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Not Your Mother’s Drugs: Synthetic Cannabinoids

Not Your Mother’s Drugs: Synthetic Cannabinoids. Diane A. Tennies, Ph.D., LADC Lead TEAP Health Specialist. Learning Objectives. Describe the synthetic cannabinoids and why they are increasing in popularity  Articulate the physiologic effects associated with synthetic cannabinoids use

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Not Your Mother’s Drugs: Synthetic Cannabinoids

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  1. Not Your Mother’s Drugs: Synthetic Cannabinoids Diane A. Tennies, Ph.D., LADC Lead TEAP Health Specialist

  2. Learning Objectives • Describe the synthetic cannabinoids and why they are increasing in popularity  • Articulate the physiologic effects associated with synthetic cannabinoids use • Discuss the current status of federal and state laws as applied to synthetic cannabinoids • Develop center-specific interventions to assist students identified as using synthetic cannabinoids

  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. 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 psychotomimetic effects for 4000 to 6000 years

  6. Psychotomimetic?? • Mimics the symptoms of psychosis (delusions and hallucinations) • Carl Sagan used ‘psychotomimetic’ (in his anonymous article “Mr.X”) to describe the effects of marijuana • Cannabinoids are psychotomimetic, especially delta-9-tetrahydrocannabinol (THC) • Psychotomimetic drugs affect: thought, perception and mood, without causing marked psychomotor stimulation or depression

  7. 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

  8. Human Chemistry • Human body produces endogenous cannabinoids and the cannabis plant produced exogenous cannabinoids • We have complex cannabinoids receptor systems • Marijuana contains a variety of unique cannabinoids that bind with these receptors

  9. Delta-9-tetrahydrocannabinol (THC)

  10. 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

  11. DUBIOUS HONOR OF BEING CREATOR OF SYNTHETIC CANNABINOIDS • 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 11

  12. 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

  13. 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 • 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 [78 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

  14. Legitimate Uses for Synthetic Cannabinoids • Nabilone – derivative of THC and in proprietary preparation Cesamet used for nausea in chemotherapy • Dronabinol/Marinol – used for nausea, vomiting • Rimonabant (Acomplia, Zimulti) – initially used for weight loss but pulled because of side-effects. NIDA investigating because it blocks the effects of THC in marijuana • Sativex – semi-synth used in Europe and Canada for pain

  15. SYNTHETIC CANNABINOIDS – LATEST IN A LONG HISTORY OF DESIGNER DRUGS • Morphine and Heroin illegal in 1925 • Synthetic hallucinogen LSD • MDMA (Ecstasy) • Every illegal drug has an unregulated "research chemical" that reputedly does the same thing • For instance, can buy MDAI, said to have similar effects to ecstasy, and mephedrone, a synthetic cousin of crystal methamphetamine

  16. The Many Versions

  17. Spice (from the Frank Dune books)AKA: • 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

  18. More Spice

  19. 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’ • Enough for 8 joints • Price comparable to marijuana

  20. “Herbal Incense” Products Contain a Variety of Herbs and Other Botanicals • Canavalia rosea: commonly known as beach bean or bay bean - vine found in tropical and subtropical beach dunes • Nymphaea caerulea: also known as Blue Egyptian water lily • Scutellaria nana: perennial herb also known as Dwarf Skullcap • Pedicularis densiflora: known commonly as Indian Warrior - a perennial herb • Leonotis leonurus: also known as Lion's Tail and Wild Dagga - a perennial shrub native to southern Africa • Zornia latifolia: a perennial herb • Nelumbo nucifera: known by a number of names including Indian Lotus, or simply Lotus - aquatic perennial commonly found in China • Leonurus sibiricus: commonly called Honeyweed or Siberian Motherwort, herbaceous plant native to Asia

  21. 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

  22. 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 and toxicology • Long half-lives = prolonged psychoactive effect • Considerable batch variability = highly potential for overdose

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

  24. So if Synthetic Cannabinoids and THC are Chemically Different…That Means?

  25. Growing Popularity • First appearance sold as herbal incense on internet 2004 • Europe – first target market by 2008 • Escalating use in USA by late 2008 • Late 2008, first article appeared in scientific literature • DEA Office of Diversion Control published one-page update on Spice in 2008 • Poison Control Centers: • 2009: 13 cases with adverse reactions to Spice • 2010: 833 cases from 41 states through 9/1/2010

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

  27. In the United States • No federal ban but Federal Drug Czar Gil Kerlikowske stated substance is “on our radar” and indicates state legislatures are dealing “well” with issue • Patchwork of local and state laws • In May, the Department of Defense banned synthetic cannabinoids from all U.S. military bases • Kansas first state in 5/2010 • Also Oregon, Michigan, Virginia, Idaho, Missouri, Alabama, Arkansas, Georgia, Kentucky, Louisiana, North Dakota, Mississippi, Illinois, Michigan, and Tennessee • Found reference to bans being considered in Indiana, New York, Florida, Iowa, Ohio, and New Jersey • As of 12/24/2010 the DEA made possession and sale of five of the Synthetic Cannabinoids illegal (including JWH018)

  28. Pharmacological effects of smoked synthetic cannabinoids • Increased heart rate and blood pressure • Altered state of consciousness • Mild euphoria and relaxation • Perceptual alterations (time distortions) • Intensification of sensory experiences • Impaired short-term memory • Increase in reaction times • Panic attacks • Agitation • Numbness and tingling • Vomiting (severe requiring sedation) • Hallucinations • Tremors and seizures

  29. “This isn’t Jerry Garcia’s Marijuana” (state Rep. Jeff Roorda, Dem – Missouri)

  30. Synthetic Cannabinoids • Users report effects last between 30 minutes and two hours • 2009 – first scientific publication documenting a Dependence syndrome corresponding with DSM-IV • Physical withdrawal syndrome similar to MJ

  31. So What Does All This Mean? • Ideas about intervening with students using synthetic cannabinoids? • What are the options?

  32. So the answer is…drug testing? • Which of the 450+ synthetic cannabinoids would be detected? • Appropriate detection cutoff levels? • Cost for testing? • Reliability and validity concerns • Dominion Diagnostics: Detection of metabolites through urine or blood • On the horizon: • As of June, California-based Redwood Toxicology Laboratories made test available to detect metabolites from JWH-018 and JWH-073 up to 72 hours after use • Another drug-testing company, Drug Free Sport, (handles testing for the NFL and NCAA) announced developing test for JWH metabolites by 12/2010

  33. BUT WAIT… IF WE JUST DO DRUG TESTING THEN WHAT ABOUT OTHER DESIGNER DRUGS? • Bromo-Dragonfly – phenethylamine derivative sold as ‘plant food’ and is potent hallucinogen with delayed onset to peak (six hours) and prolonged duration (up to several days) • Nexus (Bees, Venus, Toonies) – synthetic phenothylamine can be sold as Ecstasy (white power/tablet), causes euphoria, and hallucinations

  34. WHAT ABOUT OTHER DESIGNER DRUGS?(continued) • Mephedrone (Meow, Drone, Bubble, M-Cat) – structure similar to Cathinone (Khat) with symptoms including anxiety, panic and paranoia, as well as severe hallucinations (analog to Crystal Meth) • Salvia – perennial plant in mint family, causes vivid hallucinations and spinal anesthesia

  35. Comments, Questions and Concerns

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