2.  Become familiar with some of the new drugs of abuse – how they are used, expected toxidrome/symptoms, and emergency treatment.  Review some of the old drugs of abuse and the new creative ways they may be abused.

5.  Fake Drugs Seized in State College Drug Raid  By: Jeff Preval  Updated: February 23, 2012  STATE COLLEGE, CENTRE COUNTY - Fake drugs, recently banned in Pennsylvania have been seized in Centre County. In a raid Wednesday night, involving three State College businesses, synthetic marijuana, bath salts and other narcotic paraphernalia were reportedly seized. The charge for selling these substances is considered a felony. The Centre County district attorney says the joint investigation involved stores in State College, as well as, Schuykill and Berks County. Products were seized from Jamaica Junction, Dragon Chasers Emporium and Grasshoppers in State College. The investigation continues. Wearecentralpa.com

6.  Drug-Deal Incident Preceded Fatal Stabbing in Lemont, Police Documents Show  by Adam Smeltz on January 17, 2012 4:52 PM Adam Smeltz  A small-time drug transaction gone awry led to the fatal stabbing of a College Township man late Monday, a State College police investigation suggests. The victim, identified as Tyler Vaughn Struble, 20, of 831 Henszey St., had suffered a deep laceration to his neck area when police arrived at his Lemont home shortly after 10 p.m. He was pronounced dead later at Mount Nittany Medical Center. Authorities have charged Tyler Steven Marlatt, 20, of 821 Southgate Drive, State College, with first-, second- and third-degree murder in connection with Struble's death. Marlatt also is charged with robbery and aggravated assault. Statecollege.com

8.  Avicii on November 17, 2011 – 31 patients transported from the Bryce Jordan Center to the Emergency Department.  Sebastian-Ingrosso on Feb. 23, 2012 – 10 patients transported from the BJC to the Emergency Department.  DayGlow on April 11, 2012 – 27 patients transported and on April 12, 2012 - 31 patients transported from the BJC to the Emergency Department

9.  October 2012, Calder Commons: Penn State cheerleader Paige Raque falls from balcony  December 2012, Sigma Alpha Mu: Female falls from window  Nov. 16, 2013, Penn Tower: Student killed after falling from ninth-floor balcony  Nov. 22, 2013, The Palmerton: Student falls from second-floor balcony at The Palmerton  Jan. 19, 2014, The Palmerton: Another student falls from second-floor balcony

11.  Synthetic derivatives of federally controlled substances created by slightly altering the molecular structure of existing drugs.  Produced illegally in clandestine labs for illicit use.

13. Common Names : K2, Spice, Blaze Cost: $30-$40 for a 3 gram bag Route of Administration: smoking, snorting, or swallowing

14.  Emerged as a problem in 2009  A blend of plant and herbal materials that have been sprayed with chemicals  One in nine high school seniors have gotten high on synthetic marijuana  Calls to poison control centers in 2011 about 7000, up from 2900 in 2010

15. Desired Effects: Marijuana-like high and calming effect Adverse Effects: excessive sweating, agitation, tachycardia, aggression, restlessness, confusion, inability to speak, and STROKE

16.  Strokes caused by Spice  Thought to be embolic etiology  Siblings in Florida › 26 year old male – slurred speech and weakness to the right side of his body – given TPA › 19 year old female – severe aphasia with weakness to the right side of her body – she was left completely disabled with right hemiparesis and expressive aphasia.

17.  Intoxication?  Neurological Signs?

18. Synthetic Marijuana Treatment: Supportive care Treatment of associated symptoms Benzodiazepines for agitation, aggression IV Fluids for dehydration

21. Common Names: White Lightning, Cloud 9, Ivory Wave, White Dove Cost: $40 for 500mg Route of Administration: Snorting, swallowing, smoking, injecting

22. Desired Effects: Increased alertness; diminished requirement for food or sleep; regarded as synthetic cocaine Adverse Effects: hypertension, sweating, chest pain tachycardia, extreme paranoia, increased suicidal thoughts, necrotizing fasciitis

23.  Number of calls to poison control centers in 2011 was about 6100, up from 304 in 2010.  Bath Salts accounted for 23,000 of 2.5million drug-related visits to the ED in 2011.  Evade FDA regulation by printing warning label, “ Not for Human Consumption.”

24. Bath Salts Treatment: Supportive care Treatment of associated symptoms Benzodiazepines for agitation, paranoia, restlessness, and seizures Maintain patient and staff safety TIME

25.  Proper Name: 3, 4- Methylenedioxymethamph etamine  Common Name: MDMA, XTC, Adam, E  Cost: $20 to $30 per dosage unit retail  Route of Administration: Swallowing, snorting, smoking, injecting

26. Desired Effects: profoundly positive feelings, empathy for others, elimination of anxiety, and extreme relaxation; suppress the need to eat, drink, or sleep. Adverse Effects: diaphoresis, bruxism, jaw clenching, paresthesias, hyperthermia, fatal dysrythmia and Hyponatremia which can cause cerebral edema, confusion, and seizures.

27.  MDMA causes massive serotonin release. Coupled with dancing and dehydration, the hyperthermia is greatly exaggerated.  Many users will have pacifiers in their mouth because of bruxism

28. MDMA Treatment: Supportive care Treatment of associated symptoms Hyperthermia – cooling with ice packs and a fan, ice-lavage; antipyretics are not useful Benzodiazepines for agitation or seizures Admission if evidence suggests presence of significant hyperthermia, altered mental status, seizures, severe hyponatremia, respiratory depression, or acute renal failure secondary to rhabdomyolysis.

30.  Molly’s Plant Food is a synthetic hallucinogenic amphetamine marketed as a “plant food” that contains ingredients that produce highs similar to Ecstasy.

31.  Acute onset of agitated behavior which may result in death.

32.  Bizarre and violent behavior, most commonly violence towards glass  Removal of clothing, public nudity (even in cold weather)  Aggression  Hyperactivity  No pain perception  Hyperthermia  Paranoia  Hallucination  Incoherent speech or shouting  Grunting or animal-like sounds  Incredible strength or endurance (typically noticed during attempts to restrain victim).

33.  Other medical conditions that can resemble excited delirium are panic attack, hyperthermia, diabetes, head injury, delirium tremens, and hyperthyroidism.

34.  Treatment Suggestions for Excited Delirium:  Cooled IV fluids  Chemical Sedation (Ketamine)  ECG Monitoring  Pulse Oximetry  Sodium Bicarbonate administration

37. GHB and GBL Proper Name: Gamma-hydroxybutyric acid, gamma- butyrolactone Common Name: GHB, GBL Other Street Name(s): Grievous Bodily Harm, scoop, liquid ecstasy, cherry meth, growth hormone booster, liquid x, and Georgia homeboy. Cost: $10 per bottle, which usually contain 10 “hits” Desired Effects: Initially marketed as a fat-burner and a growth hormone promoter; now used as a hallucinogenic, euphoric, and sleep aid

38. GHB and GBL Physical Characteristics: GHB generally comes in pure powder form or mixed with water. GBL is a precursor to GHB. GBL is a solvent found in floor cleaning products, nail polish, and superglue removers. Described by users as, “alcohol-free, hang over free high with potent prosexual effects.” FDA approved for treatment of narcolepsy. First used by body builders for the euphoric effect during marathon weight lifting sessions.

39. GHB and GBL Harmful Effects: GHB quickly produces moderate amnesia but does not produce analgesia or muscle relaxation. Bradycardia, decreased systemic vascular resistance, and hypotension. CNS depression is the hallmark of GHB use. Myoclonic jerks often confused with seizure activity. Sporadic violent agitation. Hypotension occurs in 10% of GHB ingestions. Burns to lips and oropharynx may represent caustic injury from concomitant lye ingestion.

40. Rohypnol Proper Name: Flunitrazepam (Rohypnol) Common Name: Roofies Other Street Name(s): In South Florida, street names include “circles,” “Mexican valium,” “rib,” “roach-2,” “roofies,” “roopies,” “rope,” “ropies,” and “ruffies.” In Texas, flunitrazepam is called “R-2,” or “roaches.” Cost: $5 or less per tablet Desired Effects: Produce profound intoxication, boost the high of heroin, and modulate the effects of cocaine

41. Rohypnol Physical Characteristics: Flunitrazepam—marketed under the trade name Rohypnol—is manufactured worldwide, particularly in Europe and Latin America to treat severe sleep disorders However, the drug is neither manufactured nor approved for medical use in the United States. Described as 10X more potent than valium.

42. Rohypnol Harmful Effects: It has physiological effects similar to diazepam. Paradoxically, although the drug is classified as a depressant, flunitrazepam can induce excitability or aggressive behavior in some users. Dizziness, confusion, drowsiness, blurred vision, unresponsiveness, anxiety, agitation

44. Just New Flavors

45.  Nearly half of all college students (44%) report having been drunk in the prior 30 days.  About one in eight college students (13%) reported having 10 or more drinks in a row at least once in the prior two weeks, and one in twenty (5%) reported 15 or more drinks in a row.

47. Over 48 hours…66 patients presented to the ER with Alcohol intoxication or Alcohol Overdose AVERAGE BAC 282.9

48.  Ethanol Tampon: more alcohol absorption without consuming a large amount of fluid or calories

51. 'Up to five deaths' caused by drinking game Neknominate 22 February 2014 Last updated at 13:40 GMT

53. Only have to go to the family medicine cabinet!  Stimulants  CNS Depressants  Opioids  Sexual Enhancers

54.  2 nd to only marijuana as the most commonly used illicit drugs.  Oxycontin or Vicodin are the most commonly abused prescription medication.  Household survey on drug abuse indicate that the most dramatic increase in new prescription drugs for nonmedical purposes occurs in 12-17 year-olds and 18-25 year-olds.

57.  a class of drugs that enhance brain activity which leads to increased alertness, attention and energy.  Prescribed for Narcolepsy, Attention Deficit Hyperactivity Disorder (ADHD), and depression.  When misused, can become addictive.

58. Desired Effects: -Increased level of alertness -study aid -weight loss -increase focus and attention -performance enhancement Adverse Effects -increased blood pressure -increased heart rate and respiration -dangerously high body temperatures -irregular heartbeat -seizures

59.  34% of college students abuse adderall.  Used orally or crushed and used intranasal.  Some users inject it – “West Coast”  Some users mix it with heroin or cocaine – “Speed Ball”

60. Stimulant Abuse Treatment: Supportive care Treatment of associated symptoms Hyperthermia – cooling with ice packs and a fan, ice-lavage Benzodiazepines for seizures, shivering, or painful cramps

61.  Barbituates – Nembutal, Phenobarbital  Benzodiazapines – Valium, Ativan, Xanax  Sleep Medication –Lunesta, Ambien, Sonesta

62. Desired Effects: Sedation/drowsiness, reduced anxiety, feelings of well-being, lowered inhibitions, sleep aid; mellow out Adverse Effects: lowered blood pressure, slowed breathing, tolerance, withdrawal, addiction; increased risk of respiratory distress and death when combined with alcohol

63. CNS Depressants Treatment: Supportive care Treatment of associated symptoms Airway management Blood pressure support

64.  OxyContin  Lortab  Vicodin  Percocet  Norco  Demerol  Dilaudid  Lomotil  Hycodan  Tylenol #3

65.  Often prescribed to treat pain.  Often abused due to the initial euphoric effect.  May produce severe respiratory distress and prove to be fatal.

66. Narcotics Treatment: Supportive care Treatment of associated symptoms Airway management Reversal - Narcan

70.  Sizzurp is an addictive concoction that gets the user high, made by combining prescription-strength cough syrup with sugary sodas like Mountain Dew or Sprite, to which hard candies like Jolly Ranchers are added for more flavor.

71.  Sildenafil alone.  Sildenafil with amyl nitrate to get a head rush.  Both drugs are potent vasodilators and can cause coronary ischemia.

72. Figure 7.2 Specific Illicit Drug Dependence or Abuse in the Past Year among Persons Aged 12 or older - 2012

74.  Dextromethorphan  Dimenhydrinate  Ephedrine and Pseudoephedrine(or behind the counter)  Sniffing/Huffing  Glue  Gasoline  White Out  Nitrous Oxide (Whip its)

75.  Usually young people  Easily available over-the-counter  Cheap  Easy to shop-lift  Just look in mom and dad’s medicine cabinet or even grandma’s.

77.  Opioid agent used as a cough suppressant  Available since the 1960’s – new interest in abuse of this substance among adolescents.  Found in more than 140 non-prescription products.  The most frequently abused product is Nyquil.

78.  Street Names: Robo, Red Devils, DXM, or Dex  Described as an “LSD-like” high.  Teens can receive guidance on the internet on how to best abuse dextromethorphan.

80.  In high doses, it will produce a dream like state with auditory, visual, and sometimes olfactory hallucinations.  Available in Dramamine and Gravol.  School nurses report that teens are taking 8-12 tablets for an 8-12 hour “trip.”

82.  Aka “ma huang and ephedra” – BANNED  Easily converted into methamphetamine  Used by teens for weight loss, to stay awake, and for an energy boost.

84.  Glue-sniffing and gasoline-sniffing are perhaps the most commonly recognized OTC abuse for the older generation.  Today, even common products such as Whiteout or keyboard cleaner are used but fortunately they have been reformulated to reduce the effects.

85.  Street Name: NOZ,Whip-Its  Frequently inhaled and abused at Raves.  Propellants found in Wizard Air Freshener are similar to nitrous oxide but similar potential dangers.

87.  Anxiousness  Confusion  Disorientation  Disinhibition  Perpetual cough  Hypoxia

88.  Airway, Airway, Airway  Recognize toxidrome  Supportive care

90.  Salvia: herbal mint plant that can be grown from a seed and has hallucinogenic properties. It can be smoked or made into tea.  Morning Glory Seeds: contain a hallucinogenic substance resembling LSD.

91.  “Used in the exploration of consciousness.”  Can be smoked, snorted, used sublingually, or made into tea or soup.  Produces an amnestic state if enough is used

92.  Plant commonly found in home gardens or landscape.  The seeds of the morning glory plant (Ipomoea Violacea) contain a chemical similar to LSD.

93.  Produce a strong hallucinatory effect.  Most plants are coated with pesticides which can cause liver and neurological damage.  Seeds available in garden shops.

96.  These drinks are packed with herbal stimulants, sugar, and caffeine.  They claim to “Enhances athletic performance” and “Increases caloric burn and mental sharpness.”  Mixing energy drinks and alcohol can have devastating consequences.

97. Desired Effects: - Increased energy -improved weight loss - improved mental sharpness -decreased need for sleep Adverse Effects: - Dehydration as caffeine is a diuretic -Dysrythmias -Seizures

98. John Jackson allegedly bought a tin of Hero Instant Energy Mints, each of which is said to have as much caffeine as a can of Red Bull. Jackson had so much caffeine in his system after consuming the mints that his caffeine levels were nearly double those reported in other caffeine overdose deaths.  Read more: http://www.nydailynews.com/life- style/health/man-dies-caffeine- overdose-eating-energy-mints-article- 1.1484707#ixzz2rL0W5gDY http://www.nydailynews.com/life- style/health/man-dies-caffeine- overdose-eating-energy-mints-article- 1.1484707#ixzz2rL0W5gDY

100.  Available at convenience stores as of January 12, 2012.  Each puff contains 100mg of caffeine (as much as a cup of coffee) and B vitamins.  $2.99 for 6 puffs – cheaper than a cup of coffee. DANGER: No volume to drink

101.  If taken with alcohol, may have the effects of the caffeinated alcoholic beverages such as Four Loko  Risks include neurological and cardiovascular problems as well as exacerbation of asthma  The caffeine is absorbed through the mouth and digestive track and not through the lungs according to the manufacturer

103.  Marijuana (the real stuff)  LSD  Heroin  Cocaine  Mushrooms  PCP

104.  Two more cases of flesh-eating krokodil suspected in Utah as killer drug spreads through streets of U.S. Read more: http://www.dailymail.co.uk/news/article- 2465422/Krokodil-drug-2-cases-suspected- US.html#ixzz2rKlbYDVk http://www.dailymail.co.uk/news/article- 2465422/Krokodil-drug-2-cases-suspected- US.html#ixzz2rKlbYDVk

105.  Self-brewed heroin substitute made from readily available codeine and any number of toxic contaminants such as iodine, lighter fluid, gasoline, and various other hydrocarbons.

110.  Obtaining a detailed history of the ingestion or exposure from all available sources is important.  Inspect bottles of ingested substances to help identify possible alcohols.  Follow standard protocols for treating patients with airway obstruction, unconsciousness, or altered mental status

111.  HISTORY: › How Much? › When? › Where? › What Else?  Drugs › What else happened?  Are you SURE they are only drunk?  Trauma?

115.  Centredaily.com  Mollydrug.net  www.EM-News.com  www.whitehouse.gov www.whitehouse.gov  Yourlife.usatoday.com/health/story/2012-03-19  www.medscape.com www.medscape.com  Bangordailynews.com/2011/12/23  www.higheredcenter.org www.higheredcenter.org  www.monitoringthefuture.org www.monitoringthefuture.org  www.campushealthandsafety.org www.campushealthandsafety.org

116.  www.drugabuse.gov www.drugabuse.gov  www.projectghb.org www.projectghb.org  www.emed-journal.com  Toxalert-Maryland Poison Center  www.schoolnurse.com www.schoolnurse.com  www.emedmag.com  Smart Drug News  www.samhsa.gov  ACEP News