Herbal Incense and Bath Salts An Awareness Presentation

1. Herbal Incense and Bath SaltsAn Awareness Presentation Kristine Nutt, LCSW, LCAS, CSI

2. Disclaimer • This presentation is meant to provide basic awareness information on herbal incense products and bath salts. • There are hundreds of products being smoked for cannabis-like effects • Manufacturers constantly change product ingredients and market products under new names to circumvent the law. • Constantly moving target • Product names and lists, as well as the list of synthetic cannabinoids, in this presentation are not all inclusive.

3. “SMILES” 

4. “SMILES” • 2C-1 Hallucinogen synthetic drug • Part of the 2C family of drugs • Powder or Pill form • Often mixed with chocolate and candy • Schedule 1 class of drug in July 2012 • According to LAPD, there has been an increase of overdose deaths from this drug recently. Popular with teens and college students. • Formulas were published in book “PiHKAL: A chemical Love Story” (Transform Press, 1991)

5. “Smiles”  • Dessa Bergen-Cisco, a Professor of Public Health at Syracuse University stated, “Basically, it’s a pure and potent form of estacy or MDMA”. • Effects are compared to a potent combination of MDMA and LSD with terrifying hallucinations and superhuman strength. • Overdoses have been reported in California, Ohio, and other states.

6. “Smiles”

7. “SMILES”  • Recently in the news due to Johnny Lewis, 28, who was known for his role in the television show, “Sons of Anarchy” killed 81 year old landlady and her cat before jumping to his death. No evidence of drugs were found in his system. • One guy began beating his head into the ground. • One 17 year old in North Dakota overdosed and was observed shaking, growling, and foaming at the mouth. Another teen died the night before from the drug. • Does not show up on drug screens

8. Effects • Anxiety leading to panic attacks, seizures, distortions of time. Hyperventilation • Nausea and Vomiting • Terrifying auditory and visual hallucinations and feelings of fear and panic. Last hours to days. • Increased heart rate. Can cause strokes • Can cause seizures and kidney failure • Causes muscles to contract • Elevated body temperatures up to 107 degrees. • Giddiness and relaxed state

9. Bath Salts Video Clip

10. Refers to products containing synthetic cathinones, that are chemically similar to cathinone, an organic stimulant, that occurs naturally in the Khat plant. Highly pure white or brown powder or crystal form. Mostly seen in powder form. BATH SALTS

11. BATH SALTS • First developed in research labs and became a popular party drug in Europe and UK • Spread overseas around 2010 and began to show up mostly in states like Louisiana, Kentucky, and Tennessee. Some had regional names like “Hurricane Charlie” and “Bayou”. • Other product names include Bliss, Blizzard, Blue Silk, Ivory Snow, Vanilla Sky and Ivory Wave. • Became highly publicized with the cannibalistic attack in Miami.

12. BATH SALTS

13. BATH SALTS

14. BATH SALTS

15. Marketing • Sold commercially as bath salts, plant fertilizer, toy cleaner, pond cleaner, cell phone cleaner, jewelry cleaner, insect repellant, glass cleaner, and toilet cleaner. Newest is ladybug attractant. • Chemicals imported mainly from China and India • Sold mainly on the internet buy also in “head shops”, convenience stores, and gas stations. Some people have bought on e-bay. • It is not the stuff you find at Bath and Body Works!!!

16. Video of Bath Salts Sale

17. Chemical Makeup • There are several synthetic cathinones. The most common found in “Bath Salts” are MDPV (methylenendioxypyrovalerone), mephedrone(4-MMC), or methylone. The primary ingredient in most bath salts is MDPV. • MDPV – at least 4x potency of ritalin or concerta. • 15-30 minutes to onset, peak effects around one hour and last around 2 – 7 hours when used orally.

18. Bath Salts • Costs anywhere from $40 - $100 per gram. One gram contains 8 – 40 doses. • Taken orally, IV, nasal inhalation, or rectally. Snorting and swallowing are the most common methods of use. • High risk for overdose due to packages containing as much as 500 mg. Each packet contains varying amounts of the chemical.

19. Marketed as legal alternative to LSD, cocaine, ecstacy, and methamphetamine. Labeled not for human consumption but the sole purpose is for human consumption. BATH SALTS

20. Bath Salts – Generation 2 • New type of bath salt called Amped has been reported by users in Virginia. • Six people recently reported to hospitals in Virginia that they ingested this drug. • It is being marketed as ladybug attractant.

21. Naphyrone • Referred to as “Cosmic Blast” and marketed as jewelry cleaner. Contains MDPV and Naphydrone. Reuptake inhibitor of serotonin. • Stays in system for long periods. Body temperatures of up to 107 degrees have been reported.

22. BATH SALTS Users do not know how much or what they are getting. Very inexpensive and readily available high.

23. Video Effects

26. WHY DO PEOPLE USE IT? • Experience euphoria • Increased energy and alertness • Increased arousal, energy, and motivation • Sexual stimulation/aphrodesiac • Feel as if they don’t need to sleep or eat • Increases sociability • Mental stimulation

27. WHAT DO THEY DO? • “MDP V increases the body’s concentration of adrenaline-like hormones that prepare the heart and muscle tissue for “flight or fight” response”, explained Thomas Penders an associate professor at ECU. • "One system of circuits in our brains are wired to detect and respond to threats. Overstimulation of this circuit leads to overestimation of actions by others as threatening. When the system becomes overwhelmed, as it does [from an overdose of] 'bath salts,' a condition develops known as 'excited delirium,'" he said • This is characterized by a pattern of paranoia, agitation, and violent behavior.

28. WHAT DO THEY DO? • Overdoses of crack cocaine, methamphetamine, ecstasy and PCP can also induce "excited delirium." It's a state of paranoid fearfulness and rage mixed with seemingly superhuman strength, as more oxygen is delivered to muscles, increasing their power. "This, to some extent, explains the bizarre aggressive behaviors we have seen during the recent rash of 'bath salt' cases," Penders said * • “Science” on nbcnews.com 6/4/2012

29. Bath salts vs. Cocaine/Meth • Like Amphetamines, Mephedrone releases dopamine from cells, while MDPV, like cocaine blocks the reuptake of dopamine into the cell. • MDPV is ten times stronger than cocaine. • Taking Bath Salts is like taking Cocaine and Meth together • Time delay – Mephedrone releases dopamine before the reuptake is blocked. • Pbs.org – September 2012

30. Bath Salts and The Brain

31. EFFECTS • Increased dopamine and serotonin and affects mood and perception. • Cold fingers and an intolerance to pain • Body temperatures of up to 107 degrees have been reported. Often people take their clothes off. • Jerking eye movements and foaming at the mouth have been reported. Vomiting. • Restlessness and inability to sit still. • Insomnia – sleep deprivation * - Some people take Xanex and other drugs to try to sleep.

32. EFFECTS • Increased heart rate and blood pressure. • Panic attacks and chest pains are often why people show up in ER’s. • Auditory and Visual Hallucinations with common themes of monsters, demons, aliens, and God. • Irritability, suicidal thoughts, and self-harm behaviors. • Diminished thirst • Can relapse into hallucinations and paranoia weeks after last use.

33. BATH SALTS: Dangers and dependency

34. Concerns • A Marquette County, Michigan ER reported 35 admissions from November 2010 to March 2011. This prompted Law Enforcement to seize all bath salts from a local convenience store. The products tested all contained MDPV. • 17 out of 35 were hospitalized. Median age was 28 years (range 20 -55 years). One death reported. • 54% were Men, 69% self-reported a history of drug abuse, 46% or 16 patients had a history of mental illness, and 17% reported suicidal thoughts/attempts related to use of bath salts. • “Morbidity and Mortality Weekly Report, Vol 60, May 20, 2011, 624 - 627

35. Concerns • US Army Medic, David Stewart, killed his wife and 5 year old son in April 2011 after he and his wife were using bath salts. He shot his wife and suffocated his son the day before. Toxicology reports confirm they were using “Lady Bubbles” bath salts. • According to the Bangor Daily News, domestic violence calls have increased in Maine due to use of Bath Salts. • Cookeville Regional Medical Center in TN has treated 160 people since 2010.

36. Dangers and Dependency • A research study led by UNC professor CJ Malanga, MD found that mephedrone, like cocaine, has a high potential for abuse and addiction. • “The effects on the brain’s reward circuit are comparable to similar doses of cocaine” • The rodents in the study worked harder to get less reward. The drug activated the brain’s reward circuit involved in positive reinforcement. NIDA.org 2012

37. Legality • The Synthetic Drug Prevention Act signed by President Obama on July 9, 2012. This act bans the synthetic compounds found in synthetic THC and 29 compounds found in Bath Salts, and makes them Schedule I. • States will have to incorporate these into their drug scheduling list and update the list as new substances are discovered.

38. Operation “Logjam”

39. Operation logjam • July 26, Operation “Logjam” seized 5 million packets of synthetics and arrested 90 people in a nationwide effort to crackdown on these drugs. • Tested products contained anywhere from 17 milligrams to 2000 milligrams of chemicals.

40. Poison Control Center Data CALLS TO POISON CONTROL: 304 in 2010, 6,138 in 2011, and 2654 as of December 2012. e3 31, 2012. Ages <6 to over 59. Most ages 20 – 29. January – 228/301 July – 361/680 February – 230/487 August – 173/602 March – 264/639 September – 119/512 April – 285/600 October – 98/401 May – 295/720 November – 86(2012) June – 415/743 December – 78(2012) www. aapnc.org 1-800-222-1222

41. B

42. TREAMENT • Often eat up Emergency Room resources as it takes multiple nurses and doctors to treat users. • Difficult to know what someone has taken unless they self-report or someone else reports. • Does not show up on typical toxicology screens and can not be detected by drug dogs. There are now drug tests that do test for Bath Salts. Ammon labs, Redwood Toxicology, and Dominion Diagnostic offer these drug screens.

43. TREATMENT • Antipsychotics to treat psychosis • Benzodiazepines to decrease agitation • Ten to twenty times the normal dose of sedatives have been used. • Try to avoid using restraints, but speak reassuringly to people who are agitated and paranoid • Move to a quiet room with low light to help calm patient. • Avoid loud noises and try medications prior to restraint.

44. TREATMENT • Monitor the person for suicidal ideation even after they have stopped using the drug. Address both mental health and addiction issues. • Psychotic symptoms often persist after treatment • Enhance coping skills to assist the person in dealing with anger and other emotions. • Glass may exacerbate psychotic symptoms. • Train staff to deal with specialized issues and incorporate questions into intake and assessment.

45. Movie Madness • BATH SALT ZOMBIES • Available on DVD February 19 • is a new horror film directed and co-written by Dustin Wayde Mills (Puppet Monster Massacre, Zombie A-Hole, Ballad of Skinless Pete) and produced and co-written by Clint Weilerof Aggronautix. The movie sensationalizes the recent bath salt  epidemic and the attacks surrounding them

46. “Zombie Apocalypse” • The shocking wave of attacks associated with Bath Salts has sparked fears of a real-life zombie outbreak in the south. This led to The Center for Disease Control and Prevention releasing a statement saying it is not aware of any virus that can cause zombie-like behavior.

47. What next? • Partnerships and networks between the community and law enforcement have made an impact in the sale and distribution of this drug. • Education regarding the dangers of Bath Salts.

48. Spice / K2

49. What is Spice and K2? • Spice and K2 refer to commercially available products sprayed with chemicals called synthetic cannabinoids. These products claim to be a mixture of herbs but often do not have herbs in them. They include other ingredients that are unknown and not listed. • Many have warning labels as not intended for human consumption, but are solely intended for human consumption. Marketed as incense. Resembles potpourri.

50. Synthetic Cannabinoids • Synthetic Cannabinoid products are manufactured in Asia and sold in US in many different arenas (gas stations, liquor stores, smoke shops and internet) • Sold under different brand names: “K2, Spice, Spice Gold, Spice Black, Mr. Nice Guy, Yucutan Fire and many others” • Since the national ban on five synthetic cannabinoids, new brand names have developed, such as K2 Sky, K3, and K4