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

3. Marion Jones sentenced to 6 months for lying about steroids Her attorney quoted the bard in asking a judge to be merciful, but the former Olympic track gold medalist was sentenced Friday to six months in prison for lying to investigators about using performance-enhancing drugs and about her role in a check-fraud scam. Federal Judge Kenneth Karas imposed the maximum sentence suggested in Jones' plea deal, despite entreaties for a probation-only sentence from her and her lawyers. http://sports.espn.go.com/espn/wire?id=3192894&section=oly Adam Butler/Associated Press

4. Ledger's Death: Sleeping Pills, Anti-Anxiety Drugs Found at Scene Actor Heath Ledger, 28, was found dead at a Manhattan residence Tuesday. Police told ABC News' Richard Esposito that prescription drugs including sleeping pills and two anti-anxiety medications likely played a part, and the death appeared to be accidental. http://abcnews.go.com/Nightline/Story?id=4173792&page=1 Djamilla Rosa Cochran/ WireImage

5. Teens and Prescription Drugs Advertisement: “Drug Dealer” Transcript 2.3.08 TRT 00:30 (Scene opens with a drug dealer outside of a convenience store walking on a sidewalk and approaches the camera.) Drug dealer: “What’s this? What’s this? Documentary? Man, right here, this is my business.” (The drug dealer wanders up and down the sidewalk looking for potential customers and checks a pay phone for coins.) Drug dealer: “Buying, selling, whatever, you know? Slow! Business is off, man. Sales are down. Seems like half my customers, they don’t even need me anymore, you know? I mean they’re getting high for free…Out of their medicine cabinets.” (He throws up his arms and shakes his head in annoyance.) Drug dealer: “How am I supposed to compete with that!? You got kids?” (Drug dealer points at the cameraman.) Cameraman: “Yeah.” Drug dealer: “Well, next time something goes south with your kids don’t look at me, man. Ain’t my problem. I didn’t do it. (Laughs.) I wish I did!” Narrator: “Teens don’t need a drug dealer to get high.” Text: PARENTS. THE ANTI-DRUG. TheAntidrug.com 1-800-788-2800 Sponsored by Office of National Drug Control Policy/Partnership for a Drug-Free America® Narrator: “Safeguard your prescriptions. Safeguard your teens.” Material provided by the Office of National Drug Control Policy

6. Teens and Prescription Drugs Advertisement: “All My Pills” Transcript 2.3.08 TRT 00:30 (Scene opens with a teenage boy sitting in a school cafeteria with a small tin box full of pills.) (The teenage boy holds up a yellow pill.) TEENAGE BOY:" This yellow one is for my postpartum depression” (The teenage boy smirks, puts the yellow pill on the table then pulls a white pill out of the tin and holds it up.) TEENAGE BOY: “This one, sciatica, whatever that is” (The teenage boy puts the white pill on the table then pulls two blue pills out of the tin and holds them up.) TEENAGE BOY: “I got these after my hysterectomy, or my prostectomy or some ectomy” (The teenage boy puts the blue pills on the table then pulls a red pill out of the tin and holds it up.) TEENAGE BOY: “And this guy is for the pain from my last hip replacement.” (The teenage boy puts the red pill on the table then pulls an orange pill out of the tin and holds it up.) TEENAGE BOY: “And this orange one is…” (The lunch bell rings and the teenage boy scoops his pills off the table and back into the tin) TEENAGE BOY: “Gotta go” NARRATOR: “For teens, getting drugs can be as easy as opening your medicine cabinet.” (The screen goes black.) Text: PARENTS. THE ANTI-DRUG. TheAntidrug.com 1-800-788-2800 Sponsored by Office of National Drug Control Policy/Partnership for a Drug-Free America® Material provided by the Office of National Drug Control Policy

9. 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. Schedules of controlled substances

10. 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 OPI “ Opiates” “ Narcotic Analgesics” “ Pain Killers” Schedule of Substance Schedule of Products Oral (swallow) Intranasal (snort) Injection (IV,IM,SUB Q) Inhalation (smoke)

11. 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 (Time Release Tablet)

13. 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

14. 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

15. 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 Also used for diarrhea & cough.

16. 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 Lollipop Patch Not detected in immunoassays. Lozenge on plastic stick between cheeks and gums in mouth. Suck on it, twirl it. Only for breakthrough cancer pain if 16 or older. 80 x stronger than morphine! In its own class. IV/IM

17. Video #1 “Opioids” (3 minutes & 8 seconds)

19. 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 BAR “ Sedatives” “ Hypnotics” “ Anxiolytics” Used for mild sedation to surgical anesthesia. Also used for pain (e.g., tension headaches) or as anticonvulsants. Used less often for sleep/anxiety because more lethal if OD. Used in euthanasia with most animals, as well as human executions and assisted suicides (usually with muscle relaxant and potassium). Fiorecet ® has Tylenol ®/ caffeine.

22. Video #2 “Benzos” (2 minutes & 46 seconds)

25. 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 COC Used in eye, ear, nose and throat surgeries.

26. 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 MA Dextro-Levo-Methamphetamine, aka, D-Methamphetamine. Vicks ® Vapor Inhaler is Levo-Methamphetamine. All these symptoms increased if made illegally in U.S., Mexico or Asia.

27. 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 Cylert ® (pemoline) discontinued by Abbott Laboratories in 2005 (liver studies). Strattera ® (atomexetine HCI) is a non stimulant.

30. Video #3 “DXM” (1minute & 50 seconds)

31. 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

52. _____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; Prescription drug interview questions

53. _____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.

59. 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. Clinical Opiate Withdrawal Scale (COWS) . Patient’s Name:___________________________ Date: ______________

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