Presentation on theme: "NEW DRUGS OF ABUSE: BATH SALTS AND SYNTHETIC CANNABINOIDS Bruce D. Anderson, PharmD, DABAT Director of Operations Associate Professor University of Maryland."— Presentation transcript:
NEW DRUGS OF ABUSE: BATH SALTS AND SYNTHETIC CANNABINOIDS Bruce D. Anderson, PharmD, DABAT Director of Operations Associate Professor University of Maryland School of Pharmacy
Objectives Know what the commonly encountered substances called “bath salts” usually contain Understand the basic pharmacology of bath salts and synthetic cannabinoids Be able to describe the usual acute clinical effects from users of bath salts and from synthetic cannabinoids Be able to describe the potential psychiatric impact of bath salts use
Save lives by providing emergency triage and treatment information to all callers. Save dollars by managing vast majority of patients (~75%) safely and inexpensively at home. Bottom Line (continued)
Last year, ~29,432 poisoning patients were safely managed at home. Usual charge for ED evaluation and treatment: ~$1,000 per patient Estimated cost savings: ~$29,432,000 per year Fiscal Impact:
Bath Salts: Pharmacology Structurally similar to amphetamines and hallucinogenic amphetamines (e.g., MDMA) as well as cathinones Functionally closer in effect to cocaine
Clinical Effects See typical stimulant effects Hallucinogenic activity Behavioral changes are common; may be persistent
Clinical Effect# Patients (%) Agitation 194 (82%) Combative/violent behavior 134 (57%) Tachycardia 132 (56%) Hallucinations 94 (40%) Paranoia 86 (36%) Confusion 83 (34%) Myoclonus 45 (19%) Hypertension 41 (17%) Chest pain 40 (17%) Mydriasis 31 (13%) Spiller HA et al. Clinical experience with and analytical confirmation of bath salts and legal highs in the United States. Clin Toxicol 2011;49:499-505.
Management: Bath Salts Exposures Airway, Breathing, Circulation Charcoal: only for substantial, recent ingestions Calm environment Benzodiazepines Symptomatic care
Typical Case: Bath Salts 38 year old presents to ED with altered mental status Hyperverbal, talking out of his head and making no sense BP 160s/100s; HR 120s; unable to get EKG Hallucinating, sweating, agitated Given 10 mg haloperidol, 2 mg lorazepam, 20 mg ziprazidone, 10 mg olanzepine without response; in 4 point restraints Admitted to ICU, placed on dexmedetomidine; remains confused, agitated, diaphoretic, hypertensive 3 hours later, the patient is A&O * 3, VSS, just observing.
Bath Salts in Maryland 68.5% Male Age: Range: 9- 60 Mean: 29 Med: 27 79.5 % Abuse 75% Male Age: Range: 16- 48 Mean: 26 Med: 25 84.1% Abuse 2011 2012 Maryland Poison Center 2011: 73 cases 5 major effect 2 deaths 2012: 44 cases 0 major effects 0 deaths
Where to Buy? http://legalhighs.net63.net/product.php?id_product=19
Regulation Status February 24, 2010: First report of bath salt exposure. October 21, 2011: DEA emergency scheduling December 8 th, 2011: Synthetic Drug Control Act (HR 1254) July 9, 2012: Synthetic Drug Abuse Prevention Act http://www.justice.gov/dea/druginfo/drug_data_sheets/Bath_Salts.pdf. Accessed 7 Dec 2012. http://www.deadiversion.usdoj.gov/drugs_concern/mdpv.pdf. Accessed 7 Dec 2012. http://www.govtrack.us/congress/bills/112/s3189. Accessed 7 Dec 2012. Clin Toxicol 2012;50:911-1164.
Banned But Replaced http://www.fridayflyer.com/2012/10/05/banned-bath-salts-replaced-with-new-products
Synthetic Cannabinoids: Effects Altered mental status Paranoia Psychosis Seizures Tachycardia Hypertension Nausea and vomiting Loss of consciousness Acute pain Hypokalemia Acute kidney injury Bhanushali GK, Jain G, Fatima H, et al. AKI associated with synthetic cannabinoids: a case series. Clin J Am Sco Nephrol 2012;ePud ahead of print Dec 14.
Typical Case: Synthetic Cannabinoids Call from ED regarding a 15 year old who presents after smoking synthetic cannabinoids On presentation, patient was combative, screaming, and hallucinating Treated with haloperidol and alprazolam After 4 hours of observation, patients symptoms subsided and he was discharged home.
Synthetic Cannabinoids Why use? avoid urine drug screen tests Thought to be “safe” alternative to marijuana Avoid going to a drug dealer
Synthetic Cannabinoids Synthetic Drug Abuse Prevention Act of 2012 Specified “cannabinimimetic agents” as Schedule I substances Producers have changed formulations to avoid the law and are still selling online, convenience stores and in head shops
Cases of intentional abuse or misuse of synthetic cannabinoids reported to the Maryland Poison Center over time. Time Number of cases
Synthetic Cannabinoids Management: Supportive care (ABC’s) NOTE: Symptoms may persist