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Prescription drugs

adolescent abuse of prescription and over-the-counter drugs michael nerney and associates PO Box 93 long lake, NY 12847-0093 518-624-5351 mcnerneyll@frontiernet.net. Prescription drugs. In the United States: Food and Drug Administration Sole agency responsible

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Prescription drugs

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  1. adolescent abuse of prescription andover-the-counter drugsmichael nerney and associatesPO Box 93long lake, NY 12847-0093518-624-5351mcnerneyll@frontiernet.net

  2. Prescription drugs • In the United States: • Food and Drug Administration • Sole agency responsible • Center for Drug Evaluation and Research • Ten to Twelve Years Average • 5 out of 5000 go to clinical trials • 1 out of 5 is approved

  3. Prescription drugs • Investigational New Drug Application • Preclinical, lab, animal, safety • Phase 1 • Healthy subjects, 20-80 • ED(50), TD(50), LD(50) • Phase 2 • Target subjects, 100-300 • Effective against disease or disorder

  4. Prescription drugs • Investigational New Drug Application • Phase 3 • Large randomized double blind • 1000-3000 patients • Minimum/maximum doses • Combinations • Adverse effects/Contraindications • IND vs. Placebo

  5. Prescription drugs • Investigational New Drug Application • New Drug Application • Filed with FDA • 100,000 pages of data • Review time, 8-12 months • Up to 2 years • Phase 4 • Post marketing

  6. Prescription drugs • 3 Basic Outcomes • Intended effect • Adverse effect • Idiosyncratic effect

  7. Overview • Perceptions • GRASE • ACCESS

  8. overview • Motivations • Bio-Psycho-Social • Dynamics • Dose, Contaminants

  9. sources • Doctor Shopping • Home Visits • The Streets • The Internet

  10. patterns • As Needed • Medication for Feelings • 4 out of 10 • Negative Emotions

  11. patterns • Recreation • Disinhibition • Anxiety Reduction • Euphoria

  12. patterns • Cross-generational • 3 generations • Parents use children's drugs • Kids use grandparents’ drugs

  13. Drug combinations • Enhance Primary Drug Effect • Boost the initial drug • Slow metabolism • Grapefruit juice

  14. Drug combinations • Alleviate Withdrawal • Mask the withdrawal symptoms • Two separate systems • One system suppression

  15. Drug combinations • Reduce Negative Side Effects • Minimize unpleasant effects

  16. Systems Investigated • Structural • Gray Matter • White Matter

  17. concerns • New Research on the Brain • Glutamate System Suppression • Too much DA • Chemical/Structural Changes • Protein interference • Loss of flexible learning

  18. CONCERNS • New Research on the Brain • Reward System Shutdown • Too much DA • CREB • Gene code • Synthesize Dynorphin

  19. Concerns • New Research on the Brain • Embedded Memory • Too much DA • Delta FosB • Chemical Changes • Protein shift • PKMzeta • Stores the high

  20. Abuse of Prescription Drugs • Prescription Stimulants Brief History • Mechanism of action • Reuptake • Site of activity • PFC, Limbic • Neurotransmitters • DA, NE, 5HT

  21. Prescription Stimulants • Potential for Abuse/Addiction • High • Risks • Physical, Behavioral • Psychological

  22. Abuse of Prescription Drugs, continued • Prescription Tranquillizers Brief History • Mechanism of action • Second Messenger • Site of activity • Limbic • Neurotransmitters • GABA

  23. Prescription tranquillizers • Potential for Abuse/Addiction • Risks

  24. Abuse of Prescription Drugs, continued • Prescription Narcotics Brief History • Mechanism of Action • Direct • Site of activity • Limbic, Brain Stem • Neurotransmitters • Endorphin Receptors

  25. Prescription narcotics • Potential for Abuse/Addiction • High • Risks • Multiple

  26. Abuse of Prescription Drugs, continued • Other Drugs

  27. Interactions with other drugs • Alcohol • Marijuana

  28. Interactions with other drugs, continued • Ecstasy • Over-the-Counter • Aeroshots • Allergy Meds

  29. Over the counter • Robo-shots • Dextromethorphan • Opioid cough suppressant • Plus alcohol • Rapid and powerful intoxication • Motor control • Impulse control • Delusional

  30. Treatment Issues • Detoxification/Withdrawal

  31. Treatment issues • Treatment Model

  32. Current and Experimental Medications as Treatment Adjuncts • For Opioid Dependency: Trexan Vivitrol Buphenex

  33. Current and Experimental Medications as Treatment Adjuncts • For Cocaine/Methamphetamine/Stimulant Dependency: • Selegiline • Amantidine • Baclofen • Modafinil • Disulfiram

  34. The Practice of Recovery • The Clinical Connection • Access to Qualified Treatment Providers • Therapeutic Alliance • Multiple Models • Access to Support • 12 Step Programs

  35. Emotional Competencies • Self Awareness • Verbal Access • Emotional Regulation • Empathic Response • Passionate Interest

  36. Key Aspects • Fluid Intelligence • Monitoring Performance • Managing Emotions

  37. The Practice of Recovery • Practice and Repetition • Learn from Failure

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