 Hello everyone. And we're going to go ahead and get started today. Today, we're going to be discussing the pharmacology of designer drugs. Now, this is probably going to be more of an academic class than some of the others, because we're really talking again about the same basic classes of drugs, your stimulants, your depressants and your hallucinogens. From a treatment perspective, however, as a facility director or a clinician, it's important to understand what drugs are out there, what drugs are legal, that clients may still be using and abusing, and if you've worked in the field for a while, you're probably well aware that they will, clients that is, will use anything to get a high from nutmeg, to toothpaste, to, you know, spice and other drugs. So if they want to get high, they're going to get high. It's more important to understand the reason they're needing or wanting to use as opposed to specifically which substance. Although the type of substance, whether it's a stimulant or depressant may give you a clue to the underlying issues. So without all that being said, let's go ahead and progress. Let me see. Let me get the chat window up. Perfect. So if you have any questions, remember, you can feel free to send a message through the chat window at any time and I will try to answer it as quickly as possible. So we're going to review the pharmacology of alcohol. We're going to do that really quick because, you know, we've kind of belabored alcohol quite a bit. I will be putting a really good article that was written by somebody at the University of North Carolina School of Medicine that talks about the pharmacokinetics of alcohol. If you really want to get down into the, into the weeds on how alcohol works and how it's reinforcing and how it works with the dopamine, opiate and the GABA systems, more power to you. We're going to define designer drugs because that's kind of a garbage term that's thrown around. We will also review the effects of some of the most common designer drugs. Identify which designer drugs may still be, quote, legal because in a treatment center, you know, we tell them obviously you can't use anything that's illicit or mind-altering. But a lot of clients will try to find that little loophole and say, well, it's legal so you can't prevent me from using it. Well, alcohol is legal and I can prevent you from using that if you're in treatment. So, you know, let's, let's talk about, again, why you are needing or wanting to use that during your recovery period. But also understanding that those that are legal are going to be a lot easier for your clients to access when they go out on work phase, if you're doing an IOP program, etc. And then we'll also discuss ways of handling legal drug use in your programs. And we'll just kind of go from there. One thing I did want to show you, and let me see if I can do this without completely making everything go wonky. There we go. One of the best or two of the best resources to find the up and coming drugs, the ones that you need to be worried about if you work in a correctional facility, if you work in a residential treatment center, or even if you just work with persons with addictions and co-occurring disorders is police one and corrections one. These are two websites that are dedicated, obviously, to law enforcement and corrections to help them stay abreast of what may be getting brought into their facilities as contraband. They will be on the leading edge of a lot of the new designer drugs that come out. There are literally hundreds of designer drugs and things you can get high off of. It's just a matter of kind of narrowing it down to what your clients are using in your particular area and becoming more informed about those as well. So alcohol, alcohol indirectly activates the dopamine and opioid systems, which produce the reward. When people drink alcohol and they are in a social situation, they may feel more relaxed, more sociable, more energized. When they're not in a social situation, they may feel more relaxed. Either way, and again, you can get down into the weeds on the pharmacokinetics of this, but the dopamine and opioid systems are activated. Alcohol also antagonizes GABA. Now you remember antagonized means it's a big old bully and it shuts it down. So antagonizing GABA, which is our relaxation, is what causes the jitters and the anxiety and all of the symptoms that we see in withdrawal from alcohol. As those depressant and rewarding and calming effects wear off, the GABA is being antagonized. So you've still got too much glutamate in your system, which is your get up and go chemical. So the person starts to get higher blood pressure, tachycardia, all those sorts of things. The nice thing, if you will, in detox, benzodiazepines, we use librium a lot, can be used and really effectively helps moderate that system and helps relax the person enough to keep them from having a stroke or a heart attack or anything like that. So there is an NIH article on the pharmacology of alcohol that will be in your class when you go in there. Again, if you want to read about the pharmacology, it's one that's written kind of on a journal level. So it's not an easy read, but it is definitely informative and it's not too hard. It's not like reading people magazine, it's going to take some concentration. So designer drugs refer to drugs that are created in a lab. That's all it means. It doesn't mean it's the most common or the most popular, it just means it's created in a lab. The downside to this is most of your designer drugs are not created in a lab like Eli Lilly. They're created in a lab in somebody's basement or in somebody's backseat of their car or in somebody's trailer, which means it has a lot of adulterants. And the quality control, the amount of the psychoactive substances in each batch likely varies quite a bit. So designer drugs are those that can actually be more dangerous than some of your other, quote, natural drugs. For example, marijuana. We know that your average marijuana plant is going to have a certain amount of THC in it. It used to be 5% THC. Now we're up around 15 to 30% THC because of selective breeding practices. But we know that any marijuana coming from XYZ plant is probably going to have about this much THC in it. And that's not alterable nearly as much as something that's just created in the lab. My kids hate it when they come try to help me in the kitchen and they're trying to learn how to cook. I don't follow recipes. I'm like a pinch of this, a dash of that. Let's just do a sprinkle. Some of your people who are making designer drugs kind of work on that same, you know, perspective. So, you know, just let clients know that it is important to be aware of it. One other thing I found when I was doing research for this class was that there are some fake hydrocodone tablets that are out on the market now that are actually laced with fentanyl. Remember, fentanyl is 30 to 50 times more powerful than morphine or than heroin. So if somebody's taking hydrocodone, which is relatively weak compared to those drugs and they get something that has fentanyl in it, it could be deadly. Anyhow, there is a DEA booklet on drugs of abuse. It's like 80 pages and it goes through the most prominent drugs of abuse, what they look like, what their street names are, some of their effects, yada, yada, yada. The NIH drugs of abuse chart will pull up and it's basically is very similar. And you can do the drop-down, tells you street names, commercial names, common forms, common ways taken, what DEA schedule it is. We don't really care at this point. We know that we really don't want our clients taking ecstasy. Possible health effects and treatment options. If there are medication-assisted treatments available, it will be listed here. For example, alcohol. Well, of course, that's not going to have it there. But you would think they would have anti-abuse and some other things listed there. Anyhow, so back to the PowerPoint. Bath salts. This is one of the most misunderstood by old fogies like us or me. I don't know how old y'all are. When I first heard of bath salts, I was like thinking bath salts, you know, the epsom salt things that you put in your bath has nothing to do with bath salts. They are synthetic cationes, which are drugs that contain one or more synthetic chemicals related to the cation family, which are stimulants found in the cat plant. So, they take this cat plant and they extract the chemicals from it or they make synthetic chemicals that resemble it and then they put it into other stuff. These synthetic cationes are cheap substitutes for other stimulants such as methamphetamine and cocaine. So remember like fentanyl is a really cheap substitute for heroin. Bath salts are a really cheap substitute for cocaine. Products sold as molly or MDMA often can, it's actually called herbal MDMA, often contain synthetic cationes instead of the real ones. Bath salts are typically swallowed, snorted, smoked or injected. So, you know, however you want to take it, people are taking it that way. And it is not at all related to actual substances that are put in the bath. So, synthetic cationes can cause nosebleeds. Partly, well, if you're snorting it, partly because of that, but it can also increase your blood pressure enough where it causes your nose to bleed. Dilated Pupils. Pupils are one of our best tells, if you will, when we have a client come in, if they've got the stigmas, their eyes are bouncing back and forth. If they've got dilated pupils or if they've got pinpoint, unreactive pupils, we have a good idea that they're under the influence of some sort of substance. So, pupils are a good thing to look at, especially in somebody that you don't have a baseline knowledge on what their behavior is like. Paranoia, increased sociability, increased sex drive, hallucinations, panic attacks. Remember, this is a stimulant. It's going to have the same effects as most stimulants. However, since they are synthetic and we can't control the quality and we can't exactly control what the chemicals are, bath salt chemicals will differ between different batches and different producers. It can cause violent behavior, kidney failure, liver failure, and suicide. Increased tolerance for pain. This is important for us to know. It's important for law enforcement to know, because if somebody starts having a paranoid psychotic episode and they need to be restrained to some extent. Now, I don't know if you use any sort of actual physical restraints at your facility, but if law enforcement has to come, they probably need to know that Jim Bob may be on bath salts because the taser often doesn't work. They need to be aware that Jim Bob may put up quite a fight, not saying that we really want to tase him, and it may be a futile effort anyway, but it will take a lot more effort to subdue Jim Bob if he's having a bad trip on bath salts. People also may get hyperthermia, causing them to tear off their clothing to cool off. So again, this is not a normal behavior that we're going to see in anyone. If you have someone that is like actively tearing off their clothing, you probably can guess, first guess would be bath salts. That's one of the more common reasons that somebody is going to do that, or they took ecstasy. We're looking at a variety of different things. Depression or suicidal behavior can last even after the stimulatory effects of the drugs have worn off. So you have all your happy chemicals and they gush through, then when they wear off, you crash. And this depression and suicidal behavior can go on for quite a while. How long is quite a while? The research doesn't really say. My guess is it really depends based on the individual and whether they had pre-existing depression or anxiety issues. Bath salts usually look like white or brown crystals, like a powder, and are sold in plastic foil packages labeled not for human consumption. You can see how well we listen to that. Sometimes labeled as plant food, jewelry cleaner, phone screen cleaner, or keyboard cleaner. Popular types of street bath salts include ivory wave, purple wave, vanilla sky, and bliss, but there are literally hundreds of different producers and different names. We'd be here all day. Brand names to be aware of, one that we've heard a lot about is Flaka, but there's also Bloom, Cloud9, Lunar Wave, Vanilla Sky, White Lightning, and Scarface. Why is this important? Because like I said, each manufacturer has their own special little recipe. You're going to have a better idea about what to expect as far as reactions. If you have somebody come into your facility and they say, I just used bath salts, the Flaka bath salts, you're going to have an idea about what that's going to look like versus some of the others. So Kratom, I'm not even going to try to pronounce the plant, but it's also known as Ketom, Kratomum, and it's a tropical tree in the coffee family native to Southeast Asia. So I'm like coffee, cool, like coffee. It's a stimulant at low doses. And in Southeast Asia, some people chew the leaves in order to get the stimulant effects. At high doses, it's a sedative. Now there are some people who want to keep this legal because they believe it helps with opiate withdrawal. Well, it's actually a mu-opioid receptor agonist just like morphine. So it may not be as intense as morphine, but you're basically taking an opiate. So whether you're actually detoxing from it or not or just doing that kind or gentler step down detox, you know, we could argue those different points. Many people report that Kratom is an effective treatment for arthritis, restless leg syndrome, and fibromyalgia. Hmm, go figure. Something that is a painkiller is going to be helpful for these things. The effects occur within 10 minutes of ingestion and may last for up to five hours. So if somebody is having a bad trip, you know it's only going to last for about five hours. But you also know that when they take it, it's not something that's going to take 30 or 45 minutes to take effect. It's going to be in their system, bing, bing, boom. The Kratom plant is currently legal, legal in all but four states. So it's important to recognize that you can get this plant. And a lot of times it's sold as cuttings or seeds at tobacco shops, those sorts of places. It's not something you're going to find at your local Home Depot. But it is legal. Long term use produces anorexia, weight loss, insomnia, skin darkening, dry mouth, frequent urination, and constipation. So you're having especially high uses. You're having some of the effects of the opiate of the depressant because we know that opiates tend to cause dry mouth and constipation. Withdrawal syndrome include hostility, aggression, emotional mobility, and jerky movements of the limbs. Cot is a highly addictive drug categorized as a stimulant that creates feelings of euphoria. Cot is taken orally as a tea, chewed into a paste, smoked, or sprinkled on food. The leaves, twigs, and shoots of the cot shrub are most commonly chewed and stored in the cheek, kind of like tobacco. It's a stimulant. You're going to have, you know, potentially physical exhaustion after you take this because you were on a stimulant, just like if you took methamphetamine or, you know, amphetamine or ephedra or any of those. Once it wears off, it's like you've been driving your car with a pedal to the floor and running it in the red area. So the engine needs to kind of cool down for a while. Breathing difficulties, constipation, tachycardia, hallucination, manic behavior, and hyperactivity, increased alertness and concentration, and increased motor activity. Long-term effects, high risk for heart disease and cancer of the mouth. These are the ones that are going to be more important to point out to our, to a lot of our clients. Tachycardia may be a long-term effect. Moving on to dextromethorfen. This is in, Nyquil, this is in most your cough suppressants, your robitocin DM, the D stands for, guess what, dextromethorfen. In high doses, and I mean, I'm talking really high doses, is it dissociative anesthetic. At lower doses, it's a cough suppressant and generally lasts about six hours. Lately, especially among teenagers, the trend has been to take it rectally through an enema in order to increase the high because it's absorbed more quickly into the system. And, you know, as far as how popular or how new are some of these drugs, these are some of the older drugs that have been around, you know, somewhere between five and 15 years. Not all of them are popular in every single state because a lot of people go with their, what they know, you know, they're going to go with Molly and they're going to go with ecstasy. They're not as likely to go with some of the lesser known drugs if they can get their hands on the easier drugs. Supply and demand, if you will, or easy access, whatever you want to call it. The trend with dextromethorfen has caused several states to actually move it behind the counter. So people who don't abuse it actually have to jump through all kinds of hoops to get it when we know that people who do abuse it are going to get it anyway. So my own little soapbox. Effects of dextromethorfen. Okay, there's a whole lot of them. One of them. Remember, I said the eyes are our clue. That rapid eye movement at higher doses may be there when people take dextromethorfen. Lack of coordination, nausea, dizziness, hallucinations, impaired judgment. The other thing to consider is how many of these symptoms or effects, if you will, are because you're taking toxic doses of a synthetic medication. Altered perception, altered time perception, feelings of floating, visual disturbances. It's a hallucinogen. It's going to have very similar effects to your other dissociative hallucinogens. Salvia divinorum is a hallucinogenic plant native to northeastern Mexico. Now, you know, at least when I was in college and, you know, that was a while ago, people would smoke salvia. The interesting point and the point that I think a lot of people don't really realize is there are many, many, many salvia plants. And salvia is the taxonomic name for sage. Most of the salvia plants don't have the hallucinogenic effects. So if you go out into your grandma's garden and cut some of the salvia out, you're probably not going to have any effects or any you do are just going to be placebo effects. It's sold at many tobacco shops in seeds, cuttings, leaves and extracts and is not currently controlled in the United States. The other thing to watch out for is if your treatment program has a gardening component to it, be aware of what some of these natural plants look like. So you know if your clients are sneaking in seeds and growing them because they do and they will and you just have to be able to identify them and get rid of them. Anyhow, salvia leaves are smoked, chewed or vaporized. So you can take the substance from the salvia plant and put it into the vaporizer, take the warm air through it, the warm moist air through it and inhale. DEA fact sheet on that. It can produce intense hallucinations such as floating or flying and heaviness or lightness of the body. Now one interesting thing here is I've had a couple of clients who have taken spice and one of the side effects that they reported from their experience, which both of these clients in question had really bad experiences, was that they felt like their body weighed a thousand pounds. They could not move because of the heaviness, which leads me to question whether the salvia divinorum was actually one of the herbs that was in the spice that they consumed. Because we'll find out in a little while when we talk about spice that spice is just a bunch of herbs that are all crushed up and then they spray the synthetic THC on it. So you don't know exactly what you're smoking that has been coated with synthetic THC. Less intense effects of the salvia occur only when the eyes are closed, include visual hallucinations. There can also be dizziness and nausea. I get motion sickness at the drop of a hat. I can look at a car and get motion sick. So I can't imagine feeling like I'm floating or flying and close my eyes and not get nauseous. Lack of coordination, slurred speech, awkward sentence patterns, decreased heart rate and chills. And we're going to move on to spice, which is also known as synthetic cannabis or synthetic marijuana, fake pot, legal weed, herbal incense and potpourri. Again, the active ingredient, the synthetic marijuana is sprayed onto the crushed up herbs. So you don't really exactly know what you're smoking. It could be rosemary, it could be clove, it could be salvia. You just don't know. Natural marijuana gains its mind altering effects from a chemical known as THC. Synthetic marijuana, on the other hand, is coated with synthetic cannabinoids. Over 700 different chemicals fall into this category. 700, which explains why it was so hard and it is still so hard to test for spice in a urine screen. Because you would have a panel as big as the room trying to figure out what somebody had taken. These chemicals are similar to natural cannabinoids found in marijuana, THC, but affect brain receptors differently. So it's important to remember that it's chemically similar, but it doesn't activate the same brain receptors. So people who have smoked pot in the past and are expecting a similar experience when they smoke spice are generally very disappointed. Some synthetic cannabinoids are 100 times stronger than THC and operate on other brain receptors beside your endogenous cannabinoids. So you have cannabinoid receptors in your brain. THC works on those. The synthetic cannabinoids work on those plus some other things. And the other things could be anything from dopamine to opioids to GABA or glutamate, depending on which one of the 700 chemicals it is. Significant negative side effects including high blood pressure, blurred vision, heart attack, vomiting, seizures, hallucinations and severe anxiety or paranoia. See, I could really work for a pharmaceutical company and do their commercials because I'm good at this negative side effect thing. Anyway, I digress. It's some wicked stuff. There are a lot of people who try spice and will never try it again. I was working with a client who had smoked weed in the past and had been clean for quite a while and then smoked weed again. The weed she used to smoke was, you know, your old fashioned like 5% THC and the new weed she smoked. My guesses from her description was probably more like 20%. She's like, oh, I thought I was going to die. I was never going to do that again. Now that's going, you know, that's four times stronger from 5 to 20. This goes from 5 to 100 times. It's like, wow. Significant negative effects. We've talked about liquid forms of spice or K2. If you were in the marijuana class, you know that marijuana resins are being extracted or THC resins are being extracted from marijuana now. There are also liquid forms of spice or K2. Because remember, the synthetic cannabinoids are actually just a liquid that is sprayed onto various plant material. So instead of spraying it onto plant material, let's just give you the liquid. The variety of chemicals may be greater. Some suspect that a few brands of liquid spice may contain traces of synthetic psychedelics. So it just ups the ante a little bit on what the experience may be like and how bad of a trip somebody could have. But there's no way to know. It's not like you can read the label and go, oh, this has 2CP in and I'm not going near it. K2 alternatives are now out that are legal, but their chemical composition variety varies widely. The manufacturers, the people who make spice are constantly trying to stay one step ahead of the DEA, one step ahead of the FDA. So they're changing the chemical structure of this drug, of these synthetic drugs in order to make them so they are not on that controlled list. Foxymethoxy. I had to include this because I just wanted to say it. Foxymethoxy is a hallucinogen. It's typically available as a powder, capsule or tablet. The tablets sometimes are embossed with logos such as a spider or an alien head. And you're like, why do I care? Well, if you are doing a property search and you come across something that has a spider or an alien head and you go to drugs.com to try to figure out what it is, it's probably not going to show up. So knowing that Foxymethoxy has a spider or an alien gives you a heads up so you have an idea about what it might be. The users feel effects 20 to 30 minutes after administration. It's usually taken orally. Peak after approximately 60 to 90 minutes and it lasts for up to 6 hours. Remembering that it's a pretty potent hallucinogen. The person will experience dilated pupils. There are those pupils again. Visual and auditory disturbances, nausea, vomiting and diarrhea. You've got your hallucinations, talkativeness, emotional distress, diminished user inhibitions and jaw clenching. This is one that's kind of unique to Foxymethoxy and a couple others. So along with the dilated pupils, if somebody is clenching or grinding their jaw or grinding their teeth or they've got a popsicle stick that they're chewing on, it's a clue that they're probably on something that they're not supposed to be. Aphedra or aphedrine, still legal in certain formulations. There was a big uproar several years ago and because people were taking supplements in order to work out, stack or two ripped fuel and a few others that contained high levels of aphedrine. Now, aphedrine by itself is a powerful stimulant. Aphedrine with caffeine and or aspirin is like wicked powerful and it was causing a lot of negative cardiac reactions. It's an intense stimulant and it has also been touted as a safe and legal form of ecstasy. I just went on to Google and I looked to see, I just Googled by supplements with aphedra and you can buy them off the internet. The effect of these drugs definitely does vary by the person, by their body weight, by pre-existing conditions, by medications they're taking, how much they take. There's a whole host of things that will affect how something affects someone. But by the same token, if somebody has had, let's take hallucinogens, if somebody takes a hallucinogen and they've had good trips before, it doesn't mean they're always going to have a good trip. They can have a bad trip. So I don't want people to get complacent and say, well, I've used this before and it's safe for me. If we're talking designer drugs, I would say probably nothing safe. Now, aphedra is one of those that's actually, if you buy it on Amazon or something, it's going to be manufactured in a lab. But it is important to recognize and review the research on the fact that it has caused a lot of cardiac events. Alpha methyl tryptamine or AMT is a psychedelic and a stimulant. Initially, it was developed in the 1960s as an antidepressant. So we're going to wake them up and we're going to give them a really good trip and then they won't be depressed anymore. No, it didn't work so much. It creates feelings of euphoria and hallucinations similar to MDMA or LSD. Now remember, MDMA is ecstasy. It is still legal in Canada and the UK. So you can buy it online under the guise of health supplements. It was permanently classified in the United States as a Schedule I narcotic in 2004 though. So you're not going to get it legally in the United States but if you order offline and get it from Canada or the UK, if it clears customs, it's not that hard to get. Ecstasy has a lot of different names. Ecstasy X MDMA is another amphetamine-based hallucinogenic drug that's taken orally, usually in tablet or capsule form. So again, we've got hallucinations plus a stimulant. It lasts three to six hours, increases the chance of dehydration, hypertension, heart or kidney failure, increased body temperature, more pulling at the clothes to get cooled off. Long-term effects can include confusion, depression, sleep problems, anxiety, paranoia and loss of memory. Now, long-term doesn't necessarily mean permanent. However, when we look at these, you got to think about the neurotransmitters that are being turned up or turned on when you take a stimulant. So again, you're happy, you're running at a thousand percent and then you crash. Depression. When you crash and you sleep for too long and you get your circadian rhythms out of whack, you can have sleep problems. Anxiety and paranoia can be precipitated by insufficient sleep in addition to pre-existing conditions and or just again mucking with that GABA system. Herbal ecstasy, also known as MOLLE, is caffeine and a fedron. It comes in pill form and is usually taken orally. It's often referred to as cloud nine, MOLLE, rave energy or ultimate exphoria. MOLLE is a term that I used to hear a lot when I worked in the treatment center. So ultimately, drugs of abuse are used for one or more of three reasons. People either want to relax, go to sleep, you know, the depressant effects. The term depressant is so misleading because it usually doesn't make people depressed. Depressants, when people take them, typically cause that relaxation, get rid of the stress sort of feeling. Stimulation, which is why you would take an amphetamine or hallucination. You just kind of want to break from reality. All of these drugs were created to mimic the effects of other substances. The list of substances of abuse is never ending. Like I said, nutmeg, if taken at high enough doses is a hallucinogen. My ever so resourceful teenage clients used to save the orange rinds when they would have lunch. Put toothpaste on them, put them in the window. It would dry out, then they would break it apart and they would chew on it. They would get a high from it, but the high is speculated to be more from fluoride toxicity than anything else. So people will get, I mean, we had to take hand sanitizer out of the clinic because people were getting to it and trying to drink it. If somebody wants to get high or somebody wants to escape, they will. What's more important is understanding what's motivating you to do this. What is the benefit to you of using this particular drug at this particular time? Most of our clients are polysubstance abusers, which is why I say this particular drug at this particular time. Because they may have different reactions or different drug choices for different situations. They may use some drugs in order to help them loosen up and be more sociable. They may use some drugs to help them relax. They may use some drugs to help them sleep. And they may use some drugs when they just want to chill out and have fun, helping them identify why they're using. And theoretically, if they're in treatment with us, they're wanting to figure out alternatives. Remember that you're not going to get the same effects every time, even on the same person. And you're not going to necessarily experience the anticipated reaction, especially if the person has a pre-existing mental health issue. So their neurotransmitters are already kind of different. Or they're taking other medications. And it could be psychotropics. It could be blood pressure medication. It could be a whole host of things. But anytime you start combining substances, you never know what's going to produce Mount Vesuvius. So what questions do you have? When I was preparing for this presentation, one of the things I did was just Google designer drugs. And then I went to the News tab and I looked at what was making news. Because obviously, those are going to be the ones that theoretically you're going to be more interested in. Remember that some of these drugs can be brought in, you know, like on postage stamps, on envelopes, in very innocuous packages. So not only if you're in corrections, but if you're in a residential treatment facility, or even an outpatient, if somebody is bringing, you know, envelopes and stamps and they're allegedly sending letters on break, be a little bit speculative. I hate to say it, but it's true. We need to be a little bit speculative. As far as the statistics with the drugs and the death rates, you can go to the DAWN network. Let me see if I can bring that up real quick. The Drug Abuse Warning Network. And you can go to national data or any of the data tables and look at information about what's being collected. So let's just go to typical day in 2014. It talks about first substance use, alcohol, treatment, emergency department visits. In 2011, there were 845,000 drug-related emergency department visits. Almost 500,000 involved the use of illicit drugs, alcohol in combination with other substances, or intentional misuse of pharmaceuticals. Looking to see if it actually has deaths listed. But it does tell you, you know, alcohol, marijuana, illicit amphetamines or methamphetamine. Your MDMA, ecstasy, PCP, other hallucinogens, this is where you're going to find most of your designer drugs because most of them are stimulant hypnotics. And you can see the majority of them were aged 18 to 25. Well, they were looking at 18 to 25. So if you're wanting to show your clients some hardcore data, you know, you can come to the Dawn Warning Network. You can spend hours going through tables, you know, because I have no life and that's what I like to do is look at research. But no, I'm kidding. It's actually interesting to look at the trends when you think everything is going up and some things are actually going down. And you can get an idea about what's happening. As far as using this information for education, I mean the DARE program does something similar educating people to the effects of alcohol and drugs and how dangerous they are. What a lot of my clients have told me who were involved in the DARE program that just basically told them which drugs were safer to use and how to use them. So we need to increase the motivation for students to stay clean. But we also need to address, again, go back to addressing the reasons that they're using as opposed to just looking at the particular drug. Because they'll find other drugs. I mean Dextremothorfin sold at Walmart. So kids can go get it if they want it. Nutmeg probably in your parents spice rack. They can use it if they want it. And kids have a trend now and it's been there for a while that they'll go into their parents medicine cabinet and just grab a handful of any pills that are there, put them into a bowl and take a handful and see what happens. Which I have to believe they know how dangerous that is but they don't care. So my question is why don't they care? Why are they so irreverent about their own safety? Any other thoughts about using it in the public school system as information for health education classes? Okay, well that ends this presentation. So you can go into the class and take your quiz and let's see. So I'm wondering once you gave them the knowledge, how do you inspire people to... And I think a lot of it comes down to motivational interviewing. Motivating people to not experiment. You know what are the drawbacks if you use and how likely is it that you will get caught. When you look at tip 35, which is on motivational interviewing, it talks about the frames approach. And one of the first techniques in the frames, the F in frames, stands for feedback. Providing feedback to people about what's really happening because they think, well, all my friends are doing it. Well, let's look at the actual data. How many people are actually doing it? And obviously we want to know that information before we go into the discussion because if it says like 65%, then they're closer to right than we wanted them to be. But looking at giving them resources for understanding how common it is, what the side effects are. And for some of the students that I worked with, some of the teenagers, understanding what ramifications it could have in their later life. You know, if they wanted to be cops, if they wanted to be attorneys, if they wanted to be doctors. What are the ramifications if they get popped with a drug or if they end up overdosing and they go to the emergency room and then it's found that obviously they overdosed from XYZ drug and then they also have a felony record. And I think it's part of the function and it's not the school counselor's function. It's not the mental health counselor's function. It's not necessarily the parent's function. I'm not sure who needs to spearhead it. But there needs to be a grassroots effort in the community to make sure that there are resources available, that there are mental health counselors available because you're right. A lot of school counselors are put into administrative positions and are, you know, knee deep in scheduling and planning. Making sure kids know where the resources are and how to access them even if they're not in the school, such as mental health counseling is also important. Sometimes if you work, if you notice that there are, if you notice that there are needs in your school, sometimes you can work with the local nonprofit community behavioral health and they can get a grant to provide the in-school services. And what I'm reading about a lot of the programs getting terminated and it may be my own, you know, I've only had two experiences in two different school systems with this. But in both cases it was basically determined that the emphasis during school hours needed to be on preparing for the F-CAT and not providing mental health counseling so they didn't want us pulling children out of class. One way around this might be to offer the services after school where the student could ride the late bus home. And some school systems are vehemently opposed like Darcy is saying to having us in the school area in the schools because they see it as a liability. Not only is it detracting from annual testing preparation but it's seen as a liability if something would happen to little Johnny on the school grounds. At least that's what I've been told. I actually did find, you know, interestingly when I was doing the in-school counseling programs, attendance by those students on the days that they met with their counselor was almost always 100%. They almost never missed on a day that they were meeting with their counselor. So, I mean, interesting observation. Obviously, I didn't look on the days that they weren't but generally these children had some behavior and attendance problems which is why we got called in. If you go to, let me see if I can find it. I think one of the reasons the kids would show up on the days they would meet with their therapist was because that was the one time somebody listened to them but, you know, I could be speculating. To find out what grants that SAMHSA has, SAMHSA is going to be most likely to provide you with your actual treatment to practice grants as opposed to NIDA or National Institute of Mental Health which focus more on research and those are a lot harder to get for a treatment center. But if you go here, you can see what grants they have announced. Yeah, community behavioral health clinics, suicide prevention clinics, centers, traumatic stress, drug free community support program. You might be able to write a grant that falls under that. SAMHSA grants are long but if you work for a nonprofit, you can apply, the nonprofit can apply. And like I said, they're long to write but they're not difficult. It's kind of like writing your master's thesis again with a whole lot less citation and a smaller bibliography. But I rather enjoy writing them and trying to figure out how I could spend the government's money. So to find those, you just Google SAMHSA and then whatever year you're in and grants and it'll bring it right up. Every year they have grants announced that agencies can apply for. The strategic prevention framework, partnerships for success, sounds like it might be a winner based on what we're talking about. Preventing underage drinking, adolescent and traditional, transitional aged youth treatment implementation. So again, that's targeting that high school group. It's always dangerous for me to get in there and look at grants because then I want to start writing them. But you get an idea, there's a broad spectrum and it's all about wording. You want to meet their objectives but you also want to meet the need in your community so it's about how you present it. Any other questions? Let's see this chat before it goes away. Well, I really enjoyed our chat we had at the end of class today and hopefully I will see you all on Thursday. If you have any questions, feel free to shoot me an email at support at allceuse.com.