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What’s New in the Drug World
Erin Foster, CPS
Director of Prevention Services
Area Substance Abuse Council
Electronic Smoking Devices:
Trends and Implications of Vaping
What They’re Saying…
• Kansas sees first vaping‐related lung illness death: 'It is time to stop vaping‘
• CDC says stop vaping as mystery lung condition spreads
• Sixth person dies from vaping‐related illness• Liquid used in e‐cigarettes damages cells crucial for a healthy heart
• Rutgers Study: Most People Who Smoke E‐cigarettes Want to Quit– 60% “want to quit”
• Teen vapers are using eBay to dodge age restrictions
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2018 Iowa Youth Survey TrendsCurrent (past 30 day) use of..
6th 8th 11th
Alcohol 3% 7% 20%
Cigarettes 1% 2% 4%
UsedMarijuana
1% 3% 11%
Used Rx Drugs
3% 3% 4%
E-cigarettes 2% 8% 23%
2016: 9%, 155% jump
“It’s Just Water Vapor!”
• It is an aerosol, not a vapor
• Aerosol is a mixture of liquid particles suspended in a gas and can contain many chemicals
• These chemicals are left behind in the lungs
List of Chemicals
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Sound Familiar? Well, You’ve Also Seen Them In:
• Gasoline
• Pesticides
• Embalming Fluid
• Nail polish
• Rubber
• Pain thinners
• Batteries
How much Nicotine? It varies, but usually A LOT
Emerging Trend:Dripping
• Dropping e-juice directly on to hot coils– Thicker, more “flavorful” aerosol
– Exposure to higher levels of nicotine and other toxins
– 20% of HS Students who vape have also dripped
– New warning: Teens using e‐cigarettes to 'drip' nicotine (2:19)
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Youth Impact
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Why is the Youth Market Important?
• The industry knows customers are getting older and need to be replaced to make more profits– Many e‐cigarette companies owned by major Tobacco companies (IE RJ Reynolds, British American Tobacco)
• Customers for life– 80% of adult smokers started before age 18
“mission is preventing the illegal sale of our products to youth”
Gateway to Tobacco
• Teens who use e-cigarettes are 4x more likely to start using tobacco products than those who don’t
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Drug Concerns:
E-Cigarette or Drug-Delivery Device?
“Versatility” of E-Cigarettes
• Nicotine “vapes” may have their cartridges/pods tampered to put in other substances– ie “hacking the juul”
• Many vape products sold specifically for THC– Pods could use cartridges
from nicotine vapes
– “510 cartridge”‐ Used for concentrates
THC “Pods”
Juul Compatible!
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For THC Concentrates
How Common are Drug Combinations?
• 2018 Study, Major Findings:– 39.5% of those using ESDs reported vaping illicit drugs
– Most common
• THC 18%
• MDMA 11.7%
• Cocaine 10.9%
• Opioids 14.4% (heroin, RX, fentanyl)
Quick Look at Marijuana
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Not the same plant
• Source: Mehmedic et al., 2010
0.3 0.4 0.4 0.3 0.3 0.4 0.4 0.4 0.4 0.5 0.5 0.4 0.5 0.5 0.5 0.5 0.5 0.40.3
0.2 3.5 3.5 3.1 3.1 4.0 4.5 5.2 5.0 4.7 5.40.2 6.2 7.3 7.2 8.3 8.1 9.1 10.0 10.0 9.9 11.00.4 11.00.5 1.0 1.0 1.5 3.3 3.3
CBD:NON-Psychoactive
Ingredient
THC:Psychoactive
Ingredient
0.2%
THC:Psychoactive Ingredient
42%
CBDOnly
0
5
10
15
20
25
30
35
40
45
1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015
% Dry W
eight
Year
Cannabis: % THC Over Time
THC Nationally
THC Colorado
Slide use with permission from Sarah Urfer
“Concentrates are the Future of Cannabis”
Average of plant:• 1960’s was 2-4%• 2017 is 15-20%Current concentrates are 60-90%Industry reached 98% THC
“Concentrates are used in probably 95 percent of the branded products”
(ie: vape oils, the vape cartridges, the edibles)(aka: Dabs, budder, shatter, wax, oil, BHO)
Engadget.com
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THC Extraction
THC Products
THC Products
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“Fine edibles”
Medical Product
TREATMENT FOR• Inflammation• Nausea• Diabetes• Alcoholism• PTSD• Schizophrenia• Rheumatoid Arthritis• Epilepsy• Cardiovascular Disease• Psychosis• Anxiety• Muscle Spasm• Neuropathic Pain• Cancer
What Else is Going On?
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Newest Form: Liquid Meth
Manufacturers of this highly toxic drug are beginning to dissolve meth in water in order to liquefy the drugMade transporting the toxic drug so much easier
– Individuals who produce meth will often place this liquid form of the drug into various different types of liquor bottles
– Once the liquid meth has passed inspection and been shipped to its destination, individuals will then boil away the water
Only the solid form of meth will remain.
Newest Form: Liquid Meth
• “Better” form of Meth• Stronger than regular Meth• Made from made with substance named
Terofun (Pseudoephedrine HCL)• Only take minutes to make & less than 10
minutes to cook• Law Enforcement have found in gas tanks of
vehicles – 20 gallons street value is $10 Million
Other Trends• “Wasping”
– Combination of meth and insecticide
• May also be used as a substitute
– Uses active components of wasp spray to achieve “high”
– Sprayed on to or crystalized with meth
– Effects: newer trend but reports of hallucinatory sense of smell, trigger flight or flight, and toxic exposure
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Adderall
Adderall
• Adderall is a combination of amphetamine and dextroamphetamine that is used primarily to treat the symptoms of attention-deficit hyperactivity disorder (ADHD).
• It has benefits with sleep disorders and reported, off-label utility in managing some forms of severe depression as well.
• Central nervous system stimulant
Larger Issue-Mixing with Alcohol
• Adderall has the ability to mask certain indicators of intoxication that people would otherwise use to slow or stop their consumption. If these signs go unnoticed, the user is at risk of continued drinking—potentially leading to alcohol poisoning, coma, or death.
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Teen Adderall Abuse• According to SAMHSA's National Survey on Drug
Use and Health– 425,000 teens and adolescents between the ages of 12 and 17 reported misuse Adderall.
– Approximately 2.5 million among young adults age 18 to 25
• Teens who misuse Adderall are also– 3 times as likely to have used marijuana.– 8 times as likely to have used cocaine or prescription tranquilizers like Xanax and Klonopin recreationally.
– 5 times more likely to have misused prescription pain relievers.
Lean/Purple Drank/Sizzurp/Dirty Sprite
What is it?• A combination of the following:
– Prescription‐strength cough medicine.
– Soft drinks.
– Hard, fruit‐flavored candy
• The prescription cough syrups used to make lean drink present the most danger because they often contain codeine, a powerful opioid drug
• Another active ingredient in some prescription cough syrups is promethazine, an antihistamine that causes sedative effects and can impair motor functioning
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Large in Teen Culture• The U.S. Drug Enforcement Administration’s
figures show that one in ten American teens have sipped either over-the-counter or prescription syrup.
• Huge in the Hip Hop Culture– Known has “Hip Hop’s Heroin”
– Referenced in over 30 percent of rap songs that reached the top ten of Billboard’s Hot 100 in 2017
– 2014 Study found that codeine references more than tripled in rap songs between 2000 and 2007.
It’s Not Just One
The Unique Dangers of Mixing Substances
Big Picture• Data often scattered, prevalence of exact combinations
often poorly understood• Overdose data and qualitative dates show it’s common
– Federal Study: 70% of fentanyl/heroin deaths involved another drug; 74% of cocaine deaths involved another drug
• Most common substances of abuse include:– Alcohol– Heroin/other opioids– Cocaine– Marijuana– Prescription drugs
• Youth Impact– Estimates show 15‐39% of adolescents can be classified as
polysubstance users
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Alcohol & CNS Stimulants
– “Time flip” (alcohol and xanax)
• Dramatically reduced functioning with breathing and heart rate
• Used to “enhance experience”
• Exaggerates effects
• Liver damage
• Link to anxiety; depression
– “Snow coning” (Alcohol & Cocaine)
• Used to mask the negative effects of the other, enhances euphoric feeling
• Major stress on organs
• Brain damage, heart disease
• Ages 15‐24 4X more likely to binge drink
– Caffeine• “masks” alcohols depressant effects, will consume more, take more risks
Alcohol & Rx Drugs
• Alcohol & Opiates– Used to enhance effects of
opiates
– Both depressants, all common effects to higher degree
– Increased absorption of opiate, exaggerated effects
– “dumping effects”• What might be meant for slow
release could dump all at once
– Raises chances for fatal overdose
• Alcohol & Adderall– Considered fairly common,
especially with younger users• 46.4% of non‐medical users
combined with alcohol
• 19% with prescription combine with alcohol
– Alcohol & Adderall utilize same liver enzymes
– May increase alcohol’s initial stimulant effects in low doses, mask depressant effects
– May consume to fatal point of intoxication
Other Popular Mixtures• Antidepressants & MDMA
– Used to “balance out” serotonin levels after psychedelic usage
– Can lead to “serotonin syndrome”
• Rise of serotonin in CNS
• Potentially life‐threatening
• Cocaine and Opioids– Typically referred to as
“speedball” (though sometimes meth)
– Often combined with synthetic opioids (fentanyl)
– “Push‐Pull” reaction• Cocaine requires more oxygen,
opioids slow breathing
• Puts heavy strain and risks over activating parts of body including: brain, heart, lungs
– Very difficult for body to maintain appropriate levels of oxygen
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Other Popular Mixtures
• Benzodiazepines and Opioids
– Both heavily abused drugs individually
– 30% of Opioid Overdose deaths also involved a Benzo
– Many are prescribed simultaneously• 12 year study found 17% of continuous
opioid subscribers were also prescribed a benzo
– Why dangerous?• Both classifications have high addictive
potential• Benzos enhance the euphoric feeling of
opioids• Increased sedation, depressed breathing
• Z-Drug Abuse– RX similar to benzos (CNS
depressant) sold as popular sleeping medications
– Often abused with benzos, opioids
– Very similar actions, exacerbate side effects
• Especially depressed breathing
Marketing and Local impact
Tobacco Industry Success
Alcohol and marijuana following the same plan???
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Pro-Marijuana IndustryWants to shake the past and gain acceptance
1. Establish a brand/logo
2. Increase favorability– Promote benefits, dismiss negatives, create
confusion
3. Increase visibility
4. Develop products
Has any of this occurred?
Marijuana’s brand?
What is this? How many would recognize it?What colors are often paired with it?Celebrity support?TV and Movies?
Normalizing through TV
“cannabis guest starring more often on television shows as a casual or medicinal
product, rather than a taboo”
This is tobacco 101:Confuse, normalize, expand, protect
Celebrities, music, movies and TV
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New Marijuana magazines
• Broccoli
• Gossamer
• Push Mag
• Kitchen Toke
Hats
Socks
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Shirts
Who is the target?
Concealment
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Hidden Beverage
Fake tampon stashes
Paraphernalia Sold
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Paraphernalia sold for tobacco use?
OK?
Questions?
Erin Foster
319-390-4611 Ext: 193