Synthetic Drugs of Abuse: ‘Spice,’ ‘K2’ and ‘Bath Salts’ Side effects and Long term consequences Willie A. Hamilton, BC-FNP Board Certified in Sports Medicine & Nutrition

 Spice/K2 brands marketed as natural herbal incense  “Not for human consumption”  Available convenience stores, gas stations, Internet  Cannabis substitute Psychonaut Web Mapping Research Group (2009.) Spice Report. Institute of Psychiatry, King’s College London: London UK.

 delta-9 tetrahydro- cannabinol (∆ 9 -THC) agonism of cannabinoid receptor type 1 (CB1)  SCs more potent  Typical doses are often less than 1mg  Not readily detectable JWH-018 ∆ 9 -THC

Marketed as similar to cannabis:  Euphoria  Sociability  Anxiolytic  Relaxation  Stimulant Cross tolerance with THC?

 Anxiety  Paranoia  Headache  Vomiting  Psychosis  Diaphoresis  HR/BP increase  Seizures

 No data on prevalence of use  American Association of Poison Control Centers: Synthetic cannabinoids:  2009: 13 calls  2010: 2304 calls (Nov), a projected 200x increase Marijuana:  2008: 4009 calls, with 1020 for marijuana alone

 Methylenedioxypyrovalerone (MDPV) and Mephedrone  Sold as “bath salts” or “plant fertilizer”  Currently legal in the United States  Available online and in convenience stores

 CNS stimulants  Related to cathinone, an active alkaloid found in the khat plant (N. Africa)  Previously abused primarily in Europe and Australia

 Route: Intranasal most common  Also: oral, smoking, rectal, and IV  White to light brown crumbly powder  Degrades if exposed to air for significant periods of time MDMA

 CNS stimulant similar to methamphetamine, MDMA, or cocaine  Norepinephrine-dopamine reuptake inhibitor (NDRI)  Increased alertness, arousal, anxiety, agitation, diminished requirement for food and sleep, sexual arousal  Tachycardia, hypertension, vasoconstriction, diaphoresis

 “High” lasts 3-4 hours  Physical effects may last 6-8 hours  May cause seizures, panic attacks, or psychosis with high doses or increased frequency of use  Avg dose: 5 to 20mg hina-Mdpv-by-pevukka.html

 Trismus (inability to open mouth) or bruxism  Panic attacks  Psychosis with sleep deprivation  Hallucinations, delusions, suicidal ideation  Abstinence syndrome: depression, lethargy, anxiety, postural hypotension  Leads to frequent re-dosing

 UK: MDPV regulated under the Misuse of Drugs Act 1971  US: Not scheduled but banned in some states  DEA: controlled by the Federal Analogue Act? temporary-ban-on-spice-and.html

 4-methylmethcathinone (4-MMC)  Meow Meow  MCAT  Miaow  Drone  Plant Feeder  Bubbles

 NE-DA reuptake inhibitor  Similar to MA/MDMA  Reportedly less potent, shorter duration  Oral dose: 20-50mg  “Come up”: min  Peak: min  “Comedown”: min  Re-dosing: common Mephedrone Amphetamine

 Oral ingestion  Swallowing capsules  Bombing (swallowing powder wrapped in cigarette paper)  Insufflation (snorting)  Rectally (either plugging or enema)  IV (use 1/2 to 1/3 dose)

 Euphoria  Sociability  Stimulation  Sexual Arousal  Music Appreciation  Hallucinations

 Loss of appetite  Increase in body temperature, sweating, hot flushes  Tense jaw, bruxism, stiff neck, muscle clenching  HR/BP elevation, chest pains  Dehydration  Mydriasis, nystagmus  Painful nasal drip/ulcers in mouth (after insufflation)  Insomnia, paranoia, anxiety, dysphoria, psychosis

 : Banned in many European counties  December 2010: Illegal throughout the EU  Mephedrone is not specifically banned in the United States  However, some states have banned mephedrone  DEA: may be controlled by the Federal Analogue Act as an analogue of methcathinone

 No data on prevalence of use  American Association of Poison Control Centers: Bath Salts:  2010: 292 calls  2011: 469 calls (2/14/11), a projected14-fold increase

Contact Information Willie A. Hamilton, BC-FNP LIVEfit Medicine 1901 Brookside Dr. Kingsport, TN (423)