Synthetic Drugs of Abuse:  ‘Spice,’ ‘K2’ and ‘Bath Salts’
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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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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

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.


Pharmacology

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


Psychoactive effects

Psychoactive Effects

Marketed as similar to cannabis:

  • Euphoria

  • Sociability

  • Anxiolytic

  • Relaxation

  • Stimulant

    Cross tolerance with THC?

http://buyk2spice.net/


Side effects of sc products

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


Current and future epidemiology

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


Synthetic stimulants

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


Mdpv and mephedrone

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


Synthetic drugs of abuse spice k2 and bath salts side effects and long term consequences

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.


Pharmacology of mdpv

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


Effects of mdpv

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


Other sequelae of mdpv

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


Mdpv s legal status

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


Mephedrone

Mephedrone

  • 4-methylmethcathinone (4-MMC)

  • Meow Meow

  • MCAT

  • Miaow

  • Drone

  • Plant Feeder

  • Bubbles

http://www.synchronium.net/2010/01/05/mephedrone-cat/


Pharmacology1

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


Routes of administration

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


Effects of mephedrone

Effects of Mephedrone

  • Euphoria

  • Sociability

  • Stimulation

  • Sexual Arousal

  • Music Appreciation

  • Hallucinations

http://www.drugs.org.im/campaigns.htm


Mephedrone side effects

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/


Mephedrone s legal status

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


Current and future epidemiology1

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


Questions

Questions?


Synthetic drugs of abuse spice k2 and bath salts side effects and long term consequences

Contact Information

Willie A. Hamilton, BC-FNP

LIVEfit Medicine

1901 Brookside Dr.

Kingsport, TN 37660

(423)765-9500


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