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*New trends insubstance abuse-impact of drugs

Lynn Riemer“Mad”Chemist

trainings@actondrugs.org720-480-0291

Facebook/ACTonDrugsACT on Drugs 2018

*Drugs affect the parts of the brain thatdeal with: *Coordination, balance,

reaction time, altered timeand spacial perception, musclerigidity, lethargy

*Judgement, cognition, decisionmaking, speech, processing,understanding

*Short term memory, recall,attention, feelings/emotions

*Heart rate, blood pressure,breathing, body temperature –cold and clammy to sweatingACT on Drugs 2018

*Things to pay attention to… ..

*Behaviors – abnormal behaviors, boisterous orargumentative, non responsive, withdrawn, fidgety,lack of eye contact, agitated, abusive, denial ofuse, changing emotions and erratic behaviors

*Physical indicators – breath or body odor, drymouth, sweating to cold and clammy, increase ordecreased heart rate & BP, irregular breathing,groggy sleepy expression, constricted pupils,dilated pupils, tremors, uncoordinated andunsteady gait, unnecessary use of arms or supportsfor balance

*Speech – slow and slurred, nonsensical patterns,confused, can’t follow conversation

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*Over 17,000 varieties of flavored e-juice / e-drops

*Regulated by the federal and stategovernment –illegal for under 21

*Vapes are a new way to disguise druguse, especially MJ Concentrates

*A liquid solution containing varyingamounts of chemicals, water,nicotine, metals, formaldehyde,cancer causing agents, Acrolein,diacetyl, and propylene glycol(antifreeze family)

*E-Cigs, vapes, mods, e-juice

*Nicotine and health… .

*Nicotine is stimulant that is extremelyaddictive and very hard to get off of

*Binds on 6 receptors in the brain

*Symptoms of nicotine poisoning includenausea, vomiting, dizziness, tremors,sweating and quickened heart rate.

*In severe cases, nicotine poisoning cancause seizures and death, according to theNational Poison Center

*EVALI (e-cig/vaping associated lunginjury)

*As of Feb 2020, over 4,600 cases ofvaping related illnesses

*68 deaths have been confirmed in 29states

*82% of hospitalized patients report THCuse (33% - exclusively THC)

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*FDA is examining whethervitamin E acetate, a vape-juicethickener, has played a role inthe respiratory illnesses anddeaths. Found in tissue samplesof 48 of 51 EVALI patience

*What causes this illness? Avapor of ultra fine heated oilparticulates that absorb deepinto lung tissue causinginflammation of the lining of thelungs.

*EVALI (e-cig/vaping associated lunginjury)

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*X-RAY of 18YO female lungs after vaping

Day admitted to hospital –black = air

3 days later on ventilator - atypicalpneumonia or severe lung distress

*X-RAY of lung transplant patient

*What is the real cost ofvaping???

*Built portable ECMOmachine to transport tohospital for transplant

*Life expectancy lower

*On immunosuppressantdrugs for life

*What happens if bodyrejects lungs

* Will this become thefuture for people vaping?

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JUUL vapes and pods The amount ofnicotine in each

JUUL Pod isequivalent to one

pack of cigarettes

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*One bar has about 300puffs and can contain asmuch nicotine as 2 or 3packs of cigarettes

*Research shows nicotineis addictive and harmfulto adolescents'developing brains

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*According to Bonnie Halpern-Felsher,a developmental psychologist atStanford:

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1500 puffs each$120/box10 per box

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It’s aboutdisguise!

*Vapes/Mods for Marijuana…

For concentrates –oil or wax

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*Vape pens… .

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*IPhone vape cover… … .

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*Vape watch… ..

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*Vaprwear clothing

* Below are some common prescription andOTC drugs that can impair drivers:

*Antihistamines: Many ofthem slow reaction time andimpair coordination.

*Decongestants: Many over-the-counter decongestantscan cause drowsiness,anxiety and dizziness.

*Abuse/High doses can causehyper-stimulation,hallucinations, increasedheart rate & BP, sweating,vomiting, panic and agitation

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**The challenge is a new social media fadwhere teens on Tik Tok are encouragedto take as much allergy medicine as ittakes to trip out, or hallucinate, usuallya dozen or more doses of the pill

*In May, 3 teenagers were hospitalizedin Fort Worth, Texas after overdosingon diphenhydramine (aka Benadryl) Kidscall it DHP

* 14 YO Female took 14 pills, hadfractured sentences, hallucinations, andresting HR 199

*Death of 14 YO being investigated fromBenadryl death last week

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**Potential for fatal heart rhythmdisturbances when combined with othermedications

*“Blocks the cholinergic nervous systemwhich is responsible for salivaproduction, tear production, andfacilitates bodily functions such asurination. Heart rate, body temp, brainfunction and eye functioning” Robert Weber Pharm.

D. Ohio State University

*Effects of large consumption:

*High body temperature, Confusion,Blurred vision, Nausea, Vomiting,Unsteadiness, High blood pressure,Hallucinations, Seizures, Braindamage, Heart attack, and Death

**Driving accidents and deaths

*Decreased employment pool,absenteeism, theft, increased healthcare and worker’s comp costs

*Increase in ER visits & Hospitalization

*Increase in work place violence

*Increase in crime and criminalorganizations

*Increase in youth use – marketing toyouth

*Gateway to harder drugs (coke, meth,heroin)

*Homelessness and mental healthissues/depression

**#1 in Teen Vaping – confirmed vaping in 4th graders

*#1 in every age group of use for Marijuana

*#3 in abuse of ALL illicit drugs by teens

*#2 in teens needing treatment

*#49 in nation with money for treatment

*#5 in teen suicides, #9 all suicide

*# 43 in graduation rates from High School. In lowincome areas Colorado drops to #47

*Last 2 years Coke, Meth, and Heroin in middle and highschools – Middle Schools have had heroin overdoses

*Our governor decriminalize Coke, Meth & Heroin

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Number of deaths by suicide per 100,000 adolescents ages 15-19 Colorado•United States - national average

CDC WONDER Online Database, Underlying Cause of Death

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* Colorado Data2014-2017 toxicology results youth 10-17

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Source: Colorado Department of Education, at

http://www.cde.state.co.us/cdereval/suspend-expelcurrent.

ACT on Drugs 2020* Colorado Youth MJ Use Data

More than half of high school students who use marijuana reported that they dabmarijuana to get high. Healthy Kids Colorado Survey 2019

*Spike in Meth and Coke deaths…

“Bubbles”“Rosin”

99% pure THC

THCa crystalline100% pure

$120 per gramACT on Drugs 2018

*MARIJUANAConcentrates

*Bud dipped in wax andwrapped with Kiefshake

*Smoke rolled in paper,in a pipe/bong

*Cannabis Caviar, Weed Caviar, Caviar Weed

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*Marijuana inhalers… … … .. *10mg DissolvableTHC

*THC GreenTea

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*THC Candies5mg each

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*Marijuana Tampons160 mg THC

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*Repetitive vomiting episodes, abdominal pain andyelling (”scromitting”)

*Seen daily in ER’s – no age limits

*The cause of hyperemesis is unclear

*Frequently present with marked electrolyteabnormalities.

*High costs – average cost to diagnose (ED andradiologic costs) - ~77K US dollars

*Resolution after stopping cannabis(Simonetto, DA et al, Mayo Clinic Proceedings 2012;87(2)114-9)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6339733/

*Hyperemesis Syndrome

ACT on Drugs 2017

*Hyperemesis Syndrome

*Ulceration or inflammationof the posteriororopharynx or vocal cords

*Evidence of pulmonaryaspiration

*Cavities of the back teeth

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**There are many new and emerging studies that showuse of cannabis changes the epigenetic make up ofthe user’s chromosomes – male and female.

*These are passed down to their offspring – lendinga predisposition to addiction.

*There are other genetic abnormalities being seenwith children of THC consumers.

*Head start/early childhood development programsreport an increase in children with autism spectrumdisorder and with emotional/behavioral issues.

*https://www.drugabuse.gov/publications/drugfacts/genetics-epigenetics-addiction

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*Cannabinoid and opioid receptors belong to thesubfamily of G-protein-coupled receptors

*Studies showing THC damages the receptors, and higheramounts of Opioids needed for pain relief, thus increasein OD

*A Lancet study found that heavy marijuana users end upwith more pain and are more likely to abuse opioids

*Opioids and cannabinoids both can cause sedation, lowblood pressure, drop in body temp, decreased intestinalmotility, euphoria, and pain relief.

*In 2017 Colorado had a record number of opioidoverdose deaths from any opioid, including heroin andColorado has had a medical marijuana program since2001.

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Colorado Department of Public Health and Environment, Vital Statistics Program

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* **Synthetic opioids are often prepared in powder ortablet form

*Can be mixed with street level traditional opioids(hydrocodone, oxycodone, heroin, fentanyl) andstimulants (ecstasy, coke and meth)

*Effects of severe opioid intoxications include:

*Loss of consciousness

*Bradypnea

*Hypercapnia

*Arterial hypotension and miosis

*Fatal Respiratory Depression

*Require large amounts of Naloxone

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*“Iso” “Toni”

*Isotonitazene is the most persistent and prevalentnew opioid in the U.S.

*Isotonitazene is derived from a powerful opioidcalled Etonitazene, was first identified during themid-1950s and is about 60 times more potent thanmorphine- may require large amount of Naloxone

*Isotonitazene is dissimilar in structure to popularsynthetic opioids typically encountered in forensiccasework (e.g. fentanyl analogues)

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Fentanyl

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*“Iso” “Toni”

*Reports seeing nearly 40-50isotonitazene related deaths permonth in the U.S. First linked in2019 in Midwest

*Isotonitazene was detected inover a dozen overdose deaths inIllinois and Indiana, where it wasmixed with cocaine

*Now it is being used to makecounterfeit pain medication

*1,900 tablets found in Nova Scotia- identical to an 8mg Dilaudid(hydromorphone) tablet

*New novel psychoactive substance(NPS) (aka research chemical) thathas no currently approved clinicalusages

*As of June 2020, it is listed as aSchedule I drug

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*The heroin and fentanylmarkets, alreadyintertwined, willcontinue to result intraffickers mixingheroin with fentanyl tostretch heroin suppliesand maximize revenues.

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*substance tested positivefor fentanyl, heroin,Tramadol, and traces ofmeth

*seen in Ohio and Canada sofar -there's a good chanceit's going to spread acrossthe country

*not only dangerous for drugusers, but for unsuspectingofficers or anyone who thinkthey might be handling weedwhen it's actually fentanyl

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Paraphernalia

Can hide odors of smokingin the house by filling anempty toilet paper rolewith dryer sheetsCan make pipes out offruit

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Paraphernalia

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*Ways to hide drugs

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Questions?Comments?Answers?

Lynn Riemer720-480-0291

trainings@actondrugs.org

ACT on Drugs 2018