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Rx Drug Abuse, A Nation’s Epidemic A presentation on the link between prescription drugs and heroin, how these drugs are getting here, the science behind.

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Presentation on theme: "Rx Drug Abuse, A Nation’s Epidemic A presentation on the link between prescription drugs and heroin, how these drugs are getting here, the science behind."— Presentation transcript:

1 Rx Drug Abuse, A Nation’s Epidemic A presentation on the link between prescription drugs and heroin, how these drugs are getting here, the science behind it, and what we do now! MSgt Candace L. Stefanik New York National Guard Counterdrug Task Force Monday, December 9 th, 1:00-4:00 p.m. Saratoga Springs Public Library, H. Dutcher Community Room

2 Overview The Epidemic, an overview Where are they coming from? Commonly abused drugs What's the dangers, risk, signs and symptoms and brain chemistry of opioid abuse Statistics Strategies

3 A Nations Epidemic Prescription narcotics, often called narcotic analgesics, are the most used and abused substances today. Misuse and abuse of prescription opioids has reached epidemic proportions in the U.S. according to the surgeon general While much of the problem is attributable to illicit drug use, appropriate use of medications for pain may also lead to unnecessary adverse events, addiction, and death. The "war on drugs" has focused nearly exclusively on dealers trafficking drugs like cocaine, heroin, and marijuana, while most of the “new drug dealers” live right next door to you. These new dealers are your Doctors, lawyers, students, teachers, etc. Unwittingly and unprepared we became a nation obsessively trying to feel good, succeed and control behavior in our youth. By the time we questioned whether these legal drugs would have a lasting effect on our nation the death toll was rising along with the addition rates.

4 Pharmageddon Pharmageddon' Is Upon Us Pharmageddon is "the prospect of a world in which medicines and medicine produce more ill-health than health, and when medical progress does more harm than good" -- and it is no longer a prospect but fully upon us. Those most at risk from dying from this new drug crisis are people you would least expect; the analysis revealed the death toll is highest among people in their 40s, but all ages, from teenagers to the elderly, and all walks of life are being affected. In fact, prescription drugs are now the preferred "high" for many, especially teens, as they are typically used legally, which eliminates the stigma of being a "junkie.“- The Baltimore Sun

5 Where are they coming from? Pharm Parties Friends/Family Theft Dr. Shopping Drug Dealers Internet Legal Prescription

6 Where is it coming from? And according to the 2012 Monitoring the Future survey, about 50 percent of high school seniors said that opioid drugs other than heroin (e.g., Vicodin) would be fairly or very easy to get.

7 Drug Companies WHEN THINKING OF STRATAGIES DON’T FORGET WHERE THEY COME FROM! Here is just a sampling of what the top drug companies are up to: Merck: More than $5.5 billion in judgments and fines levied against it, it was five years before Merck made its $30-billion recall of the painkiller Vioxxx. Baxter: Dozens of recalls of products that caused deaths and injuries, at least 11 different guilty pleas to fraud and illegal sales activity, more than 200 lawsuits – and more than $1.3 billion in criminal fines and civil penalties. Pfizer: In the largest health care fraud settlement in history, Pfizer was ordered to pay $2.3 billion to resolve criminal and civil allegations that the company illegally promoted uses of four of its drugs, including the painkiller Bextra, the antipsychotic Geodon, the antibiotic Zyvox, and the anti-epileptic Lyrica

8 Internet - Silk Road The site was operated on an anonymous network known as Tor, making activity on Silk Road virtually untraceable. The only money accepted on Silk Road was the digital currency bitcoin, adding an additional layer of anonymity to buyers and sellers. The use of bitcoin helped Silk Road become a giant money laundering operation, according to the FBI. To process bitcoin transactions, Silk Road used what the FBI described as a "tumbler," a complex system that used countless dummy transactions to digitally conceal where the money came from. Over the past two and a half years, the FBI said the site generated revenue worth more than 9.5 million bitcoins -- valued at $1.3 billion. The FBI said Ulbricht's net worth was essentially his value in Silk Road's commissions, which totaled more than 600,000 bitcoins ($85 million). Silk Road wasn't restricted to illegal drugs. The FBI says it was also used to trade firearms, hire assassins and employ hacker s.

9 9 UNCLASSIFIED//FO OFFICIAL USE ONLY NATIONAL / INTERNATIONAL THREATS IMPACTING NEW YORK STATE Mexican-based Transnational Criminal Organizations (TCO) and their associates dominate the supply and wholesale distribution of most illicit drugs in the United States. These organizations control much of the production, transportation, and wholesale distribution of illicit drugs destined for and in the United States. Currently, seven Mexican based TCOs (Sinaloa Cartel, Los Zetas, Gulf Cartel, Juárez Cartel, BLO, LFM, and Tijuana Cartel) are in a dynamic struggle for control of the lucrative smuggling corridors leading into the United States, resulting in unprecedented levels of violence in Mexico. Numerous other types of organizations and groups are present, active, and thriving. For example, Colombian based TCOs operate primarily in the Northeast and in southern Florida, while ethnic Asian, Dominican, and Cuban organizations are expanding operations. In addition, various street gangs, prison gangs, and outlaw motorcycle gangs (OMGs) make up the bedrock of retail drug distribution throughout the country.

10 10 UNCLASSIFIED//FOR OFFICIAL USE ONLY Latin American political leaders have long argued that if the U.S. population did not consume such large quantities of illegal drugs and there were not so many American drug addicts and users, then Latin American and Caribbean countries would not produce such large quantities of illegal drugs like marijuana, cocaine, and heroin for export. As a result the region would not be plagued by the powerful and well-financed drug trafficking organizations that have sprung up throughout the hemisphere over the last twenty five years plus. The United States has been for decades, and remains today, the largest single consumer market for illicit drugs on the planet. Although there is no definitive estimate, the value of all illicit drugs sold annually in the United States may reach as high as $150 billion. Some $37 billion per year may be spent on cocaine alone.

11 11 UNCLASSIFIED//FOR OFFICIAL USE ONLY NATIONAL / INTERNATIONAL THREATS IMPACTING NEW YORK STATE The Mexican-based organizations’ preeminence derives from a competitive advantage based on several factors, including access to and control of smuggling routes across the U.S. Southwest Border and the capacity to produce (or obtain), transport, and distribute nearly every major illicit drug of abuse in the United States. These advantages are unlikely to change significantly in the short term, ensuring the dominance of Mexican-based TCOs for at least the next several years. Mexican-based TCOs were operating in more than a thousand U.S. cities during 2009 and 2010, spanning all nine Organized Crime Drug Enforcement Task Force OCDETF regions. (New York and New Jersey have their own region)

12 12 UNCLASSIFIED//FOR OFFICIAL USE ONLY NATIONAL / INTERNATIONAL THREATS IMPACTING NEW YORK STATE Ethnic Dominican trafficking organizations are significant cocaine and heroin distributors in the New York/New Jersey and New England Regions. They are expanding their networks of suppliers and drug distribution operations. Dominican TCOs obtain cocaine and South American heroin from Colombian TCOs and smuggle the drugs into the United States for distribution, primarily in Northeastern markets. They also distribute cocaine, heroin, and marijuana in the Southeast Region. The involvement of ethnic Dominican organizations in domestic drug trafficking will increase in the near term as they continue to develop and expand trafficking connections. Dominican trafficking organizations are unique in that they operate independently of one another. There exists no national or regional leadership and no centralized direction of their activities. Consequently, the expansion of these organizations will be contingent on the exploitation of local opportunities.

13 13 UNCLASSIFIED//FOR OFFICIAL USE ONLY Drug availability in the united states Heroin: The availability of heroin in the United States and the number of markets in which it is available is increasing as a result of increased production in Mexico, even as Colombian production declines. The level of illicit poppy cultivation in Mexico was second only to that in Afghanistan in 2009, potentially producing an estimated 50 metric tons of heroin. The overwhelming bulk of the heroin produced in Mexico is destined for the United States. The increase in Mexican heroin production coupled with increased transportation of South American heroin by Mexican TCOs correlates with an increase in heroin seizures along the Southwest Border, the primary pipeline for U.S. heroin supplies. In addition, these factors have likely contributed to increased heroin availability in some U.S. markets, including Illinois, Missouri, New York, North Carolina, Pennsylvania, and South Carolina. Some cocaine distributors are switching to heroin sales because of the continuing cocaine shortage and the higher availability of heroin. This trend has increased the accessibility of heroin to existing users and created new users in some markets, particularly in the Northeast and Mid-Atlantic regions. As a result, some drug abusers have experimented with heroin when their primary drug of choice crack or powder cocaine was not available, and some cocaine users seem willing to switch to heroin despite significant differences between the two drugs.

14 14 UNCLASSIFIED//FOR OFFICIAL USE ONLY HEROIN TRANSPORTATION ROUTES

15 15 UNCLASSIFIED//FOR OFFICIAL USE ONLY MDMA TRANSPORTATION ROUTES MDMA is generally transported from POEs in Washington, Michigan, New York, and Vermont to markets throughout the United States.

16 Molly-MDMA Someone who buys or takes Molly now is probably ingesting dangerous synthetic drugs that have not been tested and are produced in widely varying strengths. The DEA says only 13% of the Molly seized in New York state the last four years actually contained any MDMA, and even then it often was mixed with other drugs. The drugs frequently found in Molly are Methylone, MDPV, 4-MEC, 4-MMC, Pentedrone and MePP. What does Molly do? The lab-created chemicals mimic the effects of MDMA; most of them are central nervous system stimulants that cause euphoric highs. They can also cause a rapid heartbeat, high blood pressure, blood vessel constriction and sweating, and can prevent the body from regulating temperature. Some of the chemicals have been reported to cause intense, prolonged panic attacks, psychosis and seizures. After they wear off, the chemicals can cause devastating depression. Several of these compounds have caused deaths. (Drew Griffin. Nelli Black and Patricia DiCarlo, CNN Investigations)

17 CLANDESTINE LABORATORY RESPONSES / INCIDENTS (Incidents include: dumpsites & other meth related incidents indirectly related to production) 2013 (as of November 7, 2013) TOTAL LABS / INCIDENTS: 119 MET H ANHYDROUS AMMONIA THEFT

18 Commonly Abused Drugs

19 Benzodiazepines: Valium, Xanax Valium and Xanax are examples of benzodiazepines, another type of depressant. They may be prescribed to treat anxiety, acute stress reactions, panic attacks, convulsions, and sleep disorders (typically for short- term use). Like other depressants, they have reasonable uses but may be abused. Withdrawal from benzodiazepines "can be problematic" but is rarely life- threatening, notes the National Institute on Drug Abuse (NIDA).

20 Sleep Medicines Sleep medicines are depressants. The sleep drugs Ambien, Sonata, and Lunesta are newer sleep medicines called nonbenzodiaze pines. These drugs may have less potential for addiction than other depressants.

21 Barbiturates Prescribed to ease anxiety or promote sleep, depressants slow the brain's function. Barbiturates are a type of depressant. Phenobarbital is a barbiturate; others are Mebaral, Seconal, and Nembutal. Though helpful when used as prescribed, barbiturates can be addictive. If taken with certain drugs, including alcohol, the heart and breathing can slow, which can lead to death. Slang for barbituates includes "barbs," "reds," red birds," "phennies," "tooies," "yellows," and "yellow jackets."

22 Codeine and Morphine Pain relievers are another group of prescription drugs that are commonly abused. They include codeine and morphine. Brands of morphine include Avinza, Kadian, MS Contin, Oramorph, and Roxanol. Morphine is typically prescribed for severe pain; codeine, for milder pain. Street names for codeine include "Captain Cody" and "Cody." Slang for morphine includes "M" and "Miss Emma

23 Vicodin, Lortab, Lorcet Vicodin, Lortab, and Lorcet contain the opioid hydrocodone plus acetaminophen. Opioids can cause drowsiness, constipation, and may depress breathing, depending upon how much you take. Vicodin's street names include "vike" and "Watson-387." Vicodin, or any other prescription drug, shouldn't be shared; it's only for the patient with the prescription.

24 Amphetamines Stimulants increase alertness, attention, and energy. They're prescribed for narcolepsy, attention deficit hyperactivity disorder (ADHD), and depression that doesn't respond to other treatments. The ADHD drugs Dexedrine and Adderall, are stimulants called amphetamines, which may be abused by people looking for a sense of euphoria. Risks include fast or irregular heartbeat, reduced appetite, heart failure, nervousness, insomnia, and addiction. Nicknames for amphetamines include "bennies," "black beauties," and "speed.“

25 OxyContin, Percocet OxyContin, Percocet, Percodan, and Roxicodone share an active ingredient, oxycodone, which is an opioid pain reliever. These drugs aren't identical; Percocet also contains acetaminophen, while Percodan also contains aspirin. These drugs should only be taken under medical supervision. Street names include "oxy," "O.C.," and "oxycotton" for OxyContin and "percs" for Percocet or Percodan.

26 Dextromethorphan (DXM) Dextromethorphan (DXM) is the active ingredient in many nonprescription cough and cold medicines. Those products are safe when taken as recommended, but very large doses can lead to euphoria and impaired judgment -- as well as nausea and vomiting, loss of coordination, and increased heart rate. DXM's street names include "Orange Crush," "Triple Cs," "Dex," "Robo," and "Skittles."

27 Methylphenidate Methylphenidate is a stimulant found in the ADHD drugs Ritalin, Concerta, Metadate, and Methylin. Its nicknames include "MPH," R-ball," "Skippy," "the smart drug," and "vitamin R." Taking high doses of a stimulant can lead to a dangerously high body temperature, an irregular heartbeat, and the potential for cardiovascular failure or lethal seizures

28 Identifying a Suspicious Pill Found a random pill and want to know what it is? WebMD's Pill Identification Tool may help. But because there are hundreds of drugs and thousands of pills and tablets of all shapes, colors, and sizes, try taking the pill to a pharmacist to get help identifying it.

29 Pseudoephedrine Pseudoephedrine is commonly found in nonprescription cold medicines. It's used as an ingredient for making the illegal drug methamphetami ne ("meth"). That's why there are laws limiting the amount of pseudoephedrine -containing drug products that can be bought at a time.

30 WebMD Identifying tool Identifying a Suspicious Pill Found a random pill and want to know what it is? WebMD's Pill Identification Tool may help. But because there are hundreds of drugs and thousands of pills and tablets of all shapes, colors, and sizes, try taking the pill to a pharmacist to get help identifying it.

31 Heroin

32 Heroin’s History First synthesized from morphine in 1874, heroin was not extensively used in medicine until the beginning of this century. Commercial production of the new pain remedy was first started in While it received widespread acceptance from the medical profession, physicians remained unaware of its potential for addiction for years. The first comprehensive control of heroin in the United States was established with the Harrison Narcotic Act of The biggest global threat from the Taliban is, by far, the drugs created from Afghan opium poppies, which the United Nations Office on Drugs and Crime said is responsible for 100,000 deaths each year worldwide. The $65-billion global market for heroin, opium and morphine also helps fund terrorist and insurgent operations, including up to $600 million annually for the Taliban. Law-enforcement seizes only about 20 percent of illicit opiate traffic, according to the report. Opium Wars broke out in the late 1850s. These wars gave the English language the expression "gunboat diplomacy" and secured Hong Kong as a British colony until Indeed, the import and export of opium was crucial to the British economy until its prohibition in the early 20th century.

33 Opium-Heroin Opium grows in Southeast Asia, Southwest Asia, and Western Hemisphere (Mexico, Guatemala, and Colombia) Opium is converted into heroin in laboratories. Opium grown in Afghanistan and South West Asia is generally consumed in Asian and European markets. North and South America gets theirs from Columbia and Mexico. Afghanistan had become the world leader in supply of opium, producing about 92% of total worlds supply.

34 Opium Opium consist of morphine, codeine, thebaine and other substances. This is used to make heroin. Just before reaching maturity the poppy plant produces a flower. In a week these petals fall off leaving a capsule. The surface of the capsule is “scored” with a knife with 3-4 blades. Opium gum oozes from the cuts. The next day it is “scrapped”. The plant can be scored 3-5 times before being cut to dry and its seeds are extracted for next years harvest. The farmers allows to dry for several days then wraps the gum in banana leaves or plastic.

35 Heroin Heroin, an illegal opiate drug known on the street as smack, junk, brown sugar, dope, horse, skunk and other names is derived from the resin of the poppy plant which grows predominantly in southeast and southwest Asia, Mexico and now in Colombia. It is manufactured in remote laboratories using rudimentary equipment which presses the powder into bricks for bulk shipment to destination countries like the United States. Smaller amounts are smuggled by couriers who swallow heroin-filled latex balloons before boarding commercial airlines.

36 Heroin Pure heroin is a white powder with a bitter taste. Most illicit heroin is a powder form which may vary in color from white to dark brown because of impurities left from the manufacturing process or the presence of additives. Pure heroin is rarely sold on the street. A "bag" --slang for a single dosage unit of heroin--may contain 100 mg of powder, only a small portion of which is heroin. The remainder could be sugars, starch, powdered milk, or quinine. Traditionally the purity of heroin in a "bag" has ranged from one to ten percent. More recently, heroin purity has ranged from one to ninety-eight percent, with a national average of thirty-five percent.

37 Heroin Another form of heroin, "black tar," has also become increasingly available in the western United States. The color and consistency of black tar heroin results from the crude processing methods used to illicitly manufacture the substance in Mexico. Black tar heroin may be sticky, like roofing tar or hard like coal, and its color may vary from dark brown to black. It is often sold on the street in its tar-like state at purities ranging from twenty to eighty percent. This heroin is most frequently dissolved, diluted and injected.

38 Heroin The typical heroin user today consumes more heroin than a typical user did just a decade ago, which is not surprising given the higher purity currently available at the street level. Until recently, heroin in the United States almost exclusively was injected either intravenously (rapid onset 7-8 seconds), subcutaneous (skin- popping), or intramuscularly(slower onset 5-8 minutes). Injection is the most practical and efficient way to administer low-purity heroin. The availability of higher purity heroin has meant that users now can snort or smoke the narcotic ( onset min.). Evidence suggests that heroin snorting is widespread or increasing in those areas of the country where high-purity heroin is available, generally in the northeastern United States. This method of administration may be more appealing to new users because it eliminates both the fear of acquiring syringe-borne diseases such as HIV/AIDS and hepatitis, and the historical stigma attached to intravenous heroin use.

39 Heroin Two types of heroin being sold in the US Midwest: a grey soft powder of medium-low potency, and a tan rocked powder of medium-strong to strong potency. Both were analyzed and both were found to be cut with quinine. The greyer powder was also cut with lactose. Photo by Hammilton. © 2013 Erowid.org Heroin

40 What's the dangers, risk, signs and symptoms? Opioids are narcotic, painkilling drugs produced naturally from opium or made synthetically. This class of drugs includes heroin, morphine, codeine, methadone and oxycodone (OxyContin). Signs of narcotic use and dependence can include: Reduced sense of pain Sedation Depression Confusion Constipation Slowed breathing Needle marks (if injecting drugs)

41 Effects of Heroin PRESCRIPTION OPIOIDS Fractures from falls in patients aged 60 years and older Fatal overdose from respiratory depression. Opioids suppress respiratory drive and decrease respiratory rate. Respiratory depression is more common with use of alcohol, benzodiazepines, antihistamines, and barbiturates. Tolerance, physical dependence, withdrawal, and opioid dependence (addiction) Drowsiness Increased pain sensitivity (hyperalgesia) Sexual dysfunction and other endocrine effects Constipation Nausea/vomiting Chronic dry mouth Dry skin/itching/pruritus

42 Barbiturates and benzodiazepines Barbiturates and benzodiazepines are prescription central nervous system depressants. Phenobarbital, amobarbital (Amytal) and secobarbital (Seconal) are examples of barbiturates. Benzodiazepines include tranquilizers, such as diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin) and chlordiazepoxide (Librium) Signs of use and dependence can include: Drowsiness Slurred speech Lack of coordination Memory problems Confusion Slowed breathing and decreased blood pressure Dizziness Depression

43 Club Drugs Club drugs are drugs commonly used by teens and young adults at clubs, concerts and parties. Examples include Ecstasy (MDMA), GHB, Rohypnol ("roofies") and ketamine. These drugs are not all classified in the same category, but they share some similar effects and dangers. Signs of club drug use and dependence can include: An exaggerated feeling of great happiness or well-being (euphoria) Reduced inhibitions A heightened or altered sense of sight, sound and taste Amphetamine-like effects (with ketamine and Ecstasy) Decreased coordination Poor judgment Memory problems or loss of memory Increased or decreased heart rate and blood pressure Drowsiness and loss of consciousness (with GHB and Rohypnol) GHB and Rohypnol are particularly dangerous. At high doses, they can cause seizures, coma and death. The danger increases when these drugs are taken with alcohol. Because they worsen consciousness and memory and they're easy to give someone without his or her knowledge or consent, these drugs are both commonly used as date-rape drugs.

44 Methamphetamine, cocaine and other stimulants This class of drugs includes amphetamines, methamphetamine, cocaine and methylphenidate (Ritalin). Signs of use and dependence can include: Euphoria Decreased appetite Rapid speech Irritability Restlessness Depression as the drug wears off Nasal congestion and damage to the mucous membrane of the nose in users who snort drugs Insomnia Weight loss Increased heart rate, blood pressure and temperature Paranoia Methamphetamine, also known as "meth," is a particularly dangerous drug. It's highly addictive and causes a number of short-term and long-term health consequences. Methamphetamine is relatively inexpensive and widely available.

45 Hallucinogens Use of hallucinogens produces different signs and symptoms depending on the drug. The most common hallucinogens are LSD and phencyclidine (PCP). Signs of LSD use include: Hallucinations Greatly reduced perception of reality, for example, interpreting input from one of your senses as another, such as hearing colors Permanent mental changes in perception Rapid heart rate High blood pressure Tremors Flashbacks, a re-experience of the hallucinations — even years later Signs of PCP use include: Hallucinations Euphoria Delusions Panic Loss of appetite Depression Aggressive, possibly violent behavior

46 Brain Chemistry Dr. Nora D. Volkow, the neuroscientist in charge of the National Institute on Drug Abuse stated that “ it all boils down to pretty much the same thing, addiction is all about the dopamine. The pleasure, pain and devilish problem of control are simply the detritus left by waves of this little molecule surging and retreating deep in the brain.”

47 Risk Factors People of any age, sex or economic status can become addicted to a drug. However, certain factors can affect the likelihood of your developing an addiction: Family history of addiction. Drug addiction is more common in some families and likely involves the effects of many genes. If you have a blood relative, such as a parent or sibling, with alcohol or drug problems, you're at greater risk of developing a drug addiction. Being male. Men are twice as likely to have problems with drugs. Having another psychological problem. If you have a psychological problem, such as depression, attention- deficit/hyperactivity disorder or post-traumatic stress disorder, you're more likely to become dependent on drugs. Peer pressure. Particularly for young people, peer pressure is a strong factor in starting to use and abuse drugs. Lack of family involvement. A lack of attachment with your parents may increase the risk of addiction, as can a lack of parental supervision. Anxiety, depression and loneliness. Using drugs can become a way of coping with these painful psychological feelings. Taking a highly addictive drug. Some drugs, such as heroin and cocaine, cause addiction faster than do others. Age of first onset Generation “Y” brain priming

48 Master Control The human brain is made up about 100,000,000,000 information processing cells, called neurons. The neurons are connected by 'wires' that carry electrical signals, rather like the wires in a computer do. The total length of these 'wires' in a human brain is about 100,000 miles! That's half the distance between the earth and the moon.

49 Brain Chemistry There are approximately 50 neurotransmitters identified. There are billions of nerve cells located in the brain, which do not directly touch each other. Nerve cells communicate messages by secreting neurotransmitters. Neurotransmitters can excite or inhibit neurons (nerve cells). Some common neurotransmitters are acetylcholine, norepinephrine, dopamine, serotonin and gamma aminobutyric acid (GABA). Acetylcholine and norepinephrine are excitatory neurotransmitters while dopamine, serotonin, and GABA are inhibitory. Each neurotransmitter can directly or indirectly influence neurons in a specific portion of the brain, thereby affecting behavior.

50 Brain Chemistry cont. in a structure called the postsynaptic membrane of another nearby neuron. Once the neurotransmitter is picked up by receptors in the postsynaptic membrane, the molecule is internalized in the neuron and the impulse continues. This process of nerve cell communication is extremely rapid. Once the neurotransmitter is released from the neurotransmitter vesicles of the presynaptic membrane, the normal movement of molecules should be directed to receptor sites located on the postsynaptic membrane. However, in certain disease states, the flow of the neurotransmitter is defective. For example, in depression, the flow of the inhibitory neurotransmitter serotonin is defective, and molecules flow back to their originating site (the presynaptic membrane) instead of to receptors on the postsynaptic membrane that will transmit the impulse to a nearby neuron. The mechanism of action and localization of neurotransmitters in the brain has provided valuable information concerning the cause of many mental disorders, including clinical depression and chemical dependency, and in researching medications that allow normal flow and movement of neurotransmitter molecules.

51 Brain Chemistry Drug addictions Cocaine and crack cocaine are psychostimulants that affect neurons containing dopamine in the areas of the brain known as the limbic and frontal cortex. When cocaine is used, it generates a feeling of confidence and power. However, when large amounts are taken, people "crash" and suffer from physical and emotional exhaustion as well as depression. Opiates, such as heroin and morphine, appear to mimic naturally occurring peptide substances in the brain that act as neurotransmitters with opiate activity called endorphins. Natural endorphins of the brain act to kill pain, cause sensations of pleasure, and cause sleepiness. Endorphins released with extensive aerobic exercise, for example, are responsible for the "rush" that long-distance runners experience. It is believed that morphine and heroin combine with the endorphin receptors in the brain, resulting in reduced natural endorphin production. As a result, the drugs are needed to replace the naturally produced endorphins and addiction occurs. Attempts to counteract the effects of the drugs involve using medications that mimic them, such as nalorphine, naloxone, and naltraxone.

52 Brain Chemistry Neurons can become sensitized or desensitized to dopamine One important aspect of drug addiction is how cells adapt to previous drug exposure. For example, long-term treatment with dopamine antagonists increases the number of dopamine receptors. This happens as the nervous system tries to make up for less stimulation of the receptors by dopamine itself. Likewise, the receptors themselves become more sensitive to dopamine. Both are examples of the same process, called sensitization.

53 Brain Chemistry An opposite effect occurs after dopamine or dopamine agonists repeatedly stimulate dopamine receptors. Here overstimulation decreases the number of receptors, and the remaining receptors become less sensitive to dopamine. This process is called desensitization.

54 Brain Imaging There tends to be several similarities seen among classes of drugs when it comes to brain imaging. The most common similarity among drug and alcohol abusers is that the brain has an overall toxic look to it. In general, the SPECT (Brain Images) studies look less active, more shriveled, and overall less healthy. A “scalloping effect” is common amongst drug abusing brains. Normal brain patterns show smooth activity across the cortical surface. Scalloping is a wavy, rough sea-like look on the brain’s surface. This pattern is also seen in patients who have been exposed to toxic fumes or oxygen deprivation.

55 Brain Imaging SPECT Normal brain view 39 y/o top down surface view, full symmetrical activity 39 y/o yr. hx of frequent heroin use, top down surface view marked overall decreased activity

56 Brain Imaging SPECT 39 y/o yrs. of frequent heroin use 40 y/o, 7 yrs. on methadone heroin 10 yrs. prior

57 Statistics NIDA, SAMHSA, PATS, DAWN Drug Free. org Statistics Nearly One-Third of Parents Believe Stimulants Can Improve Academic Performance, Even for Teens Who Do Not Have Attention Deficit Hyperactivity Disorder ~

58 Overview

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61 R X A BUSE P REVENTION T OOLKIT - from awareness to action Rx Access Points— Friends & Family Source of Concern SAMHSA. (2008). Results from the 2007 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series: H-34, DHHS Publication No. SMA ). Rockville, MD. Available at:

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63 Concerning Trends in Teen Prescription Drug Abuse According to the New PATS Data (Partnership Attitude Tracking Study ( ) The new PATS data confirm that misuse and abuse of prescription drugs is now a normalized behavior among teens: One in four teens (24 percent) reports having misused or abused a prescription drug at least once in their lifetime (up from 18 percent in 2008 to 24 percent in 2012), which translates to about 5 million teens. That is a 33 percent increase over a five-year period. Almost one in four teens (23 percent) say their parents don’t care as much if they are caught using Rx drugs without a doctor’s prescription, compared to getting caught with illegal drugs. Of those kids who said they abused Rx medications, one in five (20 percent) has done so before age 14. More than a quarter of teens (27 percent) mistakenly believe that misusing and abusing prescription drugs is safer than using street drugs. One-third of teens (33 percent) say they believe “it’s okay to use prescription drugs that were not prescribed to them to deal with an injury, illness or physical pain.”

64 Rx stimulants are a key area of concern, with misuse and abuse of Ritalin and Adderall in particular driving the noted increases in teen medicine abuse. Stimulants are a class of drugs that enhance brain activity and are commonly prescribed to treat health conditions including ADHD and obesity. The 2012 data found: One in eight teens (about 2.7 million) now reports having misused or abused the Rx stimulants Ritalin or Adderall at least once in their lifetime. 9 percent of teens (about 1.9 million) report having misused or abused the Rx stimulants Ritalin or Adderall in the past year (up from 6 percent in 2008) and 6 percent of teens (1.3 million) report abuse of Ritalin or Adderall in the past month (up from 4 percent in 2008). One in four teens (26 percent) believes that prescription drugs can be used as a study aid. Statistics

65 Abuse of prescription pain medicine remains at unacceptably high levels among teens, but the new PATS data show it may be flattening. Teen abuse of prescription pain relievers like Vicodin and OxyContin has remained stable since 2011, with one in six teens (16 percent) reporting abuse or misuse of an Rx pain reliever at least once in their lifetime and one in 10 teens (10 percent) admitting to abusing or misusing an Rx painkiller in the past year. Statistics

66 Almost one-third of parents (29 percent) say they believe ADHD medication can improve a child’s academic or testing performance, even if the teen does not have ADHD. One in six parents (16 percent) believes that using prescription drugs to get high is safer than using street drugs. Teens reported that during the last conversation they had with their parents regarding substance abuse, only 16 percent said they discussed the misuse or abuse of prescription pain relievers with their parents, and just 14 percent indicate the same for discussions about any type of prescription drug. In comparison, a majority of teens (81 percent) say they have discussed the risks of marijuana use with their parents, 80 percent have discussed alcohol and nearly one-third of teens (30 percent) have discussed crack/cocaine. More than half of teens (56 percent) indicate that it’s easy to get prescription drugs from their parent’s medicine cabinet. In fact, about half of parents (49 percent) say anyone can access their medicine cabinet. More than four in 10 teens (42 percent) who have misused or abused a prescription drug obtained it from their parent’s medicine cabinet. Almost half (49 percent) of teens who misuse or abuse Rx medicines obtained them from a friend. Statistics

67 PATS Methodology The 24th annual Partnership Attitude Tracking Study (PATS) of 3,884 teens in grades 9-12 and 817 parents is nationally projectable with a +/- 2.1 percent margin of error for the teen sample and +/- 3.4 percent for the parent sample. Conducted for The Partnership at Drugfree.org and MetLife Foundation by GfK Roper Public Affairs & Corporate Communications, the 2012 PATS teen survey was administered in private, public and parochial schools, while the parent survey was conducted through in-home interviews by deKadt Marketing and Research, Inc. Teens are more likely to use prescription drugs if they believe that their parents are more lenient toward prescription drug misuse or abuse compared to illegal drug abuse, and if their parents use drugs themselves. One in five parents (20 percent) report that they have given their teen a prescription drug that was not prescribed for them. The PATS survey also found that 17 percent of parents do not throw away expired medications, and 14 percent of parents say that they themselves have misused or abused prescription drugs within the past year. Statistics

68 Between 2004 and 2009, the number of emergency department visits for opioid analgesic misuse and abuse in New York City more than doubled, rising from approximately 4500 to more than 9000 visits. In 2009, 1 in every 4 unintentional drug poisoning (overdose) deaths in NYC involved prescription opioid analgesics, excluding methadone. In NYC, one-third of unintentional drug poisoning overdose deaths involve a benzodiazepine the most common is alprazolam (Xanax®). Risks of unintentional poisoning may be increased when opioids are taken with benzodiazepines because both cause respiratory depression. Statistics

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73 NONOPIOID APPROACHES TO MANAGING PAIN Pharmacologic approaches include: Acetaminophen Selected anticonvulsants Selected antidepressants Capsaicin (for neuropathic pain) Corticosteroids Nonsteroidal anti-inflammatory drugs (NSAIDs) Transdermal lidocaine Nonpharmacologic approaches include: Behavioral management (eg, assessment for depression/stress, chemical dependency) Physical therapy Self-management therapies (eg, relaxation, cognitive behavioral therapy) Chiropractic care Acupuncture Bio-feedback CPE’s Educate! Implement Trainings De-stigmitize Write!

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78 Conclusion It is shown that universal drug prevention strategies have proven to be effective. Preventing this abuse can improve quality of life, increase job performance, academic performance, decrease financial cost in the judicial system as well as health care cost, military preparedness and the cost of lives. It is important that we now do all we can to educate and prevent any further damage.


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