Susan Adams Kilman LCSW, AADC DRUG TRENDS 2018 Susan Adams Kilman LCSW, AADC

REFER TO COMMONLY ABUSE DRUGS HANDOUT FOR DETAILS OBJECTIVES EXAMINE SUBSTANCES WITH THE HIGHEST RATE OF USE IN ARKANSAS, PARTICULARLY OPIATES BRIEF DISCUSSION OF IMPACT ON PHYSICAL, MENTAL, AND EMOTIONAL FUNCTIONING. REVIEW TREATMENT OPTIONS FOR EACH SUBSTANCE DISCUSS THE ROLE OF PREVENTION REFER TO COMMONLY ABUSE DRUGS HANDOUT FOR DETAILS

OVERVIEW RECENT INTERVIEW WITH LAW ENFORCEMENT OFFICAL REVEALED THAT IN CENTRAL ARKANSAS: 1) ALCOHOL CONTINUES TO BE THE MOST ABUSED SUBSTANCE 2) CANNABIS/UTILIZATION OF E-CIGS FOR WAX/BUDDER 3) OPIATES ($6 TO $20 PER PILL DEPENDING ON SUPPLY/DEMAND) CARFENTANIL IS A DANGEROUS AS THEY SAY HE ALSO NOTED: FEWER LOCAL LABS FOR METH, OBTAINED FROM SIX SUPER LABS IN MEXICO. MORE BROWN HEROIN THAN BLACK TAR, ISSUES WITH MIX. (Officer interview, 01/19/2018)

ALCOHOL https://www.youtube.com/watch?v=ue2-ZVxpVjc

ALCOHOL ABUSE Examined in three categories: alcohol use, binge use, and heavy use Binge use Men = 5+ on at least one occasion in past thirty days Women=4+ on at least one occasion Heavy use Men =5+ on at least five days in the past thirty Women 4+ on at least five days in the past thirty

ALCOHOL In 2016, 136.7 Million Americans, ages 12+ report alcohol abuse, including 65.3 million who report binge drinking, and 16. 3 million who report heavy drinking. One in Five underage Americans ages 12 to 20 report alcohol use A recent report indicated that binge and heavy drinking has increased from 2014- 2016 for adults. Drinking before age 15 leads a person to be 4x more likely to become alcohol dependent.

CANNABIS https://www.youtube.com/watch?v=2Fr4X7XEqv0

See handout on Marijuana Concentrates CANNABIS Marijuana is the most commonly used illicit substance The rate of use in Arkansas is increasing but still less than the national average. In 2015, 53% of drug related arrests came from marijuana/hashish In 2016, 24 million Americas age 12+ reported using marijuana. 6.5% 12 to 17 years of age- 20.8% or 1 in 5 for 18-25 years of age 7.2 % 26 and older Marijuana concentrates: “budder” or “dabbing” contain extraordinary levels that could range from 40 to 80% CBD and THC are the two primary cannabinoids produced by the cannabis (marijuana) plant. See handout on Marijuana Concentrates See handout on CBDs

PRESCRIPTION DRUGS https://www.youtube.com/watch?v=Bm_BoaDxhpE

PRESCRIPTION DRUG ABUSE Approximately 16 million people in the United States abuse prescription medications. In general, men abuse prescription drugs more than women – with the exception of people ages 12 to 17. In this group, females abuse more than males. More than 1,600 teens begin abusing prescription drugs every day. Many teens and young adults mistakenly believe prescription drugs are safer than other street drugs. After marijuana and alcohol, the most common drugs teens are using/misusing are prescription medications. Among people 18-22, full-time college students are twice as likely to use a stimulant for non-medical reasons compared to those who aren’t in college or are going to college part-time. Approximately 1 in 4 teens reported abusing or misusing a prescription drug.

PRESCRIPTION DRUG ABUSE A recent report by the U.S. Centers for Disease Control and Prevention (CDC) shows Arkansas’ 75 counties had rates higher than the national average of 66.5 prescriptions per 100 people for overall opioid prescribing. Arkansas has a prescription opioid rate of 114.6 per 100, which is second only to Alabama's 2016 average of 121 per 100 people. The CDC reported from June of 2016 to June of 2017 that Arkansas had 392 deaths from opioid overdose up 6.2% from 369 the prior year. The report also shows nationally that the trend of overdose deaths from drug overdoses continue to rise. At least 66,324 drug overdoses deaths during the 12-month period ending in May 2017, which is up 17% from the 56,488 who died between May 2015 and May 2016, according to data published by the National Center for Health Statistics. https://globenewswire.com/news-release/2018/01/25/1305349/0/en/The- Recover-Completes-Guide-For-Inpatient-Drug-Rehab-Arkansas-Facilities.html

SYNTHETIC OPIATES U47700 U-47700 is a synthetic opioid developed in the 1970s by the Michigan-based pharmaceutical manufacturing firm Upjohn. A chemical compound formed during research, U-47700 sat dormant for many years but has resurfaced on the streets. U-47700 is being sourced overseas from China and Eastern Europe. The painkiller is almost eight times stronger than morphine and is readily available, and affordable, online. U-47700’s extreme potency, and lack of government regulation, has health officials deeply concerned as overdoses rise. U-47700 is commonly referred to as U-4, Pink or Pinky.

SYNTHETIC OPIATES CAREFENTANIL Carfentanil is a synthetic opioid that is 10,000 times more potent than morphine and 100 times more potent than fentanyl, which itself is 50 times more potent than heroin. DEA, local law enforcement and first responders have recently seen the presence of carfentanil, which has been linked to a significant number of overdose deaths in various parts of the country. Improper handling of carfentanil, as well as fentanyl and other fentanyl-related compounds, has deadly outcomes. Used as an animal sedative.

SYNTHETIC OPIATES GRAY DEATH Start with heroin. Mix in the powerful painkiller fentanyl, which has 50 times more punch. Add a dash of carfentanil, which is an animal tranquilizer 100 times more powerful than fentanyl and made to be used on tigers and elephants.

ARKANSAS CONTROLLED SUBSTANCES http://www.pharmacyboard.arkansas.gov/Websites/pharmacy/images/docu ments/controlled_substances_list.pdf

SYNTHETIC CATHINONES

EXPERIENCES WITH BATH SALTS A 33-year-old Hot Springs man who told authorities he was "tripping out" on bath salts is accused of causing thousands of dollars worth of damage to a fast-food restaurant This product is poison… After the first hour I started to feel the cocaine-ish comedown that grew increasingly worse. The left side of my chest began to tighten and my heart was beating faster than ever… Paranoia set in… I was very close to requesting hospital treatment, but I waited it out. I would get better, a little worse, back and forth, but eventually after 3 to 4 hours I was feeling thankful to be alive and sober… The reports of people dying, or going to the hospital ARE NOT BULL***T… This is dangerous poison that some scum is making cash off of in the most evil of ways.” —G.F. (Foundation for a Drug Free America)  

E-CIGS AND VAPING 11 percent of all high school students — nearly 1.7 million youths — reported using e-cigarettes within the past month. The booming, $10-billion vaping industry is expected to grow to $34 billion by 2021, but there’s still a lot scientists don’t know about how e-cigarettes affect health. Flavors are more likely to poisonthe immune system and raising the risk of infections and life-threatening diseases, according to new research. Mixing them up is even worse, a new study found. Flavoring chemicals and liquids used in the battery-powered devices are toxic to the white cells in the blood, warn scientists. Exposure can cause significant inflammation to monocytes – the biggest type of white blood cell in the immune system that combat bacteria and viruses.  

JUUL E-CIGS “Going viral” according to surgeon general Looks like a USB flash drive and charges by laptop Multi-flavors available Some schools are taking off doors on stalls due to use of the JUUL They can be filled with marijuana, a homemade substance, or a flavor pod which can deliver more than half the nicotine (and buzz) of other products Can be ordered online. $49.99 for starter kit on website/prepaid debit card The company puts out 20 million juul-related products per month Urban slang includes “wop”, “wop machine” and “juuling”

E-CIGS Conclusive evidence: E-cigarette use increases airborne concentrations of particulate matter and nicotine in indoor environments. Substantial evidence: Except for nicotine, exposure to potentially toxic substances from e- cigarettes is most often significantly lower than from conventional cigarettes. Limited evidence: The number of metals in e-cigarette vapor could be greater than the number of metals found in traditional cigarettes, except for cadmium, which is markedly lower in e-cigarettes. Substantial evidence: E-cigarette use increases risk of ever using traditional tobacco products among youths and young adults. Moderate evidence: E-cigarettes with nicotine are more effective than e-cigarettes without nicotine for smoking cessation. Limited evidence: E-cigarettes may be effective aids to help quit smoking. (FDA report Jan 2018)

E-Cigarette Regulations - Arkansas Use of vapor products or e-liquids on grounds of any school or at off-campus school-sponsored events, in or on the grounds of any child care facility or healthcare facility prohibited. Ark. Code Ann. § 26-57-254(b) and Ark. Code Ann. § 6-21-609(b) (2017) Use of e-cigarettes “prohibited on each campus of state-supported institutions of higher education.” Ark. Code Ann. § 6-60-804(a) (2017) Use of e-cigarettes in registered child-care facilities and/or vehicles prohibited. Ark. Admin. Code §§ 016.22.1-1101(8), and 016.22.6-1101(7) (2017) Use of e-cigarettes near State Park buildings restricted. Ark. Admin Code. § 013.05.1-1191 (2017)  

PREVENTION Arkansas has first in nation prevention curriculum for prescription drug abuse for high school students. Successful take back prescription programs

PREVENTION INFORMATION Arkansas Contacts Agency Arkansas Office of Alcohol and Drug Abuse Prevention 305 South Palm Street Little Rock, Arkansas 72205 National Prevention Network Contact Tenesha Barnes Early Intervention and Prevention Manager Arkansas Department of Human Services, Division of Behavioral Health Services 501-686-9982 Tenesha.Barnes@dhs.arkansas.gov(link sends e-mail) Epidemiologist Kristy Bondurant 501-212-8614 KBondurant@afmc.org(link sends e-mail)

FINAL THOUGHT PEOPLE ARE NOT ADDICTED TO IDEAS OF USING ALCOHOL AND DRUGS. THEY ARE ADDICTED TO ESCAPING REALITY, EVEN IF THE ESCAPE IS INTO DEATH.