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New Highs for the New Millennium
Brandon J. Warrick MD Assistant Clinical Professor
Wayne State University
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Disclosures
• No financial disclosures
• All treatments mentioned in this talk are FDA approved.
• Treatment dosing may exceed package insert
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Objectives
• What are “Bath Salts”? • What is “Spice or K2”? • Epidemiology • Were did designer drugs come from? • Were are designer drugs going?
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What are “Bath Salts”?
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Testimonials • “I don’t believe in the hype so I ordered some offline
and received in roughly a week and a half. It came in a 250mg package that ran me roughly 18 dollars with tax and shipping included. I tried roughly 10mg and absolutely loved it. Immediately after ingestion of the bath salts I felt a rush of energy and even a slight euphoria to go along with it. My mind felt like it was working in overdrive and I wanted to talk to anyone about anything I possibly could…”
• “At about 1 hour and 10 minutes in I got the strongest urge to redose I have ever felt from a drug, including cocaine.”
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• White to Light Brown • Hydrophilic • Crumbly powder • Slight odor
Physical Properties
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Michigan; How it Began • First call December 18, 2010 • First Death February 3 2011 • February 2-7 10 cases
• Reported
– Bay City – Iron Wood – Mt. Clemons
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PCC & Health Department
PCC – Poison Control Center MDCH – Michigan Department of Community Health * - In Collaboration
Need PCC MDCH24/7 Call Center Yes NoAble to give medical advice Yes NoReal-time reporting Yes YesAble to mandate reporting No YesAble to take legal action No YesAble to create EPI-X alerts* Yes YesAble to create HAN* No YesAble to submit MMWR* No YesParticipates in SENTRY drugs of abuse reporting* No Yes
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The Plan
• Poison Center will act as part of Health Department
• Mandatory reporting to Poison Center • Poison Centers will report to MDCH • MDCH take care of bureaucracy
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Demographics
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Clinical EffectsAgitation 61.4%
Tachycardia 56.8%Hallucination 30.0%Hypertension 25.7%
Confusion 19.5%CPK 16.1%
Drowsy 11.0%Mydriasis 7.7%
Tremor 7.5%Electrolytes 7.1%Hypotension 3.4%
Coma 3.3%Seizures 2.8%
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Co-Ingestant No PercentTHC Homologs 143 10.9%Opioids 80 6.1%THC 78 5.9%Ethanol 53 4.0%Benzos 32 2.4%Cocaine 30 2.3%Amphetamines 24 1.8%Antipsycotics 9 0.7%Tramadol 5 0.4%
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Top Brand Number of casesWhite Rush 43Ivory Wave 14
Zoom 15White Lightning 30
MDPV 9Bliss 9
Cloud Nine 8Red Dove 8Unknown 1034
Other 145
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Current Federal Legislation
• September 7, 2011 • Emergency Schedule I
– MDPV – Methylone – Mephedrone
• Permanent paper work
pending
• Based on PCC data
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Website Following DEA Announcement
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Soothing Bath Salts - Relax and soak away in RECHARGE EXTRA Concentrated Bath Salts. Add the contents to a hot bath to naturally soften the water which will leave you feeling very soothed and relaxed.
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PLEASE NOTE: The RECHARGE Extra line of Bath products provide a immediate and intense experience that is always enjoyable. Once you have experienced RECHARGE EXTRA Bath Salts, you will know which method of application provides the most exhilarating experience for you. **This Powerful and Immediate rush of heightened sensation lasts from 1-3 hours. NOT FOR HUMAN CONSUMPTION
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Alexander and Ann Shulgin
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The Past
“I love Alexander Shulgin. I’ve loved him from the first moment I read about him. He is my idol, my hero, my sun, my O2.” -Hamilton Morris
http://www.viceland.com/int/v17n5/htdocs/the-last-interview-with-alexander-shulgin-423.php?page=1
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The Past
• Published in 1991 • 179 chemicals
– Chemical Synthesis – Description of Effects
• 150 others discussed • Most are legal • Free at Erowid.com
I Have Known And Loved
Phenethylamines
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Phenethalamines
NH2
Serotonin
Dopamine Norepi
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“How many numbers are to the right of the decimal point
in π?” -Hamilton Morris
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NH2
Amphetamine Speed
N H
Methamphetamine
N H
HO
HO
OH
Norepinephrine
Ecstasy
N H
O
O
N H
OH
Pseudoephedrine
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MDMA
Methylone
Methcathinone
Mephedrone
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Because They Could
Bromo Dragonfly
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Present
• Published in 2011 • 1300 Compounds • Most are legal
• $84 at Transform
Press
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What Amazon Reviews Say
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Other Books By Shulgin
Tryptamines i Have Known And Loved: The Chemistry Continues
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Other Books By Shulgin
LSA LSD
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Professional Hippy OR …
• War Hero • Environmentalist • Teacher • DEA Consultant • Outstanding
Researcher
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Who is this Clemson Professor?
• John W. Huffman (JWH) • Funded National Institute
on Drug Abuse • Studied cannabinoid
receptors
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More JWH
• 450 products developed
• More potent than THC
• Structurally different than THC
• UDS-negative for THC
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“Herbal Blend”
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K2 & Spice
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Hebrew University
HU-210
Delta-9 THC
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There Are More
AM-630
WIN 55,212-2
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In Addition to THC Effects K2/Spice
• Seizures • Tachycardia • Hallucinations • Agitation • Withdrawal
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Where to buy?
• Gas stations • “Head Shops” • Friend • Internet
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What They Sell
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Synthetic Cocaine
Dimethocaine/lorococain
3-(p-fluorobenzoyloxy)tropane (pFBT)
cocaine
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Benzylpiperazine BZP
• Glaxo-Wellcome synthesized in 1944 as a potential anti-parasitic agent
• 1970s tested as an antidepressant
• 1990s reported as adulterant • Frequently found in “Ecstasy” • Amphetamine like effects • High rate of seizures
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Derivatives • Befuraline-antidepressant • Bifeprunox-antipsychotic • Buclizine-antihemetic • Chlorbenzoxamine-GI
agent • Fipexide-Nootropic • Imatinib-antineoplastic • Piberaline-Parkinson’s • Piribedil-antiparkinsonian • Trimetazidine-antianginal
• Vesnarinone-cardiotonic • Meclizine-antihistamine • 4-methyl-1-benzylpiperazine
(MBZP) • 4-Bromo-2,5-dimethoxy-1-
benzyliperazine (2C-B-BZP • 1,4-Dibenzyliperazine (DBZP) • 3,4-Methylenedioxy-1-
benzyliperazine (MDBZP) • Trifluoromethylphenylpiperazi
ne
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PCP and Ketamine
• NDMA antagonists • Dissociative • Mu agonism • Uses
– Sedation – Addiction treatment – Pain syndromes
http://www.metrohealthanesthesia.com/edu/ivanes/ketamine2.htm
Ketamine
PCP Phencyclidine
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PCP Analogs
http://en.wikipedia.org/wiki/Phencyclidine
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Analogs that Have Emerged
Piritramide Tiletamine
2-phenyl-2-N-ethylaminocyclohexanone lefetamine
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What’s Next?
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What’s Next?
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Challenges to Regulation
• Near infinite compounds • Important medical compounds • Easy to make • Internet
– Anonymous seller – Out of the country
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Near infinite compounds
• Controlled Substance Analogue Enforcement Act of 1986
• Problems – Analogue definition is vague – Substantially similar to or greater than
schedule I and II drug – Does not cover products not meant for human
consumption
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Amphetamines - Sources • Legal Uses
– ADHD – Weight Loss – Narcolepsy – Military
• Modafanil
• Diversion – Medical, Law students
• Clandestine production
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Non-Amphetamines
• ICU – Epi – Norepi – Dopamine – Dobuamine
• Parkinson Drugs
• Antidepressant – Bupropion – MAOI
• Decongestants • Asthma/COPD
– albuterol – theophylline
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What is this?
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Analogue?
JWH-073
“As I said they are so chemically distinct, what possible enzymatic process could result in a common chemical product?” http://www.drugs-forum.com/forum/showthread.php?t=91939&page=2#ixzz1RkzUDjoG
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What’s The Next Drug?
• We will leave that up to the drug companies
• We should be asking – Next incense, plant food, bath salt, pond
water cleaner, collector's item, or ….. • Labeled product as “Does Not Contain…”
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What Can You Do?
• Be curious and suspicious • Report cases
– Poison Centers – Health Department – Obtain substances
• Monitor forums like Erowid.com • Follow trends from www.ecstasydata.org/
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A Special Thanks
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Questions
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Reference • Images from Google Images • Erowid.com • M. Badioun K2/Spice Lecture to PCC • T. Kuschel K2/Pyrovalorne and Spice Lecture to
PCC • D. Rhodes Bath-salts May Be Not Lecture to
PCC • B. Dolcourt Phenethamines Grand Round
presentation • Wikipedia.com • http://www.emcdda.europa.eu/index.cfm