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Designer Drugs An Awareness Presentation

Designer Drugs 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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Designer Drugs An Awareness Presentation

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  1. Designer DrugsAn 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. “SMILES” 

  4. “SMILES” • 2C-1 Hallucinogen synthetic drug • Part of the 2C family of drugs • Powder or Pill form • Often mixed with chocolate and candy • Schedule 1 class of drug • According to LAPD, there has been an increase of overdose deaths from this drug recently. Popular with teens and college students. • Formulas were published in book “PiHKAL: A chemical Love Story” (Transform Press, 1991)

  5. “Smiles”  • Dessa Bergen-Cisco, a Professor of Public Health at Syracuse University stated, “Basically, it’s a pure and potent form of ecstasy or MDMA”. • Effects are compared to a potent combination of MDMA and LSD with terrifying hallucinations and overwhelming anxiety. • Overdoses have been reported in California, Ohio, and other states.

  6. “Smiles”

  7. “SMILES”  • Recently in the news due to Johnny Lewis, 28, who was known for his role in the television show, “Sons of Anarchy” killed 81 year old landlady and her cat before jumping to his death. No evidence of drugs were found in his system. • One 17 year old in North Dakota overdosed and was observed shaking, growling, and foaming at the mouth. Another teen died the night before from this drug. • Does not show up on toxicology screens.

  8. Effects • Anxiety leading to panic attacks. • Nausea and Vomiting. • Terrifying auditory and visual hallucinations. • Increased heart rate. Can cause strokes • Can cause seizures and kidney failure • Elevated body temperature. • Giddiness, Empathy, and Relaxed State.

  9. Bath Salts Video Clip

  10. Derivatives of cathinonefound naturally in the herbal stimulant khat. Part of phenethylamine family that includes, amphetamines, methamphetamine, and ecstasy. BATH SALTS

  11. BATH SALTS • First developed in research labs and became a popular party drug in Europe and UK • Spread overseas around 2008, and began to show up mostly in states like Louisiana, Kentucky, and Tennessee. Some had regional names like “Hurricane Charlie” and “Bayou”. • Other product names include Bliss, Blizzard, Blue Silk, Ivory Snow, Vanilla Sky and Ivory Wave. • Became highly publicized with the cannibalistic attack in Miamiand other reports of violence.

  12. BATH SALTS

  13. BATH SALTS

  14. BATH SALTS

  15. Marketing • Sold commercially as bath salts, plant fertilizer, toy cleaner, pond cleaner, cell phone cleaner, jewelry cleaner, insect repellant, glass cleaner, toilet cleaner, and ladybug attractant. • Sold as tablets, capsules, and white or beige crystals/powder. Capsules may be sold in combination with caffeine or amphetamine. Has been sold as ecstasy. • Sold mainly on the internet buy also in “head shops”, convenience stores, and gas stations. Some people have bought on e-bay. Low cost and readily available. • It is not the stuff you find at Bath and Body Works!!!

  16. Marketed as legal alternative to LSD, cocaine, ecstasy, and methamphetamine. Labeled not for human consumption but the sole purpose is human consumption. BATH SALTS

  17. Video of Bath Salts Sale

  18. Chemical Makeup • There are several synthetic cathinones. The most common found in “Bath Salts” are MDPV (methylenendioxypyrovalerone), mephedrone(4-MMC), or methylone. Found in 98% of tested products. • Advertised as above 95% purity but samples tested in Italy were only 40 – 50% pure. Some purchased online had benzocaine, lidocaine, and caffeine. Users truly don’t know what they are getting or how much.

  19. Bath Salts • Costs anywhere from $40 - $100 per gram. • Taken orally, IV, nasal inhalation, intramuscular, or rectally. Snorting and swallowing are the most common. Users may combine 2 methods (oral and inhalation) to obtain more rapid and prolonged effects. • High risk for overdose due to packages containing varying amounts of the chemicals.

  20. Marketed as legal alternative to LSD, cocaine, and amphetamines. May imply safety for user. Labeled not for human consumption but that is the sole purpose! BATH SALTS

  21. Naphyrone • Referred to as “Cosmic Blast” and marketed as jewelry cleaner. Contains MDPV and Naphydrone. Reuptake inhibitor of serotonin. • Stays in system for long periods. Body temperatures of up to 107 degrees have been reported.

  22. BATH SALTS Users do not know how much or what they are getting. Package labeling implies “relaxation” but not stimulant effects.

  23. Video Effects

  24. Trends in Use • Mostly males with a mean age of mid-late twenties. • 2012 Monitoring the Future Survey reported .9% annual prevalence of use among students in grades 8,10, and 12 combined. • Google Trends (2013) showed rapid increase in Internet searches for “buy Mephedrone” in Europe and “bath salts” in the U.S. in 2012.

  25. MDPV • Phenethylamine and norephinephrine-dopamine reuptake inhibitor. Hallucinogenic effects. Lasts longer than Mephedrone or Methylone. • Similar form of this was developed in 1960’s to treat chronic fatigue syndrome but rejected due to issues with dependency. • Doses of 5 - 20 mg can produce effects with oral and inhalation.

  26. Mephedrone • Derived from cathinone and increases dopamine, serotonin, and norephinephrine levels. • Users report longer and better high than cocaine. Users report it is like using cocaine and ecstasy together. Effects last about an hour. Known as meow-meow. • Users usually ingest capsules, dissolve in water, snort, or use rectally (bombing).

  27. Methylone • Stimulant in the phenethylamine class.More potency in terms of serotonin reuptake inhibition. Similar structure to MDMA. • After oral, nasal, or rectal use, effects occur within 20 minutes, and last about 2 hours. • *Low concentrations of endogenous phenethylamine have been found in people with ADHD and high concentrations have correlation with incidence of schizophrenia.

  28. Bath salts vs. Cocaine/Meth • Like Amphetamines, Bath Salts release dopamine from cells, while blocking the reuptake of dopamine into the cellsimilar to cocaine. • MDPV is ten times stronger than cocaine. • Taking Bath Salts is like taking Cocaine and Meth together. • Time delay – MDPV is able to cross blood-brain barrier which may impact onset of action and toxicity. • Pbs.org – September 2012

  29. Bath Salts and The Brain

  30. Why Do People Use Them? • Increased energy, alertness, and concentration. • Sexual stimulation and mood enhancement. • Decreased appetite and need for sleep. • Low cost and advertised to users as “they will never fail a drug test”. • Readily available and accessible.

  31. Effects • Patients reporting to ER’s have cardiovascular complications, such as tachycardia, chest pains, and hypertension. • Dizziness, jaw clenching, and confusion. • Body temperatures of up to 107 degrees have been reported. Often people take their clothes off. • Jerking eye movements and foaming at the mouth have been reported. Vomitingand nosebleeds. • Restlessness and inability to sit still. • Insomnia – sleep deprivation * - Some people take Xanex and other drugs to try to sleep.

  32. EFFECTS • Auditory and Visual Hallucinations with common themes of monsters, demons, aliens, and God. This leads to paranoid delusions and violent behavior in response to hallucinations. • Irritability, suicidal ideation, self-harm behaviors, and prolonged anxiety. “Excited Delirium”. • Begin 10 – 20 minutes, peak 45 – 90, last 2-3 hours then decrease. Users reported effects after 24 hours. Nonpsychiatric symptoms usually resolve in 1 to several days, but psychosis can persist.

  33. Concerns • A Marquette County, Michigan ER reported 35 admissions from November 2010 to March 2011. This prompted Law Enforcement to seize all bath salts from a local convenience store. The products tested all contained MDPV. • 17 out of 35 were hospitalized. Median age was 28 years (range 20 -55 years). One death reported. 63% used by injection. • 54% were Men, 69% self-reported a history of drug abuse, 46% or 16 patients had a history of mental illness(bipolar disorder, schizophrenia and depression), and 17% reported suicidal thoughts/attempts related to use of bath salts. • “Morbidity and Mortality Weekly Report, Vol 60, May 20, 2011, 624 - 627

  34. Concerns • According to the Bangor Daily News, domestic violence calls have increased in Maine due to use of Bath Salts. • Cookeville Regional Medical Center in TN has treated over 160 people since 2010.

  35. Dangers and Dependency • A research study led by UNC professor CJ Malanga, MD found that Mephedrone, like cocaine, has a high potential for abuse and addiction. • Study by Scripps Research Institute in California suggests that Bath Salts are more addictive than Meth. Rats averaged 60 level presses for meth versus 600 for MDPV. Some even pressed 3000 times for a single hit. Exhibited obsessive behavior, such as, licking, biting, and sniffing their cages. NIDA.org 2012 Sydney Herald 2013.

  36. Acute Toxicity of Substituted Cathinone Product. Use Compiled From 2 US Case Series Reports (n = 271)* • Signs and Symptoms Percentage • Agitation 66-82 • Tachycardia 56-63 • Combative violent behavior 57 • Delusions/hallucinations 40 • Paranoia 36 • Confusion 34 • Seizures tremor 29 • Drowsiness 23 • Hypertension 17-23 • Paranoia 20 • Mydriasis 13-20 • Myoclonus 19 • Chest pain 17

  37. Dangers • Users report repeated dosing and binging over several days leading to tolerance. • Acute toxicity may be linked to larger binge consumption, using multiple substances, and other individual use patterns. • Journal of Addiction Medicine, May/June 2013

  38. Legality • The Synthetic Drug Prevention Act signed by President Obama on July 9, 2012. This act bans 29 chemicals found in Bath Salts and Synthetic THC and makes them Schedule I. • States will have to incorporate these into their drug scheduling list and update the list as new substances are discovered.

  39. Operation “Logjam”

  40. Operation logjam • July 26, Operation “Logjam” seized 5 million packets of synthetics and arrested 90 people in a nationwide effort to crackdown on these drugs. • Tested products contained anywhere from 17 milligrams to 2000 milligrams of chemicals.

  41. Poison Control Center Data CALLS TO POISON CONTROL: 304 in 2010, 6,138 in 2011, 2065 in 2012, Ages <6 to over 59. Most ages 20 – 29. January – 228/301 July – 361/680 February – 230/487 August – 173/602 March – 264/639 September – 119/512 April – 285/600 October – 98/401 May – 295/720 November – 86(2012) June – 415/743 December – 78(2012) www. aapnc.org 1-800-222-1222

  42. TREAMENT • Often eat up Emergency Room resources as it takes multiple nurses and doctors to treat users. • Difficult to know what someone has taken unless they self-report or someone else reports. • Does not show up on typical toxicology screens and can not be detected by drug dogs. There are now drug tests that do test for Bath Salts. Ammon labs, Redwood Toxicology, and Dominion Diagnostic offer these drug screens.

  43. TREATMENT • Low dose antipsychotics to treat psychosis • Benzodiazepines, usually Ativan, to decrease agitation is first treatment. • Ten to twenty times the normal dose of sedatives have been used. • Try to avoid using restraints, but speak reassuringly to people who are agitated and paranoid • Move to a quiet room with low light to help calm patient. • Avoid loud noises and try medications prior to restraint.

  44. TREATMENT • Monitor the person for depression and suicidal ideation even after they have stopped using the drug. Address both mental health and addiction issues. Follow guidelines for treatment of stimulant users. • Psychotic symptoms often persist after treatment • Enhance coping skills to assist the person in dealing with anger and other emotions. • Train staff to deal with specialized issues and incorporate questions into intake and assessment.

  45. Movie Madness • BATH SALT ZOMBIES • Available on DVD February 19 • is a new horror film directed and co-written by Dustin Wayde Mills (Puppet Monster Massacre, Zombie A-Hole, Ballad of Skinless Pete) and produced and co-written by Clint Weiler of Aggronautix. The movie sensationalizes the recent bath salt  epidemic and the attacks surrounding them

  46. “Zombie Apocalypse” • The shocking wave of attacks associated with Bath Salts has sparked fears of a real-life zombie outbreak in the south. This led to The Center for Disease Control and Prevention releasing a statement saying it is not aware of any virus that can cause zombie-like behaviour.

  47. What next? • Partnerships and networks between the community and law enforcement have made an impact in the sale and distribution of this drug. • Education regarding the dangers of Bath Salts.

  48. Spice / K2

  49. 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. Resembles potpourri.

  50. 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, Yucatan Fire and many others” • Since the national ban on five synthetic cannabinoids, new brand names have developed, such as K2 Sky, K3, and K4

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