not your mother’s drugs: the new designer drugs diane a. tennies, ph.d., ladc lead teap regional...
TRANSCRIPT
Not Your Mother’s Drugs: The New Designer Drugs
Diane A. Tennies, Ph.D., LADC
Lead TEAP Regional Health Specialist
Humanitas, Inc.
1
Learning Objectives
Describe the different designer drugs including synthetic cannabinoids, bath salts and kratom
Discuss why the designer drugs are increasing in popularity
Articulate the physiologic effects associated with their use
Discuss the current status of federal and state laws surrounding designer drugs
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‘The Good Ole Days’
Opiates Cocaine Phencyclidine (PCP) Extensive scientific literature (clinical
and experimental)Kinetics (the chemical process)Toxicological effects (on humans)
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Designer Drugs
Synthetic drugs produced by underground chemists
Labeled ‘designer drugs’ as same changes to chemical structures so are specifically ‘designed’ or altered
They are technically legal by chemical formulation
Commonly used by young people and adults (ages 21-30)
Originally called “club drugs”
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Designer Drugs (Continued)
Marketed as having similar effects of the illegal counterpart
Easily obtain instructions for mixing, making, dosing and ingesting synthetic drugs on line (Erowid.org)
Easily obtained as Internet is flourishing marketplace
Dangerous and unpredictable side effects because: More potent Last longer Never tested on humans No regulatory oversight or quality control More addictive potential (intentionally designed)
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Our Brave New World
K2/Spice – “Fake Pot” – A synthetic cannabinoid which mimics marijuana
Bath Salts – The “New Cocaine” – a synthetic stimulant whose affects last 3 to 4 hours
Kratom – The “latest” designer drug – A plant from Thailand with opiate-like properties which is legal in most areas of USA
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But Is This REALLY a Problem?
American Association of Poison Control Centers ReportFor synthetic cannabinoids:
2009: 15 cases with adverse reactions to Spice 2010: Over 2500 calls from all 50 states 2011: 6600 calls through 06/2011*
For bath salts: 2009: No data 2010: 303 calls 2011: 3740 calls through 06/2011*
For research chemicals (2C-E – drugs which mimic LSD and other drugs):
2009 : No data 2010: 22 calls 2011: 75 calls*
*preliminary data as not all centers have reported fully
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Mother dies after smoking spice: A mother of two is dead after using a synthetic-marijuana laced incense known as spice (Middletown, Indiana 08/04/2010)
Bangor police chief says bath salts creating crisis – Bangor Daily News 08/01/2011
“Bath Salt” Abuse Hits Epidemic Proportions - Emergency Physician’s Monthly Report 04/13/2011
Never heard of Kratom? Trust Us, You Will – 08/02/2011 In the Fix: Addiction and Recovery Straight Up
Designer Drugs Have a Long History
Morphine and Heroin made illegal in 1925 = legal alternatives remained available until 1968
Synthetic hallucinogen = LSD MDMA (Ecstasy) initially introduced in 1912
by Merck as appetite suppressant. 1970’s became ‘club drug’ and unregulated until 1985
Crystal methamphetamines
Conclusion: Most illegal drugs have an unregulated "research chemical”
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So If They Are Popular and Legal Then Sales Can Be Tracked
“Herbal Incense” (synthetic cannabinoids) accounted for nearly…..
Five billion dollars in sales*
*Retail Compliance Association (2010)
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Spice (Named From the Frank Herbert books)
Spice gold Spice silver Spice diamond Yucatan fire Sence Chill X Genie Algerian blend
K2 Solar flare K2 summit PEP Spice Fire n’ Ice Zombie World Bad to the Bone Black Mamba Dark Night G-Force
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Let’s Review Marijuana
Listed in US Pharmacopea until 1944 when removed due to political pressure to ban social use in USA
Cannabis preparations have been used for over 4000 to 6000 years
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Cannabinoids 101
Occurs naturally in dried flowering/fruiting tops of Cannabis sativa plant
Cannabinoids active compounds extracted from cannabis
Renewed interest in using cannabinoids for medicinal purposes
Discovery of cannabinoids receptors and endocannabinoids opened new era in research on pharmaceutical applications of cannabinoids
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What is This Eminent Professor Best Known For?
Dr. John W. Huffman, (JWH) professor of organic chemistry at Clemson University in South Carolina for 50 years
Ph.D. from Harvard and the National Institutes of Health's Senior Scientist Award 17
Dubious Honor of Being Creator of Synthetic Cannibinoids
Researching the effects of cannabinoids on the brain (For NIDA in 1990’s)
Developed chemical compounds to mimic effects of marijuana (like JWH-018)
1995 paper contained the method/ingredients and was published
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The Spread of K2/Spice K2/Spice is unintended result of scientific research on
marijuana's effects
2008 - German pharmaceutical company THC Pharm developed three versions of the herbal incense brand Spice with JWH-018 as primary ingredient
By summer of 2009, packets of dried herbs sprayed with JWH compounds were sold throughout the world as "herbal incense" products
March 2011 Drug Enforcement Agency exercises its emergency scheduling powers and bans five of the synthetic cannabinoids (JWH-018; JWH 073; JWH 200; CP47,497; and cannabicyclohexanol)
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Dr. Hoffman Says: The materials to make JWH-018 are available from laboratory
chemical suppliers. A good college senior chemistry major could probably make them with some supervision and decent lab equipment. JWH-018 was made by a summer undergraduate research student, with supervision
There are no valid, peer-reviewed studies of the effects of this compound in humans, nor are there any data regarding its toxicity…it’s like playing Russian Roulette. You don't know what it's going to do to you. You're a potential winner of a Darwin award (referring to the tongue-in-cheek awards given to people who “do a service to humanity by removing themselves from the gene pool”)
I emphasize that this compound was not designed to be a super-THC. It should absolutely not be used as a recreational drug
I’ve lived around the world a long time [79 years old] and come to the conclusion that if an enterprising person wants to find a new way to get high, they’re going to do it
People who use it are idiots 22
Physical Form of K2/Spice
Pure state – either solids or oils Smoking mixtures – usually sold in metal-foil
sachets Solution of the cannabinoids sprayed onto
herbal mixture Contain 3 g dried ‘vegetable matter’ Price comparable to marijuana (with the ban
price seems to have increased)
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Effects of Synthetic Cannabinoids: Research Says…
Behavioral pharmacology studies show JWH-018 has Δ9-THC-like activity in animals
In mice, it decreases overall activity,
produces analgesia, decreases body temperature and produces catalepsy
A search in the literature found no published
studies of the effects of JWH-018 in humans
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Pharmacology
Cannabinoids receptor agonists mimic effects of THC by interacting with CB1 receptors in brain
Synthetic compounds bind more strongly than THC (up to 100 x’s more tightly)
Little known about pharmacology & toxicology
Long half-lives = prolonged psychoactive effect
Considerable batch variability = highly potential for overdose
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Countries That Control Synthetic Cannabinoids
Denmark Germany Estonia France Ireland Italy Latvia Lithuania Luxembourg
Austria Poland Romania Sweden UK Chile Finland South Korea Switzerland
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In the United States In May 2010, the Department of Defense
banned synthetic cannabinoids from all U.S. military bases
Kansas first state to criminalize in 5/2010
Patchwork of local and state laws current exist
16 states have laws regulating, in addition to the federal ban of 03/2011 30
So its just ‘fake pot’ right?
What’s the big deal??
When I was young I knew plenty of people who….
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Pharmacological Short-Term Effects of Smoked Synthetic
Cannabinoids Altered state of
consciousness Mild euphoria and
relaxation (less common) Perceptual alterations
(time distortions) Intensification of sensory
experiences Impaired short-term
memory Increase in reaction times Altered depth perception
Panic attacks Severe agitation* Numbness and tingling Severe GI upset/vomiting* Long term altered depth
perception “Flash backs” Hallucinations/delusions Tremors and seizures* Tachycardia* Hypertension* Death*
*Symptoms NOT consistent with cannabis intoxication 33
Severe Symptoms Are Not Consistent with Cannabis Use
o Symptoms Severe agitation Severe GI upset/vomiting* Hallucinations/delusions Tremors and seizures* Tachycardia
o New speculation is these symptoms caused by myriad on contaminants in the K2/Spice
o (Remember no regulatory oversight or control)o Long term symptoms: NO RESEARCH on humanso Withdrawal symptoms: drug craving, nightmares,
sweating, nausea, tremor, headaches, HBP, and racing heartbeat
34
Is It Really Legal?
As of July 2011 = 28 states have ban possession of the drug
There is no federal law prohibiting sale, although the Federal Drug Enforcement Agency is considering another emergency scheduling
The European Union ban bath salts products in April 2010
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Availability Retail outlets include:
Head Shops Truck stops Gas stations
Readily available via Internet Benign names
Ivory Wave, Bliss, White Lightning, Hurricane Charlie, Zoom 2 50 to 500 milligram packets Relatively inexpensive: $25 to $50 per 50-milligram
packet* Disclaimer: ‘Not for human consumption’
*According to US Department of Justice 38
Bath Salts 101
Active ingredients are: MDPV (methylenedioxypyrovalerone) Mephedrone (4-methylmethcathinone or 4-
methylephedrone) Classified as synthetic stimulant –
central nervous system stimulant Method of Use:InjectionSmokingSnortingLiquid form mixed into alcoholic drinksAtomizer – occasionally
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Symptoms Associated With Bath Salt Use
Agitation Extreme energy Paranoia Tachycardia Sweating/dry mouth High blood pressure Hallucinations Combative behaviors Rapid onset of suicidal ideation – can remain
for days/weeks40
Extreme Behaviors Associated With Bath Salts
Panama City, Florida: Several officers needed to subdue a man who tore out a radar unit out of police car with his teeth*
Women attached her mother with a machete because “she was a monster”*
Another user hospitalized after attempting to remove his own liver with a mechanical pencil*
ABC News reported on 06/29/2011 that Federal DEA agented arrested ten people in first ever “bath salts” bust
*Emergency Physicians Monthly 04/13/2011
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Kratom
Latest designer drug to hit America Common name for the plant Mitragyna
speciosa Korthals Originated South-East Asia In Thailand the leaves of this tree-like plant
have been used for centuries for their medicinal and psychoactive qualities
Comparable to opiates in symptoms
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Kratom (Continued)
Kratom is unique because effects depending dose Both stimulant and sedative-like qualities
(nicknamed Nature’s Speedball) Activates mu- and delta-opioid receptors Effects within 5 to 10 minutes of ingesting (typically
in “tea”) Lasts 4 to 6 hours Include:
Relaxation and sedation Analgesia and euphoria More talkative/sociable/energetic
Not extremely dangerous and rarely lethal Interacts with other medications for harmful effects
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Our Brave New World: Revisited
K2/Spice – “Fake Pot” – A synthetic cannabinoid which mimics marijuana and undetectable on drug screens.
Bath Salts – The “New Cocaine” – a synthetic central nervous stimulant with highly unpredictable and dangerous side-effects resulting in escalating ED visits with no clear recommended treatment
Kratom – The latest designer drug – while no serious concerns yet the opiate-like properties are of significant potential for abuse 45