Drug Overdose in the Adolescent - PowerPoint Presentation

Slide1

Drug Overdose in the Adolescent

Carla Laos MD, FAAP

Pediatric Emergency Medicine PhysicianSlide2

Objectives

Provide epidemiology surrounding adolescents and overdose and suicide

Discuss the medical effects of various ingestions

Skittles Parties

Marijuana, Synthetic marijuana

Alcohol

Huffing

OTC medications ( Nyquil, Listerine,

Corcidin

)

Role of social media with adolescents and substance abuse

Lack of

m

edia coverageSlide3

Suicide

Suicide



3

rd

leading cause of death 15y-19y

1950-1990 suicide rate increased by 300%

1990-2013 suicide rate decreased by 20%

2013: 1748 suicides, true number may be higher

Successful, Males: Females

 6:1

Unsuccessful, Female: Males  2:1

National Youth Risk Behavior Survey:

9-12 graders

24% of students had seriously considered attempting suicide during previous year.Slide4

Fixed Risk Factors for Suicide

Family history

of suicide or suicide attempts

History of adoption

Male gender

Parental mental health problems

Lesbian, gay, bisexual or questioning sexual identity

History of

physical or sexual abuse

Previous suicide attemptSlide5

Risk Factors for Suicide

Psychosocial stresses

Conflicts with parents

Breakup of a relationship

15 y/o male with self inflicted wounds, large X on chest

School difficulties/failure

Social isolation (bullying)

14 year old male with ‘Everyone hates me’ etched into his chest/abdomen

Long term high levels of community violence may increase conduct/emotional problems and add to suicide risk for exposed youthSlide6

Mental Health Risk Factors for Suicide

Sleep disturbances

Depression, bipolar

Substance intoxication and substance use disorders

Alcohol use/alcoholism (

a/w

50% of suicides)

15 year old dropped off by friends at DCMC, unconscious for unknown period of time. DOA.

PTSD, Panic attacks, psychosis

History of aggression, impulsivity, severe anger

Pathologic internet use

More than 90% of adolescent suicide victims met criteria for a psychiatric order before their deathSlide7

Social and Environmental Risk Factors

Bullying

Impaired parent-child relationship

Living outside the home (homeless, corrections facility, group home)

School difficulties

Not working or attending school

Legal or romantic difficultiesSlide8

Nonsuicidal Self-injury (NSSI)

By definition, does not included intent to die

NSSI is a risk factor for suicide attempts and suicidal ideation

(Include

pics

)Slide9

Bullying

Aggressive or deliberately harmful behavior that is:

Between peers

Repeated over time

Involves an imbalance of power (physical strength or popularity)

4 categories:

Direct-physical (assault, theft)

Direct verbal (threats, insults, name calling)

Indirect relational (social exclusion, rumors)

Cyberbullying

16 year old female ingestion of

T

ylenol due to spreading of naked

pics

on social mediaSlide10

Bullying

Clear relationship between bullying and suicidal ideation in children and adolescents

Bullying predicts future mental health problemsSlide11

Internet Use

Pathologic internet use correlates with SI and NSSI

Video games &

intenet

> 5 hours

a/w

depression and SI/SA

Suicide related

seraches

a/w

completed suicides among young adults

Participation in online forums can be dangerous

Attempts made by susceptible individuals encouraged by conversationsSlide12

Leading Methods of Suicide (15-19y)

Suffocation (42%)

Discharge of firearms (42%)

Poisoning (6%)

Falling (3%)Slide13

Alcohol

M

ost

widely used psychoactive drug in the

USA.

Financial

cost to society

is $

166.5

billion/year (medical

treatment, rehabilitation therapy, lost earnings, car

crashes)

Societal double standard:

“

Parents will say, ‘My kid may be drinking, but at least he’s not doing drugs.’ Slide14

Alcohol & Teens

An adolescent may employ similar logic to gain permission to drink alcohol.

“

C’mon, Dad, the three of us are just

gonna

split a six-pack while watching the playoffs at Andy’s house. How come you and your friends get to do it and we can’t? Besides, it’s not like I’m smoking weed or shooting up heroin. It’s just beer.

”

A

ddress

the glaring contradictions in our

society.

C

andor

will be appreciated. Here is an example of what you might say

:Slide15

Alcohol and Teens

“It does seem hypocritical... we say it’s okay for adults to drink but not to smoke marijuana. Maybe nobody should use alcohol at all, but it’s such a part of our culture that I don’t see us going back to the days of Prohibition.

“Until you turn twenty-one, you are not to drink, if for no other reason than it is against the law. Once you’re of legal age, then it will be your decision whether or not to use alcohol. Illicit drugs, you are never to take; I don’t care how old you are.”Slide16

Alcohol & the Teenage Brain

Short Term Effects:

Difficulty making good decisions

Less aware that behavior inappropriate or risky

More likely to engage in risky behavior

Less likely to recognize potential behavior

Long Term Effects:

Alcohol during teen years can interfere with development and change the brain

Negative effects on information processing/learning

Increases risk of alcohol use disorder later in lifeSlide17

Alcohol & Teens

Additional Long

-Term Effects

Blackouts, memory

loss

Vitamin deficiencies

Malnutrition

Suppression of

immune system

Hormonal

deficiencies, sexual dysfunction,

infertility

Inflammation of the pancreas (pancreatitis)

Alcoholic hepatitis

Alcoholic cirrhosis

Cardiovascular disease and strokeSlide18

Alcohol & Teens

Alcohol

-withdrawal delirium, or

delirium

tremens:

C

an

range in intensity from mild irritability and sleeplessness, to frightening hallucinations and

delusionsSlide19

Alcohol & Teens

Statistics from the National Council on Alcoholism and Drug

Dependence:

A

lcohol

use

invovled

in about

half of all sexual assaults involving adolescents and college students, including date rape.

O

ne

in

six teens—

admit to having experienced alcohol-induced blackouts, where they could not recall the events of the previous evening.Slide20

Alcohol & Teens

Sexually active teens who overindulge are

less

likely to protect themselves against pregnancy and sexually transmitted

diseases

.

Stated simply, they are

too besotted to take the necessary precautions before having

intercourse.

The

fact that heavy drinking wears down the immune system adds to their risk of contracting a sexually transmitted disease (STD).Slide21

Huffing/Sniffing

According to national surveys,

inhaling dangerous products is becoming one of the most widespread problems in the country

.

Household products such as gasoline are readily available

,

H

as

resulted in a significant rise in the number teens and young adults abusing this substance.Slide22

Huffing/Sniffing

Long-Term Health Risks:

Mental

deterioration, chronic

injury to the nervous system are the principal health dangers of chronic abuse of solvents, including gasoline.

This

leads to other health issues, such as:

Problems with attention, memory, and problem-solving

Muscle weakness

Tremor

Balance problems

Mood changes

Dementia

Nephritis and tubular necrosis

Certain

cancersSlide23

Inhalants

Inhalants

Young people today can face strong peer pressure to try drugs, including a group of substances called

inhalants

. Inhalant abuse is particularly a problem with younger teens, but even children as young as 5 or 6 years may try inhalants.

Inhalants have the special risk of being deadly any time they are used—even the first time.Slide24

Inhalants

Types of inhalants

More than 1,000 products typically found around the house can be misused as inhalants to get

high

. Because these products are commonly found in homes, offices, and classrooms, they are legal, cheap, easy to get, and easy to hide. Nearly 1 in 10 eighth graders have tried inhalants.

There are 3 general types of inhalants: solvents and fuels, nitrous oxide, and volatile nitrites.Slide25

Inhalants

Solvents

are household or industrial products that contain liquid or aerosol, including glues and adhesives

,

Nearly

all products in pressurized spray cans can be abused, including hair spray, deodorants, computer cleaners, and spray paint.

Fuels

inhaled for

abuse: butane

, propane, gasoline, octane boosters, and refrigerants.

Nitrous oxide

or laughing gas is usually diverted from medical use or is found in whipping cream chargers (steel cylinder or cartridge filled with nitrous oxide used with whipping cream dispenser).

Volatile nitrites

found in air fresheners are mostly tried by older teens who believe this drug will enhance sexual function.Slide26

Inhalants

How inhalants are used

A

buse called

solvent abuse, huffing, sniffing, glue sniffing, or volatile substance abuse.

Users will

Sniff,

huff

(breathe in fumes from a rag soaked with chemicals), or inhale directly from product cans or other containers that hold inhalants.

Spray inhalants into a bag or an empty container like a soda can and inhale them.

Medical

gases like nitrous oxide are often put into balloons.

Spray or pour inhalants onto a cloth or piece of clothing, then inhale deeply from the fabric

.Slide27

Inhalants

How inhalant use affects health

Contain chemicals never

meant for people to inhale.

Even the

first use can result in death.

H

eart is

sensitive to inhalant effects, leading to abnormal heart rhythms and sudden death.

Can cause permanent brain damage.

High happens fast, lasts

few seconds to minutes, unless the user inhales repeatedly.

At

first, inhalant users feel stimulated, but very

soon

feel dizzy and may slur their

speech/ stumble

. Sometimes users think they see things that are not there.Slide28

Inhalants

Short-term effects include

Excitement, no inhibition, impulsive behavior

Double vision, dizziness, unsteady walking

Sneezing, coughing, runny nose, red eyes

Slurred speech, nausea, vomiting

Sleepiness, headache, passing out

DeathSlide29

Inhalants

Long-term effects from brain and nerve damage include

Trouble with attention, poor problem-solving

Muscle weakness and tremor

Balance problems

Poor memory, mood changes, dementiaSlide30

Marijuana

Marijuana use affects health and well-being

School

Marijuana users have a hard time thinking clearly, concentrating, remembering things, and solving problems. Frequent marijuana use often causes grades to drop. Users often lose interest in school and may quit

.Slide31

Marijuana

Driving and physical activity

Marijuana impairs judgment, complex motor skills, and the ability to judge speed and time. Those who drive or take other risks after smoking marijuana are much more likely to be injured or killed.

Sexual health

Teens who smoke marijuana are more likely to take sexual risks and have unwanted or unprotected sex.Slide32

Marijuana

Long-term health

Teens' bodies and brains are still growing and maturing, so smoking anything, including marijuana, is not good for lung health. Marijuana use may also lead to addiction or mental health problems (

ie

, depression, anxiety or schizophrenia). Slide33

Cough & Cold Medicines

Dexamethorphan

acts

onsame

receptors as ketamine or PCP

Causes hallucinations

Codeine binds to same receptors as heroin

Both codeine and DXM increase dopamine in the brain’s reward pathwaySlide34

Cough and Cold Medicines

Abuse of DXM can cause:

Loss of coordination

Paresthesias

Nausea

Elevated BP, HR

Rarely, hypoxia, causing brain damage when DXM taken with decongestants

Abuse of Promethazine- Codeine Cough syrup

Bradycardia

Slowed breathing ( high doses can lead to overdose and death)

These medications even more dangerous when taken with other drugsSlide35

Protective Factors

Religious involvement

Connection between teen and parents, school and peersSlide36

Approaching the Adolescent

No data indicate that inquiry about suicide precipitates the behavior.

Suicidal thoughts or comments should never be dismissed.

Behavioral problems that may be manifestations of masked depression

Truancy

Academic deterioration

Running away

Defiance of authorities

Drug/Alcohol abuse

Delinquency

Sexual acting outSlide37

Approaching the Adolescent

Screen patients for suicide, mood disorders and substance abuse/dependence

Ask about emotional difficulties, use of drugs/alcohol

Assess level of danger to self/others

Where resources lacking, others encouraged to obtain extra training and become competent in providing an in depth assessmentSlide38

Role of Media

Youth may imitate suicidal behavior seen on television

Media coverage of an adolescent’s suicide may lead to cluster suicides

Additional deaths directly proportional to amount/duration/prominence of media coverageSlide39

Management of the Suicidal Adolescent

Management depends on risk

Adolescents at high risk:

Plan or recent suicide attempt

Stated current intent to kill themselves

Recent SI or behavior accompanied by current agitation/hopelessness

Impulsivity

and profoundly

dysphoric

mood

a/w

bipolar, depression, psychosis or a

substance abuse disorder

Those who seem at low risk, joke, or seek help for repeated somatic complaints may be asking for help. Slide40

Management of the Suicidal Adolescent

Moderate or high risk of suicide or attempt:

Immediate mental health professional evaluation

Options include hospitalization, transfer to emergency department, same day evaluation by MH professional

Consider psychiatric

h

ospitalization

Previous attempts

High degree of intent to commit suicide

Serious depression or other psychiatric illness

Engage in substance abuse/have active substance use disorder

Low impulse control

Families unwilling to commit to counselingSlide41

Careful of the ‘Suicide Gesture’

This term should not be used.

Adolescent who took 8 Motrin tablets:

May have thought it was lethal and may do something more lethal the next time

May

hae

known dose was not lethal and took the pills as a rehearsal for a lethal attempt

The benefit of the doubt is generally on safety in the management of the suicidal adolescentSlide42

References

Suicide and Suicide Attempts in Adolescents, Committee on

Adolescents.

Pediatrics

Apr 2000

, 105 (4) 871-874;

DOI

Suicide and Suicide Attempts in Adolescents

Committee on Adolescence. Pediatrics Jul 2016, 138 (1) e20161420; DOI: 10.1542/peds.2016-14204

National Institute of Mental Health (best practices for media and online reporting of deaths by suicide)

Teens.drugabuse.gov

National Institute on Drug Abuse (NIDA)

drugabuse.gov