Effects of Illicit Drugs on the Heart

and Brain

Presented by: Jeffrey Sather, MD, FACEP

Trinity Health

2014 Stroke/Cardiac

System of Care

Conference

Disclosures

No Financial incentives

No off label use of any drug or medical

device to be discussed

Case Study

21 Year old male presents to critical access

hospital agitated and confused

Possibly ingested 2 grams of

Methamphetamine

Extremely agitated

Ativan 2 mg IV

Ativan 2 mg IV

Haldol 5 mg IV

Haldol 5 mg IV

Ativan 2 mg IV

Hypertensive

Labetolol 5 mg IV

Labetolol 5 mg IV

Extremely agitated

Seizing

Temperature reaches 104

All of the above happening over 30 minutes.

Then intubated to be transferred by fixed

wing aircraft.

Cardiac arrest

Cardiac arrest while being loaded to

airplane.

Returned to CAH hospital for resuscitation

About 10 minutes of CPR first arrest

About 2 minutes of CPR second arrest

Labs

Labs

Drugs of abuse screen

Objectives

What does a drug screen indicate?

What are common drugs abused?

What are the effects of drugs on the heart

and brain?

How does it effect treatment?

North Dakota:

Leader of the Pack

North Dakota Ranks #1 in

Binge Drinking

Teen Alcohol Statistics

95% of the alcohol consumed by youth under the age of 21 in the U.S.

is in the form of binge drinks.

Binge drinking is associated with many health problems, including—

Unintentional injuries (e.g., car crashes, falls, burns, drowning)

Intentional injuries (e.g., firearm injuries, sexual assault, domestic violence)

Alcohol poisoning

Sexually transmitted diseases

Unintended pregnancy

Children born with Fetal Alcohol Spectrum Disorders

High blood pressure, stroke, and other cardiovascular diseases

Liver disease

Neurological damage

Sexual dysfunction, and

Poor control of diabetes.

Drug Use - Study

In 2009, the safety agency issued the

National Roadside Survey of Drug and

Alcohol Use by Drivers:

Alcohol was the most likely intoxicant

8.6 percent of the total tested had used

marijuana

3.9 percent had used cocaine

1.3 percent tested positive for

methamphetamine

Drug Use

Two studies (44,000 collisions):

One out of four drivers involved in crashes

had marijuana, cocaine, amphetamines, or

some combination of those drugs in their

system

Approximately 14 percent of all drivers on

the road have an illegal drug in their

system

Marijuana

Marijuana

Raises the heart rate 20-100%

4.8 fold increase in the risk of AMI in the first

hour after smoking.

This risk increases as other risk factors increase.

Effects thinking and memory

Stunts brain development

Causes a decrease in IQ in subjects using through

teens and twenties.

Increased respiratory illness

Marijuana

Linked to increased mental illness such as:

Depression

Anxiety

Suicide

Psychosis

Impairs judgment and contributes to

increased risk of injury or death.

Specific link to lung cancer not well

established at this point

Marijuana

No Specific antidote

Symptomatic Treatment

Narcotics

One of the oldest pharmacological

substances

Histamine releasing properties

Produce bradycardia and hypotension by

increasing parasympathetic and decreasing

sympathetic response

Strong respiratory depressant

Can produce coma

Infection from injection

Narcotic Treatment

Symptomatic treatment

Antidote is Naloxone

Half life can be shorter than the narcotic

Cocaine

Strong central nervous system stimulant that

increases levels of dopamine

Changes the short and long term reward

system in the brain

Cocaine Effects

Constricts blood vessels

Increases heart rate

Increases blood pressure

Increases body temperature

Increased risk of AMI and Stroke

Increased risk of sudden cardiac arrest.

Cocaine Treatment

No specific antidote

Symptomatic Treatment

Synthetic Drugs

“Fake Substances . . . Real Dangers”

K2, Spice, Bath Salts, Smiles . . .

Synthetic Drugs

What are they?Synthetic marijuana (often known as “K2” or “Spice”) and

bath salts products are often sold in legal retail outlets as

“herbal incense” and “plant food,” respectively, and

labeled “not for human consumption” to mask their

intended purpose and avoid FDA regulatory oversight of

the manufacturing process.

Synthetic Drugs

How frequently is synthetic marijuana used?Use of synthetic marijuana is alarmingly high

o 11.4 percent of 12th graders used Spice or K2 in the past year

*second most commonly used illicit drug among seniors

Synthetic Drugs

What are they?

Bath salts contain manmade chemicals related to

amphetamines, also known as substituted

cathinones.

Cathinone derivatives are claimed to have effects

similar to cocaine, amphetamine or MDMA (ecstasy).

Smiles (not the good kind)

“Designer Drug” – 2C-

IThe drug, a hallucinogen, has been

linked to two deaths in Grand

Forks, North Dakota. Though

little is known about this drug's

dangers.

Smile’s effects: combination

of MDMA (ecstasy) and LSD

“speedy charge along with

intense visual and auditory

hallucinations”

Synthetic Treatment

No specific antidote

Symptomatic Treatment

Methamphetamine

2012

0.4% of population or 1.2 million report using

103,000 ED visits directly related in 2011

4th most commonly mentioned abused drug

by ED patients nationally behind Marijuana,

Cocaine, and Heroin

Methamphetamine effects

Increased attention and decreased fatigue

Increased activity and wakefulness

Decreased appetite

Euphoria and rush

Rapid/irregular heartbeat

Vasoconstriction

Hypertension

Hyperthermia

Methamphetamine chronic

effects

Anxiety

Confusion

Insomnia

Mood disturbances

Violent behavior

Psychosis

Hallucinations visual and auditory

Paranoia

Effects of Meth on the Brain

Meth rewires the brain. Prolonged

use not only modifies behavior, but

literally changes the brain in

fundamental and long-lasting ways.

Even while recovery may be

possible, the brain won’t be the

same.

Effects of Meth on the Brain

PET Scan of a

meth user and a

control subject

Face lift courtesy of meth

2 months later 1 year, 5 months later

2 years, 5 months later1 year, 5 months later

Effects of Meth

Dental DecaySkin

Lesions

Psychosis

Unnecessary Deaths

Teenage male collapses from unknown causes.

Dies one day later.

Dx: Sudden cardiac death secondary to “bad” meth.

Unnecessary Deaths

17-year-old male and 23-year-old female

with AMI. Both heavy meth users.

19-year-old presents with blood pressure of

290/160. Dies from a stroke after meth

injection.

Methamphetamine

Treatment

No specific antidote

Symptomatic Treatment

Drugs of Abuse Screen

Screening test not a definitive test

Must be metabolized and excreted to be

present

Metabolites present for variable periods

Most 2-3 days

Does not test for all abused substances

For example fentanyl a synthetic opiate does not

trigger positive for opiates.

Pearls

No specific antidote for most abused drugs

except for Narcotics and Benzodiazepines.

Pearls

Flumazenil should not be given to

benzodiazepine abusers and should only be

used for iatrogenic overdose.

Pearls

Naloxone reverses narcotics

Reversing narcotic overdose usually results

in “bad behavior”

Half life is shorter than many abused

narcotics and repeated dosing may be

needed.

Pearls

Gastric lavage has almost no utility

Treatment is generally symptomatic

Drug screen utility is to add evidence to

clinical findings

Case Study

Case Study

Arrives intubated with no neurologic

response.

In Rhabdomyolysis and has hyperkalemia.

Case Study

Case Study

Case Study

Hypothermia protocol for 24 hours

Treated for Rhabdo and hyperklemia

Rewarmed

No neurologic recovery

MRI shows diffuse edema and herniation

Brain death testing protocol

Support pulled and patient died

Diagnosis: Death due to anoxic encephalopathy

secondary to methamphetamine overdose