This presentation aims to describe and compare the new designer drugs, #KratomEffects or sometimes referred to as "legal highs" (kratom, bath salts and k2, among others) to the opiates and cocaine from the good old days.
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The New Designer Drugs
1. Not Your Mother’s Drugs:
The New Designer Drugs
1
Diane A. Tennies, Ph.D., LADC
Lead TEAP Regional Health Specialist
Humanitas, Inc.
2. 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 2
4. ‘The Good Ole Days’
Opiates
Cocaine
Phencyclidine (PCP)
Extensive scientific literature (clinical and
experimental)
Kinetics (the chemical process)
Toxicological effects (on humans)
4
5. 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”
5
6. 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)
6
7. 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
7
8. But Is This REALLY a Problem?
American Association of Poison Control Centers Report
For 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
8
2011: 75 calls*
*preliminary data as not all centers have reported fully
9. 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
Never heard of Kratom? Trust Us, You Will –
08/02/2011 In the Fix: Addiction and Recovery
Straight Up
“Bath Salt” Abuse Hits Epidemic Proportions - Emergency
9
Physician’s Monthly Report 04/13/2011
10. 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”
10
12. So If They Are Popular and Legal
Then Sales Can Be Tracked
“Herbal Incense” (synthetic cannabinoids)
accounted for nearly…..
Five billion dollars in sales*
12
*Retail Compliance Association (2010)
13. Spice (Named From the Frank
Herbert books)
Spice gold K2
Spice silver Solar flare
Spice diamond K2 summit
Yucatan fire PEP Spice
Sence Fire n’ Ice
Chill X Zombie World
Genie Bad to the Bone
Algerian blend Black Mamba
Dark Night
G-Force
13
15. Let’s Review Marijuana
isted in US Pharmacopea
until 1944 when removed
due to political pressure to
ban social use in USA
annabis preparations have
been used for over 4000 to
6000 years
15
16. 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
16
17. 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
18. 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 18
19. 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)
19
22. 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
23. 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)
23
24. 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
24
25. 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
25
Considerable batch variability = highly potential
for overdose
29. Countries That Control Synthetic
Cannabinoids
Denmark Austria
Germany Poland
Estonia Romania
France Sweden
Ireland UK
Italy Chile
Latvia Finland
Lithuania South Korea
Luxembourg Switzerland
29
30. 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
31. So its just ‘fake pot’ right?
What’s the big deal??
When I was young I knew plenty of
people who….
31
33. Pharmacological Short-Term Effects
of Smoked Synthetic Cannabinoids
Altered state of Panic attacks
consciousness Severe agitation*
Mild euphoria and Numbness and tingling
relaxation (less common) Severe GI upset/vomiting*
Perceptual alterations (time
distortions) Long term altered depth
perception
Intensification of sensory
experiences “Flash backs”
Impaired short-term Hallucinations/delusions
memory Tremors and seizures*
Increase in reaction times Tachycardia*
Altered depth perception Hypertension*
Death*
*Symptoms NOT consistent
with cannabis intoxication 33
34. 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 humans
o Withdrawal symptoms: drug craving, nightmares,
sweating, nausea, tremor, headaches, HBP, and 34
racing heartbeat
35. “This isn’t Jerry Garcia’s Marijuana”
(Rep. Jeff Roorda (D), Missouri)
35
37. 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
37
38. 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
39. 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:
Injection
Smoking
Snorting
Liquid form mixed into alcoholic drinks
39
Atomizer – occasionally
40. 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/weeks
40
41. 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
41
*Emergency Physicians Monthly 04/13/2011
43. 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
43
44. 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 44
Interacts with other medications for harmful effects
45. 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
THIS WAS SAME TIME HAD MAJOR DRUGS OF ABUSE - Been around for decades (centuries?) All been used in medical practice
Morphine and heroin made illegal in 1925, several legal alternatives, with virtually identical effects, were promptly marketed and sold were popular, and remained so even after its criminalization in 1968 MDMA 1912 by Merck chemist Anton Köllish and championed throughout the '70s and '80s by chemistry professor Alexander Shulgin and psychotherapist Leo Zeff. It also became popular as a euphoric at nightclubs worldwide and was unregulated in the U.S. until 1985, when the DEA used emergency scheduling power for the first time to ban MDMA Emergency scheduling gives the government the power to ban chemicals for up to 18 months while gathering evidence for a permanent scheduling. MDMA was permanently scheduled in 1988
The United States Pharmacopeia (USP) is a non–governmental, official public standards–setting authority for prescription and over–the–counter medicines and other healthcare products manufactured or sold in the United States
in the academic Journal of Pharmacology and Experimental Therapeutics in 1998
JWH-018 binds to the brain cannabinoid receptor CB1 with higher affinity than Δ9-THC, suggesting that it would have the same effects as Δ9-THC These four effects indicate Δ9-THC-like psychoactivity in humans