The vast majority of Marin teens do not abuse prescription or so called “hard” drugs. California Healthy Kids Survey (“CHKS”) results for 2015-16 show past month use of these drugs by Tamalpais High School District 11th grade teens to be in the single digits (although lifetime use is higher in the double digits).
Yet there are disturbing increases in use, especially with respect to prescription drugs, and the consequences for those who abuse these drugs are harsh. Over the past 15 years, drug related ER visits and deaths in Marin have tripled. Teen and adult drug related deaths in Marin occur at shocking rates.
From 2012 to 2013, there was one accidental overdose death every two weeks in Marin. The year 2016 was a particularly deadly one, with more drug related deaths of young Marin males than in previous years. These deaths often resulted from a combination of alcohol and other drugs or the abuse of multiple drugs at the same time (called “polysubstance abuse”).
For this reason, Marin County’s Public Health Officer, Dr. Matt Willis, who has a child at Drake High School, has called drug use in Marin “an ongoing public health crisis.” For an alarming article about the magnitude of this problem, read “A Dangerous Game” at http://marinmagazine.com/September-2016/Dangerous-Game/.
Prescription (Rx) Drug Abuse
ADDERALL, RITALIN and Other ADHD Drug Abuse. Adderall and Ritalin are two popular drugs which are used primarily to treat the symptoms of attention-deficit hyperactivity disorder (“ADHD”). Other ADHD drugs include Dexedrine, Focalin, Vyvanse and Concerta. Adderall, normally referred to as “Addies”, is the most commonly abused of these drugs and is a combination of amphetamine (known as “speed” or “uppers”) and dextroamphetamine. Ritalin is also abused and is a methylphenidate, which has similar effects to amphetamines.
Stimulant Classification. These drugs are classified as central nervous system stimulants, which means they speed up and heighten certain bodily processes. Those who have been diagnosed properly as having ADHD and take these drugs feel a calming, centering effect.
Abuse is Common. Yet, increasing numbers of teens and young adults who don’t have ADHD inaccurately believe that taking these drugs will help improve their ability to maintain focus and productivity while studying, taking tests, working or participating in sports. Some take these drugs recreationally. For those users, taking these drugs feels just like taking speed - legal speed.
Adderall and Ritalin abuse is becoming ubiquitous in high schools and college environments. For a Redwood High School Bark article on the use of Adderall by students, go to www.redwoodbark.org/2012/11/students-turn-to-drugs-to-enhance-test-performance.
Side Effects. Common symptoms of Adderall abuse include dry mouth, headache, hoarseness, nausea, digestive issues, reduced appetite, anxiety, restlessness, insomnia, irritability, excessive fatigue, pounding or fast heartbeat and shortness of breath. Ritalin abuse runs the risk of similar negative side effects.
Dangerous Consequences. With long-term or high dose abuse, the symptoms can compound and lead to even more dangerous effects. These include weakness or numbness in the arms or legs, dizziness, slowed or difficult speech, chest pain, hives or rashes, changes in vision, aggressive behavior, paranoia, mania and seizures. Since these are stimulants, serious cardiovascular complications include increased heart rate, increased body temperature to dangerous levels, heart attacks, cardiac arrest or strokes.
Symptoms of Overdose. These include panic attack, hyperventilation, cardiac rhythm abnormalities, hallucinations, uncontrollable tremors, profound confusion or delirium, vertigo, loss of consciousness and coma.
Post-effect Crash. Like Cocaine or any other stimulant, the “up feeling” from Adderall and Ritalin is followed by a crash, a feeling of fatigue, depression and decreased alertness. This can lead to additional abuse to obtain the high.
Tolerance, Dependency and Addiction. Unprescribed abuse of Adderall can be very addictive. Long-term abuse can lead to increased tolerance. Often, as use increases, it becomes impossible to ever recreate the initial high. This can lead to dependency, which in turn can lead to addiction. Over time, the resulting increase in dopamine activity can because subtle brain changes that reinforce drug behavior to the point of being quite difficult to reverse on one’s own.
An interview that highlights why teens are more susceptible to addiction is at http://www.npr.org/sections/health-shots/2015/01/28/381622350/why-teens-are-impulsive-addiction-prone-and-should-protect-their-brains
Short versus Long-term Use. On a short-term basis, non-ADHD users may stay up all night, read more and finish more problems, or work harder, but on a long-term basis, sleep/wake cycles are interrupted and the drugs do not improve one’s ability to learn or work. Non-ADHD users are learning or working in an “altered state” which is called “state dependent learning”. Someone who studies or works in an altered state may not remember the information when he or she returns to a non-altered state.
As Dr. Jan Maisel, a Greenbrae pediatrician has stated, “if someone stays up all night, whether assisted by a medicine or not, and does all this work and then goes off to take a test on this work or make a presentation, if they haven’t slept sufficient hours, they are much less able to put the work that they did into their long-term memory”. Studies show that students who abuse Adderall and Ritalin are more likely to have lower grades than students who do not abuse the substance.
Easy Access. A 2016 survey among 18-28 year olds found that roughly 63% obtained these drugs from friends, 18% from classmates and 20% from family.
Using for Recreational Purposes or Combining with Alcohol. Popping ADHD drugs with alcohol keeps users awake for more partying as these drugs counter the depressive effects of alcohol. The euphoria and happiness from these drugs, as well as reportedly better and more frequent sex, can lead to recreational abuse at parties and nightclubs.
Gateway drug. Unprescribed Adderall, Ritalin and other ADHD drugs are becoming known as gateway drugs to Cocaine, Ecstasy, Heroin and Methamphetamine (“meth”), especially when those drugs are cheaper. Meth and Adderall are almost chemical siblings - the methyl group simply allows the Meth to race through the body and hit harder. After that, meth breaks down and metabolizes into amphetamine. Meth and amphetamine cause the same side effects, same potential for overdose and same risk of physical dependence and addiction.
Research done at UC Berkeley identified a relationship between ADHD and use of stimulants in childhood and dependence on other stimulants in adulthood. According to another study, adolescent rats given repeated doses of Ritalin were more likely to self-administer Cocaine.
Slang Terms. These include Kiddy Cocaine, Truckdrivers, Uppers, Speed, Double Trouble, Christmas trees, Skippy, Jif, Bennies, Beans, Black Beauties, Roses, Hearts, Crosses, LA Turnaround, Addies (for Adderall) and Rittys, Rits (for Ritalin).
Prevention. A critical part of prevention is to inform your child that there is no association documented between ADHD drug abuse and increased study abilities or intelligence. The more you speak with your child about the dangers of drug use, the less likely your child will abuse drugs. If your child is prescribed ADHD drugs, monitor their use to ensure that the drugs are not being diverted to others.
Xanax and Other Drugs Used to Treat Anxiety
Drugs such as Xanax, Valium, Klonopin, Ativan, Halcion and Restoril are in a category of drugs called Benzodiazepines (“Benzos”) and are typically prescribed to treat patients suffering from anxiety and panic disorders. They also aid sleep and are prescribed for other reasons, e.g., Klonopin and Valium are also anti-seizure drugs. Benzos are central nervous system depressants, slowing down aspects of mental and physical health. They are highly addictive if taken over a prolonged period or in large quantities. It is important to remember that teens and young adults are more susceptible to addiction because of their developing brains.
Xanax. This is perhaps the most commonly abused Benzo and is the trade name of the prescription medication Alprazolam. Street names include Xannies/Zannies, Handlebars/Bars or Blue Footballs. Xanax bars are becoming increasingly common in Marin high schools, are 2 milligrams, shaped like a bar and divided into quarters.
Signs of abuse. These include, sleepiness, lethargy, lacking in motivation to engage in normal activities of daily life, slurred speech, monotone voice, appearing distracted, agoraphobia (not wanting to leave the house) and reclusiveness (avoiding other people). Benzos are known to slow down respiratory rates which alone can be dangerous as breathing slows. But when mixed with alcohol, another depressant (not uncommon among teens and young adults), their combined effect can lead to serious injury, coma or death.
After long term use, individuals may become even more reclusive, agoraphobic and scared of people, behaving more strangely, and have twitching eyes and a tense neck.
Slang terms. These include Candy, Downers, Downs, Chill Pills, Tranks, Tranqs, Totem Poles, Sleeping Pills, French Fries, Blues, Z-bar and Bricks.Mixing Benzos with Alcohol. Combining Benzos with alcohol is especially dangerous. Since both substances are depressants, that can greatly relax muscles and bring the central nervous system to a crawl, which can result in unconsciousness, coma or death. A slang term for a mix of prescription drugs with alcohol is “recipe”.
Opioids are a class of drugs that include the illicit drug Heroin, as well as regular prescription (Rx) pain relievers such as Oxycodone (OxyContin and Percocet), Hydrocodone (Vicodin, Lortab), Codeine, Morphine, Methadone, Fentanyl and others.
Opioids are one of the most abused drugs in the U.S. and they are easy to get ahold of, readily prescribed and are very addictive - a dangerous combination. Of particular concern is that opioids can cause measurable symptoms of addiction in less than three days!
The 2014 National Survey on Drug use and Health has estimated that there were 4.3 million non-medical users of pain relievers in the U.S. in 2014, a population second only in size to marijuana users.
The U.S. is in the midst of an opioid epidemic. Drug overdoses today are the leading cause of accidental deaths in the U.S. - more than car crashes and gun deaths combined - and opioids are driving this epidemic. The CDC announced in December 2016 that more people died from drug overdoses in 2015 than in any other year on record and 60% of those deaths came from opioids. This is a uniquely American issue. While Americans comprise less than 5% of the world’s populace, we consume 80% of the world’s opioids and 99% of the world’s Hydrocodone and Oxycodone.
PRESCRIPTION (Rx) OPIOIDS. In 2014, more young adults died from prescription drug (mostly opioid) deaths, than overdoses from any other drug, including heroin and cocaine combined, including many more needing emergency room treatments.
Nearly a half million teens (aged 12-17 years old) used prescription painkillers non-medically for the first time in 2014. These drugs are easily accessible from family or friends’ medicine cabinets. The prescribing rates for prescription opioids among adolescents and young adults nearly doubled from 1994-2007.
As stated above, in the Tamalpais HS Union District, 24% of 11th grade teens surveyed used prescription pain killers or other prescription stimulants, according to the 2015-16 CHKS survey. Most teens do not believe that painkillers are dangerous, because they are prescribed by a doctor and are not illegal. The terms “pharming” or “pharm party” refer to swapping or sharing Rx drugs. The term “trail mix” or “skittles” refers to mixing various prescription drugs at pharm parties. Fortunately, pharm parties are not common in our Marin high schools.
Opioids bind to the brain’s opioid receptors. Once attached, they initiate a cascade of neurochemical activity which signals a massive influx of dopamine. The signals sent to the brain block pain, slow breathing and have a general calming and antidepressant effect.
Signs of Misuse. These include constricted, small pupils (pinprick or pinpoint in size), noticeable euphoria (feeling high), marked sedation, intermittent nodding off or loss of consciousness, respiratory depression (shallow or slow breathing), nausea, vomiting, constipation, and analgesia (feeling no pain). Withdrawal symptoms can mimic flu symptoms.
Slang terms. These include Hillbilly Heroin, Kickers, Oxy, OC, Oxycotton, Cotton or being Jammed (Oxycodone) and Jerry Rice (80mg tabs), Percs, Percodans (Percocet), Vic, Vikings, Vikes, Watson-377 (Vicodin) and Happy Pills and Big Boys.
Mixing Alcohol and Opioid Painkillers. As with Benzos, both alcohol and opioid painkillers are central nervous system depressants. When combined, these substances can have a catastrophic interplay. Concurrent use can hasten an overdose due to a synergy in respiratory depression. While alcohol alone can have harmful effects on the liver, the risk of liver damage is severe as many painkillers also contain acetaminophen.
Gateway to Heroin. Four out of five new heroin users started out by misusing prescription painkillers.
Although rare, heroin use unfortunately exists in Marin County and in our high schools. With over 1 million heroin users in the U.S., heroin-related deaths are skyrocketing, made possible in part by the cheap supply of heroin, easy availability and Fentanyl-infused heroin (which is 50 times more potent than heroin.) Many of these deaths are also attributable to new government manufacturing requirements that make opioid prescription pills more difficult to crush and inject into the bloodstream. These factors have made prescription drug users shift to heroin.
Heroin deaths rose 23% in 2015 and were higher than gun deaths. Over the past several years, heroin has resulted in too many tragic deaths of Marin teens and young adults.
Signs of Use. After a “fix” or after smoking heroin, a heroin user will look “stoned”. Signs of use are very small pupils, glassy looking eyes (light colored eyes can turn bright blue), difficulty in keeping eyes open (appearing as nodding off - called “goofing off”), inability to finish sentences, slurred speech, shallow breathing, scratching, excessive smoking, loose facial muscles, blood stains on clothes from using needles, bloody tissues, track marks on hands, arms and legs, long sleeves in warm weather to hide track marks.
Slang Terms. These include H, Horse, Smack, Junk, Dope, White Horse, China White, Skunk, Skag, Helldust, Brown Sugar, Thunder, Chiva and Chasing the Dragon. Kryptonite refers to marijuana with heroin.
What is most alarming is that prescription pills are sometimes being laced with fentanyl and other synthetic opiates and these counterfeit drugs are extremely deadly. (Remember, fentanyl is 50 times more potent than heroin - a legal dose is approximately 2 milligrams). This has been occurring since 2013-14 and there is a new and ongoing Fentanyl crisis (the first was in 2006 with fentanyl infused heroin).
Motivated by enormous profits, traffickers are exploiting high consumer demand for prescription medications by producing inexpensive, fraudulent prescription pills containing fentanyl. Counterfeit pills containing fentanyl are smuggled into the U.S. from Mexico and Canada and clandestine pill press operations also occur in the U.S., with China as the primary source. Traffickers usually purchase powdered fentanyl and pill presses from China to create counterfeit pills to supply illicit U.S drug markets. The pills are manufactured to look like Vicodin, Percocet, Xanax and other prescription pills. See https://www.dea.gov/docs/Counterfeit%20Prescription%20Pills.pdf.
Cold & Cough Medications
(Coricidin pills, Robitussin Cough Syrup).
In October 2015, five students at Tamalpais and Drake high school overdosed in one week after taking large doses of cold and cough medicine, known as “Triple C”. When taken in large quantities, these drugs cause a high that produces hallucinations and a sense of dissociation. The primary ingredient is dextromethorphan or DXM, which can create psychotic results.
Signs of use are dilated pupils, vomiting and poor motor control. Use can result in seizures, coma and death.
Another dangerous version of cough syrup contains Codeine and Promethazine, which is prescribed, but can be abused easily. Known as “Purple Drank”, it is often mixed with soda and is attributed to the loss of at least one Marin youth.
Slang terms. DXM abuse is also referred to as Triple C, skittles or robotripping. Codeine with Robitussin is called Cody, Captain Cody, Schoolboy or Tuss.