Current%20Trends%20K2/Spice,%20

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Current Trends K2/Spice, Bath Salts Others

• Ken Dickinson, M.S., R.Ph.
• 610-291-3109
• kdickinson_at_gaudenzia.org

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Introductions

• Presenters
• Rodney Ken
• Attendees
• Experience with Bath Salts and K2/Spice
• Expectations or goals for this workshop

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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

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Designer Drugs Background

• Trend started in late 1970s
• 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

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Mephedrone Methamphetamine
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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.
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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.

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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

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Designer Drugs

• Todays 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

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Web Sites

• www.erowid.org
• www.lycaeum.org
• www.hightimes.com
• http//en.wikipedia.org/wiki/Synthetic_cannabis
• www.k2info.org

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K2 Products
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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

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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.

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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)

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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

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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

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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

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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

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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
  bodys-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 bodys immune system.

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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.

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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
  CONSUMPTION  Must be 18 to purchase

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HU-211 and HU-2101
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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 ?9-THC which binds with
  almost equal affinity to CB1 and CB2 receptors
• Behavioral pharmacology studies show that JWH-018
  and JWH-073 both have ?9-THC-like activity in
  animals

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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

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K2 Study (contd)

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

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K2 Study (contd)

• 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

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K2 Study (contd)

• Field Sobriety Tests
• 3 to 4 inches of sway, leg body tremors
• Loss of balance
• Loss of motor coordination

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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

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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

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On Line Reported K2 Effects

• Self mutilation
• Paranoia
• Auditory visual hallucinations
• Delirium
• Agitation

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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

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K2 Products
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K2 Products
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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

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How Diagnosis is Made

• Usually access system via behavioral crisis
• Criminal Justice system
• Crisis Centers, ERs Psychiatric Hospitals
• ERs are seeing and identifying more due to acute
  intoxication
• Toxicology testing continues to improve

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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

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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

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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.

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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

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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

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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

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Withdrawal Case StudyContd

• Began using again
• When wanted to stop checked into hospital
• Experienced classic withdrawal that lasted 7 days

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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

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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 JWHs
• http//www.redwoodtoxicology.com/documents/service
  s/3369_sc_sellsheet.pdf

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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

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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

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Mitragyna Speciosa

• Used in
• Malaysia
• Thailand
• Indonesia
• Local names
• Ithang
• Biak Biak
• Ketum
• Kakuam

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Kratom Pharmacology

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

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Kratom Opioid Treatment

• Currently used for heroin and methadone
  dependence in some countries
• New Zealand
• Thailand
• Used in detox to manage withdrawal symptoms from
  opioids

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Kratom

• Seems to be a stimulant in lower doses
• Mitragynine
• Seems to be sedative in higher doses
• 7 hydroxymitragynine
• Often produces a mixed effect
• Onset 5 t o 10 minutes
• Duration several hours

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Kratom Side Effects

• Short term (immediate)
• Dry mouth
• Increased or decrease urination
• Loss of appetite
• Nausea and/or vomiting
• Side effects
• Anorexia/weight loss
• Depression
• Addiction

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Mephedrone(4-Methylmethcathinone)
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Bath Salts

• Toxic psychoactive drugs disguised or
  pretending to be Bath Salts
• They are NOT
• Some people have snorted real BSs

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Bath Salts Are
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What are Synthetic Cathinones?

• Synthetic cathinones are related to the parent
  compound cathinone.
• Since the mid-2000s, unregulated ring-substituted
  cathinone derivatives have appeared in the
  European and American recreational drugs market.

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What are Synthetic Cathinones?

• The most commonly available synthetic cathinones
  sold on the recreational market in the period up
  to 2012 appear to be 3, 4-Methylenedioxypyrovalero
  ne (MDPV), mephedrone, and methylone.
• These products are usually encountered as highly
  pure white or brown powders. Cathinone
  derivatives are claimed to have effects similar
  to those of cocaine, amphetamine or MDMA
  (ecstasy), but little is known of their detailed
  pharmacology.

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Khat

• Native to tropical East Africa and the Arabian
  Peninsula
• Fresh Leaves/tops chewed or consumed as tea
• Stimulation and euphoria
• Part of social culture in many countires (coffee,
  tea, coca or khat)

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Khat

• Coca ---------------cocaine
• Khat ----------------cathinone (Schedule I)
• Cathinones Structure similar to amphetamines
• Euphoria
• Anorexia
• Stimulation
• Dilated pupils
• Hypnagogic hallucinations when wearing off

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Mephedrone Background

• Discovered 1929
• Rediscovered 2003 web site The Hive
• Was a replacement for Ecstasy
• Sold as plant food later bath salts
• Manufactured in clandestine labs
• Methylenedioxypyrpvalerone (MDPV)
• Known as substituted cathinones

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MDPV Timeline

• MDPV was developed in the 1960s, and has been
  used for the treatment of chronic fatigue, but
  caused problems of abuse and dependence.
• 1969 Boehringer Ingelheim files a patent
  application for MDPV.
• 2005 MDPV appears as a recreational drug first
  mention on Drugs-Forum.
• 2007 First seizure of MDPV as a recreational
  drug, by customs officials in the German state of
  Saxony. The drug had been shipped from China.
• 2008 First seizure of MDPV in the United States.
  

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MDPV Timeline

• 2009 MDPV made illegal in Denmark.
• 2010 MDPV made a controlled drug in the UK,
  Sweden, Germany, Australia and Finland. First
  reports of the widespread retail marketing of
  'bath salts' containing MDPV in the US. The US
  considers both Mephedrone (July, 2010) and MDPV
  (December, 2010) "a drug and chemical of
  concern".
• 2011 2012 MDPV sale and possession are banned
  in most US states with legislation being
  introduced in Maryland an other states.

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Mephedrone/MDPV Appearance

• Distinctive odor
• Fishy
• Vanilla
• Stale urine
• Bleach
• Circuit boards

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Mephedrone MDPV Use

• Capsules, tablets or white granuels
• Can be swallowed, smoked, snorted, injected
• Prominent use in Europe
• Out of 70 Dutch users of mephedrone, 58 described
  it as an overall pleasant experience and 12
  described it as an unpleasant experience

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Mephedrone/MDPV Effects

• Duration
• Total 2 5 hours
• Onset 15-45 minutes
• Coming up 15 30 minutes
• Plateau 15 30 minutes
• Coming down 30 90 minutes
• After effects 2 4 hours

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Mephedrone/MDPV Desired Effects

• Mental and physical stimulation
• Euphoria, mood lift
• Feelings of empathy, openness
• Increase in sociability, desire to talk with
  others
• Pleasurable rushing
• Sense of being sped up

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Mephedrone/MDPV General Effects

• General change in consciousness (as with most
  psychoactives)
• Decreased appetite
• Pupil dilation
• Unusual body sensations (facial flushing, chills,
  goosebumps, body energy)
• Change in body temperature regulation
• Sweating
• Increase in heart rate and blood pressure

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Mephedrone/MDPV Toxic Effects

• Strong desire to re-dose, craving to recapture
  initial euphoric rush
• Uncomfortable changes in body temperature
  (sweating/chills)
• Heart palpitations, sense of racing heart
• Impaired short term memory
• Insomnia

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Mephedrone/MDPV Toxic Effects

• Severe paranoia
• Psychosis
• Hypersexuality
• Aggression
• Hallucinations
• Anxiety and depression
• Seizures

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PA Criminal Intelligence Center

• February 2011, Schuylkill County PSP, Schuylkill
  Haven members were attempting to serve a mental
  health warrant and noticed the subject was
  fidgety and talking very fast.
• The subject admitted to taking methamphetamine
  earlier in the day and snorting two lines of
  TranQuility bath salts approximately three hours
  prior to PSP arrival.
• The subject related he felt no pain, was
  invincible, and likened the effects to that of a
  cocaine overdose. He was unable to perform any
  field sobriety tests

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PA Criminal Intelligence Center

• February 2011, Lebanon County PSP, Jonestown
  members responded to a burglary where a subject
  broke a window and jumped through a glass door.
• After he was confronted by the occupant, the
  subject ran outside and kicked in a garage door.
• While being interviewed by troopers, he jumped
  onto the hood of the patrol car, rolled off, and
  went into a fetal position. The subject was
  incoherent, claimed he was being electrocuted,
  and was eventually transported to the hospital.

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Another PA Story

• March 2011, two Pennsylvania men were found dead
  in the woods after missing for two weeks.
  Toxicology reports indicate that they had taken
  bath salts prior to their deaths. The bath salts
  probably led to their disorientation and they
  died from exposure and hypothermia.

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More Bath Salts Tragedy

• January 2011, a 48 year old Florida woman was
  jailed after shed attacked and attempted to
  behead her 710 Y.O. mother with a machete. The
  woman was high on bath salts she purchased from a
  local head shop
• Remember they are
• Potent
• Lethal
• Highly addictive

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One More Story

• November 2010-a 21 year old Louisiana man snorts
  a packet of Cloud 9 Bath salts and endures
  several days of delirium and paranoia. He cuts
  his own throat with a kitchen knife only to
  survive and then shoots himself later when he had
  visions of army soldiers swarming his house.

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Bath Salt Data

• American Association of Poison Control Centers
  of calls
• June 9, 2012 report
• Year 2010 304
• Year 2011 6,138
• Year 2012 to May 31 1,320

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Berks PA County Head Shop Bust
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Same Head Shop
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Mephedrone/MDPV Treatment Issues

• Similar to strong amphetamine addiction
• Similar to PCP abuse/addiction
• Stabilization and Safety highest priority
• Safety of client
• Safety of staff and others

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Mephedrone/MDPV Treatment Issues

• If psychotic or dissociated need to medicate
• Neuroleptics
• Haldol for emergency stabilization
• Atypicals (Seroquel/Respirdol/etc.) for ongoing
  stabilization
• Decease sensory exposure
• Rock or Rave medicine
• Talking down bad trips
• De-escalation techniques

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Excited Delirium

• Delirium Defined
• Acute change in mental status characterized by
  impairment of attention.
• Excited Delirium Defined
• Delirium with continuous agitation

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Excited Delirium

• Diagnostic Criteria for Delirium
• Disturbance of consciousness with reduced ability
  to focus, sustain, or shift attention.
• A change in cognition such as memory deficit,
  disorientation, language disturbance
• The disturbance develops over a short period of
  time (usually hours to days) and tends to
  fluctuate.

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ED Research Findings

• Excited Delirium often involved psycho-stimulant
  drugs
• Amphetamines
• amphetamine derivatives
• Cocaine
• Sometimes even the lack of having taken certain
  prescription drugs could cause a similar response
  behavior
• i.e. lithium in the case of manic depressants

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ED Research Findings

• Psycho-stimulant drugs can produce a number of
  potentially lethal effects
• Psycho-stimulant overdoses can cause
• cardiovascular compromise
• Seizures
• hyperthermia.

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Mephedrone MDPV Treatment Issues

• Once stable and safe be aware of cognitive
  impairment
• May need tincture of time to grasp recovery
• Supportive non threatening environment
• Screen for COD (high probability)

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Bath Salts Overview

• They are sold mostly on the internet, but can
  also be found in select shops locally.
• They're known by a variety of names, including
  Red Dove, Blue Silk, Zoom, Bloom, Cloud
  Nine, Ocean Snow, Lunar Wave, Vanilla Sky,
  Ivory Wave, White Lightning, Scarface
  Purple Wave, Blizzard, Star Dust, Lovey,
  Dovey, Snow Leopard, Aura, and Hurricane
  Charlie.
• While they have become popular under the guise of
  selling as bath salts, they are sometimes sold
  as other products such as insect repellant, or
  plant food with names like Bonsai Grow among
  others.

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Effects of MDPV

• MDPV is sometimes labeled online as legal cocaine
  or legal amphetamines.
• The effects have a duration of roughly 3 to 4
  hours, with after effects such as tachycardia,
  hypertension, and mild stimulation lasting from 6
  to 8 hours.
• High doses have been observed to cause intense,
  prolonged panic attacks in stimulant-intolerant
  users, and there are anecdotal reports of
  psychosis from sleep withdrawal and addiction at
  higher doses or more frequent dosing intervals.

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Synthetic Cathinones Effects Summary Sheet

• Aggression
• Agitation
• Breathing difficulty
• Bruxism (grinding teeth)
• Confusion
• Dizziness
• Extreme anxiety sometimes progressing to violent
  behavior
• Fits and delusions
• Hallucinations
• Headache

• Hypertension (high blood pressure)
• Increased alertness/awareness
• Increased body temperature, chills, sweating
• Insomnia
• Kidney pain
• Lack of appetite
• Liver failure
• Loss of bowel control
• Muscle spasms
• Muscle tenseness
• Vasoconstriction (narrowing of the blood vessels)
  

• Nausea, stomach cramps, and digestive problems
• Nosebleeds
• Psychotic delusions
• Pupil dilation
• Renal failure
• Rhabdomyolysis (release of muscle fiber contents
  myoglobin that could lead to kidney problems)
• Severe paranoia
• Suicidal thoughts
• Tachycardia (rapid heartbeat)
• Tinnitus

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Dangers/Legal Issues

• Dr. Volkow, the NIDA Director stated Because
  these products are relatively new to the drug
  abuse scene, our knowledge about their precise
  chemical composition and short- and long-term
  effects is limited.
• In February, 2011, Congressman Charles Schumer
  (D-NY) introduced legislation that would add bath
  salts to a list of federally controlled
  substances. September 7, 2011, finally saw this
  legislation in the form of a proposed temporary
  DEA ban.

93
Federal Ban Proposed on 09/7/2011

• The United States Drug Enforcement Administration
  (DEA) is using its emergency scheduling authority
  to temporarily control three synthetic cathinones
  (Mephedrone, 3,4 methylenedioxypyrovalerone
  (MDPV) and Methylone).
• Except as authorized by law, this action will
  make possessing and selling these chemicals or
  the products that contain them illegal in the
  U.S. for at least one year while the DEA and the
  United States Department of Health and Human
  Services (DHHS) further study whether these
  chemicals should be permanently controlled.

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Synthetic Drug Abuse Prevention Act of 2012

• July 10, 2012 President signed Law making
  temporary law permanent
• October 1, 2012 Synthetic Drugs now listed as
  Schedule I
• All substituted cathinones now Schedule I
• Chemists working on making non-cathinone
  stimulants
• http//www.ncsl.org/issues-research/justice/synt
  hetic-drug-threats.aspx

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National vs. State-by-State Bans

• Just because a federal ban is enacted on a drug,
  it does not mean local authorities will take
  action on this drug.
• States still need to enact legislation to ban the
  substances in order for state (then local)
  authorities to take action.
• Federal bans will go after larger distributors,
  but it will be locally determined as to whether
  users and smaller, local distributors (such as
  non-chain convenience stores and gas stations)
  will be sought after without a state ban.

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Prevention For K2 Bath Salts

• Heighten awareness via Education
• Schools, parent groups, community groups, law
  enforcement, medical treatment, etc.
• Legislation against precursor chemicals
• Legislation making drugs Schedule I
• Patrick Meehan Synthetic Drug Control Act
• Goes into effect October 1 2012!!!
• Hit the retailers in their pocket book
• Civil suits by victims (users and families)
• Authorities appealing to retailers with amnesty
  if stop and destroy

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Urine Detection Information

• Redwood Toxicology Laboratory shows currently
  they have detection for MDPV and Mephedrone. (see
  w.K2info.org/drugtesting)
• June 11, 2012 Redwood expanded to test for 21
  designer stimulants
• http//www.redwoodtoxicology.com/services/designer
  _stimulant_testing.html
• Atlantic Labs- Bensalem, PA Bath Salts 20.00 and
  K2 15.00.
• Most labs now testing
• Check with your lab

98
Urine Detection Information(Expanded to 21 June
2012)

• Redwood has a 2 panel drug test (MDPV,
  Mephedrone) and a 14 panel drug test which tests
  for the following drugs
• BZP (Benzylpiperazine)
• Butylone (ß-keto-N-methylbenzodioxolylpropylamine,
  bk-MBDB)
• Cathinone (Khat or Benzoylethanamine)
• Ethylone (3,4-methylenedioxy-N-ethylcathinone,
  MDEC, bk-MDEA)
• MBDB (Methylbenzodioxolylbutanamine, Methyl-J,
  Eden)
• mCPP (meta-Chlorophenylpiperazine)
• MDA (3,4-Methylenedioxyamphetamine,
  tenamfetamine)
• MDEA (3,4-Methylenedioxy-N-ethylamphetamine,
  MDEA, MDE, Eve)
• MDPV (Methylenedioxypyrovalerone, Cloud 9, Ivory
  Wave, White Lightning)
• MDMA (3,4-Methylenedioxymethamphetamine, ecstasy,
  E, X)
• Mephedrone (4-methylmethcathinone 4-MMC,
  4-methylephedrone, Meph, MCat)
• Methcathinone (a-methylamino-propiophenone, may
  be confused with mephedrone)
• Methylone (3,4-methylenedioxy-N-methylcathinone,
  bk-MDMA, MDMC, M1)
• TFMPP (3-Trifluoromethylphenylpiperazine, Legal
  X)

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On-Site Testing

• Many labs now have available
• On site may be useful in treatment
• Problem labs report as high as 35-40 false
  negatives with on-site
• On-site shows no use but when testing for
  accuracy they send to lab for confirm and up to
  40 tested positive.

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You May Ask Whats Next?

• Krokodil?
• In Russia and Europe
• 2C-1 or Smiles
• Yahoo reports 09/19/2012
• Kratom
• Here today in Maryland Mid-Atlantic States
• Marketed as Natural substitute for K2 K3

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Krokodil

• Opioid- desomorphine
• Result of attempt to extract codeine
• Injected can be used by other routes
• Russia spreading through Europe
• Tissue breakdown
• Highly addicting- Usually fatal

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Points to Ponder

• WHAT
• Did I learn so far?
• What do I think about it?
• How do I feel about it?
• So WHAT
• Does this information mean to me professionally
  and personally?????

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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
• Prevention and treatment issues