suicide: Ecstasy, Cocaine, Heroin & Oxycodone


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REFERENCES

  • 1. 2001 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2002; 20(5): 391-452.

  • 2. Ellenhorn, Matthews. J. New York. Ellenhorn’s Medical Toxicology Diagnosis & Treatment of Human Poisoning. 2nd edition. 1998.

  • 3. National Institute on Drug Abuse Home Page [Resource on World Wide Web]. URL: http://www.drugabuse.gov

  • 4. United States Department of Justice Home Page [Resource on World Wide Web]. URL: http://www.usdoj.gov

  • 5. Micromedex


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Substance-Abuse Headlines


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ISSUES RELATED TO DRUG ABUSE

  • Affects on pregnancy

  • Young teenagers being punished with penalty

  • Money becomes a factor

  • General places for drug exchange lead to problems

  • Some drugs…good or bad for medical use


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DRUG & LAUNDRY BUST WITH NEW TECHNIQUES

  • Drugs and cash found hidden in clothes dryer.

  • Trail lead to a van which had a secret code with more cocaine.

  • Decoding resulted in electronic sequence where a car had to be running, all doors locked, defroster on & rear vents in certain positions simultaneously.

    Philadelphia Inquirer, The (PA): Raid nets 5 arrests, 24 kilos.Http://doc.newsbank.com

    December 11 2003. By: Thomas J Gibbons Jr.


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PIZZA WITH A SIDE ORDER OF DRUGS WITH HANDCUFFS

  • Pizza shop as a front to sell cocaine.

  • Called the ringmasters of a distribution network that sold, packaged, or stored cocaine at the pizza shop.

  • Detected through tapped cell phones & walkie talkies.

    Philadelphia Inquirer, The (PA): Police: Trooper pizza shop was front for a drug ring

    http://docs.newsbank.com February 5, 2004. By: Keith Herbert


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MONEY IS GOOD BUT NOT THE JAIL TIME

  • 11 year-old arrested for dealing crack and heroin.

  • 14 & 15 year-old arrested in dragnet and charged for distributing crack and heroin.

  • Money made from dealing versus money used if possible for bail.

  • Philadelphia Inquirer, The (PA):3 boys among 19 arrested in drug sting. http://docs.newsbank.com March 13, 2004. By: Sam Wood


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DRUGS AND PREGNANCY

  • Women taking cocaine while pregnant lead to a dead baby and accused for murdering child.

  • Women tested positive for cocaine when delivered dead baby.

  • Lead to conviction and case still in court. Philadelphia Inquirer, The (PA): High court declines to hear appeal of murder

    conviction in stillbirth. http://docs.newsbank.com October 7, 2003 By: Anne Gearan.


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MEDICAL USE FOR MARIJUANA?

  • Marijuana used for pain for sick and dying patients

  • Some states agree, Federal law recognizes no medical purpose for it.

  • Questioning for specific cases such as cancer & AIDS patients.

  • Court investigating physicians who agree to the treatment.

  • Philadelphia Inquirer, The (PA): Medical marijuana fight draws civil rights analagy. http://docs.newsbank.com August 11, 2003 By: Anne Gearan


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DEBATE FOR & AGAINST PEYOTE

  • Historical background of peyote resulting in pain relief and positive attitude amongst families.

  • Considered a hallucinogenic & leading to spiritual experiences.

  • May lead to brain damage vs. healing agent.

  • Found toxins that cane lead to a risky undertaking.

    Philadelphia Inquirer, The (PA): Envisioning uses for hallucinogens.

    http://docs.newsbank.com November 17, 2003. By: Faye Flam


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PEOPLE OF ALL AGES AND ALL CONDITIONS

ABUSE IN USE

ABUSE IN QUESTION

EVERY PART OF THE WORLD

SUICIDAL

POLICE

LAW

JUDGES

COURT

HEALTH CARE

ISSUES WITH DRUG ABUSE


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