Drug abuse: Emerging trends and exaggerations

By Rob Curran

News reports from around the globe have recently included both well known and emerging drugs for abuse, and unusual methods to absorb them. Some are implicated in so-called "zombie attacks." EMS responders must be aware of current trends in drug use and abuse so they can provide the best possible care.????

Bath salts
"Bath salts" are synthetic powders sold online and in drug paraphernalia stores under a variety of names, such as "Ivory Wave," "Purple Wave," "Red Dove," "Blue Silk," and? "Zoom."

These products often contain various amphetamine-like chemicals, typically administered orally, by inhalation, or by injection, with the worst outcomes apparently associated with snorting or intravenous administration. They can cause chest pains, increased blood pressure, increased heart rate, agitation, hallucinations, extreme paranoia, and suicidal ideation.

These drugs are made in a lab with constantly changing chemicals, with effects similar to combining the intake of amphetamine and cocaine which may last for days. While these substances have gained media notoriety by their supposed implication in bizarre crimes, often no such link exists.

Alcohol
Alcoholism is a significant health problem, especially for the younger population. According to the National Institute for Alcoholism and Alcohol, 5,000 people under age 21 die each year from alcohol-related car crashes, homicides, suicides, alcohol poisoning, and other injuries such as falls, burns, and drownings, and more than 190,000 people under age 21 visited an emergency room for alcohol-related injuries in 2008 alone.¹

Teens and those into their twenties are more prone to both binge drinking as well as "gimmick" drinking. One of these gimmicks popularized on YouTube is "vodka eyeballing."

In this activity, participants literally close their eyes around a bottle of vodka or a shot glass of vodka and try to "drink" the shot through their eyes. While some alcohol can be absorbed through the cells of the eye, the American Academy of Ophthalmology has warned, "eyeballing" can kill endothelial cells in deeper layers of the cornea. While seen on videos on the Internet and picked up as "news" by papers and websites, the American College of Emergency Physicians reports no evidence of this practice.²

Yet another reported gimmick is alcohol tamponing.? Reportedly, people soak tampons in high-alcohol content spirits and then insert them either into the vagina or rectum. Physiologically, alcohol would easily pass through the vaginal and anal tissues, but would also cause burning pain and potentially damage these delicate tissues. There are no case reports of this occurring, but online news outlets have repeated this as a fad. Both The American College of Emergency Medicine and the American Congress of Obstetricians and Gynecology report no information on this issue.³

Alcohol Without Liquid (AWOL)

AWOL is a process introduced first in Asia and Europe that allows people to take in liquor without actually consuming liquid. The machine is basically a nebulizer, similar to those used to administer albuterol. Possession of an AWOL device is illegal in many states. Vaporized alcohol theoretically enters the bloodstream faster and can have faster effects than traditional counterparts as it has not passed through the liver for primary detoxification. The vaporizers and the practice of vaporizing alcohol have been banned in many states and in sites throughout the world.⁴

Synthetic marijuana

While marijuana is steadily popular, and illegal, New York State recently took emergency action against "Mr. Nice Guy" ,"K2," "Spice", "Skunk" and "Zohai". The New York State Health Department banned the sale of synthetic marijuana products like those in March 2012.

These products contain dried, shredded plant material and presumably, chemical additives that are responsible for their psychoactive (mind-altering) effects commonly marketed as use for incense, but bought for their marijuana-like effect. Marketing labels often make unverified claims that Spice products contain up to 3.0 grams of a natural psychoactive material taken from a variety of plants.

While Spice products do contain dried plant material, chemical analyses of seized spice mixtures have revealed the presence of synthetic (or designer) cannabinoid compounds. These bind to the same cannabinoid receptors in the body as THC (delta-9-tetrahydrocannabinol), the primary psychoactive component of marijuana.

Evidence supports that these drugs bind to similar receptors as MDMA (Ecstasy) and dopamine. This year's Monitoring the Future survey captured the use of Spice among high school seniors for the first time. According to the results, almost 1 in 9 or 11.4% of high school seniors reported using "Spice" in the past year.^5,6

Prescription drugs

Prescription drug abuse in the fastest growing drug problem in the United States. In 2008, more than 36,000 people died from drug overdoses, and most of these deaths were caused by prescription drugs.

Among the legal drugs, the most common drug categories involved were drugs acting on the central nervous system, especially opioid painkillers, and psychotherapeutic drugs, especially sedatives and antidepressants. Almost all prescription drugs involved in overdoses come from prescriptions originally; very few come from pharmacy theft.

Among the most popular drugs of abuse, fueling crime in many areas, are the ultrapotent opiods with names like percs (for Percodan, Percocet); juice (for Dilaudid); oxy, OC, hillbilly heroin (for OxyContin). In addition, Xanax sticks or bars remain abused.⁷

One in 5 U.S. high school students say they have taken a prescription drug without a doctor's prescription, according to the 2009 National Youth Risk Behavior Survey (YRBS) released by the Centers for Disease Control and Prevention. The survey asked if they'd ever taken a prescription drug such as OxyContin, Percocet, Vicodin, Adderall, Ritalin, or Xanax, without a doctor's prescription.

Prescription drug abuse was most common among 12th grade students (26 percent) and lowest among 9th grade students (15 percent).^8,9

Summary

As long as humans act upon the nature of taking risks, abusing the use of medications and recreational drugs will continue. This means that EMS providers will have to assess for, and manage the effects of such misuse. Knowing about the current trends will maintain our readiness to respond.

References

1. "Alcohol Use and Health." Centers for Disease Control and Prevention. 28 Oct. 2011. Web. Retrieved Sept. 27, 2012, from? <http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm>.
2. Statement from the American Academy of Ophthalmology regarding "Vodka Eyeballing". American Academy of Ophthamology, 1 June 2010. Web. Retrieved Sept. 27, 2012 from <http://www.aao.org/newsroom/release/20100601a.cfm>.?Office of Communications, The American College of Obstetricians and Gynecologists.
3. "Vodka Tamponing." Message to the author. 6 May 2012. E-mail.
4. "Machines which dispense shots of oxygen and alcohol have been immobilised." Spain Review. 27 Aug. 2011. Web. Retrieved Sept. 27, 2012, from <http://www.spainreview.net/ index.php/2011/08/27/machines-which-dispense-shots-of-oxygen-and-alcohol-have-been-immobilised/>.
5. Mogul, Fred. "NY Makes 'Synthetic Marijuana' Illegal." WNYC News. New York Public Radio, 29 Mar. 2012. Web. Retrieved Sept. 27, 2012 from <http://www.wnyc.org/articles/ wnyc-news/2012/mar/29/ny-bans-sale-synthetic-marijuana/>.
6. "What is the 'Spice' Phenomenon?" Vol. 5.1. Pittsford Alliance for Substance Free Youth Summer 2011: 1-4. Retrieved Sept. 27, 2012 from <http://pittsfordalliance.org/Newsletter Summer2011.pdf>.
7. Policy Impact: Prescription Painkiller Overdoses. Rept. Centers for Disease Control and Prevention, Nov. 2011. Web. Retrieved Sept. 27, 2012 from <http://www.cdc.gov/Home andRecreationalSafety/pdf/PolicyImpact-PrescriptionPainkillerOD.pdf>.
8. "CDC Newsroom Press Release." Centers for Disease Control and Prevention, 3 June 2010. Web. Retrieved Sept. 27, 2012 from <http://www.cdc.gov/media/pressrel/2010/r100 603.htm>.
9. "Monitoring the Future Survey, Overview of Findings 2011." National Institute on Drug Abuse, n.d. Web. Retrieved Sept. 27, 2012 from <http://www.drugabuse.gov/related-topics/trends-statistics/monitoring-future/overview-findings-2011>.
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Source: http://www.ems1.com/ems-news/1398377-Drug-abuse-Emerging-trends-and-exaggerations/

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