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Synthetic Drugs of Abuse: ‘Spice,’ ‘K2’ and ‘Bath Salts’ Side effects and Long term consequences

Synthetic Drugs of Abuse: ‘Spice,’ ‘K2’ and ‘Bath Salts’ Side effects and Long term consequences. Willie A. Hamilton, BC-FNP Board Certified in Sports Medicine & Nutrition. Synthetic Cannabinoids (SCs). Spice/K2 brands marketed as natural herbal incense “Not for human consumption”

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Synthetic Drugs of Abuse: ‘Spice,’ ‘K2’ and ‘Bath Salts’ Side effects and Long term consequences

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  1. Synthetic Drugs of Abuse: ‘Spice,’ ‘K2’ and ‘Bath Salts’ Side effects and Long term consequences Willie A. Hamilton, BC-FNP Board Certified in Sports Medicine & Nutrition

  2. Synthetic Cannabinoids (SCs) • Spice/K2 brands marketed as natural herbal incense • “Not for human consumption” • Available convenience stores, gas stations, Internet • Cannabis substitute Psychonaut Web Mapping Research Group (2009.) Spice Report. Institute of Psychiatry, King’s College London: London UK.

  3. Pharmacology • delta-9 tetrahydro-cannabinol (∆9-THC) agonism of cannabinoid receptor type 1 (CB1) • SCs more potent • Typical doses are often less than 1mg • Not readily detectable ∆9-THC JWH-018

  4. Psychoactive Effects Marketed as similar to cannabis: • Euphoria • Sociability • Anxiolytic • Relaxation • Stimulant Cross tolerance with THC? http://buyk2spice.net/

  5. Side Effects of SC Products • Anxiety • Paranoia • Headache • Vomiting • Psychosis • Diaphoresis • HR/BP increase • Seizures http://investigationmiami.blogspot.com/2011/01/be-afraid-really-afraid.html

  6. Current and Future Epidemiology? • No data on prevalence of use • American Association of Poison Control Centers: Synthetic cannabinoids: • 2009: 13 calls • 2010: 2304 calls (Nov), a projected 200x increase Marijuana: • 2008: 4009 calls, with 1020 for marijuana alone

  7. Synthetic Stimulants • Methylenedioxypyrovalerone (MDPV) and Mephedrone • Sold as “bath salts” or “plant fertilizer” • Currently legal in the United States • Available online and in convenience stores

  8. MDPV and Mephedrone • CNS stimulants • Related to cathinone, an active alkaloid found in the khat plant (N. Africa) • Previously abused primarily in Europe and Australia http://www.herbalextracts.net/library/supplements/khat_uses.html

  9. MDPV • Route: Intranasal most common • Also: oral, smoking, rectal, and IV • White to light brown crumbly powder • Degrades if exposed to air for significant periods of time MDMA http://www.stompin-gardeners.com/index.

  10. Pharmacology of MDPV • CNS stimulant similar to methamphetamine, MDMA, or cocaine • Norepinephrine-dopamine reuptake inhibitor (NDRI) • Increased alertness, arousal, anxiety, agitation, diminished requirement for food and sleep, sexual arousal • Tachycardia, hypertension, vasoconstriction, diaphoresis

  11. Effects of MDPV • “High” lasts 3-4 hours • Physical effects may last 6-8 hours • May cause seizures, panic attacks, or psychosis with high doses or increased frequency of use • Avg dose: 5 to 20mg http://www.tradevv.com/chinasuppliers/chwhtltd_p_198b58/china-Mdpv-by-pevukka.html

  12. Other Sequelae of MDPV • Trismus (inability to open mouth) or bruxism • Panic attacks • Psychosis with sleep deprivation • Hallucinations, delusions, suicidal ideation • Abstinence syndrome: depression, lethargy, anxiety, postural hypotension • Leads to frequent re-dosing

  13. MDPV’s Legal Status • UK: MDPV regulated under the Misuse of Drugs Act 1971 • US: Not scheduled but banned in some states • DEA: controlled by the Federal Analogue Act? http://addiction-dirkh.blogspot.com/2010/11/dea-slaps-temporary-ban-on-spice-and.html

  14. Mephedrone • 4-methylmethcathinone (4-MMC) • Meow Meow • MCAT • Miaow • Drone • Plant Feeder • Bubbles http://www.synchronium.net/2010/01/05/mephedrone-cat/

  15. Pharmacology • NE-DA reuptake inhibitor • Similar to MA/MDMA • Reportedly less potent, shorter duration • Oral dose: 20-50mg • “Come up”: 10-20 min • Peak: 45-60 min • “Comedown”: 60-120 min • Re-dosing: common Amphetamine Mephedrone

  16. Routes of Administration • Oral ingestion • Swallowing capsules • Bombing (swallowing powder wrapped in cigarette paper) • Insufflation (snorting) • Rectally (either plugging or enema) • IV (use 1/2 to 1/3 dose) http://www.guardian.co.uk/society/mephedrone

  17. Effects of Mephedrone • Euphoria • Sociability • Stimulation • Sexual Arousal • Music Appreciation • Hallucinations http://www.drugs.org.im/campaigns.htm

  18. Mephedrone Side Effects • Loss of appetite • Increase in body temperature, sweating, hot flushes • Tense jaw, bruxism, stiff neck, muscle clenching • HR/BP elevation, chest pains • Dehydration • Mydriasis, nystagmus • Painful nasal drip/ulcers in mouth (after insufflation) • Insomnia, paranoia, anxiety, dysphoria, psychosis http://theblackheartofgrahamquirk.blogspot.com/

  19. Mephedrone’s Legal Status • 2008-2010: Banned in many European counties • December 2010: Illegal throughout the EU • Mephedrone is not specifically banned in the United States • However, some states have banned mephedrone • DEA: may be controlled by the Federal Analogue Act as an analogue of methcathinone

  20. Current and Future Epidemiology? • No data on prevalence of use • American Association of Poison Control Centers: Bath Salts: • 2010: 292 calls • 2011: 469 calls (2/14/11), a projected14-fold increase

  21. Questions?

  22. Contact Information Willie A. Hamilton, BC-FNP LIVEfit Medicine 1901 Brookside Dr. Kingsport, TN 37660 (423)765-9500

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