IN006.1.A.6. Identify the Florida statute that addresses the scheduling of substances. The Florida Comprehensive Drug Abuse Prevention and Control Act, Chapter 893, F.S., places all substances regulated under existing federal law into one of five schedules. Schedule I is reserved for the most dangerous drugs and/or other substances that have NO medical use. Schedule V is the classification for the least dangerous drugs. A substance’s schedule IS based on medicinal value, harmfulness, and the potential for abuse and/or addiction. ALCOHOL
1.1. IN006.1.A. Identify evidence of drugs or alcohol usage.
Empty or open alcohol cans or bottles nearby Smell of alcoholic beverage on clothes or breath Glassy, bloodshot, and watery eyes 1.2. IN006.1.B.3. Identify ways drugs or alcohol is taken. Drinking is the primary way to use alcohol. Some severe alcoholics also use enemas. 1.3. IN006.1.B.5. Identify how fast an effect will typically occur for alcohol. Enema: Immediate Orally: 10–30 minutes Immediate 1.4. IN006.1.B. Identify possible behavioral characteristics of individuals under the influence of alcohol. Sluggish behavior; extreme fatigue; thick, slurred speech; intoxication
1.5. IN006.1.B.1. Identify physical signs and symptoms of individuals under the influence of alcohol. Eyes cross when an object is brought close to user’s face. Horizontal gaze nystagmus (HGN—a rapid involuntary oscillation or jerkiness of the eyes) usually present, glazed or bloodshot eyes, unsteady walk, slow reflexes, flaccid (limp or loose) muscles, impaired coordination and judgment, breath that smells strongly of an alcoholic beverage 1.6. IN006.1.B.6. Identify the signs of individuals withdrawing from alcohol. Insomnia, vomiting, anxiety, restlessness, convulsions
CANNABIS (MARIJUANA) 2.1. IN006.1.A. Identify evidence of cannabis usage. Strong smoke smell, often like a skunk Odor of burnt hemp rope Presence of seeds, plant material, and paraphernalia, including rolling papers, pipes, pipe cleaners, bongs (water pipes), scales, film canisters, plastic bags, and roach clips 2.2. IN006.1.B.3. Identify ways cannabis is taken. The three forms of cannabis are herbal, resin, and hash oil. Herbal
The most common form of cannabis is made from the plant’s dried leaves and flowers. It looks like coarsely chopped, dried herbs used for cooking. Usually greenishbrown, it has a sweet herbal smell.
Resin (Hashish)
This form is made by compressing sap on the plant’s leaves and stems into blocks. Varying in color from almost black to pale golden brown, some forms of resin are hard and brittle like charcoal, while others are as soft as licorice. Hash oil When dissolved in a solvent, filtered, and allowed to evaporate, cannabis resin leaves this thick oil. Varying in color from black to green, it smells strongly of rotting vegetables.
2.3. IN006.1.B.5. Identify how fast an effect will typically occur for cannabis. Smoked: 10–30 minutes Orally: 30–45 minutes 2.4. IN006.1.B. Identify possible behavioral characteristics of individuals under the influence of cannabis. Relaxed, disoriented, happy, euphoric, paranoid 2.5. IN006.1.B.1. Identify physical signs and symptoms of individuals under the influence of cannabis. Increased appetite, anxiety and panic attacks, impaired coordination, fatigue, impaired judgment, possible psychosis, body tremors, reddening of the conjunctivae (eyes) 2.6. IN006.1.B.6. Identify the signs of individuals withdrawing from cannabis. Insomnia, nausea, decreased appetite, irritability, anxiety Cocaine/Crack (Type of CNS Stimulant)—Schedule II Drugs Evidence of Use (IN006.1.A)
Glass vials, bags, syringes, razor blades, long fingernails, scales, small hand mirrors, needle marks, white crystalline powder around nostrils, grinders for crushing cocaine, short straws and coffee stirrers for powder cocaine, aluminum cans (crack pipe), antennas (crack pipe), glass pipes (crack pipe), steel wool (screen device for crack pipe) Appearance of Substance Most street cocaine is a white crystalline powder that looks like very fine salt. It is usually bought in a wrap containing 1g of powder. Crack comes as crystals that look like small rocks. Some pieces look like grains of sand, although normally pieces can be as large as 2 cm across. Color varies from pale yellow or pink to white. Freebase crack is a fine white powder that looks a bit like powdered sugar. Method of Use (IN006.1.B.3.) Onset of Effects (IN006.1.B.5.) Duration of Effects
Injected
Behavioral Characteristics (IN006.1.B.) Agitation, excited state, exaggerated reflexes, euphoria, teeth grinding, increased alertness, body tremors, fast gait and speech, panic attacks Physical Signs and Symptoms (IN006.1.B.1.) Loss of appetite, insomnia, high blood pressure, dilated pupils, increased perspiration (appears to be hot even in cool temperature), increased heart rate, wild-looking eyes, talkative, nervousness, blistered and burned fingertips, red, runny eyes and nose, sniffing a lot Withdrawal Symptoms (IN006.1.B.6) Increased body temperature, hallucinations, panic attacks, confusion, convulsions, cardiac arrest Narcotics (Narcotic Analgesics)—Schedule I, II, III, IV Drug (heroin, methadone, morphine, opium, paregoric, codeine, Demerol) Evidence of Use (IN006.1.A) Hypodermic needles and syringes, lighters, aluminum foil, straws, aluminum bottle caps, spoons, tourniquets, razors, mirrors, plastic bags Appearance of Substance Heroin comes in three forms: brown, china white, and pharmaceutical Brown - This low-grade, unclean form is smoked. Its color ranges from creamy white to dark coffee. The lighter the color, the higher the heroin content, which varies from 10 to 60 percent. China white This form is smoked or injected. The gray granules resemble instant coffee. Pharmaceutical This pure form of heroin is used for medical purposes. It comes as a pure white powder, tablets, or vials of clear liquid. Note: Heroin has no approved medical usage in the U.S. (DEA) Methadone comes as tablets, oral concentrate, and vials of clear, injectable liquid. It is also found as brown, orange, or green, gummy, edible substances of varying strengths or as DTF, a mixture that comes in the same colors but is stronger. Other narcotic painkillers take a variety of forms—capsules, tablets, syrups, elixirs, solutions, and suppositories. Method of Use (IN006.1.B.3.) Onset of Effects (IN006.1.B.5.) Duration of Effects Inhaled heroin Injected heroin, codeine, Orally morphine, paregoric,
codeine, opium, Demerol, heroin, methadone
Smoked opium, heroin Behavioral Characteristics (IN006.1.B.) Clammy skin, slow movement, face scratching, restlessness, slow speech, “on the nod” (switching between a state of semi-consciousness to alert)
Physical Signs and Symptoms (IN006.1.B.1.) Drowsiness, respiratory depression, nausea, dry mouth, euphoria, clammy skin, convulsions, coma, depressed reflexes, pupils constricted to 2.9 mm or smaller Withdrawal Symptoms (IN006.1.B.6.) Watery eyes, runny nose, yawning, loss of appetite, irritability, tremors, panic attacks, nausea, abdominal cramps, chills, sweating Hallucinogens—Schedule I & II Drugs PCP (phenylcyclohexyl piperidine hydrochloride) Evidence of Use (IN006.1.A) Distinctive chemical odor resembling ether Appearance of Substance The texture of powder PCP ranges from a granular sugar to loose powder to lumps. (The terms crystals and powder are interchangeable.) The liquid form is clear or yellow. Powder PCP The most common form of packaging is the hand-rolled cigarette or joint. 35–50 mg of PCP are sprinkled on vegetable matter (parsley, mint, oregano, or marijuana, for example) and then hand-rolled into a cigarette. Small PCP crystals should be visible when the cigarette is broken open. The powder is hermetically sealed in plastic, wrapped in aluminum foil, and placed in a tied plastic bag. Liquid PCP Because it is clear or yellow, liquid PCP can be disguised by adding color to it. It can be carried in eyedropper bottles, film canisters, glass or plastic vials, spice jars, plastic bags, tobacco pouches, tablets/capsules, syringe/needles, vanilla extract bottles, or similar containers. It can be sprayed, sprinkled, or soaked into a handrolled cigarette or joint. Method of Use (IN006.1.B.3.) Onset of Effects (IN006.1.B.5.) Duration of Effects Behavioral Characteristics (IN006.1.B.) Blank stare; disorientation; confusion; agitation; repetitive speech; initial lack of response but talkativeness later; sparse, slurred, and incoherent speech; possible violent and/or combative behavior; aggressive, self-destructive, bizarre behavior; feelings of weightlessness Physical Signs and Symptoms (IN006.1.B.1.) Increased pain threshold, “super human” strength, generalized numbness, slurred speech, skin warm to the touch, incontinence, irritability, horizontal and vertical gaze nystagmus, poor concentration, appetite loss, anxiety, depression, hallucinations, difficulty reasoning, mimics alcohol intoxication Large doses of PCP cause additional symptoms: moaning, groaning, inability to articulate, apparent wakefulness but lack of response to verbal stimuli, convulsions, coma, death Withdrawal Symptoms (IN006.1.B.6.) No physical dependence. Psychological dependence is unknown. Tolerance can develop. Hallucinogens—Schedule I Drug LSD (d-lysergic acid diethylamide) Evidence of Use (IN006.1.A) Plastic film canister, aluminum foil, plastic bag, liquid squeeze bottle (typically blue), pack of gum. (One hit— a piece of blotter paper—is placed on an unwrapped stick of gum. The gum is rewrapped and replaced in the pack.) Appearance of Substance Acid is a transparent crystal in its pure form. Typically, acid is sold in a liquid form. Acid is almost always soaked into small squares of blotting paper called tabs, blotters, or pieces. Tabs come in sheets of more than 100. Each tab is about 5 mm square and has a picture or design that varies according to fashion. Microdots, small, colored pills impregnated with acid, are not as common as tabs. Only 2–3 mm across and available in different colors, they often contain high doses of acid. Method of Use (IN006.1.B.3.) Orally, Absorbed Through the Skin
(Officer safety note: LSD can be absorbed into the skin transdermally, so precaution should be taken when potentially handling this drug) Onset of Effects (IN006.1.B.5.) 30–90 minutes Duration of Effects
Behavioral Characteristics (IN006.1.B.) Euphoria, expressiveness, relaxation, rapidly changing and exaggerated emotions, lowered emotional inhibitions, spontaneous laughing, crying, and smiling, altered perceptions of time, distance, size, movement, color, spatial arrangement, sound, touch, synesthesia (the transposition of the senses—sights may be transposed into odors, or sounds into sights, etc.) and own body image (the user might lose the ability to tell the difference between his or her body and the rest of the environment.) Physical Signs and Symptoms (IN006.1.B.1.) Dilated pupils, rapid heart rate, flushed face, increased body temperature, heart rate, and blood pressure, flashbacks Withdrawal Symptoms (IN006.1.B.6.) No physical dependence. Psychological dependence is unknown. Tolerance can develop. Hallucinogens—Schedule I Drug Ecstasy – “e”, MDMA (N-methl-3-4 methylenedioxymethamphetamine) Evidence of Use (IN006.1.A) Nasal inhalers and decongestant rubs are the most common indicators of MDMA ecstasy use. Blow pops, baby pacifiers, plastic bags, shampoo bottles for smuggling overseas, packs of candies that are the same size and consistency as MDMA pills Appearance of Substance MDMA powder Color varies from bright white to tan to brown; same texture as cocaine MDMA wafer Size of chewable vitamin C; off-white or tan color with visible dark specks MDMA bootleg pill Aspirin-sized, various colors (often offwhite); no markings on front or back MDMA pill Aspirin-sized, various colors (often offwhite); design stamped on front indicates name of pill. May have a line scored on the back MDMA capsule Clear gelatin capsule filled with MDMA powder or small blueand- white capsule (a smurf) Method of Use (IN006.1.B.3.) Onset of Effects (IN006.1.B.5.) Duration of Effects Injected Behavioral Characteristics (IN006.1.B.) Teeth grinding, nervousness, dizziness, panic attacks, seizures, jaw thrusting, euphoria, biting of lips and inner mouth, skin scratching and rubbing, free-flowing conversations Physical Signs and Symptoms (IN006.1.B.1.) No desire to eat or sleep until trip is over, abundant energy, constant movement, aggressive sexual behavior (dancing and flirting), hugging, physical touching, body massaging to intensify the high, scattered thought processes, profuse perspiration, body overheating, deep breathing, muscle cramping, rubbing of different textures to enjoy heightened sense of touch Withdrawal Symptoms (IN006.1.B.6.)
No physical dependence. Psychological dependence is unknown. Tolerance can develop. Hallucinogens—Schedule I Drugs Psilocybin and Psilocin (Mushrooms), Mescaline (Peyote), Salvia divinorum & Salvinorin A
Evidence of Use (IN006.1.A)
No paraphernalia needed for dried mushrooms or Peyote cactus. Gelatin capsules used for synthetic Mescaline. Rolling papers or water pipe for Salvia divinorum & Salvinorin A Appearance of Substance Mushrooms Light to dark brown dried mushrooms, some with long, thin stems and ballshaped crowns.
Mescaline Disc-shaped buttons cut from Peyote cactus; 2–3 inches in diameter, 1/2–1 inch thick (in natural form); brown-colored powder in a clear, gelatin capsule (synthetic form); manufactured substance is mescaline sulfate.
Salvia divinorum & Salvinorin A Dried leaves light brown in color, covered with short hairs giving the leaves a velvety appearance in certain light.
Method of Use (IN006.1.B.3.) Onset of Effects (IN006.1.B.5.) Duration of Effects Salvia divinorum & Salvinorin A: Smoked or chewed
Behavioral Characteristics (IN006.1.B.)
Effects on users depend on their tolerance and the strength of the mushrooms. Users feel happy and euphoric; they may giggle and find everything hilarious. They feel detached from the world and on a different wavelength than everyone else. People become excited and engrossed in whatever they are doing. Some see and hear things that are not really there (hallucinate). For others, sounds and colors become distorted or intense, and things change shape (psychedelic effect). Users may lose track of time. If unprepared for the results of the drug, users often have panic attacks. Salvia divinorum & Salvinorin A: Effects on users may include uncontrollable laughter, unintelligible speech, past/childhood memories, overlapping realities, sensations of movement or disconnection from reality. Physical Signs and Symptoms (IN006.1.B.1.)
No physical dependence. Psychological dependence is unknown. Tolerance can develop. Inhalants—Not Scheduled Evidence of Use (IN006.1.A)
Odor of substance on clothing or breath; paint stains on clothing, fingertips, or around the nose or mouth Appearance of Substance Appearance is related to product used. For example, spray paints (silver and gold) have high toluene content. Plastic bags containing chemically soaked rags Nitrous oxide tanks and canisters, paint thinner, air freshener, gasoline, model cement, airplane glue, rubber cement, fingernail polish remover, whipped cream, insecticides, hairsprays, deodorants, glass chillers, frying pan lubricants (PAM), lighter fluid, spot remover, correction fluid, balloons, paper bags saturated with glue and rubber cement Method of Use (IN006.1.B.3.) - Inhaled fumes Onset of Effects (IN006.1.B.5.) - 2–4 seconds Duration of Effects - 0.5–2 hours Behavioral Characteristics (IN006.1.B.)
Sudden mood swings, defensiveness, impaired judgment, antisocial behavior, low academic achievement, juvenile delinquency, increased aggression, scattered thought process, lack of concentration, exaggerated feelings of well-being, euphoria, vigor and high spirits, followed or replaced by drowsiness and disordered perception Physical Signs and Symptoms (IN006.1.B.1.)
Sneezing, coughing, runny nose, and other cold symptoms, horizontal gaze nystagmus, vertical gaze nystagmus, appetite and weight loss, poor coordination, slurred speech, red, glassy eyes, inflamed nose or nosebleeds, rash or sores around nose and mouth, odor of substance on breath, dilated pupils, sloppy dress, sudden lack of personal hygiene Withdrawal Symptoms (IN006.1.B.6)
Increased body temperature, panic attacks, hallucinations, confusion, convulsions, cardiac arrest Depressants (CNS Depressants)—Schedule I, II, III, IV Drugs GHB (Gamma-hydroxybutyrate), barbiturates, sedatives, tranquilizers
Appearance of Substance GHB is usually sold in bottles that contain about 40 ml of liquid. Somewhat thicker than water, it has a slightly salty taste. It may be in powder, tablet, or capsule form. Artificial flavorings and colorings are sometimes added to avoid detection. Method of Use (IN006.1.B.3.) Onset of Effects (IN006.1.B.5.) Duration of Effects
Generic Depressants Injected Injected
Behavioral Characteristics (IN006.1.B.)
Slurred speech, disorientation, long periods of sleep, drunken behavior with no alcohol odor, confused behavior GHB Anxiety, increased sexual pleasure, nausea, loss of muscle control, impaired judgment, loss of inhibition and coordination
Physical Signs and Symptoms (IN006.1.B.1.)
Staggering, slow heart and respiratory rates, confusion, lack of coordination, depression, muscular rigidity, horizontal gaze nystagmus, vertical gaze nystagmus, weak and rapid pulse, clammy skin, dilated pupils, lowered blood pressure GHB Euphoria, hallucinations, dizziness, horizontal gaze nystagmus, vertical gaze nystagmus, memory loss, deep sleep, slowed breathing and heart rates Withdrawal Symptoms (IN006.1.B.6) Anxiety, insomnia, tremors, delirium, convulsions, possible death Methamphetamine (Type of CNS Stimulant)—Schedule II (Crank, Speed, Crystal, ICE, Glass, or Shards)
Evidence of Use (IN006.1.A)
Red Devil Lye, coffee filters, Pseudophedrine (Sudafed), plastic tubing, glass bottles, empty milk jugs, solvents, strong chemical smell, steel wool (Brillo pads), hazardous chemicals, hydrochloric acid, phosphorous, iodine, ether, fingernail polish remover, kerosene, gasoline, rock/table salt, camera batteries, methanol, blacked out or boarded up windows Appearance of Substance Beige or white powder, white crystalline rock, chalk Method of Use (IN006.1.B.3.) Onset of Effects (IN006.1.B.5.) Duration of Effects Injected
Behavioral Characteristics (IN006.1.B.)
Anxiety, body tremors, decreased appetite, dizziness, dry mouth, euphoria, excitability, grinding teeth, hallucinations, impaired awareness, increased alertness, insomnia, loss of coordination, restlessness, bizarre behavior, long intense trips, and psychosis Physical Signs and Symptoms (IN006.1.B.1.) Headaches, sweating, chills, dilated pupils, elevated pulse, blood pressure, and body temperature, burn marks on fingers or lips and gums called “brands”, lesions on skin called “drug bugs”, dried and blistered condition on tongue called “White Tongue”, dark carbon stains on teeth and gums Withdrawal Symptoms (IN006.1.B.6.)
De interpretatie van een laboratoriumresultaat moet soms in weinig tijd gebeuren. De arts heeft niet steeds de tijd om ook de eenheden en de referentiewaarden na te kijken. Indien de arts altijd met hetzelfde laboratorium werkt, is dat geen probleem, maar als Erik Briers het resultaat van meerdere laboratoria kan komen, is er behoefte aan het gebruik van uniforme eenheden. Vandaag bestaa
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