Current Trends K2/Spice, “Bath Salts” & Others

1. Current Trends K2/Spice, “Bath Salts” & Others Ken Dickinson, M.S., R.Ph. 610-291-3109 kdickinson@gaudenzia.org

2. Introductions Presenters: Rodney & Ken • Attendees • Experience with “Bath Salts” and K2/Spice • Expectations or goals for this workshop

3. Objectives • History and background of “new synthetic designer drugs” • Epidemiology and current trends • Effects and dangers of these drugs • How sold, what they look like and how used • Legal, prevention and treatment issues

5. Designer Drugs: Background • Trend started in late 1970’s • Drugs of abuse are classified by DEA • Drugs of abuse work according to structure • Analogs • Can “design” an analog to have same or similar activity but not listed as a “controlled substance” • Not subject to legal penalties and restrictions

6. Mephedrone & Methamphetamine

7. Federal Drug Schedules Federal Controlled Substances Act (CSA) of 1970 Schedule I: No medical use, high abuse potential (heroin) Schedule II: Accepted medical use, high abuse potential (OxyContin, Ritalin) Schedule III: Accepted medical use, less abuse potential than I or II (Vicodin) Schedule IV: Accepted medical use, less abuse potential than I-III (Valium, Xanax) Schedule V: Accepted medical use, lowest abuse potential (Robitussin AC) SOURCE: ATTC National Office, CONNECT to Fight Prescription Drug Abuse.

8. Designer Drugs designer drugs  (in designer drugs (chemistry)) ...to see a marginally different version appear, using substances not covered in the original law. In the United States this problem was addressed in the Anti-Drug Abuse Act of 1986, which contained a Controlled Substance Analogue Enforcement Act (commonly called the Designer Drug Act), which prohibited the manufacture of “substantially similar” analogues of banned chemicals.

9. Designer Drugs: Evolution • Internationally do not have such laws • Being manufactured in other countries • Many “designer drugs” do not test (+) • A way to “Beat the Bladder Police”

10. Designer Drugs • Today’s trend • Make an analog that is not listed in laws • Since legal can make an distribute as an everyday household product e.g. “Bath Salts” “Plant Food”, potpourri, incense, jewellery cleaner, hummingbird attractant, etc. • Then label “not for human consumption” • Market via social media and retail outlets

11. Web Sites www.erowid.org • www.lycaeum.org • www.hightimes.com • http://en.wikipedia.org/wiki/Synthetic_cannabis • www.k2info.org

12. K2 Products

13. Herbal Incense • Crushed non-psychoactive herbal plant matter treated with one or more synthetic cannabinoids • First generation: “K2”, “Spice”, “Black Mamba” • Second generation “K3”, “Splice”, “Apocalypse”, “Cloud 10”, “Destiny”

14. Synthetic Marijuana (JWH- 018) Known as Spice or K2 K2 originated at Clemson University, where researchers developed synthetic cannabinoids in an effort to create therapeutic drugs. But the cannabinoids also have effects akin to THC, the key ingredient in marijuana K2 is largely created by individual sellers, it's anyone's guess what else is added to the mix.

15. K2 For $35, users can buy 3 grams of K2 "incense" with nothing more than a credit card or PayPal account. Did not have drug test or it Now do but extra expense and only some labs Smokable herbal blends marketed as "legal highs" have become increasingly popular and as easy to buy as cigarettes. (before 03.01.11)

16. K2 Spice • K2 contains synthetic chemicals, known as JWH-018 and JWH-073, that mimic THC by acting on the cannabinoid receptors in the brain • Other analogs detected • HU-210 • AM-2201 • CP-47, CP-497, C6, C8, C9

17. K2 Data • American Association of Poison Control Centers • Reported in article June 2012 • Year 2010 #2, 906 • Year 2011 #6,959 • Year 2012 up to May 31 #2,883

18. Description of the Drug • Mixture of herbal and spice plant products • Leaf can be: marshmallow leaf, parsley, etc. • Sprayed with synthetic cannabinoids • Marketed as incense and “not for human consumption” • No regulations to list ingredients or age requirements to purchase

19. Alarming Fact • Tests show that even the same brand may have different drugs– in different amounts-at different times • User has no way of knowing what or how much they are taking

20. s • Dr. Huffman & Dr. Huestis (Chief of Chemistry/Drug Metabolism at National Institute for Drug Abuse) indicate that when taking these drugs, it is “hijacking the part of the brain important for many major functions: temperature control, food intake, perception, memory and problem solving. • Many people taking these high-potency drugs are affecting important functions throughout their body’s-hormone functions for example.” • Doctors also express concern that the drugs may involve acute toxicity levels, possibly long term, as well as impacting cannabinoid receptors that regulate body’s immune system.

21. K2 Impact • Retailers selling the drugs report a recent (2011) increase in sales from app. $1000 daily up to $10, 000 daily. • Medical reports indicate that K2/Spice drugs potentially result in users developing a rapid and powerful addiction on a level not usually found among smokers of “real” marijuana. • Recently linked (Dec 2011) to over 352 nationwide emergency room incidents-includes suicide attempts, extremely elevated heart rate/blood pressure, comas, seizures, and anxiety attacks.

22. Incense EmporiumOnline K2/Spice Ad (Current): • Note from the owners:  On Dec 24, the federal government banned certain ingredients commonly found in K2 - our products have been scientifically analyzed and certified not to contain any of the controlled ingredients, for more information please click on the "Contact Us" above.Thanks for being loyal Incense Emporium customers! • Buy 1 Get 1 FREE on all Herbal Incense!!! Buy whatever you HERBAL INCENSE would like and we will automatically double it when we package it for shipping.  It's that simple!  Buy 2, Get 4...Buy 5, Get 10...Buy 100, Get 200...No Limits!!!   • $129.99 for 2 ounces...that's only $65 per ounce!!! Our products are NOT FOR HUMAN CONSUMPTIONMust be 18 to purchase

23. HU-211 and HU-2101

24. JWH-073 and JWH-0181 • JWH-018 and JWH-073 • JWH-018 and JWH-073 are synthetic cannabinoid agonists without the classical cannabinoid chemical structure • In vitro studies show that JWH-018 and JWH-073 binds to the brain cannabinoid receptor CB1 with higher affinity than Δ9-THC which binds with almost equal affinity to CB1 and CB2 receptors • Behavioral pharmacology studies show that JWH-018 and JWH-073 both have Δ9-THC-like activity in animals

25. Missouri K2 Administration Study • Bob Welsh- PI • IRB Human subjects approval • Six subjects smoked K2 Summit • Each contained JWH-018 & JWH-073 or CP47, 497 • Subjects performed Standardized Field Sobriety Tests, cognitive tests & Drug Recognition Expert Exam • Blood, urine and oral fluid collected

26. K2 Study (cont’d) • Onset of effects in about 2-3 minutes • Dry mouth • Light headedness • Blurred vision • Agitation, Motor restlessness • Time dilation (?) • Theory in physics, time travel

27. K2 Study (cont’d) • Drug Recognition Expert Exam • Increased pulse and blood pressure • Lack of convergence • Movement of the two eyes so coordinated that the images of a single point fall on corresponding points of the two retinas • No horizontal or vertical gaze nystagmus • Pupils normal, muscle tone normal

28. K2 Study (cont’d) • Field Sobriety Tests • 3 to 4 inches of sway, leg body tremors • Loss of balance • Loss of motor coordination

29. Missouri Study Self Reported K2 Effects • Tachycardia • Dry Mouth • Felt Impaired, subjective thought disruption • Changes in perception • Impaired sense of time • Mild anxiety, paranoia • Sedation & Post-intoxication exhaustion

30. On Line Reported K2 Effects • Strong dysphoria-Panic attacks-Heavy body load-Extreme nausea -Fear, Panic, Anxiety-Strong aural hallucinations--Racing heart (higher doses) • Heart attack

31. On Line Reported K2 Effects • Self mutilation • Paranoia • Auditory & visual hallucinations • Delirium • Agitation

32. On Line Reported K2 Effects • Marijuana-like effects • Euphoria • Giddiness • Silliness • Impaired short-term memory and concentration • Increased appetite • “Most angiogenic substance I ever ingested”

33. K2 Products

34. K2 Products

35. How Diagnosis is Made • Mainly supported by clinical history rather than presentation or mental status exam • Duration of intoxication or “high” is relatively short (30 min. or less) • Do not typically present acutely intoxicated to an outpatient visit • Unlike marijuana do not have a typical or signature smell

36. How Diagnosis is Made • Usually access “system” via behavioral crisis • Criminal Justice system • Crisis Centers, ER’s & Psychiatric Hospitals • ER’s are seeing and identifying more due to acute intoxication • Toxicology testing continues to improve

37. User Report #1 This is the worst experience I have ever had The most angiogenic substance I have ever used Nausea, vomiting, heart pounding like I am going to have a heart attack Not sure if I just said that, thought it, or read it Two hours later will never take this again

38. User Report #2 • Three individual hits from a small pipe • Organic, no chemical odor or taste • Five minutes feels like cannabis • Ten minutes like an intense cannabis high • More than three puffs might be too much

39. Why the Discrepancy in Reports? • Use of other drugs with incense • Varying potency • Overdose • Presence of different cannabinoids • Knock-offs • User/environment characteristics • Set & setting, etc.

40. K2 Overview No quality control Manufacturing process may be associated with adverse effects Subjective effects most closely resemble those of very powerful marijuana Almost complete lack of scientific study Street information very inconsistent

41. K2 Treatment Issues • High rates of addiction (K2info.org) • Withdrawal due to physical addiction • Treated with sedatives and clonidine • Before D/A treatment need to be medically and psychiatrically safe and stable • Residual effects for weeks (or months) due to long half-life & fat storage

42. Withdrawal Case StudyWebMD • German male 20 y.o. used Spice Gold daily for 8 months • Due to tolerance increased dose 10 fold • Felt need to continue use daily • When unable to get drug experienced: • Unrest, drug craving, nightmares, sweating, nausea, tremor, headache, high BP, tachycardia

43. Withdrawal Case StudyCont’d • Began using again • When wanted to stop checked into hospital • Experienced classic withdrawal that lasted 7 days

44. K2 Harm Reduction Tips Not all incense blends are created equal. JWH-018 is more expensive than real pot Herbal incense blends are harsh JWH-018 does not mix well with alcohol The high last no more than 30 minutes

45. K2 Testing • Many labs have a test for the first generation JWH chemicals • In February 2010, Redwood Labs, California developed a saliva test for JWH-018, JWH-073 and JWH-250 • Saliva and urine tests recently developed for second generation JWH’s • http://www.redwoodtoxicology.com/documents/services/3369_sc_sellsheet.pdf

46. K2 Testing • Following a single low dose exposure, synthetic cannabinoids can be detected up to 72 hours in human urine. • In case of chronic exposure the window of detection is much longer

47. Maryland Law: K2 & Bath Salts • On March 1, 2011, the possession and distribution of 5 synthetic cannabinoid compounds became illegal in the U.S. per an emergency ban by the U.S. Drug Enforcement Administration • Maryland no enactment yet for K2 as of Sept 25, 2012 • Local bans such as Ocean City • July 21, 2012 Bath Salts now Schedule I in Maryland

49. Mitragyna Speciosa • Used in: • Malaysia • Thailand • Indonesia • Local names: • Ithang • Biak Biak • Ketum • Kakuam

50. Kratom Pharmacology • Mitragynine • Structurally similar to some hallucinogens • No hallucinogenic activity or effects • Acts on opioid receptors