Professional Documents
Culture Documents
Petros Levounis, MD, Director of the Addiction Institute of NY Dan Medeiros, MD, Director of the Child and Family Institute November 16, 2011
www.monitoringthefuture.org Data from 2010 Lifetime Use Eighth grade cigarettes alcohol Been drunk marijuana Other illegal drugs 20.0% 35.8% 16.3% 17.3% 10.6% Tenth grade 33.0% 58.2% 36.9% 33.4% 16.8% Twelfth grade 42.2% 71.0% 54.1% 43.8% 24.7%
Eighth grade cigarettes alcohol Been drunk marijuana Other illegal drugs 7.1% 13.8% 5.0% 8.0% 3.5%
Eighth grade cigarettes alcohol drunk Binge drink last 2 weeks marijuana 2.9% 0.5% 0.2% 7.2% 1.2%
Substance Dependence
Maladaptive pattern of use, leading to impairment or distress, occurring in same 12 month period, at least 3 criteria: 1) Tolerance 2) Withdrawal 3) Substance often taken in larger amounts or over longer period than intended 4) Persistent desire or unsuccessful efforts to cut down/control use 5) Lots of time spent in activities to obtain drug, use the drug, or recover from the drug 6) Important social/occupational/recreational activities given up/reduced because of drug use 7) Use despite knowing physical/psychological problem is caused by/exacerbated by the substance
Substance Abuse
Maladaptive use of substance leading to significant impairment/distress, within 12 month period, at least one: 1) 2) 3) 4) Recurrent drug use resulting in failure to fulfill major obligations at work, school, or home Recurrent drug use in situations which are physically hazardous Recurrent drug-related legal problems Continued use despite having physical/psychological problem caused by/exacerbated by the substance
Inter/Intra-product variability
Other stimulants Lidocaine/benzocaine
Major Concern
SYNERGY 1+1=3
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Problem #1
The explosion of prescription opioids: Oxycodone (OxyContin) Hydrocodone (Vicodin) Hydromorphone (Dilaudid) Fentanyl (Duragesic) Methadone
RESPIRATORY DEPRESSION
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Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, November 1, 2011
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Problem #2
The stimulant surge: Amphetamines
Methylphenidate (Ritalin) MDMA (Ecstasy) Crystal Methamphetamine
Cocaine Some older antidepressants And now Bath Salts as well SEROTONIN SYNDROME
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200
DA Concentration (% Baseline)
Food
Sex
200 150
% of Basal DA Output
150
100
Female Present
Time (min)
Sample 1 2 Number
Adapted from: Di Chiara et al., Neuroscience, 1999 Adapted from: Fiorino & Phillips, J Neuroscience, 1997
AMPHETAMINE
Adapted from: Di Chiara & Imperato, Proceedings of the National Academy of Sciences USA, 1988; courtesy of Nora D Volkow, MD.
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Courtesy of www.streetdrugs.org.
Methamphetamine
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Pseudoephedrine
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Courtesy of www.streetdrugs.org
Problem #3
The sex and drugs combination: Sildenafil (Viagra) Crystal Methamphetamine
HIV TRANSMISSION
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Levounis P, Ruggiero JS: Outpatient management of crystal methamphetamine dependence among gay and bisexual men: How can it be done? Primary Psychiatry 13, 75-80, 2006
Primary Prevention
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Courtesy of Daniel L. Carlson, Crystal Meth Working Group (HIV Forum), www.hivforumnyc.org.
Secondary Prevention
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Courtesy of Daniel L. Carlson, Crystal Meth Working Group (HIV Forum), www.hivforumnyc.org.
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Courtesy of Daniel L Carlson, Crystal Meth Working Group (HIV Forum), www.hivforumnyc.org.
People Recover
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Thank You
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