PRC Training: Update on Synthetic Drugs 01.20.16

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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.

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.

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

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.

Using Turning Point
• Audience Response System
• Choose your answer, only records answers once.
• Poll closes after all votes are recorded.

Enteransw
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25% 25%25%25%
Favorite Ice Cream Flavor
A. Chocolate
B. Vanilla
C. Strawberry
D. Rather eat cake

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%

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%

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%

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%

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%

Will They Turn You into a Zombie?
What Clinicians Need to Know about
Synthetic Drugs (2nd Edition)

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

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

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

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%

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%

“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

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.

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

AN INTRODUCTION TO KEY
TERMS AND DEFINITIONS
27

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

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

“Designer” Psychoactive Substances
SOURCE: http://www.drugs-forum.com, updated 2013. 30

SOURCE: http://www.drugs-forum.com, updated 2013.

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

After repeated drug use, “deciding” to use
drugs is no longer voluntary because
DRUGS CHANGE THE BRAIN!

A REVIEW OF
SYNTHETIC DRUGS
37

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

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

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

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.

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

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%

Spice/K2 is legal in Texas.
A. True
B. False
True
False
0%0%

The Texas Tribune:
Cracking Down on K2

Synthetic Cannabinoids
Spice vs. “Spice”
46

Synthetic Cathinones
Bath Salts vs. “Bath Salts”
47

• 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

• 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

Fox 29 Report: Del Rio Police Make K2
Bust After Students Overdose

 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
51

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

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

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

2271
658
17
0
500
1000
1500
2000
2500
Male Female Unknown
Patient gender
Number

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

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

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

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

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

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

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

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+

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

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

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

• 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

Synthetic Cathinones are b-keto (‘bk’)
Analogs of Amphetamine
69

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

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

THE EFFECTS OF SYNTHETIC
DRUGS
72

Short-Term Effects of
• 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

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

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

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

THE EPIDEMIOLOGY
OF SYNTHETIC
DRUG USE
77

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

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

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.

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
MDMA
Hallucinogens
LSD
SOURCE: Monitoring the Future Survey, 2012 results. 81

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.

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.

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.

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

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.

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

Counties that had an Increase in Seizures by
Dose Units in 2014
0
500
1000
1500
2000
2500
Dose Units
2013 2014

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

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 %

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

OTHER NOTABLE SYNTHETIC
DRUGS – “NEW AND OLD”
92

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

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

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

Someone Help Me Find “Molly”

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

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

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

• 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.

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

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

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.

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!

Recruitment for Advisory Group
Every 3rd Tuesday
of the month from
1:30pm – 2:30pm,
before the COSA
Coalition Meeitng.

PRC Training: Update on Synthetic Drugs 01.20.16

PRC Training: Update on Synthetic Drugs 01.20.16

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