Adolescent Drug Abuse: The New Player - February 2007
Although recent data suggests that there is less overall drug use among adolescents compared to the peaks in the 1990s, children are using drugs at an earlier age and abusing multiple substances. The National Institute on Drug Abuse has been collecting data on adolescent drug use through surveys of nationally representative samples of high school students since 1975. The 2006 survey found that 21% of eighth graders, 36% of 10th graders and 48% of 12th graders admit to taking an illicit drug during their lifetime. “Club Drug” and prescription-type drug abuse remains high.
MDMA (Street names: ecstasy, XTC, E, Adam, hug drug, M&M)
Ecstasy (3,4-Methylenedioxymethamphetamine) is a synthetic derivative of methamphetamine that both increases the release and inhibits the reuptake of predominately serotonin, but also dopamine and norepinephrine from presynaptic neurons. This drug prevents the destruction of those neurotransmitters by inhibiting the enzyme MAO (monoamine-oxidase). It also possesses the central stimulant properties of its amphetamine precursors. MDMA is usually sold as a capsule or tablet but is also found in a powder form that can be snorted or smoked. MDMA use is highly associated with “raves” and marathon dancing, explaining its affinity for dehydration and hyperthermia. Single tablets (50 mg-150 mg) sell for between $10 to $50. The drug is used to create a sense of enhanced insight, feelings of closeness, euphoria, increased energy and self-esteem, and altered visual perceptions. Two and one-half percent of 8th grade, 4.5% of 10th grade and 6.5% of 12th grade students report some lifetime use of MDMA.
MDMA use demonstrates a wide array of clinical signs and symptoms. Cardiovascular effects include hypertension, tachycardia, arrhythmias, palpitations and diaphoresis. Neuropsychiatric symptomology includes sensory enhancement, illusions, hallucinations, dysphoria, confusion, delirium, paranoia, panic attacks, memory impairment, headaches, depression, restlessness, psychosis, coma, seizures and status epilepticus. Neuromuscular and metabolic effects include: spasm, rigidity, trismus, bruxism, rhabdomyolysis, hyperthermia, acidosis, hyperkalemia and hyponatremia. Zakzanis et al demonstrated that continued long-term (greater than one year) use of MDMA was associated in humans with progressive decline in terms of both immediate and delayed recall. Further research could associate this drug with a number of neuropsychiatric disorders in which serotonin has been implicated, including depression, anxiety, panic disorder, and disorder of impulse control.
GHB (Street names: grievous bodily harm, Georgia home boy, liquid ecstasy, liquid X, liquid E, soap, easy lay, scoop, salty water, g-riffick, cherry meth, somatomax and organic qualude)
Gamma Hydroxybutyrate (GHB) is found naturally in the central nervous and serves to regulate sleep cycles, temperature, cerebral glucose metabolism, cerebral blood flow, memory and emotional control. Its proposed actions are mediated through specific brain receptors for GHB, which then influences dopaminergic activity. The prevalence of GHB use has remained relatively unchanged from 2003 through 2006. In 2006, 2.5% of eighth grade, 4.5% of 10th grade and 6.5% of 12th grade students reported using GHB. Prodrugs of GHB such as GBL have been marketed at health food stores and on the Internet to induce sleep, burn fat and enhance sexual activity and athletic performance. GHB is produced in either an odorless, colorless liquid form or a white powder. It is usually ingested in a liquid mixture, most commonly alcohol. GHB is usually sold by the capful and sells for $5 to $25 per cap. The desired effects of the drug include: euphoria, hallucinations, muscle growth, and an intensifying effect of other drugs, especially MDMA.
Signs and symptoms of GHB abuse include: aggressive behavior, drowsiness, confusion, amnesia, syncope, hypotonia, incontinence, ataxia, nystagmus, tremors, clonic movements of face and extremities, nausea and vomiting. Overdoses usually require emergency room treatment, including intensive care admissions for respiratory depression and coma.
Ketamine (Street names: special K, vitamin K, K, super K, ketaset, jet, super acid, green, purple and mauve)
Ketamine is an arylhexylamine analog that is structurally related to PCP (phencyclidine). It selectively depresses neuronal function in parts of the cortex and thalamus while simultaneously stimulating parts of the limbic system, thus creating functional disorganization of nonspecific pathways in midbrain and thalamic areas. Ketamine was first used in the 1960s as a dissociative anesthetic. The drug is often used in Pediatric Emergency Room settings today for procedures requiring moderate sedation, as cortical awareness is blocked from pain-related input while brainstem, cardiac and respiratory functioning remain intact.
The desired effect of the drug is a dream-like state with out-of-body experiences, floating sensations and hallucinations. Usage prevalence reported in 2006 Monitoring the Future is 0.6% of 8th grade students, 1% of 10th grade students and 1.6% of 12th grade students. Ketamine comes in a clear liquid and a white or off-white powder form. The liquid form can be injected, consumed in drinks or added to smokable materials. The price for one dose on the street averages between $20 to $25.
Symptoms of ketamine drug abuse include nystagmus, mydriasis, agitation, slurred speech, delirium, rigidity, anxiety, seizures, bizarre facial expressions, dystonic reactions, alterations in perception, vivid dreams and illusion, and flashbacks. Cardiopulmonary effects include palpitations, tachycardia, hypertension, respiratory depression, apnea and pulmonary edema. While little data is available on the long-term effects of ketamine, Curran et al showed that three days after drug ingestion, recreational users display memory impairment and dissociative and schizotypal symptomatology which could reflect chronic effects of taking the drug.
Methamphetamine (Street names: speed, ice, glass, crystal, crank, meth and crystal meth)
Methamphetamine’s popularity has declined from its peak in the 1990s, but continues to be a drug of choice. Reports show 2.7% 8th grade students, 3.2% 10th grade students and 4.4% 12th grade students have used methemphatmine. This drug is a sympathomimetic amine related to ephedrine and amphetamine that acts as a potent central nervous system stimulant by both blocking the uptake and stimulating the release of the cytoplasmic pool of dopamine. Methamphetamine is currently classified as a Schedule II stimulant drug by the Drug Enforcement Agency (DEA) with approval for treatment of attention deficit disorder, narcolepsy (off-label use) and exogenous obesity. The desired effect for illicit adolescent use includes: an increase in internal arousal mechanisms, an intense feeling of pleasure/power, hyperactivity, hyperexcitability, euphoria and heightened sexual awareness.
Clinical signs and symptoms of methamphetamine abuse include: anxiety, dysphoria, tachycardia, hypertension, hypertonicity, delusions, paranoia, aggressive behavior, anorexia and weight loss. Large amounts may precipitate myocardial infarction, seizures, systemic vasospasm, irreversible cardiomyopathy and acute pulmonary edema, leading to death.
References
1. www.monitoringthefuture.org
2.http://www.drugabuse.gov/infofacts
3. www.whitehousedrugpolicy.gov/drugfact/club
4. Curran, HV. Cognitive, Dissociative and Psychotogenic Effects of Ketamine in Recreational Users on The Night of Drug Use and 3 DaysLater. Addiction: volume 94, #4; April 2000.
5. Ellenhorn’s Medical Toxicology, 2nd edition. Copyright 1997, Williams and Wilkins.
6. Graeme, K. New Drugs of Abuse. Emergency Medicine Clinics of North America: volume 18, #4, November 2000.
7. Hogan, M. Diagnosis and Treatment of Teen Drug Use. Medical Clinics of North America: Volume 84, #4; July 2000.
8. McRae, A. et al. Advances in the Pathophysiology and Treatment of Psychiatric Disorders: Implications For Internal Medicine. Medical Clinics of North America: volume 85, #3; May 2001.
9. Rakel: Conn’s Current Therapy, 53rd edition. Copyright 2001, W.B. Sanders Company.
10. www.dea.gov
11. Zakzanis, K. Memory Impairment in Abstinent MDMA “Ecstasy”) users: A Longitudinal Investigation. Neurology: volume 56, #7; April 10, 2000.
This information provided by Jason Zamkoff, M.D., Pediatric Hospitalist Program, California Pacific Medical Center Department of Pediatrics.