II. Pathophysiology: Drug progression among teen users (NY study n=7611)

  1. Level 1: Alcohol and Tobacco use
  2. Level 2: Marijuana ("Gateway Drug")
  3. Level 3: Stimulants, Inhalants or Hallucinogen use
  4. Level 4: Cocaine Abuse
  5. Level 5: Crack use

III. Risk Factors: Social corollaries to escalating use

  1. Declining:
    1. Decreasing Grades and Homework time
    2. Decreasing Family and Religious involvement
    3. Decreased parental rule following
    4. Decreasing health status
  2. Rising
    1. Increased absenteeism
    2. Increased doctor visit frequency

IV. Causes: Common Illicit Drugs in Adolescents

  1. Cannabinoids (Marijuana, K2, Spice)
    1. Most common drug of abuse in U.S. and progressively increasing annually among grades 8-12
  2. Opioids (e.g. Oxycodone, Morphine, Heroin)
    1. Non-medical use of prescription Analgesics (10% Incidence ages 12-18 years old)
      1. Oxycodone (e.g. Percocet)
    2. Over-the-counter pharmaceuticals
      1. Dextromethorphan Abuse (Hallucinogenic effects)
    3. Unintentional associated agent toxicity
      1. High risk of Acetaminophen Overdose (due to combination agent abuse, e.g. Percocet)
      2. Risk of Anticholinergic Toxicity in OTC compounds containing Diphenhydramine (e.g. Coricidin)
  3. Stimulants (e.g. MDMA, Psychoactive Bath Salts, Cocaine)
    1. Amphetamines (e.g. MDMA or Ecstasy, Methamphetamine)
    2. Synthetic Cathinones (Psychoactive Bath Salts)
  4. Volatile Inhalants (Sniffing, Huffing, Bagging)
    1. More common drug of abuse in ages 10-14 years old
    2. Risk of Sudden Sniffing Death Syndrome
  5. Hallucinogens (LSD, PCP, Ketamine, Dextromethorphan)
    1. See Ketamine Abuse (includes Methoxetamine)
    2. See Dextromethorphan Abuse
  6. Alcohol
    1. Ethanol-based hand sanitizer (especially in health care centers)
      1. Small ingestions of hand sanitizer can cause significant Alcohol Intoxication (60% Alcohol)
      2. Some abusers of hand sanitizer extract the Alcohol with salt
  7. Methylenedioxymethamphetamine (MDMA, Ecstasy)
  8. Gamma Hydroxybutyrate (GHB)

VII. Precautions

  1. Consider toxicity from co-ingestions
    1. Acetaminophen Overdose in combination Opioid Abuse
      1. Most common emergency presentation following prescription Opioid Abuse in ages 15-17 years
    2. Niacin Overdose to mask Urine Drug Screen

VIII. Prevention: Efficacy of school programs

  1. D.A.R.E school based program is ineffective
    1. West (2004) Am J Public Health 94:1027-9 [PubMed]

IX. Resources

  1. Campaign for Tobacco-Free Kids
    1. http://www.tobaccofreekids.org
  2. Adolescent and School Health
    1. http://www.cdc.gov/healthyyouth/

X. References

  1. (1994) Am Fam Physician 50(8):1737-40 [PubMed]
  2. Fontes (2014) Crit Dec Emerg Med 28(1): 14-24

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