Presentation on theme: "Current Trends K2/Spice, “Bath Salts” & Others Ken Dickinson, M.S., R.Ph. 610-291-3109"— Presentation transcript:
Current Trends K2/Spice, “Bath Salts” & Others Ken Dickinson, M.S., R.Ph
Introductions Presenters: Rodney & Ken Attendees –Experience with “Bath Salts” and K2/Spice –Expectations or goals for this workshop
Objectives History and background of “new synthetic designer drugs” Epidemiology and current trends Effects and dangers of these drugs How sold, what they look like and how used Legal, prevention and treatment issues
Designer Drugs: Background Trend started in late 1970’s Drugs of abuse are classified by DEA Drugs of abuse work according to structure Analogs –Can “design” an analog to have same or similar activity but not listed as a “controlled substance” –Not subject to legal penalties and restrictions
Mephedrone & Methamphetamine
Federal Drug Schedules Federal Controlled Substances Act (CSA) of 1970 Schedule I: No medical use, high abuse potential (heroin) Schedule II: Accepted medical use, high abuse potential (OxyContin, Ritalin) Schedule III: Accepted medical use, less abuse potential than I or II (Vicodin) Schedule IV: Accepted medical use, less abuse potential than I-III (Valium, Xanax) Schedule V: Accepted medical use, lowest abuse potential (Robitussin AC) SOURCE: ATTC National Office, CONNECT to Fight Prescription Drug Abuse.
Designer Drugs designer drugs (in designer drugs (chemistry))...to see a marginally different version appear, using substances not covered in the original law. In the United States this problem was addressed in the Anti-Drug Abuse Act of 1986, which contained a Controlled Substance Analogue Enforcement Act (commonly called the Designer Drug Act), which prohibited the manufacture of “substantially similar” analogues of banned chemicals. designer drugs (chemistry)
Designer Drugs: Evolution Internationally do not have such laws –Being manufactured in other countries Many “designer drugs” do not test (+) A way to “Beat the Bladder Police”
Designer Drugs Today’s trend –Make an analog that is not listed in laws –Since legal can make an distribute as an everyday household product e.g. “Bath Salts” “Plant Food”, potpourri, incense, jewellery cleaner, hummingbird attractant, etc. – Then label “not for human consumption” –Market via social media and retail outlets
Web Sites abishttp://en.wikipedia.org/wiki/Synthetic_cann abis
Herbal Incense Crushed non-psychoactive herbal plant matter treated with one or more synthetic cannabinoids –First generation: “K2”, “Spice”, “Black Mamba” –Second generation “K3”, “Splice”, “Apocalypse”, “Cloud 10”, “Destiny”
Synthetic Marijuana (JWH- 018) Known as Spice or K2 K2 originated at Clemson University, where researchers developed synthetic cannabinoids in an effort to create therapeutic drugs. But the cannabinoids also have effects akin to THC, the key ingredient in marijuana K2 is largely created by individual sellers, it's anyone's guess what else is added to the mix.
K2 For $35, users can buy 3 grams of K2 "incense" with nothing more than a credit card or PayPal account. Did not have drug test or it Now do but extra expense and only some labs Smokable herbal blends marketed as "legal highs" have become increasingly popular and as easy to buy as cigarettes. (before )
K2 Spice K2 contains synthetic chemicals, known as JWH-018 and JWH-073, that mimic THC by acting on the cannabinoid receptors in the brain Other analogs detected –HU-210 –AM-2201 –CP-47, CP-497, C6, C8, C9
K2 Data American Association of Poison Control Centers Reported in article June 2012 Year 2010#2, 906 Year 2011#6,959 Year 2012 up to May 31#2,883
Mixture of herbal and spice plant products –Leaf can be: marshmallow leaf, parsley, etc. Sprayed with synthetic cannabinoids Marketed as incense and “not for human consumption” No regulations to list ingredients or age requirements to purchase Description of the Drug
Alarming Fact Tests show that even the same brand may have different drugs– in different amounts- at different times User has no way of knowing what or how much they are taking
s Dr. Huffman & Dr. Huestis (Chief of Chemistry/Drug Metabolism at National Institute for Drug Abuse) indicate that when taking these drugs, it is “hijacking the part of the brain important for many major functions: temperature control, food intake, perception, memory and problem solving. –Many people taking these high-potency drugs are affecting important functions throughout their body’s-hormone functions for example.” Doctors also express concern that the drugs may involve acute toxicity levels, possibly long term, as well as impacting cannabinoid receptors that regulate body’s immune system.
K2 Impact Retailers selling the drugs report a recent (2011) increase in sales from app. $1000 daily up to $10, 000 daily. Medical reports indicate that K2/Spice drugs potentially result in users developing a rapid and powerful addiction on a level not usually found among smokers of “real” marijuana. Recently linked (Dec 2011) to over 352 nationwide emergency room incidents-includes suicide attempts, extremely elevated heart rate/blood pressure, comas, seizures, and anxiety attacks.
Incense Emporium Online K2/Spice Ad (Current): Note from the owners: On Dec 24, the federal government banned certain ingredients commonly found in K2 - our products have been scientifically analyzed and certified not to contain any of the controlled ingredients, for more information please click on the "Contact Us" above. Thanks for being loyal Incense Emporium customers! Buy 1 Get 1 FREE on all Herbal Incense!!! Buy whatever you HERBAL INCENSE would like and we will automatically double it when we package it for shipping. It's that simple! Buy 2, Get 4...Buy 5, Get 10...Buy 100, Get No Limits!!! $ for 2 ounces...that's only $65 per ounce!!! Our products are NOT FOR HUMAN CONSUMPTION Must be 18 to purchase
HU-211 and HU-210 1
JWH-073 and JWH JWH-018 and JWH-073 JWH-018 and JWH-073 are synthetic cannabinoid agonists without the classical cannabinoid chemical structure In vitro studies show that JWH-018 and JWH-073 binds to the brain cannabinoid receptor CB1 with higher affinity than Δ9-THC which binds with almost equal affinity to CB1 and CB2 receptors Behavioral pharmacology studies show that JWH-018 and JWH-073 both have Δ9-THC-like activity in animals
Missouri K2 Administration Study Bob Welsh- PI IRB Human subjects approval Six subjects smoked K2 Summit Each contained JWH-018 & JWH-073 or CP47, 497 Subjects performed Standardized Field Sobriety Tests, cognitive tests & Drug Recognition Expert Exam Blood, urine and oral fluid collected
K2 Study (cont’d) Onset of effects in about 2-3 minutes –Dry mouth –Light headedness –Blurred vision –Agitation, Motor restlessness –Time dilation (?) Theory in physics, time travel
K2 Study (cont’d) Drug Recognition Expert Exam –Increased pulse and blood pressure –Lack of convergence Movement of the two eyes so coordinated that the images of a single point fall on corresponding points of the two retinas –No horizontal or vertical gaze nystagmus –Pupils normal, muscle tone normal
K2 Study (cont’d) Field Sobriety Tests –3 to 4 inches of sway, leg body tremors –Loss of balance –Loss of motor coordination
Missouri Study Self Reported K2 Effects Tachycardia Dry Mouth Felt Impaired, subjective thought disruption Changes in perception Impaired sense of time Mild anxiety, paranoia Sedation & Post-intoxication exhaustion
On Line Reported K2 Effects Strong dysphoria -Panic attacks -Heavy body load -Extreme nausea -Fear, Panic, Anxiety -Strong aural hallucinations --Racing heart (higher doses) –Heart attack
On Line Reported K2 Effects Self mutilation Paranoia Auditory & visual hallucinations Delirium Agitation
On Line Reported K2 Effects Marijuana-like effects –Euphoria –Giddiness –Silliness –Impaired short-term memory and concentration –Increased appetite “Most angiogenic substance I ever ingested”
How Diagnosis is Made Mainly supported by clinical history rather than presentation or mental status exam Duration of intoxication or “high” is relatively short (30 min. or less) –Do not typically present acutely intoxicated to an outpatient visit Unlike marijuana do not have a typical or signature smell
How Diagnosis is Made Usually access “system” via behavioral crisis –Criminal Justice system –Crisis Centers, ER’s & Psychiatric Hospitals ER’s are seeing and identifying more due to acute intoxication Toxicology testing continues to improve
User Report #1 This is the worst experience I have ever had The most angiogenic substance I have ever used Nausea, vomiting, heart pounding like I am going to have a heart attack Not sure if I just said that, thought it, or read it Two hours later will never take this again
User Report #2 Three individual hits from a small pipe Organic, no chemical odor or taste Five minutes feels like cannabis Ten minutes like an intense cannabis high More than three puffs might be too much
Why the Discrepancy in Reports? Use of other drugs with incense Varying potency Overdose Presence of different cannabinoids Knock-offs User/environment characteristics –Set & setting, etc.
K2 Overview No quality control Manufacturing process may be associated with adverse effects Subjective effects most closely resemble those of very powerful marijuana Almost complete lack of scientific study Street information very inconsistent
K2 Treatment Issues High rates of addiction (K2info.org) Withdrawal due to physical addiction –Treated with sedatives and clonidine Before D/A treatment need to be medically and psychiatrically safe and stable Residual effects for weeks (or months) due to long half-life & fat storage
Withdrawal Case Study WebMD German male 20 y.o. used Spice Gold daily for 8 months Due to tolerance increased dose 10 fold Felt need to continue use daily When unable to get drug experienced: –Unrest, drug craving, nightmares, sweating, nausea, tremor, headache, high BP, tachycardia
Withdrawal Case Study Cont’d Began using again When wanted to stop checked into hospital Experienced classic withdrawal that lasted 7 days
K2 Harm Reduction Tips Not all incense blends are created equal. JWH-018 is more expensive than real pot Herbal incense blends are harsh JWH-018 does not mix well with alcohol The high last no more than 30 minutes
K2 Testing Many labs have a test for the first generation JWH chemicals In February 2010, Redwood Labs, California developed a saliva test for JWH- 018, JWH-073 and JWH-250 Saliva and urine tests recently developed for second generation JWH’s vices/3369_sc_sellsheet.pdf
K2 Testing Following a single low dose exposure, synthetic cannabinoids can be detected up to 72 hours in human urine. In case of chronic exposure the window of detection is much longer
Maryland Law: K2 & Bath Salts On March 1, 2011, the possession and distribution of 5 synthetic cannabinoid compounds became illegal in the U.S. per an emergency ban by the U.S. Drug Enforcement Administration Maryland no enactment yet for K2 as of Sept 25, 2012 –Local bans such as Ocean City July 21, 2012 Bath Salts now Schedule I in Maryland
Mitragyna Speciosa Used in: –Malaysia –Thailand –Indonesia Local names: –Ithang –Biak Biak –Ketum –Kakuam
Kratom Pharmacology Mitragynine Structurally similar to some hallucinogens No hallucinogenic activity or effects Acts on opioid receptors
Kratom & Opioid Treatment Currently used for heroin and methadone dependence in some countries –New Zealand –Thailand Used in detox to manage withdrawal symptoms from opioids
Kratom Seems to be a stimulant in lower doses –Mitragynine Seems to be sedative in higher doses –7 hydroxymitragynine Often produces a mixed effect Onset 5 t o 10 minutes Duration several hours
Kratom Side Effects Short term (immediate) –Dry mouth –Increased or decrease urination –Loss of appetite –Nausea and/or vomiting Side effects –Anorexia/weight loss –Depression –Addiction
Bath Salts Toxic psychoactive drugs “disguised” or “pretending” to be “Bath Salts” They are NOT Some people have snorted real BS’s
“Bath Salts” Are
What are Synthetic Cathinones? Synthetic cathinones are related to the parent compound cathinone. Since the mid-2000s, unregulated ring- substituted cathinone derivatives have appeared in the European and American recreational drugs market.
What are Synthetic Cathinones? The most commonly available synthetic cathinones sold on the recreational market in the period up to 2012 appear to be 3, 4- Methylenedioxypyrovalerone (MDPV), mephedrone, and methylone. These products are usually encountered as highly pure white or brown powders. Cathinone derivatives are claimed to have effects similar to those of cocaine, amphetamine or MDMA (ecstasy), but little is known of their detailed pharmacology.
Khat Native to tropical East Africa and the Arabian Peninsula Fresh Leaves/tops chewed or consumed as tea Stimulation and euphoria Part of social culture in many countires (coffee, tea, coca or khat)
Khat Coca cocaine Khat cathinone (Schedule I) Cathinones: Structure similar to amphetamines –Euphoria –Anorexia –Stimulation –Dilated pupils –Hypnagogic hallucinations when wearing off
Mephedrone Background Discovered 1929 Rediscovered 2003 web site “The Hive” Was a replacement for Ecstasy Sold as “plant food” & later “bath salts” Manufactured in clandestine labs Methylenedioxypyrpvalerone (MDPV) Known as substituted cathinones
MDPV Timeline MDPV was developed in the 1960s, and has been used for the treatment of chronic fatigue, but caused problems of abuse and dependence. 1969: Boehringer Ingelheim files a patent application for MDPV. 2005: MDPV appears as a recreational drug; first mention on Drugs-Forum. 2007: First seizure of MDPV as a recreational drug, by customs officials in the German state of Saxony. The drug had been shipped from China. 2008: First seizure of MDPV in the United States.
MDPV Timeline 2009: MDPV made illegal in Denmark. 2010: MDPV made a controlled drug in the UK, Sweden, Germany, Australia and Finland. First reports of the widespread retail marketing of 'bath salts' containing MDPV in the US. The US considers both Mephedrone (July, 2010) and MDPV (December, 2010) "a drug and chemical of concern". 2011& 2012: MDPV sale and possession are banned in most US states with legislation being introduced in Maryland an other states.
Mephedrone & MDPV Use Capsules, tablets or white granuels Can be swallowed, smoked, snorted, injected Prominent use in Europe Out of 70 Dutch users of mephedrone, 58 described it as an overall pleasant experience and 12 described it as an unpleasant experience
Mephedrone/MDPV Desired Effects Mental and physical stimulation Euphoria, mood lift Feelings of empathy, openness Increase in sociability, desire to talk with others Pleasurable rushing Sense of being sped up
Mephedrone/MDPV General Effects General change in consciousness (as with most psychoactives) Decreased appetite Pupil dilation Unusual body sensations (facial flushing, chills, goosebumps, body energy) Change in body temperature regulation Sweating Increase in heart rate and blood pressure
Mephedrone/MDPV Toxic Effects Strong desire to re-dose, craving to recapture initial euphoric rush Uncomfortable changes in body temperature (sweating/chills) Heart palpitations, sense of racing heart Impaired short term memory Insomnia
Mephedrone/MDPV Toxic Effects Severe paranoia Psychosis Hypersexuality Aggression Hallucinations Anxiety and depression Seizures
PA Criminal Intelligence Center February 2011, Schuylkill County: PSP, Schuylkill Haven members were attempting to serve a mental health warrant and noticed the subject was fidgety and talking very fast. The subject admitted to taking methamphetamine earlier in the day and snorting two lines of TranQuility bath salts approximately three hours prior to PSP arrival. The subject related he felt no pain, was invincible, and likened the effects to that of a cocaine overdose. He was unable to perform any field sobriety tests
PA Criminal Intelligence Center February 2011, Lebanon County: PSP, Jonestown members responded to a burglary where a subject broke a window and jumped through a glass door. After he was confronted by the occupant, the subject ran outside and kicked in a garage door. While being interviewed by troopers, he jumped onto the hood of the patrol car, rolled off, and went into a fetal position. The subject was incoherent, claimed he was being electrocuted, and was eventually transported to the hospital.
Another PA Story March 2011, two Pennsylvania men were found dead in the woods after missing for two weeks. Toxicology reports indicate that they had taken bath salts prior to their deaths. The bath salts probably led to their disorientation and they died from exposure and hypothermia.
More Bath Salts Tragedy January 2011, a 48 year old Florida woman was jailed after shed attacked and attempted to behead her 710 Y.O. mother with a machete. The woman was high on bath salts she purchased from a local head shop Remember they are: –Potent –Lethal –Highly addictive
One More Story November 2010-a 21 year old Louisiana man snorts a packet of Cloud 9 Bath salts and endures several days of delirium and paranoia. He cuts his own throat with a kitchen knife only to survive and then shoots himself later when he had visions of army soldiers swarming his house.
Bath Salt Data American Association of Poison Control Centers # of calls June 9, 2012 report Year 2010 #304 Year 2011 #6,138 Year 2012 to May 31 #1,320
Berks PA County Head Shop Bust
Same Head Shop
Mephedrone/MDPV Treatment Issues Similar to strong amphetamine addiction Similar to PCP abuse/addiction Stabilization and Safety highest priority –Safety of client –Safety of staff and others
Mephedrone/MDPV Treatment Issues If psychotic or dissociated need to medicate –Neuroleptics: Haldol for emergency stabilization Atypicals (Seroquel/Respirdol/etc.) for ongoing stabilization Decease sensory exposure –“Rock or Rave” medicine –Talking down bad trips –De-escalation techniques
Excited Delirium Delirium Defined: –Acute change in mental status characterized by impairment of attention. Excited Delirium Defined: –Delirium with continuous agitation
Excited Delirium Diagnostic Criteria for Delirium –Disturbance of consciousness with reduced ability to focus, sustain, or shift attention. –A change in cognition such as memory deficit, disorientation, language disturbance –The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate.
ED: Research Findings Excited Delirium often involved psycho- stimulant drugs –Amphetamines –amphetamine derivatives –Cocaine Sometimes even the lack of having taken certain prescription drugs could cause a similar response behavior –i.e. lithium in the case of manic depressants
ED: Research Findings Psycho-stimulant drugs can produce a number of potentially lethal effects Psycho-stimulant overdoses can cause –cardiovascular compromise –Seizures –hyperthermia.
Mephedrone & MDPV Treatment Issues Once stable and safe be aware of cognitive impairment May need “tincture of time” to grasp recovery Supportive non threatening environment Screen for COD (high probability)
Bath Salts Overview They are sold mostly on the internet, but can also be found in select shops locally. They're known by a variety of names, including “Red Dove,” “Blue Silk,” “Zoom,” “Bloom,” “Cloud Nine,” “Ocean Snow,” “Lunar Wave,” “Vanilla Sky,” “Ivory Wave,” “White Lightning,” “Scarface” “Purple Wave,” “Blizzard,” “Star Dust,” “Lovey, Dovey,” “Snow Leopard,” “Aura,” and “Hurricane Charlie.” While they have become popular under the guise of selling as ‘bath salts’, they are sometimes sold as other products such as insect repellant, or plant food with names like “Bonsai Grow” among others.
Effects of MDPV MDPV is sometimes labeled online as legal cocaine or legal amphetamines. The effects have a duration of roughly 3 to 4 hours, with after effects such as tachycardia, hypertension, and mild stimulation lasting from 6 to 8 hours. High doses have been observed to cause intense, prolonged panic attacks in stimulant-intolerant users, and there are anecdotal reports of psychosis from sleep withdrawal and addiction at higher doses or more frequent dosing intervals.
Synthetic Cathinones Effects Summary Sheet Aggression Agitation Breathing difficulty Bruxism (grinding teeth) Confusion Dizziness Extreme anxiety sometimes progressing to violent behavior Fits and delusions Hallucinations Headache Hypertension (high blood pressure) Increased alertness/awareness Increased body temperature, chills, sweating Insomnia Kidney pain Lack of appetite Liver failure Loss of bowel control Muscle spasms Muscle tenseness Vasoconstriction (narrowing of the blood vessels) Nausea, stomach cramps, and digestive problems Nosebleeds Psychotic delusions Pupil dilation Renal failure Rhabdomyolysis (release of muscle fiber contents [myoglobin] that could lead to kidney problems) Severe paranoia Suicidal thoughts Tachycardia (rapid heartbeat) Tinnitus
Dangers/Legal Issues Dr. Volkow, the NIDA Director stated: “Because these products are relatively new to the drug abuse scene, our knowledge about their precise chemical composition and short- and long-term effects is limited.” In February, 2011, Congressman Charles Schumer (D-NY) introduced legislation that would add bath salts to a list of federally controlled substances. September 7, 2011, finally saw this legislation in the form of a proposed temporary DEA ban.
Federal Ban Proposed on 09/7/2011 The United States Drug Enforcement Administration (DEA) is using its emergency scheduling authority to temporarily control three synthetic cathinones (Mephedrone, 3,4 methylenedioxypyrovalerone (MDPV) and Methylone). Except as authorized by law, this action will make possessing and selling these chemicals or the products that contain them illegal in the U.S. for at least one year while the DEA and the United States Department of Health and Human Services (DHHS) further study whether these chemicals should be permanently controlled.
Synthetic Drug Abuse Prevention Act of 2012 July 10, 2012 President signed Law making temporary law permanent October 1, 2012 Synthetic Drugs now listed as Schedule I All substituted cathinones now Schedule I Chemists working on making non- cathinone stimulants research/justice/synthetic-drug-threats.aspx
National vs. State-by-State Bans Just because a federal ban is enacted on a drug, it does not mean local authorities will take action on this drug. States still need to enact legislation to ban the substances in order for state (then local) authorities to take action. Federal bans will go after larger distributors, but it will be locally determined as to whether users and smaller, local distributors (such as non- chain convenience stores and gas stations) will be sought after without a state ban.
Prevention For K2 & Bath Salts Heighten awareness via Education –Schools, parent groups, community groups, law enforcement, medical & treatment, etc. Legislation against precursor chemicals Legislation making drugs Schedule I –Patrick Meehan “Synthetic Drug Control Act” Goes into effect October !!! “Hit the retailers in their pocket book” –Civil suits by victims (users and families) –Authorities appealing to retailers with amnesty if stop and destroy
Urine Detection Information Redwood Toxicology Laboratory shows currently they have detection for MDPV and Mephedrone. (see w.K2info.org/drugtesting) June 11, 2012 Redwood expanded to test for #21 designer stimulants _stimulant_testing.html Atlantic Labs- Bensalem, PA Bath Salts $20.00 and K2 $ Most labs now testing –Check with your lab
Urine Detection Information (Expanded to #21 June 2012) Redwood has a 2 panel drug test (MDPV, Mephedrone) and a 14 panel drug test which tests for the following drugs: 1.BZP (Benzylpiperazine) 2.Butylone (β-keto-N-methylbenzodioxolylpropylamine, bk-MBDB) 3.Cathinone (Khat or Benzoylethanamine) 4.Ethylone (3,4-methylenedioxy-N-ethylcathinone, MDEC, bk-MDEA) 5.MBDB (Methylbenzodioxolylbutanamine, Methyl-J, “Eden”) 6.mCPP (meta-Chlorophenylpiperazine) 7.MDA (3,4-Methylenedioxyamphetamine, tenamfetamine) 8.MDEA (3,4-Methylenedioxy-N-ethylamphetamine, MDEA, MDE, “Eve”) 9.MDPV (Methylenedioxypyrovalerone, Cloud 9, Ivory Wave, White Lightning) 10.MDMA (3,4-Methylenedioxymethamphetamine, ecstasy, “E”, “X”) 11.Mephedrone (4-methylmethcathinone [4-MMC], 4-methylephedrone, “Meph”, “MCat”) 12.Methcathinone (α-methylamino-propiophenone, may be confused with mephedrone) 13.Methylone (3,4-methylenedioxy-N-methylcathinone, bk-MDMA, MDMC, “M1”) 14.TFMPP (3-Trifluoromethylphenylpiperazine, “Legal X”)
On-Site Testing Many labs now have available On site may be useful in treatment Problem: labs report as high as 35-40% false negatives with on-site –On-site shows no use but when testing for accuracy they send to lab for confirm and up to 40% tested positive.
You May Ask What’s Next? Krokodil? –In Russia and Europe 2C-1 or “Smiles” –Yahoo reports 09/19/2012 Kratom –Here today in Maryland & Mid-Atlantic States –Marketed as “Natural” substitute for K2 & K3
Krokodil Opioid- desomorphine Result of attempt to extract codeine Injected can be used by other routes Russia & spreading through Europe Tissue breakdown Highly addicting- Usually fatal
Points to Ponder WHAT –Did I learn so far? –What do I think about it? –How do I feel about it? So WHAT –Does this information mean to me professionally and personally?????
Objectives History and background of “new synthetic designer drugs” Epidemiology and current trends Effects and dangers of these drugs How sold, what they look like and how used Prevention and treatment issues