Middle School in the 21st Century

Middle School in the 21st Century

As a psychotherapist who treats adolescents who are in high school, I often hear parents concerns about what teens face in high school. For example, many parents worry about drugs and alcohol. There are numerous other issues too. The parents do need to be concerned because these are issues in high school. If they have a child in middle school too and I mention they need to address theses issues with their child in middle school, many parents look surprised.

I hear parents say every day that they don’t need to worry about drugs or alcohol with their child in middle school because their child is too young for that right now. Well the reality is that Middle School Students are drinking, using drugs and having sex. Many parents are unaware of what is happening in Middle Schools these days. Drugs and alcohol are just the tip of the iceberg. Children that are in the age group of middle school are now involved numerous dangerous activities such as selling drugs.

To begin with, most campuses are better pharmacies than your pharmacy. I have had middle school kids say they can get Vicodin, Concerta, Ecstasy and of course weed and alcohol on their school campus. Some kids use at school and some use after school and on the weekends. More and more middle school kids are deciding to experiment with drugs and alcohol due to the pressure to feel successful as a teenager and so they fit in with friends.

Also many middle school kids are sexually active, but they don’t think they are sexually active. They think because they are not engaging in intercourse and they are engaging in oral sex that it doesn’t count. The kids say they are just “messing around” with each other and do not consider this sex. They also have no idea about sexually transmitted diseases or how to protect themselves for STDs or getting pregnant. However, the number of middle school kids engaging in oral sex and intercourse has increased significantly over the last few years. The rate is now high enough that some middle schools, such as the San Francisco School District, are providing condoms to middle school kids. Yes, Middle Schools are giving condoms to children in the sixth grade. These kids are only 11 years old.

Another common issue in middle school is bullying. However, we are not just talking about one kid teasing another kid at school anymore. Today there is for a group of kids teasing one kid and it is not just at school. Now kids are using Facebook, Twitter, Instagram, Snapchat and texting by cellphone to tease and harass other kids. And as many of you may recall there have been a number of kids who have committed suicide due to the teasing at school. I recently wrote an article about a middle school girl who committed suicide and in her obituary she left a note to the other students just asking them to be nice to each other. Another issue with teasing, is that a number of middle school students have been arrested for photos they text and for harassment. Besides teasing, texting a nude photo of a student in middle school means the middle school child violated child pornography laws. Something many parents and students are not aware of is that when a child texts a nude photo of a middle school student, who is under 18 years old, it violates child pornography laws and the child who texts it and received it can both be arrested.

Also many kids in middle school, especially boys, don’t feel safe and are afraid of someone trying to beat them up before or afraid school. They say they have to fight because other kids are recording it and posting it on YouTube. Boys are bragging about their fights on YouTube and comparing how many people have watched their fight with their friend’s fight. Therefore, boys feel they must fight, otherwise if they don’t fight the other kids will think they are a “whimp” so they have to fight. Due to this fear many middle school students carry knives, metal pipes, guns or anything they can think of to protect themselves. This is very sad that kids have to live in fear for their lives and safety at school. Also parents and students don’t realize, if a student is caught with any of these items on campus they can be removed from their entire school district and required to go to continuation school. In addition, the school can have the student arrested. Due to terrorist activities, schools take anyone possessing items that can severely hurt someone very seriously.

These are just a few of the issues that are occurring at all middle schools and they are very serious. Your child is not going to come to you to ask about these issues or tell you about them because they feel embarrassed and they are afraid of getting in to trouble. So parents even though you may feel embarrassed or awkward discussing these issues with your 11 year-old child, please do so. If you notice anything about your child’s behavior that seems different to you and you feel a sense of concern, ask your child about what is happening at school and with friends. Mention they are getting older so are the issues in their lives and mention drinking, sex or being teased and ask if they need to talk about it. You may be saving their lives because they are dealing with things they know nothing about and these things can kill or have life long effects.

Here is a YouTube video that might help:

Dr Michael Rubino is an expert dealing with adolescents and adolescent issues. He has over 20 years experience treating adolescents. For more information about Dr. Michael Rubino’s practice check his website http://www.rcs-ca.com or his Facebook page http://www.Facebook.com/Drrubino3.

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Teenagers and Their High School Prom

Teenagers and Their High School Prom

Yes it is that time of year again — Prom Season. Along with the prom come the concerns of who will I go with? What will I wear? How much can I spend on a dress? And a number of other issues. Hopefully, you and your teen have already discussed the issues around dating and have agreements regarding dating. If not, Prom may be a harder issue because now you have to deal with issues regarding dating and Prom.

As a parent, the first thing to do is to contact your teen’s High School and see what rules and guidelines the school has already established. Many High Schools have rules regarding who can attend, such as only students of that high school can attend, a dress code and some high schools require you to inform them if you are going and your date’s name and the telephone numbers for both set of parents. They do this so if your teen fails to arrive by the designated time or if there are any problems at the Prom, they know who to call.

Another reason to contact the school is to find out where the Prom is being held. Due to the number deaths associated with alcohol or drug use, a number of high schools have decide to have the entire Prom on the school campus. They serve dinner and have the dance at the school. Once you have the details then it is time to discuss with your teen what your expectations are regarding the Prom. This is also the time where you will set the rules for the Prom and make your agreements with your teen.

Assuming the Prom is not being held at the campus and instead being held at a Hotel, there are a few items to discuss. The first issue is price. Most teens want to go to an expensive dinner, hire a limo for the night and for the girls there is the Prom dress. I have seen teens spend over $2,000 on their Prom dresses. A limo for the night can cost $2000 and dinner can cost $350. If you have this money and are willing to indulge your teen then there is no problem. However, most parents don’t have this extra money so you need to agree on a budget. For example, a limo is not a necessity for the Prom. As a parent you may feel safer with a limo because your teen is not driving. Also there is a new law and limos cannot carry liquor when they are driving for Proms and they must card anyone consuming alcohol in the limo. You can bring the price down by having your teen split the cost of the car with 2 to 3 other couples. However, you will want to talk to the parents of your teen’s date and any friends they are going with to ensure all the parents agree.

Another option is letting your teenager pay for part of their prom. There is nothing wrong with expecting them to contribute to the cost of their prom. In fact, it is a good way to educate them about money. If they are having to spend their own money, they may choose some cheaper options. to the . This is a good way to start teaching your teen about managing money. If they are using their own money, they may choose some less expensive options. You can have your teen purchase the prom tickets, pay for the dinner, girls can pay for part of their dress and boys can pay to rent a tuxedo and for a corsage for their date. As a parent you may want to help with the limo, if they are using one, and the Prom pictures. Some teenagers may need some help budgeting money and parents can help teens with figuring out ways to budget and less expensive options for some items. For example, parents can suggest a very nice restaurant that is not very expensive.

If you have a daughter you need to negotiate the cost of the dress or consider renting a dress. In my opinion she does not need to spend $500 on a dress or more to look good. The same rule goes for her hair. She does not need to spend $300 on styling her hair for one night. She can rent a dress and there are beauticians who do not charge as much but still do an excellent job.

You also need to talk with your teen regarding your expectations about consuming alcohol, using drugs and sexual activity on Prom night. Many teens plan After Parties for their Proms. Quite often at the After Parties is where the drinking, drug use or sexual activity occurs. This is another reason why it is important to know who your teen will be going with to the Prom and their parents. You should never allow your teen to go to an After Party where there is no adult supervision. If the party is at a friend’s house with adult supervision and you have spoken with the adult, there should be no problem. If your teen wants to rent a hotel room so their date and their friends can have a party, this is a huge problem and should not be allowed. There are too many incidents where teens overdose, drink to the point of alcohol poisoning, get pregnant or trash the hotel room. Most hotels will not rent a room to someone under 18, but many teens find away around this rule using friends or cousins who are 18 years or older. Also some parents will rent the room for their teen because they want to be viewed as the nice parent. Remember being a parent is not a popularity contest and some times you need to make an unpopular decision because that is what is best for your teenager. This is also a reason why you would want to talk to the parents of the friends your teenager is going to the Prom with. You may want to ask if any of the parents agreed to rent a hotel room.

Another issue to discuss is curfew. Yes it is their Prom and you want them to have a good time, but there is no reason why they need to stay out the entire night or for the entire weekend. If there is adult supervision the entire time it may work. If there is not adult supervision it is a recipe for disaster. Yes some parents plan a breakfast for the morning after the prom. They may serve breakfast at 4 am. If there are plans such as these, your teen could simply text you at some point that everything is going fine. No one needs to know that they checked in with you.

One other issue you need to be prepared for is if your teen does not have a date for the Prom. This can be devastating to a teenager. If this occurs reassure them that it means nothing about them as a person and allow them to express their feelings. Many schools are realizing how much pressure having a date is placing on teenagers and some teens are not ready to date in High School. Therefore, a number of High Schools have changed policies regarding the Prom. Many schools allow teens to make a choice. If they want to take a date they can or if they do not want to take a date and just go with friends that is fine. So if your teen does not have a date and the school does not require one explain not everyone is ready to date in High School and there is nothing wrong with them. Reinforcing their self-esteem can be very important because as a teen many teenager’s self-esteem are fragile and they need your support.

Finally, you need to have a discussion with your teen regarding acting responsibly and to have self-respect. The Prom is a major event and it is another step that your teen is taking into the adult world. They need to remember if they want to act like adults, they have to be willing to accept being treated like an adult. So if they violate the rules that their school has established for the Prom, they may be giving up their right to graduate with their class. The Prom should be a happy event that you and your teen both remember for a long time. If you discuss the issues before the Prom and come to agreements that you both accept then it should be a safe, happy event for all. Good luck!

Dr. Michael Rubino specializes in working with teenagers, their parents and high schools. For more information on his work visit his website http://www.rubinocounseling.com, his Facebook page http://www.Facebook.com/drrubino3 or follow him on Twitter @RubinoTherapy.

I Love My Child, but I Don’t Like My Child

I Love My Child, but I Don’t Like My Child

What should I do when my teen is driving me crazy. Here are ideas for those days when you love your child but don’t like your child. Every parents has those days. It’s normal. I Love My Child But Sometimes I Can’t Stand Him! https://www.empoweringparents.com/article/i-love-my-child-but-sometimes-i-cant-stand-him/?utm_source=Empowering+Parents+Newsletter&utm_campaign=4a33f0d3da-Newsletter_2019-03-01&utm_medium=email&utm_term=0_5bbf2964fe-4a33f0d3da-112844061&goal=0_5bbf2964fe-4a33f0d3da-112844061&mc_cid=4a33f0d3da&mc_eid=e93a7440c4

The Teenage Vaping Epidemic

The Teenage Vaping Epidemic

Many people thought that teenage tobacco use was decreasing. In fact, over the past few years teenage tobacco use had been decreasing. However, a recent report by the CDC indicates that teenage tobacco use has increased. Between 2017 and 2018, 1.3 million teenagers starting using tobacco. In high school students the increase is 77% and for middle school students the increase is 48.5% (CDC). This increase eliminates any decrease that in the use of tobacco since 1999.

The report contributes the increase in smoking to e-cigarettes, vaporizing and the use of JUUL. These products especially juul uses flavored tobacco such as bubblegum. Teenagers start using the flavored tobacco thinking it is safe and become hooked on nicotine. It is then an easy jump from juul or vaporizing to smoking cigarettes. In the period between 2017-2018 the use of Juul went up 600%. Tobacco companies are targeting teenagers with the flavored tobacco products. As a result, teenagers are trying it because they think it is safe. However, they are smoking more when using a juul, vaporizing or using an e-cigarette. Since they are using flavored tobacco products they think they are safe. However, they are gradually becoming addicted to nicotine and addicted to cigarettes.

The Juul is so addictive that many retailers who sell tobacco products are refusing to sell juul products anymore. One store owner said he would not continue to carry juuls because it was an easy way for tobacco companies to get teenagers addicted to nicotine.

If you are a parent, you need to discuss this situation with your teenagers and children in middle school. I hear many teenagers and middle school students tell me that vaporizing and juuls are safe to use. They tell me how different they are from cigarettes. However, when I challenge them to stop vaporizing or using a juul, they find out that it is very difficult. They then admit that maybe vaporizing or a juul is not as safe as they thought. However, they are now addicted to nicotine.

Therefore, if you have a calm conversation with your teenager and if you go to CNN on line, you can find the report. If you discuss it with them calmly maybe you can prevent your teenager from becoming addicted to nicotine. Also vaporizing and juuls create a significant number of problems at school too.

Dr. Michael Rubino is a psychotherapist who specializes in treating adolescents and children. He has over 20 years experience working with teenagers and children. For more information about Dr. Rubino’s work or private practice please visit his website http://www.RubinoCounseling.com or his Facebook page http://www.Facebook.com/drrubino3.

Facts about Teenage Mental Health Care in the United States

Facts about Teenage Mental Health Care in the United States

The week is dedicated to children’s mental health care. As a psychotherapist who specializes in treating teenagers, I have seen how teenagers and their parents do not receive the access to the mental health care they deserve. Hopefully this article will explain what teenagers and their parents currently deal with and the changes that we need.

We often hear parents complain that their teenager is driving them crazy or a teenager complaining how unfair their parents are to live with on a daily basis. However, there are another set of complaints that get ignored on a routine basis. The complaints that get ignored are parents begging for mental health care for their teen or a teen crying out for help by cutting themselves or running away.

Many of us assume that if a parent wants mental health care help for their teen or if a teen needs help, all either one of them has to do is ask for help. Unfortunately, this is not how our world works.

It is very common for parents to ask everyone they can think of for help for their teenager and the only answer they get is, “I am sorry we cannot help you or your child.”

It is also not uncommon for teens to ask for help by admitting to someone that they are feeling suicidal and the teen is told stop being so dramatic or “sorry there is nothing we can do for you, but try calling this number.”

Some of you may assume that I must be exaggerating, but I am not. I have had many parents beg me to see their child because no one has any appointments or they don’t deal with teen issues. When I interview the parents, they have been every where asking for help, but no one has offered any help or referred them to someone else because they don’t deal with their child’s issues.

For example, one Thanksgiving I had a mother have my answering service page me and she was begging me for help because her teen was suicidal. I was referred her to the mother by the County hospital because the County hospital said they had no room for her son. When speaking to the mother it was obvious the teenager needed to be hospitalized. When I asked her why her son was not in the hospital, she again told me the County hospital gave her my telephone number because they had no more beds for suicidal teenagers. No one in the system cared what she was dealing with and how concerned she was about her son.

Again, some people might believe this is an isolated case. Sadly this is not an isolated case. I specialize in treating suicidal and bipolar teens. There have been a number of times I have sent a suicidal teen by ambulance from my office to the County hospital only to have the teen released in less than an hour because the hospital had no beds. I had one person on the Psychiatric Crises Unit tell me on the telephone unless the person had a shotgun in their mouth not to send them to the Hospital because they had no beds for suicidal teens.

Now, some of you may assume the situation would be different if the teen had private insurance because I have been referring to the County Hospital. If you are thinking having private insurance would make a difference, you are wrong. I have had many private insurance companies deny my request to authorize additional therapy sessions for a suicidal teenager. When I remind the insurance that the teen is suicidal and needs therapy to prevent them from acting on their feeling, they often say to refer them to a community counseling center. When I remind them that most non-profit counseling centers have closed due to the economy they simply say sorry they have exhausted their benefits and they will no longer cover their treatment.

This puts the therapist in a difficult position. Do you just discharge the teen or do you continue to treat the teen for a low fee or for free? When 1 out of 5 teens have a psychological condition that needs treatment, what do you do when treatment is denied or there are no treatment options? Also, when you examine the results further you find that teens who need therapy but fail to receive it are more likely to get involved with drugs, crime, are more likely to drop out of school, more likely to get pregnant or father a child and that child is more likely to become a foster child. These teens are also more likely to end up on probation, homeless and on welfare.

As a society we do not place much emphasis on mental health care. Mental health care programs are always some of the first programs cut when the budget is cutback. In fact if you look at the recent cut backs due to the Congress not balancing the budget, mental health programs were some of the first programs to be cut.

I find it very interesting that Contra Costa County had enough money to build a new Juvenile Hall, which is three times the size of the old Juvenile Hall, but there was not enough money to fund a large number of mental health services which had to be cut.

We often look at teens who are acting out and blame their parents. We ask why don’t they get their child the help they need? What stops them from helping their teenager? Why is the teen always getting involved with drugs or not going to school? The answer could be because the teen needs mental health care and the parents have been and continue to try to get their teen help but their is no help. The teen may be acting out because they are tired of asking for help and being in pain so they start looking for the easiest way out of pain.

If we want our teenagers to grow up to become productive members of society then we need to provide them with the mental health care they need. If we want parents to be responsible parents then we need to provide parents options for how to get their teens help when they ask for it.

What can we do? We can write our Congressmen and Senators and demand that they fund community mental health centers. We need more mental health clinics. We don’t need an useless wall on the Southern border.

We can also demand that private insurance companies be required to offer teenagers and their families adequate mental health benefits based on what professional therapists are recommending. The professional treating the child knows what the child needs not some clerical worker with a Bachelors degree who is answering phone calls at the insurance company.

In short, if we want our teenagers to survive their teen years we all need to act together and demand that our children receive the treatment they need and deserve. Private insurance companies make huge profits and drive the cost of health care up based on how they do business. If we don’t start to speak up for our kids, they will never receive the care they need. Look at your next pay stub and look at how much you pay for health insurance and compare that to the benefits you receive.

Dr. Michael Rubino has over 20 years experience treating children and teenagers. If you would like more information about his work or private practice visit his website at http://www.RubinoCounseling.com.

The New High School Drugs

The New High School Drugs

High school students are out of school for the next two weeks for Winter Break. They are looking forward to spending time with their friends at school and those returning from college. This usually means a lot of late nights and parties. Many parents are concerned about the challenges their children will experience in these environments. A common one is peer pressure and drugs. As a psychotherapist who treats teenagers, I hear about what is going on with teenagers and what they are doing. I have been hearing from many teens about new designer drugs they are taking. Many people assume teenagers are primarily using marijuana. However, teenagers are looking for new drugs and ways to modify how they use marijuana. These new drugs can be very dangerous, even deadly. However, many teenagers are not aware of the dangers and risks they are taking.

Winter break is only two weeks so many teens will want to get in as many parties as they can. During winter break for many teenagers this means partying with old and new friends. Drugs are often part of these parties. One major problem facing teens is the fact that many Emergency Room physicians cannot keep up with all the new drugs teenagers are using. Therefore, if a teenager ends up in the Emergency Room due to overdosing or having a bad reaction to one of these new drugs, a teenager may die before an Emergency Room physician determines what the teenager took and how to treat it. The show The Good Doctor had an episode which addressed this issue. The teen had used, Molly, not a new drug but because there were so many options, the teenager almost died before they could determine how to treat him.

Recently I read an article by Angela Chen. The article discusses these new dangerous drugs and how deadly these drugs can be. I have included her article below so parents can be aware of the dangers facing their teenagers. Hopefully, parents will also take this opportunity to discuss this issue with their teenagers.

On a July day a little over a year ago, over 30 people collapsed on a street in Brooklyn. They lay on the ground, vomiting down their shirts, twitching and blank-faced. Some, half-naked, made jerking movements with their arms, eyes rolled back. Others groaned and clutched onto fire hydrants to try to stay upright. Witnesses said the scene was like The Walking Dead. Headlines claimed that people had turned into “zombies,” while police said that the 33 affected were lucky to be alive.

All had smoked an “herbal incense” product called AK-47 24 Karat Gold. Eighteen people were sent to the hospital by ambulance. The situation had all the signs of a drug overdose, and so doctors ordered the usual tests: blood count, urine analysis, heart rate monitoring.

The first patient tested was a 28-year-old man who was slow to respond, but otherwise showed few clear signs of trauma. Heart sounds: normal. Blood count: normal. His lungs were clear and there were no major neurological problems, no excessive sweating or skin lesions. He tested negative for opiates, cocaine, amphetamines. Nothing came up.

The case went to the Department of Homeland Security and the Drug Enforcement Agency. They knew who to call to get a second opinion. They packed blood and urine samples on dry ice and shipped them to a small lab 3,000 miles away in San Francisco, run by toxicologist Roy Gerona. If anyone in the country could figure out what was in 24 Karat Gold, it would be him.

Forty years ago, drugs had easy names: cocaine, meth, heroin. Today, the names can read like an ingredients list for a chemistry class: 5F-AMB, PX-2, MDMB-CHMINACA. Today’s designer drugs are made by synthesizing chemicals and hoping they give you a high that’s strong enough to be worth it, but not strong enough to send you to the hospital.

Designer drugs are volatile. If you tweak just one molecule, you can get an entirely differently substance, one you hadn’t bargained for. They’re also easy to get. There’s no shortage of “research chemicals” vendors on the dark web are willing to sell. And they’re growing more popular. These so-called “novel psychoactive substances” entered the mainstream in 2009. That year, according to the United Nations Office on Drug and Crime, there were about 100 of these substances reported; six years later, there were nearly 500. Because designer drugs don’t show up on traditional drug tests, they’re hard to track and identify. It’s a public health problem that requires a special set of skills to handle.

One of the most prominent categories of designer drugs are those intended to mimic marijuana, called synthetic cannabinoids. Marijuana, or cannabis, is widely considered one of the safest drugs, but synthetic cannabinoids are some of the most dangerous synthetic drugs. The Global Drug Survey (GDS) found that last year, for the fourth year running, the risk of seeking emergency medical treatment was higher after using synthetic weed than for any other drug.

When you smoke a regular joint, a chemical called tetrahydrocannabinol (THC) travels through your blood. It binds with receptors called CB1 and CB2. Because of the structure, there’s “kind of a limit on how stoned you can get,” says Adam Winstock, a London-based psychiatrist who administers the GDS. If you’re smoking a popular cannabinoid like K2 Spice, a chemical travels through your blood, but this time, it’s not THC. It’s something else that also binds with CB1 and CB2 — but unlike with regular weed, we don’t know exactly how these chemicals bind, especially when they’re illicit drugs from the black market. This mystery makes synthetic marijuana likely to lead to “much more extreme responses,” like seizures and psychosis, according to Winstock.

Synthetic cannabinoids originated in a quest to create a better pain medication. A Clemson University chemist named John W. Huffman synthesized hundreds of compounds in an attempt to find a better painkiller, but often created incredibly psychoactive substances with no medicinal properties at all. When he published the results of these compounds — called JWH compounds, after his initials — he made the information available to be copied.

There are more than 300 JWH compounds alone, and around 2004, labs in China began studying old research papers, synthesizing the compounds and distributing them as “herbal incense” products. K2 Spice itself — often partly based off the JWH-018 compound — started in China, became popular in Germany around 2008, and entered the US around 2009.

Labs can also turn to the expired patents — patents that are rich fodder, even if (or perhaps because) there was a good reason said drugs never made it to market. It’s nearly impossible to figure out how to shut down the overseas labs producing these drugs. As soon as you ban one substance, the labs move on to another.

Gerona, a toxicologist with gray hair styled in an undercut, was the one who received the biological samples from the DEA. From a small lab in the Medical Sciences Building at the University of California, San Francisco, Gerona says he and his team are playing a “cat and mouse game” with illicit international drug manufacturers. When an overdose happens, Gerona’s team tries to identify the drug in question — often synthetic substances no one has seen before. But the lab goes one further: Gerona’s lab attempts to identify and classify these substances before the mass overdoses even happen.

Inside, the lab is meticulously neat: rows of spotless tables are covered in bottles with orange rubber caps, all labeled with orange duct tape, and small gray centrifuges. A window overlooking a courtyard has molecular structures scribbled over it in pink and green marker. Near the door sits an enormous freezer, filled with thousands of brightly colored, frost-covered boxes of drug samples kept at -112 degrees Fahrenheit.

Gerona launched his toxicology lab in 2010, in partnership with the San Francisco Poison Control Center. The date wasn’t a coincidence; he says that 2010 was the year that a designer drug called “bath salts” began flooding the market. “Bath salts” is a blanket term for a group of designer drugs made from stimulants; they create a euphoric high like MDMA, sometimes with hallucinations thrown in. The drugs usually come in powdered and capsule form, and can cause freak-outs that were well-documented on YouTube at the time. The most famous of these was a viral story of a 31-year-old Miami resident attacking and then eating a homeless man. (Scientists dispute the drugs’ role.)

For users and the DEA, the spike in bath salts use was a nightmare. For Gerona, the increased interest in designer drugs led to more work and more samples from around the country. Eventually, the lab caught the notice of both Michael Schwartz, a toxicologist at the Centers for Disease Control and Prevention, and DEA pharmacologist Jordan Trecki. A collaboration between Gerona’s lab and the DEA was formed. (Neither the DEA nor the CDC responded to repeated requests for comment.)

The first step in doing an analysis at Gerona’s lab is getting the sample — urine, blood or, rarely, a tiny bit of drug itself — shipped over on dry ice. In traditional drug testing, you check to see if the sample matches any of the known substances: marijuana, heroin, cocaine, and so on. They match, or they don’t. Designer drugs, almost by definition, are made of chemical combinations we haven’t seen before. They almost never match traditional databases, and the chemists often don’t know what they’re looking for. So Gerona’s lab gathers as much information about the substance as possible.

A tiny vial of the biological sample — usually plasma, the colorless part of blood — goes into a bulky, printer-like machine. That machine is called a liquid chromatography mass spectrometer, and very crudely put, it separates out all the different parts of the plasma by mass. (Think of it like an extremely sensitive centrifuge.) That process makes it easier to identify chemicals, and the mass spectrometer then spits out the different measurements in a computer chart with peaks and valleys called a chromatogram.

Then, says Axel Adams, a graduate student in Gerona’s lab, you turn to the so-called “prophetic library.”

“ RESEARCHES LOOK FOR POSTS ABOUT DRUGS ON SUBREDDITS LIKE R/RESEARCHCHEMICALS

Gerona’s “prophetic library,” about three years in the making, is a detailed catalog of already synthesized variants that his team believes is going to be the next big street drug. The library was made possible with the help of Samuel Banister, a synthetic chemist at Stanford University. Banister synthesizes variants of popular street drugs and takes down their chemical information to create “reference standards.” Synthesizing can take anywhere from a few days to a couple of weeks; the lab now has almost 150 variants on file. It’s a side job for Banister, but at one point, he says, “I was pumping out five to 10 a week.” The final products look like white crystalline solids and are kept in drawers in the lab, ready for when a case like AK-47 24 Karat Gold comes along.

In addition, lab members spend hours each week on drug forums, researching trends. It’s more of an art than a science. Researches look for posts about drugs on subreddits like r/researchchemicals. They reference surveys like the Global Drug Survey and survey “trip reports” from experiential documentation sites like Erowid and PsychonautWiki.

They look for terms like synthetic pot, K2, Spice, and sometimes, scientific terms like “cannabinoids,” or a specific popular class of cannabinoids, like “FUBINACA” or “JWH compounds.” Often, the posts themselves will include the name of the chemical. Gerona has ordered drugs off the dark web. In one case, the invoice billed him for “cosmetics,” and the package included lipstick, fake eyelashes, and tabs labeled “powder.” The “powder,” unsurprisingly, turned out to be drugs. But most of the time, the drugs in the powder were not the drug that was ordered.

“ THE INVOICE BILLED HIM FOR “COSMETICS,” AND THE PACKAGE INCLUDED LIPSTICK, FAKE EYELASHES, AND TABS LABELED “POWDER”

If there is a match because the compound is already in the library, finding the right variant is “only going to take 15 minutes,” says Gerona. “Otherwise, it could take a week, or it could not be solved.”

Adams checked the results of a blood sample tied to AK-47 24 Karat Gold against the prophetic library. The computer pulled up a chart that indicated a line — jagged, up and down — that shows the mass of the components of AK-47 24 Karat Gold, versus the same information for AMB-FUBINACA.

Drugs don’t pass through the body untouched. Once they’re ingested, the body processes the compounds. So by the time they’re in the blood or urine, it’s not exactly the same compound as the drug that was ingested. It’s hard enough to find a reference standard for the original compound; it’s even more difficult to find a reference standard for the possible variants. In the case of AMB-FUBINACA, the chemical in the biological sample from Brooklyn wasn’t the parent compound. It was a derivative. Luckily, Banister had already synthesized that variant, too.

The peaks and valleys of the two lines of AK-47 24 Karat Gold and AMB-FUBINACA matched up precisely. It took the team only seven days to identify the substance in the Brooklyn case — and most of that time was spent waiting for the sample to get there.

Gerona’s lab has worked on cases across the country, from New York City to Sacramento to Colorado. The number of cases varies. Sometimes, they’ll get 15 to 25 samples a month. One Mississippi case involving synthetic cannabinoids resulted in over 400 samples. The average turnaround on results is about six months, says Adams. That’s not good enough for Gerona.

And it’s not likely that the problem will go away. Marijuana legalization advocates claim that people will stop with the synthetic stuff once the real thing is okay. But that’s not true in the experience of Andrew Monte, a clinical toxicologist at the University of Colorado School of Medicine who collaborates with Gerona’s lab. Recreational marijuana is legal in Colorado, but he sees patients who are on these synthetic compounds anyway. Monte’s team has surveyed people who come into the ER and even set up at music festivals to ask attendees questions. Synthetic drug users are “taking it for a different reason, to get a different high,” Monte says. “They’re really looking for something different than what pot gives, the same way you might choose cocaine over pot or meth over pot.”

“ ONE MISSISSIPPI CASE INVOLVING SYNTHETIC CANNABINOIDS RESULTED IN OVER 400 SAMPLES

To help address this problem, in 2016 Gerona started a new research consortium called P SCAN, or the Psychoactive Surveillance Consortium and Analysis Network. (Yes, the double entendre is intended.) They’re working with about 10 poison control centers in places like Kansas and Colorado. They’ve had more than 100 cases referred to them and are writing up case reports and manuscripts. (The 24 Karat Gold case was published by the New England Journal of Medicine.)

P SCAN will continue to do the surveillance work Gerona has been doing for years, but also create a database of clinical data connected to the specific synthetic drugs they track and discover. Think of it like a medical version of Erowid. This way, the next time there’s an outbreak like the one in Brooklyn, investigators and researchers can look at specific physical indicators (heart rate, respiratory information, neurological information, and more) and say, “Ah, this matches the symptoms of AMB-FUBINACA” — all without shipping samples across the country.

But even with P SCAN and the prophetic library, the task is huge. “The identity of a lab needs to constantly expand and rework in order for it to stay relevant,” says Gerona.

Gerona is a biochemist by training. Before launching his lab, he didn’t know anything about Spice, or AK-47 Gold, or the dark net. But now, Gerona says, “I have no other choice but to really learn about it, so that I am relevant and retain my relevance in the field.” He’s hoping to work with people in technology to automate this “market research” to glean new insights and make the prediction process even faster. “It would be so great if we could predict the drugs coming in with more accuracy, instead of after people are hurt,” he says.

Weeding out designer drugs is a Sisyphean task, Gerona admits. It may be impossible to shut down the overseas labs, but he wants to have even better methods for predicting what’s going to get big and then, instantly identifying the substances. He compares the endless drug variations to nature: the cold virus is still around because it changes all the time. HIV has never been cured because it continues mutating. “In a sense, they’re reinventing themselves all the time, so reinvention is key to persistence. As long as you’re reinventing yourself, you can persist.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating teenagers. He treats teenagers with drug issues and has seen many end up in the Emergency Room because teenagers think they are the experts. For more information about Dr. Rubino’s work or his private practice visit his website http://www.RubinoCounseling.com or his Facebook page http://www.Facebook.com/Drrubino3.

Why Are We Ashamed about Mental Health?

Why Are We Ashamed about Mental Health?

When people hear about mental health they often think about people sleeping in the street or eating out of garbage cans. However, this is not the reality. Mental health issues are the same as physical health issues. They need to be treated. Diabetes is caused by a chemical imbalance, the chemical being insulin. Depression is caused by a chemical imbalance. The amount of serotonin is off for a person dealing with depression. Therefore why should we treat them differently?

This stigma does result in people succeeding at Suicide and it can destroy families because someone does not seek mental health care. If they commit suicide, this impacts the entire family. The shooting in Thousand Oaks is an example of what can happen when people don’t receive mental health care. The mother said she had been afraid of her son for a long time and tried to seek help. The mother lived for years in fear of her son and now she has to live with the fact that her son murdered 12 people and injured many more. All because of the negative stigma associated with mental health care and the lack of mental health care.

I have included a link to a video by Heads Together where a husband and wife discusses how the stigma associated with mental health impacted their family. https://www.facebook.com/201404780244288/posts/671244049927023/

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children and teenagers. For more information about Dr. Rubino visit his website http://www.RubinoCounseling.com or http://www.Facebook.com/drrubino3.