Pills and Potions: You took what? Mark G. Oraskovich, MD Objectives: • Identify past, current, and future trends in drugs of abuse • Describe the basic pharmacology associated with current drugs of abuse • Recognize common clinical presentations seen with drug abuse in the Emergency Department setting • Identify effective treatment
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Pills and Potions: You took what?
Mark G. Oraskovich, MD
Objectives: • Identify past, current, and future trends in drugs of abuse • Describe the basic pharmacology associated with current drugs
of abuse • Recognize common clinical presentations seen with drug abuse in
the Emergency Department setting • Identify effective treatment
Pills, Powders & PotionsCurrent Trends in Drugs of Abuse
Mark Oraskovich, MD, FACEPMay 15, 2015
• Identify past, current, and future trends in drugs of abuse
• Understand the basic pharmacology associated with current drugs of abuse
• Recognize common clinical presentations seen with drug abuse in the Emergency Department setting
• Identify effective treatment modalities for common toxidromes associated with drugs of abuse
Quiz Time !
Can you name the drug ?
Name this drug ?
Name this OTC drug commonly abused by teens
Drug Abuse Timeline3500 BC - Earliest reports of alcohol production
1884 - Sigmund Freud treats his own depression with cocaine. Describes “Exhilaration and lasting euphoria”
1889 - Dr William Halsted founds John Hopkins Hospital. Exemplary surgical career despite morphine dependence.
1903 - Coca Cola ingredient changed to caffeine from cocaine
1920 - US Dept of Agriculture encourages Americans to grow Marijuana as a profitable undertaking.
1971 - President Nixon calls Drug Abuse: America’s Public Enemy No. 1
Drugs of Abuse Trends1920s - 1930s
Alcohol , Opiates
1950s - 1960s
Marijuana , Amphetamines , Psychedelics
1980s - 1990s
Cocaine, Crack, Ice
2000s
Methamphetamine , Prescription Opiates
2015
Designer Synthetic Drugs , Marijuana , Heroine
Drugs of Abuse TrendsOnline Sources:
Erowid , Bluelight, YouTube
Synthetic drugs appearing at rapid rate
Many are “legal”
Undetectable on drug screens
Drug TerminologyShoot / Hit the main line
to inject a drug
Skin Popping
to inject under the skin
Shot gun
blow smoke from joint backward into another persons mouth
Eight Ball
1/8 ounce ( 3.5gm) of a drug (cocaine)
Speedball
Heroine / Cocaine combo
Freebase
inhaling fumes from drug heated on spoon
Current Trends in Drug Abuse
Bath Salts3,4 - Methylenedioxypyrovalerone (MDPV) & other Synthetic Cathinones
Synthetic Cathinones - aka “Bath Salts”“Vanilla Sky, Ivory Wave, Purple Wave, Bliss, Red Dove, Blue Silk, Cloud Nine,Ocean Snow, Lunar Wave, Blizzard, White Lightening, Zoom”
Analogs of naturally occurring cathinones such as Catha eludes (khat). Khat is native to Yemen and eastern Africa where leaves are chewed.
Common active ingredients are: MDPV, Mephedrone, Methylone, Naphyrone
Marketed not only as bath salts but as plant food (“Bonsai Grow”), jewelry cleaner, and cell phone cleaner
Packets labeled “not for human consumption”
Synthetic Drug Abuse Prevention Act of 2012 made it illegal to possess, use, or distribute many of the chemicals (26) used to make bath salts and synthetic cannibus. Now labeled as Schedule I drugs.
Dissociative anesthetic that has gained popularity as a drug of abused. Accepted use in medical and veterinary settings for anesthesia, pain management, treatement depression.
NMDA receptor antagonist
Schedule III controlled substance as of 1999.
Distorts perceptions of sight and sound, produces feelings of detachment from oneself and the environment.
Ketamine can be snorted, injected, mixed in drinks or smoked. Most abusers take small lines or “bumps” for a mild, dreamy effect.
Used as a Club-drug and date-rape drug
“Bump” of 100mg is usually enough for “K-hole” experience
KetaminePhysical effects are dose dependent
Lower Dosing:
Mild inebriation, dreamy thinking, clumsy, vertigo, nausea, “robotic movements”, sense of seeing world differently.
Higher Dosing, “K-Hole”:
Detachment from surroundings and bodies with visual & auditory hallucintations, difficulty communicating, sense of movement through space, strange fabrics or textures, alternate plane of existence
Emergence Reaction
Characterized by vivid dreams, hallucinations, delirium, agitation in 10-20% at anesthetic doses