The New Designer Drugs

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This presentation aims to describe and compare the new designer drugs, #KratomEffects or sometimes referred to as "legal highs" (kratom, bath salts and k2, among others) to the opiates and cocaine …

This presentation aims to describe and compare the new designer drugs, #KratomEffects or sometimes referred to as "legal highs" (kratom, bath salts and k2, among others) to the opiates and cocaine from the good old days.

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  • THIS WAS SAME TIME HAD MAJOR DRUGS OF ABUSE - Been around for decades (centuries?) All been used in medical practice
  • Morphine and heroin made illegal in 1925, several legal alternatives, with virtually identical effects, were promptly marketed and sold were popular, and remained so even after its criminalization in 1968 MDMA 1912 by Merck chemist Anton Köllish and championed throughout the '70s and '80s by chemistry professor Alexander Shulgin and psychotherapist Leo Zeff. It also became popular as a euphoric at nightclubs worldwide and was unregulated in the U.S. until 1985, when the DEA used emergency scheduling power for the first time to ban MDMA Emergency scheduling gives the government the power to ban chemicals for up to 18 months while gathering evidence for a permanent scheduling. MDMA was permanently scheduled in 1988
  • The United States Pharmacopeia (USP) is a non–governmental, official public standards–setting authority for prescription and over–the–counter medicines and other healthcare products manufactured or sold in the United States
  • in the academic Journal of Pharmacology and Experimental Therapeutics in 1998
  • JWH-018 binds to the brain cannabinoid receptor CB1 with higher affinity than Δ9-THC, suggesting that it would have the same effects as Δ9-THC These four effects indicate Δ9-THC-like psychoactivity in humans

Transcript

  • 1. Not Your Mother’s Drugs: The New Designer Drugs1 Diane A. Tennies, Ph.D., LADC Lead TEAP Regional Health Specialist Humanitas, Inc.
  • 2. Learning Objectives Describe the different designer drugs including synthetic cannabinoids, bath salts and kratom Discuss why the designer drugs are increasing in popularity Articulate the physiologic effects associated with their use Discuss the current status of federal and state laws surrounding designer drugs 2
  • 3. Remember When?Simpler and Easier Times 3
  • 4. ‘The Good Ole Days’ Opiates Cocaine Phencyclidine (PCP) Extensive scientific literature (clinical and experimental)  Kinetics (the chemical process)  Toxicological effects (on humans) 4
  • 5. Designer Drugs Synthetic drugs produced by underground chemists Labeled ‘designer drugs’ as same changes to chemical structures so are specifically ‘designed’ or altered They are technically legal by chemical formulation Commonly used by young people and adults (ages 21-30) Originally called “club drugs” 5
  • 6. Designer Drugs (Continued) Marketed as having similar effects of the illegal counterpart Easily obtain instructions for mixing, making, dosing and ingesting synthetic drugs on line (Erowid.org) Easily obtained as Internet is flourishing marketplace Dangerous and unpredictable side effects because:  More potent  Last longer  Never tested on humans  No regulatory oversight or quality control  More addictive potential (intentionally designed) 6
  • 7. Our Brave New World K2/Spice – “Fake Pot” – A synthetic cannabinoid which mimics marijuana Bath Salts – The “New Cocaine” – a synthetic stimulant whose affects last 3 to 4 hours Kratom – The “latest” designer drug – A plant from Thailand with opiate-like properties which is legal in most areas of USA 7
  • 8. But Is This REALLY a Problem?American Association of Poison Control Centers ReportFor synthetic cannabinoids:  2009: 15 cases with adverse reactions to Spice  2010: Over 2500 calls from all 50 states  2011: 6600 calls through 06/2011*For bath salts:  2009: No data  2010: 303 calls  2011: 3740 calls through 06/2011*For research chemicals (2C-E – drugs which mimic LSD and otherdrugs):  2009 : No data  2010: 22 calls 8  2011: 75 calls**preliminary data as not all centers have reported fully
  • 9. Mother dies after smoking spice: A mother of two is dead after using a synthetic-marijuana laced incense known as spice (Middletown, Indiana 08/04/2010) Bangor police chief says bath salts creating crisis – Bangor Daily News 08/01/2011 Never heard of Kratom? Trust Us, You Will – 08/02/2011 In the Fix: Addiction and Recovery Straight Up“Bath Salt” Abuse Hits Epidemic Proportions - Emergency 9Physician’s Monthly Report 04/13/2011
  • 10. Designer Drugs Have a Long History Morphine and Heroin made illegal in 1925 = legal alternatives remained available until 1968 Synthetic hallucinogen = LSD MDMA (Ecstasy) initially introduced in 1912 by Merck as appetite suppressant. 1970’s became ‘club drug’ and unregulated until 1985 Crystal methamphetaminesConclusion: Most illegal drugs have an unregulated "research chemical” 10
  • 11. Synthetic Cannabinoids 11
  • 12. So If They Are Popular and Legal Then Sales Can Be Tracked “Herbal Incense” (synthetic cannabinoids) accounted for nearly….. Five billion dollars in sales* 12*Retail Compliance Association (2010)
  • 13. Spice (Named From the Frank Herbert books) Spice gold  K2 Spice silver  Solar flare Spice diamond  K2 summit Yucatan fire  PEP Spice Sence  Fire n’ Ice Chill X  Zombie World Genie  Bad to the Bone Algerian blend  Black Mamba  Dark Night  G-Force 13
  • 14. More Spice 14
  • 15. Let’s Review Marijuana isted in US Pharmacopea until 1944 when removed due to political pressure to ban social use in USA annabis preparations have been used for over 4000 to 6000 years 15
  • 16. Cannabinoids 101 Occurs naturally in dried flowering/fruiting tops of Cannabis sativa plant Cannabinoids active compounds extracted from cannabis Renewed interest in using cannabinoids for medicinal purposes Discovery of cannabinoids receptors and endocannabinoids opened new era in research on pharmaceutical applications of cannabinoids 16
  • 17. What is This Eminent Professor Best Known For?  Dr. John W. Huffman, (JWH) professor of organic chemistry at Clemson University in South Carolina for 50 years  Ph.D. from Harvard and the National Institutes of Healths Senior Scientist Award 17
  • 18. Dubious Honor of Being Creator of Synthetic Cannibinoids  Researching the effects of cannabinoids on the brain (For NIDA in 1990’s)  Developed chemical compounds to mimic effects of marijuana (like JWH-018)  1995 paper contained the method/ingredients and was published 18
  • 19. The Spread of K2/Spice K2/Spice is unintended result of scientific research on marijuanas effects 2008 - German pharmaceutical company THC Pharm developed three versions of the herbal incense brand Spice with JWH-018 as primary ingredient By summer of 2009, packets of dried herbs sprayed with JWH compounds were sold throughout the world as "herbal incense" products March 2011 Drug Enforcement Agency exercises its emergency scheduling powers and bans five of the synthetic cannabinoids (JWH-018; JWH 073; JWH 200; CP47,497; and cannabicyclohexanol) 19
  • 20. 20
  • 21. 21
  • 22. Dr. Hoffman Says: The materials to make JWH-018 are available from laboratory chemical suppliers. A good college senior chemistry major could probably make them with some supervision and decent lab equipment. JWH-018 was made by a summer undergraduate research student, with supervision There are no valid, peer-reviewed studies of the effects of this compound in humans, nor are there any data regarding its toxicity… it’s like playing Russian Roulette. You dont know what its going to do to you. Youre a potential winner of a Darwin award (referring to the tongue-in-cheek awards given to people who “do a service to humanity by removing themselves from the gene pool”) I emphasize that this compound was not designed to be a super-THC. It should absolutely not be used as a recreational drug I’ve lived around the world a long time [79 years old] and come to the conclusion that if an enterprising person wants to find a new way to get high, they’re going to do it People who use it are idiots 22
  • 23. Physical Form of K2/Spice Pure state – either solids or oils Smoking mixtures – usually sold in metal-foil sachets Solution of the cannabinoids sprayed onto herbal mixture Contain 3 g dried ‘vegetable matter’ Price comparable to marijuana (with the ban price seems to have increased) 23
  • 24. Effects of Synthetic Cannabinoids: Research Says… Behavioral pharmacology studies show JWH-018 has Δ9-THC-like activity in animals In mice, it decreases overall activity, produces analgesia, decreases body temperature and produces catalepsy A search in the literature found no published studies of the effects of JWH-018 in humans 24
  • 25. Pharmacology Cannabinoids receptor agonists mimic effects of THC by interacting with CB1 receptors in brain Synthetic compounds bind more strongly than THC (up to 100 x’s more tightly) Little known about pharmacology & toxicology Long half-lives = prolonged psychoactive effect 25 Considerable batch variability = highly potential for overdose
  • 26. Same or Different Chemical Structures? JWH-018 THC 26
  • 27. So if Synthetic Cannabinoids and THCAre Chemically Different…That Means? 27
  • 28. 28
  • 29. Countries That Control Synthetic Cannabinoids Denmark  Austria Germany  Poland Estonia  Romania France  Sweden Ireland  UK Italy  Chile Latvia  Finland Lithuania  South Korea Luxembourg  Switzerland 29
  • 30. In the United States In May 2010, the Department of Defense banned synthetic cannabinoids from all U.S. military bases Kansas first state to criminalize in 5/2010 Patchwork of local and state laws current exist 16 states have laws regulating, in addition to the federal ban of 03/2011 30
  • 31. So its just ‘fake pot’ right? What’s the big deal??When I was young I knew plenty of people who…. 31
  • 32. 32
  • 33. Pharmacological Short-Term Effectsof Smoked Synthetic Cannabinoids Altered state of  Panic attacks consciousness  Severe agitation* Mild euphoria and  Numbness and tingling relaxation (less common)  Severe GI upset/vomiting* Perceptual alterations (time distortions)  Long term altered depth perception Intensification of sensory experiences  “Flash backs” Impaired short-term  Hallucinations/delusions memory  Tremors and seizures* Increase in reaction times  Tachycardia* Altered depth perception  Hypertension*  Death* *Symptoms NOT consistent with cannabis intoxication 33
  • 34. Severe Symptoms Are Not Consistent with Cannabis Useo Symptoms  Severe agitation  Severe GI upset/vomiting*  Hallucinations/delusions  Tremors and seizures*  Tachycardiao New speculation is these symptoms caused by myriad on contaminants in the K2/Spiceo (Remember no regulatory oversight or control)o Long term symptoms: NO RESEARCH on humanso Withdrawal symptoms: drug craving, nightmares, sweating, nausea, tremor, headaches, HBP, and 34 racing heartbeat
  • 35. “This isn’t Jerry Garcia’s Marijuana” (Rep. Jeff Roorda (D), Missouri) 35
  • 36. Bath Salts 36
  • 37. Is It Really Legal? As of July 2011 = 28 states have ban possession of the drug There is no federal law prohibiting sale, although the Federal Drug Enforcement Agency is considering another emergency scheduling The European Union ban bath salts products in April 2010 37
  • 38. Availability Retail outlets include:  Head Shops  Truck stops  Gas stations Readily available via Internet Benign names  Ivory Wave, Bliss, White Lightning, Hurricane Charlie, Zoom 2  50 to 500 milligram packets  Relatively inexpensive: $25 to $50 per 50-milligram packet*  Disclaimer: ‘Not for human consumption’ *According to US Department of Justice 38
  • 39. Bath Salts 101 Active ingredients are:  MDPV (methylenedioxypyrovalerone)  Mephedrone (4-methylmethcathinone or 4- methylephedrone)  Classified as synthetic stimulant – central nervous system stimulant  Method of Use:  Injection  Smoking  Snorting  Liquid form mixed into alcoholic drinks 39  Atomizer – occasionally
  • 40. Symptoms Associated With Bath Salt Use Agitation Extreme energy Paranoia Tachycardia Sweating/dry mouth High blood pressure Hallucinations Combative behaviors Rapid onset of suicidal ideation – can remain for days/weeks 40
  • 41. Extreme Behaviors Associated With Bath Salts Panama City, Florida: Several officers needed to subdue a man who tore out a radar unit out of police car with his teeth* Women attached her mother with a machete because “she was a monster”* Another user hospitalized after attempting to remove his own liver with a mechanical pencil* ABC News reported on 06/29/2011 that Federal DEA agented arrested ten people in first ever “bath salts” bust 41*Emergency Physicians Monthly 04/13/2011
  • 42. Kratom 42
  • 43. Kratom Latest designer drug to hit America Common name for the plant Mitragyna speciosa Korthals Originated South-East Asia In Thailand the leaves of this tree-like plant have been used for centuries for their medicinal and psychoactive qualities Comparable to opiates in symptoms 43
  • 44. Kratom (Continued) Kratom is unique because effects depending dose Both stimulant and sedative-like qualities (nicknamed Nature’s Speedball) Activates mu- and delta-opioid receptors Effects within 5 to 10 minutes of ingesting (typically in “tea”) Lasts 4 to 6 hours Include:  Relaxation and sedation  Analgesia and euphoria  More talkative/sociable/energetic Not extremely dangerous and rarely lethal 44 Interacts with other medications for harmful effects
  • 45. Our Brave New World: Revisited K2/Spice – “Fake Pot” – A synthetic cannabinoid which mimics marijuana and undetectable on drug screens. Bath Salts – The “New Cocaine” – a synthetic central nervous stimulant with highly unpredictable and dangerous side-effects resulting in escalating ED visits with no clear recommended treatment Kratom – The latest designer drug – while no serious concerns yet the opiate-like properties are of significant potential for abuse 45
  • 46. Comments, Questions, and Concerns 46