Prescription Drugs

Pain Killers

 

The abuse of prescription drugs is skyrocketing. There are several types of prescription medications that are commonly abused. The three most common are: (1) opioids, which are prescribed to treat pain; (2) central nervous system depressants, which are used to treat anxiety and sleep disorders (tranquillizers) and (3) stimulants, which are prescribed to treat specific sleep disorders and attention-deficit hyperactivity disorder (ADHD). This presentation will focus on the abuse of prescription pain killers.

 

The US makes up 4.6% of the world population yet consumes 80% of all the narcotic pain killers in the world. In 2008, ONDCP released information stating that everyday 2,500 kids illicitly used prescription drugs for the first time in 2007 and that narcotic-prescription drug abuse among young people equals that of methamphetamine, heroin, cocaine, and ecstasy combined. 

 

Pharming (for pharmaceuticals), candy dish parties, or "skittle parties" are a big problem on college campuses today.  Entry to these  “parties”  requires bringing a prescription drug. Once inside, the drugs are poured into a bowl, mixed and taken by the handful.  The pills may be taken orally or crush and snorted. Taking the pills is typically followed by drinking alcohol: a very dangerous combination.  

 

Effects of prescription drug use vary depending on the type of drug taken. The more common effects for the painkillers Vicodin, Percocet, Morphine and OxyContin are constricted pupils, muscle relaxation, lowered blood pressure and heart rate, drowsiness, impaired coordination, clammy cold skin, decreased physical activity, constipation, chills, and coma.

Prescription drugs are abused by crushing and snorting the drug or smoking it on aluminum foil. Abuse of the pain killers (OxyContin, Vicodin, Percocet) may lead to heroin use. The price of the pills on the street can be extremely expensive while the price of heroin has dropped. 

 

Withdrawal symptoms from prescription opiates are often missed by parents and others. Withdrawal symptoms may mimic having  flu-like symptoms; nausea, vomiting, body aches, chills, exhaustion. The paraphernalia used for prescription abuse is a tea strainer.  Users pack pills into tea strainers, run them under cold water to breakdown the harder outside coating, thus making it easier to smoke or snort, leaving a white residue in the trainer 

 

Street Names / Slang terms Associated with OxyContin:  

 

OC, Oxy, Cotton, Hillbilly Heroin, Roxies, Scarecrow, Ocean City, Tomater, Ox

Short Term Effects

 

Short-term use of narcotic prescription drugs produce euphoria, sedation and a feeling of tranquility. Repeated administration rapidly produces tolerance (increasing the dose, reducing intervals between doses or both) and intense physical dependence. Overdose causes respiratory depression.

 

Long Term Effects

 

The most important complication is drug interaction. If the physician or pharmacist is not aware of everything that a person is taking they may prescribe a medication that will interact with the illicit drug and result in serious side effects.  Vitamins and herbal remedies fall into this category. The combination of alcohol and prescription drugs can affect the central nervous system, leading to respiratory distress or failure, or even death. 

 

Commonly abused prescription opiates

Of the 7 million people abusing prescription drugs, 5 million are abusing opiate painkillers. With the reformulation of OxyContin limiting abuse, the prevalence of other prescription painkillers is increasing.

 

Oxycodone - Percocet & Roxicodone:

Oxycodone is among the fastest growing of all prescription drugs people abuse in the United States. Percocet is the brand name of a painkiller containing oxycodone and acetaminophen (Tylenol). Overdose can cause, abdominal pain, dark urine, clay-colored stools, liver damage, and jaundice.  Percocet known as Perc’s on the street, can be smoked, snorted, and injected. Percocet taken in large doses, or when the tablet is crushed for snorting, smoking or injecting (destroying the time-release mechanism) and can cause a “high” similar to using to heroin.

Roxicodone is a painkiller in the oxycodone family with a high potential for abuse. It is in an immediate-release form and acts more quickly than the timed-release forms of opiate pain-killers. Addicts and treatment providers state that 30mg of Roxicodone when abused by snorting, smoking, or injecting is the painkiller that produces effects most similar to heroin. On the street it is known as Blues, OxyIR, Blueberry, Thirties, OC, or Roxys.

Oxymorphone – Opana:

Opana became more sought after once OxyContin was reformulated. Opana is an extended release opiate painkiller in the oxymorphone family. Many think oxymorphone has less potential for abuse than OxyContin (oxycodone), however oxymorphone is metabolized oxycodone. Opana is extremely potent with many experts claiming it is more addictive than cocaine or heroin. Opana can be snorted, smoked, or injected.

In 2011, Indiana’s state health department investigated an increase in Hepatitis C cases in a county in southeastern Indiana. As more Opana users transitioned to injection, hepatitis C spread quickly through sharing of syringes. The CDC estimated that between 2010 and 2012, new hepatitis C infections rose 75%, to about 23,000 new cases a year. In January 2015, the Indiana State Health Department began an ongoing investigation of a rise in HIV cases in this county. Of the 135 confirmed cases of HIV, 108 cases report dissolving and injecting Opana as their drug of choice. This is the first documented HIV outbreak in the United States associated with injection of a prescription painkiller. (CDC, Morbidity & Mortality Weekly Report, April 2015)

In August 2012, three cases of unexplained thrombotic thrombocytopenic purpura (TTP), a rare but serious blood disorder, were reported by a nephrologist to the Tennessee Department of Health (TDH).  By the end of October, 15 such cases had been reported.  A case-control study was conducted, and investigators determined that the cases of TTP-like illness were associated with dissolving and injecting tablets of Opana ER. Seven of the 15 were treated for sepsis and TTP-like illness, 12 patients reported chronic hepatitis C or had a positive test for anti HCV antibodies. Health care providers and pharmacists who prescribe or dispense Opana ER should inform patients of the risks associated with the drug being used in ways other than being prescribed. Health care providers should ask patients with TTP like illness of unknown origin about any IV drug use. (CDC, Morbidity & Mortality Weekly Report, Jan 2013)

Signs of Opana overdose:
  • Suppression of breathing
    
  • Cold or clammy skin
    
  • Muscle flaccidity
    
  • Stupor
    
  • Coma
    
  • Chest pain
    
  • Drop in blood pressure & heart rate
    
  • Numbness in arms and legs
    
  • Circulatory collapse
    
  • Cardiac Arrest
    
  • Death
    

 

Dilaudid Abuse:  

Dilaudid on the street is known as “Big D” “M-80’s” and “Peaches”. Dilaudid is a schedule II drug and often used to manage moderate to severe pain. Dilaudid is hydromorphone hydrochloride and is a very powerful semi-synthetic opioid narcotic painkiller considered to be almost 10 times stronger than morphine.  Dilaudid is often used as an alternative to morphine. Dilaudid takes effect within 15 minutes and lasts for longer than six hours. It can be addictive like all other opiates. Tolerance and dependence can occur within a couple weeks of use. Dilaudid can be ingested, smoked, snorted or injected.

 

Fetal Exposure to Opiates


About 4% of women admit taking opiates while pregnant, resulting in more than 400,000 newborns annually exposed to these drugs. Over 29% of exposed newborns are born prematurely and have a high mortality rate, either as a result of drug exposure, mother not taking care of herself or a combination of both. Babies may be born addicted to opiates (neonatal abstinence syndrome) and require treatment within the first few weeks of life. Methadone may be prescribed to pregnant women to facilitate withdrawal from opiate addiction and safe guard the newborn infant. Unfortunately, chronic use of methadone may also result in neonatal addition.
 

Newborns exposed to cocaine or opiates during pregnancy can develop withdrawal symptoms after birth (Neonatal Abstinence Syndrome). Symptoms include tremors, irritability, sleep problems, seizures, yawning, stuffy nose, sneezing, unstable temperature, poor feeding, vomiting, and diarrhea.

 

Naloxone (an opiate blocker) is given immediately after birth to any infant born to a mother who is known to be using opium, heroin, methadone or hydrocodone. However, the mother’s drug history may not be known until infants develop symptoms after birth. Symptoms may start as early as 1 day or as late as 7 days after birth.  Treatment includes keeping the infant swaddled and in a quiet, dark room, but most babies need medications. Morphine elixir and phenobarbital are the most commonly used drugs. Treatment may be required for 1-2 weeks or longer.

 

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