CPP REVIEW SUBSTANCE ABUSE

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CPP REVIEW SUBSTANCE ABUSE

• JAMES F. SMITH II, CPP
• Area Manager
• SBC Communications
• ASIS CPP Review 8/21/01

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SUBSTANCE ABUSE STATS

• 73 of illegal drug abusers are employed.
• Drug and alcohol abuse is one of the four top
  reasons for the rise in workplace violence.
  
• In 1998, an estimated 13.6 million Americans were
  current illicit drug users.
  
• Marijuana is the most commonly used illicit drug,
  81 of current drug users.
  

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ECONOMIC IMPACT

• Data indicates that substance abuse costs are
  estimated at over 100 billion dollars annually.
  
• Alcoholism causes 500 million lost work days
  every year.
  
• Drug using employees at GM average 40 days sick
  leave each year, compared to 4.5 days for
  non-users.

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ECONOMIC IMPACT-TREATMENT

• After employees successfully completed SA
  treatment programs in Ohio, employers reported
  
• 1. Those employees had a 91 decrease in
  absenteeism.
  
• 2. Those employees had a 88 decrease in
  problems with supervisors.
  
• 3. Those employees had a 93 decrease in
  mistakes at work.
  
• .

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NATIONAL COCAINE HOTLINE

• 75 reported using drugs on the job.
• 64 admitted drugs adversely affected their job
  performance.
  
• 44 sold drugs to other employees.
• 18 had stolen from co-workers to support their
  habit.
  

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THE CONTROLLED SUBSTANCES ACT OF 1970

• Places all substances regulated by Federal law
  into one of five schedules, with Schedule 1
  containing the most restricted.
  
• The schedule a substance is in affects the
  penalties related to the illegal possession,
  sale, or transfer of that substance.
  

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CSA of 1970

• Placement in a schedule is based upon
• 1. Potential for abuse.
• 2. Accepted medical use in U.S.
• 3. Safety and dependence factors.

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PSYCHOLOGICAL DEPENDENCE

• The condition in which the repeated use of a drug
  results in increasing tolerance which requires
  progressively larger doses to attain the desired
  effect, therefore reinforcing the compulsive
  behavior.

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PHYSICAL DEPENDENCE

• Refers to an alteration of the normal functions
  of the body which necessitates the continued
  presence of a drug to prevent the withdrawal
  syndrome which is characteristic of addictive
  drugs.

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ANALOGUES (DESIGNER DRUGS)

• Produced in clandestine laboratories in an
  attempt to circumvent existing drug laws.
  
• They have slight variations in their chemical
  structures to avoid being listed as controlled
  substances.

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TOLERANCE

• Body condition wherein ever-increasing amounts of
  a drug are needed to gain the desired effect.

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DRUG

• A drug is a substance which, because of its
  chemical make-up alters the mood, perception, or
  consciousness of the user. All drugs are not
  illegal.
• The most abused drug is alcohol and the most
  used drug is alcohol.

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BEHAVIORAL CHARACTERISTICS

• Abrupt changes in work attendance, quality of
  work, and work output.
  
• Attitude changes.
• Withdrawal from responsibility.
• Breakdown in personal appearance.
• Wearing of sunglasses at inappropriate times (to
  hide dilated or constricted pupils).

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BEHAVIORAL CHARACTERISTICS

• Wears long-sleeved garments to hide needle
  marks.
  
• Association with known substance abusers.
• Excessive borrowing of money.
• Stealing small items.
• Secretive habits.

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METHODS OF INGESTION

• Swallowing
• Inhaling
• Injecting
• Snorting
• Sublingual
• Contact

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CLASSIFICATIONS OF DRUGS

• Narcotics
• Depressants
• Stimulants
• Hallucinogens
• Cannabis

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NARCOTICS

• Narcotic in its medical meaning refers to
  opium, opium derivatives, and synthetic
  substitutes.
  
• Generally prescribed as sedatives, painkillers,
  to induce sleep, or to control diarrhea.
  
• Essential in the practice of medicine, most
  effective agents known for the relief of intense
  pain.

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NARCOTICS

• Medically, administered orally or by injection.
• As drugs of abuse they are sniffed, smoked,
  subcutaneously injected (skin popping), or
  intravenously injected (mainlining).
  

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NARCOTICS EFFECTS

• Pinpoint pupils.
• Drowsiness.
• Euphoria.
• Reduced vision.
• Respiratory depression.
• Nausea.

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NARCOTICS OF NATURAL ORIGIN

• The poppy, cultivated in many countries around
  the world, is the main source of nonsynthetic
  narcotics.
  
• Opium is extracted from the unripe seedpod, as a
  milky fluid, air dried to produce opium gum.
  
• Modern method is poppy straw process of
  extracting the alkaloids from the mature dried
  plant.

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OPIUM

• The 25 alkaloids extracted from opium fall into
  two general categories
  
• Phenanthrene alkaloids represented by morphine
  and codeine. Used as analgesics and cough
  suppressants.
  
• Isoquinoline alkaloids represented by papaverine.
  Used as intestinal relaxant.
  
• Both physical and psychological dependence is
  rated high with the use of opium.
  

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NATURAL NARCOTICS

• Opium.
• Morphine.
• Codeine.
• Thebaine.

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SEMI-SYNTHETIC NARCOTICS

• These drugs are produced by the modification of
  the chemicals contained in opium
  
• Heroin
• Hydromorphone
• Oxycodone
• Etorphine and Diprenorphine
• Hydrocodone

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HEROIN

• Pure heroin is a white powder with a bitter
  taste. Illicit heroin varies from white to dark
  brown with a purity of 1 to 98.
  
• Black Tar heroin is primarily from Mexico, 20
  to 80 pure.
  
• Injected, sniffed, or smoked.
• High physical and psychological dependence.

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HYDROMORPHONE

• Most commonly sold as Dilaudid. Marketed in both
  tablet and injectables.
  
• Potency is 2-8 times that of morphine.
• Shorter acting and more sedating than morphine.
• Highly abusable drug, much sought after by
  narcotic addicts.

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OXYCODONE

• Synthesized from Thebaine.
• Similar to Codeine, but more potent and with a
  higher dependence potential.
  
• Combined with aspirin to create Percodan, for
  pain relief.
  
• Addicts take Percodan orally, or dissolve tablets
  in water, filter out the insoluables, and
  mainline the active drug.

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ETORPHINE AND DEPRENORPHINE

• Both substances made from Thebaine.
• Etorphine is more than a thousand times more
  potent as morphine in its analgesic, sedative,
  and respiratory depressant effect.
  
• Great danger of overdose. Used by vets to
  immobilize large wild animals.
  
• Deprenorphine used to counter the effects of
  Etorphine.

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SYNTHETIC NARCOTICS

• Meperidine, Methadone, Fentanyl.
• Created entirely within the laboratory.
• Continuing search for a product with the
  analgesic properties of morphine, without the
  dangers of tolerance and dependence.
  
• Have yet to yield a drug not susceptible to
  abuse.

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MEPERIDINE (PETHIDINE)

• Also known as Demerol and Pethadol.
• Most widely used drug for the relief of moderate
  to severe pain.
  
• Administered either orally or by injection.

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METHADONE

• Synthesized during WWII by German scientists.
• Almost as effective when administered orally as
  it is by injection.
  
• Designed to control narcotic addiction, it is a
  major overdose hazard.
  
• Long acting, effects last up to 24 hours.
• Physical psychological dependence rated as
  high.

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FENTANYL

• Used extensively for anesthesia and analgesia.
• More than 12 analogues have been produced
  clandestinely.
  
• Biological effects indistinguishable from those
  of heroin.
  
• May be hundreds of times more potent than heroin.
  Commonly injected but may be snorted or smoked.

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DEPRESSANTS

• Legitimately prescribed for relief of anxiety,
  irritability, tension, and insomnia.
  
• In excessive amounts, induce an intoxication
  similar to alcohol.
  
• High potential for physical and psychological
  dependence.

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DEPRESSANTS

• Tolerance to the intoxicating effects develops
  rapidly, leading to a progressive narrowing of
  the margin of safety between an intoxicating and
  lethal dose.
• Used by addicts to soothe nerves brought on by
  use of stimulants, quell anxiety of flashbacks
  resulting from prior use of hallucinogens, or to
  ease withdrawal from heroin. This compounds the
  dangers of depressants.

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BARBITURATES

• Widely prescribed to induce sleep and sedation.
• Often result in a build-up of tolerance and
  dependence on them is widespread.
  
• Physical and psychological dependence classified
  as high moderate.

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METHAQUALONE (QUAALUDE)

• A synthetic sedative, it was widely abused
  because it was once mistakenly thought to be
  non-addictive and effective as an aphrodisiac.
  
• Both the physical and psychological dependence
  rated as high.

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BENZODIAZEPINES

• Marketed as mild tranquilizers and sedatives.
• Known under names of Librium, Clonopin, Valium,
  Xanax, Serax, and others.
  
• Dependence of these drugs rated as low.

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STIMULANTS

• Of all abused drugs, stimulants are the most
  powerfully reinforcing.
  
• Stimulants can lead to increasingly compulsive
  behavior.
  
• The two most prevalent stimulants are nicotine
  and caffeine.
  
• The protracted use of stimulants is followed by a
  period of depression known as crashing.
  

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POSSIBLE EFFECTS ASSOCIATED WITH STIMULANTS

• Increased alertness.
• Excitation.
• Euphoria.
• Increased pulse rate and blood pressure
• Insomnia.
• Loss of appetite.
• Irritability,anxiety, and apprehension.

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COCAINE HYDROCHLORIDE (HCL)

• Most potent stimulant of natural origin,
  extracted from the leaves of the coca plant.
  
• Grown in Andean highlands (Peru, Bolivia,
  Columbia) of South America since prehistoric
  times.
  
• Generally processed in Columbia.

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HCL - PROCESSING

• Coca leaves are stomped in Apozo pits with
  various chemicals, including kerosene, to extract
  the alkaloids and produce crude coca paste.
  
• The cocaine base is mixed with acetone and acid.
  The resulting cocaine hydrochloride crystals are
  strained and dried, producing pure cocaine.

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HCL

• Cocaine is usually distributed as a white, off
  white crystalline powder or compressed powder.
  
• Often diluted with sugars such as lactose,
  inositol, mannitol, and local anesthetics such as
  lidocaine.
  
• Diluted to increase volume and thus to multiply
  profits.
  
• Commonly snorted or injected.

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COCAINE BASE - CRACK

• HCL powder mixed with water and baking soda.
• HCL converts to the base which is water
  insoluble.
  
• Water evaporated off leaving Cocaine Freebase
  (Crack)
  
• Cooled and cut into chunks or rocks. Beige
  substance with wax like appearance.

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PARAPHERNALIA

• HCL
• Spoons, Straws, Razor Blades, Syringe.
• Crack
• Pipes (cans, glass tubes, antennas)
• Vials

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COCAINE

• Because of the intensity of its effects, has the
  potential for extraordinary psychic dependency.
  
  
• Excessive doses may cause seizures and death from
  respiratory failure or stroke.
  
• There is no specific antidote for cocaine
  overdose.
  
• There is no safe dose of cocaine.

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AMPHETAMINES - SLANG

• Speed, Uppers, Pep Pills.
• Black Beauties, Hearts, Bumblebees.
• Crank, Crystal Meth, Crystal.
• Ice - Smokable form of methamphetamine.

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AMPHETAMINES

• Closely parallel cocaine in both short-term and
  long-term effects.
  
• Generally taken orally or injected. White to
  brown powder or tablets.
  
• Ice is to Meth what Crack is to Cocaine.
  Ice-clear crystal like material, rock candy.
  

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HALLUCINOGENS

• Generally, both natural and synthetic substances
  which distort the perception of reality.
  
• Induce a state of excitation of the central
  nervous system shown by mood alterations, usually
  euphoric. The mood may also become severely
  depressive.
• The senses of direction, distance, and time
  become disoriented.

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HALLUCINOGENS

• In large doses, produces delusions and visual
  hallucinations.
  
• Depression sometimes becomes so severe that
  suicide is possible.
  
• Most common danger is impairment of judgment
  which often leads to rash decisions and
  accidents.
  
• Recurrent use produces tolerance which tends to
  encourage using greater amounts.

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HALLUCINOGENS

• Long after hallucinogens are eliminated from the
  body, users may experience flashbacks which are
  fragmentary recurrences of psychedelic effects.
  
• Recurrent use tends to produce psychic
  dependence.
  
• No evidence of physical dependence.

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PEYOTE AND MESCALINE

• The primary active ingredient of the peyote
  cactus is Mescaline, which comes from the fleshy
  parts or bottoms of the cactus plant.
  
• Mescaline can also be produced synthetically.
• Full spectrum of effects is that of a chemically
  induced model of mental illness.

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PEYOTE AND MESCALINE

• Peyote is usually ground into a powder and taken
  orally.
  
• A dose of 350 to 500 mg of mescaline produces
  illusions and hallucinations lasting from 5 to 12
  hours.
  
• Peyote is used by the Native American church, and
  Indians in northern Mexico, in religious
  ceremonies.

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PSILOCYBIN PSILOCYN

• Mushrooms that grow in cow dung.
• Chemically related to LSD.
• When eaten, affect mood and perception in a
  manner similar to mescaline and LSD.
  
• Used for centuries in traditional Indian rites.
• Can now be made synthetically.

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PCP (PHENCYCLIDINE)

• Commonly known as PCP, Angel Dust, Supergrass,
  Killer Weed, Embalming Fluid, and Rocket Fuel.
  
• Unique among popular drugs of abuse in that it is
  able to produce psychoses indistinguishable from
  schizophrenia.
  
• Sold in tablets, capsules, powder, and liquid
  form.
  
• Usually applied to leafy material (parsley, mint,
  oregano, or marijuana) and smoked.

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LSD

• Commonly known as acid and microdot.
• Usually sold in the form of impregnated paper
  (blotter paper), tablets (microdots), or thin
  squares of gelatin (window panes).
  
• Effects include impaired depth and time
  perception, accompanied by distorted perception
  of the size and shape of objects, movements,
  color, sound, touch, and the users own body
  image.

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LSD

• Derivative of alkaloid found on rye fungus
  ergot.
  
• Very potent, 20 ug (a ug is a millionth of a
  gram) is a dose.
  
• LSD is 5000 times as potent as Mescaline and 200
  times as potent as psilocybin.

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LSD

• Tolerance develops rapidly.
• After the LSD trip, acute anxiety or depression
  may occur for a variable period.
  
• Flashbacks may occur days or months after taking
  the last dose.

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CLUB DRUGS

• Refers to drugs being used by young adults at
  all-night dance parties, such as raves,
  trances, dance clubs, and bars.
  
• Include MDMA (Ecstasy), GHB, Rohypnol, Ketamine,
  Meth, and LSD.
  
• Most often used in combination with alcohol,
  making it even more dangerous.

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MDMA, MDA, DOB, DOM

• Chemical variations of mescaline and amphetamine.
  (Any Acronym)
  
• Slang terms Ecstasy, XTC, X, Adam, Clarity,
  Lovers Speed.
  
• Produce both stimulant and hallucinogenic
  effects.
  
• Taken orally, usually in a tablet or capsule.
  Sometimes snorted.

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GHB

• Slang Grievous Bodily Harm, G, Liquid Ecstasy,
  Georgia Home Boy.
  
• Produced in clear liquid, white powder, tablet
  and capsule forms.
  
• Abused for its intoxicating, sedative, euphoriant
  properties.

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KETAMINE

• Slang Special K, K, Vitamin K, Cat Valiums.
• Produced in liquid form or as a white powder that
  is snorted or smoked with tobacco products or
  marijuana.
  
• Large doses cause reactions similar to those
  associated with PCP, such as dream-like states
  and hallucinations.

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ROHYPNOL

• Tasteless and odorless and it dissolves easily in
  carbonated beverages.
  
• Sedative in the class of drugs along with Valium
  and Xanax.
  
• One mg dose can impair victim for 8 to 12 hours.
  Loss of memory.
  
• Comes in tablet but can be ground up and snorted.

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CANNABIS SATIVA L

• The source of cannabis is the hemp plant which
  grows wild throughout most of the tropic and
  temperate regions of the world.
  
• Green leafy material usually smoked in the form
  of loosely rolled cigarettes called joints, or
  in pipes.

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CANNABIS - EFFECTS

• Euphoria.
• Relaxed inhibitions.
• Increased appetite.
• Disoriented behavior.
• State of intoxication may not be noticeable to an
  observer.

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CANNABIS

• The cannabis plant contains chemicals called
  cannabinoids.
  
• The psychoactive effects of cannabis are caused
  by one of the chemicals, delta-9-tetrahydrocannabi
  nol (THC).
  
• One joint of todays marijuana is equal to 14
  joints from the late 1970s.

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HASHISH

• Consists of resinous secretions of the cannabis
  plant, which are collected, dried, and compressed
  into forms such as balls, cakes, or cookie-like
  sheets.
• Hashish Oil higher concentration. Produced by a
  process of repeated extraction of cannabis plant
  materials to yield a dark viscous liquid. One
  drop of this liquid on a cigarette is equal to a
  single joint of marijuana.

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SUBSTANCE ABUSE PROGRAMS

• Rationale Control and rehabilitation is more
  humane and cost effective than termination.
  
• The policy of the organization should include
• The attitude of the organization on drug abuse.
• The criteria to be applied.
• The actions that will be taken.

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DRUG SCREENING

• Enzyme Multiplied Immunossay Technique (EMIT).
• Easy to administer and relatively inexpensive.
• Can be used for a combination of substances.

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DRUG SCREENING

• Gas Chromatography/Mass Spectrometry highly
  reliable tests predominately used for confirming
  initial positives or preliminary tests.
  
• Confirming tests should be done on the same
  specimen.