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Designer Drug Update 2014

Designer Drug Update 2014. Michael P. Frost MD, MS Medical Director, Eagleville Hospital President, The Frost Medical Group. Objectives. Identify synthetic drugs as emerging threats in the diseases of addiction Recognize the physical and mental effects of these drugs

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Designer Drug Update 2014

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  1. Designer Drug Update 2014 • Michael P. Frost MD, MS • Medical Director, Eagleville Hospital • President, The Frost Medical Group

  2. Objectives • Identify synthetic drugs as emerging threats in the diseases of addiction • Recognize the physical and mental effects of these drugs • Become familiar with available drug testing • Understand the current legal standingof these substances • Understand aspects of treatment related to syntheticdrugs

  3. Synthetic drugs: • Easy to make • Cheap to buy • Easier to get than cocaine, heroin • “Legal high” • Harder to detect, monitor • Presumed to be safer

  4. Since 2009, DEA has seen rise in reports from poison control, hospitals, law enforcement • Widely available in convenience stores, smoke shops, gas stations, and the internet • Mistakenly thought to be safe because of the way they are obtained

  5. synthetic drug use on the rise

  6. Bath Salts

  7. Bath Salts • Methylenedioxypyrovalerone (MDPV, Methadrone) • Cathinone family of stimulants • Synthetic analogue of Cocaine • Norepinephrine/Dopamine reuptake inhibitor

  8. Intoxication withMDPV • Euphoria • Increased wakefulness/arousal • Increased energy • Increased mental focus • Increased empathy

  9. Adverse Effects • Tachycardia • Hypertension • Vasoconstriction • Arrhythmia/MI • Nausea • Bruxism • Hyperthermia • Tinnitus • Extreme anxiety • Psychomotor agitation • Paranoia • Psychosis

  10. Adverse Effects • Violent behavior • Suicidality • Rhabdomyolysis • Hepatorenal failure • Sleep disturbance

  11. Detection • GC/MS becoming more widely available • Multiple labs now offering on-site testing kits for most common cathinones • Testing lags behind the compounds on the market. • Detection window/half life not well known.

  12. Legal Status • PA Bath Salt ban June 2011 • DEA has made most common compounds Schedule I • Illegal to manufacture, sell or possess MDPV • Placed in same category as heroin

  13. Case #1 - “Face-Eating zombie” On May 26, Miami police shot and killed a homeless man who was allegedly feasting on the face of another homeless man in a daylight attack on a busy highway. Before now-infamous "face-eating cannibal" Randy Eugene was stopped by four police bullets, say authorities, he had gnawed the face of victim Ronald Poppo down to his goatee. "The forehead was just bone," said a witness. "No nose, no mouth." Police said that Eugene, 31, who had ripped off his clothes and refused police orders to stop eating Poppo's flesh, showed behavior consistent with ingesting the synthetic cocaine substitute known as bath salts. Bath salts have been connected to a range of violent incidents and a spike in emergency room visits since they became popular several years ago. Last fall, the Drug Enforcement Administration banned three chemicals used in bath salts, and 38 states have enacted their own bans, but incidents continue.

  14. Synthetic Cannabinoids • K2 • Spice • Mr Nice Guy • Herbal Incense • Black Diamond incense

  15. K2 • Have chemical names such as canabicyclohexanol, JWH-018, JWH-073 • Very high affinity for cannabinoid receptors • Similar “high” as THC • Greater intensity of adverse effects

  16. Adverse Effects • Agitation • Anxiety • Paranoia • Psychosis • Tremor • Hyperthermia • Sweating • Hypertension • Tachycardia • Hallucinations • Violent behavior • Suicidality

  17. Detection • Urine and blood immunoassays readily available from most labs • GC/MS confirmation • Designers changing compounds rapidly to evade detection • Will not show up on test as THC • DEA schedule I

  18. Kratom • Mitragyna tree native to Southeast Asian • Opiate-like compounds in leaves • Used in Thai traditional medicine as pain reliever and anti-diarrhoeal and to treat opiate withdrawal. • Low dose is stimulating • High dose is sedating/analgesic

  19. Kratom Side Effects • Agression • Hallucinations • Nervousness • Decreased libido • Weight loss • Hyperpigmented skin • Somnolence

  20. Kratom Withdrawal • Similar to Opiate withdrawal • Myalgias/bodyaches • Irritability • Runny nose • Diarrhoea • Muscle twitching • Lacrimation

  21. Kratom • Showing up in ER’s • More common in southern states • Little known about duration of effects • Little known about drug-drug interaction • Has some potential interest in preventing opiate dependence (appears to reduce activity of NMDA receptors)

  22. Illegal in Thailand (same category as THC) and throughout most of Asian, Australia • Not expressly illegal in U.S. except in Indiana • Is on DEA list of “Drugs & Chemicals of Concern” • Individual states considering bans (Iowa, Hawaii, Vermont)

  23. Drug Testing • Urine and oral fluid testing widely available • Does not show up as opiate on standard UDS

  24. krokodil • Developing problem in Russia/Eastern Europe • Codeine mixed with gasoline/paint thinner/hydrochloric acid/red phosphorus • Cheap and easy to make • Cases now reported in Lehigh Valley/Northern/Western PA, Ohio &Tennessee

  25. krokodil • Desmomorphine - derivative of morphine • 8-10 x more potent than morphine • simple to synthesize from morphine/codeine • First seen in Siberia 2003 • In Russia, Codeine products were OTC until 2012 • Legal form of desmomorphine produced in Switzerland as pain medication

  26. Injection site becomes scaly and resembles crocodile skin • Necrosis and sepsis often develops • Average user only lives 2-3 years • Effects last only 90 min • “Krokodil houses” need full-time cook

  27. This highly addictive drug causes peoples skin to rot and start falling off. It has become an epidemic in russia. It seems like it must be fake, but it is real. Some people thing is is the beginning of a zombie Apocalypse.

  28. krokodil

  29. GRAVEL

  30. gravel • Synthetic stimulant - alpha-pyrolidinopentiophenone (alpha-PVP) • Cathinone class • Sold as “Gravel” or “Plant fertilizer” • Has been diluted with rat poison and ammonium nitrate (fertilizer)

  31. Adverse effects • Hypertension • Tachycardia • Violence • Paranoia • Hallucinations • Brain damage • Skin deterioration/necrosis

  32. gravel • Tissue necrosis causes permanent deformity • DEA Schedule I • Cases reported in Tennessee as of Aug-Nov 2013

  33. gravel

  34. summary • Legality gives false sense of safety • Patients use synthetic drugs to help avoid detection • Providers need to stay informed about current trends • When one drug is made illegal/detectable, a new drug will take it’s place

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