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In a year’s time, we’ve seen a huge increase in the teen use of illicit drugs and the average age is decreasing with kids as young as 16 averaging their start with marijuana. The estimates of use in the U.S. is 14 million Americans are using substances and heroin is increasing in its use because of greater purity and decrease in cost. It’s being marketed by the same people that used to bring you cocaine so cocaine’s desirability is going down. We’re seeing it more in the unglamorous crowds and heroin is part of the glamour crowd. Why is that? We’ll talk about that a little bit later.
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First I want to cover stimulants even though cocaine is being relegated to female, older and mentally ill chemically abusing populations, MICA, and that concept which we’ll cover more tonight if you attend the dual diagnosis seminar, MICA is primarily psychotic severely disabled mentally ill patients who dabble in substance abuse as opposed to people who have primary substance abuse – the majority of people with a substance abuse problem in the U.S. who have secondary symptoms but we’ll talk about that more tonight. Methamphetamine, big problem in Hawaii, the West Coast. Some East Coast areas now but more in the south. We’re not seeing it really in the Northeast for some reason but easily cooked up in my kitchen and I haven’t tried this by the way so I can’t explain exactly how you do it but I’m told that I can do better than academia.
It does seem to damage dopaminergic and serotonergic terminals in the brain. This is rat brain. We don’t know the clinical significance in humans but it’s important to know that. MDMA, another amphetamine derivative popularly known as ecstasy. Methamphetamine is known as crank, speed, ice. Ecstasy for MDMA. The neurons themselves are damaged in rat brain. We don’t know the clinical significance in humans.
The big problem with heroin is it’s so pure now that inhaled alone is sufficient to make people dependent. It’s not just a gateway anymore that leads them to IV use. It does lead people to IV use but it’s enough to get people so dependent that I’ve had to refer patients who are just heroin smokers or snorters to methadone treatment because they can’t get off the stuff.
Marijuana is now the choice of teenagers throughout the land. It’s been increasing since 1992 and there are lots of combination lacings of marijuana now to improve the marketing. You may have heard of embalming fluid being laced to marijuana and fry is the mixture. Fry. And I think that’s a rye comeback on the advertisement we used to see, “This is your brain on drugs.” You know, it was the egg being fried in the frying pan. Now the kids are saying, “Oh, yeah. Let’s do it.” So this is one of the crises of raising teenagers in America. Mine aren’t quite teenagers and I’m just bracing for the experience.
Club drugs. Rohipnol – the date rape drug. Sedative. GHB, gamma hydroxybutyrate. These are mostly sedatives but LSD is being used, MDMA ecstasy, big rave party drug. Raves are these all night nonstop very crowded sweaty trance-like dance parties with music, I guess, that’s the second generation of disco which really shows you how the taste is going in America.
Pregnancy. 5.5% of pregnant women in studies are found to be using drugs of abuse which is pretty shocking. Almost 20% alcohol and smoking cigarettes despite all that we know about the effects of fetal alcohol syndrome and low birth weight, low head circumference with smoking. So a lot of important trends and epidemiology and we can talk about that maybe in questions if people are particularly interested.
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But I want to stress that some familiarity with this is important. It can appear on the boards but at least have down the basics of diagnosis. Now, there are many syndromes of psychiatric disturbance that are associated with intoxication or withdrawal and so we want to be familiar with these names. So Roman numeral II on your outline which I think is page 279 has the substance induced syndromes and these are listed separately along with the dependent syndromes.
The two to be most aware of are the delusional or psychotic induced syndrome which many of these substances can induce and delirium and hallucinosis which just about all of the hallucinatory, stimulatory and even the sedative substances can produce delusions, delirium… well, at least delirium and hallucinosis. Sometimes in intoxication, in other cases like a sedative withdrawal or alcohol withdrawal during withdrawal. Of course, not caffeine or nicotine. So an easy point to remember. It can easily show up as a multiple choice test with all of the above. You just have to know that the all of the above probably does include all of the above. Generic viagra pharmacy.
But what is abuse? Separate from these substance induced syndromes, abuse is a very simple problem. It’s just any one persisting problem – role failure, use in hazardous situations or recurrent legal or social problems. So it’s a good diagnosis for the alcohol intoxication driving arrest and the patient says, “This has never happened to me before. I drink when I come home from work. At the bar I stop off with my pals and I make it home fine and this arrest has nothing to do with alcoholism.” Well, that may be true but it is alcohol abuse to drink and then drive. So that’s an easy diagnosis to make.