SUBSTANCE ABUSE DRUGS

1
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.

2
Use of this Presentation

• This presentation may be used for educational
  purposes.
• Please obtain permission by using contact
  information on the next page

3
Acknowledgement

• Contact Grace Earl, Pharm.D. at g.earl_at_usip.edu
• 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

4
Reviewed by

• Laura Mandos, Pharm.D.
• Associate Professor
• University of the Sciences in Philadelphia
• Philadelphia College of Pharmacy and Science

5
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.

9
GHB STREET NAMES

• GBH
• Grievous Bodily Harm
• G
• Liquid Ecstasy

• Easy Lay
• Energy Drink
• Liquid E

10
GHB DOSAGE FORMS

• A teaspoon or capful ? normal dose.
• Proper dose is unknown. A teaspoon could also be
  an overdose.

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GHB POSSIBLE EFFECTS

• LOW DOSES
• Euphoric effect (alcohol)
• Relax
• Happy
• Sociable

• HIGH DOSES
• Dizziness
• Sleepiness
• Vomiting
• Muscle spasms
• Loss of consciousness

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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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ROHYPNOL STREET NAMES

• 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

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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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ROHYPNOL POSSIBLE 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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ECSTASY STREET NAMES

• E
• X
• XTC

• Adam
• Clarity
• Lovers Speed

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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
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LSD STREET NAMES

• 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

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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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LSD MEDICAL 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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MARIJUANA STREET NAMES

• Pot
• Grass
• Weed
• Mary Jane

• Dope
• Reefer
• Skunk
• Boom

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MARIJUANA DOSAGE FORMS

• Smoked as a cigarette or joint, or in a pipe or
  bong.
• Appeared in "blunts" gtcigars 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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COCAINE STREET NAMES

• Coke
• C
• Snow

• Flake
• Blow
• Speedball (when linked with Heroin)

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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).
•  Freebase refers 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
  Erythroxylon coca 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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HEROIN POSSIBLE CONSEQUENCES

• Rush
• Depressed respiration
• Clouded mental functioning
• Nausea vomiting

• Suppression of pain
• Spontaneous abortion
• Addiction

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HEROIN POSSIBLE CONSEQUENCES OF IV USE

• Infectious diseases
• Viral
• HIV/AIDS
• Hepatitis B C
• Bacterial Infections
• Abscesses

63
HEROIN OVERDOSE EFFECTS

• Muscle spasticity
• Pinpoint pupils
• Bluish colored fingernails and lips
• Tongue discoloration

64
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 mans pot
• Satans 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

70
VOLATILE INHALANTS OVERDOSE EFFECTS

• Sudden sniffing death syndrome
• Accidental suffocation
• Red, glassy or watery eyes nosebleeds
• Some products are carcinogens
• Asphyxiation (displacing of available oxygen in
  lungs.)

71
VOLATILE INHALANTS MEDICAL 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
  brains 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 only for 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

77
OXYCODONE OVERDOSE EFFECTS

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

78
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

80
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

83
MEDICAL USE OF KETAMINE

• Used in human medicine for pediatric burn cases
  and dentistry
• Used in experimental psychotherapy.

84
DEXTROMETHORPHAN

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

85
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.

87
DEXTROMETHORPHAN OVERDOSE EFFECTS

• Slurred speech
• Restlessness
• A feeling of poor coordination
• Difficulty breathing
• Seizures

88
DEXTROMETHORPHAN APPEARANCE

• Liquid
• Lozenges
• Powder
• Syrup
• Tablets

89
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. Ellenhorns
  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

91
Substance-Abuse Headlines
92
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 drugsgood or bad for medical use

93
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.

94
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

95
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

96
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.co
  m October 7, 2003 By Anne Gearan.

97
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

98
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

99
ISSUES WITH DRUG ABUSE

• 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