The Real Dangers of Synthetic Drugs in The 21 st Century

1. The Real Dangers of Synthetic Drugs in The 21st Century Ken Dickinson, M.S., R.Ph. kdickinson@gaudenzia.org 610-291-3109

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

3. Objectives • • Describe the current trend of synthetic drugs of abuse being marketed as “legal” household products; • • Identify the compounds referred to as “bath salts” and K2/synthetic marijuana;  • • Demonstrate the effects on users with emphasis on the high incidence of psychosis; • • Review the legal aspects and current legislation aimed at regulating and limiting access to these chemicals; • • Discuss prevention and treatment approaches

4. Please Take Note Very little science Very little research Now accumulating data & science Today’s information anecdotal Face to face with users, Law Enforcement, etc Forums & discussions on web Some research

6. 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

7. Mephedrone & Methamphetamine

8. 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”

9. 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

10. European Drug Monitoring • #24 new psychoactive drugs 2009 • #41 in 2010 • #49 in 2011 • #57 in 2012 • Since 2012 more than one a week • Synthetic cathinones & synthetic cannabinoids make up more than 2/3 of new drugs

11. Schematic highlighting the major families and subfamilies of research chemicals, and some of their most prominent members. ResearchChemicals

12. Phenylethylamines I Have Known & Loved • Alexander Shulgin & Ann Shulgin • Book: PiHKAL A Chemical Love Story (1991) • Lists #179 psychoactive compounds • “A prerequisite to the psychedelic experience • The book is arranged into two parts: • A fictionalized autobiography of the couple. • Detailed synthesis instructions for over 200 psychedelic compounds (most of which Shulgin discovered himself), including bioassays, dosages, and other commentary.

13. Historical Background All drugs of abuse started out as legal (uncontrolled) substances in US Heroin, LSD, Cocaine, Amphetamine, Marijuana and MDMA (ecstasy) Many sat on the shelf for years before becoming abused A mixture of rumor, myth and science have all contributed to changes in the legal status of these substances

14. Web Sites • www.k2info.org • www.bluelight.ru • www.drugs-forum.org • www.erowid.org • www.lycaeum.org

15. K2 Products

16. 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 • First generation called K2 or “Spice” • Second generation called K3 or “Splice”

17. Synthetic Marijuana (JWH- 018) 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.

18. Synthetic Cannabinoids Pharmacology Research supported by NIDA-John W.Huffman Two cannabinoid receptors in human brain CB1 and CB2 CB2 affects inflammatory pain (target of NIDA study) JWH analogs target both receptors Huffman: “JWH is easiest to make outside of a lab only need two commercial products” Transferring to plant material only requires using acetone

19. Any Dangers Involved in Spice/K2 Use? Yes. Until a drug is tested, it cannot be considered safe. Not only have synthetic cannabinoids not been tested, nearly all were created for experimental use in animals and cell cultures, not tested for use in humans. JWH-018 inventor John W. Huffman, PhD, puts it bluntly: "It is like Russian roulette to use these drugs. We don't know a darn thing about them for real." These synthetic cannabinoids have been associated with impaired driving incidents, attempted suicides, and emergency department visits, and have been linked to such adverse effects as increased anxiety, panic attacks, heart palpitations, respiratory complications, aggression, mood swings, altered perception, and paranoia.

20. Dangers Involved in K2 • Recent reports (Jan 2013) of kidney failure • Reports of cardiac events such as heart attack in young male users • 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.

21. Teens & K2 Effects in ER • One 16-year-old girl was catatonic, unable to speak or respond to any touch, when she arrived in the emergency room. A urine drug test showed she had cannabinoids in her system. • Another teen, a 16-year-old boy, had problems with movement and trouble with his speech. Although he was alert, he seemed confused, and could only answer simple questions. • And an 18-year-old boy was brought to the emergency room agitated and excessively sweating. He was restless, aggressive and uncooperative.

22. 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

23. K2 Data American Association of Poison Control Centers Reported in article June 2012 Year 2010 #2, 906 Year 2011 #6,959 Year 2012 #5,205

24. Spice is typically smoked like marijuana

25. 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

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

27. On Line Reported K2 Effects Marijuana-like effects Euphoria Giddiness Silliness Impaired short-term memory and concentration Increased appetite

28. K2 Products

30. Scooby Snacks: K2

38. What Are Spice Users Saying? But when I smoked this sonic boom stuff, I was completely high. I was trippin’ for over an hour. It’s insane but fun. I got to the point where my vision kept zooming in and out. But I do not recommend this drug if you are a first time smoker or you don’t like weed. This stuff gives you an intense head high, thus starting to trip and having hallucinations. This is very similar to the marijuana high but just a bit stronger. The only bad thing about this is that it is very bad for you because it’s an incense. Source: Various Blog Sites

39. What Are Spice Users Saying? Spice is nowhere near as dangerous as some people say it is. Sure it’s in no way good for you and it would kill you from the carcinogens eventually but that’s about it. If you’re responsible and just smoke a little every now and again you’re not going to die and you’re definitely not going to get addicted. I have literally taken a drug test the day after smoking it and passed no problem. Source: Various Blog Sites

40. 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.

41. Unrest & Agitation Anxiety & Panic Attacks Tremors Heart Palpitations Nausea Vomiting Sweating Nightmares Cravings Depression Spice Withdrawal

42. 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 • Unpredictable

43. 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

44. 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 http://www.redwoodtoxicology.com/services/synthetic_cannabinoid_testing.html

45. When Done Right, Drug Testing Works! Traditional lab-based drug testing methods work at detecting synthetic marijuana, including: Urine Oral fluid However, the lab will not conduct a traditional test for THC… it’s a different test to detect chemical structure of synthetic marijuana… but it can be detected with lab-based oral fluid and urine. So far, no evidence that instant urine testing devices, including products marketed as “home” drug test kits, work at detecting synthetic marijuana.

46. Then Came Oral Fluid Testing… Well, it’s not urine Easy to administer internally Virtually impossible to adulterate Legal in most jurisdictions Legally defensible Rapidly increasing in popularity

47. Oral Fluid Testing… Drugs are detected immediately after use “Under the influence” indicator Less invasive collection process Comparable to blood Science continues to progress and get better Flexible… sample can be collected any time, anywhere There are FDA cleared oral fluid collection and testing products (for laboratory based testing) Source: Myths & Facts About Oral Fluid Drug Testing, On File OraSure Technologies, 3/2011

48. Cheating Urine tests are susceptible to drug test cheating Oral fluid is very difficult to adulterate Collection takes place in the presence of both the donor and the administrator of the test Typical cheating methods such as switching samples or adding something to a sample are virtually impossible to successfully pull off A search of the Internet will find thousands of hits for cheating on a urine drug test… only a handful for oral fluid testing

49. Cheating A good website for oral fluid drug test cheating is wikihow.com/pass-a-drug-test. Quoting directly from the website: “Try to avoid the test. If one is being tested and has used in the past 3 days you will need to overcome the saliva collection. To do this you will have to avoid submitting saliva and perform the steps requested of you by the instructor.” Another offers this advice: “To pass this [an oral fluid test] you should always know the detection time of the drug you have taken. Marijuana can be detected via saliva drug testing from an hour after ingestion up to 24 hours depending on use. Between these periods of time, you must avoid being screened or you will surely test positive.”

50. Dignity No urine, no bathroom… no humiliating observed collections, no gender match-up issues, no threats of drug test cheating Donor and administrator observe the collection together Specimen never leaves the donor’s sight Embarrassing shy bladder issues are eliminated There’s virtually no way to cheat The testing process protects the dignity and privacy of the donor.