Sunday, October 18, 2009

Introduction

The topic about mixing illicit, prescription and over-the-counter (OTC) drugs is most commonly found in young adults purposely mixing and older (elderly) adults not intentionally mixing drugs. Prescription and OTC drugs are easily accessible, and some household products are being used because all of these substances can be found in their homes. Young adults use and mix these drugs for the purpose of getting “high”, and experiencing the sign effects or drug interactions. There is a misunderstanding of using or mix these drugs because they believe it’s a safe way to get high.

It has been found that young adults would use any drug or mix illicit, prescription and OTC drugs with the combination of alcohol. Consequences of drug combinations can lead to drug interactions, respiratory failure, damage to organs such as the kidneys, liver, or brain, addiction, over dose, and death.


It is important that parents, caregivers, and nurses take preventive steps by educating themselves, communicating with others, and monitoring their medications at home.



Be aware of signs and symptoms

Educate:

Educate yourself about the drugs that are being mixed and abused.

Be aware of signs and symptoms, street terminology, and consequences.

Nurses should educate their patients about any prescription and OTC drugs that they are taking, and use protective measures to prevent this abuse.

Communication:

Communication is important with your child. Educate them about why these substances and actions are harmful.

Listen and learn about peer pressure associated with drug use and mixing. Give them advice and suggestions on how to handle this problem.

Share information with other parents and people that are present in your child’s life such as coaches, teachers, school staff, and counselors.

Nurses, offer helpful tips to parents on how to approach the topic with their child. Suggest things to mention in the conversation.

Monitor:

Observe and monitor medication and products in your home.

Pay attention to the quantity and take inventory.

Keep medication and products out of reach in a secure place.

Handle all medications that your child is on. If medication is needed during school, contact the school officials and take the medication to the nurse office yourself.


Sources:
Centers for Disease Control and Prevention, 2009
http://www.cdc.gov/nchs/fastats/druguse.htm

California Department of Alcohol and Drug Programs, 2009
http://www.adp.cahwnet.gov/youth/prescriptiondrugs.shtml

The Partnership for a Drug-Free America, 2008
http://www.drugfree.org/Portal/DrugIssue/Features/Preventing_Teen_Abuse_of_Prescription_and_Over-the

Managing Self-Medication

One of the most troubling aspects of self medicating is the unintentional mixing of drugs that should not be taken together. If you were to sample ten random individuals on the street, you could bet that none of these individuals would be taking the exact same medications. Also consider the numerous over the-counter medications, vitamins, and dietary supplements that are available and are widely considered to be “safe.” It is because of this that negative drug interactions occur in certain individuals and that people may be unknowingly poisoning themselves.

This is extremely problematic among older adults, especially individuals who are sixty-five and older. According to a journal article by Curry, Walker, Hogstel, and Burns, this age group accounts for the majority of medical services, prescriptions, and purchases of over-the-counter medications each year. Many self-medicate and are uninformed about the consequences of mixing certain drugs together. It is often assumed to be safe, and even healthy, to take vitamins and herbs; however this is not always the case. According to Curry et. al., ginkgo biloba hinders the formation of clots. While this herb is typically used as a memory enhancer, it should not be used by an individual who is taking aspirin, warfarin, or Plavix, which are drugs that also impede clot formation. The video below is a news clip with Dr. Barry Ramo discussing the issue on mixing prescription and over-the-counter drugs.


Anyone who is on medication, whether it be over the counter or prescribed, should consult a doctor or pharmacist before adding a new drug into the mix. When seeing a physician, be sure to present an updated list of all of the medications, vitamins, and illicit drugs that you are currently taking. This could potentially help the doctor to understand your symptoms better, as well as to know which medications would be safe to prescribe to you. Nurses and other health care professionals should carefully educate their patients on the use of medications, so that the patient may safely administer the medication to themselves when they are back at home. Potential side effects of medications should also be discussed with patients. By increasing the knowledge you have regarding your health and medications, you can be proactive in your care and lead a healthier life.

Sources:
Curry, L., Walker, C., Hogstel, M., & Burns, P. (2005). Teaching older adults to self-manage medications: preventing adverse drug reactions. Journal Of Gerontological Nursing, 31(4), 32-42. http://libproxy.uta.edu:2066

Karen B. Felbus, MD, 2006
http://www.fda.gov/downloads/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/UCM102777.pdf

U.S. Food and Drug Administration, 2009
http://www.fda.gov/Drugs/ResourcesForYou/Consumers/TipsforSeniors/default.htm

Pharm Parties

Rates of teen drug abuse have grown steadily in the past decade, however the fastest growing trend amongst teens isn’t use of illicit drugs; it is use of readily available, legal drugs found in parents’ medicine cabinets. Pharming parties, or “pharming”, are where teens gather and swap prescriptions and over-the-counter drugs. They may either trade one set of prescription drugs for another, or they may arrange a “candy bowl”, where all the pills are mixed up and everyone grabs a handful. It is not unusual for a person to take several combinations in one night, whether its painkillers (OxyContin and Vicodin), tranquilizers (Xanax), or stimulants (Ritalin). These drugs are usually chased with alcohol, and this interaction can lead to potentially deadly consequences, such as rapid drops in heart rate, addiction, breathing difficulties, and death.

Some studies argue that the reason pharming parties are so popular is because there isn’t as much stigma in mixing legal drugs as there is in buying illegal substances from dealers. Price is a factor as well because teens don’t have to pay for illicit drugs on the streets—they can just steal them from their parents’ medicine cabinets. Lastly, teens don’t see pharming parties as dangerous, because they’re using legal, readily available drugs.

The link below is a news clip from CBS investigating this new trend of drug-taking behavior.

Nurses and parents should not treat this situation lightly. One of the reasons that teens are so cavalier about pharming parties is because adults are just as casual about prescription drugs; most parents don’t think these drugs can be abused.

Parents should establish a positive, trusting relationship with their teens. The first step in doing that is communication. When good communication is built, the parents and their teens are more open to talking about “uncomfortable” subjects such as drug abuse.

Nurses should take proactive measures against pharming parties. Go to the local schools and offer resources and information about mixing drugs (what drugs do to the brain, the dangers of addiction, etc.). Lesson plans and video features on the subject can help nurses inform students that drug mixing is dangerous and life threatening.

Sources:
U.S. Department of Health and Human Services, 2008
http://www.family.samhsa.gov/talk/prescrip03-07-03.pdf

Mary Pat Flaherty, 2005
http://www.washingtonpost.com/wp-dyn/content/article/2005/07/07/AR2005070701180.html

Carolyn Banta, 2005
http://www.time.com/time/magazine/article/0,9171,1086173-2,00.html

National Institutes of Health, 2009
http://www.nida.nih.gov/drugpages/prescription.html

Consequences of Mixing Drugs

So, it’s the day after. From the vague memories of last night, you recall mesmorizing lights and still sense the rhythm of the beat pulsing through your body. Is it your heart or the music? Oh well, doesn’t matter. All that matters is that you're okay, right? I mean, you’re conscious, can still see out of both eyes, your hearing is good, and there's no gashes or traces of dried blood anywhere. Cool, you made it, and can’t wait for next weekend so you can do it all over again. I mean, you lived through it, and whatever doesn’t kill you only makes you stronger, right? That’s where you’re terribly wrong.

For starters, your health problems will slowly increase. Most of these problems go unnoticed, since they happen slowly. You assume since you didn’t overdose on pills from the night before, you made it scott free, and can do it again without any consequences. You never suspect that you will suffer from long-term brain damage, memory loss, permanent damage to neurons, and overall decrease in cognitive abilities and performance. Not only that, but you have increased your risk of cardiac problems, which are mostly, but not limited to, higher blood pressure. This increase in blood pressure will not only take its toll on your heart, but can also be a culprit to kidney failure as well. Even external features can be affected, such as baldness and acne. These can cause more stress, which in turn, can trap you into a recurring cycle that also contributes to baldness and acne – funny how that works.

Not even your sexual life is safe! Oh no, impotence is a common long-term side effect. So even if you do stop popping pills, now you get to pop viagra. On a more serious note, since your thinking is impaired after popping several pills, there is an increase in sexual activity. I know what you’re thinking, but this isn’t necessarily a good thing. You just opened up another door to several other potential hazards. You’re not thinking clearly, so you’re going to refrain from using protection, right? Well, it’s called protection for a reason! Without that latex barrier, STDs and pregnancies are now very possible, and both (especially the latter) are definitely long term. The odds of unwanted pregnancies, as well as AIDS/HIV, are elevated when you’re messed up on pills. Now you can potentially affect other people’s lives if you continue to engage in unprotected sex with them, unaware that you have HIV. I’m sure I don’t need to elaborate any more on the life-changing phenomena of having a baby with someone you most likely had a one-night stand with. If you choose to have an abortion, now you get to live with this on your conscience for the remainder of your life, which has led to depression before. Date rape, or even rape in general, is also more profound from those who take pills to escape reality. Actress Mackenzie Phillips, former “One Day at a Time” star, admitted to waking up from a blackout and finding herself having sex with her own father, who was also on drugs. For the woman, especially Mackenzie, this can lead to life-long emotional trauma, and yet another unwanted pregnancy. For the guy, if he’s caught, you’re looking at jailtime. See how easy it is for one mistake to lead to another?

This last point I’m going to make should be common sense, but unfortunately is often overlooked and something not realized until brought to attention. These pills are a gateway drug! This means that you’re much more likely to start abusing other drugs, many of which are illegal. You start off small and work your way up. In the U.S., drug abuse is the root cause for 25% of the total deaths. That’s one in every four Americans! In a year, over half of one million Americans have spent time in the ER for drug abuse treatmant, which equates to 1400 patients daily. Nearly all over-the-counter pills, as well as many perscription pills, are very easy to obtain. So if you have the will, the way is nearly inevitable. Really, I don’t think I need to elaborate too much on what can stem from getting hooked on illicit drugs…basically anything bad. I really can’t think of anything good coming from illicit drugs.

Now, if you’re already taking way over your limit of therapeutic doses of pills, you can still stop, and the sooner the better! When you take these drugs on a regular basis, your brain will grow accustomed to the new chemicals (take dopamine, for example), so now the brain is going to expect these levels, and will decrease its output of dopamine to compensate for the extra levels. This will make an overdose almost impossible to avoid in the future. Your brain will keep decreasing the levels, and to get the same high, you will be required to take more and more of this drug. If your brain becomes dependent on the drug to provide the remaining chemicals that it’s not producing, surely you can understand that when you stop providing this substance, your body will not have adequate levels of these chemicals, which attribute to the major withdrawal symptoms that you can experience. It will take more than willpower to break from the addiction at this point. You’ll need to seek help, and there are literally thousands of organizations that are more than willing to do so. It’s never too late!

Sources:
U.S. Department of Health and Human Services
http://ncadi.samhsa.gov/govpubs/phd852i/

The Partnership for a Drug-Free America
http://download.ncadi.samhsa.gov/ken/pdf/PHD1113/PHD1113.pdf

Drug Addiction Support, 2009
http://www.drug-addiction-support.org/Drug-Addiction-Statistics.html

KIRO-TV, Inc., 2009
http://www.kirotv.com/entertainment/21081050/detail.html

Psychotropics Cornucopia, Inc., 2009
http://www.drugabusehelp.com/statistics/

Mixing Drugs and Alcohol


Dangerous interactions can occur when consuming alcohol while taking drugs. According to the Community Anti-Drug Coalitions of America, about a third of all emergency room visits related to drugs involve the patient drinking alcohol while taking other drugs. Many do not understand the serious repercussions that can occur when using drugs in combination with alcohol. Individuals who take certain medications on a regular basis may not consider how alcohol will interact with the drugs in their systems, causing a potentially fatal response.

However, some people mix drugs and alcohol intentionally. Although alcohol can decrease the effect a drug has on a person’s body, alcohol and drugs can also work synergistically. Alcohol can greatly increase the effect a drug can have on your body by working with the drug.

Pain killers, such as Vicodin, are some of the most popular drugs to mix with alcohol. Some people take pain killers before a big night out drinking. These drugs can increase the effect of alcohol, making the person feel the effects harder and faster. There are many negative side effects that can occur with this powerful combination. Impaired motor control, difficulty breathing, drowsiness, and memory problems are all negative side effects of combining pain killers and alcohol. However, the most serious side effect is the increased risk of liver damage.

Acetaminophen (Tylenol) is one of the most common drugs found at candy bowl parties, since it is found in most households. Though damage can occur when using Tylenol correctly, when mixed with alcohol, this drug can cause severe liver damage. You can imagine how extensive the damage is for teens that take too many pills and then ingest alcohol. It is important to ensure teens are well-educated on this topic. Even though they may change their lifestyle when they get older, it may be too late by then.

Anti-anxiety medications such as Xanax and Valium are sometimes mixed with alcohol for recreational purposes as well. Alcohol, Xanax, and Valium all act as sedatives. When combined together, anti-anxiety pills and alcohol depress the central nervous system, causing exaggerated sedative effects as well as depressing cardiac and respiratory function.

When drinking alcohol, be conscious of the interactions that can occur between the medications you are on and the drink in your hand. Aside from the side effects listed above, death is also a real possibility when mixing drugs and alcohol.

Additional Information:
http://www.msnbc.msn.com/id/16311712/

http://pubs.niaaa.nih.gov/publications/aa27.htm

http://www.rochester.edu/uhs/healthtopics/Alcohol/interactions.html

Sources:
Community Anti-Drug Coalitions of America, 2007
http://www.cadca.org/resources/detail/emergency-room-visits-climb-misuse-prescription-and-over-counter-drugs

University of Colorado at Boulder
http://www.colorado.edu/alcohol/students/mixing.html#mixing

Nicole Canfora
http://www.ehow.com/about_4564862_acetaminophen-alcohol.html#

Natinal Institute on Alcohol Abuse and Alcoholism, 2007
http://pubs.niaaa.nih.gov/publications/Medicine/medicine.htm

Major Protective Factors for Drug-taking Behavior among Adolescents

The table below is a list of some preventive steps that parent and nurses should have knowledge of. The table goes into further detail about having a positive home environment, education experience, peer relationships, and attitude and beliefs. The Search Institute in Minneapolis has found that these factors have decreased the likelihood of drug-taking behavior and the high-risk behavior such as sexual activity and violence.


As a nurse, it might be hard to be informed or have knowledge of the patient’s personal family issues. However, in patient interaction and conversation, be aware of words or statements that the patient uses indicating there is drug-abuse in their home. Nurses then should refer patients to valuable resources such as brochures, counseling, or even educating them about preventive steps. Most importantly, show respect and don’t be judgmental about the patient’s situation. Nurses offer support and knowledge, therefore they are a valuable source to the patient.

Source:
Levinthal, Charles F. "Major protective factors for drug-taking behavior among adolescents." Drug, Behavior, and Modern Society. Ed. Stephen Frail. Boston: Pearson Education, Inc., 2008. 20.

Cheese

“Cheese” is a drug composed of black tar heroin from Mexico, and Tylenol PM or any other sleep aid medication, such as cold medicine.

The Dallas Independence School District (DISD) has found an increase incident of possession, dealing, arrests and overdose with cheese with their students. In 2007, Dallas Morning News states arrests relating to Cheese has significantly increased by 82 percent in one school year. There are two youth deaths this year, four deaths in 2008, ten deaths in 2007 and eleven deaths in 2006.

Cheese is cheap, affordable, and accessible for adolescents. It is found to cost as low as $2 per dose (10th of a gram). It is a highly addictive drug because people can not tolerate the physical withdraws symptoms. From Rehab Centers, students young as 9 years old are addicted to the drug and going through treatment.


Parent’s Guide to “Cheese” from Dallas Morning News, 2009
Be aware of symptoms of Addiction
- Sleepiness, difficulty waking up
- Disorientation
- Personality shifts, possible aggressive behavior or dropping grades
- Flu-like symptoms, nausea, vomiting and anxiety from withdrawal

For more information about Cheese, the link below will have more hyperlinks to other news report and stories about it.

Sources:
Jason Trahan and Tawnell D. Hobbs, 2009
http://www.dallasnews.com/sharedcontent/dws/dn/education/stories/DN-cheese_24met.ART0.State.Edition2.4e7bcbc.html

Dallas Morning News, 2009
http://www.dallasnews.com/sharedcontent/dws/news/longterm/stories/020909dnmetcheeseguide2.35a65b6e.html

Jason Trahan and Tawnell D. Hobbs, 2007
http://www.dallasnews.com/sharedcontent/dws/dn/latestnews/stories/040807dnmetcheese.39c5f2e.html

Thursday, October 15, 2009

Definitions

Drug
A chemical substance that, when taken into the body, alters the functioning of the body in some way, excluding those nutrients considered to be related to normal function.

Drug Abuse
Drug-taking behavior resulting in some dorm of physical, mental, or social impairment—primarily motivation for drug abuse is for recreational purpose.

Prescription Drugs
Medication purchase from a pharmacy that requires a written or oral order from a medical practitioner.

Over-The-Counter Drugs (also known as OTC)
Drug products that is available for consumers to purchase without a prescription from a medical practitioner. These products are regulated by the U.S. Food and Drug Administration (FDA). Some OTC has regulation such has having a proof of a legal identification proving the age requirement.

Licit Drugs (also known as Legal Drugs)
Substances that are available for purchase with requirements met, such as alcohol, nicotine and caffeine. Alcohol purchase requires customers to be age of 21 and older. Nicotine or cigarette products require customers to be the age of 18 or older.

Illicit Drugs (also known as Street Drugs)
A substance whose manufacture, sale, or possession is illegal; drugs purchased from a drug dealer or a person with no license to distribute medication (not a pharmacists); may be a legal substance, sold illicitly (without a prescription, and not for medical use), or it may be a substance that is illegal to possess.

Instrumental Use
Referring to the motivation of drug user who takes the drug for a specific purpose other than getting “high”
Ex: recovery from an illness or achieving reduction in pain, antidepressant, Rx for insulin.

Recreational Use
Referring to the motivation of the drug user who takes the drug only to get “high” or achieve some pleasurable effect (or positive state of mind)

Legal vs. Illegal Usage
Legal: A person using a drug prescribed by a medical practitioner has legal use and possession of that drug.
Illegal: A person using a drug not prescribed by a medical practitioner, actions are illegal to use and possess.

The following table is an example about
[Licit vs. Illicit] versus [Instrumental Use vs. Recreational Use]


Sources:
Levinthal, Charles F. "Drugs and Behavior Today." Drug, Behavior, and Modern Society. Ed. Stephen Frail. Boston: Pearson Education, Inc., 2008. 3-6.

U.S. Food and Drug Administration, 2009
http://www.fda.gov/AboutFDA/CentersOffices/CDER/ucm093452.htm

Thursday, October 1, 2009

In conclusion...

The intentions of this blog are to make everyone aware of the problem of mixing illicit, prescription and OTC drugs. Mixing drugs can have serious and life threatening side effects. This issue is found in not only young adults but in older adults too. The action of mixing these drugs can be on purpose or accidental. The participation of event can occur at any place and any time, such as at the privacy of your home, house parties, clubs, raves or any social events.

As a parent, sibling, family member, friend, teacher, or nurse, drug abuse is a touch situation to deal with. Know that you are not alone, and there are people and resources there to help you. If you need more information or valuable resources, the following references and links are available for you.

Call 911 or your local Poison Control for any case of an emergency.

Drug Abuse Helpline
866-344-1857
Available 24 hours a day, 7 days a week

American Association of Poison Control Centers
1-800-222-1222
www.aapcc.org/DNN

Safe and Drug-Free Schools Program
U.S. Department of Education (DoE)
800-872-5327
www.ed.gov

Drug Enforcement Administration (DEA)
U.S. Department of Justice (DOJ)
202-307-1000
www.dea.gov

SAMHSA's National Clearinghouse for Alcohol and Drug Information
800-729-6686
TDD 800-487-4889
linea gratis en espaƱol 877-767-8432
ncadi.samhsa.gov

The Partnership for a Drug-Free America: Find Treatment
http://www.drugfree.org/Intervention/FindTreatment/
800-662-HELP

Teen Help
800-828-8173
http://www.teendrugabuse.us/

NIDA for Teens: The Science Behind Drug Abuse
http://www.teens.drugabuse.gov/

Centers for Disease Control and Prevention
Youth Alcohol and Drug Use
http://www.cdc.gov/HealthyYouth/alcoholdrug/index.htm

U.S. Food and Drug Administration
http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm111085.htm
http://www.fda.gov/Drugs/ResourcesForYou/Consumers/default.htm
http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm
http://www.fda.gov/ForConsumers/ByAudience/ForWomen/TakeTimetoCareProgram/ucm116695.htm
http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/default.htm