National Problem?? DRUG DEATHS 07/15/ th School Nurses Conference 2018 Identifying the Impaired Person Causes for Fatal Crashes

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1 National Problem?? 35 th School Nurses Conference 2018 Identifying the Impaired Person Sgt. Chris Storm New Hampshire State Police Commander Special Enforcement Unit/ Drug Recognition Unit Opioids prescription and illicit are the main driver of drug overdose deaths. Opioids were involved in 42,249 deaths in 2016, and opioid overdose deaths were five times higher in 2016 than In 2016, the five states with the highest rates of death due to drug overdose were West Virginia (52.0 per 100,000), Ohio (39.1 per 100,000), New Hampshire (39.0 per 100,000), Pennsylvania (37.9 per 100,000) and (Kentucky (33.5 per 100,000). Data:CDC DRUG DEATHS 2018 Current Drug Data as of 07/03/ Confirmed Drug Deaths Confirmed, 70 pending toxicology Drug Deaths as of July 4, Causes for Fatal Crashes Fatal Crash Causation 2017 Hit & Run Unsafe Lane Change Animal 1% 1% 1% Reckless Operation Undetermined 1% 9% Operator Error 4% Speed Road & Weather Speed 6% 6% Impairment 30% Inattention Distraction 6% Failure to Yield 7% Centerline Encroachment 8% Total Fatal Crashes: 98 Pedestrian Error 8% Medical Event 12% State of New Hampshire Department of Safety / DMV Fatal Crash Unit 1

2 STILL A PROBLEM? Impaired Driving? 9000 NH DWI Convictions WHAT IS A DRE Police officers who are highly trained in detecting and recognizing impairment caused by substances other than alcohol. DRE TRAINING 12 Field Evaluations 6 hands on 72 Hours of Classroom 5 Quizzes and 2 Tests (80% on all) Opinionate 3 of the 7 categories 75% confirmation through toxicology Final Knowledge Exam Recertification every 2 years 8 hours of drug related training every year NH DRE Program 1991 started with 18 candidates 1992 certified 4 instructors DRE s, 1 Instructor remaining 1995 began running annual schools active DRE s, 16 certified instructors, representing 32 agencies DRE s, 28 instructors DRE S, 27 instructors DRE S, 24 Instructors DRE s, 25 Instructors SEVEN DRUG CATEGORIES CNS Depressant CNS Stimulant Hallucinogens Dissociative Anesthetics Narcotic Analgesic Inhalants Cannabis 2

3 Alcohol Barbiturates Tranquilizers Anti Depressants Sleeping pills GHB Rohypnol Soma CNS Depressants CENTRALNERVOUS SYSTEM (CNS) DEPRESSANTS Horizontal Gaze Nystagmus - Present Vertical Nystagmus - Present Lack of Convergence- Present Pupil Size -Normal Reaction to Light -Slow Pulse Rate-Down Blood Pressure- Down Body Temperature- Normal General Indicators of CNS Depressants Drowsiness Thick, Slurred Speech Uncoordinated Fumbling Slow, Sluggish Reactions Slowed Internal Clock CNS STIMULANTS Cocaine Amphetamine Methamphetamine Ritalin Cylert Preludin Adderall Synthetic Cathinone (Bath Salts) STIMULANTS Eye and Vital Indicators Horizontal Gaze Nystagmus - None Vertical Nystagmus - None Lack of Convergence- None Pupil Size -Dilated Reaction to Light -Slow Pulse Rate-Up Blood Pressure- Up Body Temperature- Up 3

4 Indicators of CNS Stimulant Influence General Indicators Restlessness, Excitation Talkative Euphoria Exaggerated Reflexes Anxiety Grinding Teeth Redness to Nasal Area Runny Nose Body Tremors Pupils will be noticeably dilated HALLUCINOGENS LSD Peyote Mushrooms Ecstasy Toad licking (Bufotenine) Nutmeg Other synthetic psychedelic amphetamines HALLUCINOGENS Eye and Vital Indicators Horizontal Gaze Nystagmus - None Vertical Nystagmus - None Lack of Convergence- None Pupil Size -Dilated Reaction to Light - Normal (Exceptions) Pulse Rate-Up Blood Pressure- Up Body Temperature- Up Indicators of Hallucinogen Abuse General Indicators Hallucinations Dazed Appearance Disoriented, Uncoordinated Body Tremors Perspiring Paranoia Difficulty in Speech Nausea Piloerection(goose bumps) 4

5 Dissociative Anesthetic Phencyclidine (PCP) Ketamine DMX( Dextromethorphan) Dissociative Anesthetic Eye and Vital Indicators Horizontal Gaze Nystagmus - Present Vertical Nystagmus - Present Lack of Convergence- Present Pupil Size -Normal Reaction to Light -Normal Pulse Rate-Up Blood Pressure- Up Body Temperature- Up Dissociative Anesthetic General Indicators of Use Perspiration Warm to the touch Blank stare Speech problems Increased pain threshold Easily agitated Cyclic behavior Impaired perception Moonwalking Possible chemical odor Heroin Morphine Opium Methadone Percodan Percocet Demerol Fentanyl Vicodin Suboxone Methadone NARCOTIC ANALGESICS 5

6 NARCOTICS Eye and Vital Indicators Horizontal Gaze Nystagmus - None Vertical Nystagmus - None Lack of Convergence- Present Pupil Size - Constricted Reaction to Light -Little or None Pulse Rate-Down Blood Pressure- Down Body Temperature- Down General Indicators of Narcotic Analgesics Track marks On the nod Slowed reflexes Low, slow raspy speech Facial Itching Dry mouth Euphoria Pupils visibly & obviously constricted Flaccid muscle tone On the Nod!! On THE Nod!! Inhalants Glue Gasoline Paint thinner Spray Paint Nitrous Oxide Scotchguard Freon 6

7 INHALANTS Eye and Vital Indicators Horizontal Gaze Nystagmus - Present Vertical Nystagmus - Present Lack of Convergence- Present Pupil Size -Normal (Can be dilated) Reaction to Light -Slow Pulse Rate-Up Blood Pressure- Down (Gases) Up (Solvents) Body Temperature- Variable Inhalants- breathable chemicals that produce mind altering results. Huffing Glading Called Deliriants Delirium-state of incoherent excitement, confused speech, and possible hallucinations. Depending on the Inhalant the effects could be similar to CNS Stimulants, Depressants, or Hallucinogens. General Indicators Whippets Nitrous Oxide sold in cartridges to propel whip cream. Rush or Locker Room slang for Amyl Nitrite and Butyl Nitrite. Products sold in small glass bottles in paraphernalia stores as room deodorizers. Confusion Bloodshot, watery eyes Lack of muscle control Flushed face Intense headache Residue of substance Odor of substance Possible nausea Slurred speech Disorientation Was He Huffing?? What can we do? INHALING TOXIC VAPORS FOR EFFECT (644:5-a) 7

8 Marijuana Hashish Hash oil weed dope Thai sticks Marinol Drabinol Butane Honey Oil Shatter Synthetic Cannabinoids CANNABIS Impact of Legalization on youth in the State of Washington One in five 10th grade students reported riding with a driver who had used marijuana 9% reported driving within three hours of consumption During , 48% of statewide student expulsions and 42% of suspensions directly involved marijuana; 98% of the student drug violations within the Seattle Public Schools from September 2013 to May of 2014 involved marijuana; In 2014, youth under the age of twenty made up 45% of statewide Poison Center calls since legalization in 2012, these calls have increased 80%; Youth treatment admissions for marijuana have remained between 66% and 70% of overall admissions since 2010; NWHIDTA Marijuana Impact Report March 2016 CANNABIS Eye and Vital Indicators Horizontal Gaze Nystagmus -None (Variable in Pursuits) Vertical Nystagmus - None Lack of Convergence- Present Pupil Size -Dilated, can be Normal Reaction to Light -Normal Pulse Rate-Up Blood Pressure- Up Body Temperature- Normal General Indicators of Cannabis Odor of marijuana Impaired perception of time and distance Marked reddening of the whites of the eyes Body tremors Eyelid tremors Disorientation Impairs attention Relaxed inhibitions Vape Legal Drugs That You Will See!! KRATOM What is kratom? Kratom( Mitragymaspeciosa) is a plant indigenous to Thailand and Southeast Asia. Kratomleaves produce complex stimulant and opioid like analgesic effects when ingested. It is said to be used for fatigue mitigation, to manage pain, diarrhea, cough and opioid withdrawal. 8

9 KRATOM Cont. Cannabidiol(CBD) oil Cannabidiol is extracted from the flowers and buds of marijuana or hemp plants. It says that it does not produce intoxication; marijuana's "high" is caused by the chemical tetrahydrocannabinol (THC). NOT FDA Approved Many Stories of High Like effects. CBD Cont. The Drug Recognition Evaluation Procedures 12- Step standardized and systematic process DREs are trained to follow an evaluation checklist Proceeds from BAC through assessment of signs of impairment to toxicological analysis Similar to standard medical diagnosis procedures HGN Lack of Convergence 9

10 Modified RhomburgBalance Eyelid Tremors Walk and Turn One-Leg Stand Finger to Nose Finger to Nose 10

11 Eye Exams Eye Exams Cont. Nasal Cavity Check Oral Checks Injection Marks Medical Conditions that may Mimic Drug Impairment 11

12 TOXICOLOGY Use a non-alcoholic skin cleanser Check blood tube expiration dates Try to obtain at least 20cc/20mls of blood (10cc/10mls per tube) Obtain the paperwork from the officer for your records and the hospital records What Should I do with them if they are High? Contact 911 if signs or symptoms of overdose are present. Contact 911 If you observe poor driving. Follow proper protocol set forth by the school administration. QUESTIONS Sergeant Christopher Storm New Hampshire State Police Headquarters Commander Special Enforcement Unit And Drug Recognition Unit Christopher.Storm@dos.nh.gov