Emerging Drug Trends

1. Emerging Drug Trends Heidi Denton Substance Abuse Prevention Allegan CMH March 15, 2012

2. Topics covered today: • Explore the problems about: • K-2 Spice (Synthetic Marijuana) • Bath Salts • Prescription Drugs • Over the Counter Drugs • Learn who is abusing • Solutions & resources

3. Every Generation of youth Looks for New Ways to Get “High”

4. Scope of the Problem • Alcohol use-declining among teens • Marijuana use-rising among teens • Prescription drug use-rising among teens • Over the Counter-rising among teens • K2 and Bath Salts—Limited Data • Source: Monitoring the Future Study-2010 • www.monitoringthefuture.org

5. Why Should We Care? • The long term health effects are unknown for RX abuse, OTC abuse, K2 spice & Bath Salts • Kids generally go on to other drugs or use them in combination with alcohol and other drugs once they start abusing • Addiction is possible • Legal involvement

6. What Drug am I? Police Report Highlights: Crossed raised median 3 times, hit concrete wall 2x, driving on sidewalk w/ broken axle / tire .000 BAC Hallucinating “Death is all around me” Threatening to kill the Officer Hallucinating, vomiting, paranoid

7. “K2” or “Spice”

9. History of K2/Spice origin • JWH-018 & other synthetic cannibinoids (chemicals) were created in an attempt to find a drug that would help ease cancer patients’ nausea & pain. • Historically THC has been known to relieve these symptoms. • Researchers were hoping to develop an alternative to THC that wouldn’t have any of the psychoactive side effects.

10. History… • Dr. John H Huffman- a chemist at Clemson University created JWH-018 and hundreds of other synthetic cannabinoids. • Dr. Huffman & his team published a book on his findings in 1998. • No human testing was conducted- only tested on lab mice. • JWH-018 was detected in a smoke able herbal blend sold in Germany in 2008. • The chemical was found in the herbal blend and had several reports of adverse reactions in users. • The chemical eventually found its way back to the U.S. in the form or K2/Spice herbal incense.

11. K2 Spice “not for human consumption” Plant material (herbs, flowers, spices). Marketed as incense- the package says “not for human consumption” Laced (sprayed) with various synthetic compounds that behave like THC Smoked or mixed in drink or food Sold LEGALLY and LOCALLY up until recent Michigan Law banned the chemical components. 1g -5g packages. Cost approximately $20 per 3gm package.

12. Who is using this? • High School Students • Local access, hard to detect use “These products are so readily available-there’s no age restriction for buying them on the internet or in stores, that kind of accessibility for a drug is unique.” Dr. Vandrey-Drug and Alcohol Dependence-Join Together • 18-24 year old “group” • Not as much social stigma as using “harder drugs”

13. Signs of Use • Strong clove smell • Coffee grinder – finer the powder, easier to smoke • Drug paraphernalia (pipes, screens, etc.) • Typically smoked

14. Ingredients: Baybean, Blue Lotus, Lion's Tail, Lousewort, Indian Warrior, Dwarf Scullcap, Maconha Brava, Pink Lotus, Marshmallow, Red Clover, Rose, Siberian Motherwort, Canavalia Maritime, Leonotis Leonurus, Leonurus Sibiricus, Pedicularis Densiflora, Scuttellaria Nana, Vanilla Planifolia, Zorinia Latifolia, Magnolia Officinalis, Rosa Gallica, Trifolium

15. Other common brands or flavors:(remember, not for human consumption)

16. Psychoactive Compounds Solid (white powder) or Oil Over 100 Synthetic Cannabinoids (chemical compounds) “out there” 7 main Cannabinoids have been found in ‘Spice’ by Volker Auwarter (2008) Not all samples tested contained all of them however DEA Lab had similar findings making this drug’s effects even more unpredictable

17. Chemical compounds in K2 CP-47,497 Not structurally related to THC Created by Pfizer 1995 JWH-073 Not structurally related to THC JWH-018 5x more potent then THC JWH-200 3x more potent then THC HU-210 100-800x more potent than THC Structurally and pharmacologically similar to THC HU-211 No THC- like effects

18. K2 Spice vs. Marijuana Unregulated mixture of you name it (higher potential for overdose) Mixed / Unpredictable symptoms Longer half-life (prolonged high) Never tested on humans Same basic chemical compound in marijuana Well-known symptoms Well-known duration

19. K2 Spice vs. Marijuana Reports of Addiction / Withdrawal Not able to detect in blood or urine until recently On set 5- 10 Min Hallucinations Intense paranoia Anxiety Increase heart / BP Not considered physically addictive Able to detect in blood /urine Almost immediate No Hallucinations* No paranoia* Relaxing Increase heart rate /BP *In pure marijuana plants

20. Calls Received by Poison Control Centers for Human Exposure to Synthetic Marijuana, 2010 to January 2012 Michigan banned K2 chemicals in Oct. 2010 Projection based on preliminary January data 2012 2011 Source: American Association of Poison Control Centers, Synthetic Marijuana Data, Updated February 8, 2012 (Preliminary data) 2/2012

21. Deaths and Hospitalizations related to Spice and K2 • <iframe width="420" height="315" src="http://www.youtube.com/embed/0kTpxbHS8Vw" frameborder="0" allowfullscreen></iframe>

22. Long Term Effects of K2 • Evidence is lacking on the long-term effects of synthetic marijuana on the brain and body. However, since it is smoked, it can affect the lungs negatively. Scientists warn that there is no data about the toxicity of the JWH-018 chemical used in synthetic marijuana. Therefore, they warn against using this drug.

23. “MI House bill 6038” As of Friday Oct 1, 2010; K2 and several similar products were made illegal in Michigan. Chemicals banned include HU-210, JWH-018, JWH-015, JWH-200, JWH-250, CP47, CP497 90 day misdemeanor (same penalties as possession of marijuana)

24. K2 legal status in the U.S. The smokable herbal products were designated as Schedule 1 substances, the federal government’s most restrictive category, ostensibly reserved for drugs with “no accepted medical use for treatment in the United States and a lack of accepted safety for use of the drug under medical supervision.” *Marijuana is also a Schedule 1 drug, along with heroin, Ecstasy, and LSD

25. Drug testing is now availablewww.redwoodtoxicology.com Will a standard drug test detect synthetic cannabinoids? Conventional drug test panels will not detect the broad range of synthetic cannabinoids. They pass undetected in standard urine testing for such drugs as cocaine, marijuana, heroin and amphetamines. RTL’s Synthetic Cannabinoid Test can be ordered with your standard panel to ensure JWH-018 and JWH-073 are detected.

26. Resources • www.mdch.gov (type K2 in the search) • www.dea.gov • www.cadca.org • www.drugfree.org/join-together

27. Questions/Discussion • Any questions/thoughts on K-2 spice?

28. Calgon, don’t take me away…“Bath Salts” aka “Molly”, Ivory Snow…

29. Fake bath salts are not typically found at the standard bath and body store but are available over the counter at convenience stores, head shops and over the internet. The substance is usually sold in small containers with exotic names like Tranquility, Red Dove, Ivory Snow or Vanilla Sky.   Bath Salts

30. How can you tell? If it says it is “Not For Human Consumption” Or it is not illegal Or it is only for 18+ Adults Only It is probably for ingestion, not a hot bath

31. Many Brands and Names and Not Always Sold as Bath Salts Plant Feeder Insect Repellent Stain Remover

32. “Bath Salts” Found to contain: 3,4 -Methylenedioxmethcathinone (methylone) 3,4 -Methlenedioxypryovalerone (MDPV) 3 –Fluoromethcathinone 4- Methylmethcathinone (Mephedrone)

33. “Bath Salts” Ingested orally, snorted (most common), smoked, inserted rectally Amphetamine Type high Sold in wallet sized packets and clear jars for about $25 per 250 milligrams

34. Signs and Symptoms of Bath Salt Abuse • Extreme Paranoia • Violent Behavior • High Blood Pressure • Hyper Alertness • Sleep Deprived • Extreme Anxiety • Compulsive Water Drinking • Motor Automatisms (compulsive repeated hand washing) • Many are Symptomatic for 2-3 days

35. Health Effects of Bath Salt Abuse • Mimics the effect of cocaine, LSD, Ecstasy and or methamphetamine. • Impaired perception • Reduced motor control • Disorientation • Extreme paranoia and violent episodes • Rapid Heart Rate • Chest Pain • Suicidal Thoughts • Nose bleeds

36. Health Effects of Bath Salt Abuse-Cont • MDCH “Patients ingesting these chemicals can be extremely paranoid and may not respond to usual calmatives. Some have been involved in homicides and suicides while under the influence. Many describe being chased by demons, gods, aliens, or foreign solders. Severe cases may require long term psychiatric care.” 2/4/11-Press release by MDCH

37. Who is abusing? • MDCH is reporting that the majority of people who are abusing bath salts are in their 20’s and early 30’s. • Why? • Easy Access • Less social stigma than using “heavier drugs” • It’s new!

38. Intervention- Bath Salts <iframe width="560" height="315" src="http://www.youtube.com/embed/crnD2vsQq48" frameborder="0" allowfullscreen></iframe>

39. Poison Control • National call volume to Poison Control due to Bath Salts dramatically increased from 2010 to 2011. • Michigan: (January –June 16, 2011) 86 cases of “bath salts” in the ER, up from 65 for all of 2010.

40. Calls To Poison Control Centers Nationwide for Human Exposure to Bath Salts, 2010 to January 2012 DEA ban July 2011 In early 2011, calls closed in each month* spiked through June, then gradually declined and is level in the past 3 months. The number of calls closed in 2011 are over 20 times that in 2010. Projection based on preliminary January data 2011 2012 *Numbers may change as cases are closed and additional information is received. Source: American Association of Poison Control Centers, Bath Salts Data, Updated February 8, 2012 (Preliminary data). 2/2012

41. Legal status of bath salts • The ingredients, including mephedrone & MDPV are Schedule 1 drugs in Michigan. • HB 4565 was signed on July 15, 2011-banning the hallucinogenic drug methylenedioxypyrovalerone—”bath salts” along with the other main “components” found in the drug.

42. DEA ban • September 8, 2011- DEA is temporarily banning three “bath salt” ingredients as of October 1st, lasting at least one year. • The government will study three stimulants: Mephedrone, MDPV, and Methylone to see if they should be permanently banned.

43. Word of Caution…. • Bath Salts have recently been given a lot of national attention on shows such as Good Morning America • Be sure to check your local data sources to find out if this really is a problem in your community. Don’t bring attention to something if it isn't an issue in your community! • *We don’t have “use” numbers for Allegan or Ottawa specifically yet, but local law enforcement have started to track arrests and incidents

44. Resources • www.mdch.gov (type Bath Salts in the search) • www.inspirationsyouth.com/Synthetic-Cocaine-Ivory-Wave-Bath-Salt.asp • http://en.wikipedia.org/wiki/MDPV • www.dea.gov

45. Questions • Any questions or thoughts on Bath Salts??

46. Prescription Drug Abuse

47. The Teen – Rx Abuse Connection RxMedications are All Around Us…and Teens Notice • Patients leave the doctor’s office with a prescription in hand in 7 out of 10 visits. • Direct-to-consumer advertising on TV and in magazines is pervasive. • Many people don’t know how to safely use these medications or ignore their doctor’s instructions.

48. As a result… Rx drugs are part of teen culture. Teens: • Normalize this form of drug abuse. • Take these meds for legitimate reasons – with or without a prescription – to stay awake, remain alert or to go to sleep. • Purposely abuse these drugs to get high. They participate in “pharming” and “skittle” parties. • Are often unaware that these activities can lead to disastrous results.

49. As a result… • Next to marijuana, the most common illegal drugs teens are abusing are prescription medications. • Twenty percent of U.S. high school students say they have taken Rx drugs without consulting a doctor. • 1 in 5 teens has abused Rx drugs. • 1 in 3 teens say there is “nothing wrong” with abusing Rx medications “every once in a while.” • Every day, almost 2,500 teens abuse an Rx medication for the first time. Rx Abuse Prevention Toolkit - from awareness to action

50. Access to RX Drugs • Where are they getting these from? • Medicine Cabinet • Home • Friends • Other relatives (grandparents) • School • Kids at school sell and share • Recent focus group results found that Allegan & Ottawa County youth report they can get RX medications at anytime during the school day