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Herbal Incense and Bath Salts An Awareness Presentation. Kristine Nutt, LCSW, LCAS, CSI. 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

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Herbal Incense and Bath Salts An Awareness Presentation

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    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. Bath Salts 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.

    4. Marketing • Sold commercially as bath salts, plant fertilizer, toy cleaner, pond cleaner, cell phone cleaner, jewerly cleaner, insect repellant, and ladybug attractant.

    5. Chemical Makeup • Contains MDPV (methylenendioxypyrovalerone), mephedrone(4-MMC), or methylone. Most contain MDPV or mephedrone. • MDPV – 4x potency of ritalin and concerta. 15-30 minutes to onset and effects 3 – 7 hours.

    6. BATH SALTS Marketed as legal alternative to LSD, cocaine, and methamphetamine. Chemists say it has the worst attributes of methamphetamines, cocaine, and LSD. Labeled not for human consumption but the sole purpose is for human consumption. Product names include Bliss, Blizzard, Blue Silk, Ivory Snow, Vanilla Sky, White Lightning, and Ivory Wave.

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

    8. Naphyrone • Referred to as “Cosmic Blast” and marketed as jewelry cleaner. Contains MDPV and Naphydrone, which is 0-2482 and Naphthylpyrovalerone derived from Pyrovalerone. It is a reuptake inhibitor and has a stimulant effect. • Stays in system for long periods and since it is a reuptake inhibitor of serotonin, body temperatures of 107 -108 degrees have been reported.

    9. BATH SALTS Users do not know how much or what they are getting. Cost about $25 - $50 per 50 mg packet. Very inexpensive and readily available high. October 21, 2011 the DEA invoked emergency scheduling authority to ban the three substances in bath salts.

    10. Effects Chest pains to the point people have felt they are having a heart attack, diminished thirst, jerking eye movements, extreme paranoia, auditory and visual hallucinations with common theme of monsters, demons and aliens, anxiety, increased blood pressure and heart rate, combativeness, irritability, suicidal thoughts and self-harm behaviors. Symptoms can last for days. Suicidality has been reported to last for long periods even after stimulatory effect wears off.

    11. Dangers and Dependency • A 29 year old man shot himself, while using ivory wave. His toxicology screen was negative. Deaths have been directly linked to bath salts. • A 21 year old man in Louisiana died after snorting bath salts and having hallucinations for days. He shot himself with a rifle. • A store was broken into four times in one month to steal bath salts. • Users report intense cravings for the drug leading to issue of dependency?

    12. Treatment CALLS TO POISON CONTROL: 304 in 2010, 6,138 in 2011, and 722 as of March 31, 2012. • Treated with antipsychotics and benzodiazepines to decrease agitation. • Often restraint to avoid self-harm. • Psychotic symptoms often persist after treatment with antipsychotics. • No standard treatment; just treat the symptomsof the individual.

    13. 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.

    14. 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

    15. What is a Synthetic Cannabinoid? • A class of synthetic substances that bind to the cannabinoid receptors(CB1 and CB2) in the body. When used they create a high similar to THC. There are approximately 250 synthetic cannabinoids. • Used in an attempt to avoid laws that make marijuana illegal. National Ban on five cannabinoids began in March 2011.

    16. History of Spice and K2? • The cannabinoid-like chemicals were first developed in research laboratories to study receptors in the body and brain and for other research purposes. The five banned cannabinoids are JWH-018, 073, 200, CP 47, and 497. • JWH-018 was first made in 1995 by Dr. John Walter Huffman at Clemson University. Manufacturers read research and copied it to produce this cannabinoid and marketed it for commercial distribution. • Brand “Spice” was released in 2004 and gained popularity in 2006.

    17. Spice and K2 • The company that started the “Spice” line went from assets of 65,000 Euros in 2006 to 899,000 Euros in 2007. Spice was the dominant brand until 2008. Then competing brands like “K2” hit the market. Now there are many distributors of these products. • In 2011, Redwood Toxicology Lab developed testing for six synthetic cannabinoid chemicals. 72 hours for urine and 24 – 48 for saliva.

    18. Spice Products • Spice • Spice Gold • Spice Diamond • Spice Tropical Synergy • Spice Arctic Synergy • Spice Gold Spirit • PEP Spice

    19. Many Faces of Spice

    20. Genie Yucatan Fire Dream Ex-ses Blaze Spike 99 Blaze Spark Fusion MANY others! Other Herbal Incense Products

    21. Spice Ingredients • One or more synthetic cannabinoid compounds. Can be different mix each time. • JWH-018, CP 47, 497, C8, JWH-073, and JWH-250 have been found most often in spice products. • Other legal substances such as Pink Lotus and Dwarf Skullcap. • Potentiate or add to effects • Create different effects between products • Many have psychoactive effects on their own • Some used as marijuana substitutes in the past. • Cost $30 - $40 per 3 gram bag.

    22. Other Synthetic Cannabinoids HU named after Hebrew University where they were created. • HU-210 • Various studies show it is anywhere from 66-800 times more potent than ∆9 THC1 • Schedule I under CSA: Illegal in U.S. • HU-211 • Studies tentatively show no ∆9 THC-like effects • Used to research treatment of brain damage related to stroke, brain trauma, glaucoma, and multiple sclerosis • HU-311 • Has potent antineoplastic and antiproliferative activity (cancer fighting drug) 1 J. Med. Chem.35 (11): 2065–9.

    23. Synthetic Cannabinoids • CP 47,497 and analogues (CP Created by Pfizer) • 3 to 28 times more potent than ∆9 THC • CP 55,940 • 45 times more potent than ∆9 THC • JWH-015 • JWH-018 4-5 x more potent than THC and same chemical structure shared with known cancer causing agents. • JWH-073 • WIN 55,212-2 (WIN is for Sterling Winthrop) • Used to research treatment for Alzheimer's • Effects milder and don’t last as long as ∆9 THC

    24. Baybean Blue Lotus Lion's Tail Lousewort Indian Warrior Dwarf Scullcap Maconha Brava Indian Pennyworth Clove Hops Tribulus Terrestris Pink Lotus Marsh Mallow Red Clover Rose Vanilla and Honey Fly Agaric Siberian Motherwort Damiana Stevia Leaf Lemon Grass Turnera diffusa Other Herbal Incense Ingredients(Not all inclusive) Many other legal herbs and herbal extracts are used to enhance aroma, potency

    25. Why Do People Use It? • Herbal incense products are smoked or snorted for marijuana-like effects • Legal substitute to marijuana • Other reasons: increase creativity, reduce stress, experience euphoria, increase personal insight, and increase appreciation for the arts • There are numerous blogs and websites the provide users the opportunity to share experiences.

    26. Effects • Marijuana-like effects: euphoria, giddiness, silliness, bloodshot eyes, impaired short-term memory and concentration, and “munchies.” • Other common effects: cotton mouth, light sensitivity, a warm sensation in the limbs, dry eyes, paranoia, light headedness, auditory and visual hallucinations, painless head pressure, time distortion, panic attacks, delirium, impaired coordination, and sleeplessness • Onset/duration: 5-10 minutes, and effects up to 2 hours. Can get high off a hit or two.

    27. Effects • A number of users experience hangover-like effects the morning after use including dry mouth, intense headaches • Depending on the product, inhaled smoke is as harsh as marijuana smoke • Taste can vary from a very bad to sickly sweet.

    28. Effects • One hospital reported a patient with a 1-3 gram a day habit to the point of being at risk of losing his job and severe withdrawal symptoms (tremors, headache, nausea, vomiting and depression). • One person reported spending $2000 in the last month on Spice and Bath Salts.

    29. Dangers • A Boston University School of Medicine study suggests that use may cause increase in paranoia, hearing voices, disorganized behavior, and panic symptoms. • Psychotic symptoms may last for a few days to months. • Another study found these products may create psychosis in patients with no history of psychiatric disorder.

    30. Dangers Poison Control Centers had 112 calls in 2009, 2906 in 2010, 6,959 in 2011, and 639 in January 2012. • Users are experimenting with combining different products, which can dramatically change or increase the effects. These cannabinoids were created for experimental use. Not tested on people. No one knows long term effects of these products.

    31. Dangers • JWH-018 and others, have a shared chemical structure with cancer causing agents, according to NIDA. • A hospital in Kansas reported 8-10 people hospitalized in past month after smoking the products with hallucinations, seizures and bleeding from the nose and mouth. • Three teens ages 16 and 18, showed up in ER with anxiety, agitation, excessive sweating, and inability to speak.

    32. Dangers • Kids’ brains are still developing. • Across the US, people are showing up in emergency rooms with aggressive and unusual behavior. Suicides have been reported. • A NIDA study stated that 11% of 15,000 high school seniors have used K-2 in 2011. • Medical personnel often don’t know what they are dealing with unless the person self-reports.

    33. Appearance • Most herbal incenses appear as an olive green leafy material very similar in appearance to marijuana, oregano

    34. Paraphernalia • Herbal incense smokers will use the same or similar products used by marijuana smokers • Pipes, bongs, hookahs • Rolling papers • Blunts (hollowed out cigars packed with product) • Herbal incense specific paraphernalia • Vapor Genie • Grinders (to further grind into a finer mixture)

    35. Hookah

    36. Vapor Genie Grinders

    37. Controlled Substances Act • In Nov. 2010, the USDEA moved to ban 5 synthetic cannabinoids, placing them in Schedule I status due to high potential for abuse, and no known medical benefits. The ban would be in effect for one year. • The ban was delayed due to companies stating the ban was unconstitutional. • On March 1, 2011 the National Ban was enacted. • This means that is illegal to possess and sell products containing these. • Before the ban, 15 states had already taken action to control one or more of these five chemicals.

    38. Challenges - Manufacturing • Manufacturing occurs in countries where synthetic cannabinoids are legal. • As detection catches up with manufacturing, makers will alter ingredients. They are using new ingredients which are not illegal at this time. • Federal bans target larger distributors. States will need to go after smaller distributors.

    39. Challenges - Marketing • Product will not cause positive drug test • “There's never been a case reported by our clients that any of our Herbal Smoke Blends caused them to fail a test” • “YOU'LL NEVER FAIL A DRUG TEST” • Why would this be an issue for a product marketed as incense and not for human consumption?

    40. Challenges - Marketing • Ingredients1 • Synthetic cannabinoids not listed • Listed ingredients are not necessarily in the product • Consumers don’t know what they are actually getting • Raises questions of consumer protection and product misrepresentation 1 Understanding the ‘Spice’ Phenomenon Thematic Paper, European Monitoring Centre for Drugs and Drug Addiction, 2009, Portugal