Designer Drugs (Synthetics): drugs, which are created (or reformulated, if the drug already existed) to get around existing drug laws CSA (controlled substance act), usually by modifying the molecular structures of existing drugs to varying degrees Sources of Incense Products: internet/on-line sources headshops/alternative medicine stores / convenience stores/flea markets 1-(800) phone ordering services individual distributors Preparation of the incense: Botanical plants/herbs are sprayed with liquid preparations of: HU-210 HU-211 CP 47,497 JWH-018 JWH-073 JWH-250 JWH-081 JWH-210 XLR-11, UR-144 And many more Origins of Synthetic Cannabinoids CP 47,497 - developed by Pfizer in 1980 as an analgesic (pain reliever) HU-210 & HU-211 - synthesized at Hebrew University , Israel in 1988. HU-210 is an anti- inflammatory; HU-211 as an anesthetic JWH-018 & JWH-073 - synthesized by a researcher at Clemson (1995) for use in THC receptor research - John W. Huffman more than 200 different synthetic cannabinoids have been created How K2/Spice works: Synthetic Cannabinoids act as THC agonists -An agonist is a chemical that binds to a receptor and triggers a response – often mimicking the action of the naturally occurring substance. Receptor Drug (agonist) Why Change the Key? • prolong the effect of the drug • increase the potency of the drug • selectthe desired effect • avoid patent infringement • make the drug more difficult to detect • make an illegal drug legal
Transcript
Designer Drugs (Synthetics):
drugs, which are created (or reformulated, if the drug already existed) to get around existing drug laws CSA (controlled substance act), usually by modifying the molecular structures of existing drugs to varying degrees
Sources of Incense Products:
internet/on-line sources �head� shops/alternative medicine stores /
Botanical plants/herbs are sprayed with liquid preparations of: HU-210 HU-211 CP 47,497 JWH-018 JWH-073
JWH-250 JWH-081 JWH-210 XLR-11, UR-144 And many
more
Origins of Synthetic Cannabinoids CP 47,497 - developed by Pfizer in 1980 as an
analgesic (pain reliever) HU-210 & HU-211 - synthesized at Hebrew
University, Israel in 1988. HU-210 is an anti-inflammatory; HU-211 as an anesthetic
JWH-018 & JWH-073 - synthesized by a researcher at Clemson (1995) for use in THC receptor research - John W. Huffman
more than 200 different synthetic cannabinoids have been created
How K2/Spice works: Synthetic Cannabinoids act as THC agonists
-An agonist is a chemical that binds to a receptor and triggers a response – often mimicking the action of
the naturally occurring substance. Receptor
Drug (agonist)
Why Change the Key? • prolong the effect of the drug • increase the potency of the drug • �select� the desired effect • avoid patent infringement • make the drug more difficult to detect • make an illegal drug �legal�
Pharmacological Effects of Synthetic Cannabinoids are Similar to THC increase heart rate & blood pressure altered state of consciousness, mild euphoria relaxation, perceptual alterations (time distortion) intensification of sensory experiences pronounced cognitive effects impaired short-term memory reduction in motor skill acuity increase in reaction times kidney damage
Synthetic Marijuana Use Linked to Kidney Damage Such designer drugs, called Spice or K2, may have toxic additives, researchers say By Mary Elizabeth Dallas - Tuesday, February 12, 2013
(HealthDay News) -- Case studies analyzed by doctors from the University of Alabama at Birmingham found that this designer drug, which mimics the effects of marijuana, has been directly linked to serious kidney damage. The researchers suggested that doctors should suspect the use of synthetic marijuana when patients, particularly young adults, have unexplained acute kidney damage "Cases of acute coronary syndrome associated with synthetic marijuana use have been reported, but our publication is the first to associate use with acute kidney injury," study co-author Dr. Gaurav Jain, an assistant professor in the nephrology division, said in a university news release. Abnormally rapid heart rate and seizures have also been reported with synthetic marijuana use, he noted.
Reported Effects of Synthetic Cannabinoids are different to THC
production inconsistencies herbal incense blends are harsher to inhale effect on appetite is non-existent increased restlessness & aggressive behavior herbal incense produces a shorter �high� (perceptual
alterations & sensory effects are limited) doesn’t mix well with alcohol (hangovers) incense costs more than marijuana?
Cannabis (THC) vs. Cannabinoids (k2): Effects Seen in Clinical Cases Most symptoms are
SOURCES: Hermanns-Clausen et al . (In Press), Addiction; Rosenbaum et al . (2012). Journal of Medical Toxicology; Forrester et al. (2011). Journal of
Addictive Disease; Schneir et al . (2011). Journal of Emergency Medicine.
Public release date: 2-Oct-2013 American Chemical Society
Toward understanding the dangers of the fake marijuana called 'Spice' or 'K2’ The study, published in the ACS journal Analytical Chemistry, describes development of a method that could someday help physicians diagnose and treat the thousands of young adults and teens who end up in emergency rooms after taking the drugs. Jeffery Moran and colleagues note that synthetic marijuana, often marketed as "natural incense," "potpourri," Spice or K2, is a significant public health concern, and 1 in 9 high school seniors admit recent use. The substances produce a "high," but also can cause a wide range of dangerous side effects including seizures, hallucinations, severe kidney damage, psychotic behavior and heart attacks. To gain insight into the effects of designer marijuana products, Moran's team developed a new method and used it to study how the body processes two popular forms in Spice and K2, known as JWH-018 and AM2201. Urine samples from 15 people who tested positive for use showed significant differences in how the individuals' bodies processed the drugs. This finding could help explain why some people experience more severe effects from the drugs than others.
Drug Testing: Synthetic THC / K2 Rapid, onsite instant test (as of 3/1/12)
Laboratory-based screening test (limited) Most Laboratories are employing LC/MS/MS
technology Primarily via urine, however some labs can test via
oral fluid and blood $$$ varies greatly Onsite vs Lab is very different testing methodology
On-site vs Laboratory testing for K2
On-site K2
JWH-018 & JWH-073 primarily
Cut-off at 25 or 50ngs/ml Testing limited metabolites Much higher threshold to
trigger positive Screening technology
Laboratory K2
JWH-018, 073, plus *17 other synthetic cannabinoid structures
JWH-019, 081, 122, 200, 203, 210, 250, 398, AM2201, MAM2201, RCS4, RCS8, AM-694, AM-1248, AKB-48,UR-144, XLR-11 Cut-off 1ng/ml or less Testing for hydroxy acid & other
components/metabolites Detecting presence
Confirmatory technology
*Redwood Toxicology Laboratory
CESAR FAX U n i v e r s i t y o f M a r y l a n d , C o l l e g e P a r k
A Weekly FAX from the Center for Substance Abuse Research
• The majority of synthetic cannabinoid users reported that they used the drug to avoid positive drug tests, either because they were under community correctional supervisions, seeking employment, residing in a sober living facility, or joining the military. According to one user, �Spice would give you a weed like effect without the positive test�
• �Most of the users of Spice-type products in this study consumed these products as a substitute for marijuana during drug-testing periods, and returned to marijuana use once that period ended�. According to one user, �I was trying to get a job where they were going to drug test . . . so I got that stuff [Spice], and I liked it enough. I enjoyed it. I did it for a while . . . Then, my job search ended �cause I wasn’t going to do any of them. So I went back to the regular stuff�
• Nearly all the SC users learned of the drug from someone who was using SC to avoid detection on drug tests. For example, one user reported that he �was talking to some kids that went to a Christian school, and they get drug tested. So, all the kids there would smoke Spice instead of weed�
• All the SC users also used marijuana, and half had a history of drug problems, such as sobriety attempts, drug-related offending, and negative drug experiences.
July 8, 2013 Vol. 22, Issue 27
Synthetic Cannabinoid Users Report Using the Drug to Avoid Positive Drug Tests; Return to Marijuana Use When Not Being Tested
NOTE: Findings are from in-depth, semi-structured interviews with 25 Southern California adults who had used K2, mephedrone, bath salts, or Salvia divinorum at least once. Participants were recruited using flyers distributed to head shops, cafes and other businesses; advertisements posted in free weekly newspapers; and snowball sampling.
.
Synthetic cannabinoids, also known as K2 or Spice, are not included in most routine drug test panels because they require specialized, more expensive testing. Furthermore, studies have shown that the types and amounts of synthetic cannabinoid (SC) metabolites can vary greatly between products, lots, and even within the same package1, making it difficult to decide which specific SC metabolite should be included in drug testing programs. Some SC users use the drug as a substitute for marijuana to avoid positive drug tests, according a qualitative study of SC users in Southern California. The study found that:
CESAR Pilots New Community Drug Early Warning System in Criminal Justice System; Finds Synthetic Cannabinoids in All Populations Studied
UR-144 and XLR-11
31%
XLR-11Only4%
UR-144 Only60%
UR-144 and JWH-018
3%3+ Metabolites
2%
• SCs were detected in the specimens from all participating sites in the District of Columbia, Maryland, and Virginia. Furthermore, all of the SC positive specimens contained one or two of the metabolites (UR-144 and XLR-11)
• SCs were most likely to be detected in younger men. What was not expected was the level of use that was found. For example, one-quarter to one-third of young men in the three populations studied in DC tested positive for SC.
• Unlike other prescription and illicit drugs, SCs were as likely to be found in persons who had failed the limited CJS screen as in persons who had passed. In other words, current drug testing screens which do not test for SCs are likely missing significant drug use (and users) in the populations they monitor. One possibility is that persons who know they will be tested use SC products because they know that the drug is not included in most test panels.
Metabolites Found in All Synthetic Cannabinoid Positive Specimens from
Five CJS Populations, 2013 (N=118)
Detection Window ???
testing for metabolites educated guess - same as real marijuana? many labs advertise �up to 72 hours� limited studies passive inhalation? fact is - we don�t know all the answers
Wet Marijuana Embalming Fluid-Soaked Marijuana: smoking marijuana soaked in embalming fluid is gaining popularity throughout the United States. The syndrome of intoxication looks nearly identical to that seen following phencyclidine (PCP) use, with agitation, disorganized speech, and thoughts, and diminished attention. This new trend in drug use involving marijuana also presents a resurgence in PCP use. Soaked in water – uneven burn Mixed with PCP: wet, fry, crystal joint, supergrass Mixed with codeine containing cough syrup Mixed with methamphetamines
What’s in Bath Salts:
MDPV (Methylenedioxypyrovalerone) - a psychoactive drug with powerful stimulant properties which acts as both a norepinephrine & dopamine reuptake inhibitor (NDRI). “A two for”
usually snorted like cocaine duration of effect 2-3 hours /adverse effect 6-8 hrs MDPV - no history of FDA approved medical use Sold as a “research chemical” adverse medical or psychiatric ramifications
amphetamine-like properties, powerful stimulant �rediscovered� by synthetic chemists in 2003 reformulation of cathinone, a chemical found in the
khat plant of Eastern Africa khat existence traced to 15th C. Ethiopia khat is banned in the U.S.
Mephedrone (Methylmethcathinone)
Methylone (3,4-methylenedioxy-N-methylcathinone)
very similar to MDMA stimulant phenethylamine, amphetamine, and
cathinone properties euphoria and increased sociability insomnia and restlessness hallucinations and psychosis
MDMA – Molly/Ecstasy - Molly is not new, exactly. - MDMA, or 3,4-methylenedioxy-N-methylamphetamine, was patented by Merck pharmaceuticals in 1914 - did not make much news until the 1970s, when psychotherapists began giving it to patients to get them to open up.
-arrived at New York nightclubs in the late 1980s, and by the early ’90s it became the preferred drug at raves, inducing feelings of euphoria, closeness and diminished anxiety,
- Ecstasy was quickly embraced by Wall Street traders and Chelsea gallerinas. as demand increased, so did the adulterants in each pill (caffeine, speed, ephedrine, ketamine, LSD, talcum powder and aspirin, to name a few), and by the new millennium, the drug’s reputation had soured. - in the last decade, it returned to clubs as Molly, a powder or crystalline form of MDMA that implied greater purity and safety: Ecstasy re-branded as a gentler, more approachable drug.
- thanks in part to that new friendly moniker, MDMA has found a new following in a generation of conscientious professionals who have never been to a rave and who are known for making careful choices in regard to their food, coffee and clothing. - -
Molly - continued common side effects, include teeth grinding, dehydration, anxiety, insomnia,
fever and loss of appetite. more dangerous ones include hyperthermia, uncontrollable seizures, high blood
pressure and depression caused by a sudden drop in serotonin levels in the days after use, nicknamed Suicide Tuesdays.
capsules sell for $8 to $40. the most common Molly additives are bath salts, including methylone and
mephedrone. Bath salts are chemically similar to MDMA. A report recently released by the DEA's New York division highlighted the
results of 143 lab tests over the past four years of substances suspected of being Molly. Only 13% of the drugs were MDMA, while 41% were 4-MEC, a type of bath salt, and 20% were methylone.
Veteran MDMA users say they ask that drugs be tested before they buy them, using kits that can be bought online. "If I'm getting more than a gram, they'll test it right in front of you," said a 27-year-old ad salesman from Oakland, Calif. DanceSafe, an organization that promotes safety at raves, sets up testing tables at some events.
Pharmacological Effects of �Bath Salts�:
increase heart rate & blood pressure pupil dilation, rapid speech hyperactivity, arousal, & over stimulation increased energy & motivation euphoria - agitation dizziness, nausea hallucinations, seizures, convulsions breathing difficulties!!! diminished perception of the requirement for food and sleep death
Testing for Bath Salts?? Yes! However:
No on-site, rapid, instant tests No laboratory-based screening tests Laboratories employing GC/MS and
LC/MS/MS technologies Detection times remain unknown Best procedure for detecting
metabolites vs parent drug unknown
Legal Status of Synthetics with the (DEA) Fed - Update
June, 2012 DEA added 26 compound to the CSA “9 different 2C chemicals and 15 synthetic cannabinoids cannabamimetic agents”or similar compounds
July 9, 2012 bill signed into Law - Synthetic Drug Abuse Prevention Act of 2012
45 States have some type of legislative ban Synthetic cannabinoids and stimulants treated as Schedule 1
drugs a high potential for abuse
no currently accepted medical use
lack of accepted safety for use of the drug under medical supervision
Status of Synthetics in OH HB 64 (Signed July 2011)
- Effective October 20111 JWH-018; JWH-073; JWH-200; CP 47,497 and C8 homologue.
Bans Synthetic Stimulants Bath Salts
-MDPV / Mephedrone and others
2C-I Nicknamed “Smiles” popular among teens, responsible for dozens of overdoses
and deaths especially in Midwest. white crystalline powder, typically snorted or ingested. High & Effects can last a few hours to a few days,
described as being a “roller coaster through hell” a combination of MDMA and LSD, only more intense. 2C-I is being made by dealers and “hobbyists,” chemicals can be obtained over the internet 2C-I overdoses can cause seizures, kidney failure, and fatally
high blood pressure.
Pharmacological Effects
Dilated pupils Sweating Dry mouth Rapid speech Rapid/frequent mood swings Hyperactivity/ Elevated BP Hair standing on end Nasal passage irritation
Erowid.com “Documenting the complex relationships between humans and psychoactives”
Great resource for information Take with a grain of salt Your clients are probably aware of this site as
Heroin Makes a Comeback This Time, Small Towns are Increasingly Beset by Addiction, Drug-Related Crimes Thursday, August 8, 2013 As of 12:23 AM EDT - WSJ ELLENSBURG, Wash.—This small city east of the Cascade Mountains is known for its hay farms, rodeos and, increasingly, something more sinister: a growing heroin problem. The fatal overdose of a state trooper's son in May convulsed the town—especially when the two men arrested and charged with selling him heroin turned out to be a county official's sons. Heroin use in the U.S. is soaring, especially in rural areas, amid ample supply and a shift away from costlier prescription narcotics that are becoming tougher to acquire. Much of the heroin that reaches smaller towns such as Ellensburg comes from Mexico, where producers have ramped up production in recent years, drug officials say. Heroin seizures at the Southwest border, from Texas to California, ballooned to 1,989 kilograms in fiscal 2012 from 487 kilograms in 2008, according to figures from the Drug Enforcement Administration. The heroin scourge has been driven largely by a law-enforcement crackdown on illicit use of prescription painkillers such as oxycodone and drug-company reformulations that make the pills harder to crush and snort, drug officials say. That has pushed those who were addicted to the pills to turn to heroin, which is cheaper and more plentiful. A 21-year-old recovering addict said she made the switch from pain pills to heroin after her dealer one day held out both options in his hands and encouraged her to choose the cheaper one Drug experts say the heroin sold today is generally purer and thereby more potent than the varieties prevalent in past decades, increasing the risk of overdose. A baggie "may be 15% pure one day, and the next day it's 60%," said Skip Holbrook, the police chief in Huntington, W.Va., which sits in an area of Appalachia where heroin is spreading. "It's like playing Russian roulette."
Opiate epidemic spreading in Philly POSTED: October 10, 2013
ROLAND LAMB, director of the city's Office of Addiction Services, can rattle off drug stats all day long, but the button on his lapel - the word "stigma" with a slash through it - tells you where he stands on America's drug war. It's Lamb's way of protesting an "arrest first, treat later mentality" that he says is similar to "locking up type 2 diabetics for not following their medication and not staying on their diets.” Yesterday, Lamb presented his office's latest statistics, showing that Philadelphia continues to struggle with an opiate epidemic. Not just heroin, but also strong prescription painkillers that produce a similar high and can turn some patients - or their friends and relatives - into addicts. "This is a serious issue that crosses all age groups and demographics," Lamb said. Last year, for example, opiates accounted for five of the 10 most frequently detected drugs in bodies handled by the city Medical Examiner's Office.
Opiate vs Oxycodone Screen why you should consider splitting them out when testing
Opiate Screen @ 300ng
Primarily targets morphine and codeine
Oxycodone – 30,000ng Needed to trigger a positive Miss the chippers, O.O.U.
Opana – Oxymorphone 100,000ng needed to trigger
positive on onsite Opiate test
Oxycodone Screen @ 100ng
Oxycodone – 100ng Needed to trigger a positive Detect the chippers
Will detect oxymorphone and hyrdocodone at 1562ngs
Opana – Oxymorphone Oxycodone lab EIA screen has
100% cross reactivity to Oxymorphone
Opana (ER) – time release
Opana Information Opana is more potent, per milligram, than Oxy Users vulnerable to O.D, kidney failure, death Street names: "stop signs," ”Obomb,”new blues” crushed - either snorted or injected. Endo Pharmaceuticals, announced in Dec 2011
that it would reformulate Opana. The new pill is being manufactured
Opana ER (Extended Release) Small blood clots under the skin/cause blood
disorders
Take away comments
If positive on an Opiate screening test – an Opiate family member most likely detected
If confirmed for 6-AM (6-Acetylmorphine )at the Lab: Heroin use
If confirmed positive just for Morphine Metabolized heroine to morphine and or morphine use i.e. from a prescription, poppy seed use
Suboxone-Buprenorphine FDA approved in 2002 used to treat opiate addiction alternative to methadone partial agonist (ceiling) in pill, film, patch 2mg & 8mg doses will not test positive on an opiate test significant diversion contains naloxone- guard against misuse Individuals will get high on this stuff
What’s the attraction to Bup?
user’s experience a euphoria effect if taken in conjunction with other sedative drugs like
alcohol, sleeping pills(ambien) or benzodiazepines (clonopin)- extreme sedation, drowsiness, unconscious, or even death may occur
Method of ingestion – typically sublingual (under the tongue), pill format going away, reports of snorting
injected? only test positive if specifically testing for buprenorphine
