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OMAHA, Nebraska (AP) — Only an anti-anxiety medication turned up in toxicology tests done on the body of the 19-year-old gunman who fatally wounded eight people before killing himself last month at a shopping mall.

 The autopsy report on Robert Hawkins revealed diazepam in his system. The tranquilizer is better known by its market name, Valium. Douglas County Attorney Don Kleine told the Omaha World-Herald in a copyright story Tuesday that authorities sometimes "see people who have abused drugs or alcohol to give them the ability to carry out their misdeed."

"In this case, it doesn’t appear he had abused either," he said.

The teen’s blood revealed only therapeutic levels of the medication.

The autopsy report also said Hawkins killed himself December 5 by a single shot from his assault rifle from under his chin.

Before committing suicide, Hawkins went into the Von Maur store at Westroads Mall and took an elevator up to the third floor. There he opened fire, fatally wounding eight people. Five other people were hit by bullets or bullet fragments, injuring two seriously.
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Investigators will try to find out whether Hawkins had a prescription for the Valium, he needed Valium Detox, Kleine said.  Diazepam is often given to people who have anxiety attacks or insomnia, said Dr. Todd Stull, director of the University of Nebraska Medical Center’s drug and alcohol program.

"It’s a calming kind of medicine," Stull said. "A lower dose can help with anxiety."

People can get high on it, he said, but "it’s not a very common addiction."

Court records and friends say Hawkins regularly smoked marijuana, but Kleine said there was no evidence of it or any other drugs in his blood.

WASHINGTON (AP) — About 3.1 million people between the ages of 12-25 have used cough and cold medicine to get high, the government reported Wednesday.

 The number of young people who abused over-the-counter cold medicines is comparable to use of LSD and much greater than that for methamphetamine among the age group, according to the federal Substance Abuse and Mental Health Services Administration.

The agency’s 2006 survey on drug abuse and health found that more than 5 percent of teenagers and young adults had misused cough and cold medicines and indicated that these people also had experimented frequently with illicit drugs. Nearly 82 percent also had used marijuana. Slightly less than half also used inhalants or hallucinogens, such as LSD or Ecstasy, the agency said.  The cough suppressant DXM is found in more than 140 cough and cold medications available without a prescription. When taken in large amounts, DXM can cause disorientation, blurred vision, slurred speech and vomiting.

Health Library  -  MayoClinic.com: Robotripping — abusing cough medicine

 
Among all persons aged 12 to 25, the rate of past year misuse among whites was 2.1 percent, which was three times higher than the level for blacks, 0.6 percent, and also significantly higher than the level for Hispanics, 1.4 percent.

"While increasing attention has been paid to the public health risk of prescription drug abuse, we also need to be aware of the growing dangers of misuse of over-the-counter cough and cold medications, especially among young people," said Terry Cline, the agency’s administrator.

Problems associated with an individual’s drug addiction can vary significantly. People who are addicted to drugs come from all walks of life. Many suffer from mental health, occupational, health, or social problems that make their addictive disorders much more difficult to treat. Even if there are few associated problems, the severity of addiction itself ranges widely among people.

A variety of scientifically based approaches to drug addiction treatment exists. Drug addiction treatment can include behavioral therapy (such as counseling, cognitive therapy, or psychotherapy), medications, or their combination. Behavioral therapies offer people strategies for coping with their drug cravings, teach them ways to avoid drugs and prevent relapse, and help them deal with relapse if it occurs. When a person’s drug-related behavior places him or her at higher risk for AIDS or other infectious diseases, behavioral therapies can help to reduce the risk of disease transmission. Case management and referral to other medical, psychological, and social services are crucial components of treatment for many patients. The best programs provide a combination of therapies and other services to meet the needs of the individual patient, which are shaped by such issues as age, race, culture, sexual orientation, gender, pregnancy, parenting, housing, and employment, as well as physical and sexual abuse.

Medications, such as antidepressants, mood stabilizers, or neuroleptics, may be critical for addiction treatment success when patients have co-occurring mental disorders, such as depression, anxiety disorder, bipolar disorder, or psychosis.

Treatment can occur in a variety of settings, in many different forms, and for different lengths of time. Because drug addiction is typically a chronic disorder characterized by occasional relapses, a short-term, one-time treatment often is not sufficient. For many, addiction treatment is a long-term process that involves multiple interventions and attempts at abstinence.

Why can’t drug addicts quit on their own?

Nearly all addicted individuals believe in the beginning that they can stop using drugs on their own, and most try to stop without treatment. However, most of these attempts result in failure to achieve long-term abstinence. Research has shown that long-term drug use results in significant changes in brain function that persist long after the individual stops using drugs. These drug-induced changes in brain function may have many behavioral consequences, including the compulsion to use drugs despite adverse consequences the defining characteristic of addiction. Long-term drug use results in significant changes in brain function that persist long after the individual stops using drugs.

Understanding that addiction has such an important biological component may help explain an individual’s difficulty in achieving and maintaining abstinence without treatment. Psychological stress from work or family problems, social cues (such as meeting individuals from one’s drug-using past), or the environment (such as encountering streets, objects, or even smells associated with drug use) can interact with biological factors to hinder attainment of sustained abstinence and make relapse more likely. Research studies indicate that even the most severely addicted individuals can participate actively in treatment and that active participation is essential to good outcomes.

About 1 in 20 high school seniors now acknowledges taking OxyContin, a prescription drug for managing severe pain that, when abused, can be powerfully addictive. In its annual survey of teen drug use, the National Institute on Drug Abuse reports that OxyContin use by 12th graders is up 40 percent nationwide in just three years. Five times as many 12th graders report using OxyContin than report using methamphetamine. The results have been tragic.

Fast-Forming Addiction

Prescription drugs are the second-most used drugs among teens, behind marijuana. Teens are doing stimulants, barbiturates and painkillers. Many don’t realize how highly addictive and dangerous some of these pills can be — OxyContin in particular.

“I was sick as a dog and I was in bed and I couldn’t believe it. I was actually scared,” recalls 17-year-old Ryan, a high school senior from Tewksbury, Mass.

Ryan, who asked that NPR use only his first name, is enrolled at a drug-treatment clinic at Children’s Hospital in Boston. He says he first tried OxyContin at a party when he was 16. Kids crush up the 12-hour time release pills and snort them, so they get hit with all the opiate at once. Ryan says pot made him feel “weirded out.” OxyContin just made him feel good — warm and relaxed. And it’s easy to get.

“There’s always someone who has it,” he says. “There’s kids selling it. I know alone, like, 10 kids selling it themselves.”

But just a week after he started using OxyContin, Ryan realized that if he didn’t get a pill every day or two, he’d start to feel sick. So he kept using it. He says he had no idea how bad he was hooked until the next time he tried to stop.

“It was like somebody was inside of your head with a hammer,” Ryan recalls. “You feel like you’re going to die. Just laying there in the bed, sweat pouring off of you… Then five minutes later, you’re freezing… then you’d be throwing up.”

A Pricey Habit

OxyContin is very expensive on the street: $80 for one pill. To pay for his habit, Ryan says he cashed $7,000 in savings bonds his aunts had given him on birthdays. He sold his PlayStation, leather jackets, cell phone — everything he had — just to stay high and keep from getting sick. He finally broke down and asked his parents for help. Looking back on it, Ryan says he didn’t think using OxyContin would be that dangerous because it was a prescription pill — that made it seem safe. Many different kids at his high school were playing around with it, he says: “People from every sort of group — the burnouts, athletic kids, the geniuses and, like, girls playing wicked-good softball [who were] offered scholarships to places — they would be using it.”

That sentiment is echoed by 18-year-old Mike, a recovering OxyContin addict in Winthrop, Mass. Mike says he was always an athlete and played football. Until his sophomore year in high school, he attended a prep school with wealthier students; he later transferred to the local public school. He says that, if anything, he saw more OxyContin at the prep school.

“All the popular kids — that was the cool thing to do,” Mike says. “It seemed like it was cool because it was so expensive, this big rich drug. And a lot of rich kids were doing it because the poor kids couldn’t afford it.”

OxyContin is so expensive that many teens turn to stealing to support their habit.

“I stole so much money from my parents,” says Katie, 18, who is also a recovering OxyContin habit. She says she and a friend both stole their parents’ ATM cards to support their habits. “I stole $5,000 from my parents in two months.”

Katie also wrote checks from her mother’s checkbook. Katie’s parents say she and her friends stole cameras and jewelry from their house. Somebody stole her father’s wedding ring out of his top drawer.

“It’s like someone just punched you in the stomach,” Katie’s father said in an interview with NPR. “You know you’re never going to get it back. And what did it get used for? The addiction.”

Gateway to Heroin

Katie’s parents say they feel lucky to still have their daughter. More than a year has passed since they enrolled her into a treatment program. She’s relapsed twice. Doctors say OxyContin addiction can plague people for years. And some users move on to heroin. It is much cheaper than OxyContin, and it satisfies the same craving. Instead of $80 a pill, heroin costs about $5 a bag around Boston. One night when Katie was getting sick and desperate, she called a women she’d used OxyContin with before whom she knew also used heroin.

“I didn’t think if she had heroin I would do it,” Katie recalls, “but then when I had that option — to be sick or do this — I did that.”

Deadly Consequences

All the teens interviewed for this story said they knew at least one young person who had overdosed and died recently either on OxyContin or on heroin after first getting hooked on OxyContin. Cheryl Oates of the middle-class suburb of Burlington, Mass., knows the deadly repercussions of OxyContin addiction all too well. Two months ago, her 19-year-old son, Christopher, died of a heroin overdose.

Oates says her son was not the kind of teen one would expect to become a drug addict. He was a captain of his football and wrestling teams at Burlington High School and popular among his teammates. He got good grades and didn’t have behavior problems, Oates says.

“He was the kind of kid who would walk through the mall with me and hold my hand,” Oates says. “He didn’t care what other people thought and said. Christopher was just his own person.”

But by his junior year, Christopher was experimenting with Percocet, another opioid painkiller. It had been prescribed to him for a football injury. By his senior year, he and some friends were using OxyContin; they got hooked. Soon after he graduated, he started using heroin, too.

“The night before Christopher overdosed, we sat in the kitchen and we talked until three in the morning,” Oates says. “And he said he knew he needed help. He was such a good kid and he loved so much. And he got grabbed by something that was greater than him.”

Oates says she’d tell other parents to keep all prescription medications in a locked cabinet, just to make it harder for teens to start experimenting with them. She says it is frightening that more than 5 percent of high school seniors nationally now report using OxyContin in the past year.

Xanax is a Central Nervous System (CNA) depressant known as benzodiazepine, which is commonly prescribed by physicians to treat panic attacks, nervousness, and tension. Xanax, also known as alprazolam, is considered to be a Schedule IV controlled substance under the Controlled Substance Act (CSA). Xanax has been used as a tranquilizer since the 1960s. With strong opposition to the use of benzodiazepines in the 1970s, there was a 25 percent drop in the number of prescriptions written and today, with approximately 3 million Americans (1.6% of the adult population) having used benzodiazepine on a daily basis for at least 12 months, they are the most controversial of all psychotropic medicines.

According to the United States Department of Justice Drug Enforcement Agency (DEA) and under the CSA, all controlled substances are rated on a five-schedule system. Schedule V, the lowest, for the potential for abuse and dependency and I, the highest. Xanax is a Schedule IV. All Schedule IV controlled substances have the following attributes: a low potential for abuse, a currently accepted medical use in treatment in the United States, and if abused, may lead to limited physical dependence or psychological dependence. Other examples of drugs included in schedule IV are Darvon®, Talwin®, Equanil®, Valium®, and Xanax®.

Although there are many benefits to taking Xanax and other Schedule IV drugs, many patients are becoming addicted and therefore require an intervention and drug treatment program to overcome their addictions. The patient’s body can also build up a tolerance to the drug and require larger doses if taken for long periods of time. With these increases in Xanax use come physical and psychological dependencies. Xanax is not drug to quit cold turkey. The Journal of Postgraduate Medicine stated that up to 25 percent of patients who stop taking their medication experienced withdrawal symptoms such as: nausea, vomiting, dizziness, headache, anxiety, irritability, insomnia, chills, lethargy, fatigue, moodiness, crying, dystonia, paresthesia, tremor, vivid dreams, and myalgias.

The National Institute on Drug Abuse found during a two-year treatment outcome study that 15 percent of heroin users also used benzodiazepines daily for more than one year, and 73 percent used benzodiazepines more often than weekly. Studies also indicate that from 5 percent to as many as 90 percent of methadone users are also regular users of benzodiazepines. With this information in mind, the Xanax abuse treatment involves careful monitoring and counseling in an in-patient or outpatient treatment facility. The American Psychiatric Association’s (APA) report on benzodiazepines revealed that 11 to 15 percent of the adult population has taken a benzodiazepine one or more times during the preceding year, but only 1 to 2 percent have taken benzodiazepines daily for 12 months or longer (4). However, in psychiatric treatment settings and in substance-abuse populations, the prevalence of benzodiazepine use, abuse and dependence is substantially higher than that in the general population. Treatment encompasses a patient’s thought process, behavior, and helps them to cope with everyday life. Patients suffering from Xanax addiction should be tapered off gradually. There are basic outpatient plans available for discontinuation of the drug including: gradual discontinuance over a six to 12 week schedule, monitoring and helping the patient to feel in control of their dosage, and supplying a helpline when the patient needs reassurance. Other plans include inpatient treatment centers and 12-step programs such as Narcotics Anonymous, and drug treatment exchanges such as, Clonidine, propranolol, or carbamazepine. Although these substitutes can be dangerous, an inpatient setting where dosages can be physician monitored until the patient can reach a zero dose of the benzodiazepine is recommended.

Dozens of opiates and related drugs (sometimes called opioids) have been extracted from the seeds of the opium poppy or synthesized in laboratories. The poppy seed contains morphine and codeine, among other drugs. Synthetic derivatives include hydrocodone (Vicodin), oxycodone (Percodan, OxyContin), hydromorphone (Dilaudid), and heroin (diacetylmorphine). Some synthetic opiates or opioids with a different chemical structure but similar effects on the body and brain are propoxyphene (Darvon), meperidine (Demerol), and methadone. Physicians use many of these drugs to treat pain.

Opiates suppress pain, reduce anxiety, and at sufficiently high doses produce euphoria. Most can be taken by mouth, smoked, or snorted, although addicts often prefer intravenous injection, which gives the strongest, quickest pleasure. The use of intravenous needles can lead to infectious disease, and an overdose, especially taken intravenously, often causes respiratory arrest and death.

Addicts take more than they intend, repeatedly try to cut down or stop, spend much time obtaining the drug and recovering from its effects, give up other pursuits for the sake of the drug, and continue to use it despite serious physical or psychological harm. Some cannot hold jobs and turn to crime to pay for illegal drugs. Heroin has long been the favorite of street addicts because it is several times more potent than morphine and reaches the brain especially fast, producing a euphoric rush when injected intravenously. But prescription opiate analgesics, especially oxycodone and hydrocodone, have also become a problem.

In anyone who takes opiates regularly for a long time, nerve receptors are likely to adapt and begin to resist the drug, causing the need for higher doses. The other side of this tolerance is a physical withdrawal reaction that occurs when the drug leaves the body and receptors must readapt to its absence. This physical dependence is not equivalent to addiction. Many patients who take an opiate for pain are physically dependent but not addicted: The drug is not harming them, and they do not crave it or go out of their way to obtain it.

Detoxification

For some addicts, the beginning of treatment is detoxification — controlled and medically supervised withdrawal from the drug. (By itself, this is not a solution, because most addicts will eventually resume taking the drug unless they get further help.) The withdrawal symptoms — agitation; anxiety; tremors; muscle aches; hot and cold flashes; sometimes nausea, vomiting, and diarrhea — are not life-threatening, but are extremely uncomfortable. The intensity of the reaction depends on the dose and speed of withdrawal. Short-acting opiates, like heroin, tend to produce more intense but briefer symptoms.

No single approach to detoxification is guaranteed to be best for all addicts. Many heroin addicts are switched to the synthetic opiate methadone, a longer-acting drug that can be taken orally or injected. Then the dose is gradually reduced over a period of about a week. The anti-hypertensive (blood pressure lowering) drug clonidine is sometimes added to shorten the withdrawal time and relieve physical symptoms.

Methadone Maintenance

Since the 1970s, professionals who care for opiate addicts have reluctantly recognized that many of them will not or cannot stop taking the drug. The solution is maintenance — dispensing opiates under medical supervision. More than 100,000 American addicts are now using methadone as a maintenance treatment. Although it is still politically controversial, this practice has better scientific support than any other treatment for any kind of drug or alcohol addiction.

Because there is a risk of diversion to the illicit market, addicts must come to specialized clinics for methadone, which they take daily in liquid form. A single dose lasts 24–36 hours, and there are few side effects. Some methadone clinics also provide other medical and social services.

Addicts who switch from illicit opiates to methadone avoid the highs and lows and the medical risks of intravenous injection and the criminal behavior that supports it. Studies show that they are less depressed, more likely to hold a job and maintain a family life, less likely to commit crimes, and less likely to contract HIV or hepatitis. Methadone can be continued indefinitely, or the dose can be gradually reduced in preparation for withdrawal. It has been estimated that about 25% of patients eventually become abstinent, 25% continue to take the drug, and 50% go on and off methadone repeatedly.

Buprenorphine

A promising approach to maintenance is the partial opioid agonist buprenorphine. This drug is taken three times a week as a tablet held under the tongue. It occupies opiate nerve receptors and produces a mild opiate-like effect. At higher doses, it continues to produce the same weak effect while displacing more potent drugs. In a person who is physically dependent on opiates, buprenorphine causes a withdrawal reaction. There is some risk of abuse if the tablet is dissolved and injected, so buprenorphine has been made available in combination with the short-acting opiate antagonist naloxone, which has little effect when absorbed under the tongue but neutralizes the effect of injected opiates.

The main advantage of this combination, sold under the name Suboxone, is that patients do not have to come to clinics to take it, because there is no illicit market and no danger of diversion. Since 2002, individual physicians with proper training and certification have been allowed to prescribe buprenorphine in their offices for patients to take home.