VA Calc Fall 2010 Drive in Conference Alcohol Energy Drink Update & Spice (K2) Update

1. VA Calc Fall 2010 Drive in ConferenceAlcohol Energy Drink Update&Spice (K2) Update Linda Hancock, FNP, PhD Virginia Commonwealth University lhancock@vcu.edu

2. Definitions

4. Research Update: Since the production of 12% Joose began, sales in Rochester, NY have increased by 78%.

5. www.marininstitute.org

6. http://www.adp.ca.gov/youth/aed_index.shtml

7. What are AEDs?(Alcohol Energy Drinks) • Can be either malt or distilled spirits based • Malt beverage content ranges 5% to 12% alcohol • Distilled spirits based up to 40% alcohol or more • Amount of caffeine UNKNOWN manufacturers have not discloses that information

8. History of AEDs • 2002 McKenzie-River Introduction of “Sparks” • Web-based marketing strategies lead to rapid growth • Led other companies such as AB to create their own brands (Tilt, B to the E) • Miller Brewing purchased Sparks in 2006

9. Pressure and ashift in who makes AEDs • In 2008, Anheuser-Busch and MillerCoors signed agreements with Attorneys General to remove all stimulants from their products. • These agreements left a void in the market which has been filled by many AED brands marketed by smaller companies. There are many more brands now on the market

10. Efforts to address the issue of AEDs • Attorney Generals of 18 different states and one city attorney submitted concerns about the safety of caffeinated alcoholic beverages to the FDA. • November 2009 - The FDA notified the makers of alcohol energy drinks, such as Joose and Liquid Charge, that they had 30 days to establish that adding caffeine to the alcohol is safe and legal.

12. In July Schumer pushed the FTC to launch an investigation into these drink manufacturers’ marketing practices. The FTC has yet to indicate whether it has acted on that request.

13. Michigan's Liquor Control Commission • The state regulatory agency unanimously passed a motion this month to examine the packaging of flavored alcoholic drinks with caffeine and other stimulants • Michigan is among the first states to independently target the drinks • Plan to examine labels and see if they are in any way “confusing or misleading"

14. http://www.adp.ca.gov/youth/reducing_risks.shtml

16. www.Gainesville.com Aug 2010AE drunk driver kills father & 3 sons • St. Petersburg police say on July 31, 20-year-old Demetrius Jordan told them he had been drinking Four Loco and smoking marijuana before he ran a red light and slammed into another car, killing all four of the occupants

17. Statement by Chris Hunter,founder & managing partner of Phusion Products (makers of Four Loko) • "People have safely enjoyed mixing alcohol and caffeine products for years in their homes, and in restaurants and bars," Hunter wrote. "Having coffee after a meal with wine, or consuming rum and cola, an Irish coffee or a Red Bull and vodka are all popular practices. However, only the pre-mixed, malt-based caffeinated alcoholic beverages, such as our products, appear to be targeted by some as unsafe." • Hunter said Phusion Products is saddened by the deaths in St. Petersburg and that stores that sell Phusion products to minors should be prosecuted to the fullest extent of the law. • "We have a vested interest - both personal and professional - in assuring the continued responsible consumption of our products," he said.

18. Update from Aug 10 article www.gainesville.com • FDA spokesman Michael Herndon said no decision has been made, with 19 companies responding for their call for information. • Quote from FDA Director: • "The FDA's decision regarding the regulatory status of caffeine added to various alcoholic beverages will be a high priority for the agency," Herndon said.

19. Update on K2 or spice

20. Google spice or K2

21. THC to THC Variants • But most synthetic cannabinoids are quite different chemical structures from THC. And unlike cannabis, the new drugs have never been tested in humans. • One of these synthetic cannabinoids, JWH 018, was first made in 1995 for experimental purposes in the lab of Clemson University researcher John W. Huffman, PhD. • More than 100 different synthetic cannabinoids have been created.

22. Is Spice Safe? • JWH 018 inventor John W. Huffman, PhD, puts it bluntly in the WebMD interview: • "It is like Russian roulette to use these drugs. We don't know a darn thing about them.” • Most of these drugs were created because they bind much more tightly to the body's cannabinoid receptors than THC does. THC, in fact, only partially binds to these important regulators of body function. Many of the synthetic cannabinoids fully activate the receptors.

23. Do today’s college students even remember why we have an FDA? Thalidamide babies It is no exaggeration to state that the story of thalidomide is the story of the modern FDA.

24. Quote from ER physician • "Typically people will come in tachycardia, which is an elevated heart rate. They will come in and they are sweaty. Their blood pressure will be higher. I've actually had patients that are hallucinating. I've had individuals who have had seizures are a result as well.“ • Other side effects? Short term? Long term? • “couchlock” or the inability to move

25. Tara KunkelAdult Drug Court AdministratorChesterfield County, VA804-717-6801kunkelt@chesterfield.gov • The Virginia Drug Court Association is working with Senator Hanger to get legislation introduced about Spice

26. Drug Court people know a lot

27. Questions & Answers about K2submitted by Drug Court Practitioners Document at Drug Court Site by… Paul L. Cary, M.S., director of the Toxicology Laboratory at the University of Missouri

28. His Caveats • It is important to acknowledge that there is a dearth of research on the absorption, distribution, metabolism and elimination of synthetic cannabinoids. • Also limited definitive information on the actual chemical make-up of many of the herbal incense products being marketed

29. Trends and K2 • American Association of Poison Control Centers reported that during the first half of 2010, there were 567 cases (in 41 states) in which people suffered adverse reactions to herbal incense products. • This is in contrast to only 13 cases reported in all of 2009 - an increase of over 4000%.

30. Any material, compound, mixture, or preparation that contains any quantity of the following substances, their salts, homologues, isomers, and salts of isomers, unless specifically excepted, whenever the existence of these salts, homologues, isomers, and salts of isomers is possible within the specific chemical designation: • 1-pentyl-2-methyl-3-(1-naphthoyl)indole, also known as JWH-007; • (2-Methyl-1-propyl-1H-indol-3-yl)-1-naphthalenylmethanone, also know as JWH-015; • (1-pentyl-3-(1-naphthoyl)indole), also known as JWH-018; • 1-hexyl-3-(naphthalen-1-oyl)indole, also known as JWH-019; • naphthalen-1-yl-(1-butylindol-3-yl)methanone, also known as JWH-073; • 4-methoxynaphthalen- 1-yl- (1-pentylindol- 3-yl)methanone, also known as JWH-081; • 4-methoxynaphthalen-1-yl-(1-pentyl-2-methylindol-3-yl)methanone, also known as JWH-098; • (6aR,10aR)-3-(1,1-Dimethylbutyl)-6a,7,10,10a-tetrahydro -6,6,9-trimethyl-6H-dibenzo[b,d]pyran, also known as JWH-133; • 7-methoxynaphthalen-1-yl-(1-pentylindol-3-yl)methanone, also known as JWH-164; • (1-(2-morpholin-4-ylethyl)indol-3-yl)-naphthalen-1-ylmethanone, also known as JWH-200 or WIN 55,225; • (1-pentyl-3-(2-chlorophenylacetyl)indole) or 2-(2-chlorophenyl)-1-(1-pentylindol-3-yl)ethanone, also known as JWH-203; • 4-ethylnaphthalen-1-yl-(1-pentylindol-3-yl)methanone, also known as JWH-210; • (1-pentyl-3-(2-methoxyphenylacetyl)indole) or 2-(2-methoxyphenyl)-1-(1-pentylindol-3-yl)ethanone, also known as JWH-250; • 1-pentyl-3-(4-chloro-1-naphthoyl)indole, also known as JWH-398; • 2-[(1R,3S)-3-hydroxycyclohexyl]- 5-(2-methyloctan-2-yl)phenol, to include its C6, C8, and C9 homologues; also known as CP 47,497; • (2S,4S,4aS,6R,8aR)-6-(hydroxymethyl)-4-[2-hydroxy-4-(2-methyloctan-2-yl)phenyl]-1,2,3,4,4a,5,6,7,8,8a-decahydronaphthalen-2-ol, also known as CP 55,244; • 2-[(1R,2R,5R)-5-hydroxy-2-(3-hydroxypropyl) cyclohexyl]-5-(2-methyloctan-2-yl)phenol, also known as CP 55,940; • (6aR,10aR)- 9-(Hydroxymethyl)- 6,6-dimethyl- 3-(2-methyloctan-2-yl)- 6a,7,10,10a-tetrahydrobenzo [c]chromen- 1-ol, also known as HU-210; Note: HU-210 is currently a Schedule I controlled substance under the Controlled Substances Act. • (6aS,10aS)-9-(Hydroxymethyl)- 6,6-dimethyl- 3-(2-methyloctan-2-yl)- 6a,7,10,10a-tetrahydrobenzo [c]chromen-1-ol, also known as HU-211 or dexanabinol; • R)-(+)-[2,3-Dihydro-5-methyl-3-(4-morpholinylmethyl)pyrrolo [1,2,3-de)-1,4-benzoxazin-6-yl]-1-napthalenylmethanone, also known as WIN 55,212-2.

31. Most common Cannabimimetics • JWH018 • JWH073 • HU-210 • “WADA will now ban these ingredients in 2011, and the UCLA laboratory can now test for the most commonly seen ingredients (JWH018, JWH073, and HU-210). ” Eric Patterson |The National Center for Drug Free Sport, Inc.®

32. Can you test for Spice/K2? YES! Somewhat 4 labs able to test for spice State of the Art in Drug Testing NO on-site screening devices (instant tests) for the detection of synthetic cannabinoids are yet available. No “immunoassay-like” screening tests available on analyzers in drug testing laboratories. However,there are some laboratories offering synthetic cannabinoid testing using mass-spectrometry instrumentation. • Redwood Toxicology (used by Chesterfield Co. Drug Court) • Norchem • MedTox • National Medical Services PA

34. What else do YOU know?What do we do as a group?Educate or Not?Advocate or Not?