1. Copyright 2009 Seattle/King County EMS Overview of CBT 937 Street Medicine – Street Drugs Complete course available at www.emsonline.net

2. Copyright 2009 Seattle/King County EMS Introduction Street Drugs Trends in substance abuse are constantly changing Change is even more rapidly today due to easily accessible information on the Internet

3. Copyright 2009 Seattle/King County EMS Practical Skills Airway maintenance protection Assisted ventilation of patient with respiratory depression or respiratory arrest To receive CBT or OTEP credit, you must perform the following practical skills: A roundtable discussion is optional at the discretion of the training officer and evaluator. See skills checklist on EMS Online Downloads page.

4. Copyright 2009 Seattle/King County EMS Terms agonist — A substance that produces a specific action in the body by binding with a cell receptor, for example heroin. antagonist — A substance that blocks cell receptors preventing the physiological response of another substance. For example, Narcan (naloxone) is an antagonist to the opioid class of drugs. benzodiazepine — A class of medications that causes sedation. Uses include: anesthesia, treatment of seizures, treatment of serious anxiety or panic disorders and management of insomnia. dependence — A physical or psychological condition where the body requires a particular substance or chemical without which it reacts adversely.

5. Copyright 2009 Seattle/King County EMS Terms, continued huffing — The purposeful inhalation of chemical vapors to achieve an altered mental or physical state, also called dusting, snorting or sniffing. nystagmus — An unintentional, beating movement of the eyes where the eyes track in one direction and then move back mid-view repeatedly. opioid — A class of drugs that acts on the opioid receptors. Opioids receptors can inhibit pain and potentially cause symptoms of sedation, respiratory depression or euphoria. sympathomimetics — A class of drugs that stimulate the sympathetic nervous system. The also are called CNS stimulants. Examples are cocaine, caffeine and Ecstasy.

6. Copyright 2009 Seattle/King County EMS How Drugs Work Drug-receptor interaction is like lock and key

7. Copyright 2009 Seattle/King County EMS How Drugs Work, cont. Drug molecules are carried by the circulatory system to receptor sites in body tissues

8. Copyright 2009 Seattle/King County EMS How Drugs Work, cont. It is here that the drug molecules bind with the cell receptor and produce an action

9. Copyright 2009 Seattle/King County EMS Agonists Drugs that produce a specific action by binding with a receptor are agonists

10. Copyright 2009 Seattle/King County EMS Antagonists Drugs that block the body's own substances from fitting into a cell’s receptors are antagonists

11. Copyright 2009 Seattle/King County EMS Prescription Pain Medications Upward trend in misuse of prescription drugs is an increasing health and safety problem esp. among teenagers and young adults Vicodin, OxyContin and methadone account for a large percentage

12. Copyright 2009 Seattle/King County EMS Inhalants Trend among children and adolescents Chemical vapors can produce mind-altering effects “Huffing” or “sniffing” Gasoline, glues, sprays, nail polish, hair spray, cleaning fluids and butane

13. Copyright 2009 Seattle/King County EMS Club Drugs Used by teenagers and young adults at nightclubs, bars, parties and raves. Ecstasy, GHB, Rohypnol, LSD and ketamine Image credit: © iStockphoto

14. Copyright 2009 Seattle/King County EMS Over-the-Counter Medications Cough medicines, diet pills, motion sickness pills and sleep aids Cough and cold meds contain dextromethorphan (DXM) a nervous system depressant

15. Copyright 2009 Seattle/King County EMS Alcohol Most commonly abused and potentially dangerous substance Depressant qualities Causes severe CNS depression and death

16. Copyright 2009 Seattle/King County EMS Classes of Street Drugs Opioids CNS stimulants Depressants Hallucinogens Inhalants

17. Copyright 2009 Seattle/King County EMS Opioids Morphine-like action in the body Suppress CNS Prescribed for pain relief

18. Copyright 2009 Seattle/King County EMS Opioids, continued Heroin Morphine Methadone Vicodin OxyContin Codeine Demerol Darvon Dilaudid

19. Copyright 2009 Seattle/King County EMS CNS Stimulants Activate sympathetic nervous system and CNS Mimic effect of epinephrine Increase heart rate, constrict blood vessels and elevate BP and increase the work of heart Can raise body temperature and cause cardiac dysrhythmias

20. Copyright 2009 Seattle/King County EMS CNS Stimulants, continued Cocaine Crack cocaine Methamphetamine Ecstasy Amphetamines Ritalin Dexedrine

21. Copyright 2009 Seattle/King County EMS Depressants Sedate or depress CNS Treat anxiety and insomnia Abused by patient or gets into hands of someone who abuses them Effects include sedation, mild euphoria, loss of inhibition, relaxation and poor judgment

22. Copyright 2009 Seattle/King County EMS Depressants, continued Barbiturates DXM Xanax Librium Valium Ativan Klonopin Rohypnol Ambien GHB Image credit: Public domain, Kodak Photodisc

23. Copyright 2009 Seattle/King County EMS Hallucinogens Alter perception, thought or mood Effects: anxiety, panic, irrational behavior and psychosis Can lead to injury to both the patient and responders

24. Copyright 2009 Seattle/King County EMS Hallucinogens, continued LSD PCP Ketamine Mescaline Peyote Psilocybin mushrooms Use extreme caution! Hallucinogens can cause unpredictable behavior.

25. Copyright 2009 Seattle/King County EMS Inhalants Volatile solvents, aerosols and gases Sniffed to produce a state that resembles alcohol intoxication Effects: initial excitation, drowsiness, lightheadedness and agitation, loss of consciousness

26. Copyright 2009 Seattle/King County EMS Inhalants, continued Volatile solvents Paint thinners Paint removers Degreasers Dry-cleaning fluids Gasoline Lighter fluid Correction fluid Felt tip markers Glue

27. Copyright 2009 Seattle/King County EMS Inhalants, continued Aerosols Hair spray Deodorant spray Vegetable oil spray Fabric protector spray Spray paint

28. Copyright 2009 Seattle/King County EMS Inhalants, continued Gases Nitrous oxide Propane gas Computer keyboard cleaner Ether Chloroform Halothane Butane Propane Whipped cream dispensers (nitrous oxide)

29. Copyright 2009 Seattle/King County EMS Scene Safety Be aware of what’s going on around you Request police assistance Approach doors from the side Scope out two exits Be alert to changes in patient’s demeanor Leave patient an exit (don’t stand between him and the door)

30. Copyright 2009 Seattle/King County EMS Assessment Combining intoxicants is common Mixed presentation of signs and symptom Often unpredictable and dangerous

31. Copyright 2009 Seattle/King County EMS Street Drugs - Effects Opioids Shallow respirations Slow respiratory rate Hypotension Pinpoint pupils Lethargy Respiratory arrest Coma CNS stimulants Hypertension Tachycardia Cardiac dysrhythmias Hyperthermia Sweaty skin Dilated pupils Seizures, rigidity Agitation Delusions Paranoia

32. Copyright 2009 Seattle/King County EMS Street Drugs - Effects, continued Depressants Shallow respirations Slow respiratory rate Hypotension Lethargy, stupor Slurred speech Sedation Coma Hallucinogens Tachycardia Tachypnea Hypertension Panic Seizures Visual illusions Disorientation

33. Copyright 2009 Seattle/King County EMS Street Drugs - Effects, continued Inhalants Cardiac dysrhythmias Tingling Numbness Swollen membranes Coma

34. Copyright 2009 Seattle/King County EMS Immediate Threats to Life Opioids CNS stimulants Depressants Hallucinogens Inhalants Respiratory depression/arrest Hypotension Cardiac dysrhythmias Seizures Decreased level of consciousness Respiratory depression Self-inflicted trauma Violence Cardiac dysrhythmias

35. Copyright 2009 Seattle/King County EMS Emergency Care Maintain airway Prepare for vomiting Administer oxygen as needed Assist ventilation Monitor vital signs Anticipate cardiac arrest Treat for shock

36. Copyright 2009 Seattle/King County EMS Summary Drugs that produce a specific action in the body by binding with cell receptors are called agonists Antagonists are drugs that cause a specific action by binding with cell receptors and blocking other agonists

37. Copyright 2009 Seattle/King County EMS Summary, continued Current trends Prescription pain medications Inhalants Club drugs such as Ecstasy Over-the-counter meds such as DXM

38. Copyright 2009 Seattle/King County EMS Summary, continued Opioids have a morphine-like action and suppress the CNS Heroin Morphine Methadone Vicodin OxyContin

39. Copyright 2009 Seattle/King County EMS Summary, continued CNS stimulants increase heart rate, constrict blood vessels and open air passages Cocaine Crack cocaine Methamphetamine Ecstasy Amphetamines

40. Copyright 2009 Seattle/King County EMS Summary, continued Depressants depress the CNS Barbiturates DMX Xanax Librium Valium Ativan

41. Copyright 2009 Seattle/King County EMS Summary, continued Hallucinogens cause an alteration in perception, thought or mood LSD PCP Mescaline Peyote Psilocybin

42. Copyright 2009 Seattle/King County EMS Summary, continued Inhalants can produce a quick high that resembles alcohol intoxication with initial excitation, drowsiness, lightheadedness and agitation Volatile solvents Aerosols Gases

43. Copyright 2009 Seattle/King County EMS Summary, continued Emergency care Maintain airway Prepare for vomiting Administer oxygen as needed Assist ventilation Monitor vital signs Anticipate cardiac arrest Treat for shock