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PRC Training: Update on Synthetic Drugs 01.20.16

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Slideshow presentation from 01.20.16 on Update of Synthetic Drugs. Presentation covered different names, types, categories of synthetic drugs, and their health consequences. National, state and regional data were also included.

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PRC Training: Update on Synthetic Drugs 01.20.16

  1. 1. Welcome to SACADA
  2. 2. Youth Prevention Programs Project Heart (8-13) Middle School (6th – 8th) Adolescent/Teen (14 – 18) Hype Production Alternative Programs Adult and Family Services Assessment and Referrals Project ADELANTE WORC Project Resource Center Brochures DVD/CD Posters Fact Sheets Community Coalition The Circles of San Antonio Education and Training Drugs & Alcohol Trends Workplace Court Mandated
  3. 3. The Region 8, Prevention Resource Center is one of 11 PRCs across Texas funded by the Texas Department of State Health Services (DSHS). We cover 28 counties in South Central Texas.
  4. 4. PRC Purpose • Our purpose is to enhance and improve the substance abuse prevention services throughout the State of Texas with our focus on the state’s three priorities of alcohol (underage drinking), Marijuana, Prescription drugs, Tobacco and other drugs.
  5. 5. The Purpose of the Regional Needs Assessment (RNA) The regional needs assessment is a document developed with state, regional and local data to provide the community at large with a comprehensive view of information about the trends, outcomes and consequences associated with drugs and alcohol Consumption Alcohol Marijuana Non-Medical Prescription Drug (NMDP) Use Regional Observations of Substance Tobacco
  6. 6. How to Use the Regional Needs Assessment (RNA) To identify SA patterns and trends overtime. To identify gaps and strengths in data and resources. To identify differences in SA across communities. To make DDD to support policy decisions and grant writing activities.
  7. 7. Survey Time!!
  8. 8. Using Turning Point • Audience Response System • Choose your answer, only records answers once. • Poll closes after all votes are recorded.
  9. 9. Enteransw ertext...Enteransw ertext...Enteransw ertext...Enteransw ertext... 25% 25%25%25% Favorite Ice Cream Flavor A. Chocolate B. Vanilla C. Strawberry D. Rather eat cake
  10. 10. Have your ever attended a drug and alcohol abuse prevention training at your work/school? A. Yes B. No C. Don’t Know Yes No Don’tKnow 0%0%0%
  11. 11. Would you like to attend a drug and alcohol abuse prevention training/event at your work/school? A. Yes B. No C. Don’t Know Yes No Don’tKnow 0%0%0%
  12. 12. Do you know where you can get help/educated for alcohol or drug related problems or concerns? A. Yes B. No C. Don’t Know Yes No Don’tKnow 0%0%0%
  13. 13. Do you know how to recognize/explain signs of alcohol or drug use or abuse in a friend, family member, co-worker or individual? A. Yes B. No C. Don’t Know Yes No Don’tKnow 0%0%0%
  14. 14. I am a: (choose all that apply) A. Student B. Work in the MH or SA field C. Veteran D. None of the Above Student W orkin the M H orSA field Veteran Noneofthe Above 0% 0%0%0%
  15. 15. Will They Turn You into a Zombie? What Clinicians Need to Know about Synthetic Drugs (2nd Edition)
  16. 16. Training Collaborators • South Southwest Addiction Technology Transfer Center – University of Texas at Austin, School of Social Work • Pacific Southwest Addiction Technology Transfer Center – UCLA Integrated Substance Abuse Programs • Centre for Addiction and Mental Health, Research Imaging Centre 18
  17. 17. Special Acknowledgements • Dr. Volker Auwaerter, University Medical Center Freiburg, Germany • Dr. Michael Bauman, Intramural Research Program, NIDA • Dr. Raimondo Bruno, University of Tasmania • Mathias Forrester, Texas Department of State Health Services • Dr. Paul Griffiths, EMCDDA • James Hall, Nova Southeastern University • Dr. Barry Logan, National Medical Services Labs, Inc. • J. Randall Webber, JRW Behavioral Health Services 19
  18. 18. Special Acknowledgements • Dr. Volker Auwaerter, University Medical Center Freiburg, Germany • Dr. Michael Bauman, Intramural Research Program, NIDA • Dr. Raimondo Bruno, University of Tasmania • Mathias Forrester, Texas Department of State Health Services • Dr. Paul Griffiths, EMCDDA • James Hall, Nova Southeastern University • Dr. Barry Logan, National Medical Services Labs, Inc. • J. Randall Webber, JRW Behavioral Health Services 20
  19. 19. What knowledge do you have on synthetic drugs? A. No knowledge B. Some knowledge C. Knowledgeable D. Very knowledgeable No know ledgeSom e know ledge Know ledgeableVeryknow ledgeable 0% 0%0%0%
  20. 20. How comfortable are you speaking to someone about synthetic drugs? A. Uncomfortable B. Comfortable C. Very Comfortable D. Not sure Uncom fortable Com fortable VeryCom fortable Notsure 0% 0%0%0%
  21. 21. Remember when this happened?
  22. 22. “Tales of Bath Salts and Zombie Cannibalism” • Bath Salts made headlines in summer 2012 when a story of possible cannibalism was reported in Miami, FL • The Miami-Dade Medical Examiner found no traces of bath salts, LSD, or synthetic marijuana in the perpetrator's system • The sole psychoactive substance detected was cannabis (marijuana) 24
  23. 23. Have your heard these other media reports about “Bath Salts”? • The man who slashed himself to remove the “wires” in his body. • The mother who left her demon-ridden 2-year-old in the middle of the highway. • The 21-year-old son of a family physician who, after snorting bath salts once, shot himself following 3 days of acute paranoia and psychosis, including hallucinations of police squad cars and helicopters lined up outside his house to take him away. 25SOURCE: Slomski, A. (2012). JAMA.
  24. 24. Educational Objectives At the end of this presentation, participants will be able to: 1. Identify the key characteristics and effects of synthetic drugs, most notably synthetic cannabinoids and synthetic cathinones. 2. Explain the neurobiology of synthetic drug use, and the differential impact of synthetic drugs vs. “classic” illicit drugs, such as marijuana and cocaine. 3. Describe the current information available on the availability and patterns of synthetic drug use at the statewide, regional and national level. 26
  25. 25. AN INTRODUCTION TO KEY TERMS AND DEFINITIONS 27
  26. 26. How Psychoactive Substances Work • Because of their chemical structure, alcohol and drugs have dramatic effects on neurotransmitters in CNS • Effects on: – Mental processes – Behavior – Perception – Alertness SOURCE: NIDA. (2010). Drugs, Brains, and Behavior: The Science of Addiction. 28
  27. 27. Commonly Used Psychoactive Substances SOURCE: National Institute on Drug Abuse. SUBSTANCE EFFECTS Alcohol (liquor, beer, wine) euphoria, stimulation, relaxation, lower inhibitions, drowsiness Cannabinoids (marijuana, hashish) euphoria, relaxations, slowed reaction time, distorted perception Opioids (heroin, opium, many pain meds) euphoria, drowsiness, sedation Stimulants (cocaine, methamphetamine) exhilaration, energy Club Drugs (MDMA/Ecstasy, GHB) hallucinations, tactile sensitivity, lowered inhibition Dissociative Drugs (Ketamine, PCP, DXM) feel separated from body, delirium, impaired motor function Hallucinogens (LSD, mushrooms, Mescaline) hallucinations, altered perception 29
  28. 28. “Designer” Psychoactive Substances SOURCE: http://www.drugs-forum.com, updated 2013. 30
  29. 29. “Designer” Psychoactive Substances SOURCE: http://www.drugs-forum.com, updated 2013.
  30. 30. “Designer” Psychoactive Substances SOURCE: http://www.drugs-forum.com, updated 2013.
  31. 31. “Designer” Psychoactive Substances SOURCE: http://www.drugs-forum.com, updated 2013.
  32. 32. “Designer” Psychoactive Substances SOURCE: http://www.drugs-forum.com, updated 2013.
  33. 33. Why People Use Psychoactive Substances Why Start? • Experimentation • Peer Pressure • Medical Why Continue? • Relieve stress/pain • Function better • Have fun/relax • Cope with mental health disorders SOURCE: NIDA. (2010). Drugs, Brains, and Behavior: The Science of Addiction. 35
  34. 34. After repeated drug use, “deciding” to use drugs is no longer voluntary because DRUGS CHANGE THE BRAIN! SOURCE: NIDA. (2010). Drugs, Brains, and Behavior: The Science of Addiction. 36
  35. 35. A REVIEW OF SYNTHETIC DRUGS 37
  36. 36. “Designer” Psychoactive Substances Two classes: 1. Stimulants: mephedrone, MPDV, piperazines, “bath salts” 2. Psychedelics: 2C-B, mescaline, DMT, etc. Differences in users: 1. Stimulant users similar to other ecstasy users; (shifting to mephedrone and MPDV due to shortage of Ecstasy?) 2. Psychedelic users started ecstasy use earlier; were more frequent users; used multiple substances; had more legal, mental health, and social problems. SOURCE: Bruno et al. (2012). Drug and Alcohol Dependence, 124(1-2), 19-25. 38
  37. 37. Examples of Major Synthetic Psychedelics DRUG NAME DESCRIPTION 2C-I Phenethylamine, via PiHKAL; stimulant and hallucinogen Slow onset (1 hr); long duration of action (8- 10 hr.) 2C-B Phenethylamine, via PiHKAL; visuals Faster onset; shorter duration than 2C-I 5-MeO-DMT Tryptamine; naturally occurring (toad, shamantic brews) Smoked: almost immediate, very intense, short effect (<30 min) DMT Tryptamine; naturally occurring Smoked: almost immediate, very intense, short effect (<20 min) SOURCE: Slide courtesy of R. Bruno et al., 2011, with revisions by James Hall, 2012. 39
  38. 38. Examples of Major Synthetic Stimulants DRUG NAME DESCRIPTION Mephedrone 4-methyl-methcathinone; “Miaow” Similar to cocaine and MDMA (ecstasy) Methylone β-MDMA: 3,4-methylenedioxy- methcathinone; “Explosion” Similar to cocaine and MDMA (ecstasy) MDPV 3,4-methylenedioxyprovalerone; MDPV; “NRG-1” (Brandt, 2010); “Ivory Wave” Stimulant with rapid onset; 2-4 hour duration of action BZP 1-benzyl-piperazone Similar to amphetamine 1/10 potency of d-methamphetamine SOURCE: Slide courtesy of R. Bruno et al., 2011, with revisions by James Hall, 2012. 40
  39. 39. From the term “Bath Salts” to… Synthetic Cathinones Mephedrone, methylone, 4- MEC Stimulants related to methcathinone, MDMA, amphetamines 2C- Phenethylamines Psychedelics related to mescaline Some were created in the past to imitate MDMA Tryptamines 5-MeO-DMT & 4- AcO-DMT Psychedelics related to psilocin & bufotenin Piperazines BZP & TFMPP Stimulants And Dissociatives related to ketamine and PCP and Opioids related to morphine, fentanyl, and heroin.
  40. 40. Synthetic Drugs • Not really “Spice,” “Bath Salts,” “Incense,” or “Plant Food” • Chemically-based; not plant derived • Complex chemistry • Constantly changing to “stay legal” • Need to prove “intended to use” to convict in some areas 42
  41. 41. Which one is NOT a synthetic drug? A. Space B. Climax C. Calgon D. Ivory Wave Space Clim ax Calgon IvoryW ave 0% 0%0%0%
  42. 42. Spice/K2 is legal in Texas. A. True B. False True False 0%0%
  43. 43. The Texas Tribune: Cracking Down on K2
  44. 44. Synthetic Cannabinoids Spice vs. “Spice” 46
  45. 45. Synthetic Cathinones Bath Salts vs. “Bath Salts” 47
  46. 46. Synthetic Cannabinoids • Wide variety of herbal mixtures • Marketed as “safe” alternatives to marijuana • Brand names include: “Spice,” “K2,” fake weed, “Yucatan Fire,” “Skunk,” “Moon Rocks,” herbal incense, “Crazy Clown,” “Herbal Madness” • Labeled “not for human consumption” • Contain dried, shredded plant material (inert) and chemical additives that are responsible for their psychoactive effects. SOURCE: NIDA. (2012). NIDA DrugFacts: Spice (Synthetic Marijuana). 48
  47. 47. Synthetic Cannabinoids • Mainly abused by smoking (alone or with marijuana); may also be prepared as an herbal infusion for drinking. • Many of the active chemicals most frequently found in synthetic cannabis products have been classified by the DEA as Schedule I controlled substances, making them illegal to buy, sell, or possess. • Multiple “generations” of drugs. SOURCE: NIDA. (2012). NIDA DrugFacts: Spice (Synthetic Marijuana). 49
  48. 48. Fox 29 Report: Del Rio Police Make K2 Bust After Students Overdose
  49. 49.  JWH-018/073 arrived early and have come and gone.  JWH-250 arrived a little later and has also cycled out.  JWH-081 was part of a second wave that has already completed its cycle.  JWH-122 was part of the same wave but has persisted in popularity and is part of the current scene.  AM-2201 was part of the same second wave and has gained in popularity, probably currently the most prevalent.  JWH-022 and JWH-210 are showing signs of increasing popularity.  Recent emergent drugs are the adamantoyl (AM-1248) and tetramethylcyclopropyl (XLR-11 and UR-144) indoles which are ahead of the latest attempts to schedule these drug classes. SOURCE: Logan, B.K. (2012). Testing Strategies to Monitor Novel/Emerging/Designer Drug Use in At-Risk Populations, Presented at 74th Annual CPDD. The Emergence of Synthetic Cannabinoids 51
  50. 50. Why Spice became So Popular… • They induce psychoactive effects • They are readily available in retail stores and online • The packaging is highly attractive • They are perceived as safe drugs • They are not easily detectable in urine and blood samples SOURCE: Fattore & Fratta. (2011). Frontiers in Behavioral Neuroscience, 5(60), 1-12. 52
  51. 51. Marijuana homolog exposures reported to the Texas Poison Center Network during 1/1/10-2/28/15 (n=2,946) 6 12 15 29 32 41 605959 6263 66 27 40 58 64 60 46 90 67 43 27 39 27 44 36 61 48 67 39 47 3231 2526 18 29 37 46 53 62 44 33 40 24 40 2927 32 30 4344 70 105 70 80 90 82 72 64 68 66 0 20 40 60 80 100 120 Jan-10M ar-10M ay-10Jul-10Sep-10N ov-10Jan-11M ar-11M ay-11 Jul-11Sep-11N ov-11Jan-12M ar-12M ay-12Jul-12Sep-12N ov-12Jan-13M ar-13M ay-13 Jul-13Sep-13N ov-13Jan-14M ar-14M ay-14Jul-14Sep-14N ov-14Jan-15 Month Number Texas ban 9/1/11 US ban 7/9/12 Source: South Texas Poison Control Network
  52. 52. Marijuana homolog exposures reported to the Texas Poison Center Network during 1/1/10-2/28/15 (n=2,946) 1322 1555 69 0 200 400 600 800 1000 1200 1400 1600 1800 <20 20+ Unknown Patient age (years) Number Age range: 1-75 years
  53. 53. Marijuana homolog exposures reported to the Texas Poison Center Network during 1/1/10-2/28/15 (n=2,946) 2271 658 17 0 500 1000 1500 2000 2500 Male Female Unknown Patient gender Number
  54. 54. Marijuana homolog exposures reported to the Texas Poison Center Network during 1/1/10- 2/28/15 (n=2,946) 2101 444 273 1 3 1 1 1 1 0 500 1000 1500 2000 2500 Inhalation Ingestion Inhalation+ Ingestion Parenteral Inhalation+ Parenteral Dermal Ingestion+ Dermal Inhalation+ Ingestion+ Parenteral Unknown Route Number
  55. 55. Marijuana homolog exposures reported to the Texas Poison Center Network during 1/1/10- 2/28/15 (n=2,946) 2505 146 107 26 162 0 500 1000 1500 2000 2500 3000 Abuse/misuse Attempted suicide Unintentional Adverse reaction Unknown Exposure reason Number
  56. 56. Marijuana homolog exposures reported to the Texas Poison Center Network during 1/1/10- 2/28/15 (n=2,946) 2040 75 5 10 62 1 119 36 598 0 500 1000 1500 2000 2500 Own residence Other residence Workplace Healthcare facility School Food service Public area Other Unknown Exposure site Number
  57. 57. Marijuana homolog exposures reported to the Texas Poison Center Network during 1/1/10- 2/28/15 (n=2,946) 431 25 6 2141 8 2 305 28 0 500 1000 1500 2000 2500 Own residence Other residence Workplace Healthcare facility School Public area Other Unknown Caller site Number
  58. 58. Marijuana homolog exposures reported to the Texas Poison Center Network during 1/1/10- 2/28/15 (n=2,946) 166 2335 407 33 5 0 500 1000 1500 2000 2500 On site (home) Already at healthcare facility Referred to healthcare facility Other Unknown Management site Number
  59. 59. Marijuana homolog exposures reported to the Texas Poison Center Network during 1/1/10- 2/28/15 (n=2,946) 162 645 1202 232 4 1 178 489 32 1 0 200 400 600 800 1000 1200 1400 No effect Minor Moderate Major Death NF (nontoxic) NF (minor?) NF (toxic?) Unrelated Unknown Medical outcome Number NF: not followed
  60. 60. Marijuana homolog exposures reported to the Texas Poison Center Network during 1/1/10-2/28/15 (n=2,946), caller county Anderson – 13 Andrews – 3 Angelina – 6 Aransas – 3 Atascosa – 2 Bailey – 1 Bastrop – 1 Bee – 4 Bell – 46 Bexar – 218 Bosque – 1 Bowie – 6 Brazoria – 28 Brazos – 9 Brewster – 1 Brown – 8 Burleson – 1 Burnet – 3 Caldwell – 2 Calhoun – 4 Cameron – 17 Camp – 2
  61. 61. Marijuana homolog exposures reported to the Texas Poison Center Network during January 1, 2010-February 28, 2015, by caller county No. calls 5-9 4 3 2 1 10+
  62. 62. Marijuana homolog exposures reported to the Texas Poison Center Network during 1/1/10-2/28/15 (n=2,946), clinical effects • Cardiovascular – Asystole – 4 – Bradycardia – 77 – Cardiac arrest - 6 – Chest pain – 142 – Conduction disturbance – 28 – Dysrhythmia – 13 – ECG change – 21 – Hypertension – 275 – Hypotension – 111 – Tachycardia – 993
  63. 63. Six States Report Cases of Kidney Damage Linked to Synthetic Cannabinoids • Sixteen cases of kidney damage reported by CDC – All admitted to hospital – Five required hemodialysis • Fifteen of the patients were male; ranged in age from 15 to 33, no history of kidney disease • In early Feb 2013, UA-Birmingham reported 4 cases of previously healthy young men, whose acute kidney injury was associated with synthetic marijuana – Symptoms of nausea, vomiting, and abdominal pain – All four men recovered kidney function, and none required dialysis SOURCE: Join Together Online. (2013). Story published February 15, 2013. 65
  64. 64. Synthetic Cannabinoid Use Leads to Dangerous Symptoms in Pregnant Women • Leads to symptoms similar to those caused by dangerous conditions known as preeclampsia and eclampsia – Preeclampsia is marked by high blood pressure and a high level of protein in the urine – Preeclampsia can lead to eclampsia, which can cause a pregnant woman to develop seizures or coma, and in rare cases is fatal SOURCE: Join Together Online, May 8, 2013. 66
  65. 65. Synthetic Cathinones • Could be MDPV, 4-MMC, mephedrone, or methylone • Sold on-line with little info on ingredients, dosage, etc. • Advertised as legal highs, legal meth, cocaine, or ecstasy • Taken orally or by inhaling • Serious side effects include tachycardia, hypertension, confusion or psychosis, nausea, convulsions • Labeled “not for human consumption” to get around laws prohibiting sales or possession SOURCE: Wood & Dargan. (2012). Therapeutic Drug Monitoring, 34, 363-367. 67
  66. 66. Navy Bath Salts PSA
  67. 67. Synthetic Cathinones are b-keto (‘bk’) Analogs of Amphetamine 69
  68. 68. Sources and Continuing Availability • A number of synthetic marijuana and bath salt products appear to originate overseas and are manufactured in the absence of quality controls and devoid of governmental regulatory oversight. • The large profits from sales, plus the fact that these chemicals can be easily synthesized to stay one step ahead of control, indicate there is no incentive to discontinue retail distribution of synthetic cannabinoid products under the current statutory and regulatory scheme. SOURCES: ONDCP, 2012; EMCDDA, 2011. 70
  69. 69. Human Exposure Calls to U.S. Poison Centers on Synthetic Cannabinoids and Cathinones and the Effect of Federal Regulations 71SOURCE: American Association of Poison Control Centers, 2010-2013 data. 0 100 200 300 400 500 600 700 800 2010 2011 2012 2013 The Effect of Federal Controls on Synthetic Cannabis Calls to Poison Centers 0 100 200 300 400 500 600 700 800 2010 2011 2012 2013 The Effect of Federal Controls on Synthetic Cathinone Calls to Poison Centers
  70. 70. THE EFFECTS OF SYNTHETIC DRUGS 72
  71. 71. Short-Term Effects of Synthetic Cannabinoids • Loss of control • Lack of pain response • Increased agitation • Pale skin • Seizures • Vomiting • Profuse sweating • Uncontrolled spastic body movements • Elevated blood pressure • Elevated heart rate • Heart palpitations In addition to physical signs of use, users may experience severe paranoia, delusions, and hallucinations. SOURCE: Join Together Online, December 4, 2012. 73
  72. 72. Cannabis vs. Synthetic Cannabinoids: Effects Seen in Clinical Cases • Most symptoms are similar to cannabis intoxication: – Tachycardia – Reddened eyes – Anxiousness – Mild sedation – Hallucinations – Acute psychosis – Memory deficits • Symptoms not typically seen after cannabis intoxication: – Seizures – Hypokalemia – Hypertension – Nausea/vomiting – Agitation – Violent behavior – Coma SOURCES: Hermanns-Clausen et al. (In Press), Addiction; Rosenbaum et al. (2012). Journal of Medical Toxicology; Forrester et al. (2011). Journal of Addictive Disease; Schneir et al. (2011). Journal of Emergency Medicine. 74
  73. 73. Synthetic Cannabinoids: Other Considerations • Unlike cannabis, synthetic cannabinoids have no therapeutic effects • Example: no cannabidiol (anti-anxiety), so mood effects unpredictable • Packets can contain other psychoactive substances: opioids, oleamide, harmine/harmaline (MAO-Is) that can interact with the synthetic cannabinoid • Cancer-causing potential of inhaling smoke from these compounds unknown SOURCE: Doris Payer, #CHSF2013. 75
  74. 74. Agitation 82% Combative/Violent behavior 57% Tachycardia 56% Hallucinations 40% Paranoia 36% Confusion 34% Myoclonus/Movement disorders 19% Hypertension 17% Chest pain 17% CPK elevations 9% Clinical Symptoms of Synthetic Cathinone Use in Patients Admitted to the Emergency Department (N=236) SOURCE: Spiller et al. (2011). Clinical Toxicology, 49, 499-505. 76
  75. 75. THE EPIDEMIOLOGY OF SYNTHETIC DRUG USE 77
  76. 76. Emerging Drug Items Identified in U.S. NFLIS Forensic Labs: 2010-2012 3,286 731 23,688 6,949 41,458 14,239 - 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000 Synthetic Cannabinoids Synthetic Cathinones 2010 2011 2012 SOURCE: U.S. DEA, Office of Diversion Control, NFLIS data, 2012. 78
  77. 77. Number of Unique Types of Synthetic Drugs Identified Nationally: NFLIS (2010-2012) 19 17 44 25 55 37 0 10 20 30 40 50 60 Synthetic Cannabinoids Synthetic Cathinones 2010 2011 2012 SOURCE: U.S. DEA, Office of Diversion Control, NFLIS data, 2012. 79
  78. 78. Calls Received by U.S. Poison Control Centers for Human Exposure to Synthetic Marijuana, 2010 to July 2013 2,906 6,968 5,205 1,413 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 2010 2011 2012 1/2 2013 There was 1 cannabinoid death in 2010 and 4 in 2011 80SOURCE: American Association of Poison Control Centers, updated August 30, 2013.
  79. 79. Past Year Drug Use by 12th Grade Students: MTF, 2012 36% 11.3% 1.3% 3.8% 5.0% 2.10% 0% 5% 10% 15% 20% 25% 30% 35% 40% Marijuana Synthetic Cannabis Synthetic Cathinones MDMA Hallucinogens LSD SOURCE: Monitoring the Future Survey, 2012 results. 81
  80. 80. Percentage of U.S. Students (Grades 9 to 12) Reporting Past Year Alcohol and Other Drug Use, 2012 (N=3,884) 3% 4% 4% 4% 7% 7% 7% 8% 9% 10% 12% 39% 57% 0 10 20 30 40 50 60 Bath Salts Salvia Methamphetamine Crack OTC Cough Medicine Inhalants Cocaine Ecstasy Rx Stimulants Rx Pain Relievers Synthetic Marijuana Marijuana Alcohol 82 SOURCE: Adapted by CESAR from The Partnership for a Drug-Free America and the MetLife Foundation, The Partnership Attitude Tracking Study (PATS): Teens and Parents, 2013.
  81. 81. Emergency Room Visits Related to Synthetic Cannabis and Cathinones: DAWN, 2011 % Male % Under Age 21 % Sent to ICU or Sub. Abuse Treatment % Discharged Home Synthetic Cannabis 70% 55% 3% 78% Synthetic Cathinones 76% 14% 12% 55% 83SOURCE: OAS, SAMHSA-CSAT. (2013). Drug Abuse Warning Network, 2011 data.
  82. 82. Synthetic Cannabinoids Identified in U. S. NFLIS Forensic Labs JWH-018 64% JWH-073 , 303, 9% JWH-081 , 182 JWH-250 , 461, 14% 19 variations reported in 2010 n=3,286 AM-2201 35% JWH-018 16% JWH-081 6% JWH-122 13% JWH-210 9% SYNTHETIC CANN 7% 44 variations reported in 2011 n=23,688 AM-2201 41% JWH-122 6% MAM-2201 4% SYNTHETIC CANN 6% UR-144 13% XLR-11 14% 55 variations reported in 2012 n=41,458 84SOURCE: U.S. DEA, Office of Diversion Control, NFLIS data, 2010-2012.
  83. 83. Calls Received by U.S. Poison Control Centers for Human Exposure to Synthetic Cathinones, 2010 to July 2013 304 6,136 2,656 528 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 2010 2011 2012 Jan-June 2013 SOURCE: American Association of Poison Control Centers, updated August 30, 2013. There were no synthetic cathinone fatalities in 2010 but there were 18 in 2011 85
  84. 84. Synthetic Cathinones Identified in U.S. NFLIS Forensic Labs 17 varieties identified in 2010 n=731 34 varieties identified in 2011 n=6,949 48 varieties identified in 2012 n=14,239 4MMC 33% MDPV 52% METHY LONE 11% 4-MEC 4% 4-MMC 5% MDPV 53% METHYLONE 26% ALPHA-PBP 18% PENTEDRONE 5% 4-MMC 20% MDPV 21% METHYLONE 23% 86SOURCE: U.S. DEA, Office of Diversion Control, NFLIS data, 2010-2012.
  85. 85. 19 DU 0 0 0 22 DU 95 DU10 LO 68 DU 11 LO, 1930 DU 109 DU 1 DU 0 675 DU 656 DU 12 DU 4 LO 4 DU0 0 603 DU 1 DU 45 DU 6 DU 2 LO 24 DU 0 5 DU 0 2 DU 596 LO 71 DU Synthetic Drugs for Region 8 Uniform Crime Reporting 2014
  86. 86. Counties that had an Increase in Seizures by Dose Units in 2014 0 500 1000 1500 2000 2500 Dose Units 2013 2014
  87. 87. Counties that had a Decrease in Seizures by Dose Units in 2014 0 500 1000 1500 2000 2500 Comal Goliad Kendall Lavaca Maverick Victoria Wilson Dose Units 2013 2014
  88. 88. State and Regional Comparisons of Seizures by Dose Units in 2014 0 50000 100000 150000 200000 250000 Region 8 Texas Dose Units 2013 2014 0.23%2.73 %
  89. 89. Psychedelic Drug Use and Baby Boomers • 32 million Americans have used any psychedelic drug at least once in their lifetimes— about 17% of all American adults between the ages of 21-64. • Overall rates of lifetime psychedelic use are roughly the same among the 'baby boomers' and younger adults • Lifetime psychedelic drug use among baby boomers aged 50 to 64 was on par with that of younger adults aged 21- 25, about 15%. • The highest rate was among adults aged 30-34 (over 20%) • Adults over the age of 65 largely missed the advent of psychedelic drugs in popular culture, since only 1% reported using them. SOURCE: http://www.medicaldaily.com/psychedelic-drug-use-united-states-common-now-1960s-generation- 245218#.Ugzg8FaFeGA.email. 91
  90. 90. OTHER NOTABLE SYNTHETIC DRUGS – “NEW AND OLD” 92
  91. 91. MDMA (Ecstasy) • 3, 4-methylenedioxy-methamphetamine • Street terms: Adam, E, X, XTC, love drug, Molly • A synthetic, psychoactive drug with both stimulant and hallucinogenic properties similar to methamphetamine and mescaline • Adverse effects: enhanced physical activity, sweating, lack of coordination, mental confusion, jaw clenching, hyperthermia, and agitation NIDA. (2010). NIDA InfoFacts: MDMA (Ecstasy). 93
  92. 92. Glimpses of MDMA Situation in U.S.: 1999-2013 0 10 20 30 40 50 60 70 80 90 2001 2003 2005 2007 2009 2011 2013 Results of Pill Tests Containing MDMA* Any MDMA MDMA Only 0 5000 10000 15000 20000 25000 30000 2006 2009 2012 MDMA Reports: NFLIS Forensic Labs 2006-2012 SOURCES: http://www.ecstasydata.org/stats_substance_by_year.php; U.S. DEA, Office of Diversion Control, NFLIS data, 2006-2012. 94
  93. 93. What is “Molly”? 1. Ecstasy pills with little MDMA and lots of caffeine, meth, assorted drugs? OR 2. A pure crystalline form of MDMA, most often sold as a powder filled capsule? OR 3. Methylone? Bath salts? • Reports of desired effects of euphoria, but also increased paranoia, agitated delirium, scary hallucinations, psychotic episodes, violent or destructive self-harm behavior, including death • Bottom line - Molly usually is not a pure form of MDMA, but may be a drug that can be very dangerous since its contents are unknown SOURCE: Join Together Online. (2013). Story published June 24, 2013. 95
  94. 94. Someone Help Me Find “Molly”
  95. 95. Krokodil • Russian cheap replacement drug for heroin made from cooking down desomorphine with gasoline, paint thinner, alcohol, iodine, red phosphorous (match heads), etc. • In Russia, lack of clean needles and methadone, high cost of heroin, poverty, high numbers of HIV+ individuals, etc. • No confirmed cases of desomorphine in the U.S. since 2 were identified in 2004. • Injuries that look like krokodil can be due to shared dirty needles, bacteria, toxic adulterants, gangrene, staph infection, MRSA. 97
  96. 96. What do you do if someone has taken a Synthetic Drug? • Call your local poison center at 1-800-222-1222 – 57 poison centers around the country have experts waiting to answer your call. – The experts at the Center can help you decide whether someone can be treated at home, or whether he or she must go to a hospital. • Dial 9-1-1 immediately if they: – Stop breathing – Collapse – Have a seizure SOURCE: American Association of Poison Control Centers (AAPCC). (2012). Facts about Bath Salts. …or if they have taken one of these and are having physical symptoms or behaving in a way that is concerning to you 99
  97. 97. In Summary: Key Points • Research is needed to better understand the side effects and long-term consequences associated with the use of synthetic cannabinoids and synthetic cathinones. • More toxicological identification of these new drugs, more information on the sources of them, as well as their distribution and patterns of use is needed to curtail future increases in use. 100
  98. 98. • We do not have human neurobiological data or long- term data, but we can extrapolate a few key points from the existing literature: – Synthetics vs. Classics: Neurobiological concerns hold up, plus more – In all cases, neurobiology predicts abuse potential – In general, synthetic versions are not a simple substitute for “classics” – effects tend to be more intense (including side effects), some unexpected, and some new interactions that were not a concern before In Summary: Key Points 101SOURCE: Doris Payer, #CHSF2013.
  99. 99. Resources for Continued Learning • American Association of Poison Control Centers, www.aapcc.org • Drug Enforcement Administration, www.dea.usdoj.gov • European Monitoring Centre for Drugs and Drug Addiction, www.emcdda.europa.eu • National Institute on Drug Abuse, www.nida.nih.gov • Office of National Drug Control Policy, www.ondcp.org • Pacific Southwest ATTC, www.psattc.org • Refer to the Synthetic Drugs Reference List** 102
  100. 100. For more information: Jane C. Maxwell: jcmaxwell@austin.utexas.edu Beth Rutkowski: brutkowski@mednet.ucla.edu Doris Payer: doris.payer@camh.ca Pacific Southwest ATTC and South Southwest ATTC: http://www.psattc.org http://www.attcnetwork.org/regcenters/index_southsouthwest.aspt 103
  101. 101. Call to Action and Closing Message • Work with your community coalitions. • Keep yourself updated on the most recent data. Visit pro-drug websites too! • Be cognizant and aware of potential data or data sources we could utilize for the RNA.
  102. 102. Questions from the Audience
  103. 103. Community Agreement with PRC 8 • Provide the PRC with any data that may contribute the data repository (alcohol (underage drinking), marijuana, and prescription drugs). • Assist the PRC with networking and coordination to help collect data and identify resources for the regional data collection. • Assist PRC in promoting community efforts to raise awareness and generate support in attending PRC presentations on local, county regional data collected for RNA. • Offer networking assistance to strengthen prevention efforts in our community. We WANT You.. To Partner with us!
  104. 104. Recruitment for Advisory Group Every 3rd Tuesday of the month from 1:30pm – 2:30pm, before the COSA Coalition Meeitng.

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