Not Your Mother’s Drugs: The New Designer Drugs

1. Not Your Mother’s Drugs: The New Designer Drugs 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

3. Remember When?Simpler and Easier Times

4. ‘The Good Ole Days’ • Opiates • Cocaine • Phencyclidine (PCP) • Extensive scientific literature (clinical and experimental) • Kinetics (the chemical process) • Toxicological effects (on humans)

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”

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)

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

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 • 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 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”

11. Synthetic Cannabinoids

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* *Retail Compliance Association (2010)

13. 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

14. More Spice

15. 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

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

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

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)

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

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)

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

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 • Considerable batch variability = highly potential for overdose

26. Same or Different Chemical Structures? JWH-018 THC

27. So if Synthetic Cannabinoids and THC Are Chemically Different…That Means?

29. Countries That Control Synthetic Cannabinoids • Denmark • Germany • Estonia • France • Ireland • Italy • Latvia • Lithuania • Luxembourg • Austria • Poland • Romania • Sweden • UK • Chile • Finland • South Korea • Switzerland

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

31. So its just ‘fake pot’ right? What’s the big deal?? When I was young I knew plenty of people who….

33. 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

34. Severe Symptoms Are Not Consistent with Cannabis Use • Symptoms • Severe agitation • Severe GI upset/vomiting* • Hallucinations/delusions • Tremors and seizures* • Tachycardia • New speculation is these symptoms caused by myriad on contaminants in the K2/Spice • (Remember no regulatory oversight or control) • Long term symptoms: NO RESEARCH on humans • Withdrawal symptoms: drug craving, nightmares, sweating, nausea, tremor, headaches, HBP, and racing heartbeat

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

36. Bath Salts

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

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

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 • 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

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 *Emergency Physicians Monthly 04/13/2011

42. Kratom

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

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 • 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

46. Comments, Questions, and Concerns