Handbook of Child and Adolescent Drug and Substance Abuse: Pharmacological, Developmental, and Clinical Considerations

516 Pages·2012·4.11 MB·English

by  Louis A. Pagliaro

HANDBOOK OF CHILD AND
ADOLESCENT DRUG AND
SUBSTANCE ABUSE
Pharmacological, Developmental, and Clinical Considerations
LOUIS A. PAGLIARO
ANN MARIE PAGLIARO
Professors Emeriti
University of Alberta
Substance Abusology and Clinical Pharmacology Research Group
John Wiley & Sons, Inc.
This book is printed on acid-free paper.
Copyright © 2012 by John Wiley & Sons, Inc. All rights reserved.
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Published simultaneously in Canada.
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Library of Congress Cataloging-in-Publication Data:
Pagliaro, Louis A.
Handbook of child and adolescent drug and substance abuse: pharmacological, developmental, and clinical
considerations / Louis A. Pagliaro and Ann Marie Pagliaro.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-470-63906-1 (cloth : alk. paper)
ISBN 978-1-118-11793-4 (ebk)
ISBN 978-1-118-11795-8 (ebk)
ISBN 978-1-118-11794-1 (ebk)
ISBN 978-1-118-10105-6 (obk)
1. Drug and substance abuse—North America. 2. Children—Drug and substance use—North America.
3. Adolescents—Drug and substance use—North America. I. Pagliaro, Ann Marie. II. Title.
[DNLM: 1. Substance-Related Disorders—North America. 2. Adolescent—North America. 3. Child—
North America. 4. Pharmaceutical Preparations—North America. WM 270]
RJ506.D78P34 2012
618.92'860097—dc22
2011010982
Printed in the United States of America
10 9 8 7 6 5 4 3 2 1
To all North American children and adolescents. It is our fervent hope that this text will help to
bring about a greater awareness and a deeper understanding of the nature and extent
of your exposure to and use of the drugs and substances of abuse. We trust that
this awareness and understanding will help to stem the growing tide and
assuage your associated pain and suffering.
LAP/AMP
Contents
Preface vii
Acknowledgments xvi
|
I EXTENT OF USE AND PHARMACOLOGICAL CONSIDERATIONS
|
1 THE PSYCHODEPRESSANTS 3
|
2 THE PSYCHOSTIMULANTS 43
|
3 THE PSYCHODELICS 87
|
II DEVELOPMENTAL CONSIDERATIONS
|
4 EXPLAINING CHILD AND ADOLESCENT USE OF THE DRUGS
AND SUBSTANCES OF ABUSE 117
|
5 EXPOSURE TO THE DRUGS AND SUBSTANCES OF ABUSE
FROM CONCEPTION THROUGH CHILDHOOD 171
|
6 EFFECTS OF THE DRUGS AND SUBSTANCES OF ABUSE
ON LEARNING AND MEMORY DURING CHILDHOOD
AND ADOLESCENCE 221
|
III CLINICAL CONSIDERATIONS
|
7 DETECTING ADOLESCENT USE OF THE DRUGS AND SUBSTANCES
OF ABUSE: SELECTED QUICK-SCREEN PSYCHOMETRIC TESTS 245
|
8 DUAL DIAGNOSIS AMONG ADOLESCENTS 289
v
vi Contents
|
9 PREVENTING AND TREATING CHILD AND ADOLESCENT USE
OF THE DRUGS AND SUBSTANCES OF ABUSE 317
Appendix: Abbreviations Used in the Text 365
References 371
Index 455
About the Authors 511
Preface
Children and adolescents throughout North
America, regardless of age, culture, education,
ethnicity, gender, race, religion, sexual orienta-
tion, or socioeconomic status, may be exposed
to and may actively use the various drugs and Abusable Nonabusable
Psychotropics Psychotropics
substances of abuse (see Figure P.1, Table P.1)1
in a variety of ways that adversely affect their
health, safety, and well-being (see Figure P. 2).
Their exposure to and use of these drugs and
substances of abuse also may adversely affect
Figure P.1 The Drugs and Substances of Abuse:
the health, safety, and well-being of their fami- The Abusable Psychotropicsa
lies, including siblings, and that of their friends aThe term “psychotropics” refers to all exogenous sub-
and schoolmates and the larger c ommunities, stances (i.e., chemicals, including plant products, drugs,
including the schools and neighborhoods, of and xenobiotics) that: (1) elicit a direct effect on the central
nervous system resulting in changes in cognition, learn-
which they are a part.2 Consequently, all those
ing, memory, behavior, perception, or affect; and (2) are
who work to promote the optimal growth and used specifi cally for these major effects. The psycho-
development of children and adolescents— tropics can be further divided into either abusable or
nonabusable psychotropics. The r egular, long-term use
child and adolescent psychiatrists and psy-
of the abusable psychotropics is generally associated
chologists; community health, mental health, with the development of physical and/or psychological
and school nurses; family physicians; family dependence characterized by (a) the need to use more
and more of the drug or substance of abuse in order to
therapists; home health-care workers; juve-
achieve desired psychotropic actions (i.e., because of
nile justice workers; midwives; pediatric nurse
the development of tolerance) and (b) a withdrawal syn-
practitioners; pediatricians; pharmacists; school drome that occurs with the abrupt discontinuation of its
counselors; school psychologists; and social regular, long-term use and that is terminated immediately
when use is resumed. The nonabusable psychotropics—
workers—require an unbiased and specialized
anticonvulsants, antidepressants, antiparkinsonians, and
reference source that presents c urrent research, antipsychotics (see Table P.1)—while also used for their
across the lifespan, concerning the prevalence major psychotropic actions, have not been consistently
associated with physical or psychological dependence
and characteristics of child and adolescent
and thus are not considered in this reference text. The
exposure to and use of the drugs and substances proposed classifi cation presented here has been found to
of abuse in North America. be both accurate and parsimonious. However, because the
term “abusable psychotropics” may be awkward for many
These health and social care profession-
readers, we consistently use the more common phrase
als also require a reference text that provides
“drugs and substances of abuse” to denote this major
up-to-date clinical pharmacological informa- class of chemicals, drugs, and xenobiotics.
1 See related discussion in Chapter 1, The Psychodepressants, Chapter 2, The Psychostimulants, and Chapter 3, The
Psychodelics, for specifi c detailed information regarding these drugs and substances of abuse and their use by North
American children and adolescents.
2 W e now fi nd ourselves in the midst of “reaping the whirlwind” because of the woeful inattention over the past three decades
by society, in general, and the North American governments, in particular, to the serious nature and growing extent of prob-
lems associated with the use of the drugs and substances of abuse by children and adolescents. This situation will be examined
in depth in the chapters of this text.
vii
viii Preface
TABLE P.1 The Abusable and Nonabusable Psychotropics
Abusable Psychotropicsa Nonabusable Psychotropics
Psychodepressants Anticonvulsantsb (e.g., carbamazepine [Tegretol®], phenytoin
Opiate Analgesics (e.g., codeine, heroin, [Dilantin®], primidone [Mysoline®], valproic acid
meperidine [Demerol®], morphine [Depakene®])
[MS Contin®])
Antidepressants
Sedative-Hypnotics (barbiturates, Monoamine Oxidase Inhibitors (e.g., moclobemide [Manerix®],
benzodiazepines, Z-drugs, miscellaneous phenelzine [Nardil®], tranylcypromine [Parnate®])
sedative-hypnotics (e.g., alcohol
Selective Serotonin Reuptake Inhibitors (e.g., Fluoxetine [Prozac®],
[beer, wine, distilled liquor];
paroxetine [Paxil®], sertraline [Zoloft®])
gamma-hydroxybutyrate [GHB])
Tricyclic Antidepressants (e.g., amitriptyline [Elavil®], desipramine
Volatile Solvents and Inhalants
[Norpramin®], imipramine [Tofranil®], nortriptyline
(e.g., gasoline, glue)
[Aventyl®])
Psychostimulants (e.g.,amphetamines,
Miscellaneous Antidepressants (e.g., amoxapine [Ascendin®],
caffeine, cocaine, nicotine [tobacco])
bupropion [Wellbutrin®], maprotiline [Ludiomil®])
Psychodelics (e.g., cannabis
Antiparkinsonians (e.g., amantadine [Symmetrel®], levodopa
[i.e., marijuana, hashish, hash oil],
[Dopar®], selegiline [Eldepryl®], trihexyphenidyl [Artane®])
lysergic acid diethylamide [LSD],
mescaline [peyote], phencyclidine [PCP], Antipsychotics (e.g., chlorpromazine [Thorazine®], clozapine
methylenedioxymethamphetamine [Clozaril®], haloperidol [Haldol®], olanzapine [Zyprexa®],
[MDMA]) risperidone [Risperdal®])
a See Chapters 1, The Psychodepressants, 2, The Psychostimulants, and 3, The Psychodelics for a comprehensive listing and
discussion of the abusable psychotropics.
b Some abusable psychotropics (e.g., barbiturates, benozdiazepines) are clinically used as anticonvulsants. However, these
listed anticonvulsants are not used as abusable psychotropics.
tion about these drugs and substances of abuse • Juvenile justice workers to patterns of
and state-of-the-art clinical strategies that focus criminal and violent behavior that are asso-
on: (1) identifying children and adolescents, a ciated with the use of particular drugs and
priori, who are at risk for using the drugs and s ubstances of abuse, such as the use of
substances of abuse; (2) assessing actual or gamma-hydroxybutyrate (GHB) and fl u-
potential harmful patterns of using the drugs nitrazepam (Roofi es) for the perpetration
and substances of abuse with attention to the of date-rape, particularly in the context of
personal and social consequences of such use; parties and raves, or the use of alcohol,
(3) providing effective treatment for children and amphetamines, cocaine, or phencyclidine
adolescents when an active drug or substance use (PCP) that can contribute to, or exacer-
disorder is encountered; and (4) monitoring the bate, the perpetration of physical assault,
effi cacy of prevention and treatment approaches including homicide.
that have been implemented. • Nurses to the accidental injuries and other
It is fairly axiomatic that an understand- health consequences, including death, that
ing of the nature and extent of child and ado- may be associated with the use of the various
lescent exposure to and use of the drugs and drugs and substances of abuse by children
substances of abuse is vital for optimal pro- and adolescents, such as burns related to
fessional practice among all health and social the use of the volatile solvent, gasoline, and
care providers who have an interest in, and/or sudden-sniffing-death associated with the
provide direct care to, North American chil- use of the volatile inhalant, glue. It also will
dren and adolescents. However, a few specifi c alert them, for example, to the need for the
examples are offered to help to support this prevention of infections (e.g., hepatitis C,
assertion. For example, this understanding will human immunodeficiency virus) associ-
help to alert: ated with sharing contaminated intravenous
Preface ix
High
Patterns of Using, or Not Using, the Drugs and Substances of Abuse
s)
sm
herble Relapsed Use
Harm to self and otalth and social pro SociaHl UabsietuaAl UbCusosemivpe uUlssieve Use Controlled Use
e
h
(
Initial Use
Resumed
Nonuse Nonuse
Low
Time
Figure P.2 Patterns of Using the Drugs and Substances of Abuse and Associated Harm
needles and syringes or having unprotected substances of abuse (e.g., amphetamines; opi-
sex with multiple partners—as occurs in the ate analgesics) and to focus more carefully on
context of sex-for-drug exchanges. the prevention of associated pathology (e.g.,
• Pharmaciststo actual and possible problems teratogenesis, such as the fetal alcohol syn-
such as significant drug interactions, poly- drome [FAS]3 among offspring of adolescent
pharmacy, and illicit patterns of use (e.g., an girls who drink alcohol while pregnant).
adolescent selling his legitimate prescrip- • Psychologists to the need to consider the
tion for mixed amphetamines [Adderall®], use of drugs and substances of abuse by
which he received for the management of children and adolescents as a possible
his attention-deficit/hyperactivity disorder explanation for problem behavior (e.g.,
[A-D/HD], at school to criminal youth gang amotivational syndrome associated with
members; a child who has Type 1 diabetes cannabis use). It also will alert them to con-
mellitus [insulin dependent] giving, selling, sider other mental disorders (e.g., anxiety
or trading her injection supplies [i.e., insulin disorders, major depressive disorder, and
needles and syringes] to siblings, friends, or psychotic disorders, including cannabis-
parents to be used for the injection of their induced psychosis) that may occur with, or
drugs and substances of abuse). be masked by, the use of various drugs and
• Physicians to rule out the use of drugs and sub- substances of abuse.
stances of abuse by children and adolescents • Social workers to investigate high-risk drug
when formulating diagnoses (e.g., clinical or substance of abuse related problems in
depression; learning disorders; unexplained the home (e.g., child or parental physical,
injuries) and when clinically monitoring psychological, or sexual abuse; use as a
therapeutic response (e.g., lack of therapeutic marijuana grow-op or mom-and-pop meth
improvement). It also alerts them to the possi- lab) and community (e.g., increased pres-
bility of patients faking signs and symptoms ence and development of criminal youth
to obtain prescriptions for desired drugs and gangs). It also alerts them to needed action
3 F etal alcohol syndrome also is commonly referred to in the published literature as the fetal a lcohol spectrum disorder
(FASD). For additional discussion, see Chapter 5, Exposure to the Drugs and Substances of Abuse from Conception
Through Childhood.
x Preface
to decrease associated potential harm to 3. Available published research fi ndings and
children and adolescents, their families, and conclusions do not address children and
their communities. adolescents in a major way and rarely sep-
• School psychologists and teachers to arate children and adolescents from adults,
the effects of child or adolescent use of either in research designs or in conclusions
the drugs and substances of abuse on class- and recommendations.6
room performance (e.g., inattention; poor 4. Authors often demonstrate a signifi-
learning outcomes; memory impairment) cantly biased perspective in their con-
and troublesome schoolyard behavior (e.g., clusions and recommendations. For
bullying). It also alerts them to recognize example, some writers go to extremes in
that selling drugs and substances of abuse, their attempts to inaccurately minimize,
and related crime and violence, do not or trivialize, the harm associated with
stop at the schoolyard fence or even at the using various drugs and substances of
school’s main entrance. abuse,7 perhaps, in order to rationalize
their own use of these drugs and sub-
Unfortunately, a true understanding of the stances of abuse or to help further the
nature of the use of the drugs and substances social agenda for the decriminalization/
of abuse and the characteristics and extent of legalization of all drugs and substances
their use by children and adolescents is not of abuse (i.e., these biased views are
easily gained by those who require this infor- most often ensconced in a libertarian
mation and would benefi t from it. There are or secular progressive perspective that
many reasons for this situation, including: those authors are attempting to advance).
Other writers may exaggerate associ-
1. An overwhelming majority of the published ated harm, perhaps to rationalize harsh
research fi ndings and conclusions reported legal penalties and consequences asso-
over the last decade in textbooks and jour- ciated with possession and use of the
nal articles, as well as over the Internet, pro- various drugs and substances of abuse.
vide very little direct attention and insight.4 This latter viewpoint is often laden
2. Potentially valuable research often p resents with moral underpinnings (i.e., that the
only equivocal or mixed results in terms use of a drug or substance of abuse is
of the incidence and consequences.5 not only illegal but immoral—a view
4 Some of these limitations in research design, methods, and dissemination of results are understandable because of the diffi culty
inherent in o btaining data from children and adolescents. As minors who are identifi ed as a vulnerable population group,
children and adolescents require their own consent (and/or assent) to participate in research studies as well as that of their
parents or legal guardians and schools or school districts if the research is being conducted in school. In addition, the nature
of the very behavior being studied (i.e., use of the drugs and substances of abuse) is generally illegal and, therefore, makes it
more diffi cult to obtain accurate reports of behavior from participants who may fear being arrested or having their parent(s)
informed about their illegal behavior.
5 In addition, these published research studies often conclude with the phrase: “more (or additional) research is necessary.”
Therefore, the use of potentially helpful fi ndings is limited because of the need for study replication or extension into
more specifi c population groups (e.g., boys versus girls, tweens versus teens). In addition, the phrase is rarely followed
with specifi c recommendations for replicating the study or for research questions aimed at extending the reported
fi ndings.
6 In these studies, the population sample, while often including adolescents, is generally age neutral when results are pre-
sented (i.e., the subjects may be identifi ed solely as, for example, Americans of Hispanic descent or as 16 years of age and
older).
7 S uch authors may use, for example, the accurate but deliberately misleading argument that the harm associated with the use
of marijuana in North America would be, in comparison, signifi cantly less than that associated with the use of alcohol (see
related discussion in Chapters 1, The Psychodepressants, and 3, The Psychodelics).
Preface xi
most often ensconced in a conservative of clinical practice. This challenge motivated
perspective).8 us in the early 1970s to begin work on our fi rst
clinical pharmacology text. At that time, we
Consequently, health and social care pro- physically had to go through printed volumes
viders desperately require, but do not currently of the Index Medicus, by hand, in order to
have, ready access to an objective, and subjec- fi nd needed published journal article citations
tively explicit and truthful, reference—a schol- and, then, literally, go into the medical library
arly reference that presents a deep depth and stacks (i.e., the storage area for bound cop-
wide breadth of understanding coincident with ies of published journals from the mid-1800s
a timely analysis and synthesis of the available to date) in order to compile the data for the
research conclusions and recommendations users of our texts. One diffi culty was obtain-
regarding the status, trends, and individual ing some of the most recent journal articles
pharmacology of the drugs and substances (i.e., those articles that were published over
of abuse used by children and adolescents the last year or two) that were often waiting to
throughout North America. This text fi lls that be bound and added to the stacks. Journals
void for required knowledge (i.e., current and that were waiting to be bound could not be
accurate data and informed, refl ective interpre- borrowed, or checked out, or removed from
tation). Thus, this text assists readers to under- the library. Thus, articles had to be read in
stand the use of the drugs and substances of the circulation area of the library and notes
abuse by children and adolescents in a current taken on index cards—copy machines had just
and unbiased context that refl ects a compre- been invented and were not widely available (1
hensive interpretation of the published research or 2 per library), and the cost of Xeroxing an
and related available information—complete article seemed to be, for us at that time, a very
with referenced documentation. high 25 cents per page. Thus, the primary chal-
Since we began work on our fi rst textbook, lenge then was to fi nd and access the rather
Problems in Pediatric Drug Therapy, which limited amount of published data available
was initially published by Drug Intelligence (and often well and deeply hidden in the stacks
in 1979, the particular needs of readers and of university medical libraries).
our approach to preparing professional texts The challenge for us and our readers today
for publication have changed dramatically. For has changed from toolittle available data to too
example, at that time there was no such thing much available data. So, too, has our approach
as a personal computer (PC) or the Internet. to the preparation of clinical pharmacology
The primary challenge for clinicians—our and other texts, particularly those focusing
intended audience—was obtaining relevant solely on the drugs and substances of abuse,
published research fi ndings that could be changed. We no longer have to physically go
appropriately applied in their respective areas into the stacks in order to retrieve relevant
8 O n this point, it should be made explicit that we tend to view the use of the various drugs and substances of abuse as being nei-
ther good nor bad, neither moral nor immoral. As scientists rooted in several views of science (e.g., positivism, postpositivism,
postmodernism) and as expert clinicians, our focus instead is on evaluating the results of these sciences based on their inher-
ent assumptions, research methods, and claims to fact (i.e., their theories and inherent truth). Most important, as subscribers
to the scientist-clinician model, we are concerned with the contribution of a study or research program in regard to
its ability to further knowledge and understanding that will lead to valuable outcomes for children and adolescents in
regard to their use of the drugs and substances of abuse. Thus, we are concerned with the result of the interaction of
the use of a particular drug or substance of abuse by a particular child or adolescent in a particular context (e.g., the use of
an opiate analgesic, such as morphine, for a child hospitalized with a broken leg to relieve his pain versus the use of mor-
phine by a homeless adolescent girl that results in her death due to an overdosage). Thus, for us, it is not the use of a particu-
lar drug or substance of abuse by a particular child or adolescent that is good or bad. Rather, it is the result or outcome of the
use of the drug or substance of abuse by a particular child or adolescent in a particular context that is good or bad.