Not Your Mother’s Drugs: The New Designer Drugs

Diane A. Tennies, Ph.D., LADC

Lead TEAP Regional Health Specialist

Humanitas, Inc.

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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

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Remember When?Simpler and Easier Times

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‘The Good Ole Days’

Opiates Cocaine Phencyclidine (PCP) Extensive scientific literature (clinical

and experimental)Kinetics (the chemical process)Toxicological effects (on humans)

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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”

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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)

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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

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But Is This REALLY a Problem?

American Association of Poison Control Centers ReportFor 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 other drugs):

2009 : No data 2010: 22 calls 2011: 75 calls*

*preliminary data as not all centers have reported fully

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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

“Bath Salt” Abuse Hits Epidemic Proportions - Emergency Physician’s Monthly Report 04/13/2011

Never heard of Kratom? Trust Us, You Will – 08/02/2011 In the Fix: Addiction and Recovery Straight Up

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 methamphetamines

Conclusion: Most illegal drugs have an unregulated "research chemical”

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Synthetic Cannabinoids

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So If They Are Popular and Legal Then Sales Can Be Tracked

“Herbal Incense” (synthetic cannabinoids) accounted for nearly…..

Five billion dollars in sales*

*Retail Compliance Association (2010)

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Spice (Named From the Frank Herbert books)

Spice gold Spice silver Spice diamond Yucatan fire Sence Chill X Genie Algerian blend

K2 Solar flare K2 summit PEP Spice Fire n’ Ice Zombie World Bad to the Bone Black Mamba Dark Night G-Force

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More Spice

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Let’s Review Marijuana

Listed in US Pharmacopea until 1944 when removed due to political pressure to ban social use in USA

Cannabis preparations have been used for over 4000 to 6000 years

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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

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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 Health's Senior Scientist Award 17

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

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The Spread of K2/Spice K2/Spice is unintended result of scientific research on

marijuana's 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)

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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 don't know what it's going to do to you. You're 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

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)

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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

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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

Considerable batch variability = highly potential for overdose

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Same or Different Chemical Structures?

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JWH-018 THC

So if Synthetic Cannabinoids and THC Are Chemically Different…That

Means?

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Countries That Control Synthetic Cannabinoids

Denmark Germany Estonia France Ireland Italy Latvia Lithuania Luxembourg

Austria Poland Romania Sweden UK Chile Finland South Korea Switzerland

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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

So its just ‘fake pot’ right?

What’s the big deal??

When I was young I knew plenty of people who….

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Pharmacological Short-Term Effects of Smoked Synthetic

Cannabinoids Altered state of

consciousness Mild euphoria and

relaxation (less common) Perceptual alterations

(time distortions) Intensification of sensory

experiences Impaired short-term

memory Increase in reaction times Altered depth perception

Panic attacks Severe agitation* Numbness and tingling Severe GI upset/vomiting* Long term altered depth

perception “Flash backs” Hallucinations/delusions Tremors and seizures* Tachycardia* Hypertension* Death*

*Symptoms NOT consistent with cannabis intoxication 33

Severe Symptoms Are Not Consistent with Cannabis Use

o Symptoms Severe agitation Severe GI upset/vomiting* Hallucinations/delusions Tremors and seizures* Tachycardia

o New speculation is these symptoms caused by myriad on contaminants in the K2/Spice

o (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 racing heartbeat

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“This isn’t Jerry Garcia’s Marijuana” (Rep. Jeff Roorda (D), Missouri)

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Bath Salts

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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

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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

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:InjectionSmokingSnortingLiquid form mixed into alcoholic drinksAtomizer – occasionally

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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/weeks40

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

*Emergency Physicians Monthly 04/13/2011

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Kratom

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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

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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 Interacts with other medications for harmful effects

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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

Comments, Questions, and Concerns

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