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GOOD MORNING



          David B. Aber,
          NREMT-P, I/C
They’ll Huff and Puff and…..
     What they’re using today
TIME TO WAKE UP
*Get out on time
     *Learn something
*Get High-Legally of course
TOPICS
Energy Drinks
Huffing
Salvia
GHB
Prescription abuse and
Combinations
Energy Drinks
Red Bull, Monster, Octane, Rock Star, and
others added daily
A Soda on “Crack”
  25-40 mg Caffeine vs up to 280 mg Caffeine
  SUGARRRR
Effects on
heart rate and
blood pressure

                                           6
Energy Drinks
Cases of exercise induced cardiac arrest
with contributing use of energy drinks.

Dehydration
  Caffeine + Exercise = increased diuresis
  RedBull and Vodka= why some of you feel
  hung over!!!!



                                             7
Energy Drinks
    Ephedrine - A stimulant that works on the central
    nervous system. It is a common ingredient in weight-loss
    products and decongestants, but there have been
    concerns about its effects on the heart.
• Taurine - A natural amino acid produced by the body that helps
  regulate heart beat and muscle contractions. Many health experts
  aren't sure what effect it has as a drink additive (and the rumor that
  taurine comes from bull testicles is false).
• Ginseng - A root believed by some to have several medicinal
  properties, including reducing stress and boosting energy levels.
•   B-vitamins - A group of vitamins that can convert sugar to energy and improve muscle tone.
•   Guarana seed - A stimulant that comes from a small shrub native to Venezuela and Brazil.
•   Carnitine - An amino acid that plays a role in fatty acid metabolism.
•   Creatine - An organic acid that helps supply energy for muscle contractions.
•   Inositol - A member of the vitamin B complex (not a vitamin itself, because the human body can
    synthesize it) that helps relay messages within cells in the body.
•   Ginkgo biloba - Made from the seeds of the ginkgo biloba tree, thought to enhance memory.

                                                                                                     8
HUFFING
Huffing
Background
    Breathable chemical vapors that cause a
  mind altering effect on the user.
  Usually pressurized containers.
    Can be Non-Solvent

Street Names
  Poppers, Snappers, Bang, Hippie Crack, Head
 Cleaner, Rush, Poor Man’s Pot, Bagging
Huffing

Types of Huffing Materials
  Volatile Solvents
    Liquids that vaporize at room temperatures
       Paint thinner, gasoline, White-out™, Glue (Rubber
       Cement™)
  Aerosols
    Sprays containing propellants and solvents
       Spray paint, Deodorant, Fabric Protector
          Silver and Gold spray paints are most popular
Huffing
Types of Huffing Materials (cont.)
  Gases
    Substances that lack definite shape or volume.
       Butane, Air conditioner Refrigerants, Dust Off™
       Medical gasses
           Chloroform, Nitrous Oxide (laughing gas)
               Whippets
  Nitrates
    Amyl Nitrate and Butyl Nitrate
       Sexual enhancement
          Found in adult books stores
Huffing

So who uses this stuff?
ANYONE!!!
Over 1,000,000 reported uses
  12-17 year olds most common
4th most abused substance for high school
age
HUFFING

 Suffocation, inhaling fluid or vomit into the
lungs, and accidents each cause about 15%
of deaths linked to inhalant abuse. 
 Approximately 8.9% of youth ages 12—17
have misused inhalants. 
 55% of deaths linked to inhalant abuse are
caused by “Sudden Sniffing Death
Syndrome.” SSDS can occur on the first use
or any use. 
HUFFING


 22% of inhalant abusers who died of SSDS
had no history of previous inhalant abuse.
In other words, they were first-time users. 
Huffing
Sudden Sniffing Death Syndrome (SSDS)
  Usually associated with aerosols and gasses
  Causes Heart Failure and eventually death
  Can occur first time use


Occurs when startled or surprised.
  Surge of Epinephrine
    Increased Heart Rate and Blood Pressure
    Inhalant use makes myocardium more sensitive
Huffing
   Put your thinking hat on……..
! What commonly prescribed medication for young
  adults could make this syndrome occur more
  often?
Huffing

Put your thinking hat on……..
What commonly prescribed medication for
young adults could make this syndrome
occur more often...

RITALIN—BUT WHY???
Huffing
Put your thinking hat on……..
What commonly prescribed medication for
young adults could make this syndrome
occur more often...

RITALIN—BUT WHY???
Ritalin has a sympathomimetic effect…Big
word for adrenaline.
  Adrenaline = Epinephrine
Huffing—Video
Huffing—Video
Huffing
What EMS needs to know…………….
   Patient Presentation
   Similar to intoxication
        Drowsiness
        Lightheadedness
        Loss of inhibitions
   Long Term Exposure
        Hallucinations         D E LAWA
                                          RE
        Belligerence           Blue Hens
Huffing
What we are going to treat
No rapid fix
Oxygen, Oxygen, Oxygen
Airway support
  Be aware of residual substances
Patient Safety
Bring substance if safe
Decontamination
  Off gassing
Huffing
INHALET             EXAMPLE                    EFFECTS
Toluene             Spray paint                Hearing loss
                    Glue                       Damage to spinal cord or
                    De-waxer/floor stripper     brain
                    Fingernail polish          Liver and kidney damage


Trichloroethylene   Cleaning fluid              Hearing loss
                    Correction fluid            Liver and kidney damage


Hexane              Glue                       Limb spasms
                    Gasoline                   Blackouts


Nitrous Oxide       Whipped cream dispensers   Limb spasms
                    Gas cylinders              Blackouts



Benzene             Gasoline                   Bone marrow damage
SALVIA
The most controversial one we will
        be talking about
Salvia Divinorum
“Salvia”
Used in Mexico as a medicinal herb during ritual
 healing.
Salvia

Effects last usually less than 5 minutes
  EMS may only gets reports of behavior
Comes in various strengths
  1x up to 100x
Smoked, chewed, and brewed
Street Names
  Deviner’s Sage, Sally-D, Magic Mint
Salvia	
Signs and symptoms


  Bright lights, vivid colors and shapes, as well as,
  body movements and body or object distortions.


  Other effects include uncontrolled laughter, a sense
  of loss of body, overlapping realities, and
  hallucinations
Salvia--Effects

 Feelings of calmness: 42.2%
 Weird thoughts: 36.4%
 Things seeming unreal: 32.4%
 Floating feelings: 32%
 Mind racing: 23.2%
 Feeling lightheaded: 22.2%
(Baggott, et al) from the University of California Berkeley and California Pacific Medical Center Research Institute conducted a
survey of 500 salvia users
SALVIA VIDEO



               29
SALVIA—TRIP VIDEO
SALVIA—TRIP VIDEO
Salvia
               Brett’s Law
         Originated in Delaware
             Brett Chidester
       Committed Suicide @ 17yrs.
Note stated that a"er using Salvia he found
         life was not worth living
Honor Roll Student

National honor society

Honors band
Honor Roll Student

National honor society

Honors band
drug tests negative
drug tests negative

police found salvia after death
drug tests negative

police found salvia after death

7-10 notes about salvia
drug tests negative

police found salvia after death

7-10 notes about salvia

3 page suicide note
drug tests negative

police found salvia after death

7-10 notes about salvia

3 page suicide note
Salvia-CNN Report
Salvia
Delaware, Florida, Illinois, Kansas,
Mississippi, Missouri, North Dakota, South
Dakota,Ohio,Oklahoma, Virginia and
others have passed their own laws.
Schedule 1

Alabama, Alaska, California Florida, Iowa,
Michigan, New Jersey, New York, Ohio,
Oregon, Pennsylvania, California and
Texas have proposed legislation.
Salvia

Who’s using it…………….
2008
  1.8 million (est.) individuals 12 and older have used it
  750,000 within the past year
  Most common age was 18-25

  National Survey on Drug Use and Health Report published by SAMHSA in February 2008
Salvia

EMS Intervention
  Protection
  Possible other AMS causes
  Calm quiet transport
WHO’S READY TO GET
       HIGH
Time to feel what they feel!!!
WARNING: Avoid prolonged staring if you are prone to
seizures or motion sickness
Ketamine
Ever heard of it?
Ketamine
Ever heard of it?
Ketamine
K
Special K
Vitamin K
Bump
Cat Valium
Raver’s Smack
Ketamine
Now used more often then Cocaine in the
UK.

 The trip — also called K-hole — that
results from ketamine usually lasts up to 2
hours.
KETAMINE
•Users may become nauseated or vomit, become
 delirious, and have problems with thinking or
 memory.


•At higher doses, ketamine causes movement
 problems, body numbness, and slowed breathing.
Date Rape Drugs

Rohypnol
  Roofies, roach, forget-me pill
Anti-anxiety medication
  10x Valium
Memory loss, Hypotension, Nausea, and
Drowsiness, Loss of inhibitions
Date Rape Drugs
GHB
  Gamma-Hydroxybutyric Acid
    Naturally occurring in the body
Once used legally by bodybuilders
    Still used in hospital as a sedative
Mixed with alcohol as a liquid
Patients may complain of a salty taste that
was in the drink
Airway management it top concern
Date Rape Drugs
GHB
  Gamma-Hydroxybutyric Acid
    Naturally occurring in the body
Once used legally by bodybuilders
    Still used in hospital as a sedative
Mixed with alcohol as a liquid
Patients may complain of a salty taste that
was in the drink
Airway management it top concern
Date Rape Drugs
GHB
  Gamma-Hydroxybutyric Acid
    Naturally occurring in the body
Once used legally by bodybuilders
    Still used in hospital as a sedative
Mixed with alcohol as a liquid
Patients may complain of a salty taste that
was in the drink
Airway management it top concern
Pain Medications

 Between 2006 and 2007
     Cocaine use decreased 23 percent.
     Prescription medication abuse increased 12
     percent
2007 Substance Abuse and Mental Health Services Administration (SAMHSA).



 Over 15 million Americans
 Most common is OxyContin™
Polypharm
Heroin laced with Fentanyl
       WHAT’S THE PROBLEM?
       2005-2006 = Over 1,000 Deaths
WET
CHIP
BUDDA
Many “pill popper” patients are on anti-
depressants
       Side effect of anti depressants?
Thank you!!!!!
Enjoy the rest of your conference
 Contact info--302-737-4044 or
        www.see4life.com

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Street Drugs-Huff and Puff

  • 1. GOOD MORNING David B. Aber, NREMT-P, I/C
  • 2. They’ll Huff and Puff and….. What they’re using today
  • 4. *Get out on time *Learn something *Get High-Legally of course
  • 6. Energy Drinks Red Bull, Monster, Octane, Rock Star, and others added daily A Soda on “Crack” 25-40 mg Caffeine vs up to 280 mg Caffeine SUGARRRR Effects on heart rate and blood pressure 6
  • 7. Energy Drinks Cases of exercise induced cardiac arrest with contributing use of energy drinks. Dehydration Caffeine + Exercise = increased diuresis RedBull and Vodka= why some of you feel hung over!!!! 7
  • 8. Energy Drinks Ephedrine - A stimulant that works on the central nervous system. It is a common ingredient in weight-loss products and decongestants, but there have been concerns about its effects on the heart. • Taurine - A natural amino acid produced by the body that helps regulate heart beat and muscle contractions. Many health experts aren't sure what effect it has as a drink additive (and the rumor that taurine comes from bull testicles is false). • Ginseng - A root believed by some to have several medicinal properties, including reducing stress and boosting energy levels. • B-vitamins - A group of vitamins that can convert sugar to energy and improve muscle tone. • Guarana seed - A stimulant that comes from a small shrub native to Venezuela and Brazil. • Carnitine - An amino acid that plays a role in fatty acid metabolism. • Creatine - An organic acid that helps supply energy for muscle contractions. • Inositol - A member of the vitamin B complex (not a vitamin itself, because the human body can synthesize it) that helps relay messages within cells in the body. • Ginkgo biloba - Made from the seeds of the ginkgo biloba tree, thought to enhance memory. 8
  • 10. Huffing Background Breathable chemical vapors that cause a mind altering effect on the user. Usually pressurized containers. Can be Non-Solvent Street Names Poppers, Snappers, Bang, Hippie Crack, Head Cleaner, Rush, Poor Man’s Pot, Bagging
  • 11. Huffing Types of Huffing Materials Volatile Solvents Liquids that vaporize at room temperatures Paint thinner, gasoline, White-out™, Glue (Rubber Cement™) Aerosols Sprays containing propellants and solvents Spray paint, Deodorant, Fabric Protector Silver and Gold spray paints are most popular
  • 12. Huffing Types of Huffing Materials (cont.) Gases Substances that lack definite shape or volume. Butane, Air conditioner Refrigerants, Dust Off™ Medical gasses Chloroform, Nitrous Oxide (laughing gas) Whippets Nitrates Amyl Nitrate and Butyl Nitrate Sexual enhancement Found in adult books stores
  • 13. Huffing So who uses this stuff? ANYONE!!! Over 1,000,000 reported uses 12-17 year olds most common 4th most abused substance for high school age
  • 14. HUFFING Suffocation, inhaling fluid or vomit into the lungs, and accidents each cause about 15% of deaths linked to inhalant abuse.  Approximately 8.9% of youth ages 12—17 have misused inhalants.  55% of deaths linked to inhalant abuse are caused by “Sudden Sniffing Death Syndrome.” SSDS can occur on the first use or any use. 
  • 15. HUFFING 22% of inhalant abusers who died of SSDS had no history of previous inhalant abuse. In other words, they were first-time users. 
  • 16. Huffing Sudden Sniffing Death Syndrome (SSDS) Usually associated with aerosols and gasses Causes Heart Failure and eventually death Can occur first time use Occurs when startled or surprised. Surge of Epinephrine Increased Heart Rate and Blood Pressure Inhalant use makes myocardium more sensitive
  • 17. Huffing Put your thinking hat on…….. ! What commonly prescribed medication for young adults could make this syndrome occur more often?
  • 18. Huffing Put your thinking hat on…….. What commonly prescribed medication for young adults could make this syndrome occur more often... RITALIN—BUT WHY???
  • 19. Huffing Put your thinking hat on…….. What commonly prescribed medication for young adults could make this syndrome occur more often... RITALIN—BUT WHY??? Ritalin has a sympathomimetic effect…Big word for adrenaline. Adrenaline = Epinephrine
  • 22. Huffing What EMS needs to know……………. Patient Presentation Similar to intoxication Drowsiness Lightheadedness Loss of inhibitions Long Term Exposure Hallucinations D E LAWA RE Belligerence Blue Hens
  • 23. Huffing What we are going to treat No rapid fix Oxygen, Oxygen, Oxygen Airway support Be aware of residual substances Patient Safety Bring substance if safe Decontamination Off gassing
  • 24. Huffing INHALET EXAMPLE EFFECTS Toluene Spray paint Hearing loss Glue Damage to spinal cord or De-waxer/floor stripper brain Fingernail polish Liver and kidney damage Trichloroethylene Cleaning fluid Hearing loss Correction fluid Liver and kidney damage Hexane Glue Limb spasms Gasoline Blackouts Nitrous Oxide Whipped cream dispensers Limb spasms Gas cylinders Blackouts Benzene Gasoline Bone marrow damage
  • 25. SALVIA The most controversial one we will be talking about
  • 26. Salvia Divinorum “Salvia” Used in Mexico as a medicinal herb during ritual healing.
  • 27. Salvia Effects last usually less than 5 minutes EMS may only gets reports of behavior Comes in various strengths 1x up to 100x Smoked, chewed, and brewed Street Names Deviner’s Sage, Sally-D, Magic Mint
  • 28. Salvia Signs and symptoms Bright lights, vivid colors and shapes, as well as, body movements and body or object distortions. Other effects include uncontrolled laughter, a sense of loss of body, overlapping realities, and hallucinations
  • 29. Salvia--Effects Feelings of calmness: 42.2% Weird thoughts: 36.4% Things seeming unreal: 32.4% Floating feelings: 32% Mind racing: 23.2% Feeling lightheaded: 22.2% (Baggott, et al) from the University of California Berkeley and California Pacific Medical Center Research Institute conducted a survey of 500 salvia users
  • 33. Salvia Brett’s Law Originated in Delaware Brett Chidester Committed Suicide @ 17yrs. Note stated that a"er using Salvia he found life was not worth living
  • 34.
  • 35. Honor Roll Student National honor society Honors band
  • 36. Honor Roll Student National honor society Honors band
  • 37.
  • 39. drug tests negative police found salvia after death
  • 40. drug tests negative police found salvia after death 7-10 notes about salvia
  • 41. drug tests negative police found salvia after death 7-10 notes about salvia 3 page suicide note
  • 42. drug tests negative police found salvia after death 7-10 notes about salvia 3 page suicide note
  • 44. Salvia Delaware, Florida, Illinois, Kansas, Mississippi, Missouri, North Dakota, South Dakota,Ohio,Oklahoma, Virginia and others have passed their own laws. Schedule 1 Alabama, Alaska, California Florida, Iowa, Michigan, New Jersey, New York, Ohio, Oregon, Pennsylvania, California and Texas have proposed legislation.
  • 45. Salvia Who’s using it……………. 2008 1.8 million (est.) individuals 12 and older have used it 750,000 within the past year Most common age was 18-25 National Survey on Drug Use and Health Report published by SAMHSA in February 2008
  • 46. Salvia EMS Intervention Protection Possible other AMS causes Calm quiet transport
  • 47.
  • 48. WHO’S READY TO GET HIGH
  • 49. Time to feel what they feel!!! WARNING: Avoid prolonged staring if you are prone to seizures or motion sickness
  • 50.
  • 51.
  • 54. Ketamine K Special K Vitamin K Bump Cat Valium Raver’s Smack
  • 55. Ketamine Now used more often then Cocaine in the UK. The trip — also called K-hole — that results from ketamine usually lasts up to 2 hours.
  • 56. KETAMINE •Users may become nauseated or vomit, become delirious, and have problems with thinking or memory. •At higher doses, ketamine causes movement problems, body numbness, and slowed breathing.
  • 57. Date Rape Drugs Rohypnol Roofies, roach, forget-me pill Anti-anxiety medication 10x Valium Memory loss, Hypotension, Nausea, and Drowsiness, Loss of inhibitions
  • 58. Date Rape Drugs GHB Gamma-Hydroxybutyric Acid Naturally occurring in the body Once used legally by bodybuilders Still used in hospital as a sedative Mixed with alcohol as a liquid Patients may complain of a salty taste that was in the drink Airway management it top concern
  • 59. Date Rape Drugs GHB Gamma-Hydroxybutyric Acid Naturally occurring in the body Once used legally by bodybuilders Still used in hospital as a sedative Mixed with alcohol as a liquid Patients may complain of a salty taste that was in the drink Airway management it top concern
  • 60. Date Rape Drugs GHB Gamma-Hydroxybutyric Acid Naturally occurring in the body Once used legally by bodybuilders Still used in hospital as a sedative Mixed with alcohol as a liquid Patients may complain of a salty taste that was in the drink Airway management it top concern
  • 61. Pain Medications Between 2006 and 2007 Cocaine use decreased 23 percent. Prescription medication abuse increased 12 percent 2007 Substance Abuse and Mental Health Services Administration (SAMHSA). Over 15 million Americans Most common is OxyContin™
  • 62. Polypharm Heroin laced with Fentanyl WHAT’S THE PROBLEM? 2005-2006 = Over 1,000 Deaths WET CHIP BUDDA Many “pill popper” patients are on anti- depressants Side effect of anti depressants?
  • 63. Thank you!!!!! Enjoy the rest of your conference Contact info--302-737-4044 or www.see4life.com

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