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

Synthetic Drugs of Abuse: ‘Spice,’ ‘K2’ and ‘Bath Salts’. Erik Gunderson, MD Assistant Professor Department of Psychiatry and Neurobehavioral Sciences and Department of Medicine Director, Clinical Pharmacological Research Unit University of Virginia April 14, 2011.

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

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  1. Synthetic Drugs of Abuse: ‘Spice,’ ‘K2’ and ‘Bath Salts’ Erik Gunderson, MD Assistant Professor Department of Psychiatry and Neurobehavioral Sciences and Department of Medicine Director, Clinical Pharmacological Research Unit University of Virginia April 14, 2011

  2. 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.

  3. Spice and K2 • Cost: $30-45 per 3gm • Route: pipes, water pipes or rolled cigarettes • Contents: inert plant material sprayed with SCs • JWH-018, JWH-073, JWH-250, CP-47,497, HU-210 http://buyherbalspice.com/spice_reviews/category/news/

  4. 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

  5. Psychoactive Effects Marketed as similar to cannabis: • Euphoria • Sociability • Anxiolytic • Relaxation • Stimulant Cross tolerance with THC? http://buyk2spice.net/

  6. 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

  7. Legal Timeline for SCs • 2009: Restricted in the UK, EU • 11/2010: DEA Notice of Intent to temporarily ban 5 SCs • 3/1/2011: Five SCs Designated Schedule I • JWH-018, JWH-073, JWH-200, CP-47,497, and cannabicyclohexanol • Effective for one year

  8. 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

  9. 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

  10. 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

  11. Mtv MDPK Magic Super Coke Peevee Energy-1 (NRG1) Charge Plus White Lightning Scarface Cloud 9 Ocean Ivory Wave Product Marketing http://www.helphopehealing.org/

  12. 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.

  13. 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

  14. 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

  15. 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

  16. 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

  17. Mephedrone • 4-methylmethcathinone (4-MMC) • Meow Meow • MCAT • Miaow • Drone • Plant Feeder • Bubbles http://www.synchronium.net/2010/01/05/mephedrone-cat/

  18. 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

  19. 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

  20. Effects of Mephedrone • Euphoria • Sociability • Stimulation • Sexual Arousal • Music Appreciation • Hallucinations http://www.drugs.org.im/campaigns.htm

  21. 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/

  22. 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

  23. 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

  24. Questions?

  25. References • Brunt, T.; Poortman, A.; Niesink, R.; Van Den Brink, W. (2010). "Instability of the ecstasy market and a new kid on the block: mephedrone". Journal of psychopharmacology. • Drug Enforcement Administration: Office of Diversion Control; Drug and Chemical Evaluation Section. Methylenedioxypyrovalerone [(MDPV) (1-(1,3-Benzodioxol-5-yl)-2-(1-pyrrolidinyl)-1-pentanone].Available at: www.deadiversion.usdoj.gov/drugs_concern/mdpv.pdf. Accessed February 7, 2011. • EMCDDA (2009). Action on new drugs briefing paper: Understanding the ‘spice’ phenomenon. A report from an EMCDDA expert meeting, 6 March, 2009, Lisbon. • "Europol - MCDDA Joint Report on a new psychoactive substance: 4-methylmethcathinone (mephedrone)". European Monitoring Centre for Drugs and Drug Addiction. 27 May 2010. • Psychonaut WebMapping Research Group (2009). MDPV report. Institute of Psychiatry, King’s College London: London UK. Available at: www.nascsa.org/news/psychonautmdpvreport.pdf. Accessed February 23, 2011. • Psychonaut WebMapping Research Group (March 2010). "Mephedrone Report." Institute of Psychiatry, King's College: London UK. • Psychonaut Web Mapping Research Group (2009.) Spice Report. Institute of Psychiatry, King’s College London: London UK. • United States Drug Enforcement Agency. Office of Diversion Control. Drugs and Chemical of Concern: 4-methylmethcathinone [Mephedrone, 4-MMC, meow meow, m-CAT, bounce, bubbles, mad cow]. July 2010. • United States Drug Enforcement Agency. Office of Diversion Control. Rules 2011:Schedules of Controlled Substances: Temporary Placement of Five Synthetic Cannabinoids Into Schedule I. Federal Register Volume 76, Number 40 (Tuesday, March 1, 2011). • Wehrman J. U.S. Poison Centers Raise Alarm about Toxic Substance Marketed as Bath Salts; States Begin Taking Action. AAPCC. February 14, 2011. Available at: http://www.aapcc.org/dnn/Portals/0/prrel/FEB14BATHSALTSUSE.pdf • Winstock, A.; Mitcheson, L.; Deluca, P.; Davey, Z.; Corazza, O.; Schifano, F. (2010). "Mephedrone, new kid for the chop?". Addiction 106 (1).

  26. Acknowledgement Laura Willing, BS Contact Information Erik Gunderson, MD 434-924-8013 office ewg2n@virginia.edu

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