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Illicit Use of Prescription Drugs in College Students and Designer Drugs

ADHD. Rise in prescribing psychoactive meds for ADHDUse of prescription stimulants and diagnosis of ADHD higher in US than any other nationWe consume majority of worlds ritalinIncreased awareness of ADHDIncreased treatment duration meaning more people bringing to college. ADHD. First line therap

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Illicit Use of Prescription Drugs in College Students and Designer Drugs

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    1. Illicit Use of Prescription Drugs in College Students and Designer Drugs Josh Spencer AM Report 8-21-2007

    2. ADHD Rise in prescribing psychoactive meds for ADHD Use of prescription stimulants and diagnosis of ADHD higher in US than any other nation We consume majority of worlds ritalin Increased awareness of ADHD Increased treatment duration meaning more people bringing to college

    3. ADHD First line therapy stimulants Methylphenidate ritalin Amphetamine-dextroamphetamine Adderall

    4. Abuse of Adderall and Ritalin With increased prescription rates of adderall and ritalin abuse also rising Non-medical use of prescription subtances in college second only to MJ in illicit use EtOH abuse staying steady

    5. Prevalance of Abuse: Study 1 Survey of over 10,000 college students randomly selected Lifetime prevalence of 6.9% Past year prevalence 4.1% Past month prevalence 2.1% Use highest in white male members of fraternities with lower GPA’s Highest use in north eastern colleges and colleges with high academic requirements More likely to abuse other drugs--Binge drinking, MJ, ecstasy, cocaine

    6. Pevalence of Abuse: Study 2 Self-administered web based survey of randomly selected college students N=4580 Lifetime-8.3% Past year-5.9% 3/4 of the past year use with adderall 1/4 of past year with ritalin Caucasians and Hispanics 3X more likely to use than African-Americans and 2X more likely than Asians

    7. Motives Better grades

    8. Motives Increase concentration “Help Study” Increase alertness Get high Experimentation Lose weight (women)

    9. Routes of Administration Oral use 95% 38% snorting 5% smoke Very few inject

    10. Clinical Manifestations of Amphetamine overdose Increase peripheral and central catecholamine concentrations Tachycardia, HTN, AMI, seizures, intracranial bleeds, CVA Hyperthermia, rhabdo Mydriasis Agitation Acute psychosis Death

    11. Amphetamine Overdose Treatment ABC’s Monitor and treat arrhythmias Gastric lavage if oral ingestion and recent use (approximately 1 hour) IV drips for vasodilatation-nifedipine, nitroprusside; alpha blockade-phentolamine; alpha-beta antagonists-labetalol) Hold BB IV fluids if signs of rhabdo Cool down patient (more on this later) Counseling

    12. Designer Drugs Synthetic derivatives of controlled substances made by altering molecular structure Mid 80’s legislation made illegal to due this Some of most popular amphetamine derivatives

    13. Amphetamine Analogs Made by attaching different substituent groups to different positions on the phenyl ring of amphetamine or methamphetamine Substituents-methoxy, methyl, halogen, sulfur

    14. Methylenedioxymethamphetamine MDMA Ecstasy, E, X-TC, Adam, Clarity, Stacy, Lover’s Speed, Essence First made in 1914 for appetite suppressant, later use in 1970’s by psychotherapists and now a schedule I drug Most made in Europe and smuggled to US Stimulant and psychedlic effects Effects by serotonin and small degree Dopamine

    15. Forms of MDMA Capsule or tablet Powder snorted or smoked One tablet-$10-30$ or more Can find descriptions of synthesis in scientific journals and internet but still hard to make Improper synthesis responsible of the many impurities found in MDMA

    16. Mechanism of Action On neurons that make and release serotonin MDMA-causes release of serotonin into synaptic cleft, inhibits its breakdown, and does not allow reuptake Therefore increased concentration in cleft and intracellular depletion of serotonin Effects begin 1 hour after ingestion and last 3-6 hours Chronic use-paranoid psychosis similar to schizophrenia and can go away after prolonged drug free state Chronic use-can lead to cognitive decline

    17. Other Amphetamine Analogs Methamphetamine Speed, crank, meth, crystal meth Schedule II drug Contaminants-lead (acute lead poisoning) Methylenedioxyamphetamine Methylenedioxyethamphetamine Paramethoxyamphetamine

    18. Clinical Manifestations Increased energy and ability to concentrate, euphoria, relaxation, empathy, paranoia Impulsive with increased risk taking Suppress thirst and hunger-dehydration and heat exhaustion Tachycardia, HTN, hyperthermia, tremors, pupillary dilation MDMA-raised HR 28BPM, DBP 7mmHg, cardiac output by 2L/Min

    19. Treatment As amphetamine overdose

    20. Treatment-Drug Induced Hyperthermia Life threatening and similar to heat stroke Discussion with toxicologist recommended Active cooling measures--iced IVF, cool water bladder washes, cooling blanket Hypotension-IVF and pressors Dantrolene has been used but no controlled trials Intubation and paralyzation to decrease muscle contractions and rigidity Careful with succinylcholine as can cause malignant hyperthermia making problem worse Normalize intracranial pressures DIC Metabolic acidosis and hypocalcemia

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