1. Drugs Use and Abuse- Recognizing the Key Issues in Medical Settings Chapter 10-Drugs March 8, 2016

2. 2 KCSOS Prevention/Intervention Program Staff Sal Arias Prevention Specialist - Project 180 Gang Prevention saarias@kern.org 661-852-5661 saarias@kern.org Tatia Hunter-Jennings School Counselor – Prevention Programs tahunter-jennings@kern.org 661-852-5664 tahunter-jennings@kern.org Kevin Keyes Prevention Specialist-Tobacco Use Prevention Education (TUPE) kekeyes@kern.org 661-852-5665 kekeyes@kern.org Daryl Thiesen Prevention Programs Coordinator II dathiesen@kern.org 661-852-5649 dathiesen@kern.org Sal Arias Prevention Specialist - Project 180 Gang Prevention saarias@kern.org 661-852-5661 saarias@kern.org Tatia Hunter-Jennings School Counselor – Prevention Programs tahunter-jennings@kern.org 661-852-5664 tahunter-jennings@kern.org Kevin Keyes Prevention Specialist-Tobacco Use Prevention Education (TUPE) kekeyes@kern.org 661-852-5665 kekeyes@kern.org Daryl Thiesen Prevention Programs Coordinator II dathiesen@kern.org 661-852-5649 dathiesen@kern.org

3. What Is a Drug? Drug: substance other than food that affects the structure or function of the body through its chemical action –Psychoactive drugs change brain chemistry and alter consciousness, perception, mood, thought (intoxication) Drug of abuse: medical drug used for nonmedical (recreational) purposes, or a drug that has no medical uses Substance: drug of abuse, a medication, or a toxin; the term is used interchangeably with drug 3 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

4. Who Uses? Patterns of Illicit Drug Use Rates of illicit drug use vary by age, gender, race and ethnicity, education, employment status, and geographical region Among Americans aged 12 or older, more than 47% report having used an illicit drug in their lifetime The most commonly used drug is marijuana There is also a substantial misuse of psychotherapeutics (prescription-type drugs) 4

5. Who Uses? Patterns of Illicit Drug Use The number of college students who abuse prescription drugs increased dramatically between 1993 and 2005 –Pain relievers (e.g., OxyContin, Vicodin, Percocet): use increased by 343% –Stimulants (e.g., Ritalin, Adderall): use increased by 93% –Tranquilizers (e.g., Xanax, Valium): use increased by 450% –Sedatives (e.g., Nembutal, Seconal): use increased by 225% 5 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

6. How Bad Is It? 1 Prescription Drug Overdose Every 19 Minutes 40,393+ Drug Induced Deaths in 2010 4x Increase in Substance Abuse Treatment Admissions from 2004 to 2008 2,500 Teens Abuse a Painkiller for the First Time Every Day Prescription Drug Deaths Now Outnumber Traffic Accidents in the U.S.

7. Illicit Drug Use in Past Month 7 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

8. Trends in drug use Current use among persons 12 and older: 2012 NSDUH, 2013 8 Tobacco AlcoholMarijuana

9. Illicit Drug Use by Age 9 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

10. Effects of Drugs on the Brain Many addictive drugs act on neurons in three brain structures: –The ventral tegmental area (VTA) in the midbrain –Nucleus accumbens –Prefrontal cortex Neurons in these structures form a pathway referred to as the pleasure and reward circuit Addictive psychoactive drugs activate and cause surge in levels of dopamine and associated feelings of pleasure 10 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

11. Effects of Drugs on the Brain All or nearly all addictive drugs operate via the pleasure and reward circuit Some also operate via additional mechanisms, i.e., the opioids –Similar structure to endorphins, which block pain when the body undergoes stress Individuals trying to recover from addiction must overcome: –Altered brain chemistry –Drug-related memories –Impaired impulse control 11 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

12. Pleasure and Reward Circuit 12 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

13. Drug Misuse and Abuse Drug misuse: use of prescription drugs for purposes other than those for which they were prescribed or in greater amounts than prescribed, or the use of nonprescription drugs or chemicals for purposes other than those intended by the manufacturer Drug abuse: use of a substance in amounts, situations, or a manner such that it causes problems, or greatly increases the risk of problems, for the user or for others 13 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

14. Drug Misuse and Abuse Substance use disorders is defined by the DSM-5 as a number of cognitive, behavioral, and physiological symptoms that persist even as the individual experiences a number of significant life-changing substance-related problems –DSM-5 does not separate substance use disorders and dependence 14 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

15. Types of Drugs Drugs are classified in several different ways 1.Legal drugs include: –Medication prescribed by physicians –Over-the-counter (OTC) medications –Herbal remedies 2.Pharmaceutical drugs are developed for medical purposes, whether over-the- counter or prescription 3.Illicit drugs are unlawful to possess, manufacture, sell, or use 15 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

16. Drug Misuse and Abuse Many will continue to view substance use problems in terms of drug abuse, addition, dependence, withdrawal symptoms, and tolerance –Addiction is the chronic relapsing brain disease characterized by compulsive drug seeking and use, despite harmful consequences –Tolerance is reduced sensitivity to the effects of the drug –Withdrawal symptoms are uncomfortable feelings when drug use stops 16 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

17. Drugs of Abuse Drugs of abuse are usually classified as –Stimulants –Depressants –Opioids –Hallucinogens –Inhalants –Cannabinoids 17 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

18. Drugs of Abuse: Group Activity 1.Opioids 2.Cannabinoids-Marijuana 3.Stimulants 4.Depressants 5.Hallucinogens 6.Inhalants Task: Count off by 1-2-3-4-5-6, go over chapter 10, slides and any resources and fill out chart; prepare summary and present to the whole class 15 minutes to plan/3 minutes each to present 18 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

19. What type of drug is it? How is the drug typically ingested? What should we know about this drug and WHY should we remember it Jigsaw Activity List adverse effects of the drug 19

20. Routes of Administration Oral—most drugs are taken orally Injection –Involves a hypodermic syringe to deliver drug into the bloodstream by Intravenous injection Intramuscular injection Subcutaneous injection Inhalation: smoking or huffing Application to mucous membranes Application to skin 20 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

21. 21 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

22. Factors Influencing the Effects of Drugs Characteristics of the drug –Chemical properties of the drug and its actions Characteristics of the person –Age –Gender –Body weight and mass –Physical condition –Mood –Experience with the drug –Expectations Characteristics of the situation –Environmental experience 22 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

23. Central Nervous System Stimulants Drugs that speed up activity in the brain and sympathetic nervous system Effects similar to the “fight-or-flight” reaction May stimulate movement, fidgeting, and talking, and produce intense feelings of euphoria and create a sense of well-being Examples: –Cocaine –Amphetamines –MDMA (Ecstasy) –Bath salts –Caffeine 23 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

24. Stimulants Effects Dexedrine  Increased Heart Rate & Blood Pressure  Increased Breathing  Heart Attack  Lethal Seizures  Psychotic Episodes Adderall Ritalin

25. Central Nervous System Depressants Slow down activity in the brain and sympathetic nervous system Can be deadly if misused, especially when mixed with alcohol CNS depressants carry a high risk of dependence Examples: –Barbiturates and hypnotics –Anti-anxiety drugs (benzodiazepines) –Rohypnol –GHB (gamma hydroxybutyrate) 25 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

26. Opioids Natural and synthetic derivatives of opium Currently prescribed as pain relievers, anesthetics, antidiarrheal agents, and cough suppressants Produce feelings of pleasure and block the sensation of pain Examples: –Morphine –Heroin –Synthetic opioids (OxyContin, Vicodin, Demerol, Dilaudid, Percocet, Percodan) 26 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

27. Opioids With low doses opioid users experience: –Euphoria –Drowsiness –Constriction of the pupils –Slurred speech –Slowed movement –Impaired coordination, attention, and memory At high dosage users can experience depressed respiration, loss of consciousness, coma, and death Opioids have a high potential for dependence 27 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

28. Dose of Reality Natural OpiumMorphineCodeine Synthetic Fentanyl(Sublimaze)Methadone(Dolophine)Propoxyphene(Darvon)Pentazocine(Talwin) Semi-Synthetic Heroin(Diamorphine)Hydrocodone(Vicodin)(Lortab)Hydromorphone(Dilaudid) Meperidine(Demerol)Oxycodone(Percodan)(OxyContin)

29. Where Do Abusers Get Them? Where Do Abusers Get Them?

30. Hallucinogens Also known as psychedelics Alter perceptions and thinking in characteristic ways Intensify and distort visual and auditory perceptions and produce hallucinations Examples: –LSD (lysergic acid diethylamide) –PCP (phencyclidine) –Peyote 30 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

31. Inhalants Breathable chemical vapors that alter consciousness, producing a state that resembles drunkenness Active ingredients are all powerful toxins and carcinogens The most significant negative effect for chronic users is widespread and long-lasting brain damage Examples: –Paint thinner, gasoline, glue, and spray-can propellant 31 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

32. Inhalants Youth are intentionally breathing the fumes from common household and commercial productsYouth are intentionally breathing the fumes from common household and commercial products –Youth call it SniffingSniffing SnortingSnorting BaggingBagging HuffingHuffing Youth are intentionally breathing the fumes from common household and commercial productsYouth are intentionally breathing the fumes from common household and commercial products –Youth call it SniffingSniffing SnortingSnorting BaggingBagging HuffingHuffing

33. Cannabinoids Marijuana is the most widely used illicit drug in the United States –Derived from the hemp plant, Cannabis sativa –Active ingredient is delta-9-tetrahydrocannabinol (THC) –Use produces mild euphoria, sedation, lethargy, short-term memory impairment, increase in appetite, distorted sensory perceptions, distorted sense of time, impaired coordination, and an increase in heart rate Researchers have found that THC has a variety of effects on the brain, perhaps accounting for some impairments in problem solving and decision making 33 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

34. Today’s marijuana is not the marijuana of the 1960s. In the past 15 years, marijuana potency has tripled and since 1960 it grown 5 times stronger. Increased Potency 34

35. THC: Psychoactive Ingredient 35

36. Cannabis-related emergency hospital admission rates have been rising sharply in the US From an estimated 16, 251 in 1991 to over 374,000 in 2008 ER admission rates rising SAMHSA, 2011 36

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40. 40 KERN Stop METH Now… Did You Know” 77% of teens who have tried METH began using at age 15 or younger