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LESSON PLAN Course: DUI/SFST Class Title: Determination of Driving Under the Influence of Drugs Effective Date: January 14, 2013 1 COVER PAGE TIME: COURSE : CLASS TITLE: 240 Minutes DUI/SFST Determination of Driving Under the Influence of Drugs CLASS LEVEL: OBJECTIVES: AIT See page 3 METHOD OF INSTRUCTION: METHOD OF TESTING: TRAINING AIDS: Lecture Written PowerPoint, Proxima, Screen, Computer, Drug Cart REFERENCES: See page 4 COMPLETED BY: DATE: REVISIONS BY: DATE OF REVISIONS: Bill Eckler February 2008 Michael Roe December 18, 2012 APPROVED BY (signature): DATE APPROVED: Scottie Saltsman December 18, 2012 2 OBJECTIVES Without reference, the recruit will be able to: 8.7.1 describe in approximate, quantitative terms the incidence of drug involvement in motor vehicle crashes and in DUI enforcement in accordance with NHTSA standards. 8.7.2 define the term “drug” in the context of DUI enforcement in accordance with NHTSA standards. 8.7.3 name the major categories of drugs in accordance with NHTSA standards. 8.7.4 describe the observable signs of impairment generally associated with the major drug categories in accordance with NHTSA standards. 8.7.5 identify and describe appropriate procedures for dealing with drug impaired and/or medically impaired subjects in accordance with NHTSA standards. 8.7.6 describe medical conditions and other situations that can produce similar signs as impairment as explained n class. 3 REFERENCES: NHTSA. DWI Detection and Standardized Field Sobriety Testing, 2006, U. S. Department of Transportation, Washington D.C. The Detection of DWI Motorcyclists, July 2006, NHTSA: Pamphlet: DOT HS 807856, Washington D.C. The Visual Detection of DWI Motorists, NHTSA: Pamphlet: DOT HS 808 677, Washington, D.C. 4 LEC: INTRO The purpose of this session is to improve your ability to recognize suspects who may be medically impaired or under the influence of drugs other than alcohol and to take appropriate action when you encounter such a suspect. Alcohol remains the most frequently abused drug, and most impaired drivers are under the influence of alcohol. But many drivers also routinely abuse many other drugs. It is highly likely that every experienced DUI enforcement officer has encountered at least some suspects who were impaired by drugs other than alcohol. Depending on what specific type or types of drugs they have taken, some drug-impaired suspects may look and act quite a bit like a person under the influence of alcohol. But others will look and act very differently from alcohol-impaired suspects. It is important that you be able to recognize suspects who may be under the influence of other drugs, so you will be able to summon assistance from TIME: NA—opening slide 5 physicians or other appropriate people. 5 LEC: So, the purpose for this block of training is: to improve your ability to recognize suspects who may be medically impaired or impaired by drugs other than alcohol and to take appropriate action when you encounter such a suspect. TIME:XX 6 LEC: By the end of this class you should be able to… • Describe the term Drug in the context of DUI enforcement. • Describe the incidence of drug involvement in motor vehicle crashes and DUI enforcement. • Name the Major categories of drugs. TIME:XX 7 LEC: Describe the observable signs associated with the major drug categories. Describe medical conditions and other situation that can produce similar signs. Describe appropriate procedures for dealing with drugimpaired or medically-impaired suspects. TIME:XX 8 QTC: What is a drug? AR: Medicines, cocaine, marijuana, etc TIME:XX 9 LEC: QTC: AR: QTC: AR: LEC: Any substance which, when taken into the human body, can impair the ability of the person to operate a vehicle safely. What are some things physicians would consider being drugs that are not covered under this definition? Nicotine, caffeine……… What are some common chemical substances that doctors do not usually consider as drugs, but definitely impair driving ability? Model airplane glue, gasoline, spray paint etc. I am going to show you the seven categories of drugs that we will be discussing during this block of training. I will discuss in more detail, step by step on each category later in our training. TIME:XX 10 Category # 1 Central Nervous System Depressants LEC: CNS Depressants slow the mind and body down. Some depressants include: Alcohol Barbiturates Rohypnol ro-hip-nol (old date rape drug) Muscle relaxants Valium/Xanax/Prozac/ Librium GHB - gamma hydroxy butyrate (new date rape drug) TIME:XX 11 Category # 2 Central Nervous System Stimulants LEC: Stimulants: are psychoactive drugs which induce temporary improvements in either mental or physical function or both. Examples of these kinds of effects may include enhanced alertness, wakefulness, and locomotion, among others. Due to their effects typically having an "up" quality to them, stimulants are also occasionally referred to as "uppers". Cocaine Amphetamines Meth-amphetamines Ritalin TIME:XX 12 Category # 3 Hallucinogens LEC: These classes of psychoactive drugs have in common that they can cause subjective changes in perception, thought, emotion and consciousness. Unlike other psychoactive drugs, such as stimulants and opiods, these drugs do not merely amplify familiar states of mind, but rather induce experiences that are qualitatively different from those of ordinary consciousness. These experiences are often compared to non-ordinary forms of consciousness such as trance, meditation, and dreams. LSD (Lysergic Acid Diethylamide) di-eth-la-mide Peyote (cactus button) MDMA (Methylene-Deoxy Meth-Amphetamines) Better known as ECTASY TIME:XX 13 Psilocybin (sil-o-sybin) Magic Mushrooms 13 Category # 4 Dissociative Anesthetics LEC: The most significant subjective differences between dissociatives and the classical hallucinogens (such as LSD and mescaline) are the dissociative effects, including: depersonalization, the feeling of being unreal, disconnected from one's self, or unable to control one's actions; and derealization, the feeling that the outside world is unreal or that one is dreaming PCP - Phencyclidine Ketamine Dextro-meth-orphan or DXM which is the substance found in cough syrups like Robitussin. Analogs refer to the various formations of PCP,”K” DXM (Powder, liquid, pills, capsules, etc…) TIME:XX 14 Category # 5 Narcotic Analgesics (pain killer) LEC: Opioids are among the world's oldest known drugs; the use of the opium poppy for its therapeutic benefits predates recorded history. The analgesic (painkiller) effects of opioids are due to decreased perception of pain, decreased reaction to pain as well as increased pain tolerance. Heroin Morphine Codeine Oxycontin Synthetic Opiates (Demerol, Methadone Fentanyl) TIME:XX 15 Category # 6 Inhalants LEC: Inhalants are a broad range of drugs whose volatile vapors are taken in via the nose and trachea. They are taken by volatilization, and do not include drugs that are inhaled after burning or heating. For example, amyl nitrate and toluene are considered inhalants, but tobacco, marijuana, and crack are not. Examples: Toluene Spray paint Gasoline Glue Nitrous Oxide Hundreds of common household items TIME:XX 16 LEC: AFQ: LEC: Category # 7 Cannabis Cannabis, also known as marijuana and by other names that refers to preparations of the Cannabis plant intended for use as a psychoactive drug and as medicine. Chemically, the major psychoactive compound in marijuana is delta-9-tetrahydocannabanol (Δ9-THC); it is one of 400 compounds in the plant, including other cannabanoids, such as cannabidiol (CBD), cannabinol (CBN), and tetrahydrocannabivarin (THCV), which can produce sensory effects unlike the psychoactive effects of THC. Marijuana is the herbal form of cannabis, and comprises the flowers, the subtending leaves, and the stalks of mature pistillate female plants; hashish is the resinous, concentrated form of cannabis. Marijuana Hashish Marinol (medical marijuana) Hash oil These seven categories are organized on the basis of the clinical effects that they produce. TIME:XX 17 Category # 7 Cannabis (Continued) LEC: A) The drugs that belong to a particular category all produce basically the same effects. Example- Alcohol and Valium both are CNS Depressants. A person under the influence of Valium will look, act and feel basically the same as a person under the influence of alcohol. B) Two different categories produce different effects. Example- A person under the influence of a CNS Stimulant will not look, act or feel exactly like someone under the influence of PCP. TIME:XX 18 LEC: Results from the 2010 National Survey on drug use and Health: National Findings. http://www.samhsa.gov/data/NSDUH/2k10Results/Web/PD FW/2k10Results.pdf If time permits go to the above url and review some other interesting drug and alcohol statistics from the 2010 survey. In 2010, an estimated 11.4 percent of persons aged 12 or older drove under the influence of alcohol at least once in the past year. This percentage had dropped since 2002, when it was 14.2 percent. The rate of driving under the influence of alcohol was highest among persons aged 21 to 25 (23.4 percent). TIME:XX 19 LEC: Nearly less than half (49%) of the inmates surveyed in state prisons reported being under the influence of drugs or alcohol while committing the offense they were incarcerated for. 17 % reported committing the offense for money to buy drugs. TIME:XX 20 LEC: University of Tennessee found 40 % of crash injured drivers had drugs other than alcohol in them. The Maryland Shock Trauma Center found nearly one-third of crash–injured drivers had recently used marijuana. TIME:XX 21 LEC: Studies of fatally injured drivers consistently show that nearly 20 percent had drugs or the combination of drugs and alcohol in their systems at the time of the crash. TIME:XX 22 QTC: What is one of the most reliable signs of alcohol influence that can be observed in the eyes? AR: Red eyes, blood-shot eyes, relaxed eyelids…….. LEC: Horizontal Gaze Nystagmus 1. The eyes disclose some of the clearest signs of drug impairment or medical conditions. a. Horizontal gaze nystagmus is a very clear indication, in a suspect's eyes, of possible alcohol impairment. b. There are a number of drugs, other than alcohol, that will enhance H.G.N. TIME:XX 23 LEC: c. There are a number of other drugs that will not cause horizontal gaze nystagmus. (Cannabis, stimulants, hallucinogens, narcotics) d. There are many other clues that the eyes will disclose, all of which will suggest the presence or absence of drugs or medical impairment. ( a need to call E.M.S.) If the eyes track equally, but "jerk" while they are moving, then the possible presence of three categories of drugs should be noted: they are: Depressants, Inhalants, Dissociative Anesthetics. TIME:XX 24 LEC: Drugs that will enhance nystagmus: Depressants Inhalants Dissociative Anesthetics “These are what we call our DID drugs”. This involuntary jerking is what we call Horizontal Gaze Nystagmus (HGN). TIME:XX 25 Drugs causing pupil dilation. LEC: Cannabis, Stimulants, Hallucinogens. If the pupils are noticeably dilated, then the possibility exists that the subject could be impaired by certain categories of drugs: CNS stimulants Examples: cocaine, methamphetamine, amphetamine, etc. Hallucinogens Examples: LSD, peyote, psilocybin, MDA, Ecstasy, etc. Cannabis Examples: Marijuana, Hashish, Hash Oil. TIME:XX 26 LEC: Notice how large the pupils are, even with light shining in to them. the normal pupil would constrict in this case. There are times the suspect’s pupils are so large or dilated, it is hard to tell the color of the eyes. If the two pupils are distinctly different in size it is possible that the subject has a glass eye, or is suffering from a head injury or a neurological disorder. It is sufficient to look at a suspect's pupils and estimate whether they look noticeably small ,(constricted) about normal, or noticeably large, (dilated). TIME:XX 27 Narcotic analgesics usually cause pupil constriction. LEC: NTF: If the pupils are noticeably constricted, then the possibility exists that the subject could be impaired by a narcotic analgesic. Examples: Heroin, codeine, demerol, oxycodone, fentanyl, etc. TIME:XX 28 Constricted Pupils LEC: Notice how small the pupils are. (Do you think his nose has been broken a time or two!) TIME:XX 29 C.N.S. Depressants, Inhalants, Dissociative Anesthetics (D.I.D. drugs) LEC: The types of drugs that usually enhance nystagmus usually do not affect pupil size. Major exception- Methaqualone (a CNS depressant) will cause pupils to dilate. Methaqualone is a sedative-hypnotic drug that is similar in effect to barbiturates, a general CNS depressant. Quaaludes became increasingly popular as a recreational drug in the late 1960s and early 1970s. The drug was used during sexual activity because of heightened sensitivity and lowered inhibition coupled with relaxation and euphoria. It was withdrawn from many developed markets in the early 1980s (in 1982 in the United States), being made a Schedule 1 drug in the U.S. in 1984. TIME:XX 30 LEC: PCP is a dissociative anesthetic PCP may exhibit immediate onset of nystagmus prior to 45 degrees, also vertical nystagmus usually will be present in subjects under the influence of PCP or CNS depressants or inhalants. TIME:XX 31 LEC: You are expected to remember this! Log it in your brain! Depressants Inhalants Drugs that cause nystagmus but does not effect the pupil size Dissociative Anesthetics _______________________________________ Cannabis Drugs that effect the pupil size Stimulants but does not cause nystagmus Hallucinogens (causes the pupils to dilate _______________________________________ Narcotics Drugs that effect the pupil size But does not cause nystagmus (causes the pupils to constrict) TIME:XX 32 LEC: Let’s talk about the seven drug categories and their observable effects. Category # 1 CNS Depressants *Alcohol- The most familiar CNS depressant. *Rohypnol--street name- roopies, roofies, rib. Single or double scored white tablets with manufacturer name as either ROCHE or <RH> and with the number 1 or number 2 on it, meaning 1 mg or 2 mg tablets. Method of use- usually mixed in a drink. Duration of effects 6-10 hours with onset 10-15 min. Flunitrazepam is marketed as a potent hypnotic, sedative, anticonvulsant, anxiolytic, amnestic, and skeletal muscle relaxant drug most commonly known as Rohypnol. An intermediate acting benzodiazapine, flunitrazepam is prescribed for the treatment of severe insomnia. In the United States, the drug has not been approved by the FDA and is considered to be an illegal drug.[ TIME:XX 33 LEC: Benzodiazepines are prescribed for short-term relief of severe and disabling anxiety. Benzodiazepines may also be indicated to cover the latent periods associated with the medications prescribed to treat an underlying anxiety disorder. They are used to treat a wide variety of conditions and symptoms and are usually a first choice when shortterm CNS sedation is needed. Longer-term uses include treatment for severe anxiety. Benzodiazepines include: Xanax, Librium, Klonopin, Valium, Ativan GHB- Gamma Hydroxy Butyrate- (bew-ta-rate) Street Names: Liquid Ecstasy, Scoop, Easy Lay, Georgia Home Boy, Grievous Bodily Harm, Liquid X, and Goop. The only common medical applications for GHB today are in the treatment of narcolepsy and more rarely alcoholism. GHB has a salty taste but, as it is colorless and odorless, it has been described as "very easy to add to drinks" that mask the flavor. GHB has been used in cases of drugrelated sexual assault, usually when the victim is vulnerable due to intoxication with a sedative, generally alcohol.[16] However it is difficult to establish how often GHB is used to facilitate rape as it is difficult to detect in a urine sample after a day, and many victims may not recall the rape until some time after this. GHB can be detected in hair.[22] This can be a useful tool in court cases and/or for the victim's own information. Over-the-counter urine test kits only test for date rape drugs that are benzodiazepines, which GHB is not. To detect GHB in urine, the sample must be taken within 8-12 hours of GHB ingestion, and cannot be tested at home. GHB can be detected in hair for months after GHB ingestion. Duration of effects 3-5 hours with onset 10-15 minutes. In the United States, it was placed on Schedule I of the Controlled Substances Act in March 2000. However, when sold as Xyrem, it is considered a Schedule III substance but with Schedule I trafficking penalties, one of several drugs that are listed in multiple schedules. TIME:XX 34 Indicators of CNS depressants influence LEC: General indicators; *Drunken behavior and appearance *Uncoordinated *Drowsy *Sluggish *Disoriented *Thick, slurred speech Eye indicators; *Horizontal Gaze Nystagmus *Possible Vertical Nystagmus *Pupil size generally normal (but dilated if using Methaqualone or Soma) TIME:XX 35 GHB Traffic #1 VID TIME:XX DATE:(MAR.2012/updated) 36 Category # 2 CNS Stimulants LEC: Central Nervous System Stimulants accelerate the heart rate, respirations and many other processes of the body. The two most widely abused kinds of CNS stimulants are: Cocaine and Amphetamines. Cocaine is made from the leaves of the coca plant. Amphetamines are synthetically produced, or (manufactured) drugs ie, man made. Meth-amphetamines- such as ICE-a crystalline rock that is smoked similar to the way crack is. Crank or Speed – Beige powder, white crystalline rock, white powder. Duration of effects 4–8 hours with an onset of 8 – 30 seconds. Method of use – smoked, snorted, injected. TIME:XX 37 Living and dying harder and faster in the night of the living dead. LEC: A look at stimulant use / abuse / addiction. People under the influence of CNS stimulants tend to be hyperactive indicated by nervousness extreme talkativeness and an inability to sit still. They also are usually unable to concentrate, or think clearly for any length of time. TIME:XX 38 LEC: General Indicators: Restlessness, excitation Talkative Euphoria Exaggerated reflexes Anxiety Grinding teeth (bruxism) Redness to the nasal area (if snorting) Runny nose (if snorting) Body tremors Eye indicators: No nystagmus Pupils will be noticeably dilated TIME:XX 39 LEC: Dilated Pupil caused by stimulants TIME:XX 40 LEC: Methamphetamine increases alertness, concentration, energy, and in high doses, can induce euphoria, enhance self-esteem and increase libido. Methamphetamine has high potential for abuse and addiction, activating the psychological reward system by triggering a cascading release of dopamine in the brain. Methamphetamine is FDA approved for the treatment of ADHD and exogenous obesity. It is dispensed in the USA under the trademark name Desoxyn. TIME:XX 41 LEC: Physical effects can include anorexia, hyperactivity, dilated pupils, flushing, restlessness, dry mouth, headache, tachycardia, hypertension, hypotension, hyperthermia, diaphoresis, diarrhea, constipation, blurred vision, dizziness, twitching, insomnia, numbness, palpitations, arrythmias, tremors, dry and/or itchy skin, acne, pallor, and with chronic and/or high doses, convulsions, heart attack, stroke, and death. Psychological effects can include euphoria, anxiety, increased libido, alertness, concentration, increased energy, increased self-esteem, self-confidence, sociability, irritability, aggressiveness, psychosomatic disorders, psychomotor agitation, delusions of grandiosity, hallucinations, excessive feelings of power and invincibility, repetitive and obsessive behaviors, paranoia, and with chronic TIME:XX 42 use and/or high doses, amphetamine psychosis can occur. 42 Stimulants signs and symptoms/white tongue if smoked. LEC: Crack cocaine is a substance that affects the brain chemistry of the user: causing euphoria, supreme confidence, loss of appetite, insomnia, alertness, increased energy, a craving for more cocaine, and potential paranoia (ending after use). Its initial effect is to release a large amount of dopamine, a brain chemical inducing feelings of euphoria. The high usually lasts from 5–10 minutes,[2][7] after which time dopamine levels in the brain plummet, leaving the user feeling depressed and low. TIME:XX 43 Evidence of smoking cocaine, - burnt blistered thumb/fingers, lips LEC: The short-term physiological effects of cocaine include constricted blood vessels, dilated pupils, and increased temperature, heart rate, and blood pressure. Large amounts (several hundred milligrams or more) intensify the user's high, but may also lead to bizarre, erratic, and violent behavior. Large amounts can induce tremors, vertigo, muscle twitches, paranoia, or, with repeated doses, a toxic reaction closely resembling amphetamine poisoning. Some users of cocaine report feelings of restlessness, irritability, and anxiety. In rare instances, sudden death can occur on the first use of cocaine or unexpectedly thereafter. Cocaine-related deaths are often a result of cardiac arrest or seizures followed by respiratory arrest. TIME:XX 44 Evidence of smoking cocaine – blackened gums LEC: Crack cocaine is popularly thought to be the most addictive form of cocaine, and one of the most addictive forms of any drug. TIME:XX 45 Yasmine Bleeth Mug Shot LEC: Former Baywatch star Yasmine Bleeth was arrested in September 2001 by Michigan police and charged with cocaine possession. The actress pleaded guilty to one criminal count and was sentenced in January 2002 to two years probation and 100 hours of community service. TIME:XX 46 Meth User 1979 LEC: The L.A.P.D. Hollywood division arrested this lady. She is a meth user. The L.A.P.D. tracked her many arrests over the course of 9 years. TIME:XX 47 Meth User 1982 LEC: Remember it’s the same lady!! TIME:XX 48 Meth User 1988 LEC: 9 years later. The average life expectancy of a meth addict is about 10 years! TIME:XX 49 LEC: Hallucinogens are drugs that cause hallucinations; they cause the user to perceive things differently from the way that they really are. LSD – Lysergic Acid Diethylamide (Blotter Acid) Small squares of heavy stock paper, perforated for tearing, with a drop of LSD on each. Ingested orally. Sometimes there are pictures stamped on each one. Method of use – ingested Duration of effects – variable Peyote – Peyote Cactus Button Visual description – Capsules, hard brown discs, tablets. Methods of use – Capsules & Tablets – ingested Discs – Chewed, smoked, swallowed Ingested in soup or tea form Duration of effects - variable TIME:XX 50 LEC: MDMA – Methylene Dioxy Meth-Amphetamine Ecstasy (XTC) “The Hug Drug” sometimes Referred to as “The Love Drug” Visual description – brown crystalline powder, or tablets in many different colors. Method of use – ingested, injected, snorted. Duration of effects – variable Most commonly used at Raves Notice the girls have pacifiers in their mouths; this is to keep them from grinding their teeth. MDMA causes bruxism. The males usually chew on small glowsticks. (Play RAVE Video if time allows or at end of block) Most of the people at the Rave parties will use a mask that has Vicks salve rubbed on the inside of it. This opens up the bronchial tree; therefore, if they see a red light pass in front of them they may smell a rose; this is called (synethesia) we will talk about that in a few minutes, also the menthol in the mask helps keep them cool since ecstasy heats up the body. TIME:XX 51 LEC: Various forms of MDMA tablets. Notice the colors and the markings set in each tablet. This is how some of the pushers mark their pills. For example the Mitsubishi man has got good clean stuff. It’s just another way of marketing. TIME:XX 52 LEC: (Sin-us-thee-sha) A transposition of senses Remember earlier how I was talking about if a person using MDMA saw a red light they may smell a rose? Well this is “Synesthesia”. It is a transposing of the senses. Sounds for example may be transposed into sights. Sights may be transposed into odors or sounds. TIME:XX 53 LEC: Hallucinations Dazed appearance Body tremors Uncoordinated Perspiring Disorientation Paranoia Difficulty in speech Nausea Piloerection (goose bumps) Eye indicators of Hallucinogen influence: Neither horizontal nor vertical nystagmus will be TIME:XX 54 present. The pupils will usually be noticeably dilated. 54 LEC: Flower pods containing seeds. Flower pods containing seeds, which are consumed. The plant grows wild in most of the United States. Jimson is a green bush with white trumpet shaped flowers. The pods when dried are light green in color and prickly. Methods of use – ingested, (made into a tea) Duration of effects – Variable TIME:XX 55 LEC: Peyote – Peyote Cactus Button Dried, about the size of a nickel. Visual description – Capsules, hard brown discs, tablets. Methods of Use: Capsules & Tablets – ingested Discs – Chewed, smoked, swallowed, ingested in soup or tea Duration of effects - variable TIME:XX 56 LEC: Mushrooms Psilocybin (sil-o-sybin) / Magic Mushrooms Visual description – Fresh or dried mushrooms Methods of use – Chewed and swallowed Duration of effects – Variable TIME:XX 57 LEC: A closer look at ecstasy and size comparison. Visual description – brown crystalline powder. Method of use – ingested, injected, snorted. Most common – ingested. Duration of effects – variable TIME:XX 58 LEC: LSD Blotter Acid, the Grateful Dead “Dead Heads” (groupies) carried this stuff all over the country. They basically toured with the band. They would usually arrive at the location of the concert well before the actual concert took place. TIME:XX 59 LEC: More blotter Acid with various designs LSD – Lysergic Acid Diethylamide Blotter Acid: Small squares of heavy stock paper, perforated for tearing, with a drop of LSD on each. Ingested orally. Sometimes there are pictures stamped on each one. Method of use – ingested Duration of effects – variable TIME:XX 60 LEC: LSD Notice how they started putting cartoon characters and teddy bears on the stock paper. Appears to be a lick and stick tattoo. TIME:XX 61 Category # 4 Phencyclidine (PCP) & its analogs PCP- Phencyclidine LEC: Analogs refer to the various formations of PCP (Powder, liquid, pills, capsules, etc…) TIME:XX 62 LEC: PCP LIQUID – Clear yellow liquid. Method of use – smoked, injected. Duration - onset-10-15 minutes Peak-15-30 minutes Loaded- 4-6 hours TIME:XX 63 LEC: “PCP” PCP laced in a cigarette is called a “Sherman” If laced with PCP a marijuana joint it is called “Wack” or “Super Grass” or “Super Joint”. Other street names for PCP: Wack Wet Daddies Rocket Fuel Lovely Jet Fuel Hog Dust Elephant Angel Dust TIME:XX 64 LEC: PCP Powder (Angel Dust) 3.3 grams 96% pure TIME:XX 65 LEC: Ketamine has a lot of the same characteristics as PCP. Street Names: K, Special K, Cat Valium, Jet, Super Acid, Green. Marketed as a dissociative general anesthetic for human and veterinary use, the only known source of ketamine is via diversion of pharmaceutical products. Recent press reports indicate that a significant number of veterinary clinics are being robbed specifically for their ketamine stock. DEA reporting indicates that a major source of ketamine in the United States is product diverted from pharmacies in Mexico. Ketamine liquid can be injected, applied to smokable material, or consumed in drinks. Continued next page……. TIME:XX 66 LEC: Ketamine has a lot of the same characteristics as PCP. Street Names: K, Special K, Cat Valium, Jet, Super Acid, Green. Marketed as a dissociative general anesthetic for human and veterinary use, the only known source of ketamine is via diversion of pharmaceutical products. Recent press reports indicate that a significant number of veterinary clinics are being robbed specifically for their ketamine stock. DEA reporting indicates that a major source of ketamine in the United States is product diverted from pharmacies in Mexico. Ketamine liquid can be injected, applied to smokable material, or consumed in drinks. Continued next page……. Ketamine produces physical effects similar to PCP, with the visual effects of LSD. Users report that it is better than PCP or LSD because the trip lasts an hour or less. Low doses of the drug produce an experience called “K-Land,” a mellow, colorful “wonder world.” Higher doses produce an effect referred to as “K-Hole,” an “out of body,” or “near-death” experience. Use of the drug can cause delirium, amnesia, depression, and long-term memory and cognitive difficulties. Due to its dissociative effect, it is reportedly used as a date-rape drug. Ketamine was placed on Schedule III of the CSA on August 12, 1999. TIME:XX 67 LEC: This man was under the influence of “Angel Dust” the street name for PCP. He used a broken mirror to peel off his face and lips to feed to his dogs. TIME:XX 68 LEC: Warm to the touch Perspiring Blank stare Repetitive speech Incomplete verbal responses Confused Muscle rigidity Possibly violent & combative Eye indicators of PCP influence: Horizontal gaze nystagmus usually will be present often with very early onset and very distinct jerking. Vertical nystagmus usually will be present. TIME:XX 69 Pupil size usually will be normal. 69 LEC: Heroin-Asian china-white, Black tar, Colombian, and Mexican Brown are all various forms of Heroin Morphine- Tablets, Pink Liquid continue… Codeine-Capsules, Tablets, Dark Liquid Oxycontin- White, Pink, Yellow, Green, Blue tablets which is prescribed in tablet sizes of: 10mg 20mg 40mg 80mg 160mg (Canada only) TIME:XX 70 LEC: Synthetic Opiates (e.g. Demerol, Methadone, Fentanyl ) “man made narcotics”. Narcotic Analgesics include a large number of drugs that share three important characteristics. a. They will relieve pain. Point out that "analgesic" means "pain killer". b. They will produce withdrawal signs and symptoms, when the drug is stopped after chronic administration. Point out that this characteristic implies that narcotic analgesics are physically addicting. c. They will suppress the withdrawal signs and symptoms of chronic morphine administration. d. Some narcotic analgesics are natural derivatives of opium: Morphine Heroin Codeine Many Others. TIME:XX 71 LEC: e. Some are synthetic drugs: Demerol Methadone (used to treat heroin addicts) Fentanyl Many Others. f. Some narcotic analgesics (such as heroin) usually are injected. g. Others (such as codeine) usually are taken orally. h. An important characteristic of narcotic analgesics is that users develop tolerance to them. TIME:XX 72 LEC: "Tolerance" means that the same dose of the drug will produce diminishing effects, or that a steadily larger dose is needed to produce the same effects. A tolerant user who has taken his or her "normal“ dose of heroin (for example), may exhibit little or no evidence of physical impairment. TIME:XX 73 LEC: "On the nod" Droopy eyelids Depressed reflexes Dry mouth Facial itching Low, raspy speech Fresh puncture marks may be evident Clarification: "On the nod" is a sedated condition. The subject is in a semi-conscious type of sleep, but will awaken quickly to answer questions. Eye indicators of Narcotic Analgesic influence: Neither horizontal nor vertical nystagmus will be present. Pupils usually will be severely constricted. TIME:XX 74 LEC: Pupil Comparison: Constricted Pupils (notice you can easily see the eye color) pupils pin point What a nose!!!!! TIME:XX 75 LEC: A look at some heroin. Mexican Brown Heroin TIME:XX 76 LEC: China White Heroin TIME:XX 77 LEC: Some paraphernalia used for injecting heroin. TIME:XX 78 LEC: Abscessed Injection Marks (Tracks) TIME:XX 79 LEC: More of the same. TIME:XX 80 LEC: Now lets move on to category #6 “Inhalants” Inhalants (toluene) pronounced tal-you-een Not tol-u-leen, don’t say it Man!! Say it right!! There is no such thing as Toluleen Toluene-(tal-u-een or tol-u-win) is the substance found in paints, glues, etc. TIME:XX 81 LEC: Inhalants are breathable chemicals that produce mind-altering results. Volatile Solvents: a. A wide variety of familiar household items are sometimes abused as inhalants. Examples: plastic cement (model airplane glue, Toluene), gasoline, paint , vegetable frying pan lubricants, hair sprays, insecticides and many others b. Certain anesthetics also may be abused as inhalants. Examples: nitrous oxide, ether, chloroform TIME:XX 82 LEC: Inhalants – Aerosols Hair sprays Photo/computer duster Deodorants Frying pan lubricants Glass Chillers – used in restaurants Whipped cream refills – used in restaurants TIME:XX 83 LEC: Inhalants – Anesthetic Gases Ether/isobutyl – A volatile, highly flammable liquid, derived from the distillation of ethyl alcohol with sulfuric acid and used chiefly in industry and as an anesthetic. Chloroform - A clear, colorless, heavy liquid, used in refrigerants, propellants, and resins and also used as an anesthetic. Nitrates/amyl, butyl- packaged in small bottles, sold under brand names – Locker room, Rush, Come, they are sold as room deodorizers. Nitrous Oxide/NOS – Laughing gas – small metal cylinder with a balloon or pipe, also vapors are taken from whip cream cans – they hold it upright instead of upside down. TIME:XX 84 LEC: Huffing or inhaling This power point shows subject inhaling substance through nose; however, sometimes they use mouth and nose to breathe the chemical into their body. TIME:XX 85 LEC: General indicators of inhalant influence: Disorientation Slurred speech Residue of substance on face, hands, clothing Confusion Possible nausea Eye indicators of Inhalant influence: Horizontal gaze nystag-mus usually will be present. Vertical nystagmus may be present (especially with high doses). Pupil size usually will be normal. TIME:XX 86 LEC: Our last Category, # 7, is Cannabis Marijuana – a dried leafy substance mixed with stems and possibly seeds. Hashish – Solid dark green or gold substance ingested or smoked. It is usually in a brick-like formation that is somewhat pliable and very high in THC level. Hash oil – Concentrated marijuana, thick liquid dark green in color, very high THC level. Method of use – smoked, mixed with tobacco or marijuana. Marinol – Medical marijuana in a pill or capsule form, used for cancer patients to help them with queasy/upset stomach after chemo/radiation treatments, also to help with appetite. Cannabis is the category that includes the various products of the Cannabis Sativa plant. Cannabis products usually are smoked, although they also can be ingested orally. Like in brownies TIME:XX 87 LEC: Stalked green plant with saw like or serrated edged leaves. Usually an odd number of leaves. Notice this picture shows 9 dominant leaves. TIME:XX 88 LEC: Here are some flowering tops or “BUDS”. TIME:XX 89 LEC: Unless you know what you are looking for, marijuana can be easily overlooked in sub-divisions, especially in the woods. AFQ: TIME:XX 90 LEC: Lets take a look at the indicators of marijuana/cannabis influence: General indicators of Cannabis influence: Very bloodshot eyes, with pronounced veins in the eyeballs. Body tremors Odor of marijuana Disoriented Relaxed inhibitions Difficulty in dividing attention. Eye indicators of Cannabis influence: No Nystagmus Neither horizontal nor vertical nystagmus will be present. Pupil size usually will be dilated, but may be normal, depending on amount, “dose”, strength, “THC” marijuana type. TIME:XX 91 LEC: The veins in the eyes will be very pronounced and red. TIME:XX 92 LEC: The lower eye sockets will be very red where the blood seems to pool in that area. You can see this below the eyeball, but, if you have subject to pull their lower eyelids down, it will be very vivid for you to see. TIME:XX 93 LEC: Polydrug Use – Using two or more drugs at the same time. Examples: Alcohol and almost anything else PCP and Cannabis Heroin and Cocaine Many others Combinations of Drugs 1. Many drug users appear to be "chemical gluttons": they routinely use more than one drug at a time. TIME:XX 94 LEC: This term for this condition is "polydrug use". Point out that the prefix "poly" derives from the Greek word for "many". We say more than one drug on board. In the Los Angeles Field Study (1985), 72% of the suspects, had two or more drugs in them. In that study, alcohol was often found in combination with one or more other drugs. But even if we discount alcohol, nearly half (45%) of the Field Study suspects had two or more other drugs in them. Point out that 81 of the 173 suspects (47%) in the Los Angeles Field Study had alcohol in combination with one or more other drugs. During D.R.E. Certification Training in New York City in early 1989, two-thirds (67%) of the suspects evaluated had two or more drugs other than alcohol in their urine. 2. Certain combinations of drugs appear to be fairly common. NTF: Some common combinations: Alcohol and some other drug is the most frequent combination. PCP and Cannabis is another common combination. TIME:XX 95 NTF: Remind students that many PCP users prefer to ingest that drug by smoking, and a favorite method is to sprinkle powdered PCP on marijuana. Cocaine and Heroin is another common combination. LEC: 3. Because polydrug use is so common, you should not be surprised to encounter suspects who are under the influence of more than one category of drugs. At some times and places, polydrug users may be more common than single drug users. Such as: clubs, bars etc. Be especially alert to the possibility that suspects who have been drinking may also have ingested some other drug or drugs. 4. The effects of polydrug use may vary widely, depending on exactly what combination of drugs is involved, how ingested and when they were ingested. 5. Any particular combination of drugs may produce three general kinds of effects. TIME:XX 96 General types of Polydrug effects are: LEC: * Additive - The two drugs may independently produce some similar effects. In combination, these effects may be enhanced. EXAMPLE OF ADDITIVE EFFECTS Stimulants and Hallucinogens both cause pupil dilation. Pupils would be dilated. TIME:XX 97 LEC: Antagonistic - The two drugs may produce some effects that are exactly opposite. In combination, these effects may mask each other. EXAMPLE OF ANTAGONISTIC EFFECTS: A CNS Stimulant, usually causes pupil dilation, a narcotic usually causes constriction. It is possible that someone who is simultaneously under the influence of a stimulant and a narcotic may have pupils that are nearly normal in size. It is also possible that the suspect's pupils may be dilated at one time, and then become constricted, as the effects of one drug diminish while the effects of the other increase. TIME:XX 98 LEC: Overlapping - Each drug may affect the suspect in some different way. In combination, both effects may appear. EXAMPLE OF OVERLAPPING EFFECTS: PCP and Narcotic Analgesic. PCP will enhance nystagmus, while a Narcotic Analgesic does not cause nystagmus. There-fore, you will see nystagmus. TIME:XX 99 LEC: Null - Neither drug has an effect on the indicator. EXAMPLE OF NULL EFFECTS: CNS Stimulant and Narcotic Analgesic. Neither drug causes nystagmus, there-fore you will not see nystagmus with this combination. TIME:XX 100 Medical conditions QTC: AR: LEC: What are some medical conditions that can be similar to some of the effects that we have discussed in class? Sugar Diabetes, Complex partial seizures, muscular sclerosis, Parkinson’s disease. With sugar diabetes, it is either high sugar or low sugar. With high sugar the person will emit a fruity wine like odor that is sometimes mistaken for alcohol. This odor is acetone. The body is producing too much insulin. Sometimes the person will have thick slurred speech, stupor or staggering. Excessive urination and disoriented behavior. TIME:XX 101 LEC: With low sugar, the body is not producing enough insulin; therefore the person will have similar indicators, with the exception of the acetone (the fruity wine like odor). This is when the person will need orange juice or a candy bar or glucose tablets to get their sugar level up. When they do this they will start to feel better and become more oriented to their surroundings. What can we do as an officer to help determine if this person is under the influence of a drug or a combination of drugs, or if it is a medical emergency? Ask the person if they have a medical condition you should know about. Look for medical arm bracelets or necklaces. Look for open alcohol containers or drug paraphernalia. Ask neighbors or people (witnesses) on the scene. Ask other officers if they have had any contact with this person before. When in doubt, call EMS or have a person with a higher level of training in that field to help you assess the situation. TIME:XX 102 LEC: QTC: AR: With low sugar, the body is not producing enough insulin; therefore the person will have similar indicators, with the exception of the acetone (the fruity wine like odor). This is when the person will need orange juice or a candy bar or glucose tablets to get their sugar level up. When they do this they will start to feel better and become more oriented to their surroundings. What can we do as an officer to help determine if this person is under the influence of a drug or a combination of drugs, or if it is a medical emergency? Ask the person if they have a medical condition you should know about. Look for medical arm bracelets or necklaces. Look for open alcohol containers or drug paraphernalia. Ask neighbors or people (witnesses) on the scene. Ask other officers if they have had any contact with this person before. LEC: When in doubt, call EMS or have a person with a higher level of training in that field to help you assess the situation. TIME:XX 103 QTC: What is a drug? AR: Any substance which, when taken into the human body, can impair the ability of the person to operate a vehicle safely. QTC: AR: Name the seven major categories of drugs? Depressants Drugs that cause nystagmus Inhalants but does not effect the pupil size Dissociative Anesthetics _______________________________________ Cannabis Drugs that effect the pupil size Stimulants but does not cause nystagmus Hallucinogens (causes the pupils to dilate) _______________________________________ Narcotics Drugs that effect the pupil size But does not cause nystagmus (causes the pupils to constrict) TIME:XX 104 QTC: AR: QTC: AR: QTC: AR: QTC: AR: QTC: AR: QTC: AR: QTC: AR: What effects do the DID drugs have on the eyes? They cause nystagmus, but do not affect the pupil size. What effects do the CSH drugs have on the eyes? They affect the pupil size, but do not cause nystagmus. They cause the pupils to dilate. What effect does N “narcotics” have on the eyes? They also affect the pupil size, but do not cause nystagmus. They cause the pupils to constrict. What is poly-drug use? Using two or more drugs at the same time. What is the additive effect? Two drugs independently produce some similar effects, such as: stimulants and hallucinogens will both dilate the pupils. What is the antagonistic effect? Two drugs produce some opposite effects, such as: stimulants usually cause pupil dilation; narcotic analgesics usually cause pupil constriction. What is the overlapping effect? Each drug affects people in some different way, such as: PCP causes nystagmus but doesn’t affect pupil size; Narcotic Analgesics constrict pupils, but does not cause nystagmus. Nystagmus will be seen. Constricted pupils and nystagmus is an overlapping effect. TIME:XX 105 QTC: On the HGN, what is done to rule out medical problems? AR: Equal tracking and pupil size. QTC: How can we rule out medical problems on an impaired person? AR: Ask the person if they have a medical condition you should know about. Look for medical arm bracelets or necklaces. Look for open alcohol containers or drug paraphernalia. Ask neighbors or people (witnesses) on the scene. Ask other officers if they have had any contact with this person before. When in doubt, call EMS or have a person with a higher level of training in that field to help you assess the situation. TIME:XX 106 LEC: AFQ: NTF: LEC: Although this course is not designed to qualify you as a DRE, (drug recognition expert) it is intended to make you more knowledgeable when encountering suspects impaired by substances other than alcohol. Show the videotapes of the examinations of suspects under the influence of various drugs. (Videos in box) GHB, RAVES, Heroin alley, Bell air Marijuana raid, PCP and any other video snip-its that will help demonstrate the drug categories. I am going to show you some videos that will help you understand how subjects look and act while on some of the drugs we have discussed today. This will culminate the four hour drug block. TIME: 240 MIN 107