regional wi drug corridors heroin - wisconsin nurses …€¦ · · 2016-02-032015 wna northwoods...

2015 WNA Northwoods Clinical Practice UpdateSession 3: Northwest Wisconsin Drug Trends

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Drugs: Synthetic and RealWisconsin Nurses Association (WNA)

WITC - Rice Lake 9/25/15

Chris Fitzgerald, Sheriff

Barron County Sheriff’s Department

Ron Baures, Captain


Heroin

Synthetics

K2 –synthetic marijuana

bath salts – synthetic cathinones

Flakka

Methamphetamine

Marijuana

Drug Trends in NW Wisconsin

Regional WI Drug Corridors HeroinProcessed from morphine, extracted from poppy plants

Commonly sold in WI - Columbian tan/Mexican brown South America - Columbian tan or off white Mexico - brown and black tarSouthwest Asia - white or tan powderSoutheast Asian – “China White” (more expensive)

HeroinInjected

Heroin

NW Wisconsin mainly snorted because of high purity Many young uses prefer to snort

Purity remains the sameNo paraphernalia or worry about contracting diseases from needle sharingNo evidence of intravenous use “tracks”

Smoked

Snorted


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Addictive, 100x stronger than morphine

Users feel a warm “rush” (euphoria) followed by a state of sleep anddrowsiness.

Users often buy enough to support theirown drug habit and sell the rest to otherusers for $ to “re-up”.

May never know someone is using heroin

7-10 days to Detox

Physical withdrawal can be severe, sometimes occurring 6-12 hours after last use depending on the user

Vomiting, cramping, sweating, muscle aches, agitation, diarrhea

Heroin Usage

•Hub city for heroin in NW WI is Chicago (controlled by street gangs)

•Most heroin is transported via vehicles like Greyhound buses to avoid police intervention (visit, dump, and run)

•Increase in high school use among teens who many are already abusing prescription narcotic pain relievers like Oxy’s and Hydrocodone

•18-25 year old white male - most predominant to use and sell

Heroin- Trends in NW WI

HeroinNW WI is targeted by street gangs from Chicago and

Milwaukee…untapped users with $.

Nigerian and Dominican criminal organizations are the primary heroin transporters into Milwaukee/Racine. Then regulated by African American and Hispanic gang members.

More difficult to detect compared to other drugs because of smaller quantities transported, stored, and sold.

Majority of heroin in WI is controlled by street gangs from Chicago and Milwaukee.

HeroinAverage street quantities are 1/4g-1/2g / also sold in “doses”

Average cost

¼g = $100 .1g=$25

Average purity in WI is

estimated up to 42-63%

Can be “cut” or “stepped on” w/impurities for more profits

Cutting agents are often lactose based powders like baking soda, corn starch, mannitol, dormin, and caffeine.

Needle Exchange Programs (NEP)

When the Milwaukee based program started in the 90's, their average age of an injector was about 35-years-old.

Now 17,18,19-years-old are pretty common.

9 NEP locations in WI 1). Prevent disease transmission2). Improperly discarded syringes are hazardous

to police, ems, sanitation workers, ect.3). The programs are recommended disease reduction

intervention programs at many locations aroundthe state.

Heroin- OD and Death rates in WI

Significant increases in Madison and Milwaukee

Recent reports in Hudson and Eau Claire

Narcan is used to reverse the effects


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Methamphetamine Methamphetamine

NW WI -increase in needle useHepatitis B and CHIVNeedle use among hardcore drug users

Methamphetamine Methamphetamine

“One Pot” MethodWI - Increase in “One Pot” methodQuicker, faster manufacturing methodOften less product manufactured, but more concealableMore cases in southwestern portion of the state

aka “Shake and Bake” method1 method or cook in 2 liter bottle

Video

“Shake and Bake” Meth


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Methamphetamine

Marijuana

Increase in high quality THC produced in sophisticated indoor grow operations

1960’s THC 3-5% “ditch weed”

2012 THC range is 15-30 %

aka “nugs” “bc bud”

Marijuana

Marijuana- DTO Grows

Continued DTO marijuana grow operations in NW WI by Hispanics w/ties to California and Mexico Locations- State/Federal forest locations to

conceal their grow

5-6 DTO grows in past 3 years in NW WI, each grow

may have 8,000-15,000 plants

Hispanic growers “rancheros” are often armed with guns to protect the crop. Funds go back to Mexico.

Better strains of THC = more grows per year = $$$

Marijuana Use and the Brain

Healthy Brain

16 year old

Marijuana User

16 year old daily user


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Marijuana- Signs & Symptoms

Rapid, loud talking & bursts of laughter (early intoxication)

Sleepy or daze in the later stages

Forgetfulness in conversation

Odor similar to burnt rope on clothing or breath

Brown residue on fingers

Inflammation in whites of eyes; pupils unlikely to be dilated

Tendency to drive slowly - below speed limit

www.theantidrug.com

“Synthetic” or “Designer” Drugs

NOT YOUR EVERYDAY “SPICE”

Spice, K2, Herbal Incense

Marketed as herbal incense “Not for Human Consumption” to avoid FDA inspection

K2- Signs and Symptoms Paranoia and Hallucination

Increased Heart Rate

Elevated Blood Pressure

Agitation and Anxiety

Dizziness and nausea

Vomiting and tremors

Chest pain

Suicidal or other harmful thoughts/actions

Where it’s Manufactured

Overseas (Asia and Europe)

Manufactured in WI clandestine locations (Eau Claire –Washburn Co case)

Made with chemicals (JWH-018, JWH-017,ect) sprayed and dried on foliage leaves

The illegal substance “JWH” and Acetone are sprayed on foliage leaves (binion)…then dried.

Nov 2010, DEA listed “K2” as Schedule 1 substance under their emergency powers


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American Association of Poison Control Center K2 Data

May 17, 2015

Calls to poison centers about exposures to synthetic marijuana:

Year Number of Calls

2010 2,906

2011 6,968

2012 5,205

2013 2668

2014 3680

As of 5/17/15 3291

Bath Salts- “MDPV”Synthetic Cathinones

Marketed as soothing bath salts“Not for Human Consumption”

•MDPV and Mephedrone are 2 of 6 illegal “bath salts” in WI.

•Bath salts are a synthetic stimulant that gives the user a combination effect of using ecstasy, cocaine, and meth all at the same time.

•Wisconsin passed a law in

July 2011 banning both the

bath salts and K2.

Bath SaltsSynthetic Cathinones

*

Appeared in southern US in 2009 and WI in 2010

MDPV was first detected in Germany in 2007

Marketed as “plant food” and believed by many as legitimate “bath salts”

Shipments originated from China, India, and Pakistan, manufactured by rogue chemists, and packaged to appear as beauty/household goods/plant food.

Once sold at head shops with an inference they are like “legal” cocaine, methamphetamine, and MDMA. Users report the high is like cocaine/meth/mdma all mixed together.

Primarily purchased via the Internet through email and shipped to PO box(s) or other conspirator residence to avoid detection by police, postal service inspectors, and US Customs

What About “Bath Salts”?Synthetic Cathinones

Ingestion Methods

Snorted (most common) Injected Smoked (similar to crack) Mixed with food Mixed with drink Airborne mist


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Sign/SymptomsIncreased Heart Rate

High Blood Pressure

Confusion

Hyper – alertness

Compulsive water drinking

Tremors / Seizures

Super-human strength consistent to excited delirium

Sign/Symptoms Agitation and Seizures

Paranoia & Suicidal thoughts

Hallucinations / Delusions Seeing demons, spiders,

monsters

Chest Pain

Violent Behavior

Bath Salts- MDPV

It’s in our area and it’s use is expected to continue.

American Association of Poison Control Center Bath Salts Data

March 31, 2014

Calls to poison centers about exposures to bath salts:

Year # of Calls

2010 306

2011 6,137

2012 2,691

2013 995

2014 582

As of 3/31/15 103

Effects- What Happens?

• Each user can be affected differently

Smoked / effects 5 – 10 minutes

Injected / effects can be immediate

Effect can have a “lag time” so users can double dose therefore leading to an overdose

Multiple users = Multiple EMS calls/ER visits at the same time (City of Barron cases)

June 24, 2011 Governor Walker signed Act 31 into law becoming effective in July 2011.

Now illegal to sell the drug in head shops and gas stations. Illegal to possess and distribute.

Act 31 makes the following illegal:•Synthetic Cannabinoids (Marijuana)•MDPV & Mephedrone (Bath Salts)•2C-I and “Analogs” of these substances

New Law


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Flakka (alpha-PVP)

• Stimulant - form of alphapyrrolidinopentiophenone• First report in 2014 in the US – Florida• Pronounced “”flocka” Smoke or “vaped” using an e-cigarette but can

be snorted, swallowed, injected, smoked on foil Physical appearance similar to meth (off white) Elivated heart rate, mild anxiety, paranoia, and

psychosis Highly addictive and users report feeling of

euphoria. Users known to become gressive and combative

Often mixed with other drugs like meth, cocaine, and MDMA

Flakka (alpha-PVP)

New Trends

Dangerous New Products and Trends

Alcoholic Energy Drinks 31% of 12-17 year olds

report regular consumption of energy drinks

*CDC

Beer VS. Alcoholic Energy Drinks

Miller Lite: 4.2% alcohol x 12oz = .5oz of pure alcohol

Joose= 12% alcohol x 23.5oz = 2.82oz of pure alcohol

What does this mean?

Beer VS. Alcoholic Energy Drinks

ONE 23.5oz can of JOOSE

= FIVE cans of beer!!

=


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Flasks on the Fly

Pocket Shots Disposable Flasks

Booze Bears

Alcohol Use & the BrainHealthy normal brain

Heavy teen alcohol user

Social DrinkingTeen heavy weekend user

Amen clinics

Sign/Symptoms- Alcohol Use Odor on breath

Intoxication/drunkenness

Difficulty focusing glazed apperance of the

eyes

Unexplained bruises and accidents

Irritability

Flushed Skin

Cocaine and the BrainHealthy Brain vs. Cocaine


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Prescription Drugs- Disposal

A Med Return drop box is located at the Barron County

Sheriff’s Department just outside

the dispatch office for 24/7 access.

Accepted items- Prescription

Medications, controlled and non-controlled, over the counter medications, medication samples, vitamins, medicated ointments/lotions, inhalers.

Non-accepted items- needles,

thermometers, IV bags, bloody or infectious waste, personal care products, empty containers, aerosol cans, business waster, and liquid medications

Tobacco

TAKE A L K

Can you easily pick out the tobacco?

Trends are changing…for the worse

Despite the tobacco industry’s claims of reduced health risks, these products are still deadly.

The amount of nicotine in dissolvable products varies, some have 3 times the amount in 1 cigarette.

Talk to Your Kids

Parental disapproval of underage drinking is

the number one reason that youth choose not

to drink alcohol.

Help your kids live above the influence. Talk to your kids about not using drugs and alcohol.

Talk to Your Kids

Teens whose parent’s talk to them regularly

about drugs are 42% less likely to use than those whose parent’s don’t.


Talk to Your Kids

In 2008, 14% of Barron County high school

students reported using smokeless tobacco in

the past month, compared to just 7.7% in the rest of Wisconsin.



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Social Networking

45% of employers are now

seeing this

and this!

Social Networking

24% of college admissions

officers are seeing it too!

Games

Flippy cup, beer pong, and beer bongs

Role Models? It’s Not Just Alcohol

“Its actually not a leaf but the bud i broke up and shaped to the picture i

drew.”


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Cyberbullying

•42% of kids have been bullied

online

•1 in 4 have had it happen more

then once

•9 of 10 Middle School students have

had their feelings hurt online

•75% have visited a site bashing

another kid

•Girls are twice as likely as boys to be victims

What Really Happens to my Messages?

•Every time you send a message:

•It gets stored on the cell phone company's computer server.

•Government safety agencies may have screened your messages (“Patriot Act”).

•Your parents can access your messages from the web site.

•Deleted messages are retrievable.

•You can’t control who forwards your

messages.

What Can I do?

•Stay involved in your child’s life

•Be nosy

•Get your own Facebook/MySpace account.

•Create family technology contracts.

•Talk to your kids, explain expectations.

•Have access to their username and passwords.

•Check their room

•Keep the computer in a common area, where you can monitor its use.

•Call and confirm where they are going to be

•Watch what you are doing in regards to alcohol

•Don’t provide alcohol to anyone under 21

•Talk to your kids!

Do you know something that you think law enforcement

should know?

Text an ANONYMOUS Tip to Law EnforcementText the keyword “BCTIPS” and your tip information to tip411


Barron Co Sheriff’s Dept

Sheriff Chris Fitzgerald(715) 637-6737

Captain Ron Baures(715) 637-6870

website: www.barronsheriff.org

Questions?

regional wi drug corridors heroin - wisconsin nurses …€¦ · · 2016-02-032015 wna northwoods...

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