Substance Abuse: Club Drugs, Hallucinogens, and Dissociative Drugs This course has been awarded one (1) contact hour.

This course expires on September 30, 2016. This program has been pre-approved by The Commission for Case Manager Certification to provide continuing education credit to CCM® board certified case managers. The course is approved for 1 clock hour. Activity code: W0001410. Approval Number: 20135695. Copyright © 2013 by RN.com. All Rights Reserved. Reproduction and distribution of these materials are prohibited without the express written authorization of RN.com.

First Published: June 10, 2013

Acknowledgements RN.com acknowledges the valuable contributions of… ...Kim Maryniak, RNC-NIC, BN, MSN who has over 23 years staff nurse and charge nurse experience with medical/surgical, psychiatry, pediatrics, and neonatal intensive care. She has been an educator, instructor, and nursing director. Her instructor experience includes med/surg nursing, mental health, and physical assessment. Kim graduated with a nursing diploma from Foothills Hospital School of Nursing in Calgary, Alberta in 1989. She achieved her Bachelor in Nursing through Athabasca University, Alberta in 2000, and her Master of Science in Nursing through University of Phoenix in 2005. Kim is certified in Neonatal Intensive Care Nursing and is currently pursuing her PhD in Nursing. She is active in the National Association of Neonatal Nurses and American Nurses Association. Kim’s current and previous roles in professional development include nursing peer review and advancement, education, use of simulation, quality, and process improvement. Her current role includes oversight of professional development, infection control, patient throughput, and nursing operations.

Conflict of Interest and Commercial Support RN.com strives to present content in a fair and unbiased manner at all times, and has a full and fair disclosure policy that requires course faculty to declare any real or apparent commercial affiliation Material protected by Copyright

related to the content of this presentation. Note: Conflict of Interest is defined by ANCC as a situation in which an individual has an opportunity to affect educational content about products or services of a commercial interest with which he/she has a financial relationship. The author of this course does not have any conflict of interest to declare. The planners of the educational activity have no conflicts of interest to disclose. There is no commercial support being used for this course.

Purpose and Objectives The purpose of this course is to provide healthcare workers with information about illegal drugs, drug use, and how drug use can impact patient care. After successful completion of this course, the participant will be able to: 1. Describe illegal drug use 2. Define types of substances included in “club drugs" 3. Describe physiological effects of "club drugs" 4. Identify clinical management of illegal drug use

Introduction Learning about the different types of illegal drugs and recognizing the affects that these drugs can have on the user are important for healthcare workers to understand, especially for those who work in emergency rooms, ambulatory care areas or community based clinics. Since many of these drugs manifest themselves with physical and emotional symptoms that can increase over time, it is also beneficial to learn appropriate methods of communicating with and caring for these individuals when they are under the influence or “high.” Drug abuse is widespread and not necessarily restricted to one age or social demographic. Thus, it can sometimes be difficult to distinguish between the effects of substance abuse and the symptoms of behavioral problems or an untreated disease process. A basic understanding of the types of street drugs and their physiological effects will help caregivers provide the most appropriate type of care to their patients.

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Glossary of Terms The following is a list of terms that are sometimes associated with club drugs. Terms vary depending on demographics and region. Some of these terms include:

A bad trip – an unfavorable drug experience. Cooking – manufacturing a drug. Crash - sleep off the effects of drugs. Crystal meth – methamphetamine. Dealer – any person that sells drugs. Dime bag - $10 worth of drugs. Do a line – snort (inhale) a drug such as cocaine, methamphetamine. Dope – any drugs such as methamphetamine, heroin; LSD. Dope fiend – a person who uses a lot of drugs. Dots – LSD. E-Bomb – MDMA (Ecstacy). Eight ball - 1/8 ounce of drug. Flashbacks – reoccurrence of a visual or auditory hallucination after a drug has worn off. Get down – use drugs. Get high - use drugs. Get lifted – being under the influence of drugs. Get off - being under the influence of drugs. High – under the influence of drugs. Jonesing or jonesing it – intense craving for drugs. Mainlining – injecting drugs intravenously. Meth head - regular user of methamphetamine. Meth monster – a person that has a violent reaction to methamphetamine. Mission – going to get drugs. Push – to sell drugs. Raspberry – a female who trades sex for drugs or money to buy drugs. Rave – a dance and music party designed to enhance a drug experience. Score, scored – to obtain drugs. Shoot/shoot up - to inject a drug. Skin popping – injecting drugs under the skin. Snort - to inhale drugs such as cocaine, methamphetamine. Stoned - under the influence of drugs. Strawberry - female who trades sex for drugs or money to buy drugs. Sunshine – LSD. Wasted – heavily drugged.

(National Institute on Chemical Dependancy, n.d.)

National Trends The Substance Abuse and Mental Health Services Administration conducts an annual survey about dependence, substance use and abuse among Americans from ages 12 and up. This survey is the Material protected by Copyright

National Survey on Drug Use and Health (NSDUH), and provides valuable information regarding the trends with substance abuse in the United States. According to the NSDUH, in 2011, approximately 22.5 million Americans, or 8.7% of the population, had used an illicit drug or abused a prescription medication within the past month. This is an 8.3% increase from 2002. Drug use is noted as highest with teenagers and individuals in their twenties, but there has also been an increase of drug use with people in their fifties (NIDA, 2012b).

Illegal Drugs There are many types of illegal drug substances available in the United States and unfortunately, plenty of individuals willing to try them despite the potential health consequences. Risk factors related to drug abuse are not limited to the effects of the drug alone. Drugs manufactured outside of a controlled laboratory environment may be contaminated with substances that can also be harmful. Drug abusers subject their bodies to the ingredients of the drug as well as whatever substances that the drug might be mixed with. Not all illegal drugs available on the street have been cooked in someone’s bathtub or closet though. Some drugs that are considered illegal in the United States are manufactured legally in other countries and smuggled in to be sold for profit. Many prescription medications and government controlled substances, such as narcotics, are highly desirable on the street because of the quality and consistency of their effects.

Names of Street Drugs The National Institute on Drug Abuse (NIDA) publishes a list of the many types of drugs that are available on the street. The drugs include: 

Club drugs (MDMA, Flunitrazepam, GHB) 

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Stimulants (Cocaine, Crack, Amphetamine, Methamphetamine)

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Cannabinoids (Marijuana, Hashish)

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Opioids (Heroin, Opium)

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Anabolic Steroids

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Dissociative drugs (Ketamine, PCP, Salvia  divinorum, Dextromethorphan)

Hallucinogens (LSD, Mescaline, Psilocybin)

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Prescription drugs (CNS depressants, Stimulants, Opiod relievers)

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Synthetics (Bath Salts, Spice)

Inhalants

You may have heard of some of these drugs by other names. Each category of drug also has a street name that may vary from region to region or from demographic to demographic (NIDA, 2011). An extensive list of street names can be accessed at: http://www.drugabuse.gov/sites/default/files/cadchart_2.pdf

Club Drugs In addition to the large selection of illegal drugs for sale, some drug users might buy a particular type of drug (or drugs) to orchestrate a certain type of high. Club drugs got their name becaus e their effects can enhance the sensations, movement, and feelings that might be experienced at dance clubs or at raves. Material protected by Copyright

Other drugs used for the “club” scene include hallucinogens, synthetic drugs, and dissociative drugs. (Click on the icons below to reveal details.) Drugs that are considered to be club drugs include: 

Ecstasy/MDMA (methylenedioxymethamphetamine)

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GHB (gamma hydroxybutyrate)

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Rohypnol (flunitrazepam)

Drugs considered to be hallucinogens include: 

LSD (Lysergic Acid Diethylamide)

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Mescaline

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Psilocybin Test Yourself Club drugs include: A. B. C. D.

GHB LSD Ecstasy All of the above

The correct answer is: D – all of the above.

Club Drugs Drugs considered to be dissociative drugs include: 

Ketamine (ketamine hydrochloride)

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PCP

Drugs considered to be synthetic drugs include: 

Synthetic cathinone products (“Bath salts”)

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Synthetic marijuana (“Spice”)

Each of these club drugs produces different types of effects that can alter the mind and senses of the user in different ways. Ecstasy is a synthetic, psychoactive drug similar to the hallucinogen mescaline and the stimulant methamphetamine. LSD is a hallucinogen. GHB and Rohypnol have the ability to intoxicate and sedate. Ketamine is a tranquilizer that is sometimes used by physicians to sedate children or by veterinarians to sedate animals. Ketamine, rohypnol and GHB are all central nervous system depressants. Material protected by Copyright

Ecstasy/MDMA Ecstasy, or 3-4 methylenedioxymethamphetamine (MDMA), is a central nervous system stimulant. MDMA can produce both stimulant and mild sensory-altering effects. It is believed that Ecstasy produces euphoric feelings through its action on the neurotransmitters dopamine, serotonin and norepinephrine. Research indicates that even a single dose of Ecstasy can be neurotoxic to the human brain. Using Ecstasy is associated with anxiety and depression, mood swings, memory problems, and sleep disturbances. Long-term use may depress the proper functioning of the immune system (NIDA, 2012a).

Ecstasy Symptoms Some researchers have also reported that there is a similarity between the symptoms of Alzheimer's disease and long-term use of Ecstasy. Symptoms associated with using Ecstasy can occur during the intoxication phase or for weeks after the use of the drug. Symptoms include:  Blurred vision  Nausea  Arrhythmia

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Drug craving Depression Sleep disorders

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Hyperthermia Chills or sweating Clenching of the jaw and/or grinding the teeth

Muscle tension Confusion Severe anxiety (NIDA, 2012a)

Street names for Ecstasy include: 

MBDB

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MDE

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MDA

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MDEA

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2CB

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XTC

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Adam

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Eve

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Lover’s Speed

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Clarity

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

Peace

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Uppers (NIDA, 2011)

Ecstasy Side Effects Because Ecstasy is a stimulant and can cause users to lose touch with reality, these individuals are likely to be unaware of their recent level of exertion. The user may become dehydrated from over-activity without enough water, or can drink too much water and cause hyponatremia (also known as water intoxication), brain damage and death. Hyponatremia may also occur because Ecstasy can affect hormonal sodium regulation in the blood (NIDA, 2012a). Ecstasy can also result in kidney, liver and cardiovascular problems up to and including death when it is taken in high doses (NIDA, 2012a). Initially, Ecstasy increases heart rate and blood pressure, but following repeated use, this effect is reversed (NIDA, 2012a). Some individuals that use Ecstasy will develop heart muscle damage and reductions in heart rate and blood pressure. Ecstasy is usually taken orally, in the form of a capsule or a tablet. The effects of the drug vary but last approximately 3 to 6 hours (NIDA 2012a). Ecstasy users often grind their jaws together and can damage teeth. It is not unusual to see users with baby pacifiers or lollipops to help prevent damage to the mouth while high. As the effects of the drug wear off, a person “coming down" from an Ecstasy experience is often irritable, depressed, paranoid and exhausted. If the user has taken higher doses they might experience irrational behavior, hallucinations and seizures.

Ecstasy Usage According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the use of Ecstasy has been reported across the country, with rates climbing since 2004. The Drug Abuse Warning Network (DAWN) is a public health surveillance network that monitors drug-related incidents, including emergency room visits and deaths. The 2010 DAWN Emergency Department statistics for visits to emergency departments related to Ecstasy were 3.5/100,000 in 2004, and increased to 7.1/100,000 in 2010.

Ketamine Ketamine is an anesthetic that can be injected (intravenous or intramuscular), snorted, or smoked. It has been approved for both human and animal use in medical settings since 1970. About 90 percent of the ketamine sold legally today is intended for veterinary use, much of the remainder ends up on the streets. Ketamine activates specific opioid receptors in the brain and is very addictive. Ketamine is a dissociative anesthetic that distorts perceptions of sight and sound and produces feelings of detachment from the environment and self. Street names for Ketamine include: Material protected by Copyright

 Ketter  Special K  Lady K  Vitamin K  K (NIDA, 2010b)

Ketamine Symptoms When taken in low doses Ketamine can result in:  Respiratory difficulty  High blood pressure  Depression  Impaired attention and memory  Diminished learning abilities (NIDA, 2010b)

Ketamine Side Effects Large doses of the drug can cause dream-like states and hallucinations. At even higher doses, ketamine can cause delirium and amnesia, similar to the drug PCP (phencyclidine). Ketamine can be added to smokeable materials, consumed in drinks, or injected (NIDA, 2010b). It can cause users to feel out of control with distorted perceptions of sound, sight and sensations of feeling disconnected. Ketamine can cause impaired motor function, amnesia, and delirium. Some users report that they feel like they are having an out of body experience (which is sometimes called a "K-hole" on the streets). The hallucinatory effects of Ketamine last an average of about one hour or less, however, after effects may last up to 24 hours. The user's coordination, judgment, and senses may be affected for up to 24 hours after the initial use of the drug and the user may experience withdrawal like symptoms such as feeling disoriented and detached.

Ketamine Usage The 2010 DAWN Emergency Department statistics for visits to emergency departments related to Ketamine were 0.1/100,000 in 2005, and increased to 0.3/100,000 in 2010. The incidence is noted higher with males, noted at 0.5/100,000 emergency room visits in 2010 (SAMHSA, 2010).

Rohypnol Rohypnol (flunitrazepam) belongs to the benzodiazepine family. Other drugs in this family include Valium, Halcion, Xanax, and Versed. Like other benzodiazepines, Rohypnol is a central nervous system depressant. Rohypnol is not approved for prescription use in the United States, although it is used in some countries as a sedative, a treatment for insomnia, or as a pre-surgical anesthetic. Material protected by Copyright

Rohypnol is approximately ten times more potent than Valium and is frequently abused for its euphoria-producing properties. It can also be used for its release of muscle building growth hormones that it can induce. Low doses of Rohypnol can cause muscle relaxation and may produce general sedative and hypnotic effects. Rohypnol used in higher doses can cause partial amnesia, loss of consciousness and loss of muscle control. Street names for Rohypnol:  Roofies 

Roopies

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Rope

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Rohies

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R2

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Roache

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Forget me pill

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Mexican Valium

(NIDA, 2011)

Rohypnol Symptoms Rohypnol can cause: 

Slurred speech

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Confusion

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Drowsiness

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Hypotension

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Impaired judgment

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Decreased motor coordination

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Urinary retention

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Gastrointestinal disturbances

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Seizures

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Aggression and excitability

The drug usually induces five main effects that can be classified as:  Hypnotic  Anxiolytic  Anti-seizure  Muscle relaxant  Amnesic

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Rohypnol Side Effects The toxic effects associated with Rohypnol abuse can be aggravated when used in combination with alcohol.

Rohypnol Usage A one milligram dose of Rohypnol can cause impairment for eight to twelve hours. Rohypnol is usually taken by mouth but it has also been ground up and snorted. This drug, as well as GHB,has a reputation as a "date rape" drug due to its amnesic effects and the ability to sedate and incapacitate unsuspecting victims, preventing them from resisting sexual assault (NIDA, 2010b). The 2010 DAWN Emergency Department statistics for visits to emergency departments related to Rohypnol were 0.3/100,000 in 2009, and 0.2/100,000 in 2010 (SAMHSA, 2010). True or False? Rohypnol abuse can be aggravated when used in combination with alcohol. The correct answer is: True!

Gamma-hydroxybutyrate (GHB) Gamma-hydroxybutyrate (GHB), is classified as a central nervous system depressant. GHB has a reputation as being a popular drug of choice among adolescents and young adults. Both GHB and Rohypnol are colorless, odorless and come as a liquid or ground into a powder. It is easily overdosed (NIDA, 2010b). When GHB is used in combination with alcohol, it becomes even more hazardous. GHB has been increasingly involved in poisonings, overdoses, and drug-facilitated sexual assaults. Street names for GHB include:  G  Liquid Ecstasy  Somatomax  Scoop  Georgia Home Boy  Grievous Bodily Harm  Soap  Goop  Liquid X (NIDA, 2011)

GHB Symptoms Symptoms of GHB include: 

Altered level of consciousness

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Nausea

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Slurred speech

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Confusion

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Drowsiness

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Impaired judgment

GHB Side Effects GHB can cause side effects similar to those of Rohypnol as well as causing severe respiratory depression. Other effects of GHB include:  Seizures  Hypotension  Coma  Death

GHB Usage GHB is usually ingested orally, either in liquid or powder form. The effects of GHB begin about 10 to 20 minutes after the drug is taken and frequently lasts up to approximately four hours depending on the dose. GHB is usually cleared from the body in approximately two hours. Since there are no formal detection tests for GHB its use may go undiagnosed (NIDA 2010b). The 2010 DAWN Emergency Department statistics for visits to emergency departments related to GHB were 0.6/100,000 in 2004 in 2010 (SAMHSA, 2010). Test Yourself GHB can cause: A. Hypertension B. Episodes of hyperventilation C. Severe respiratory depression D. None of the above The correct answer is: C - Severe respiratory depression

Methamphetamine Methamphetamine is a toxic, addictive stimulant that affects many areas of the central nervous system. Methamphetamine causes an excess release of dopamine and a subsequent reduction in dopamine receptors and transporters. It is chemically related to amphetamine, however; the effects of methamphetamine are much more harmful, potent, and longer lasting (NIDA, 2010a). Research suggests that long-term exposure to methamphetamine may cause cell death in the frontal cortex, the area of the brain that governs behavior control and personality. Methamphetamine street names include:  Speed  Material protected by Copyright

Crank

 Pep pills  Ice  Chalk  Meth  Crystal (NIDA, 2011)

   

Fire Tina Glass Go fast

Methamphetamine Symptoms Using methamphetamine can result in serious health consequences as well as symptoms that include: 

Decreased appetite

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Nausea and vomiting

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Increased levels of activity

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High blood pressure

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Tachycardia

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Violence and aggression

Methamphetamine Side Effects A person who is abusing methamphetamines may: 

Behave violently

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Experience confusion, insomnia, or paranoia

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Compulsively seek stimulants

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Behave evasively or lie about activities or whereabouts

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Be easily excitable

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Suffer cardiac and neurological damage

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Show agitation and exaggerated emotional responses

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Contract hepatitis and other infectious disease such as HIV/AIDS (from shared needles)

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Demonstrate psychotic behavior

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Suffer from memory loss

(NIDA, 2010a)

Methamphetamine Usage Methamphetamine is a white, odorless, bitter-tasting crystalline powder that easily dissolves in water or alcohol and is taken orally, intranasally (snorting the powder), by needle injection, or by smoking. The drug is often “cooked” (made) in clandestine labs. Some of its ingredients include over-the-counter cold remedy ingredients such as pseudo epinephrine. Chronic methamphetamine use can cause significant changes in how the brain functions. Severe structural and functional changes in areas of the brain associated with emotion and memory have been noted. These changes may account for many of the emotional and cognitive problems observed in Material protected by Copyright

chronic methamphetamine users. The euphoric effects of methamphetamine can also alter inhibition, judgment and lead people to engage in unsafe behaviors. Studies with methamphetamine abusers who also have HIV show that there is an increased amount of neuronal injury than in those individuals that have HIV but don’t use methamphetamine (NIDA 2010a). Methamphetamine has been very available in western and southwestern regions of the U.S. for several years, however, popularity has been increasing across the country. The 2010 DAWN Emergency Department statistics for visits to emergency departments related to methamphetamine were 45.3/100,000 in 2004 and decreased to 30.7/100,000 in 2010 (SAMHSA, 2010). Research suggests that long-term exposure to methamphetamine may cause cell death in the frontal cortex, the area of the brain that governs behavior control and personality.

Lysergic Acid Diethylamide (LSD) LSD (lysergic acid diethylamide) is a hallucinogen that causes abnormal sensory perceptions. Also known as a psychedelic drug, its effects are variable depending on the amount taken, on the user's personality, expectations, mood, and on the surroundings in which the drug is used (NIDA, 2009). LSD and other hallucinogens affect the central nervous system, however, the mechanism is not yet fully understood. LSD molecules are similar to the neurotransmitter serotonin and seem to affect functions influenced by serotonin such as sleep, attention and sensation. Individuals using LSD describe feeling disconnected with altered states of reality. Street names for LSD  Acid  Bart Simpsons  Barrel  Tabs  Blotter  Heavenly blue (NIDA, 2011)

include:  L  Liquid A  Microdots  Mind detergent  Orange cubes  Hits

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Paper acid Sugar Sugar lumps Sunshine Ticket Wedding bells

LSD is made into pills, tablets, or a liquid that is then soaked on to small squares of paper called blotters or tabs. The tabs are frequently printed with designs or images.

LSD Symptoms Symptoms include: 

Dilated pupils and blurred vision

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Elevated body temperature

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Dry mouth

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Loss of appetite

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Nausea

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Weakness

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Tachycardia

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Increased blood pressure

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Insomnia

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Sweating

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Tremors

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Numbness

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Poor coordination

LSD Side Effects Individuals who use LSD report an onset of effects approximately 30-90 minutes after taking it. Hallucinogens such as LSD can produce a wide range of hallucinatory experiences that may include multiple hallucinations and severe panic. Effects can last from hours to days. Some of the effects may even last for months. One effect that has been reported includes a visual trailing effect where objects appear to leave visual traces behind them. Spontaneous reoccurrence of hallucinatory effects (also known as flashbacks) may continue to occur long after the drug has been used. Individuals who use hallucinogens may become psychotic. Depression can also occur and it has been documented that in a few individuals, a one time frightening experience can result in long-term problems with a dramatic decrease in their ability to function at a normal level. LSD is not considered an addictive drug since it does not produce compulsive drug-seeking behavior. However, LSD does produce tolerance, so some users who take the drug repeatedly must take progressively higher doses to achieve the state of intoxication that they had previously achieved (NIDA, 2009).

LSD Usage Methods of taking the LSD include:  Snorting  Smoking  Cooking into foods  Injecting into the bloodstream (mainlining), muscles, or under the skin (skin popping)  Swallowing  Applying to membrane surfaces  Chewing The 2010 DAWN Emergency Department statistics for visits to emergency departments related to methamphetamine were 0.7/100,000 in 2004 and decreased to 1.2/100,000 in 2010 (SAMHSA, 2010). Test Yourself Spontaneous reoccurrence of hallucinatory effects are also known as ____. The correct answer is: flashbacks.

Synthetic Drugs Although synthetic drugs will not be discussed in detail during this course, healthcare professionals Material protected by Copyright

should be aware of these substances that are on the rise, particularly among adolescents and young adults. “Bath salts” emerged at the end of the last decade, and they rapidly gained popularity in the U.S. and Europe as “legal highs." “Spice” is a synthetic marijuana that was also s old as “incense”, but used illegally for illicit drug use. In July 2012, President Obama signed legislation permanently making several of these synthetic drugs illegal.

Signs of Illegal Drug Use Club drugs and the use of other illegal drugs is not an unusual occurrence. Of an estimated 113 million emergency department (ED) visits in the U.S. during 2006, the Drug Abuse Warning Network (DAWN) estimates that 1,742,887 ER visits were associated with drug misuse or abuse (DAWN, 2010). Although drug abuse has no boundaries, youth are often interested in experimenting with illegal drugs. Whenever children or adolescents are suspected of drug abuse, be prepared that family members will have questions about the signs of drug use. Other than obvious signs of intoxication or possession of drugs and paraphernalia, signs of abuse include: 

Any changes in behavior

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A deterioration of family relationships

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Behavioral and attitude changes

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Unexplained absences

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Stealing or lying

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Neglected appearance

(Mayo Clinic, 2011) The DAWN Surveillance Report is important because it identifies drug abuse trends and associated events in real time. It has been used in drug abuse education programs to demonstrate the very real downside of drug abuse for those who feel that drug use is a simple recreational activity. The report reveals the significant relationship between alcohol and drug abuse, and emergency room admissions because of drug overdose, detoxification or withdrawal, drug related accidents and trauma, and related mental health conditions (SAMHSA, 2010).

Initial Treatment Using club drugs can cause a variety of health problems including changes in physical and emotional behavior. Drug abusers may exhibit exaggerated or unusual responses to their environment. The effects of drug use may result in central nervous depression, a state of excitability or a combination of both. In an emergency setting when a drug abuser is unable, uncertain or unwilling to admit to the type of drug they have used, preservation of life and treating drug induced symptoms will always be the primary treatment goal. Material protected by Copyright

Healthcare workers who are familiar with the signs and symptoms of drug use should utilize their ability to recognize drug related behavior and formulate a plan for the best initial approach to facilitate treatment.

Initial Treatment Stabilizing the patient by treating the drug induced symptoms and providing for their safety is the priority. Since toxicology results may not be available for hours (or sometimes days), more specific treatment can’t be ordered. The physician’s treatment regime will be based upon the type of symptoms that the abuser is experiencing. Providing treatment for and communicating with individuals when they are under the influence of drugs should be approached with caution. Excited states of emotion can result in reactive behavior with highly exaggerated responses. Speaking in a calm and controlled tone of voice will help communicate to the user that you are in charge. The user might require frequent re-orientation to their environment and reassurance that they are safe. Nursing interventions that might help with providing care include:  Setting limits and explaining all necessary treatments and procedures  Enlisting the support of a significant other or family member (when appropriate)  Decreasing outside sources of stimulation (light, noise)

Treatment Post Intoxication There are many therapeutic options available to treat substance abuse, however, treating individuals that use club drugs can be especially challenging since the use of these types of drugs may occur intermittently or on a “recreational” basis. The users, often adolescents and young adults are often ignorant that even occasional use can cause health problems. Drug users need to learn that although they may not become directly ill from occasional drug use, they will increase their risk of becoming ill related to behaviors induced from the drug use. Explaining to the user that driving while under the influence or engaging in unprotected sexual encounters will increase their risk of traumatic injury or contracting diseases such as hepatitis or HIV. Effective treatment plans are often individualized to meet the needs of the user. A variety of specialized rehabilitation programs are available that will provide drug treatment support that is specific to the type of addiction and age of the individual that is seeking assistance. By providing club drug users with factual information about the dangers of even occasional club drug use, healthcare workers can contribute to preventing further drug use. By providing factual information about the dangers of even occasional club drug use, healthcare workers can contribute to preventing further drug use (NIDA, 2011).

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Conclusion Learning to recognize the signs and symptoms of illegal drug use can help healthcare workers to provide appropriate care to patients that may be under the influence of illegal drug substances. At times, caregivers must be prepared to treat the symptoms of drug intoxication without having knowledge of what type of drug might have been abused. Treating drug related symptoms is usually the primary and most immediate goal. Post intoxication treatment for club drug users can also a challenge since drug use may be intermittent and not considered (by the user) to be a problem. By providing education and support, healthcare workers can help drug abusers to recognize the potential and very real dangers of substance abuse.

Resources The Drug Abuse Warning Network (DAWN) is a public health surveillance system that monitors drug-related hospital emergency department (ED) visits and drug-related deaths to track the impact of drug use, misuse, and abuse in the U.S. http://www.samhsa.gov/data/DAWN.aspx The Partnership for A Drug Free America offers drug prevention, drug abuse, drug intervention, drug treatment and recovery. Drugfree.org provides answers, guidance, tips and stories. http://www.drugfree.org/ Substance Abuse and Mental Health Services Administration (SAMHSA) is a division of the United States Department of Health and Human Services (USDHHS)/ SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities. The Agency was established in 1992 and directed by Congress to target effectively substance abuse and mental health services to the people most in need and to translate research in these areas more effectively and more rapidly into the general health care system. http://www.samhsa.gov/ National Institute on Drug Abuse (NIDA) is the Federal focal point for research on drug abuse and addiction, and is part of the National Institutes of Health, Department of Health and Human Services. NIDA's mission is to lead the Nation in bringing the power of science to bear on drug abuse and addiction. NIDA addresses the most fundamental and essential questions about drug abuse - from detecting and responding to emerging drug abuse trends and understanding how drugs work in the brain and body to developing and testing new treatment and prevention approaches. http://www.drugabuse.gov/ Teen Drug Abuse Resources is dedicated to the treatment of addictions and eating disorders. They provide information and treatment resources for all types of addictions. Teen Drug Abuse was created to fill an important community need, that of providing prompt information to individuals needing Material protected by Copyright

assistance in finding the right treatment center. Referrals to Treatment Centers are offered at no charge as a community service. http://www.teen-drug-abuse.org/resources.htm At the time this course was constructed all URL's in the reference list were current and accessible. rn.com. is committed to providing healthcare professionals with the most up to date information available.

References Mayo Clinic. (2011). Drug addiction. Retrieved March, 2013 from http://www.mayoclinic.com/health/drug-addiction/DS00183/DSECTION=symptoms National Institute on Drug Abuse. (2009). Info facts: Hallucinogens: LSD, Peyote, Psilocybin, and PCP. Retrieved March, 2013 from http://www.drugabuse.gov/ National Institute on Drug Abuse. (2010a). Drug facts: Methamphetamine. Retrieved March, 2013 from http://www.drugabuse.gov/ National Institute on Drug Abuse. (2010b). Info facts: Club drugs (GHB, Ketamine, and Rohypnol) . Retrieved March, 2013 from http://www.drugabuse.gov/ National Institute on Drug Abuse. (2011). Commonly abused drugs. Retrieved March, 2013 from http://www.drugabuse.gov/sites/default/files/cadchart_2.pdf National Institute on Drug Abuse. (2012a). Drug facts: MDMA (Ectasy). Retrieved March, 2013 from http://www.drugabuse.gov/sites/default/files/nationwide_0.pdf National Institute on Drug Abuse. (2012b). Drug facts: Nationwide trends. Retrieved March, 2013 from http://www.drugabuse.gov/sites/default/files/nationwide_0.pdf Substance Abuse and Mental Health Services Administration (SAMHSA). (2011). DAWN 2010 emergency department Excel files: National trends. Retrieved March, 2013 from http://www.samhsa.gov/data/DAWN.aspx © Copyright 2013, AMN Healthcare, Inc.

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