Non-Medical Use of Synthetic Marijuana (Cannabinoids) Non-Medical Use of Synthetic Marijuana (Cannabinoids) We will be starting shortly.

Non-Medical Use of Synthetic Marijuana (Cannabinoids) April 20, 2011 Presenter Rick Moldenhauer MS, LADC, ICADC, LPCC

Introduction to Connect Pro Welcome to this Connect Pro Virtual Meeting. We will be using the following windows: –PowerPoint Window –Attendee List –Chat –Note We will also use the “Raise your Hand” feature 3 Consie English Senior Administrative Assistant

Introduction to Connect Pro Two Ways to Ask Questions 1. In Writing: –Write question in Chat window –Press “Enter” –Only the moderator will see your question Consie English Senior Administrative Assistant 4

Introduction to Connect Pro 2. By Raising Your Hand: Raise your hand by clicking You will see your status change in attendees list Un-mute your phone (press *#) when called upon Remember to mute your phone again once you have finished speaking (press *#) Lower your hand by again clicking 5 Consie English Senior Administrative Assistant

Regional Introductions ME NY PA NH VT NJ MA CT RI DE MD Jan Hofmann Associate Coordinator, Central Region Chuck Klevgaard Coordinator, Northeast Region 6 WV ND SD IA IL WI OH IN MI MN Lower Brule Sioux Tribe Little Traverse Bay Band of Odawa Indians Great Lakes Inter- Tribal Council Grand Traverse Band Oglala Sioux Tribe Leech Lake Band of Ojibwe Red Lake Nation

Learning Objectives By the end of this webinar, participants will have: Learned about various forms of synthetic cannabinoids and current developments with these substances Identified the signs of intoxication, withdrawal symptoms, and medical problems associated with synthetic marijuana Discussed actions taken by the DEA as they impact states Identified potential local- and State-level policy strategies for addressing use Chuck Klevgaard Regional Coordinator 7

Rick Moldenhauer Treatment Services Consultant at the Alcohol and Drug Abuse Division, Department of Health Services More than 25 years of direct care experience in a wealth of settings involving chemical dependency treatment. On a variety of State and Federal initiatives involving best practices and committees for various purposes. Author, frequent speaker, and technical assistant in quality delivery of chemical dependency services. 8

Rick Moldenhauer 9

Poll 10

Examples of Brand Names SPICE Spice Silver Spice Gold Spice Diamond Spice Tropical Synergy Spice Arctic Synergy Smoke Plus K2 Buddha Melt Budda Blend Smoke X. XX and XXX Chillin XXX Spicey XXX ZoHai SX Eclipse Bonzai fertilizer 11

Synthetic Cannabinoids in Herbal Blends 1. HU-210 [(6aR,10aR)-9-(hydroxymethyl)-6,6-dimethyl- 3 -(2-methyloctan-2-yl)-6a,7,10,10a- tetrahydrobenzo[c] chromen-1-ol] 2. CP 47,497 [2-[(1R,3S)-3-hydroxycyclohexyl]-5-(2- methyloctan-2-yl)phenol)] 3. Cannabicyclohexanol (CP 47,497 C8 homologue) [2-[(1R,3S)-3-hydroxycyclohexyl]-5-(2-methylnonan- 2-yl)phenol)] 12

Synthetic Cannabinoids in Herbal Blends (cont’d) 4. JWH-018 [1-pentyl-3-(1-naphthoyl)indole] 5. JWH-073 [1-butyl-3-(1-naphthoyl)indole] 6. JWH-200 [1-[2-(4-morpholinyl)ethyl]-3-(1- naphthoyl)indole] 7. JWH-250 [1-pentyl-3-(2-methoxyphenylacetyl)indole] 8. JWH-081 [1-pentyl-3-[1-(4-methoxy)naphthoyl]indole] 13 We will be talking about these two, as they are primary

JWH-018/073 - SPICE JWH-018 / 073 are analgesic chemicals from the naphthoylindole family, which acts as a full agonist at both the CB 1 and CB 2 cannabinoid receptors, with some selectivity for CB 2. Synthetic cannabinoids Sold as incense 14

Packaged as Incense: Implying Safety 15

Sample Ad for Incense 16

JWH-018 Created in 1995 for experimental purposes in animal and cell cultures, not humans, by Dr. John Huffman, PhD at Clemson University 17

JWH pentyl-3-naphthoylindole An analgesic chemical from the aminoalkylindole family. $40.00 per gram 18

JWH-018 as Agonist to CB1 Mainly found in the brain (CNS), also in lungs liver and kidneys Increase formation of fatty acids (lipogenesis) Inhibit the motor activity of the gastrointestinal tract (gastrointestinal motility) Low blood pressure (hypotension) Reduced pain sensitivity (hypoanalgesia) 19

JWH-018 as Agonist to CB1 Mainly found in the immune system and hematopoietic cells Plays a role in the autoimmune system and response Dosage varies per individual Testing issues 20

JWH-018 Route of Administration Usually dissolved from powder: 10mg/ml in 95% EtOH, mixed in 1 mg of inert material Smoked: Most common Inhaled: Vaporization through oil pipe or cigarette Oral: As granule (onset in hours);If dissolved onset < hour Insufflation: Unknown; peak effect almost instantly 21

JWH-018 JWH-018 produces a traditional decreasing (tachyphylactic) response to the drug in repeated dosing, notably decreasing after 3 days of regular dosing Likely result of CB1 down regulation, similar to tolerance developed from cannabis Some short-term memory loss associated with chronic use 22

JWH-018 THC is a partial agonist at CB1 receptors; JWH-018 (and many of its analogues) are full agonists Users may experience far more intense effects compared to smoking cannabis THC has been shown to inhibit GABA neurotransmission in the brain Some concern about hypokalaemia, resulting in Q-T prolongation, but argued in research 23

Questions? 24 We’ve just reviewed various forms of synthetic marijuana. How are we doing? Next, we will talk about signs of intoxication, withdrawal symptoms, and medical problems.

JWH-018 Desired Psychoactive Effects Visual changes Color enhancement Uncontrollable laughter Euphoria Talkativeness Sexual stimulation Time dilation Sedation Sleep aid Analgesia Anti-depressant 25

Intoxication 26

Conjunctival Injection (Redness of the Eye) 27

Xerostomia (Dry Mouth) 28

Potential Withdrawal Symptoms 29

Chat Box Question What is Happening With the Law in Your State/Tribe? ME NY PA NH VT NJ MA CT RI DE MD Jan Hofmann Associate Coordinator Chuck Klevgaard Regional Coordinator 30 WV ND SD IA IL WI OH IN MI MN Lower Brule Sioux Tribe Little Traverse Bay Band of Odawa Indians Great Lakes Inter- Tribal Council Grand Traverse Band Oglala Sioux Tribe Leech Lake Band of Ojibwe Red Lake Nation

Enacted and Pending Legislation As of April 1, H 30 ME H673 NY PA NH VT NJ MA CT RI DE MD H1383 S761 and S1098 LSR 178 (H 448) A 2644 (2010) and S 2606 S 1834 and A 5008 S 164, H 176 and H365 H 5066 Chuck Klevgaard Regional Coordinator Enacted Pending NORTHEAST REGION

Enacted and Pending Legislation As of April 1, 2011 (cont’d) 32 WV ND SD IA IL WI OH IN MI MN Lower Brule Sioux Tribe Little Traverse Bay Band of Odawa Indians Great Lakes Inter-Tribal Council Grand Traverse Band Oglala Sioux Tribe Leech Lake Band of Ojibwe Red Lake Nation S 2119 H 33 / H 34, H 186, S 35, SSB 1016/ D 1274, S 462 IL HB 6459 (2010) H 100, H1655, H 2089 H 2917, H 3042, H3486 S 152, S 5, H 1102, H 1277, S 448, S 57, H 1315 H 2505 S 63 H 64, S 57 HB 6038 (2010) S 259 H 57, S 7, S 537, S 850 Enacted Pending CENTRAL REGION Jan Hofmann Associate Coordinator HB 1015 (2011)

SCHEDULE I CONTROLLED SUBSTANCES – Elements of the ruling –Impact of the ruling Handout MN Board 33 Minnesota Board of Pharmacy Proposed Ruling on Synthetic Marijuana Rick Molderhauer

Drug Enforcement Administration Actions on Synthetic Marijuana November 24, 2010 –The Deputy Administrator of the Drug Enforcement Administration (DEA) is issuing this notice of intent to temporarily place five synthetic cannabinoids into the Controlled Substances Act (CSA) March 1, 2011 –21 CFR Part 1308 [Docket No. DEA–345F] Schedules of Controlled Substances: Temporary Placement of Five Synthetic Cannabinoids Into Schedule I Handout DEA 34

35 HF 57 –Introduced Jan 10, 2011 SF7 –Modified MS 152, Subp 2 Handout HF57 and SF7 Minnesota House and Senate Bills on Synthetic Marijuana

36 Chemical substances covered under states laws differ from state to state Capacity to enforce state and federal laws is limited Minor changes to chemicals create new substances not covered under policy Implications and Limitations of Policy

How Will You Use This? 37

Tracking Synthetic Cannabinoids National Forensic Laboratory Information System –Annual Report presents national and regional findings on drug cases analyzed during the past year, including drug seizure information by location. –First mentioned in 2008 annual report –Update in 2009 annual report The Drug and Chemical Evaluation Section (ODE) of the DEA Office of Diversion Control continues to gather information on abuse, diversion, and trafficking of “Spice” and its purported constituents. 38

Questions? 39

Treatment Services Consultant State Opioid Treatment Authority P: (651) F: (651) Alcohol and Drug Abuse Division, Department of Health Services P.O. Box St Paul, Minnesota Rick Moldenhauer MS, LADC, ICADC, LPCC 40

Thank You for Participating! 41 Jan Hofmann Associate Coordinator

Evaluation Instructions 42 Consie English Senior Administrative Assistant