21 st  Century Street Drug Pharmacology: New Drugs J. Randall Webber, MPH, CADC Principal Consultant JRW Behavioral Health...
Herbal Incense <ul><li>Crushed, non-psychoactive herbal/plant matter treated with one or more synthetic cannabinoids </li>...
Herbal Incense <ul><li>Crushed, non-psychoactive  herbal/plant matter treated with one or  more synthetic cannabinoids </l...
Current  Legal Status of  &quot;first generation&quot; Herbal Incense <ul><li>The federal Drug Enforcement Administration ...
Banned Herbal incense Brands <ul><li>Frequently marketed as “incense” under a variety of names: </li></ul><ul><ul><li>K2 <...
BANNED HERBAL INCENSE PRODUCTS
 
 
 
 
 
 
 
LEGAL HERBAL INCENSE PRODUCTS
New Herbal Incense Brands <ul><li>K2 </li></ul><ul><li>K3 </li></ul><ul><li>Destiny  </li></ul><ul><li>Splice </li></ul><u...
Apocalypse <ul><li>Specifications:   </li></ul><ul><ul><li>Most POTENT herbal incense on the market </li></ul></ul><ul><ul...
Apocalypse Flavors <ul><li>BLUEBERRY </li></ul><ul><li>STRAWBERRY  </li></ul><ul><li>JUNGLE JUICE </li></ul><ul><li>CHERRY...
 
 
 
 
 
 
AM-HI-C  “ Atomic Bomb”
 
 
DROBUD ROLL YOUR OWN
Herbal incense Pharmacology <ul><li>To date, hundreds of synthetic cannabinoids (similar to both   9-THC and endogenous c...
DEA Analysis of “New Grass”
Herbal incense Pharmacology <ul><li>Research supported by NIDA </li></ul><ul><li>Two cannabinoid receptors in the human br...
Herbal incense Pharmacology <ul><li>Research supported by NIDA </li></ul><ul><li>Two cannabinoid receptors in the human br...
A Historical Perspective  <ul><li>All drugs currently illicit in the U.S. have  started out as legal (uncontrolled) substa...
Herbal incense <ul><li>Street drugs </li></ul><ul><ul><li>Psychoactive substances  </li></ul></ul><ul><ul><li>Inconsistent...
Drug Testing <ul><li>Many laboratories have a test for some of the first generation JWH chemicals </li></ul><ul><li>In Feb...
Herbal Incense in the Popular Press <ul><li>Sales of “K2” products increased significantly in Chicago following news of it...
Herbal Incense Pharmacology: The Scientific Literature <ul><li>At present, almost nothing is known about the pharmacology,...
Herbal Incense: Typical Effects <ul><li>Cannabis-like intoxication </li></ul><ul><li>Dreaminess </li></ul><ul><li>Euphoria...
Calls to Poison Control Centers <ul><li>Data from the American Association of Poison Control Centers’ “National Poison Dat...
Herbal Incense: Other Possible Effects <ul><li>Severe anxiety (may persist after herbal incense use is discontinued) </li>...
User Report # 1 <ul><li>This is the worst experience I’ve ever had </li></ul><ul><li>The most anxiogenic substance I've ev...
User Report #2: &quot;Apocalypse&quot; <ul><li>3 individual “hits” from a small pipe </li></ul><ul><li>“ organic” taste/no...
Why the Discrepancy in Reported Effects?  <ul><li>Use of other drugs (including alcohol) with herbal incense </li></ul><ul...
Why the Discrepancy in Reported Effects?  <ul><li>User/environmental characteristics: </li></ul><ul><ul><li>Set </li></ul>...
Overview <ul><li>Herbal incense contains a cannabinoid closely related to THC/marijuana </li></ul><ul><li>No quality contr...
Overview <ul><li>Other reported effects range from intense euphoria and pleasant hallucinations to abject terror and near-...
Currently Available Legal Substances <ul><li>Herbal Incense </li></ul><ul><li>“ Bath Salts”  </li></ul><ul><li>Kratom </li...
Kratom
Kratom <ul><li>Mitragyna speciosa </li></ul><ul><li>Used in  </li></ul><ul><ul><li>Malaysia </li></ul></ul><ul><ul><li>Tha...
KRATOM CAPSULES
DRIED KRATOM LEAF
Young Kratom Tree
Kratom Leaf
Kratom Pharmacology <ul><li>7-hydroxymitragynin </li></ul><ul><li>Mitragynine </li></ul><ul><li>Structural similar to some...
Mitragynine <ul><li>Low doses </li></ul><ul><ul><ul><ul><li>Attaches to delta ( Δ ) opioid receptors </li></ul></ul></ul><...
7-hydroxymitragynine <ul><li>Recently identified as main active  ingredient.  </li></ul><ul><li>Animal research: Potent op...
History of Kratom as a Treatment  for Opiate Dependence <ul><li>1897: Europeans first noted that  that the leaves  of Mitr...
Kratom Pharmacology <ul><li>Used for: </li></ul><ul><ul><li>Prevention or delay of opiate withdrawal  symptoms </li></ul><...
Kratom <ul><li>Seems to be: </li></ul><ul><ul><li>Stimulant in lower doses (mitragynine) </li></ul></ul><ul><ul><li>Sedati...
Kratom: Side Effects <ul><li>Short-term (immediate) </li></ul><ul><ul><li>Dry mouth </li></ul></ul><ul><ul><li>Increased o...
Kratom: Side Effects <ul><li>Long term health risks : </li></ul><ul><ul><li>Currently unknown </li></ul></ul>
Khat
Khat <ul><li>Native to tropical East Africa and the Arabian Peninsula </li></ul><ul><li>Fresh leaves/tops chewed or consum...
Khat cultivation in Yemen
Khat chewing
Women in Somalia Selling Khat/Quat
2006: Bundles of khat seized by the DEA
Khat <ul><li>Coca--------Cocaine  </li></ul><ul><li>Khat---------Cathinone (Schedule I) </li></ul><ul><li>Cathinone: Struc...
Khat <ul><li>Withdrawal </li></ul><ul><ul><li>Depression </li></ul></ul><ul><ul><li>Irritability </li></ul></ul><ul><ul><l...
Methcathinone (Schedule I) <ul><li>First synthesized in 1928 </li></ul><ul><li>1930s: Used in the Soviet Union as an anti-...
Methcathinone <ul><li>European slang names: </li></ul><ul><ul><li>Ephedrone </li></ul></ul><ul><ul><li>M-Cat * </li></ul><...
BATH SALTS
<ul><li>States that have taken emergency action to ban at least two  chemicals used in designer drugs labeled as “bath sal...
“ Bath Salts” A/K/A “Plant Food” <ul><ul><li>Energizing Aromatherapy </li></ul></ul><ul><ul><li>Down2Earth White Horse </l...
Aromatherapy Bath Salts
“ White Blizzard”
“ Plant Food” “ Novelty Collector’s Item
Possible Substances in “Bath Salts” <ul><li>3,4 – Methylenedioxypyrovalerone (MDPV)  </li></ul><ul><li>4 – Methylmethcathi...
Mephedrone <ul><li>Onset:   </li></ul><ul><ul><li>Oral: 15–45 minutes </li></ul></ul><ul><ul><li>Insufflation (nasal/“snor...
Mephedrone Research <ul><li>Dutch study: </li></ul><ul><ul><li>58%: overall pleasant experience </li></ul></ul><ul><ul><li...
Mephadrone <ul><li>Intended Effects:  (Similar to MDMA/”ecstasy”, amphetamines and/or cocaine) </li></ul><ul><ul><li>Eupho...
Mephadrone <ul><li>Unintended (Side) Effects:  </li></ul><ul><ul><li>Dilated pupils </li></ul></ul><ul><ul><li>Poor concen...
Mephedrone <ul><li>4-methylmethcathinone (4-MMC, M-Cat, Meow) </li></ul><ul><li>4-methylephedrone </li></ul><ul><li>Effect...
M-CAT 4-Methylmethcathinone  & Caffeine: MDMA, caffeine &  4-Methylmethcathinone 4-Methylmethcathinone & Caffeine 4-Methyl...
Methylone <ul><li>3,4-methylenedioxy-N-methylcathinone </li></ul><ul><ul><li>M1 </li></ul></ul><ul><ul><li>bk-MDMA </li></...
Methylone <ul><li>Central Nervous System Stimulation </li></ul><ul><li>Euphoria or dysphoria, </li></ul><ul><li>Anxiolysis...
Methylone <ul><li>Tachycardia (rapid pulse) </li></ul><ul><li>Hypertension (high BP) </li></ul><ul><li>Hyperthermia </li><...
Sold as methylone Methylone Sold as ecstasy (Sold as M1) Methylone,  bk-MBDB (Sold as Dragonfly Pokeball)  Methylone,  Caf...
Plant Food “Piperazine Free” <ul><li>The piperazines are a category of substances </li></ul><ul><li>Used in medicine to ki...
BMP Products “ Charge” “ Extreme Jet”
BMP Characteristics <ul><li>Appears to have mild to moderate addiction potential  </li></ul><ul><li>Tolerance appears to d...
BMP Effects <ul><li>Dosage ranges from 50-200 mg </li></ul><ul><li>Former amphetamine addicts could not discriminate betwe...
BMP Effects <ul><li>Feelings of euphoria, wonder, amazement, well-being, energy and elation  </li></ul><ul><li>Rapid mood ...
BMP Effects <ul><li>Mild jaw clenching/bruxism  </li></ul><ul><li>Increased heart rate  </li></ul><ul><li>Dilation of pupi...
BMP Effects <ul><li>Later Effects: </li></ul><ul><ul><li>Mild headache </li></ul></ul><ul><ul><li>Nausea  </li></ul></ul><...
BMP Side Effects <ul><li>dilated pupils </li></ul><ul><li>blurred vision  </li></ul><ul><li>dryness of the mouth  </li></u...
BMP Side Effects <ul><li>Headache </li></ul><ul><li>Dizziness </li></ul><ul><li>Anxiety </li></ul><ul><li>Insomnia </li></...
BMP Side Effects <ul><li>Palpitations </li></ul><ul><li>Hyperventilation </li></ul><ul><li>Sweating </li></ul><ul><li>Hype...
Trifluoromethylphenylpiperazine  TFMMP
Trifluoromethylphenylpiperazine  TFMMP <ul><li>“ Legal X” </li></ul><ul><li>Rarely used by itself </li></ul><ul><li>Produc...
Trifluoromethylphenylpiperazine  TFMMP <ul><li>“ Crash” syndrome: </li></ul><ul><ul><li>Insomnia </li></ul></ul><ul><ul><l...
Packaging 50 to 500 milligram packets. Price  25 to $50 per 50 milligram packet
Reported Effects <ul><li>Stimulant   euphoria </li></ul><ul><li>↑  Energy </li></ul><ul><li>Reversal of fatigue/Insomnia <...
Salvia: One name-many plants
Salvia: One name-many plants <ul><li>Plants in the Mint family </li></ul><ul><li>Sage </li></ul><ul><li>Common Sage </li><...
Meadow Sage
Salvia divinorum/Herba de Maria
Salvia Divinorum <ul><li>Grows primarily in the Sierra Mazateca (Oaxaca, Mexico)  </li></ul><ul><li>Commonly used by Mazat...
Sierra Mazateca
Salvia Divinorum <ul><li>Grows primarily in the Sierra Mazateca (Oaxaca, Mexico)  </li></ul><ul><li>Commonly used by Mazat...
0.5 gm of salvia divinorum extract
Salvia Divinorum: Recreational Use <ul><li>Smoked </li></ul><ul><li>Unnoticeable or light effects from dry leaf  </li></ul...
Salvia Divinorum: Recreational Use <ul><li>Smoked </li></ul><ul><li>Unnoticeable or light effects from dry leaf  </li></ul...
After effects produced by Salvia N=500 Positive Negative Increased insight: 47% Decreased insight: 1.8% Improved mood: 44....
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21st Century Street Drug Pharmacology New Drugs Of The 2nd Decade

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This presentation was delivered at the Northwest Conference on Alcohol, July 18, 2011, Scottsdale, AZ

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  • Recovery from Methamphetamine Addiction Lighthouse Institute
  • 21st Century Street Drug Pharmacology New Drugs Of The 2nd Decade

    1. 1. 21 st Century Street Drug Pharmacology: New Drugs J. Randall Webber, MPH, CADC Principal Consultant JRW Behavioral Health Services www.randallwebber.com
    2. 2. Herbal Incense <ul><li>Crushed, non-psychoactive herbal/plant matter treated with one or more synthetic cannabinoids </li></ul>
    3. 3. Herbal Incense <ul><li>Crushed, non-psychoactive herbal/plant matter treated with one or more synthetic cannabinoids </li></ul><ul><ul><li>First Generation: “K2”, “Spice”, “Black Mamba”, “Red Dragon” </li></ul></ul><ul><ul><li>Second Generation: “K3”, “Splice”, “Apocalypse”, “Destiny”, “Cloud Ten”, “Head Trip”, house mixes </li></ul></ul>
    4. 4. Current Legal Status of &quot;first generation&quot; Herbal Incense <ul><li>The federal Drug Enforcement Administration (DEA) has used its emergency scheduling authority to temporarily control five chemicals (JWH-018, JWH-073, JWH-200, CP-47,497, and cannabicyclohexanol) that were used to make “herbal incense” products </li></ul><ul><li>Possessing/selling these synthetic substances or products in which they are contained now illegal for at least one year </li></ul><ul><li>Over next year DEA and the United States Department of Health and Human Services (DHHS) will study whether these chemicals and products should be permanently controlled </li></ul>
    5. 5. Banned Herbal incense Brands <ul><li>Frequently marketed as “incense” under a variety of names: </li></ul><ul><ul><li>K2 </li></ul></ul><ul><ul><li>Spice/Spice Gold </li></ul></ul><ul><ul><li>Arctic Synergy </li></ul></ul><ul><ul><li>Black Mamba </li></ul></ul><ul><ul><li>Yucatan Fire </li></ul></ul><ul><ul><li>Red Dragon </li></ul></ul><ul><ul><li>Genie </li></ul></ul><ul><ul><li>Blaze </li></ul></ul><ul><ul><li>Red X </li></ul></ul><ul><ul><li>Dawn </li></ul></ul>
    6. 6. BANNED HERBAL INCENSE PRODUCTS
    7. 14. LEGAL HERBAL INCENSE PRODUCTS
    8. 15. New Herbal Incense Brands <ul><li>K2 </li></ul><ul><li>K3 </li></ul><ul><li>Destiny </li></ul><ul><li>Splice </li></ul><ul><li>Apocalypse </li></ul><ul><li>Cloud Ten </li></ul><ul><li>Head Trip </li></ul><ul><li>“ House Blends” </li></ul>
    9. 16. Apocalypse <ul><li>Specifications: </li></ul><ul><ul><li>Most POTENT herbal incense on the market </li></ul></ul><ul><ul><li>23 FLAVORS!! </li></ul></ul><ul><ul><li>Customize your own flavors!!! </li></ul></ul><ul><ul><li>It has FINALLY arrived, the most anticipated </li></ul></ul><ul><ul><li>product across the United States! </li></ul></ul>
    10. 17. Apocalypse Flavors <ul><li>BLUEBERRY </li></ul><ul><li>STRAWBERRY </li></ul><ul><li>JUNGLE JUICE </li></ul><ul><li>CHERRY               COTTON CANDY </li></ul><ul><li>COCONUT              </li></ul><ul><li>LEMON </li></ul><ul><li>LIME. </li></ul><ul><li>SPEARMINT      </li></ul><ul><li>ROOT BEER </li></ul><ul><li>  BANANA       </li></ul><ul><li>BUBBLE GUM </li></ul><ul><li>ORANGE </li></ul><ul><li>COCA COLA </li></ul><ul><li>” JOOSY FRUIT” </li></ul><ul><li>RASPBERRY </li></ul><ul><li>PEACH                </li></ul><ul><li>APPLE </li></ul><ul><li>CHOCOLATE                         </li></ul><ul><li>GRAPE </li></ul><ul><li>WATERMELON                      </li></ul><ul><li>PINEAPPLE </li></ul><ul><li>MANGO            </li></ul>
    11. 24. AM-HI-C “ Atomic Bomb”
    12. 27. DROBUD ROLL YOUR OWN
    13. 28. Herbal incense Pharmacology <ul><li>To date, hundreds of synthetic cannabinoids (similar to both  9-THC and endogenous cannabinoids) have been created </li></ul><ul><li>Potency ranges from hundreds of times more potent than THC to over 1000x less potent </li></ul><ul><li>Most common psychoactive ingredient in herbal incense was JWH-018 (1-pentyl-3-[1-naphthoyl]indole) </li></ul><ul><li>Synthesized in 1995 by Dr. John W. Huffman at Clemson University </li></ul>
    14. 29. DEA Analysis of “New Grass”
    15. 30. Herbal incense Pharmacology <ul><li>Research supported by NIDA </li></ul><ul><li>Two cannabinoid receptors in the human brain, CB 1 and CB 2 </li></ul><ul><li>CB 2 affects inflammatory pain and was the focus of NIDA study </li></ul><ul><li>JWH-018 targets both receptors </li></ul><ul><li>Huffman: “JWH-018 easiest to make outside a lab, requiring only two steps involving commercial products” </li></ul><ul><li>Transferring the JWH to the botanical product involves using acetone </li></ul>
    16. 31.
    17. 32. Herbal incense Pharmacology <ul><li>Research supported by NIDA </li></ul><ul><li>Two cannabinoid receptors in the human brain, CB 1 and CB 2 </li></ul><ul><li>CB 2 affects inflammatory pain and was the focus of NIDA study </li></ul><ul><li>JWH-018 targets both receptors </li></ul><ul><li>Huffman: “JWH-018 easiest to make outside a lab, requiring only two steps involving commercial products” </li></ul><ul><li>Transferring the JWH to the botanical product involves using acetone </li></ul>
    18. 33. A Historical Perspective <ul><li>All drugs currently illicit in the U.S. have started out as legal (uncontrolled) substances </li></ul><ul><ul><li>Heroin </li></ul></ul><ul><ul><li>Cocaine </li></ul></ul><ul><ul><li>Marijuana </li></ul></ul><ul><ul><li>MDMA (“ecstasy”) </li></ul></ul><ul><ul><li>LSD </li></ul></ul><ul><ul><li>Amphetamine </li></ul></ul><ul><li>Many of these “sat on the shelf” for years before becoming popular intoxicants </li></ul><ul><li>A mixture of rumor, myth and science have all contributed to changes in the legal status of these substances </li></ul>
    19. 34. Herbal incense <ul><li>Street drugs </li></ul><ul><ul><li>Psychoactive substances </li></ul></ul><ul><ul><li>Inconsistent ingredients </li></ul></ul><ul><ul><li>Unregulated manufacture </li></ul></ul><ul><ul><li>Multiple slang names </li></ul></ul><ul><ul><li>Often difficult to specify effects </li></ul></ul><ul><ul><li>Inflated prices </li></ul></ul><ul><li>Herbal incense has many of these characteristics </li></ul>
    20. 35. Drug Testing <ul><li>Many laboratories have a test for some of the first generation JWH chemicals </li></ul><ul><li>In February, 2011 Redwood Laboratories announced a saliva based test that tests for JWH-018, JWH-073 and JWH-250 </li></ul><ul><li>Unknown if saliva/urine tests exist for the other cannabinoids in newer products </li></ul>
    21. 36. Herbal Incense in the Popular Press <ul><li>Sales of “K2” products increased significantly in Chicago following news of its impending status as a controlled substance </li></ul><ul><li>Following an August 2008 report on “herbal incense” in Germany, ER visits ↑ significantly </li></ul><ul><li>How do we inform the public of new drugs without setting of an epidemic of use? </li></ul>
    22. 37. Herbal Incense Pharmacology: The Scientific Literature <ul><li>At present, almost nothing is known about the pharmacology, toxicology and safety profile of such compounds in humans*, except the opinions of consumers in internet forums. </li></ul><ul><li>Mustata, C; Torrens, M; Pardo, R; Perez, C; Farre, M. (2009). </li></ul><ul><li>a/k/a “human guinea pigs” </li></ul>
    23. 38. Herbal Incense: Typical Effects <ul><li>Cannabis-like intoxication </li></ul><ul><li>Dreaminess </li></ul><ul><li>Euphoria </li></ul><ul><li>Introspective mood </li></ul><ul><li>Hilarity </li></ul><ul><li>Forgetfulness </li></ul><ul><li>Heightened sensory perception </li></ul><ul><li>THESE ARE THE EFFECTS MOST COMMONLY </li></ul><ul><li>REPORTED BY USERS </li></ul>
    24. 39. Calls to Poison Control Centers <ul><li>Data from the American Association of Poison Control Centers’ “National Poison Data Center” </li></ul><ul><li>2010: 2,874 calls </li></ul><ul><li>As of April 6, 2011: 1,387 </li></ul><ul><li>Total will be 5,548 calls if current trend continues </li></ul>
    25. 40. Herbal Incense: Other Possible Effects <ul><li>Severe anxiety (may persist after herbal incense use is discontinued) </li></ul><ul><li>Panic attacks </li></ul><ul><li>Dissociation (e.g., derealization) </li></ul><ul><li>Racing thoughts </li></ul><ul><li>Hallucinations </li></ul><ul><li>Rapid pulse (tachycardia) </li></ul><ul><li>Death/Suicide (?) </li></ul>
    26. 41. User Report # 1 <ul><li>This is the worst experience I’ve ever had </li></ul><ul><li>The most anxiogenic substance I've ever used </li></ul><ul><li>Nausea, vomiting, heart pounding like I’m going to have a heart attack </li></ul><ul><li>Not sure whether I just said that, thought it or read it </li></ul><ul><li>2 hours later: Will never take this again </li></ul>
    27. 42. User Report #2: &quot;Apocalypse&quot; <ul><li>3 individual “hits” from a small pipe </li></ul><ul><li>“ organic” taste/no chemical odor or taste </li></ul><ul><li>5 minutes: Feels like Cannabis </li></ul><ul><li>10 minutes: Like an intense cannabis high </li></ul><ul><li>More than 3 puffs might be too much </li></ul>
    28. 43. Why the Discrepancy in Reported Effects? <ul><li>Use of other drugs (including alcohol) with herbal incense </li></ul><ul><li>Varying potency </li></ul><ul><li>“ Hot spots” </li></ul><ul><li>Overdose </li></ul><ul><li>Presence of different cannabinoids </li></ul><ul><li>“ Knock-offs” </li></ul><ul><li>User/environmental characteristics: </li></ul><ul><ul><li>Setting </li></ul></ul><ul><ul><li>Set </li></ul></ul>
    29. 44. Why the Discrepancy in Reported Effects? <ul><li>User/environmental characteristics: </li></ul><ul><ul><li>Set </li></ul></ul><ul><ul><ul><li>Age </li></ul></ul></ul><ul><ul><ul><li>Psychological stability </li></ul></ul></ul><ul><ul><ul><li>Previous experience with psychoactive drugs </li></ul></ul></ul><ul><ul><ul><li>Immediate support system </li></ul></ul></ul><ul><li>Sensationalism (some reports taken out of context) </li></ul><ul><li>Anti- Pro-drug attitudes </li></ul><ul><li>Agency funding/Visibility </li></ul>
    30. 45. Overview <ul><li>Herbal incense contains a cannabinoid closely related to THC/marijuana </li></ul><ul><li>No quality control </li></ul><ul><li>Manufacturing process may be associated with adverse effects </li></ul><ul><li>Subjective effects most commonly resemble those of extremely powerful marijuana </li></ul>
    31. 46. Overview <ul><li>Other reported effects range from intense euphoria and pleasant hallucinations to abject terror and near-psychotic reactions </li></ul><ul><li>Almost complete lack of scientific study </li></ul><ul><li>Street information is very inconsistent </li></ul>
    32. 47. Currently Available Legal Substances <ul><li>Herbal Incense </li></ul><ul><li>“ Bath Salts” </li></ul><ul><li>Kratom </li></ul><ul><li>Salvia </li></ul><ul><li>“ Lazy Cakes ” </li></ul>“ Not for Human Consumption”
    33. 48. Kratom
    34. 49. Kratom <ul><li>Mitragyna speciosa </li></ul><ul><li>Used in </li></ul><ul><ul><li>Malaysia </li></ul></ul><ul><ul><li>Thailand </li></ul></ul><ul><ul><li>Indonesia </li></ul></ul><ul><li>Local names: </li></ul><ul><ul><li>ithang </li></ul></ul><ul><ul><li>biak biak </li></ul></ul><ul><ul><li>Ketum </li></ul></ul><ul><ul><li>Kakuam </li></ul></ul><ul><ul><li>Thom </li></ul></ul>
    35. 50. KRATOM CAPSULES
    36. 51. DRIED KRATOM LEAF
    37. 52. Young Kratom Tree
    38. 53. Kratom Leaf
    39. 54. Kratom Pharmacology <ul><li>7-hydroxymitragynin </li></ul><ul><li>Mitragynine </li></ul><ul><li>Structural similar to some psychedelics </li></ul><ul><li>No psychedelic activity or effects </li></ul><ul><li>Interacts with the opioid receptors </li></ul>
    40. 55. Mitragynine <ul><li>Low doses </li></ul><ul><ul><ul><ul><li>Attaches to delta ( Δ ) opioid receptors </li></ul></ul></ul></ul><ul><li>Higher doses </li></ul><ul><ul><ul><li>“ Crossover” to mu opioid receptors </li></ul></ul></ul>
    41. 56. 7-hydroxymitragynine <ul><li>Recently identified as main active ingredient. </li></ul><ul><li>Animal research: Potent opiate agonist </li></ul><ul><li>Ceiling effect: limits respiratory depression and euphoria. </li></ul><ul><li>No fatal overdose of kratom known to have occurred. </li></ul>
    42. 57. History of Kratom as a Treatment for Opiate Dependence <ul><li>1897: Europeans first noted that that the leaves of Mitragyna speciosa were a cure for opium dependence. </li></ul><ul><li>Currently used for methadone dependence detox in some countries (e.g., New Zealand) and by heroin addicts in Thailand to detox and manage withdrawal symptoms </li></ul>
    43. 58. Kratom Pharmacology <ul><li>Used for: </li></ul><ul><ul><li>Prevention or delay of opiate withdrawal symptoms </li></ul></ul><ul><ul><li>“ Recreational Purposes” </li></ul></ul>
    44. 59. Kratom <ul><li>Seems to be: </li></ul><ul><ul><li>Stimulant in lower doses (mitragynine) </li></ul></ul><ul><ul><li>Sedative in higher doses (7-hydroxymitragynine) </li></ul></ul><ul><li>  Often produces a mixed effect </li></ul><ul><li>Onset: Five to ten minutes </li></ul><ul><li>Duration of action: Several hours </li></ul>
    45. 60. Kratom: Side Effects <ul><li>Short-term (immediate) </li></ul><ul><ul><li>Dry mouth </li></ul></ul><ul><ul><li>Increased or decreased urination </li></ul></ul><ul><ul><li>loss of appetite </li></ul></ul><ul><ul><li>Nausea and/or vomiting. </li></ul></ul><ul><li>Side effects (Intermediate) </li></ul><ul><ul><li>Anorexia/weight loss </li></ul></ul><ul><ul><li>Insomnia </li></ul></ul><ul><ul><li>Dependence (addiction) </li></ul></ul>
    46. 61. Kratom: Side Effects <ul><li>Long term health risks : </li></ul><ul><ul><li>Currently unknown </li></ul></ul>
    47. 62. Khat
    48. 63. Khat <ul><li>Native to tropical East Africa and the Arabian Peninsula </li></ul><ul><li>Fresh leaves/tops chewed or consumed as tea </li></ul><ul><li>Stimulation and euphoria </li></ul><ul><li>Part of social culture in many countries (coffee, tea, coca or khat?) </li></ul>
    49. 64. Khat cultivation in Yemen
    50. 65. Khat chewing
    51. 66. Women in Somalia Selling Khat/Quat
    52. 67. 2006: Bundles of khat seized by the DEA
    53. 68. Khat <ul><li>Coca--------Cocaine </li></ul><ul><li>Khat---------Cathinone (Schedule I) </li></ul><ul><li>Cathinone: Structure similar to amphetamines </li></ul><ul><ul><li>Euphoria </li></ul></ul><ul><ul><li>Anorexia </li></ul></ul><ul><ul><li>Stimulation </li></ul></ul><ul><ul><li>Dilated pupils </li></ul></ul><ul><ul><li>Hypnagogic hallucinations when wearing off </li></ul></ul>
    54. 69. Khat <ul><li>Withdrawal </li></ul><ul><ul><li>Depression </li></ul></ul><ul><ul><li>Irritability </li></ul></ul><ul><ul><li>Lethargy </li></ul></ul><ul><ul><li>Nightmares </li></ul></ul><ul><ul><li>Hand tremor </li></ul></ul>
    55. 70. Methcathinone (Schedule I) <ul><li>First synthesized in 1928 </li></ul><ul><li>1930s: Used in the Soviet Union as an anti-depressant. </li></ul><ul><li>1960s: Began to be used as recreational drug in (former) Soviet Union </li></ul><ul><li>More powerful than cathinone </li></ul><ul><li>Effects similar to amphetamines/cocaine </li></ul><ul><li>1990s: Appeared in U.S. as “cat” </li></ul><ul><li>Little current use </li></ul>
    56. 71. Methcathinone <ul><li>European slang names: </li></ul><ul><ul><li>Ephedrone </li></ul></ul><ul><ul><li>M-Cat * </li></ul></ul><ul><ul><li>* M-cat also refers to methylmethcathinone/mephedrone) </li></ul></ul>
    57. 72. BATH SALTS
    58. 73. <ul><li>States that have taken emergency action to ban at least two chemicals used in designer drugs labeled as “bath salts” (pink) </li></ul><ul><li>States with current laws banning at least one so-called </li></ul><ul><li>“ bath salts” designer drug chemical (lavender) </li></ul><ul><li>States with pending legislation to ban at least one so-called </li></ul><ul><li>“ bath salts” designer drug chemical (purple) </li></ul>
    59. 74. “ Bath Salts” A/K/A “Plant Food” <ul><ul><li>Energizing Aromatherapy </li></ul></ul><ul><ul><li>Down2Earth White Horse </li></ul></ul><ul><ul><li>Kamikaze </li></ul></ul><ul><ul><li>Ivory Wave </li></ul></ul><ul><ul><li>Purple Wave </li></ul></ul><ul><ul><li>Red Dove </li></ul></ul><ul><ul><li>Blue Silk </li></ul></ul><ul><ul><li>Vanilla Sky </li></ul></ul><ul><ul><li>White Blizzard </li></ul></ul><ul><ul><li>Fake Cocaine </li></ul></ul>
    60. 75. Aromatherapy Bath Salts
    61. 76. “ White Blizzard”
    62. 77. “ Plant Food” “ Novelty Collector’s Item
    63. 78. Possible Substances in “Bath Salts” <ul><li>3,4 – Methylenedioxypyrovalerone (MDPV) </li></ul><ul><li>4 – Methylmethcathinone (Mephedrone, M-Cat, Meow, 4-MMC) </li></ul><ul><li>3,4 – Methylenedioxymethcathinone (Methylone, MDMC) </li></ul><ul><li>4 – Fluoromethcathinone (Flephedrone, 4-FMC) </li></ul><ul><li>3 – Fluoromethcathinone (3-FMC) </li></ul>
    64. 79. Mephedrone <ul><li>Onset: </li></ul><ul><ul><li>Oral: 15–45 minutes </li></ul></ul><ul><ul><li>Insufflation (nasal/“snorting): 10 minutes </li></ul></ul><ul><ul><li>i.v. injection (rare): 30 minutes </li></ul></ul><ul><li>Duration: </li></ul><ul><ul><li>Oral/Nasal: 2-3 hours </li></ul></ul><ul><ul><li>Intravenous: 30 minutes </li></ul></ul>
    65. 80. Mephedrone Research <ul><li>Dutch study: </li></ul><ul><ul><li>58%: overall pleasant experience </li></ul></ul><ul><ul><li>12 %: unpleasant experience. </li></ul></ul><ul><li>UK Study: </li></ul><ul><ul><li>Users w/ previous cocaine experience: </li></ul></ul><ul><ul><ul><li>Better quality and longer lasting high </li></ul></ul></ul><ul><ul><ul><li>Less addictive </li></ul></ul></ul>
    66. 81. Mephadrone <ul><li>Intended Effects: (Similar to MDMA/”ecstasy”, amphetamines and/or cocaine) </li></ul><ul><ul><li>Euphoria </li></ul></ul><ul><ul><li>Stimulation </li></ul></ul><ul><ul><li>Enhanced music appreciation </li></ul></ul><ul><ul><li>Decreased hostility </li></ul></ul><ul><ul><li>Improved mental function </li></ul></ul><ul><ul><li>Mild sexual stimulation </li></ul></ul>
    67. 82. Mephadrone <ul><li>Unintended (Side) Effects: </li></ul><ul><ul><li>Dilated pupils </li></ul></ul><ul><ul><li>Poor concentration </li></ul></ul><ul><ul><li>Bruxism (teeth grinding) </li></ul></ul><ul><ul><li>Problems focusing visually </li></ul></ul><ul><ul><li>Poor short-term memory </li></ul></ul><ul><ul><li>Hallucinations </li></ul></ul><ul><ul><li>Delusions </li></ul></ul>
    68. 83. Mephedrone <ul><li>4-methylmethcathinone (4-MMC, M-Cat, Meow) </li></ul><ul><li>4-methylephedrone </li></ul><ul><li>Effects similar to MDMA/”ecstasy” BUT </li></ul><ul><ul><li>No formal published studies effects on humans </li></ul></ul><ul><ul><li>No animals studies that could be applied to humans </li></ul></ul><ul><li>Controlled under federal analog act if for human consumption </li></ul><ul><li>Not controlled if “not for human consumption) </li></ul>
    69. 84. M-CAT 4-Methylmethcathinone & Caffeine: MDMA, caffeine & 4-Methylmethcathinone 4-Methylmethcathinone & Caffeine 4-Methylmethcathinone & Methylone
    70. 85. Methylone <ul><li>3,4-methylenedioxy-N-methylcathinone </li></ul><ul><ul><li>M1 </li></ul></ul><ul><ul><li>bk-MDMA </li></ul></ul><ul><li>Structure similar to MDMA/”ecstasy” </li></ul>
    71. 86. Methylone <ul><li>Central Nervous System Stimulation </li></ul><ul><li>Euphoria or dysphoria, </li></ul><ul><li>Anxiolysis or Anxiogenesis </li></ul><ul><li>Increase in sociability. </li></ul><ul><li>Insomnia </li></ul><ul><li>Restlessness </li></ul><ul><li>Derealization/depersonalization </li></ul><ul><li>Hallucinations </li></ul><ul><li>Psychosis </li></ul>
    72. 87. Methylone <ul><li>Tachycardia (rapid pulse) </li></ul><ul><li>Hypertension (high BP) </li></ul><ul><li>Hyperthermia </li></ul><ul><li>Sweating </li></ul><ul><li>Dilated pupils </li></ul><ul><li>Nystagmus </li></ul><ul><li>Trismus (inability to open the mouth) </li></ul><ul><li>Bruxism (Tooth grinding) </li></ul><ul><li>Anorexia </li></ul><ul><li>Nausea and vomiting </li></ul>
    73. 88. Sold as methylone Methylone Sold as ecstasy (Sold as M1) Methylone, bk-MBDB (Sold as Dragonfly Pokeball) Methylone, Caffeine
    74. 89. Plant Food “Piperazine Free” <ul><li>The piperazines are a category of substances </li></ul><ul><li>Used in medicine to kill parasites </li></ul><ul><li>Some have psychoactive properties and are often substituted for MDMA in “ecstasy” </li></ul><ul><ul><li>BZP (Benzylpiperazine ) </li></ul></ul>
    75. 90. BMP Products “ Charge” “ Extreme Jet”
    76. 91. BMP Characteristics <ul><li>Appears to have mild to moderate addiction potential </li></ul><ul><li>Tolerance appears to develop quickly </li></ul><ul><li>Potential for short-term toxicity moderate </li></ul><ul><li>Potential for long-term toxicity unknown </li></ul><ul><li>Potential for acute psychiatric impairment appears moderate at the least </li></ul><ul><li>Potential for persistent psychiatric impairment unknown </li></ul>
    77. 92. BMP Effects <ul><li>Dosage ranges from 50-200 mg </li></ul><ul><li>Former amphetamine addicts could not discriminate between BMP and amphetamine when injected i.v. </li></ul><ul><li>Acts as both a stimulant and a hallucinogen </li></ul><ul><li>perceptions such as taste, color or music may be subjectively enhanced. </li></ul><ul><li>Duration of action = 4-6 hours/rarely 8 hours </li></ul><ul><li>Mixed with TFMPP produces a similar effects as MDMA </li></ul>
    78. 93. BMP Effects <ul><li>Feelings of euphoria, wonder, amazement, well-being, energy and elation </li></ul><ul><li>Rapid mood elevation </li></ul><ul><li>Enhanced sociability </li></ul><ul><li>Enhanced appreciation of music </li></ul><ul><li>Increased desire to move, also slight increase in stereotypy </li></ul><ul><li>Skin tingling </li></ul><ul><li>Decreased appetite </li></ul><ul><li>Repetitive thought patterns </li></ul><ul><li>Actual and perceived changes in body temperature </li></ul>
    79. 94. BMP Effects <ul><li>Mild jaw clenching/bruxism </li></ul><ul><li>Increased heart rate </li></ul><ul><li>Dilation of pupils </li></ul><ul><li>Nausea </li></ul><ul><li>Flushing </li></ul><ul><li>Mild xerostomia (dry mouth) </li></ul><ul><li>Slight urinary incontinence, often described as &quot;leaking&quot; a small amount of urine after urinating (not due to loss of bladder control) </li></ul>
    80. 95. BMP Effects <ul><li>Later Effects: </li></ul><ul><ul><li>Mild headache </li></ul></ul><ul><ul><li>Nausea </li></ul></ul><ul><ul><li>Hang-like symptoms (common with high doses) </li></ul></ul><ul><ul><li>Fatigue </li></ul></ul><ul><ul><li>Indigestion/heartburn </li></ul></ul><ul><ul><li> hunger/thirst </li></ul></ul><ul><ul><li>Insomnia </li></ul></ul><ul><ul><li>Confusion </li></ul></ul><ul><ul><li>Depression (more pronounced with frequent/long-term use) </li></ul></ul>
    81. 96. BMP Side Effects <ul><li>dilated pupils </li></ul><ul><li>blurred vision </li></ul><ul><li>dryness of the mouth </li></ul><ul><li>extreme alertness </li></ul><ul><li>pruritis </li></ul><ul><li>confusion </li></ul><ul><li>Tremor </li></ul><ul><li>Agitation </li></ul><ul><li>Extrapyramidal symptoms (dystonia, akathisia </li></ul>
    82. 97. BMP Side Effects <ul><li>Headache </li></ul><ul><li>Dizziness </li></ul><ul><li>Anxiety </li></ul><ul><li>Insomnia </li></ul><ul><li>Vomiting </li></ul><ul><li>Chest pain </li></ul><ul><li>Hallucinations </li></ul><ul><li>Paresthesia </li></ul><ul><li>Tachycardia </li></ul><ul><li>Hypertension </li></ul>
    83. 98. BMP Side Effects <ul><li>Palpitations </li></ul><ul><li>Hyperventilation </li></ul><ul><li>Sweating </li></ul><ul><li>Hyperthermia </li></ul><ul><li>Psychosis or adverse psychiatric events </li></ul><ul><li>renal toxicity </li></ul><ul><li>Respiratory failure </li></ul><ul><li>Seizures </li></ul>
    84. 99. Trifluoromethylphenylpiperazine TFMMP
    85. 100. Trifluoromethylphenylpiperazine TFMMP <ul><li>“ Legal X” </li></ul><ul><li>Rarely used by itself </li></ul><ul><li>Produces aversive effects in animals rather than self-administration </li></ul><ul><li>Not a controlled substance </li></ul><ul><li>More commonly co-administered with BZP </li></ul>
    86. 101. Trifluoromethylphenylpiperazine TFMMP <ul><li>“ Crash” syndrome: </li></ul><ul><ul><li>Insomnia </li></ul></ul><ul><ul><li>Loss of appetite </li></ul></ul><ul><ul><li>Headache </li></ul></ul><ul><ul><li>Alcohol-like hangover </li></ul></ul>
    87. 102. Packaging 50 to 500 milligram packets. Price 25 to $50 per 50 milligram packet
    88. 103. Reported Effects <ul><li>Stimulant euphoria </li></ul><ul><li>↑ Energy </li></ul><ul><li>Reversal of fatigue/Insomnia </li></ul><ul><li>Agitation </li></ul><ul><li>Hallucinations </li></ul><ul><li>Irritability </li></ul>
    89. 104. Salvia: One name-many plants
    90. 105. Salvia: One name-many plants <ul><li>Plants in the Mint family </li></ul><ul><li>Sage </li></ul><ul><li>Common Sage </li></ul><ul><li>Mexican Bush Sage </li></ul><ul><li>White Sage </li></ul><ul><li>Greek Sage </li></ul><ul><li>Diviner's Sage (Salvia Divinorum) </li></ul>
    91. 106. Meadow Sage
    92. 107. Salvia divinorum/Herba de Maria
    93. 108. Salvia Divinorum <ul><li>Grows primarily in the Sierra Mazateca (Oaxaca, Mexico) </li></ul><ul><li>Commonly used by Mazateca shamans </li></ul>
    94. 109. Sierra Mazateca
    95. 110. Salvia Divinorum <ul><li>Grows primarily in the Sierra Mazateca (Oaxaca, Mexico) </li></ul><ul><li>Commonly used by Mazateca shamans </li></ul><ul><li>Low addiction potential (kappa opioid agonist) </li></ul><ul><li>Psychoactive component = Salvinorin A (most potent natural hallucinogen) </li></ul>
    96. 111. 0.5 gm of salvia divinorum extract
    97. 112. Salvia Divinorum: Recreational Use <ul><li>Smoked </li></ul><ul><li>Unnoticeable or light effects from dry leaf </li></ul><ul><li>More intense effects from higher doses </li></ul><ul><ul><li>Uncontrollable laughter </li></ul></ul><ul><ul><li>Past memories, such as revisiting places from childhood memory </li></ul></ul><ul><ul><li>Sensations of motion, or being pulled or twisted by forces </li></ul></ul>
    98. 113. Salvia Divinorum: Recreational Use <ul><li>Smoked </li></ul><ul><li>Unnoticeable or light effects from dry leaf </li></ul><ul><li>More intense effects from higher doses </li></ul><ul><ul><li>Visions of membranes, films and various two-dimensional surfaces </li></ul></ul><ul><ul><li>Merging with or becoming objects </li></ul></ul><ul><ul><li>Overlapping realities, such as the perception of being in several locations at once </li></ul></ul>
    99. 114. After effects produced by Salvia N=500 Positive Negative Increased insight: 47% Decreased insight: 1.8% Improved mood: 44.8% Worsened mood: 4.0% Increased connection with universe or nature: 39.8%    Decreased connection with universe or nature: 5.4% Increased sweating: 28.2% Decreased sweating: 1.6% Body felt warm or hot: 25.2% Body felt cold: 6.4% Increased self-confidence: 21.6% Decreased self-confidence: 2.4%

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