1

Nonmedical Use ofPrescription

Drugs

2

1. What is Nonmedical use of Prescription Drugs?

2. What are the Myths about Prescription Drug Use?

3. What are Stimulants?

4.What are Depressants (Narcotics & Sedatives)?

5. Are Over-the-Counter Drugs Dangerous?

6. What is the reality of prescription drug misuse?

33

Office of Applied Studies, SAMHSAAnesthetic and Life Support Drugs and Drug Safety and Risk Management Advisory CommitteesNovember 13, 2008

“Not prescribed for you”OR

“You took the drug only for theexperience

or feeling it caused”

(excludes Over-the-Counter medicine)

1. What is the meaning of NonmedicalUse of Prescription Drugs (Rx)?

4http://www.theantidrug.com/pdfs/prescription_report.pdf

Where do nonmedical users get pain relieverprescription drugs?

5

Stimulants

Sedatives

4.7 million

0.3 million

Narcotic Pain Relievers

Anti-Anxiety Medication

1.1 million

SOURCE: 2005 National Survey on Drug Use and Health (NSDUH), published Sept 2005 byDept of HHS / Substance Abuse and Mental Health Services Administration (SAMHSA)

1.8 million

In 2005, 6.4 million Americans Age 12+ used a Rx fornonmedical purposes in past month

Which prescription drugs are being abused?

Depressants

Stimulants

http://www.google.com/search?hl=en&rlz=1G1GGLQ_ENUS310&q=In+2005%2C+6.4+million+Americans+Age+12%2B+used+a+prescription+drug+for+nonmedical+purposes+in+past+

month&btnG=Search&aq=f&oq=&aqi=

6SOURCE: 2004 National Survey on Drug Use and Health (NSDUH) published Sept 2005 by theDept of HHS / Substance Abuse and Mental Health Services Administration (SAMHSA)

Nonmedical use of prescription drugs ranks 2nd

only to marijuana as the most prevalentcategory of drug abuse.

DepressantsStimulants

http://www.oas.samhsa.gov/2k6/pain/pain.cfm

77

•Prescription Drugs are “much safer” to use thanillegal drugs.

•“I think prescription drugs sound safer, even if they're not, justbecause they came from a company, and they wereprescribed to someone for a legitimate reason.”

Gilbert Quintero. Journal of American College Health. July-August 2009 v58 i1 p64(7).

•There’s “nothing wrong” with using prescriptionmedicines without a prescription “once in a while.”

•Prescription Drugs are not addictive.

•There are fewer side effects than street drugs.

2005 Partnership and Attitude Study (PATS) www.usdoj.gov/dea/concern/hydrocodone.ppthttp://www.theantidrug.com/pdfs/prescription_report.pdf

2. What are some Myths about Rx Use?

8

FROM SCHOLASTIC AND THE SCIENTISTS OF THE NATIONAL INSTITUTE ON DRUG ABUSE, NATIONALINSTITUTES OF HEALTH, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

9

StimulantMedication

10

Amphetamines, MethamphetaminesAmphetamine Congeners & Diet Pills

Intended Use:Narcolepsy, Obesity, Attention-deficit hyperactivitydisorder (ADHD), Milder stimulants to lose weight.

Nonmedical use:Surge of pleasure, rush or flash, burst of energy, to stayawake, Anorexia, Euphoric Effect

Physical effects: include increased blood pressure, heartrate and pulse rates, insomnia, loss of appetite, andphysical exhaustion.

Drugs causing similar effects cocaine, crack,methamphetamine, khat

http://www.getsmartaboutdrugs.com/drugs/amphetamines.html?v=0&t=0&p=1&f=0&df=0&dt=0http://www.drugabuse.gov/ResearchReports/Prescription/prescription4.html#HowDo

3. Prescription Drug: STIMULANTS

12

Signs of AbuseNervousness, insomnia, over confident, aggressive, paranoid, lossof appetite, violent, euphoria, increased blood pressure.

Signs of WithdrawalApathy, long periods of sleep, irritability, depression, disorientation.

Signs of an OverdoseAgitation, increased body temperature, hallucinations, convulsions,apathy, long periods of sleep, depression, disorientation & possibledeath.

Signs of Long-term UseHeart disease, mental imbalances, paranoid, aggressive, twitching,malnutrition, dehydration & psychotic, deplete energy sources &severe depression.

Prescription Drug STIMULANTS

http://www.usdoj.gov/dea/pubs/abuse/chart.htm

13

Prescription Drug STIMULANTSHow Stimulants can Kill:1-Brain damageIncreased blood pressure increases the risk of a rupturedblood vessel in the brain. Narrowing of blood vesselsreduces blood flow around the brain.2-Heart attackIncreased oxygen demand by the heart (because ofincreased motor activity) accompanied by reduced bloodsupply (narrowing of blood vessels) can lead to heart attack.3-OverheatingOne function of dopamine is to regulate body temperature.Altering dopamine levels with stimulants can affect thebody's ability to cool itself. Combined with increased motoractivity, this can lead to a dangerous increase in bodytemperature, resulting in organ failure and death.

http://learn.genetics.utah.edu/content/addiction/drugs/overdose.html

2008 DATA

Rates of Emergency Department visits, by drug,type of use and age- ADHD Stimulant Medicine

15

ADHD Stimulant Medicine-Adderall® and Ritalin®

While students feel smarter and moreintelligent, the use of stimulantsdoesn't make them "smarter" or"better", it just makes their body'sorgans worker harder and can actuallylead to the inability to concentrate orthink clearly for any length of time.

See Adderall Misuse on College Campuses

16

Cocaine- Slangs: Coke, Blow, Toot, Snow, Nose, Big C,

Methamphetamine- See next slide

Methyldioxymethamphetamine- MDA,MDMA Slangs: Ecstasy, rave, lovedrug, XTC, Adam *No one other drug is quite like MDMA, but MDMA producesboth amphetamine-like stimulation and mild mescaline-like hallucinations.

*tweaking- severe paranoid, hallucinatory, hyper vigilant thinking,& greater suicidal depression

Illegal Comparisons and/orNot considered legitimate for medical use: STIMULANTS

Ecstasyhttp://www.whitehousedrugpolicy.gov/streetterms/ByType.asp?intTypeID=3 http://www.usdoj.gov/oig/special/9712/appb.htm

Cocaine Crack Cocaine Paraphernalia Crack Pipe

17

http://www.oas.samhsa.gov/2k8/methamphetamineTX/meth.pdfhttp://www.deadiversion.usdoj.gov/drugs_concern/meth.htmhttp://www.getsmartaboutdrugs.com/drugs/methamphetamine.html?v=0&t=0&p=2&f=0&df=0&dt=0

Crystal Meth

Meth Powder

Desoxyn®

Desoxyn®:There is only one product currently marketed in 5 mgtablets. Desoxyn® has very limited use in the treatment ofobesity, and attention deficit hyperactivity disorder.Slangs: Yaba (pill form)

Meth Illicit Use:Meth abuse is also manifested by extreme anorexia,memory loss and severe dental problems.

•Slangs: Batu, Black Beauties, Chalk, Chicken Feed, Tina,Crank, Crystal, Glass, Go-Fast, Hiropon, Ice, Meth, Trash,Methlies Quick, Shabu, Poor Man's Cocaine, Shards,Speed, Stove Top, Tweak, Ventana, Vidrio, Yellow BamMeth speed ball- Methamphetamine combined with heroin

Methamphetamine (Desoxyn®)vs. Methamphetamine (Meth) pg. 2

18

•Currently, methamphetamine is primarily producedby utilizing diverted pseudoephedrine combinationproducts. (Now behind the counter at stores.)

•Meth changes brain chemistry, and after extendeduse, the brain can no longer respond to dopamine(feel-good chemical produced by the brain).

•Psychotic symptoms can persist for months andeven years after use of these drugs has ceasedand may be related to their neurotoxic effects.

http://www.deadiversion.usdoj.gov/drugs_concern/meth.htm http://www.tcada.state.tx.us/http://www.kalispell.com/stopmeth/what_is_methamphetamine.htm http://www.drugfree.org/Files/Meth_Fact_Sheets

Methamphetamine (Desoxyn®)vs. Methamphetamine (Meth) pg. 2

19

Tolerance and Cross-Tolerance

http://www.merriam-webster.com/medical/cross-tolerance

Tolerance- Decrease in susceptibility to the effects of adrug due to its continued administration. (An increase inthe amount of drug is necessary to get a similar high… theoriginal “high” is almost impossible to feel again.)

Cross-tolerance- Tolerance or resistance to a drug thatdevelops through continued use of another drug withsimilar pharmacological compound.

These factors increase the health risk when using drugs.

20

DepressantMedication

21

Sedative-Hypnotics&

Narcotics/Opioids

Similarities- Slowed breathing, high potential fortolerance & dependence (addiction).

** Alcohol is a depressant and illegal for people underthe age of 21 in the United States.

http://www.getsmartaboutdrugs.com/drugs/narcotics.html?v=0&t=0&p=2&f=0&df=0&dt=0

4. Prescription Drug Depressants

22

4. Prescription Drug Depressants-Sedative/Hypnotics

Intended Use-•To relieve Anxiety, Tension, Panic attacks, Acute stressreactions, Seizures, Sleep disorders, Epilepsy, Anesthesia(at high doses).•Muscle Relaxants- overall suppresses the Central NervousSystem.

Nonmedical Use-•To relieve agitation, induce mild euphoria, lower inhibitions.•Often use in conjunction with other drugs.•Very similar to the emotional and physical effects of alcohol.•Blackout, brownouts, suicide attempts.•Date Rape Drug

http://www.drugabuse.gov/ResearchReports/Prescription/prescription3.html#HowDo

24

Signs of Abuse- Slurred speech, disorientation, drunkenbehavior without odor of alcohol, impaired memory of events,interacts with alcohol.

Signs of Withdrawal- Headaches, tremors, musclestwitching, nausea and vomiting, anxiety, restlessness,yawing, inability to focus, sleep disturbance, dizziness,delirium, convulsions, possible death. Can be fatal andshould be medically supervised.

Signs of an Overdose- Shallow respiration, clammyskin, dilated pupils, weak and rapid pulse, coma, possibledeath.

http://www.usdoj.gov/dea/pubs/abuse/chart.htm

4. Prescription Drug Depressants-Sedative/Hypnotics

25Sign of Abuse by Gary Fisher & Thomas Harrison

Signs of Long-term Use- Disrupt thetransfer of information from short to long-termmemory. Benzodiazepines: impair the ability tolearn new information.

Alcohol- a CNS depressant, overdose iscommon, has damaging effects on every organsystem, most dangerous psychoactive drug. (Also, tolerance to alcohol results in tolerance tominor tranquilizers.)

Prescription Drug Depressants-Sedative/Hypnotics

26

Benzodiazepines: Flunitrazepam- Rohypnol®(banned in the US but legal in over 60 countries)

A small white tablet with no taste or odor when dissolved ina drink.

•Slangs- Forget-me pill, Mexican Valium, R2, Roche, roofies,roofinol, rope, rophies, date rape drug•Short Term effects: The drug creates a sleepy, relaxed, anddrunk feeling that lasts 2 to 8 hours. Other effects may includeblackouts, with a compete loss of memory, dizziness anddisorientation, nausea, difficulty with motor movements andspeaking.

Illegal Comparisons and/orNot considered legitimate for medical use:

Depressant- Sedative/Hypnotics

http://www.drugfree.org/Portal/Drug_guide/Rohypnol#

27

Intended Use-Postsurgical pain relief, Management of acute or chronicpain, Relief of cough and diarrhea

Nonmedical Use-•Deaden emotional pain•Get a rush•Induce euphoria•Prevent withdrawal symptoms

There is no limit to the development of opiod tolerance.

http://www.drugabuse.gov/tib/bupren.html

Prescription Drug Depressants-Narcotic/Opioids

Lifetime Nonmedical Use of Selected Pain Relievers,Age 12 or Older: 2007

28

0.5

0.6

0.9

1.0

1.8

2.7

3.1

4.7

7.6

8.1

0 2 4 6 8 10Percent Using in Lifetime

Ultram®

Methadone

Morphine

Demerol®

OxyContin®

Codeine

Hydrocodone

Percocet®, Percodan®, or Tylox®

Darvocet®, Darvon®, or Tylenol®

with Codeine

Vicodin®, Lortab®, or Lorcet®

Hydrocodone

Oxycodone

Office of Applied Studies, SAMHSAAnesthetic and Life Support Drugs and Drug Safety and RiskManagement Advisory CommitteesNovember 13, 2008

Propoxyphene (Darvocet and Darvon)

Oxycodone

Hydrocodone

Office of Applied Studies, SAMHSAAnesthetic and Life Support Drugs and Drug Safety and Risk Management Advisory Committees, November 13, 2008 29

Nonmedical Use of Pain Relievers in Past Year among PersonsAged 12 or Older, by Sub state Region: Percentages, AnnualAverages Based on 2004-2006

30

31http://www.getsmartaboutdrugs.com/drugs/narcotics.html?v=0&t=0&p=2&f=0&df=0&dt=0

Prescription Drug Depressants-Narcotic/Opioids

Signs of AbusePinpoint pupils, sluggishness, shallow breathing andsuppressed cough, slow pulse, low blood pressure,constipations, dryness of mouth, euphoria, numbness,slurred speech, sunken eyes.Signs of WithdrawalFlu-like symptoms, muscle cramps, dilated pupils, coughing,high blood pressure, rapid pulse, diarrhea, sweating, runnynose, anxiety, severe depression, loss of appetite, irritability,tremors, panic and vomiting. Symptoms are unpleasant anduncomfortable but rarely dangerous.Signs of an OverdoseSlow and shallow breathing, clammy skin, convulsions,coma, possible death. A single dose can be lethal to aninexperienced user.

32

Prescription Drug Depressants-Narcotic/Opioids

ToleranceDevelops physical tolerance rapidly when the drugs arerepeatedly administered and psychological tolerance isexhibit later at a slower rate. This tolerance results in theindividual’s using doses that would kill a nontolerant person.

Cross-ToleranceOccurs between natural and synthetic opioids but there is nocross-tolerance to CNS depressants (sedative/hypnotics).

Signs of Long-term UseSevere constipation, women’s period delayed, sexual desiredulled. Heavier users- eyelids droop and the head nodsforward, coordinating slowed. High tolerance and addiction.

33

Taking a large single dose could cause severerespiratory depression or death.

Typically, opioids should not be taken with alcohol,antihistamines, barbiturates, or benzodiazepines.These other substances also suppress breathingand their effects in combination with opioids couldlead to life-threatening respiratory depression.

*There is always the possibility of a lethal reactionto any drug.

How can one OxyContin pill kill you?

http://www.drugabuse.gov/ResearchReports/Prescription/prescription8.htmlhttp://www.nida.nih.gov/infofacts/PainMed.html http://www.drugabuse.gov/infofacts/PainMed.html

Under normal conditions, excitatory and inhibitorysignals are in balance, resulting in controlled, regularbreathing.

Excitatorysignal Inhibitory

signal

Heroin increasesthe inhibitory effectsof GABA. (Increases

the calming effect.)

Alcohol decreasesthe excitatory effectsof glutamate

Under the influence of alcohol or opioids, excitatoryand inhibitory signals are out of balance, suppressingthe impulse to breathhttp://learn.genetics.utah.edu/content/addiction/rewa

rd/pathways.html

A combination of heroin andalcohol can be especiallydangerous. Opioids andalcohol both suppressbreathing, but by differentmechanisms.

Many of the drugs beingabused affect eitherglutamate or GABA orboth to exert tranquilizingor stimulating effects onthe brain.

Neurotransmittersbrain's major "workhorse"

35

Heroin•Heroin is processed from morphine (a naturally occurringsubstance extracted from the seed pod ). It comes in severalforms, the main ones being "black tar" from Mexico (primarilysold in the western United States) and white heroin fromColombia (primarily sold on the East Coast.)

•Slangs: Smack, junk, tar, Mexican brown, cheese, Harry,skag, Rufus, Perze,”H”, horse, dava, boy Vick, Watson 387

•Following this initial euphoria, the user goes "on the nod,"an alternately wakeful and drowsy state. Mental functioningbecomes clouded due to the depression of the CNS.

Illegal Comparisons and/orNot considered legitimate for medical use: Opioids

http://www.drugfree.org/portal/drug_guide/heroin# http://www.tcada.state.tx.us/research/slang/terms.pdfhttp://www.getsmartaboutdrugs.com/content/drugs.aspx?duid=27eccf9b-2ceb-4f72-9076-25a11387c2f2&v=1&t=0&p=1&df=1&f=0&dt=0

36

According to the Centers for Disease Control and Prevention (CDC) NationalCenter for Health Statistics, unintentional overdose deaths* involvingprescription opioids increased 114 percent from 2001 (3,994) to 2005(8,541), the most recent nationwide data available.

Narcotic Prescription Drugs Only -Unintentional Overdose Deaths

*Does not include people prescribed drugs who died nor intentional overdoses (suicides).

http://www.usdoj.gov/ndic/pubs33/33775/execsum.htm#Figure1

37

Over-the-CounterMedicine

38

•Some over-the-counter (OTC) drugs, primarily cough andcold remedies that contain dextromethorphan (DXM), a coughsuppressant, are used to get high. Products with DXM includeNyQuil®, Coricidin®, and Robitussin®, among others.

•Slangs: CCC, Dex, DXM, Poor Man's PCP, Robo, Rojo,Skittles, Triple C, Velvet

•Illicit use of DXM is referred to on the street as "Robo-tripping," "skittling” or “dexing."

•In 2006, about 3.1 million people aged 12 to 25 had used anOTC cough and cold medication at least once to get high, andnearly one million had done so in the past year. (SAMHSA, 2008)

http://www.theantidrug.com/pdfs/prescription_report.pdf http://www.nida.nih.gov/infofacts/PainMed.htmlhttp://www.getsmartaboutdrugs.com/drugs/dextromethorphan_dxm.html?v=0&t=0&p=1&f=0&df=0&dt=0

5. Are Over-the-Counter Drugs Dangerous?

39

5. Are Over-the-Counter Drugs Dangerous? (con’t.)

•Retailers are required of non-prescription products containingpseudoephedrine, ephedrine and phenylpropanolamine to placethese products behind the counter or in a locked cabinet.(Methamphetamine is primarily produced by utilizing divertedpseudoephedrine combination products.)

•Pseudoephedrine products include- Drixoral, Zyrtec-D 12-Hour,Advil Allergy Sinus, Mucinex D, Children’s Motrin Cold, Sine-AidIB, Claritin-D 24 Hour, Sudafed 24 & 12 Hours, Afrinol.

Photo showschemicals, wastematerials,& emptypseudoephedrineblister packs.

http://www.usdoj.gov/ndic/pubs1/1837/1837p.pdfhttp://www.usdoj.gov/ndic/pubs36/36407/index.htm#foota

40

7. What is the Reality ofPrescription Drug

Misuse?

41

The reality is that brothers,grandparents, friends, moms, uncles…

are dying everyday due to misuse ofprescription drugs.

In 2009, Florida’s Medical Commission reportedprescription drugs such as oxycodone, Xanax and Valium

were present in 79 percent of the 8,653 drug-relateddeaths.

Don’t regret ignoringthe problem.

42

Josh’s doctors were aware of hisaddiction problem and continuedto prescribed him narcotic drugs.

At the age of 22,Josh wasprescribedOxyContin after aback injury. He gothooked andoverdosed threetimes, before a hetook a combinationof three prescribeddrugs that killedhim -one daybefore his 25thbirthday.

43

On August 18th, 2006, Emily,only eighteen years of age andthree days from her first day incollege, was killed accidentallywhen she consumed OxyContinthat had been prescribed for arelative.

Emily was not an experienceddrug user, and all it took wasone encounter with this drug.She had no chance to learn fromthis one-time experience. Hadshe any idea how deadly thisdrug was, she would still bealive.

44

Patrick Stewart died on July 9,2004 at 24 years of age afteringesting just one OxyContin® .

He had no other drugs in hissystem and only a small amountof alcohol.He was a SDSU graduate, a graphicdesigner and a certified personal trainer.His friends described Patrick as "the onewho puts you back on your bicycle afteryou fall off". He made the tragic mistake ofbelieving someone at a 4th of Julycelebration when he was told thatOxyContin was "sort of like a musclerelaxant, that it was prescription and FDAapproved, so therefore safe".

Close friends say that Patrickhad never before taken anOxyContin, did not know it wasequivalent to "heroin in a pill".

45

Robby L. Garvin24 years old

Died 6-11-2006Death caused by Methadonetoxicity. Robby died 40 hoursafter he took his first dose of thisdrug that was prescribed to himfor pain. Robby was neverinformed by the prescribingdoctor or the pharmacy thatfilled this prescription of thedangers and possible death thatMethadone may cause.

46

If you suspect someone is abusing and/or addicted to drugsbe proactive and persistent… addicts tend to lie and bedishonest as a means of continuing their habit, and as adefense mechanism. They are often even lying tothemselves that they have a problem. Seek Professionaland Medical advice. Don’t regret ignoring the problem.

For additional information on prescription drug abuse,addiction, support groups, and recovery please visit

www.StopRxDrugAbuse.org