1. Nonmedical Use of
Prescription
Drugs
1

2. 1. What is Nonmedical use of Prescription Drugs?
2. What are the Myths about Prescription Drug Use?
3. What are Stimulants?
4. What are Depressants (Narcotics & Sedatives)?
5. Are Over-the-Counter Drugs Dangerous?
6. What is the reality of prescription drug misuse?
2

3. 1. What is the meaning of Nonmedical
Use of Prescription Drugs (Rx)?
“Taking medication prescribed to
someone else”
OR
“Taking the drug only for the experience
or feeling it caused”
(excludes Over-the-Counter medicine)
Office of Applied Studies, SAMHSA
Anesthetic and Life Support Drugs and Drug Safety and Risk Management Advisory Committees
November 13, 2008 3

4. Where do nonmedical users get pain reliever
prescription drugs?
http://www.theantidrug.com/pdfs/prescription_report.pdf 4

5. Which prescription drugs are being abused?
In 2005, 6.4 million Americans Age 12+ used a Rx for
nonmedical purposes in past month
0.3 million Sedatives
1.1 million Stimulant
s
1.8 million Anti-Anxiety
Medication
Narcotic Pain
4.7 million Relievers Depressants
Stimulants
http://www.google.com/search?hl=en&rlz=1G1GGLQ_ENUS310&q=In+2005%2C+6.4+million+Americans+Age+12%2B+used+a+prescription+drug+for+nonmedical+purposes+in+past+month&btnG=Se
SOURCE: 2005 National Survey on Drug Use and Health (NSDUH), published Sept 2005 by
= Dept of HHS / Substance Abuse and Mental Health Services Administration (SAMHSA)
5

6. Nonmedical use of prescription drugs ranks 2nd
only to marijuana as the most prevalent
category of drug abuse.
Depressants
Stimulants
http://www.oas.samhsa.gov/2k6/pain/pain.cfm
SOURCE: 2004 National Survey on Drug Use and Health (NSDUH) published Sept 2005 by the
Dept of HHS / Substance Abuse and Mental Health Services Administration (SAMHSA) 6

7. 2. What are some Myths about Rx Use?
•Prescription Drugs are “much safer” to use than
illegal drugs.
•“I think prescription drugs sound safer, even if they're not, just
because they came from a company, and they were
prescribed to someone for a legitimate reason.”
Gilbert Quintero. Journal of American College Health. July-August 2009 v58 i1 p64(7).
•There’s “nothing wrong” with using prescription
medicines without a prescription “once in a while.”
•Prescription Drugs are not addictive.
•There are fewer side effects than street drugs.
2005 Partnership and Attitude Study (PATS) www.usdoj.gov/dea/concern/hydrocodone.ppt
http://www.theantidrug.com/pdfs/prescription_report.pdf 7

8. FROM SCHOLASTIC AND THE SCIENTISTS OF THE NATIONAL INSTITUTE ON DRUG ABUSE, NATIONAL
INSTITUTES OF HEALTH, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
8

9. Stimulant
Medication
9

10. 3. Prescription Drug: STIMULANTS
Amphetamines, Methamphetamines
Amphetamine Congeners & Diet Pills
Intended Use:
Narcolepsy, Obesity, Attention-deficit hyperactivity
disorder (ADHD), Milder stimulants to lose weight.
Nonmedical use:
Surge of pleasure, rush or flash, burst of energy, to stay
awake, Anorexia, Euphoric Effect
Physical effects: include increased blood pressure, heart
rate and pulse rates, insomnia, loss of appetite, and
physical exhaustion.
Drugs causing similar effects cocaine, crack,
methamphetamine, khat
http://www.getsmartaboutdrugs.com/drugs/amphetamines.html?v=0&t=0&p=1&f=0&df=0&dt=0
http://www.drugabuse.gov/ResearchReports/Prescription/prescription4.html#HowDo 10

12. Prescription Drug STIMULANTS
Signs of Abuse
Nervousness, insomnia, over confident, aggressive, paranoid, loss
of appetite, violent, euphoria, increased blood pressure.
Signs of Withdrawal
Apathy, long periods of sleep, irritability, depression, disorientation.
Signs of an Overdose
Agitation, increased body temperature, hallucinations, convulsions,
apathy, long periods of sleep, depression, disorientation & possible
death.
Signs of Long-term Use
Heart disease, mental imbalances, paranoid, aggressive, twitching,
malnutrition, dehydration & psychotic, deplete energy sources &
severe depression.
http://www.usdoj.gov/dea/pubs/abuse/chart.htm 12

13. Prescription Drug STIMULANTS
How Stimulants can Kill:
1-Brain damage
Increased blood pressure increases the risk of a ruptured
blood vessel in the brain. Narrowing of blood vessels reduces
blood flow around the brain.
2-Heart attack
Increased oxygen demand by the heart (because of
increased motor activity) accompanied by reduced blood
supply (narrowing of blood vessels) can lead to heart attack.
3-Overheating
One function of dopamine is to regulate body temperature.
Altering dopamine levels with stimulants can affect the body's
ability to cool itself. Combined with increased motor activity,
this can lead to a dangerous increase in body temperature,
resulting in organ failure and death.
http://learn.genetics.utah.edu/content/addiction/drugs/overdose.html
13

14. Rates of Emergency Department visits, by drug,
type of use and age- ADHD Stimulant Medicine
2008 DATA

15. ADHD Stimulant Medicine-
Adderall® and Ritalin®
While students feel smarter and more
intelligent, the use of stimulants
doesn't make them "smarter" or
"better", it just makes their body's
organs worker harder and can actually
lead to the inability to concentrate or
think clearly for any length of time.
See Adderall Misuse on College Campuses
15

16. Illegal Comparisons and/or
Not considered legitimate for medical use: STIMULANTS
Cocaine- Slangs: Coke, Blow, Toot, Snow, Nose, Big C,
Methamphetamine- See next slide
Methyldioxymethamphetamine- MDA,MDMA Slangs: Ecstasy, rave,
love drug, XTC, Adam *No one other drug is quite like MDMA, but MDMA
produces both amphetamine-like stimulation and mild mescaline-like
hallucinations.
*tweaking- severe paranoid, hallucinatory, hyper vigilant thinking,
& greater suicidal depression
Crack Pipe Ecstasy
Cocaine Crack Cocaine Paraphernalia
http://www.whitehousedrugpolicy.gov/streetterms/ByType.asp?intTypeID=3 http://www.usdoj.gov/oig/special/9712/appb.htm 16

17. Methamphetamine (Desoxyn®)
vs. Methamphetamine (Meth) pg. 2
Desoxyn®:
There is only one product currently marketed in 5 mg
tablets. Desoxyn® has very limited use in the treatment of
obesity, and attention deficit hyperactivity disorder.
Desoxyn® Slangs: Yaba (pill form)
Meth Illicit Use:
Meth abuse is also manifested by extreme anorexia,
memory loss and severe dental problems.
Meth Powder
•Slangs: Batu, Black Beauties, Chalk, Chicken Feed, Tina,
Crank, Crystal, Glass, Go-Fast, Hiropon, Ice, Meth, Trash,
Methlies Quick, Shabu, Poor Man's Cocaine, Shards,
Speed, Stove Top, Tweak, Ventana, Vidrio, Yellow Bam
Crystal Meth Meth speed ball- Methamphetamine combined with heroin
http://www.oas.samhsa.gov/2k8/methamphetamineTX/meth.pdf
http://www.deadiversion.usdoj.gov/drugs_concern/meth.htm
http://www.getsmartaboutdrugs.com/drugs/methamphetamine.html?v=0&t=0&p=2&f=0&df=0&dt=0 17

18. Methamphetamine (Desoxyn®)
vs. Methamphetamine (Meth) pg. 2
•Currently, methamphetamine is primarily produced
by utilizing diverted pseudoephedrine combination
products. (Now behind the counter at stores.)
•Meth changes brain chemistry, and after extended
use, the brain can no longer respond to dopamine
(feel-good chemical produced by the brain).
•Psychotic symptoms can persist for months and
even years after use of these drugs has ceased
and may be related to their neurotoxic effects.
http://www.deadiversion.usdoj.gov/drugs_concern/meth.htm http://www.tcada.state.tx.us/
http://www.kalispell.com/stopmeth/what_is_methamphetamine.htm http://www.drugfree.org/Files/Meth_Fact_Sheets 18

19. Tolerance and Cross-Tolerance
Tolerance- Decrease in susceptibility to the effects of a
drug due to its continued administration. (An increase in
the amount of drug is necessary to get a similar high… the
original “high” is almost impossible to feel again.)
Cross-tolerance- Tolerance or resistance to a drug that
develops through continued use of another drug with
similar pharmacological compound.
These factors increase the health risk when using drugs.
http://www.merriam-webster.com/medical/cross-tolerance
19

20. Depressant
Medication
20

21. 4. Prescription Drug Depressants
Sedative-Hypnotics
&
Narcotics/Opioids
Similarities- Slowed breathing, high potential for
tolerance & dependence (addiction).
** Alcohol is a depressant and illegal for people under
the age of 21 in the United States.
http://www.getsmartaboutdrugs.com/drugs/narcotics.html?v=0&t=0&p=2&f=0&df=0&dt=0 21

22. 4. Prescription Drug Depressants-
Sedative/Hypnotics
Intended Use-
•To relieve Anxiety, Tension, Panic attacks, Acute stress
reactions, Seizures, Sleep disorders, Epilepsy, Anesthesia
(at high doses).
•Muscle Relaxants- overall suppresses the Central Nervous
System.
Nonmedical Use-
•To relieve agitation, induce mild euphoria, lower inhibitions.
•Often use in conjunction with other drugs.
•Very similar to the emotional and physical effects of alcohol.
•Blackout, brownouts, suicide attempts.
•Date Rape Drug
http://www.drugabuse.gov/ResearchReports/Prescription/prescription3.html#HowDo 22

24. 4. Prescription Drug Depressants-
Sedative/Hypnotics
Signs of Abuse- Slurred speech, disorientation, drunken
behavior without odor of alcohol, impaired memory of events,
interacts with alcohol.
Signs of Withdrawal- Headaches, tremors, muscles
twitching, nausea and vomiting, anxiety, restlessness,
yawing, inability to focus, sleep disturbance, dizziness,
delirium, convulsions, possible death. Can be fatal and
should be medically supervised.
Signs of an Overdose- Shallow respiration, clammy
skin, dilated pupils, weak and rapid pulse, coma, possible
death.
http://www.usdoj.gov/dea/pubs/abuse/chart.htm 24

25. Prescription Drug Depressants-
Sedative/Hypnotics
Signs of Long-term Use- Disrupt the
transfer of information from short to long-term
memory. Benzodiazepines: impair the ability to
learn new information.
Alcohol- a CNS depressant, overdose is
common, has damaging effects on every organ
system, most dangerous psychoactive drug.
( Also, tolerance to alcohol results in tolerance
to minor tranquilizers.)
Sign of Abuse by Gary Fisher & Thomas Harrison 25

26. Illegal Comparisons and/or
Not considered legitimate for medical use:
Depressant- Sedative/Hypnotics
Benzodiazepines: Flunitrazepam- Rohypnol®
(banned in the US but legal in over 60 countries)
A small white tablet with no taste or odor when dissolved in
a drink.
•Slangs- Forget-me pill, Mexican Valium, R2, Roche, roofies,
roofinol, rope, rophies, date rape drug
•Short Term effects: The drug creates a sleepy, relaxed, and
drunk feeling that lasts 2 to 8 hours. Other effects may include
blackouts, with a compete loss of memory, dizziness and
disorientation, nausea, difficulty with motor movements and
speaking.
http://www.drugfree.org/Portal/Drug_guide/Rohypnol# 26

27. Prescription Drug Depressants-
Narcotic/Opioids
Intended Use-
Postsurgical pain relief, Management of acute or chronic
pain, Relief of cough and diarrhea
Nonmedical Use-
•Deaden emotional pain
•Get a rush
•Induce euphoria
•Prevent withdrawal symptoms
There is no limit to the development of opiod tolerance.
http://www.drugabuse.gov/tib/bupren.html 27

28. Lifetime Nonmedical Use of Selected Pain Relievers,
Age 12 or Older: 2007
Vicodin®, Lortab®, or Lorcet® Hydrocodone 8.1
Darvocet®, Darvon®, or Tylenol® 7.6
with Codeine Propoxyphene (Darvocet and Darvon)
Percocet®, Percodan®, or Tylox® Oxycodone 4.7
Hydrocodone Hydrocodone 3.1
Codeine 2.7
OxyContin® Oxycodone 1.8
Demerol® 1.0
Morphine 0.9
Methadone 0.6
Ultram® 0.5
0 2 4 6 8 10
Office of Applied Studies, SAMHSA
Anesthetic and Life Support Drugs and Drug Safety and Risk
Percent Using in Lifetime
Management Advisory Committees
November 13, 2008 28

29. Nonmedical Use of Pain Relievers in Past Year among Persons
Aged 12 or Older, by Sub state Region: Percentages, Annual
Averages Based on 2004-2006
Office of Applied Studies, SAMHSA
Anesthetic and Life Support Drugs and Drug Safety and Risk Management Advisory Committees, November 13, 2008 29

30. 30

31. Prescription Drug Depressants-
Narcotic/Opioids
Signs of Abuse
Pinpoint pupils, sluggishness, shallow breathing and
suppressed cough, slow pulse, low blood pressure,
constipations, dryness of mouth, euphoria, numbness,
slurred speech, sunken eyes.
Signs of Withdrawal
Flu-like symptoms, muscle cramps, dilated pupils, coughing,
high blood pressure, rapid pulse, diarrhea, sweating, runny
nose, anxiety, severe depression, loss of appetite, irritability,
tremors, panic and vomiting. Symptoms are unpleasant and
uncomfortable but rarely dangerous.
Signs of an Overdose
Slow and shallow breathing, clammy skin, convulsions,
coma, possible death. A single dose can be lethal to an
inexperienced user.
http://www.getsmartaboutdrugs.com/drugs/narcotics.html?v=0&t=0&p=2&f=0&df=0&dt=0 31

32. Prescription Drug Depressants-
Narcotic/Opioids
Tolerance
Develops physical tolerance rapidly when the drugs are
repeatedly administered and psychological tolerance is
exhibit later at a slower rate. This tolerance results in the
individual’s using doses that would kill a nontolerant person.
Cross-Tolerance
Occurs between natural and synthetic opioids but there is no
cross-tolerance to CNS depressants (sedative/hypnotics).
Signs of Long-term Use
Severe constipation, women’s period delayed, sexual desire
dulled. Heavier users- eyelids droop and the head nods
forward, coordinating slowed. High tolerance and addiction .
32

33. How can one OxyContin pill kill you?
Taking a large single dose could cause severe
respiratory depression or death.
Typically, opioids should not be taken with alcohol,
antihistamines, barbiturates, or benzodiazepines.
These other substances also suppress breathing
and their effects in combination with opioids could
lead to life-threatening respiratory depression.
*There is always the possibility of a lethal reaction
to any drug.
http://www.drugabuse.gov/ResearchReports/Prescription/prescription8.html
http://www.nida.nih.gov/infofacts/PainMed.html http://www.drugabuse.gov/infofacts/PainMed.html 33

34. Neurotransmitters
brain's major "workhorse" Many of the drugs being
ino
a-am d) abused affect either
i
amm ic ac glutamate or GABA or
(g tyr
bu both to exert tranquilizing
Excitatory
signal Inhibitory or stimulating effects on
signal the brain.
Under normal conditions, excitatory and inhibitory
signals are in balance, resulting in controlled, regular
breathing.
A combination of heroin and
alcohol can be especially
dangerous. Opioids and Heroin increases
alcohol both suppress Alcohol decreases the inhibitory effects
the excitatory effects of GABA. (Increases
breathing, but by different
of glutamate the calming effect.)
mechanisms.
Under the influence of alcohol or opioids, excitatory
and inhibitory signals are out of balance, suppressing
http://learn.genetics.utah.edu/content/addiction/rewa
rd/pathways.html the impulse to breath

35. Illegal Comparisons and/or
Not considered legitimate for medical use: Opioids
Heroin
•Heroin is processed from morphine (a naturally occurring
substance extracted from the seed pod ). It comes in several
forms, the main ones being "black tar" from Mexico (primarily
sold in the western United States) and white heroin from
Colombia (primarily sold on the East Coast.)
•Slangs: Smack, junk, tar, Mexican brown, cheese, Harry,
skag, Rufus, Perze,”H”, horse, dava, boy Vick, Watson 387
•Following this initial euphoria, the user goes "on the nod," an
alternately wakeful and drowsy state. Mental functioning
becomes clouded due to the depression of the CNS.
http://www.drugfree.org/portal/drug_guide/heroin# http://www.tcada.state.tx.us/research/slang/terms.pdf
http://www.getsmartaboutdrugs.com/content/drugs.aspx?duid=27eccf9b-2ceb-4f72-9076-25a11387c2f2&v=1&t=0&p=1&df=1&f=0&dt=0 35

36. Narcotic Prescription Drugs Only -Unintentional Overdose Deaths
According to the Centers for Disease Control and Prevention (CDC) National
Center for Health Statistics, unintentional overdose deaths* involving
prescription opioids increased 114 percent from 2001 (3,994) to 2005
(8,541), the most recent nationwide data available.
*Does not include people prescribed drugs who died nor intentional overdoses (suicides).
http://www.usdoj.gov/ndic/pubs33/33775/execsum.htm#Figure1 36

37. Over-the-Counter
Medicine
37

38. 5. Are Over-the-Counter Drugs Dangerous?
•Some over-the-counter (OTC) drugs, primarily cough and
cold remedies that contain dextromethorphan (DXM), a cough
suppressant, are used to get high. Products with DXM include
NyQuil®, Coricidin®, and Robitussin®, among others.
•Slangs: CCC, Dex, DXM, Poor Man's PCP, Robo, Rojo,
Skittles, Triple C, Velvet
•Illicit use of DXM is referred to on the street as "Robo-
tripping," "skittling” or “dexing."
•In 2006, about 3.1 million people aged 12 to 25 had used an
OTC cough and cold medication at least once to get high, and
nearly one million had done so in the past year. (SAMHSA, 2008)
http://www.theantidrug.com/pdfs/prescription_report.pdf http://www.nida.nih.gov/infofacts/PainMed.html
http://www.getsmartaboutdrugs.com/drugs/dextromethorphan_dxm.html?v=0&t=0&p=1&f=0&df=0&dt=0 38

39. 5. Are Over-the-Counter Drugs Dangerous? (con’t.)
•Retailers are required of non-prescription products containing
pseudoephedrine, ephedrine and phenylpropanolamine to place
these products behind the counter or in a locked cabinet.
(Methamphetamine is primarily produced by utilizing diverted
pseudoephedrine combination products.)
•Pseudoephedrine products include- Drixoral, Zyrtec-D 12-Hour,
Advil Allergy Sinus, Mucinex D, Children’s Motrin Cold, Sine-Aid
IB, Claritin-D 24 Hour, Sudafed 24 & 12 Hours, Afrinol.
Photo shows
chemicals, waste
materials,
& empty
pseudoephedrine
blister packs.
http://www.usdoj.gov/ndic/pubs1/1837/1837p.pdf
http://www.usdoj.gov/ndic/pubs36/36407/index.htm#foota 39

40. 7. What is the Reality of
Prescription Drug
Misuse?
40

41. The reality is that brothers,
grandparents, friends, moms, uncles…
are dying everyday due to misuse of
prescription drugs.
In 2009, Florida’s Medical Commission reported
prescription drugs such as oxycodone, Xanax and Valium
were present in 79 percent of the 8,653 drug-related
deaths.
Don’t regret ignoring
the problem.
41

42. At the age of 22,
Josh was
prescribed
OxyContin after a
back injury. He got
hooked and
overdosed three
times, before a he
took a combination
of three prescribed
Josh’s doctors were aware of his drugs that killed
addiction problem and continued him -one day
to prescribed him narcotic drugs. before his 25th
birthday.
42

43. On August 18th, 2006, Emily,
only eighteen years of age and
three days from her first day in
college, was killed accidentally
when she consumed OxyContin
that had been prescribed for a
relative.
Emily was not an experienced
drug user, and all it took was
one encounter with this drug.
She had no chance to learn from
this one-time experience. Had
she any idea how deadly this
drug was, she would still be
alive.
43

44. Patrick Stewart died on July 9,
2004 at 24 years of age after
ingesting just one OxyContin® .
He had no other drugs in his
system and only a small amount
of alcohol.
He was a SDSU graduate, a graphic
designer and a certified personal trainer.
His friends described Patrick as "the one
who puts you back on your bicycle after
you fall off". He made the tragic mistake of
believing someone at a 4th of July
Close friends say that Patrick celebration when he was told that
had never before taken an OxyContin was "sort of like a muscle
OxyContin, did not know it was relaxant, that it was prescription and FDA
approved, so therefore safe".
equivalent to "heroin in a pill".
44

45. Robby L. Garvin
24 years old
Died 6-11-2006
Death caused by Methadone
toxicity. Robby died 40 hours
after he took his first dose of this
drug that was prescribed to him
for pain. Robby was never
informed by the prescribing
doctor or the pharmacy that
filled this prescription of the
dangers and possible death that
Methadone may cause.
45

46. If you suspect someone is abusing and/or is addicted to
drugs be proactive and persistent… people with addictions
often tend to lie and be dishonest as a means of continuing
their habit, and as a defense mechanism allowing them to
justify and survive this lifestyle. They are often even lying to
themselves that they have a problem. Seek Professional
and Medical advice. Don’t regret ignoring the problem.
For additional information on prescription drug abuse,
addiction, support groups, and recovery please visit
www.StopRxDrugAbuse.org
46