Treatment is Effective

Behavioral Health is Essential to Health

Prevention Works

People Recover

Improving the quality of life for West Virginians with behavioral health needs

West Virginia Department of Health and Human ResourcesBureau for Behavioral Health and Health Facilities

WV Drug Trends

Elizabeth M. Shahan, MSW, LGSW&

Jo Anne McNemar, MS, PSIIFunded by:

This training is funded by a grant from the U.S. Department of Health

and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse

Prevention, and the West Virginia Department of Health and Human Resources,

Bureau for Behavioral Health and Health Facilities.

Learning Objectives

Recognize drugs of abuse currently trending in WV

Learn ways to prevent drug abuse

Determine how to recognize signs and symptoms of drug use

WV Drug Threat Outlook

Alcohol and tobacco will remain principal drug threats to WV because of existing high levels of abuse, availability and accessibility

Pharmaceutical abuse (opiates) has registered as a significant problem, reaching into every county in WV

Marijuana will continue to be the most widely available and commonly abused illicit drug in WV.

WV Drug Threat Outlook

Methamphetamine production has increased since 2006 and has spread throughout the state.

The threat posed by Synthetic Drugs such as Bath Salts and Synthetic Marijuana (K2) has been on the radar since 2010 and has risen significantly in 2011.

Cocaine has been found in WV but has not shown a significant increase in use during the recent past.

Alcohol

Alcohol is alcohol is alcohol…

Source: National Institute for Alcohol Abuse and Alcoholism

Alcohol

Alcohol affects your self-controlAlcohol depresses your central

nervous system, lowers your inhibitions, and impairs your judgment

Drinking can lead to risky behaviors, such as driving when you shouldn’t, or having unprotected sex

Missing work-calling in sick when you have a hangover

Signs of Drinking Problems

Getting drunk on a regular basis Lying about how much alcohol he or

she is using Believing that alcohol is necessary to

have fun Having frequent hangovers Feeling run-down, depressed, or

even suicidal Having "blackouts"--forgetting what

he or she did while drinking

Tobacco

Tobacco is addictive. Cigarettes contain nicotine-a powerfully addictive substance. Three-quarters – 75% - of young people who use tobacco daily continue to do so because they find it hard to quit.

Tobacco can kill you. Smoking is the leading preventable cause of death in this country. More than 440,000 Americans die from tobacco-related causes each year, and most of them began using tobacco before the age of 18.

Marijuana (Cannabis)

Cannabis and Hashish: Weed, Pot, 420, Grass, Hash, Joints, Mary Jane, Chronic, Herb, Dope

Marijuana

It increases heart rate It causes anxiety, paranoia, panic

attacks It causes impaired memory and

learningContributes to accidents to self and

others Automobile Household Occupational

Differences in Marijuana Today

The average potency of marijuana has

more than doubled since 1998

There are also synthetic forms of marijuana

which are chemically based and more potent

Source: National Center for National Products Research Mehmedic, Z. et al. (2010) Potency trends of THC and other cannabinoids in confiscated cannabis preparations from 1993 to 2008. Journal of Forensic Sciences, 55(5), 1209-1217.

Marijuana Paraphernalia

Specific odor Rolling papers, baggies, empty canisters Pipes, bongs, other smoking devices Abundance of incense

Source: Google Images

Other Illicit Drugs

Narcotics/Opioids Street: heroin Prescription pain

killers

Stimulants Cocaine and crack Methamphetamine

Inhalants

Synthetic Drugs Bath Salts K2/Spice

Narcotics

Drugs used medicinally to relieve pain Have a high potential for abuse and

dependence tolerance builds quickly; user needs more and

more to get same effect Cause relaxation with an immediate

“rush” Initial unpleasant effects – restlessness,

nausea Street vs. Prescription Narcotics

Street Narcotic: Heroin (Smack, Horse, Junk) Prescription Narcotics (Vicodin, Percodan,

Demerol, Oxycontin, Methadone, Codeine)

Street Narcotics: Heroin

Usually smoked, injected, sniffed, or taken orally

Use causes confusion, itching, constipation, blocks pain messages to brain

Increases risk of Hepatitis and HIV if injected

Prescription Opioids

Oxycodone (OxyContin, Percodan, Percocet)

Propoxyphene (Darvon)Hydrocodone (Vicodin, Lortab,

Lorcet)Hydrmorphone (Dilaudid)Meperidine (Demerol)Diphenoxylate (Lomotil)Morphine (Kadian, Avinza, MS Contin)CodeineFentanyl (Duragesic)Methadone

OxyContin

Minimum $1 per milligram on the

street, but this is on the rise due to tightening of

prescription drug laws.

Hydrocodone

Street Value:Approximately

$10 per pill

Average Number of Retail Prescription Drugs Filled at Pharmacies (annual per capita)

2008 2009 2010 20110

5

10

15

20

25

14.9

18.8 18.5 19.3

9.5

12.0 12.0 12.1 WVUS

Source: Kaiser State Health Facts

Prescription Drug Overdose Deaths in WVRate per 100,000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

5

10

15

20

25

30

35

40

9.212.0

13.8

18.321.5

26.6 26.7 26.624.8

30.7

36.5WV

Perc

ent R

epor

ting

Use

Source: WV Health Statistics Center

Narcotics

Possible effects: “euphoria,” drowsiness, respiratory depression, constricted (pin-point) pupils

Withdrawal Watery eyes, runny nose, yawning,

cramps Loss of appetite, irritability, nausea Tremors, panic, chills, sweating

Stimulants

Cocaine, Amphetamines, Methamphetamines

High potential for abuse/dependence

These are used to: relieve fatigue and increase alertness feel stronger and more decisive to counteract tranquilizers and alcohol

Prescribed Stimulants

Dextroamphetamine (Dexedrine and Adderall)

Methylphenidate (Ritalin and Concerta)

Source: www.justice.gov/dea

Cocaine and Crack CocaineStreet Names: Coke, Dust, Snow,

Blow, Powder, Lines, Rock (Crack Cocaine)

Cocaine and Crack Cocaine It is illegal – in any form Even first-time users can have seizures

or fatal heart attacks It is expensive – regular users can

spend hundreds or thousands of dollars on cocaine each week

Cocaine impairs judgment and increases risk for poor decision-making (financial,

breaking the law) HIV/AIDS and Hepatitis being the victim of rape and/or

unplanned pregnancy

Methamphetamines

“Meth” is an extremely powerful and addictive stimulant that affects the nervous system

Street Names: Speed, Meth, Crank, Chalk, Ice, Glass

Methamphetamine Labs Reported to Public Health

2009 2010 2011 20120

50

100

150

200

250

300

109

140

171

271

Source: WV Bureau for Public Health, Office of Environmental Health Services

As of April 16, 2013, there have

been 124 reported labs for 2013.

2012Methamphetamine Lab

Notifications

BERKELEY

GRANT

HAMPSHIRE

HARDY

MINERAL

MORGAN

PENDLETON

JEFFERSON

FAYETTEGREENBRIER

MERCER

MONROE

NICHOLASPOCAHONTAS

SUMMERS

WEBSTER

LOGAN

MCDOWELL

MIN

GO RALEIGH

WYOMING

BOONE

CABELL

LINCOLNWAYNE

CLAY

KANAWHA

JACKSON

MASON

PUTNAM

BRAXTON

GILMER LEWIS

DO

DDRID

GE

BARBOUR

RANDOLPH

TUCKER

UPSHUR

HARRISON

MARION

MONONGALIA

PRESTON

TAYLOR

TYLER

BROOKE

HANCOCK

MARSHALL

OHIO

WETZEL

ROANE

CA

LH

OU

N

RITCHIE

WIRT

WOOD

PLEA

SANTS

MARIONMARION

BARBOUR TUCKER

Total Lab Notifications:

2012: 271

2011: 1712010: 1402009: 109

8520

20

09

07 0909

22

01

02

0805

0105

01

05

01

03

04

03

0202

01

02

15

05

03

07

04

01

02

07

Source: WV Bureau for Public Health, Office of Environmental Health

Services

Stimulants

Indications of possible misuse: Excessive activity, talkativeness,

irritability, argumentativeness or nervousness

Increased blood pressure or pulse rate, dilated pupils

Long periods without sleeping or eating

Euphoria

Inhalants

1 in 5 teens have used inhalants to get high – starting in elementary school

Sudden Sniffing Death Syndrome (SSDS)

Erowid.org

Inhalants

Glues/adhesives Nail polish

remover Markers Air duster Spray paint Butane lighter

fluid Typewriter

correction fluid

Gasoline Propane gas Household

cleaners Cooking sprays Whipping cream

cans A/C coolants

Common Household Items

Inhalants

Signs of inhalant abuse: Sitting with a pen/marker near nose Constantly smelling clothing sleeves Showing paint or stain marks on

fingers, face or clothing Hiding rags, clothes, or empty

containers of potentially abused products in closets or other places

Inhalants

Prolonged use can lead to: Red or runny eyes or nose, without a

cold Nausea and/or loss of appetite Chronic use symptoms of anxiety,

excitability, irritability or restlessness Major organ and tissue damage Link between car painting in 1960s to

Parkinson’s Disease

Other Synthetics

Bath SaltsK2/Spice (synthetic marijuana)

Bath Salts

Bath Salts are synthetic stimulant drugs

VERY DANGEROUS: addictive and potentially lethal

More potent than cocaineNot organic-made with chemicalsThey do not contain fragrant soaps

or oils, yet they are packaged to seem so

Bath Salts

Crystalized powder that can be white to brown, with shades in between and even speckled.

Typically an attractive package about the size of a tea bag.

The label says “Not for Human Consumption”

Manufactured mainly in China or India. There are labs in the US…

Bath Salt Use in WV

Bath Salts abuse and problems associated with abuse are increasing at an alarming rate.

2009-no calls to Poison center for bath salts2010-304 calls (WV reported 4)2011-6,138 calls (WV reported 253)2012-2,656 calls (WV reported 45)

K2/Spice (synthetic marijuana)

Synthetic drugsSynthesized to mimic effects of

marijuanaMore potent than THCNot organic-made with chemicals

(sprayed on plant material)When burned this substance usually

has a pleasant odor…

K2 Nationally

America’s poison centers first received calls about “synthetic marijuana” in late 2009 2,960 calls in 2010--36 calls in WV 6,955 calls in 2011--77 calls in WV

80% of these calls placed from ER, compared to 20% regularly

What is the appeal? It produces a high similar to that of

marijuana It doesn't contain tetrahydrocannabinol

(THC), the psychoactive chemical in marijuana

K2 contains synthetic chemicals, known as JWH-018 and JWH-073, that mimic THC by acting on the cannabinoid receptors in the brain   It binds with the CB1 receptor and produces a

euphoric effect or high in humans. JWH-018 binds with CB1 receptors at a rate four times greater than THC (natural or synthetic)

The common marijuana drug tests are calibrated to detect THC and THC metabolites, not the synthetics used in Spice or K2

What does it look like?

How is it used?

Smoked in jointsSmoked in pipesMixed in tea

Street Names

Spice K2 Genie Yucatan Fire Sense Smoke Black Mamba Fake Weed Designer drugs

Skunk Bliss Bombay Blue Zohai

Effects

Dizziness Nausea Vomiting Anxiety Paranoia Rapid Heart Beat Increased Blood Pressure Loss of Consciousness Paranoid Behavior Intense Hallucinations Agitation Seizures

Resources

Alcoholics Anonymous 1-800-333-5051

Narcotics Anonymous 1-800-766-4442

Suicide Prevention Lifeline 1-800-273-8255

WV Prescription Drug Abuse Quit-line

1-866-987-8488

WV Poison Control 1-800-222-1222

References

Center for Substance Abuse Prevention (CSAP): www.samhsa.gov

National Drug Intelligence Center: www.usdoj.gov/ndic/index.htm

National Institute on Drug Abuse: www.nida.nih.gov/drugpages

Street Drugs: www.streetdrugs.org National Institute on Alcohol Abuse and Alcoholism:

www.niaaa.nih.gov Kaiser State Health Facts: kff.org/statedata Drug Enforcement Agency: www.dea.gov www.TheAntiDrug.com www.freevibe.com www.putingkidsfirst.org

References

www.lifematters.com k2spicediamond.com/ (this is an internet

store) stopthedrugwar.org k3spice.blogspot.com/ (this is an internet

store) CADCA Webinar – Designer Drugs: The New

Frontier Northern New England Poison Center

www.nnepc.org Bangor Police Department, Bangor, ME

www.bangormaine.gov/cs_ps_police.php Maine Drug Enforcement Agency

www.maine.gov/dps/mdea Web MD www.webmd.com American Association of Poison Control Centers

www.aapcc.org Office of National Drug Control Policy

www.whitehousedrugpolicy.gov

Special Thanks:

Some slides/pictures were adapted from presentation materials by:

Rebecca Miller, MPH, BSN, RN, CSPI, CHES

Northern New England Poison Centermiller@mmc.org

207-662-7224

Michael Ang-Rabanes, MDChestnut Ridge Hospital, Morgantown,

WV

Contact Information

Cathy Coontz, MA, MS, PSII, NPN Prevention Lead for WV and

National Prevention Network for WV

Division on Alcoholism and Drug AbuseBureau for Behavioral Health and Health

Facilities350 Capitol Street, Room 350

Charleston, WV 25301

Cathy.E.Coontz@wv.gov