New Trends in

Drug Abuse:

Mazda Shirazi MD, PhD FACMT

Local History:

• 1953: Albert L. Picchioni, PhD, arrived to teach

at the University of Arizona College

of Pharmacy.

• ~1955 the Poison Center is functioning 24/7 but

remained a volunteer effort.

• 1980 the Arizona legislature approved funding

of the Poison Center with a full time staff.

Principals of the Poison Center operation:

1- Free service to the public

2- Service 24/7/365

3- Anonymous

4- Educate, Prevent, Triage, Treat

Poison Centers: Who are we?

• Physicians- Toxicologist, Pediatrician, Pharmacologist

• Pharmacist- Poison Information specialist

• Nurses- Poison Information specialist

• Public Health educator

• Teratologist

Arizona’s Poison Centers:

Banner Poison & Drug

Information Center

Maricopa

• 14 Counties

Most of AHEC Service area

Most of Tribal countries

• Maricopa only

Poison Centers1: Who do we serve?

All the population of Arizona:

• Children

• Pregnant women

• Breast feeding mothers

• Elderly

POISON CENTERS: WHO DO

WE SERVE?

• Doctors, Nurses, Pharmacists• Clinics• Emergency Rooms• ICU• EMS• Law Enforcement • Department of Health

Poison Centers: What do we do?

• Emergency phone service 24/7/365

• Exposure registry & data base

• Prevention, train, education

• Triage & treatment

• Post marketing surveillance

• Education (physician, pharmacist, nurses)

• Research

• Public Health

Poison Centers : What do we do?

Help evaluate children’s exposure to medication, house hold chemical, plant and creators.

Help with care and treatment of drug overdose and poisonings.

Help reduce and treat medication interactions

Help treat snake bite, scorpion stings, Africanized bee attacks.

Poison Centers: Public health role

• Poison information

• Drug information

• Toxicovigilance

• Pharmacovigilance

• Substance abuse

• Prevention/treat

• Environmental toxicology

• Occupational toxicology

• Chemical incidence and disaster

Data Collected 4: NPDS

vvvv

Triage

Monitor Mana

ge

Tra

ct Data

Sharing

NDPS/ CDC

Every 9 min

Syndromic

surveillance

Alerts

ARIZONA DEPARTMENT OF HEALTH

SERVICES

Alerts

Hospitals

&

Clinics

EMS

callsPublic

Health care

facilities

EMS

Current model of

utilization of Poison

Centers:

Monitor at home

Monitor& co-managevvvv

Triage

Monitor

Ma

na

ge

Tra

ct

70+%

Health

care

facilities

EMS

refer

Arizona Public

Specialty Services:

1 - Mother to Baby: chemicals in pregnancy and breast

feeding mothers and their infants.

2 - Pediatric Environmental Health Specialty Unit.

3 - Advanced Hazardous Materials Life Support (AHLS).

4 - Snake and Scorpion Envenomations and Anti-venoms

use.

5 - Opiate Assistance and Referral (OAR- Line)

Poison Center resources for opioid

dependency and pain management:

3.5-6 % of global population between

ages 15-64, have used illicit drug at least

once in last year.

World Drug Report 2018

Drug use among young people is

still higher than that among the

older populations

World Drug Report 2018

Critical risk periods for initiation:

• 12-14 years old

• 15-17 years old

• Peak of substance use18-25 years old

World Drug Report 2018

Risk factors for substance use:

Childhood trauma

Mental Health problems

Poverty

Peer substance use & drug availability

Negative school climate

Sensation seeking

Protective factors against substance use:

Caregiver or parental involvement

Physical safety & social inclusion

Development of coping skills

Quality school environment

Adulterants:

Adulterant: a substance found within

another substance that is not legally or

otherwise allowed to exist within them.

Adulterant: illicit drugs containing

another pharmacologically active

ingredient

◦ Cocaine with aspirin

Drug Test. Analysis 2011,3,89–96

Contaminants:

Contaminants: contamination refers to

the presence of harmful intrusions such

as pathogens or toxins.

Contaminants: in illicit drugs this a

substance that is there as by-product of

manufacturing.

◦ Heroin with botulism

Drug Test. Analysis 2011,3,89–96

Diluent:

Diluent: in illicit drugs refers to inert

substance added to product to increase

the bulk.

◦ Cocaine with lactose

Drug Test. Analysis 2011,3,89–96

Why do we have adulterants, contaminants

and diluents in illicit drugs?

To add to the bulk

To enhance & mimic

To facilitate use/administration

As a result of poor and unsterile

manufacturing technique

Drug Test. Analysis 2011,3,89–96

Most commonly abused drugs by high

school seniors (other than alcohol &

tobacco):

University of Michigan ,2018 Monitoring the Future

Study

What are the illicit Drugs?

Marijuana & Hashish ~ 36%

Synthetic Cannabinoids ~ 3.5%

LSD ~ 3.2

Cocaine ~ 2.3%

MDMA ~ 2.2%

Inhalant ~ 1.6%

Heroin ~ 0.4%

Pediatrics in Review, February 2019, VOLUME 40 /

ISSUE 2

Prevalence of drug use in the United

States 2017:

Prevalence of cannabis use in Americas:

0

5

10

15

20

25

Americas North

America

Canada &

USA

Perc

en

t

33 Legal Medical Marijuana States:

What are the new trends?

Synthetics & Designer Drugs:

1- Cannabinoids

2- Methamphetamines, Cathinones

3- Natural products

4-Vaping Nicotine, Hash (32% of 10th graders)

1- Pediatrics in Review, February 2019, VOLUME 40 /

ISSUE 2

2- University of Michigan ,2018 Monitoring the Future

Study

Synthetic cannabinoids: Spice

Synthetic cannabinoids: Spice

Synthetic cannabinoids: “Spice”

Can

nab

ino

ids

What toxidrome/s has /have been

associated use of spice?

Sympathomimetic

Sedative hypnotic

What were the major adulterant found in

spice in the past year?

fentanyl

coumadin

Cathinones: “Bath Salts”

Cathinones: “Bath Salts”

Name a Medicine that

is a Cathinone?

Bupropion or Wellbutrin

What toxidrome/s has /have been

associated with the use of “bath Salts”?

• Sympathomimetic

o Agitation, Seizure

o Tachycardia,

o Hypertension

o Sweating

o Dilated pupil

What are prescription/ OTC?

Sedative hypnotics ~ 5%

Stimulants~ 4.9%

Opioids ~3.4 %

Cough/ Cold ~ 3.4%

University of Michigan ,2018 Monitoring the Future Study

Xanax

Adderall Ritalin

dextromethorphan

oxycodone

What is an opioid toxidrome?

Somnolence

Bradycardia

Bradypnea

Hypotension

Meiosis

Inhalants: Solvents

Sniffing

Huffing

Bagging

What toxidrome/s has /have been

associated with the use of inhalants?

Hydrocarbon Toxidrome:

◦ CNS depression

◦ Tachydysrhythmias-->

Sudden sniffing death

What are the top three drugs of

abuse among teenagers?

Alcohol

Tobacco (nicotine)

Marijuana

The old drugs are still with us:

1- Alcohol

2- Tobacco

3- Marijuana

Pediatrics in Review, February 2019, VOLUME 40 /

ISSUE 2

The old drugs in new forms

Questions: