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What’s New in the Drug World

Erin Foster, CPS

Director of Prevention Services

Area Substance Abuse Council

Electronic Smoking Devices:

Trends and Implications of Vaping

What They’re Saying…

• Kansas sees first vaping‐related lung illness death: 'It is time to stop vaping‘

• CDC says stop vaping as mystery lung condition spreads

• Sixth person dies from vaping‐related illness• Liquid used in e‐cigarettes damages cells crucial for a healthy heart

• Rutgers Study: Most People Who Smoke E‐cigarettes Want to Quit– 60% “want to quit”

• Teen vapers are using eBay to dodge age restrictions

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2018 Iowa Youth Survey TrendsCurrent (past 30 day) use of..

6th 8th 11th

Alcohol 3% 7% 20%

Cigarettes 1% 2% 4%

UsedMarijuana

1% 3% 11%

Used Rx Drugs

3% 3% 4%

E-cigarettes 2% 8% 23%

2016: 9%, 155% jump

“It’s Just Water Vapor!”

• It is an aerosol, not a vapor

• Aerosol is a mixture of liquid particles suspended in a gas and can contain many chemicals

• These chemicals are left behind in the lungs

List of Chemicals

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Sound Familiar? Well, You’ve Also Seen Them In:

• Gasoline

• Pesticides

• Embalming Fluid

• Nail polish

• Rubber

• Pain thinners

• Batteries

How much Nicotine? It varies, but usually A LOT

Emerging Trend:Dripping

• Dropping e-juice directly on to hot coils– Thicker, more “flavorful” aerosol

– Exposure to higher levels of nicotine and other toxins

– 20% of HS Students who vape have also dripped

– New warning: Teens using e‐cigarettes to 'drip' nicotine (2:19)

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Youth Impact

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Why is the Youth Market Important?

• The industry knows customers are getting older and need to be replaced to make more profits– Many e‐cigarette companies owned by major Tobacco companies (IE RJ Reynolds, British American Tobacco)

• Customers for life– 80% of adult smokers started before age 18

“mission is preventing the illegal sale of our products to youth”

Gateway to Tobacco

• Teens who use e-cigarettes are 4x more likely to start using tobacco products than those who don’t

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Drug Concerns:

E-Cigarette or Drug-Delivery Device?

“Versatility” of E-Cigarettes

• Nicotine “vapes” may have their cartridges/pods tampered to put in other substances– ie “hacking the juul”

• Many vape products sold specifically for THC– Pods could use cartridges 

from nicotine vapes

– “510 cartridge”‐ Used for concentrates 

THC “Pods”

Juul Compatible!

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For THC Concentrates

How Common are Drug Combinations?

• 2018 Study, Major Findings:– 39.5% of those using ESDs reported vaping illicit drugs

– Most common

• THC 18%

• MDMA 11.7%

• Cocaine 10.9%

• Opioids 14.4% (heroin, RX, fentanyl) 

Quick Look at Marijuana

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Not the same plant

• Source: Mehmedic et al., 2010

0.3 0.4 0.4 0.3 0.3 0.4 0.4 0.4 0.4 0.5 0.5 0.4 0.5 0.5 0.5 0.5 0.5 0.40.3

0.2 3.5 3.5 3.1 3.1 4.0 4.5 5.2 5.0 4.7 5.40.2 6.2 7.3 7.2 8.3 8.1 9.1 10.0 10.0 9.9 11.00.4 11.00.5 1.0 1.0 1.5 3.3 3.3

CBD:NON-Psychoactive

Ingredient

THC:Psychoactive

Ingredient

0.2%

THC:Psychoactive Ingredient

42%

CBDOnly

0

5

10

15

20

25

30

35

40

45

1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015

% Dry W

eight

Year

Cannabis: % THC Over Time

THC Nationally

THC Colorado

Slide use with permission from Sarah Urfer

“Concentrates are the Future of Cannabis”

Average of plant:• 1960’s was 2-4%• 2017 is 15-20%Current concentrates are 60-90%Industry reached 98% THC

“Concentrates are used in probably 95 percent of the branded products”

(ie: vape oils, the vape cartridges, the edibles)(aka: Dabs, budder, shatter, wax, oil, BHO)

Engadget.com

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THC Extraction

THC Products

THC Products

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“Fine edibles”

Medical Product

TREATMENT FOR• Inflammation• Nausea• Diabetes• Alcoholism• PTSD• Schizophrenia• Rheumatoid Arthritis• Epilepsy• Cardiovascular Disease• Psychosis• Anxiety• Muscle Spasm• Neuropathic Pain• Cancer

What Else is Going On?

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Newest Form: Liquid Meth

Manufacturers of this highly toxic drug are beginning to dissolve meth in water in order to liquefy the drugMade transporting the toxic drug so much easier

– Individuals who produce meth will often place this liquid form of the drug into various different types of liquor bottles

– Once the liquid meth has passed inspection and been shipped to its destination, individuals will then boil away the water

Only the solid form of meth will remain.

Newest Form: Liquid Meth

• “Better” form of Meth• Stronger than regular Meth• Made from made with substance named

Terofun (Pseudoephedrine HCL)• Only take minutes to make & less than 10

minutes to cook• Law Enforcement have found in gas tanks of

vehicles – 20 gallons street value is $10 Million

Other Trends• “Wasping”

– Combination of meth and insecticide

• May also be used as a substitute

– Uses active components of wasp spray to achieve “high”

– Sprayed on to or crystalized with meth

– Effects: newer trend but reports of hallucinatory sense of smell, trigger flight or flight, and toxic exposure

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Adderall

Adderall

• Adderall is a combination of amphetamine and dextroamphetamine that is used primarily to treat the symptoms of attention-deficit hyperactivity disorder (ADHD).

• It has benefits with sleep disorders and reported, off-label utility in managing some forms of severe depression as well.

• Central nervous system stimulant

Larger Issue-Mixing with Alcohol

• Adderall has the ability to mask certain indicators of intoxication that people would otherwise use to slow or stop their consumption. If these signs go unnoticed, the user is at risk of continued drinking—potentially leading to alcohol poisoning, coma, or death.

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Teen Adderall Abuse• According to SAMHSA's National Survey on Drug

Use and Health– 425,000 teens and adolescents between the ages of 12 and 17 reported misuse Adderall.

– Approximately 2.5 million among young adults age 18 to 25

• Teens who misuse Adderall are also– 3 times as likely to have used marijuana.– 8 times as likely to have used cocaine or prescription tranquilizers like Xanax and Klonopin recreationally.

– 5 times more likely to have misused prescription pain relievers.

Lean/Purple Drank/Sizzurp/Dirty Sprite

What is it?• A combination of the following:

– Prescription‐strength cough medicine.

– Soft drinks.

– Hard, fruit‐flavored candy

• The prescription cough syrups used to make lean drink present the most danger because they often contain codeine, a powerful opioid drug

• Another active ingredient in some prescription cough syrups is promethazine, an antihistamine that causes sedative effects and can impair motor functioning

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Large in Teen Culture• The U.S. Drug Enforcement Administration’s

figures show that one in ten American teens have sipped either over-the-counter or prescription syrup.

• Huge in the Hip Hop Culture– Known has “Hip Hop’s Heroin”

– Referenced in over 30 percent of rap songs that reached the top ten of Billboard’s Hot 100 in 2017

– 2014 Study found that codeine references more than tripled in rap songs between 2000 and 2007.

It’s Not Just One

The Unique Dangers of Mixing Substances

Big Picture• Data often scattered, prevalence of exact combinations

often poorly understood• Overdose data and qualitative dates show it’s common

– Federal Study: 70% of fentanyl/heroin deaths involved another drug; 74% of cocaine deaths involved another drug 

• Most common substances of abuse include:– Alcohol– Heroin/other opioids– Cocaine– Marijuana– Prescription drugs

• Youth Impact– Estimates show 15‐39% of adolescents can be classified as 

polysubstance users

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Alcohol & CNS Stimulants

– “Time flip” (alcohol and xanax)

• Dramatically reduced functioning with breathing and heart rate

• Used to “enhance experience”

• Exaggerates effects

• Liver damage

• Link to anxiety; depression

– “Snow coning” (Alcohol & Cocaine)

• Used to mask the negative effects of the other, enhances euphoric feeling

• Major stress on organs

• Brain damage, heart disease

• Ages 15‐24 4X more likely to binge drink

– Caffeine• “masks” alcohols depressant effects, will consume more, take more risks

Alcohol & Rx Drugs

• Alcohol & Opiates– Used to enhance effects of 

opiates

– Both depressants, all common effects to higher degree

– Increased absorption of opiate, exaggerated effects

– “dumping effects”• What might be meant for slow 

release could dump all at once

– Raises chances for fatal overdose

• Alcohol & Adderall– Considered fairly common, 

especially with younger users• 46.4% of non‐medical users 

combined with alcohol

• 19% with prescription combine with alcohol

– Alcohol & Adderall utilize same liver enzymes

– May increase alcohol’s initial stimulant effects in low doses, mask depressant effects

– May consume to fatal point of intoxication 

Other Popular Mixtures• Antidepressants & MDMA

– Used to “balance out” serotonin levels after psychedelic usage

– Can lead to “serotonin syndrome”

• Rise of serotonin in CNS

• Potentially life‐threatening 

• Cocaine and Opioids– Typically referred to as 

“speedball” (though sometimes meth)

– Often combined with synthetic opioids (fentanyl)

– “Push‐Pull” reaction• Cocaine requires more oxygen, 

opioids slow breathing

• Puts heavy strain and risks over activating parts of body including: brain, heart, lungs

– Very difficult for body to maintain appropriate levels of oxygen

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Other Popular Mixtures

• Benzodiazepines and Opioids

– Both heavily abused drugs individually

– 30% of Opioid Overdose deaths also involved a Benzo

– Many are prescribed simultaneously• 12 year study found 17% of continuous 

opioid subscribers were also prescribed a benzo

– Why dangerous?• Both classifications have high addictive 

potential• Benzos enhance the euphoric feeling of 

opioids• Increased sedation, depressed breathing

• Z-Drug Abuse– RX similar to benzos (CNS 

depressant) sold as popular sleeping medications

– Often abused with benzos, opioids

– Very similar actions, exacerbate side effects

• Especially depressed breathing

Marketing and Local impact

Tobacco Industry Success

Alcohol and marijuana following the same plan???

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Pro-Marijuana IndustryWants to shake the past and gain acceptance

1. Establish a brand/logo

2. Increase favorability– Promote benefits, dismiss negatives, create 

confusion

3. Increase visibility

4. Develop products

Has any of this occurred?

Marijuana’s brand?

What is this?  How many would recognize it?What colors are often paired with it?Celebrity support?TV and Movies?

Normalizing through TV

“cannabis guest starring more often on television shows as a casual or medicinal

product, rather than a taboo”

This is tobacco 101:Confuse, normalize, expand, protect

Celebrities, music, movies and TV

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New Marijuana magazines

• Broccoli

• Gossamer

• Push Mag

• Kitchen Toke

Hats

Socks

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Shirts

Who is the target?

Concealment

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Hidden Beverage

Fake tampon stashes

Paraphernalia Sold

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Paraphernalia sold for tobacco use?

OK?

Questions?

Erin Foster

efoster@asac.us

319-390-4611 Ext: 193