1. MEDICATION ABUSE: Over-the-Counter & Prescription Drug Abuse & Dependence Rand L. Kannenberg, M.A., LAC, CCM, CCS

11. Schedule II. (A) The drug or other substance has a high potential for abuse. (B) The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions. (C) Abuse of the drug or other substances may lead to severe psychological or physical dependence. Schedule III. (A) The drug or other substance has a potential for abuse less than the drugs or other substances in schedules I and II. (B) The drug or other substance has a currently accepted medical use in treatment in the United States. (C) Abuse of the drug or other substance may lead to moderate or low physical dependence or high psychological dependence. Schedule IV. (A) The drug or other substance has a low potential for abuse relative to the drugs or other substances in schedule III. (B) The drug or other substance has a currently accepted medical use in treatment in the United States. (C) Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in schedule III. Schedule V. (A) The drug or other substance has a low potential for abuse relative to the drugs or other substances in schedule IV. (B) The drug or other substance has a currently accepted medical use in treatment in the United States. (C) Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in schedule IV. U.S. Drug Enforcement Administration (DEA) Schedules of controlled substances

12. Opioids & morphine derivatives hydrocodone (Schedules II, III, V) Examples Hydrocodone with Acetaminophen, Vicodin®, Vicoprofen®, Tussionex®, Lortab®, Tussend®, Hycodan®, Anexsia® Nicknames vike, Watson-387 Route of Administration swallowed Desired Outcomes pain relief, euphoria Adverse Reactions drowsiness, nausea, constipation, confusion, sedation, respiratory arrest, unconsciousness, coma, constricted pupils, slow and shallow breathing, clammy skin, convulsions, possible death National Institute on Drug Abuse (NIDA) U.S. Drug Enforcement Administration (DEA)

13. Opioids & morphine derivatives oxycodone (Schedule II) Examples Roxicet®, Oxycodone with Acetaminophen, OxyContin®, Endocet®, Percocet®, Percodan®, Tylox®, Roxicodone® Nicknames Oxy, O.C., killer Route of Administration swallowed, snorted, injected Desired Outcomes pain relief, euphoria Adverse Reactions drowsiness, nausea, constipation, confusion, sedation, respiratory arrest, unconsciousness, coma, constricted pupils, slow and shallow breathing, clammy skin, convulsions, possible death National Institute on Drug Abuse (NIDA) U.S. Drug Enforcement Administration (DEA)

15. Opioids & morphine derivatives morphine (Schedules II, III) Examples Duramorph®, MS-Contin®, Roxanol®, Oramorph SR®, RMS® Nicknames M, Miss Emma, monkey, white stuff Route of Administration injected, swallowed, smoked Desired Outcomes pain relief, euphoria Adverse Reactions drowsiness, nausea, constipation, confusion, sedation, respiratory arrest, unconsciousness, coma, constricted pupils, slow and shallow breathing, clammy skin, convulsions, possible death National Institute on Drug Abuse (NIDA) U.S. Drug Enforcement Administration (DEA)

16. Opioids & morphine derivatives hydro-morphone (Schedule II) Examples Dilaudid ®, dihydromorphinone Nicknames Dust, Juice, Smack, D, Footballs Route of Administration swallowed, injected Desired Outcomes pain relief, euphoria Adverse Reactions drowsiness, nausea, constipation, confusion, sedation, respiratory arrest, unconsciousness, coma, constricted pupils, slow and shallow breathing, clammy skin, convulsions, possible death National Institute on Drug Abuse (NIDA) U.S. Drug Enforcement Administration (DEA)

17. Opioids & morphine derivatives opium (Schedules II, III, V) Examples laudanum, paregoric, papaver somniferum, extracts/fluid/poppy/tincture/granulated/powdered/raw, Parepectolin®, Kapectolin PG®, Kaolin®, Pectin P.G.® Nicknames big O, black stuff, block, gum, hop Route of Administration swallowed, smoked Desired Outcomes pain relief, euphoria Adverse Reactions drowsiness, nausea, constipation, confusion, sedation, respiratory arrest, unconsciousness, coma, constricted pupils, slow and shallow breathing, clammy skin, convulsions, possible death National Institute on Drug Abuse (NIDA) U.S. Drug Enforcement Administration (DEA)

18. Opioids & morphine derivatives other narcotics (Schedules II, III, IV) Examples Actiq®, Duragesic®, Sublimaze®, Fentanyl®, Demerol®, methadone, Darvon®, Darvocet®, Stadol®, Talwin®, Paregoric®, Buprenex®, propoxyphene, Propacet®, Innovar®, Mepergan®, pethidine Nicknames Apache, China girl, China white, dance fever, friend, goodfella, jackpot, murder 8, TNT, Tango and Cash Route of Administration swallowed, injected, smoked, snorted Desired Outcomes pain relief, euphoria Adverse Reactions drowsiness, nausea, constipation, confusion, sedation, respiratory arrest, unconsciousness, coma, constricted pupils, slow and shallow breathing, clammy skin, convulsions, possible death National Institute on Drug Abuse (NIDA) U.S. Drug Enforcement Administration (DEA)

19. Video #1 “Opioids” (3 minutes & 8 seconds) “ Prescription Drugs: Killing More Than Pain”

21. CNS depressants barbiturates (Schedules II, III, IV) Examples (methohexital) Brevital®, (thiamyl) Surital®, (thiopental) Pentothal®, (amobarbital) Amyta®, (pentobarbital) Nembutal®, (secobarbital) Seconal®, (amobarbital/secobarbital) Tuinal®, (butalbital) Fiorina®, (butabarbital) Butisol®, (talbutal) Lotusate®, (aprobarbital) Alurate®, (phenobarbital) Luminal®, (mephobarbital) Mebaral® Nicknames barbs, reds, red birds, phennies, tooies, yellows, yellow jackets Route of Administration injected, swallowed Desired Outcomes reduced pain and anxiety; feeling of well-being; lowered inhibitions Adverse Reactions slowed pulse and breathing, lowered blood pressure, poor concentration/fatigue, confusion, impaired coordination/memory/judgment, respiratory depression and arrest, death, sedation, drowsiness/depression, unusual excitement, fever, irritability, poor judgment, slurred speech, dizziness, life-threatening withdrawal National Institute on Drug Abuse (NIDA) U.S. Drug Enforcement Administration (DEA)

24. Video #2 “Benzos” (2 minutes & 46 seconds) “ Prescription Drugs: Killing More Than Pain”

27. Stimulants cocaine (Schedule II) Examples Cocaine hydrochloride Nicknames blow, bump, C, candy, Charlie, coke, crack, flake, rock, snow, toot Route of Administration swallowed, snorted, injected, smoked Desired Outcomes awake, alert, active, aware, appetite suppression, energy, euphoria, excitement, enthusiasm, enhancement of the senses Adverse Reactions dysphoric crash, death from respiratory failure, strokes, heart failure, increased heart rate, high blood pressure, increased metabolism, irregular heart beat, weight loss, nervousness, insomnia, increased temperature, chest pain, nausea, abdominal pain, seizures, headaches, malnutrition, panic attacks Criminal Justice Addiction Services National Institute on Drug Abuse (NIDA) U.S. Drug Enforcement Administration (DEA)

28. Stimulants methamphetamine (Schedule II) Example Desoxyn® Nicknames chalk, crank, crystal, fire, glass, go fast, ice, meth, speed Route of Administration swallowed, snorted, injected, smoked Desired Outcomes awake, alert, active, aware, appetite suppression, energy, euphoria, excitement, enthusiasm, enhancement of the senses Adverse Reactions inability to sleep, loss of appetite and weight, thin/gaunt, increased sensitivity to noise, agitation, restlessness, irritability, aggressiveness, dizziness, confusion, impaired judgment, diarrhea and gastrointestinal complaints, difficulty breathing, headaches, tremors or seizures, nausea and vomiting, numbness, profuse sweating, chills, muscle cramping, pain and tenderness, dehydration, low magnesium level, low potassium level, grossly dilated pupils, chest pain, increased or decreased heart rate, increased blood pressure, fever or hyperthermia, impaired speech and language, mania, psychosis with hallucinations and delusions, anxiety, panic, fear of impending doom, depression and suicidal ideation, poor hygiene and body malodor, missing teeth, bleeding gums, infected gums, dental caries/decay/cavities, dry mouth, removed enamel, teeth grinding, skin aging and damage, dryness, roughness, wrinkles, broken veins, dermatitis around the mouth, skin ulceration and infection, acne or sores, hair loss from repetitious pulling Criminal Justice Addiction Services National Institute on Drug Abuse (NIDA) U.S. Drug Enforcement Administration (DEA)

29. Stimulants methylphenidate (Schedule II) Examples Ritalin®, Methylin®, Concerta® Nicknames JIF, MPH, R-ball, Skippy, the smart drug, vitamin R Route of Administration swallowed, snorted, injected Desired Outcomes awake, alert, active, aware, appetite suppression, energy, euphoria, excitement, enthusiasm, enhancement of the senses Adverse Reactions increased heart rate, high blood pressure, increased metabolism, irregular heart beat, weight loss, heart failure, nervousness, insomnia Criminal Justice Addiction Services National Institute on Drug Abuse (NIDA) U.S. Drug Enforcement Administration (DEA)

33. Weight loss pills Examples bitter orange, chitosan, chromium, conjugated linoleic acid (CLA), county mallow (heartleaf), ephedra, green tea extract, guar gum, hoodia Nicknames same as above Route of Administration swallowed Desired Outcomes decrease appetite, block absorption of dietary fat, reduce fat, build muscle, increase calorie and fat metabolism, increase the feeling of fullness Adverse Reactions constipation, bloating, diarrhea, indigestion, high blood pressure, heart rate irregularities, sleeplessness, seizures, heart attacks, strokes, death, vomiting, flatulence Mayo Clinic

37. http://www.suremedlink.com

64. _____legal, illegal, prescription and over-the-counter substance(s) used; _____amount/route of administration/frequency/duration of use; _____when started using; _____why using/used; _____last use; _____blood alcohol level and time; _____breath test result and time; _____urine drug screen results and time; _____CIWA score and time; _____COWS score and time; _____CAGE score; Kannenberg Prescription drug interview questions

65. _____history of blackouts; _____history of intoxication or withdrawal delirium; _____history of intoxication or withdrawal seizures; _____history of substance induced psychosis, mania, anxiety or depression; _____longest time clean/sober, _____history of addiction treatment; _____history of addiction support; _____history of addiction education; _____history of substance related legal problems; _____history of physical problems as a result of using; and _____problems at home, work or school as a result of using. Kannenberg

69. 21. Neglect food : I do not eat healthy foods or eat at regular times, especially when I'm using. 22. Resentment : I feel like other people are out to get me, and I feel angry a lot. 23. Withdrawal : I need a drink or a drug in the morning or else I get the shakes or sweats because I feel terrible. 24. Can't make decisions : I can't make decisions about even small things. I just wait until things happen. 19. Work and money troubles : I have problems on the job, owe money or can't work at all because of my using. 20. Avoid friends and family : I avoid old friends and family that do not use—unless I need something from them. 18. Make changes : I change jobs, move, or leave a relationship to try to make my life better, but it doesn't make any difference. 17. Give up other things : I've stopped doing things that I used to do that didn't involve using alcohol or drugs. 16. Control : I try to control my use, but it doesn't work. 15. Promises : I promise to get my life in order and do better. I mean it, but it doesn't work out that way. 14. Show off : I show off or get pushy with other people to feel better and prove that I am okay. 13. Feel bad : I feel bad about how my using hurts other people, but I don't know what to do about it.

70. 37. Confinement : I have been in jails and mental wards because of my using. 36. Desperation : I am willing to do anything to get better. 35. I'm lost : I don't try to pretend my life is normal. I know I am an addict or an alcoholic. I believe that things will never change. 34. Turn to God : I want God or religion to save me from my life. 33. Using is everything : Getting something to use, using, and getting over using are my whole life. 32. Give up : I don't try to change anything. I just wait to see what happens. 31. Afraid : I feel like something terrible might happen to me, people are out to get me, and I have to be on guard at all times. 30. Major damage : Even when I'm not using, I have a hard time thinking, remembering, and doing things that used to be easy. 29. Find someone worse : I try to use with people who are worse off than I am so that I feel better. 28. Use all the time : I use whenever I can, and I don't try to have a normal life. 27. Over the line : I do things I said I would never do or things that do not reflect the way I was raised. 26. Decrease in amount to get high : It takes less for me to get high or doesn't matter how much I use because I can't get the effect I want. 25. Health problems : I am sick, have lost a lot of weight, or feel physically bad most of the time.

71. Scoring Sheet for Alcohol and Drug Addiction Test Early Stage Addiction Count up the number of yes answers you checked in questions 1–12 and write the number below. Number of checks for questions 1–12 _____ If you have one or more checks in this section, there is a possibility that you are addicted to alcohol or drugs. This means that you use alcohol or drugs to try to solve problems and to make yourself feel better. While using alcohol or drugs will not really make things better, it will feel like it does. If you have any checks in this section, you have a possibility of becoming addicted if you keep using. The closer your score is to 12, the higher your chance of addiction. Middle Stage Addiction Count up the number of yes answers you checked in questions 13–24 and write the number below. Number of checks for questions 13–24 ____ Any number of checks in this section means that you are addicted and have started to have bad things happen to you because of your addiction. During this stage, you may try to do things to control your addiction. Some of these may work for a while, but not for long. For questions 13–24, the closer your score is to 12, the more addicted you are, and the worse things will get if you do not get help. Late Stage Addiction Count up the number of yes answers you checked in questions 25–37 and write the number below. Number of checks for questions 25–37 ____ Any number of checks in this section means that you are in the late stage of addiction. During this stage, you may have given up and thought that you could not do anything to change. Serious life problems, such as being sick, or going to jail or a mental ward, have happened or will happen to you if you do not try to get help. For questions 25–37, the closer your score is to 13, the more addicted you are. Your chances of dying are high if you continue to use.

78. For each item, write in the number that best describes the patient’s signs or symptom. Rate on just the apparent relationship to opiate withdrawal. For example, if heart rate is increased because the patient was jogging just prior to assessment, the increase pulse rate would not add to the score. WESSON, Donald R., CNS Medications Development, Oakland, California; Medications Development Committee, American Society of Addiction Medicine. LING, Walter, Integrated Substance Abuse Programs, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles. Clinical Opiate Withdrawal Scale (COWS) Patient’s Name:___________________________ Date: ______________

80. http://www.aic.cuhk.edu.hk/web8/Horners_sweating.jpg

82. http://www.opt.indiana.edu/ecco/graphics/dilate.jpg

84. http://images.jupiterimages.com/common/detail/39/98/23119839.jpg

85. http://www.kellogg.umich.edu/theeyeshaveit/symptoms/images/tearing.jpg

87. http://www.brainexplorer.org/brain-images/tremor.jpg

89. http://www.abc.net.au/science/news/img/health/yawning071204.jpg

91. http://content.answers.com/main/content/wp/en/2/23/Goose_bumps.jpg

92. Score: 5-12 = mild; 13-24 = moderate; 25-36 = moderately severe; more than 36 = severe withdrawal Total scores with observer’s initials

107. “ National Medicine Abuse Awareness Month ” set by the United States Senate for every August starting in 2007.