1. Treatment is Effective Behavioral Health is Essential to Health Prevention Works People Recover Improving the quality of life for West Virginians with behavioral health needs West Virginia Department of Health and Human Resources Bureau for Behavioral Health and Health Facilities

3. Funded by: This training is funded by a grant from the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention, and the West Virginia Department of Health and Human Resources, Bureau for Behavioral Health and Health Facilities.

4.  This session will help the participant:  Increase awareness about the impact of bath salts and synthetic marijuana use/abuse in WV  Recognize signs and symptoms and appeal of synthetic drug use  Identify the drug and packaging as well as the dangers of use/abuse

5.  Bath Salts are synthetic stimulant drugs  VERY DANGEROUS: addictive and potentially lethal  More potent than cocaine  Not organic-made with chemicals  They do not contain fragrant soaps or oils, yet they are packaged to seem so

6.  Crystalized powder that can be white to brown, with shades in between and even speckled.  Typically an attractive package about the size of a tea bag.  The label says “Not for Human Consumption”  Manufactured mainly in China or India. There are labs in the US…

7. This is an example of packaging. The size is slightly larger than a tea bag.

8.  According to the Drug Enforcement Administration, active ingredients in bath salts are:  Methylenedioxypyrovalerone (MDPV)  and/or mephedrone MDPV and mephedrone are synthetic and addictive chemicals

9.  MDPV (methylenedioxypyrovalerone)  CFT (cocaine analog)  mephedrone (amphetamine)  cathinone (khat)  naphyrone (like amphetamine)  2-dPMP (2- diphenylmethylpiperidine or desoxypipradrol - like methylphenidate)

10.  Insect repellant  Pond scum remover  Jewelry Cleaner  Plant food  Toy cleaner  Water softener  Legal Cocaine

11. Aura Bliss Bloom Blue Silk Bolivian Bath Charge + Charge Plus Cloud 9 Cloud Nine Euphoria Scarface Sextacy Snow Leopard Stardust Tranquility Vanilla Sky White Dove White Lightning Zoom Hurricane- Charlie Ivory Coast Ivory Wave Lunar Wave Ocean Ocean Snow Pure Ivory Purple Wave Raving Dragon Red Dove

12.  Prices range from $25 to $50 for 50 mg or ½ gram – depending where bought.  Some use up to 200 mg. depending on their tolerance for drugs  Users say: “use 10th of what you would use for cocaine”  Lots of stories about being careful about using too much can cause a really bad experience.

13.  Size of a 50 cent piece  Average price $30 Pictures provided by Lt. Thomas J. Reagan Bangor Police Department

14.  Internet as bath salts and/or “legal high”  Some local shops hide it behind the counter (convenience stores)  Head shops

15. Pictures provided by Lt. Thomas J. Reagan Bangor Police Department

17.  Euphoria  Sociability  Stimulation  Sexual Arousal  Music Appreciation  Hallucinations

18.  Because “bath salts” are relatively new to the drug abuse scene, scientists are still unsure about what their long-term effects might be for those who try to use them recreationally. But one thing IS certain: it’s NOT worth the risk of finding out.

19.  Males and females  Ages early 20s to 50s  Seeing more and more young men in their 20s and increase in females  Teenager use on the rise

20.  Bath Salts abuse and problems associated with abuse are increasing at an alarming rate. 2009-no calls to Poison center for bath salts 2010-304 calls (WV reported 4) 2011-6,138 calls(WV reported 253) 2012-2,656 calls (WV reported 45)

21.  Can be used in a variety of ways in a liquid form:  Smoked  Snorted  Injected  Others

22.  By soaking cigarettes  With a crack pipe  Off of foil

25.  Oral  Capsules, ‘bombing’-wrapping MDPV powder in cigarette papers and swallowing, dabbing, dissolved in liquid  Rectal  Enema (user report: 1 mg mixed with 3 mL water)  Vaginal  Soak tampons in solution

26. 200 times MORE potent than Ritalin

27.  Paranoia  Hallucinations  Anger  Intense cravings to re- dose  Loss of coordination  Intense thirst  Dry mouth  Panic/anxiety  Vomiting  Dizziness  Profuse Sweating  Hyper alertness  Violence  Elevated Blood pressure  Jaw clenching/tooth grinding (Bruxism)  Delusions  Mood swings  Depression  Suicidal thoughts

28.  “High” lasts 3-4 hours (or even days)  Physical effects may last 6-8 hours  May cause seizures, panic attacks, or psychosis with high doses or increased frequency of use  Average dose approx. 5 to 20mg

30.  Suicidal thoughts and actions  Self mutilation  Running around, screaming  There is no crash – effects can last for days and wax and wane over the time  Paranoia can be extreme – think someone or something is out to get them – weapons have been involved – guns, knives, hatchets, etc.

31.  Agitation with or without violence  May be catatonic (lights on – no one home)  May get violent after catatonic state with little to no warning  Paranoia, yelling  Large pupils (not always)  “The Stare”  Sweat and thirst

32.  Jerky body movements  Grinding of teeth  Euphoria and stimulation for hours  Psychotic for hours to days or longer

33.  “Not for Human Consumption”  Printed warning loophole to evade scrutiny from Food and Drug Administration (FDA)

34. That’s why manufactures pretend that they are “bath salts, plant food, or water softeners”. But think about it: since when does plant food or bath powder cost $50 a milligram? In 2010, the DEA reported that MDPV and mephedrone were “related in chemical structure” to illegal drugs like Ecstasy, cathinone and methamphetamine. In other words “bath salts” are essentially analogs, or chemical cousins, to illegal drugs.

35. SUMMARY: Adding synthetic cannabinoids and hallucinogens and stimulants to the Schedule I list of controlled substances What does this mean? Now a misdemeanor to sell, buy, possess synthetic drugs in W.V. This bill was passed by both House and Senate and approved by the Governor in April 2011.

36. SUMMARY: Added synthetic cannabinoids (K2, Spice), methylenedioxypyrovalerone (MDPV) and mephedrone (bath salts) to the Schedule I list of controlled substances. What does this mean? Now a federal crime to sell, buy, or possess synthetic drugs in the U.S. This bill was passed by both House and Senate and signed by the President on July 9, 2012.

37. Some think “this is not happening in my county/city/town/neighborhood” THINK AGAIN It IS in our back yard

38. BARBOUR 1 BERKELEY BRAXTON BROOKE CABELL CLAY FAYETTE GILMER GRANT GREENBRIER HAMPSHIRE HANCOCK HARDY HARRISON JACKSON KANAWHA LEWIS LINCOLN MCDOWELL MARION MASON MERCER MINERAL MONONGALIA MONROE MORGAN NICHOLAS OHIO PENDLETON POCAHONTAS PRESTON PUTNAM RALEIGH RANDOLPH RITCHIE ROANE SUMMERS TUCKER TYLER UPSHUR WAYNE WEBSTER WETZEL WIRT WOOD WYOMING ANTS PLEAS- RIDGE DODD- HOUN CAL- MARSHALL JEFFERSON TAYLOR MINGO LOGAN BOONE Legend 1-5 Calls 6-10 Calls 11-15 Calls 16-20 Calls 20+ Calls 2011 Bath Salt Exposure Calls By County Harrison County lead the state with 45 Bath Salt Exposure Calls Kanawha County is second behind Harrison County with 39 Bath Salt Exposure Calls Source: National Poison Data System; Human exposure calls by product code 1/1/2011 through 12/31/2011

39. BARBOUR 1 BERKELEY BRAXTON BROOKE CABELL CLAY FAYETTE GILMER GRANT GREENBRIER HAMPSHIRE HANCOCK HARDY HARRISON JACKSON KANAWHA LEWIS LINCOLN MCDOWELL MARION MASON MERCER MINERAL MONONGALIA MONROE MORGAN NICHOLAS OHIO PENDLETON POCAHONTAS PRESTON PUTNAM RALEIGH RANDOLPH RITCHIE ROANE SUMMERS TUCKER TYLER UPSHUR WAYNE WEBSTER WETZEL WIRT WOOD WYOMING ANTS PLEAS- RIDGE DODD- HOUN CAL- MARSHALL JEFFERSON TAYLOR MINGO LOGAN BOONE 2011 Bath Salt Exposure Calls By Region Source: National Poison Data System; Human exposure calls by product code 1/1/2011 through 12/31/2011 Region 1: 34 Calls Region 2: 10 Calls Region 3: 20 Calls Region 4: 67 Calls Region 5: 96 Calls Region 6: 26 Calls

40.  Synthetic drugs  Synthesized to mimic effects of marijuana  More potent than THC  Not organic-made with chemicals (sprayed on plant material)  When burned this substance usually has a pleasant odor…

41.  America’s poison centers first received calls about “synthetic marijuana” in late 2009  2,960 calls in 2010--36 calls in WV  6,955 calls in 2011--77 calls in WV  80% of these calls placed from ER, compared to 20% regularly

42.  West Virginia Poison Center  36 human exposure calls received in 2010  77 human exposure calls received in 2011  West Virginia Poison Center has reported an increase in K2 exposure calls in 2011 used in combination with other drugs since 2010  House Bill 2505 banned the sale of synthetic cannabinoids in June 2011

43.  Chemicals were developed in lab for research for pain in cancer patients-much like medicinal marijuana  Recipe was destroyed because of adverse effects in lab animals  Not tested on humans, affects are not fully known  Chemist in China and Korea started using these chemicals for K2

44.  Marketed as incense  K2 is typically sold in small, silvery plastic bags of dried leaves and marketed as incense that can be smoked  Resembles potpourri (usually sprayed on lemon grass or other herbs/plant material)  Marketed toward youth

45.  It produces a high similar to that of marijuana  It doesn't contain tetrahydrocannabinol (THC), the psychoactive chemical in marijuana  K2 contains synthetic chemicals, known as JWH-018 and JWH-073, that mimic THC by acting on the cannabinoid receptors in the brain  It binds with the CB1 receptor and produces a euphoric effect or high in humans. JWH-018 binds with CB1 receptors at a rate four times greater than THC (natural or synthetic)  The common marijuana drug tests are calibrated to detect THC and THC metabolites, not the synthetics used in Spice or K2

46.  A mixture of herbs and spices (or just grass clippings)  Typically sprayed with a synthetic chemical such as: e HU-210, HU-211, JWH-018, and JWH-073.  The chemicals are known to stay in the human body for a long time.  The long term effects of the chemicals are unknown.

48.  Smoked in joints  Smoked in pipes  Mixed in tea

49.  Spice  K2  Genie  Yucatan  Fire  Sense  Smoke  Black Mamba  Fake Weed  Designer drugs  Skunk  Bliss  Bombay Blue  Zohai

50.  Mainly Online (Since 7-9-12)  “Head Shops”  Tobacco Outlets  Various Retail Outlets  Gas Stations/Convenience Stores  According to the DEA, “Manufacturers of this product are not regulated and are often unknown since these products are purchased via the Internet whether wholesale or retail. Several websites that sell the product are based in China.”

51.  $30 to $40 +/- per 3 gram packet.  Price on Community:  DUIs with fatalities  Suicides  Drug abused to evade drug screenings

52.  Dizziness  Nausea  Vomiting  Anxiety  Paranoia  Rapid Heart Beat  Increased Blood Pressure  Loss of Consciousness  Paranoid Behavior  Intense Hallucinations  Agitation  Seizures

53.  Don’t feel helpless!  Become educated about synthetics drugs  Talk about it with neighbors, relatives, and co-workers  The best prevention is setting clear expectations and guidelines for your kids and kids you know. They will listen…

54.  Get the word out about “bath salts.” Contact your local Drug Free Coalition and ask them to have a forum or a community presentation.  Get articles out in your local news papers.  If someone you know experiments with “bath salts” don’t hesitate to get professional help.

55.  Drug Enforcement Administration, www.dea.gov  American Association of Poison Control Centers, www.aapcc.org  k2spicediamond.com (this is an internet store)  stopthedrugwar.org  k3spice.blogspot.com (this is an internet store)  CADCA Webinar – Designer Drugs: The New Frontier  www.fox59.com/news/wxin-lafayette-spice-ban- 081810,0,5699301.story  Northern New England Poison Center, www.nnepc.org  Bangor Police Department, Bangor, Maine  Web MD www.webmd.com

56.  National Institute on Drug Abuse, www.nida.nih.gov  Office of National Drug Control Policy. www.whitehousedrugpolicy.gov  House Bill 2505, www.legis.state.wv.us/Bill_Status/Bills_history.cfm?input=2 505&year=2011&sessiontype=RS&btype=bill  Erowid, www.erowid.org  www.mainelegislature.org/legis/bills/bills_125th/billtexts/HP 119201.asp

57. Cathy Coontz, MA, MS, PSII, NPN Prevention Lead for WV and National Prevention Network for WV Division on Alcoholism and Drug Abuse Bureau for Behavioral Health and Health Facilities 350 Capitol Street, Room 350 Charleston, WV 25301 Cathy.E.Coontz@wv.gov