Current Trends K2/Spice, “Bath Salts” & Others - PowerPoint Presentation

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Current Trends K2/Spice, “Bath Salts” & Others

Ken Dickinson, M.S., R.Ph.610-291-3109kdickinson@gaudenzia.orgSlide2

Introductions

Presenters: Rodney & KenAttendeesExperience with “Bath Salts” and K2/SpiceExpectations or goals for this workshopSlide3

Objectives

History and background of “new synthetic designer drugs”Epidemiology and current trendsEffects and dangers of these drugsHow sold, what they look like and how used Legal, prevention and treatment issuesSlide4
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Designer Drugs: Background

Trend started in late 1970’sDrugs of abuse are classified by DEADrugs of abuse work according to structureAnalogsCan “design” an analog to have same or similar activity but not listed as a “controlled substance”Not subject to legal penalties and restrictionsSlide6

Mephedrone & MethamphetamineSlide7

Federal Drug Schedules

Federal Controlled Substances Act (CSA) of 1970Schedule 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.Slide8

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.Slide9

Designer Drugs: Evolution

Internationally do not have such lawsBeing manufactured in other countriesMany “designer drugs” do not test (+)A way to “Beat the Bladder Police”Slide10

Designer Drugs

Today’s trendMake an analog that is not listed in lawsSince 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 outletsSlide11

Web Sites

www.erowid.orgwww.lycaeum.orgwww.hightimes.comhttp://en.wikipedia.org/wiki/Synthetic_cannabiswww.k2info.orgSlide12

K2 ProductsSlide13

Herbal Incense

Crushed non-psychoactive herbal plant matter treated with one or more synthetic cannabinoidsFirst generation: “K2”, “Spice”, “Black Mamba”Second generation “K3”, “Splice”, “Apocalypse”, “Cloud 10”, “Destiny”Slide14

Synthetic Marijuana (JWH- 018)

Known as Spice or K2K2 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 marijuanaK2 is largely created by individual sellers, it's anyone's guess what else is added to the mix. Slide15

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 itNow do but extra expense and only some labsSmokable herbal blends marketed as "legal highs" have become increasingly popular and as easy to buy as cigarettes. (before 03.01.11)Slide16

K2 Spice

K2 contains synthetic chemicals, known as JWH-018 and JWH-073, that mimic THC by acting on the cannabinoid receptors in the brainOther analogs detectedHU-210AM-2201CP-47, CP-497, C6, C8, C9Slide17

K2 Data

American Association of Poison Control CentersReported in article June 2012 Year 2010 #2, 906Year 2011 #6,959Year 2012 up to May 31 #2,883Slide18

Mixture of herbal and spice plant productsLeaf can be: marshmallow leaf, parsley, etc.

Sprayed with synthetic cannabinoidsMarketed as incense and “not for human consumption”No regulations to list ingredients or age requirements to purchase

Description of the DrugSlide19

Alarming Fact

Tests show that even the same brand may have different drugs– in different amounts-at different timesUser has no way of knowing what or how much they are takingSlide20

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 body’s-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 body’s immune system.Slide21

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.Slide22

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 purchaseSlide23

HU-211 and HU-2101Slide24

JWH-073 and JWH-0181

JWH-018 and JWH-073JWH-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 Δ9-THC

which binds with almost equal affinity to CB1 and CB2 receptors

Behavioral pharmacology studies show that JWH-018 and JWH-073 both have Δ9-THC-like activity in animalsSlide25

Missouri K2 Administration Study

Bob Welsh- PIIRB Human subjects approvalSix subjects smoked K2 SummitEach contained JWH-018 & JWH-073 or CP47, 497Subjects performed Standardized Field Sobriety Tests, cognitive tests & Drug Recognition Expert Exam

Blood, urine and oral fluid collectedSlide26

K2 Study (cont’d)

Onset of effects in about 2-3 minutesDry mouthLight headednessBlurred visionAgitation, Motor restlessnessTime dilation (?)Theory in physics, time travelSlide27

K2 Study (cont’d)

Drug Recognition Expert ExamIncreased pulse and blood pressureLack of convergenceMovement of the two eyes so coordinated that the images of a single point fall on corresponding points of the two retinasNo horizontal or vertical gaze nystagmusPupils normal, muscle tone normalSlide28

K2 Study (cont’d)

Field Sobriety Tests3 to 4 inches of sway, leg body tremorsLoss of balanceLoss of motor coordinationSlide29

Missouri Study Self Reported K2 Effects

TachycardiaDry MouthFelt Impaired, subjective thought disruptionChanges in perceptionImpaired sense of timeMild anxiety, paranoia

Sedation & Post-intoxication exhaustionSlide30

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 attackSlide31

On Line Reported K2 Effects

Self mutilationParanoiaAuditory & visual hallucinationsDeliriumAgitationSlide32

On Line Reported K2 Effects

Marijuana-like effectsEuphoriaGiddinessSillinessImpaired short-term memory and concentrationIncreased appetite“Most angiogenic substance I ever ingested”Slide33

K2 ProductsSlide34

K2 ProductsSlide35

How Diagnosis is Made

Mainly supported by clinical history rather than presentation or mental status examDuration of intoxication or “high” is relatively short (30 min. or less)Do not typically present acutely intoxicated to an outpatient visitUnlike marijuana do not have a typical or signature smellSlide36

How Diagnosis is Made

Usually access “system” via behavioral crisisCriminal Justice systemCrisis Centers, ER’s & Psychiatric HospitalsER’s are seeing and identifying more due to acute intoxicationToxicology testing continues to improveSlide37

User Report #1

This is the worst experience I have ever hadThe most angiogenic substance I have ever usedNausea, vomiting, heart pounding like I am going to have a heart attackNot sure if I just said that, thought it, or read itTwo hours later will never take this againSlide38

User Report #2

Three individual hits from a small pipeOrganic, no chemical odor or tasteFive minutes feels like cannabisTen minutes like an intense cannabis highMore than three puffs might be too muchSlide39

Why the Discrepancy in Reports?

Use of other drugs with incenseVarying potencyOverdosePresence of different cannabinoidsKnock-offsUser/environment characteristicsSet & setting, etc.Slide40

K2 Overview

No quality controlManufacturing process may be associated with adverse effectsSubjective effects most closely resemble those of very powerful marijuanaAlmost complete lack of scientific studyStreet information very inconsistentSlide41

K2 Treatment Issues

High rates of addiction (K2info.org)Withdrawal due to physical addictionTreated with sedatives and clonidineBefore D/A treatment need to be medically and psychiatrically safe and stableResidual effects for weeks (or months) due to long half-life & fat storageSlide42

Withdrawal Case StudyWebMD

German male 20 y.o. used Spice Gold daily for 8 monthsDue to tolerance increased dose 10 foldFelt need to continue use dailyWhen unable to get drug experienced:Unrest, drug craving, nightmares, sweating, nausea, tremor, headache, high BP, tachycardiaSlide43

Withdrawal Case StudyCont’d

Began using again When wanted to stop checked into hospitalExperienced classic withdrawal that lasted 7 daysSlide44

K2 Harm Reduction Tips

Not all incense blends are created equal. JWH-018 is more expensive than real potHerbal incense blends are harshJWH-018 does not mix well with alcoholThe high last no more than 30 minutesSlide45

K2 Testing

Many labs have a test for the first generation JWH chemicalsIn February 2010, Redwood Labs, California developed a saliva test for JWH-018, JWH-073 and JWH-250Saliva and urine tests recently developed for second generation JWH’s http://www.redwoodtoxicology.com/documents/services/3369_sc_sellsheet.pdfSlide46

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 longerSlide47

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 AdministrationMaryland no enactment yet for K2 as of Sept 25, 2012Local bans such as Ocean CityJuly 21, 2012 Bath Salts now Schedule I in Maryland Slide48
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Mitragyna Speciosa

Used in:MalaysiaThailandIndonesiaLocal names:Ithang

Biak Biak

Ketum

KakuamSlide50

Kratom Pharmacology

MitragynineStructurally similar to some hallucinogensNo hallucinogenic activity or effectsActs on opioid receptorsSlide51
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Kratom & Opioid Treatment

Currently used for heroin and methadone dependence in some countriesNew ZealandThailandUsed in detox to manage withdrawal symptoms from opioidsSlide53
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Kratom

Seems to be a stimulant in lower dosesMitragynineSeems to be sedative in higher doses7 hydroxymitragynineOften produces a mixed effectOnset 5 t o 10 minutesDuration several hoursSlide55

Kratom Side Effects

Short term (immediate)Dry mouthIncreased or decrease urinationLoss of appetiteNausea and/or vomitingSide effects

Anorexia/weight loss

Depression

AddictionSlide56
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Mephedrone(4-Methylmethcathinone)Slide58

Bath Salts

Toxic psychoactive drugs “disguised” or “pretending” to be “Bath Salts”They are NOTSome people have snorted real BS’sSlide59

“Bath Salts” AreSlide60

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. Slide61

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-Methylenedioxypyrovalerone (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.Slide62

Khat

Native to tropical East Africa and the Arabian PeninsulaFresh Leaves/tops chewed or consumed as teaStimulation and euphoriaPart of social culture in many countires (coffee, tea, coca or khat)Slide63

Khat

Coca ---------------cocaineKhat ----------------cathinone (Schedule I)Cathinones: Structure similar to amphetaminesEuphoriaAnorexiaStimulationDilated pupilsHypnagogic hallucinations when wearing offSlide64

Mephedrone Background

Discovered 1929Rediscovered 2003 web site “The Hive”Was a replacement for EcstasySold as “plant food” & later “bath salts”Manufactured in clandestine labsMethylenedioxypyrpvalerone (MDPV)Known as substituted cathinonesSlide65

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 odorFishyVanillaStale urineBleachCircuit boardsSlide68

Mephedrone & MDPV Use

Capsules, tablets or white granuelsCan be swallowed, smoked, snorted, injectedProminent use in EuropeOut of 70 Dutch users of mephedrone, 58 described it as an overall pleasant experience and 12 described it as an unpleasant experienceSlide69

Mephedrone/MDPV Effects

DurationTotal 2 – 5 hoursOnset 15-45 minutesComing up 15 – 30 minutesPlateau 15 – 30 minutesComing down 30 – 90 minutesAfter effects 2 – 4 hoursSlide70

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 Slide71

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 Slide72

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 Slide73

Mephedrone/MDPV Toxic Effects

Severe paranoiaPsychosisHypersexualityAggressionHallucinationsAnxiety and depressionSeizuresSlide74

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 testsSlide75

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.Slide76

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.Slide77

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 shopRemember they are:PotentLethalHighly addictiveSlide78

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.Slide79

Bath Salt Data

American Association of Poison Control Centers # of callsJune 9, 2012 reportYear 2010 #304Year 2011 #6,138Year 2012 to May 31 #1,320Slide80

Berks PA County Head Shop BustSlide81

Same Head ShopSlide82

Mephedrone/MDPV Treatment Issues

Similar to strong amphetamine addictionSimilar to PCP abuse/addictionStabilization and Safety highest prioritySafety of clientSafety of staff and othersSlide83

Mephedrone/MDPV Treatment Issues

If psychotic or dissociated need to medicateNeuroleptics: Haldol for emergency stabilizationAtypicals (Seroquel/Respirdol/etc.) for ongoing stabilizationDecease sensory exposure

“Rock or Rave” medicine

Talking down bad trips

De-escalation techniquesSlide84

Excited Delirium

Delirium Defined:Acute change in mental status characterized by impairment of attention.Excited Delirium Defined:Delirium with continuous agitationSlide85

Excited Delirium

Diagnostic Criteria for DeliriumDisturbance of consciousness with reduced ability to focus, sustain, or shift attention.A change in cognition such as memory deficit, disorientation, language disturbanceThe disturbance develops over a short period of time (usually hours to days) and tends to fluctuate.Slide86

ED: Research Findings

Excited Delirium often involved psycho-stimulant drugsAmphetaminesamphetamine derivativesCocaineSometimes even the lack of having taken certain prescription drugs could cause a similar response behavior

i.e. lithium in the case of manic depressantsSlide87

ED: Research Findings

Psycho-stimulant drugs can produce a number of potentially lethal effectsPsycho-stimulant overdoses can cause cardiovascular compromiseSeizureshyperthermia.Slide88

Mephedrone & MDPV Treatment Issues

Once stable and safe be aware of cognitive impairmentMay need “tincture of time” to grasp recoverySupportive non threatening environmentScreen for COD (high probability)Slide89

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.Slide90

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.Slide91

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 Slide92

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.Slide93

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. Slide94

Synthetic Drug Abuse Prevention Act of 2012

July 10, 2012 President signed Law making temporary law permanentOctober 1, 2012 Synthetic Drugs now listed as Schedule IAll substituted cathinones now Schedule IChemists working on making non-cathinone stimulants

http://www.ncsl.org/issues-research/justice/synthetic-drug-threats.aspxSlide95

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 EducationSchools, parent groups, community groups, law enforcement, medical & treatment, etc. Legislation against precursor chemicalsLegislation making drugs Schedule IPatrick 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 destroySlide97

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 stimulantshttp://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 labSlide98

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

(

β-

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

(α-methylamino-propiophenone, may be confused with mephedrone)

Methylone

(3,4-methylenedioxy-N-methylcathinone, bk-MDMA, MDMC, “M1”)

TFMPP

(3-Trifluoromethylphenylpiperazine, “Legal X”)Slide99

On-Site Testing

Many labs now have availableOn site may be useful in treatmentProblem: labs report as high as 35-40% false negatives with on-siteOn-site shows no use but when testing for accuracy they send to lab for confirm and up to 40% tested positive.Slide100

You May Ask What’s Next?

Krokodil?In Russia and Europe2C-1 or “Smiles”Yahoo reports 09/19/2012KratomHere today in Maryland & Mid-Atlantic StatesMarketed as “Natural” substitute for K2 & K3Slide101

Krokodil

Opioid- desomorphineResult of attempt to extract codeine Injected can be used by other routesRussia & spreading through EuropeTissue breakdownHighly addicting- Usually fatal Slide102
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Points to Ponder

WHATDid I learn so far? What do I think about it?How do I feel about it?So WHATDoes this information mean to me professionally and personally?????Slide106

Objectives

History and background of “new synthetic designer drugs”Epidemiology and current trendsEffects and dangers of these drugsHow sold, what they look like and how used Prevention and treatment issues