1 Drugs and Mental Illness Sergeant Jason Ritter Deputy Justin SmithClackamas County Sheriff’s Office
2 Historical Background & QualificationsDRE Certifications / DRE Program Our Training/Scope includes psychoactive effects and characteristics of certain drugs 2 weeks of classroom followed by a roughly 4-8 hour exam. Certification Training which includes evaluations on drug impaired test subjects. All “opinions have to be 80% accurate”
3 Historical Background & Qualifications7 Drug Categories CNS Depressants CNS Stimulants Hallucinogens Dissociative Anesthetics Narcotics Inhalants Cannabis
4 Neurotransmitters Brief Overview of Neurotransmitters They control your body functions, such as emotions, overall mood, life supporting functions, such as breathing and heart rate; judgment and body temperature, muscle tone, and reactionary times. Neurotransmitters are “chemical messengers” and are utilized by our brains -Our brains constantly modify the release and absorption of these chemical messengers to suit the needs or perceived need of our bodies. For example, if someone hallucinating and believes they are in danger, their brain will release fight or flight chemicals to accelerate the bodies defense systems, likewise if we feel safe and our bodies need to relax or sleep
5 Neurotransmitters Each chemical messenger has its own receptor site which is activated by this “key and lock” system.
6 Neurotransmitters
7 Neurotransmitters Chemical Imbalance of These Neurotransmitters —Can cause dramatic shifts in emotion, behavior and body function, and can be lethal; for example, SEROTONIN SYDROME. These imbalances can be drug induced or caused by a mental illness, disease, brain damage or a combination thereof; Medications given to fight illness try and counter the chemical imbalances caused by mental illness (for example SSRIs for depression). When new medication is taken, there is a period of time where it is unknown how the patient will react and whether dosing was adequate or over-adequate (trial and error treatment).
8 Neurotransmitters
9 Neurotransmitters Some drugs, while they mimic neurotransmitters, can actually damage receptor sites. These are Neurotoxic chemicals such as Meth and Ecstasy. Neurotoxic chemicals impair brain function permanently. The brain no longer produces, or is unable to maintain normal levels, lacks the appropriate receptor sites (your body will prune these away if there is an excess of a specific transmitter)
11 Common Drugs that Treat Mental IllnessMAO Inhibitors ADHD Depression Major Depressive Disorder Migraine Prevention Parkinson's Disease SSRIs Anxiety Anxiety and Stress Bipolar Disorder Borderline Personality Disorder Depression Generalized Anxiety Disorder Major Depressive Disorder Obsessive Compulsive Disorder Panic Disorder Post Traumatic Stress Disorder Postpartum Depression Schizoaffective Disorder Severe Mood Dysregulation Social Anxiety Disorder
12 Common Drugs that Treat Mental IllnessTricyclic Anti-Depressants ADHD Anxiety Depression Obsessive Compulsive Disorder Panic Disorder Post Traumatic Stress Tranquilizers Anxiety Insomnia Psychosis Schizophrenia
13 Common Drugs that Treat Mental Illness
14 NARCOTIC ANALGESIC Prescription RX Heroin Fentanyl Oxycodone VicodinMethadone Suboxone Heroin Fentanyl
15 NARCOTIC ANALGESIC Highly addictive and dependencyMust dose every 6 hours to avoid withdrawal Build a tolerance to substance Opioid receptor in brain
16 NARCOTIC ANALGESIC Signs and Symptoms Constricted pupils On the nodDry mouth Facial itching Nausea Euphoria Droopy Eyelid
17 BATH SALTS
18 BATH SALTS Bath Salts Increased blood pressure Chest painsIncreased heart rate Agitation Hallucinations, delusions and/or paranoia Kidney pain Increased body temperature or chills Muscle tension Nausea Confusion Reduced need for food or sleep Suicidal ideas
19 Spice
20 SPICE Spice Seizures and tremors Coma and unconsciousness VomitingHallucinations and paranoia Numbness and tingling Very high blood pressure and heart rate - high enough to cause damage or danger Anxiety and panic attacks Threatening behavior and aggression Terrible headaches Inability to speak.
21 DISSOCIATIVE ANESTHETICSPerspiring Warm to the Touch Blank Stare Difficulty in speech Incomplete verbal response Repetitive speech Increased pain threshold Cyclic Behavior Confused and agitated Possibly violent and combative Moon walking
22 DISSOCIATIVE ANESTHETICSPCP; Dissociative Effects – The subject disassociates mind from body. The subject may not be hallucinating, but exhibits bizarre behavior and may become extremely combative or violent for no reason, usually characterized by disrobing and psychomotor agitation. Very early onset of HGN, no response to pain or other environmental conditions; also can be caused by large ingestion of cough syrup Dextro (DMX), “robotripping.” Watch for the 1000 yard stare
23 Mental Health Illness Schizoaffective DisorderHallucinations, which are seeing or hearing things that aren’t there. Delusions, which are false, fixed beliefs that are held regardless of contradictory evidence. Disorganized thinking. A person may switch very quickly from one topic to another or provide answers that are completely unrelated. Depressed mood. If a person has been diagnosed with schizoaffective disorder depressive type they will experience feelings of sadness, emptiness, feelings of worthlessness or other symptoms of depression. Manic behavior. If a person has been diagnosed with schizoaffective disorder: bipolar type they will experience feelings of euphoria, racing thoughts, increased risky behavior and other symptoms of mania.
24 STIMULANT CNS Stimulants Restlessness Body Tremors Euphoric TalkativeExaggerated Reflexes Anxiety Bruxism Redness to nasal area Runny nose Loss of appetite Insomnia Increased alertness Dry mouth Irritability
25 STIMULANT Stimulant Psychosis – Mimics schizophrenia maybe indiscernible from it. Hallucinations Extreme paranoia Violence or aggression Difference between schizophrenia and stimulant psychosis is that S/P is often punctuated by visual hallucinations instead of thought disruption or auditory hallucinations.
26 MENTAL HEALTH ILLNESS SCHIZOPHRENIA Symptoms Delusions HallucinationsInner Voices Psychomotor Problems Clumsiness Unusual Mannerisms Repetitive Actions
27 STIMULANT Sigmund Freud; Father of psychoanalysis;Self experimented with Cocaine and suggested its use to a friend to treat an addicted to Morphine. His friend substituted morphine addiction for cocaine addiction, taking progressively larger doses intravenously until he showed psychotic symptoms, becoming one of the first recorded cases of stimulant psychosis
28 HALLUCINOGENS Hallucinogens Dazed Appearance Body tremors SynesthesiaHallucinations Paranoia Uncoordinated Difficulty in speech Perspiring Poor perception of time and distance Memory loss Disorientation Flashbacks
29 Watch for the 1000 yard stareHALLUCINOGENS Hallucinogens – Hallucinations marked by perception absent of any real external stimulus (it’s not there); Pseudo-hallucination; subjects knows what they’re seeing is not the result of actual external stimuli (they know it’s not there) Illusions; A distortion of the senses, triggered by external stimuli, given improper identity Watch for the 1000 yard stare
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31 Mental Health IllnessesBi-Polar Highs Feelings of euphoria, abnormal excitement, or elevated mood Talking very rapidly or excessively Needing less sleep than normal, yet still having plenty of energy Feeling agitated, irritable, hyper, or easily distracted Engaging in risky behavior such as lavish spending, impulsive sexual encounters, or ill-advised business decisions Lows No interest in activities you once enjoyed Loss of energy Difficulty sleeping—either sleeping too much or not at all Changes in appetite—eating too much or too little Difficulty concentrating, remembering, or making decisions Thoughts of death or suicide
32 MARIJUANA Marijuana Panic attacks Delusions, Hallucinations, ParanoiaSome marijuana users also suffer from depersonalization, which means the person loses his grasp of who he is and what is real
33 MARIJUANA Marijuana “Overdose”– Which we will see more of, usually involves panic and may be managed by a calm reassuring conversation. Hospital treatment is not required. Most overdoses on marijuana are from eating it mixed into food, since the dosage is usually much higher. No one has ever died from a marijuana overdose since the brain stem is not affected.
34 Patrol Response Sometimes you can’tHOW CAN I TELL IF ITS DRUGS OR MENTAL ILLNESS? Sometimes you can’t Interview, call research and observation are your best tools
35 Patrol Response Calls concerning drug impaired or mentally ill personsThe reporting party usually has background information on the subject. (Although you will respond to calls where there is no information on the subject, they maybe alone, or it’s the first episode they have ever had, consider PTSD and alcohol, which can be a bad mix).
36 Patrol Response Most often with Meth users, constant psychomotor activity will be present along with incessant speech Drug users delusions are more Tactile (skin crawling) Drug users paranoia is more “realistic” (people following them etc.) instead of grandiose delusions or beliefs of being abducted by aliens
37 Patrol Response Gather as much intel as possible on the subjectHistory of drug use (CCH) Recent arrests (PCS) Associates, friends, and family Drug paraphernalia Medications, prescribed or self administered Bath salt use, other synthetic drug use (synthetic drugs are always changing so the “results may vary”) PTSD, diagnosed or undiagnosed Recent major life events (divorce, custody battle, death in the family, etc.)
38 Patrol Response On scene considerations:If you suspect a subject has overdosed on a drug or other chemical substance; then the situation should be treated like a medical emergency. If their condition is not life threatening, but they obviously need to be placed elsewhere, DETOX is always a good option. Medics should stage nearby in overdose cases. Once someone in detained in an over excited state, the person can die very rapidly in police custody (body goes from 100 mph to zero and crashes).
39 Patrol Response There is a good possibility the mentally ill subject is also using hard drugs, for various reasons. It may help them cope with mental illness or their prolonged drug abuse may have caused brain damage. Having a plan in place is always an advantage
40 Officer Safety Do not expose yourself to pathogens. Use barriers (protect your eyes, wear gloves, N95 Dust Mask), as some drugs are transdermal and the subject will typically be secreting body fluids through sweat or blood, or in some other way. Do not sacrifice your position of advantage. Do not let mental health workers / other social service employees compromise themselves (remember they do not have the training LEOs do). Use common sense Take your time
41 Officer Safety Do not insert yourself into the delusion/hallucinogen – don’t play along. Don’t lie to them, even a well intended lie can hurt your credibility down the road Sometimes a calming conversation with them will help gain cooperation long enough to safely detain a subject. Do not underestimate the strength or will of someone who is highly impaired (Sherwood shooting, subject was bean-bagged numerous times, tasered, and shot in the chest before finally being shot in the head before he stopped his advance towards a running patrol car).
42 Officer Safety If you respond to someone who is hallucinating or is in an excited delirium state, make it a party (the more help the better). Responding personnel can become exhausted, injured, or overpowered creating a lethal force situation. You may be required to detain a combative person for an extended period of time.
43 Officer Safety What could be identified as a threat?Avoid unnecessary noise Light distractions Foreign sounds What may further disorient subject? Blaring radios Flash lights Sirens may further disorient subjects hallucinating or in a dissociative state. Sherwood Police shooting went for the lights on running patrol cars
44 CONTACT INFORMATION Sergeant Jason Ritter Deputy Justin Smith We are HIRING!!!!!!