139
Marijuana & Synthetic Cannabinoids
Agenda
• Current Attitudes / Prevalence Of Use
• What Is Marijuana? How Does It Work? CB1 and THC
• Adverse Effects
• Commercialization
• Medical Cannabinoids - CB2 and Cannabidiol
• Synthetic Cannabinoids - K2 / Spice, etc.
What Are They? How Do They Work?
Prevalence, Trends, Substance Use Testing
Prevalence Of Marijuana Use Disorders
United States
Between2001-2002 And 2012-2013
RECENT RESEARCH / SURGEON GEN RPT
• Marijuana is most commonly used illicit drug in U.S.
• 22.2 million users, 12 or older, in past year (8.3%)
• Increasingly socially acceptable
• Adolescent perception of risk decreasing over past 15 years
• Non-Medical-Legal in 8 States; DC.
• Medical Use legal in 28 states, Washington, D.C.
• No legal use under age 21
• Controlled Substance Act Schedule 1 Drug
Add Maine, California, Nevada
And Massachusetts 2016
Add Maine, California, Nevada
And Massachusetts 2016
Prevalence Trend 2007 - 2014
Steady increase in past-month use from 5.8 to 8.4%, up 45%
Past-month use highest among 18- to 25-year-olds (19.8%)
Hypothesized causes include
• proliferation of medical cannabis laws
• changing public perceptions about the harms of cannabis
• declining potency-adjusted prices on the illicit market
“The Health Effects of Cannabis and Cannabinoids”
A Report of The National Academies Sciences, Engineering, Medicine
The National Academies Press, Washington, DC
Copyright 2017 by the National Academy of Sciences. All rights reserved
Group Sharing Out
Based on your experience in your community, please share your observations regarding prevalence of use
Cannabis and
its various forms
Trichomes – Home of the
active ingredients in marijuana
IndicaSativa
Cerebral
Energetic
Uplifting
Body-buzz
Sedation
Stoned
S. Ruderalis
Auto-flowering
Short grow time
Potency of Cannabis
• In the 1990s and early 2000s, the bulk of cannabis consumed in the United States was grown abroad and illicitly imported.
• The past decade has seen an influx of high-potency cannabis produced within the United States.
• Data from the U.S. Drug Enforcement Administration(DEA) seizures record a substantial increase in average potency, from 4 percent in 1995 to roughly 12 percent in 2014.
(ElSohly et al.,2016; Kilmer, 2014).
Wax:The most potent part of the plant
is extracted with butane leaving
an 80% THC content.
Butane Hash
Oil (BHO), aka:
• Dabs (Dabbing)
• Wax
• Shatter
• Honey Oil
Preparation and THC Content
The fanaticism and
cannabis
Group Sharing Out
Based on your experience in your community, please share your observations regarding current types of cannabinoids being used
Any comments on potency ?
Marijuana Use DisorderEffects of Marijuana
Endocannabinoid System
• Endocannabinoid system is part of a neural communication network which regulates the development of connectivity between brain areas responsible for learning/memory during brain development
• Plays an important role in proper formation of synapses
• Involved in a variety of physiological processes including appetite, pain-sensation, mood, and memory
• This is the brain system , CB1, with which THC interacts
DrugBrain’s Chemical
Endocannabinoid
Receptors
THC kicks off a series of cellular reactions,
causing sensations we call “high.”
Prefrontal
Cortex
Nucleus
Accumbens
Arcuate
Nucleus Ventral
Tegmental
Area
Dopamine
Opioid Peptides
Glutamate
Courtesy of Dr. John Hart, Portland, Oregon
Reward Pathways
Coordinated
MovementMemory
Sensory and
Time PerceptionConcentration
Thinking
Pleasure
CB1 Receptors are located in parts of the
brain that influence:
Cannabis Use Disorder
Down Regulation
• When cannabinoid receptors are over occupied because of an influx of phytocannabinoids, they will actually decrease in number on the cell surface. Less receptors leads to a muted cellular response to the drug signal.
• When the drug signal is returned to normal, initiated only by the endocannabinoids , there are less receptors available, homeostasis is disrupted, and normal, healthy brain functions are altered.
• This occurs mostly in regions which regulate cognition and memory. (WHO Cannabis Report 2016)
https://quizlet.com/138756146/substance-use-disorders-flash-cards/Mild=2 or 3 Moderate=4 or 5 Severe=6 or more Over 12 month period
ICD 10 Diagnostic Criteria for Substance Use Disorder
1. Larger Amounts Or Longer Period Of Time Than Intended
2. Persistent Desire Or Unsuccessful Efforts To Reduce Or End Substance Use
3. Extensive Time Devoted To Obtaining, Using, And / Or Recovering From The
Substance
4. Craving, Strong Desire, And / Or Urge To Use Substance
5. Use Of Substance Causes Failure To Fulfill Major Role Obligations At Work,
School, And / Or Home
6. Continued Use Despite Persistent Or Recurrent Social Problems Related To
The Substance Use
7. Social, Work, And / Or Recreational Activities Are Given Up Or Reduced Due
To Substance Use
8. Recurrent Substance Use In Physically Dangerous Situations
9. Continued Use Of Substance Despite Patient's Belief That It Has Caused
Physical Or Psychological Problems
10. Tolerance
Greater Amounts Needed To Achieve Intoxication Or Desired Effect
OR
Same Amount No Longer Causes The Same Level Of Intoxication Or Desired Effect
11. Withdrawal (e.g., Alcohol -> Delirium Tremens)
Physiological Withdrawal Syndrome Typical Of The Substance
OR
The Substance Or Another Substance Is Used To Relieve Or Avoid The
Physiological Withdrawal Syndrome Typical Of The Substance
2-3=mild, 4-5=moderate, 6+=severe over a 12 month periodhttps://quizlet.com/138756146/substance-use-disorders-flash-cards/
Mild=2 or 3 Moderate=4 or 5 Severe=6 or more Over 12 month period
ICD 10 Diagnostic Criteria for Substance Use Disorder
Addiction is a primary, chronic disease of brain reward, motivation,
memory and related circuitry.
American Society of Addiction Medicine (ASAM) Addiction Definition, April 2011
• Affects neurotransmission such that addictive behaviors replace healthy
self-care related behaviors
• Genetics account for 50% of addiction development
• Significant self-deception
• Disruption of healthy supports and problems in interpersonal relationships
• History of trauma or stressors that overwhelm an individual’s coping
abilities
• The presence of co-occurring psychiatric illness
• Distortion of meaning, purpose and values that guide attitudes, thinking and
behavior
• The effects to the brain allow external cues to trigger craving and drug use
• Persistent risk of and/or recurrence of relapse
• Impaired executive function so that perception, learning, impulse control,
compulsivity and judgement are impaired.
American Society of Addiction Medicine (ASAM) Addiction Definition, April 2011
The Brain
Brain Disease
Ventral tegmental area
(VTA)
Nucleus accumbens
(nAcc)
Prefrontal cortex
IncentiveSalience
Executive Function Deficit
Withdrawal,
Negative Affect
Extended
Amygdala
Incentive Salience
Executive Function Deficit
Withdrawal
Symptoms
Brain Disease
Negative Affect,
Stress
Incentive Salience
Brain Disease
Prefrontal
Cortex
Nucleus
Accumbens
Arcuate
Nucleus Ventral
Tegmental
Area
Dopamine
Opioid Peptides
Glutamate
Courtesy of Dr. John Hart, Portland, Oregon
Reward Pathways
(Am J Psychiatry 2002; 159:1642–1652)
Rita Z. Goldstein, Ph.D. Nora D. Volkow, M.D.
Users
Brain Disease
Negative Affect,
Stress,
Withdrawal
Incentive
Salience
Executive Function Deficit
Withdrawal
Symptoms
Brain Disease
Negative Affect,
Stress,
Incentive
Salience
Executive Function Deficit
Withdrawal
Symptoms
Brain Disease
Negative Affect,
Stress,
GO ! GO !
Stop
Glutamate
Addictive Behavior
GABA
Healthy Behavior
Inhibitory Excitatory
STOP GO
GO !!!
56
Gradual
Early Use, Intentional, Patterned, Problematic Involvement
Progression of Harmful Involvement
Mild Moderate Severe
Perhaps driven by Self-Medication; Always distorted by unconscious defense
mechanisms
A Cessation of heavy, prolonged use
B Three (or more) of the following signs and symptoms develop within approximately 1 week after Criterion A
• 1 Irritability, anger, aggression
• 2 Nervousness or anxiety
• 3 Sleep difficulty ( e.g., insomnia, disturbing dreams )
• 4 Decreased appetite or weight loss
• 5 Restlessness
• 6 Depressed mood
Cannabis Withdrawal
• 7 At least one of the following symptoms causing significant discomfort: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache
C The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other occupational areas off functioning
D The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance
Cannabis Withdrawal
Urine Drug Testing For THC
Interpreting the ResultsTHC Results without Normalization
397
58
135
271
196
75
279
336
259
177
0
50
100
150
200
250
300
350
400
450
1 2 3 4 5 6 7 8 9 10
TH
C V
alu
es
ng
/mL
Sample Submission
THC Confirmation Results without Normalization
7
8
1
4
Interpreting the ResultsNormalized Results:
(DRUG / CREATININE) * 100
189
29
112
258
170
59
237
310
258
236
0
50
100
150
200
250
300
350
1 2 3 4 5 6 7 8 9 10
Va
lue
Sample Submission
Creatinine Results
1
4
7
8
Interpreting the ResultsNormalized Results:
(DRUG / CREATININE) * 100
210.1
200.0
120.5
105.0
115.3
127.1
117.7
108.4100.4
75.0
0.0
50.0
100.0
150.0
200.0
250.0
1 2 3 4 5 6 7 8 9 10
TH
C V
alu
es
ng
/mL
Sample Submission
THC Confirmation Results with Normalization
78
1
4
Down Regulation
• When cannabinoid receptors are over occupied because of an influx of phytocannabinoids, they will actually decrease in number on the cell surface. Less receptors leads to a muted cellular response to the drug signal.
• When the drug signal is returned to normal, initiated only by the endocannabinoids , there are less receptors available, homeostasis is disrupted, and normal, healthy brain functions are altered.
• This occurs mostly in regions which regulate cognition and memory. (WHO Cannabis Report 2016)
Clinical EvidenceChadwick et al 2013 Frontiers in Psychiatry
• Endogenous cannabinoid system critical for prenatal &
postnatal neurodevelopment & neuroplasticity
• CB1-cannabinoid receptors & endocannabinoids help direct
neuronal projections & connections
• Cannabis use early in adolescence (<17 years) increases
adult’s vulnerability to drug addiction, anxiety, schizophrenia
& mood disorders
New England Journal of MedicineJune 5, 2014
ADVERSE EFFECTS OF MARIJUANA USE
Nora D. Volkow, M.D., Ruben D. Baler, Ph.D., Wilson M. Compton, M.D., and Susan R.B. Weiss, Ph.D.
Risk of addiction
• 9% of Marijuana users become addicted
• 16% if onset in teens
• 25% to 50% if daily use
New England Journal of MedicineAdverse Risks of Marijuana Use - June 5, 2014
Gateway
• Decrease in mesolimbic dopamine activity
• May lead to other drug use to stimulate dopamine activity
New England Journal of MedicineAdverse Risks of Marijuana Use - June 5, 2014
Brain Development
• Impaired connectivity in specific regions
• Precuneus – alertness / self conscious awareness
• Hippocampus – learning / memory
• Prefrontal cortex – executive function
• Lower IQ as adult
New England Journal of MedicineAdverse Risks of Marijuana Use - June 5, 2014
Academic performance / lifetime achievement
• Impaired school performance (+/- reversible)
• Increased dropout
• Lower income
• Increased public assistance
• Increased unemployment
• Increased criminal activity
• Lower life satisfaction
Volkow – “the trajectory of life is lowered”
New England Journal of MedicineAdverse Risks of Marijuana Use - June 5, 2014
Motor Vehicle Accidents
• Driving ability impaired with acute and chronic use
• Most common illicit drug identified in fatal accidents
• Minimum detectable blood level (1ng / ml)
New England Journal of MedicineAdverse Risks of Marijuana Use - June 5, 2014
Figure 1. (A) Three-dimensional MNI brain with slices cut at x = −12 y = 9, z =
43 showing regions with lower functional connectivity in adolescents with CUD
than healthy controls HC: (1) caudal ACC (red cluster) and (2) left DLPFC (BA
9;green cluster). (B) Line graph showing trajectory of functional
connectivity fromTime 1 scan to Time 2 scan for the CUD (purple line)
and HC (green line) groups. CUD had significant decrease in functional
connectivity across time, HC did not. CUD showed significantly lower
functional connectivity than HC.
Camchong, J., Lim, K. O., & Kumra, S. (2017).
Adverse effects of cannabis on adolescent
brain development: A longitudinal study.
Cerebral Cortex, 27(3), 1922-1930.
Figure 2. (A) Three-dimensional MNI brain with slices cut at x = −12 y = 9, z = 11
showing regions with lower functional connectivity in adolescents with CUD
than HC: (1) caudal ACC (red cluster) and (2) left SFG (BA 10; green cluster). (B)
Line graph showing trajectory of functional connectivity from Time 1 scan to
Time 2 scan for the CUD (purple line) and HC (green line) groups. HC had
significant increase in functional connectivity across time (P = 0.003), CUD did
not. CUD showed significantly lower functional connectivity than HC at Time 2
Camchong, J., Lim, K. O., & Kumra, S. (2017).
Adverse effects of cannabis on adolescent brain
development: A longitudinal study. Cerebral
Cortex, 27(3), 1922-1930.
• a) the cannabis use itself is accounting for the decreased connectivity
• b) that the decreased connectivity is accounting for the cannabis use
• c) that psychological and cognitive challenges may drive a process that both makes it more difficult for them to stay abstinent while also stunting the maturation of the connectivity between the anterior cingulate cortex and these other brain areas.
Bertha Madras Ph.D Neuroscientist
Cannabinoids and Opioids Sedate
Lower Body Temp / Blood Pressure
Produce Pain Reduction
Inhibit Intestinal Mobility
Signaling Systems “Cross-Talk”
Co-Exist In Brain Regions
Receptors Occupy Same Cells
Adolescent laboratory animals exposed to THC, who then mature without further exposure to THC, display greater heroin seeking than control group
Recent research is indicating a connection between marijuana use and later sensitivity to effects of opioids. Cannabinoid and opioid receptors are co-located throughout the brain. Bertha Madras Ph.D
Promising Research / NIDA, NIAAAAdolescent Brain Cognitive Development
Unique in its scope and duration, the ABCD study will:
• Recruit 10,000, ages 9 to 10, before they initiate drug use
• Follow them over 10 years into early adulthood to assess how substance use affects the trajectory of the developing brain
• Use advanced brain imaging as well as psychological and behavioral research tools to evaluate brain structure and function
• Track substance use, academic achievement, cognitive skills, and mental health over time
DISCUSSION
• Please discuss ways in which you’ve seen Cannabis Use Disorder manifested in your clients ?
• Adult
• Adolescent
• Briefly describe treatment, outcomes
Origin of “4:20” Street Code for Smoking Marijuana
• Tea time in Holland
• 420 active molecules in pot
• The 5 ‘Waldos’ (they hung out at a certain wall) of San Rafael HS 1971. 4:20pm was meeting time on 4/20 during harvest season to go rustle someone’s pot patch
• Police code for marijuana abuse in progress
• SB420 California’s Medical Pot initiative
• Multiplier product of a Bob Dylan song #s
The Five “Waldos”
Commercialization of Marijuana
Legalization
• Colorado
• Washington
• Oregon
• Alaska
• Maine
• California
• Massachusetts
• Nevada
• Washington, D.C.
• Profit will depend on volume consumed
Industry will be controlled by corporate
investors
( Big Tobacco / Alcohol / Pharmaceutical )
Colorado:
• Daily users = 21.8% of market,
consume 66.9% of product
• Once weekly users = 24% of
market, consume 3.3% of
product
• Colorado sales rose 98% from
4/14 to 4/15. Denver
dispensaries reported 100-300
purchasers per day,
50%Tourists
Willie Nelson and Bob Marley’s family have
each founded their own Brands
Whoopi Goldberg is also invested
in commercial marijuana products
Whoopi
Some Current Developments
California legalizes non-medical marijuana January 1, 2018
• Market to reach 6.5 billion dollars by 2020
• Budtender Apps like PotBot – Matches consumers w specific strain
• MedMen, private equity firm, $80 million for cannabis projects
• “colorful characters, and interesting mashups with people from the advocacy world and the corporate world and the underground cannabis world, all trying to make the most of this opportunity while making the world better at the same time.”
Big-name tech investors pour millions into marijuana —
both medicinal and not
By Charles Piller @cpiller
August 28, 2017 STAT News
The creation of marijuana edibles
has gone well beyond homemade
baked goods.
Products are often
packaged to look like
popular snack foods
or candy.
JAMA
• June 2015
• Cannabinoid Dose and Label Accuracy in Edible Medical Cannabis Products
• SF / LA / Seattle
• 75 products, 45 brands
Label Accuracy in
Edible Cannabis
• 17% accurately labeled
• 23% under labeled
• 60% over labeled
Label Accuracy in
Edible Cannabis
• For medical products,
THC:CBD ratio should be 1:1
• Median ratio was 36:1
• Only 7 products had
a ratio <10:1
• Only one product was 1:1
Discussion
• Please discuss the pros and cons of legalization (non medical)• Please report out your observations
Medical Marijuana
Anandamide –
• Interacts with CB1 System
• Regulates development of connectivity in brain
2AG –
• Interacts with CB2 system
• Immune system
External –Phytocannabinoids
THC –
• Interacts with CB1 system
• Causes what we call “High”
Cannabidiol (CBD) –
• Interacts with CB2 system
• Immune System
Internal –Endocannabinoid System
CB2 and Cannabidiol
• Medical Cannabinoids
• CB2 system is periphery or located mostly in the immune system, not the brain, like the CB1 system – Interacts mostly with 2AG, not Anandamide. 2AG, like Anandamide is an endocannabinoid.
• Research is pointing toward this system, CB2, for medical benefits of phytocannabinoids, mainly Cannabidiol. CBD is considered to have a wider scope of potential medical applications than THC. CBD is not psychoactive.
CB1 and CB2
http://medicalmarijuana.procon.org/view.resource.php?resourceID=000881
THC / CBD Regulation16 States
EXAMPLES
• Georgia – 20 ozs infused cannabis oils, not more than 5% THC,
CBD = to or < THC
• Mississippi – Cannabis extracts that contain more than 15%
CBD, no more than 0.5% THC
• Missouri – Twenty ozs of cannabis extracts containing 5% or
more of CBD, no more than 3/10 of 1% of THC
• N Carolina – Cannabis extracts containing less than 9/10 of 1%
of THC and at least 5% CBD by weight
POTENTIAL THERAPEUTIC VALUECBD and THC
Research suggests potential therapeutic value of marijuana’s chemical cannabinoids, mainly CBD and THC, in numerous health conditions:
• Pain
• Nausea
• Epilepsy
• Obesity
• Wasting Disease
• Addiction
• Auto-immune DisorderSurgeon General Report 2016
FDA Approved Medications
• Marinol Capsules
• Syndros Oral Solution
Both contain Dronabinol, identical in structure to THC
• Cesamet Capsules
Contains Nabilone, similar in structure to THCSurgeon General Report 2016
Indicated for use counteracting nausea and vomiting associated with chemotherapy and wasting
syndrome in AIDS patients
Synthetic Cannabinoids:
Dronabinol (Marinol)
Synthetic Cannabinoids:
Nabilone (Cesamet)
Therapeutic Areas
• Advanced Cancer Pain (1)
• Neonatal Hypoxic Ischemic Encephalopathy (1)
• Dravet Syndrome (rare catastrophic childhood epilepsy(2)
Surgeon General Report 2016
FDA “FAST TRACK” RESEARCH
Epediolex / Dravet Syndrome
• GW Pharmaceuticals funded study of cannabidiol
“Among patients with the Dravet syndrome, cannabidiolresulted in a greater reduction in convulsive-seizure frequency than placebo and was associated with higher rates of adverse events. (Funded by GW Pharmaceuticals; ClinicalTrials.gov number, NCT02091375” *
Epediolex is a concentrated CBD oil, >98% CBD
*http://www.nejm.org/doi/full/10.1056/NEJMoa1611618
Current Research / Marijuana Plant
“Evidence collected in clinical studies on marijuana plant is still insufficient to meet FDA standards for findings of safety and efficacy for any therapeutic indications.”Surgeon General Report 2016
The Health Effects of Cannabis and Cannabinoids
• In adults with chemotherapy-induced nausea and vomiting,
oral cannabinoids are effective antiemetics.
• In adults with chronic pain, patients who were treated with
cannabis or cannabinoids are more likely to experience a clinically
significant reduction in pain symptoms.
• In adults with multiple sclerosis (MS)-related spasticity, short term
use of oral cannabinoids improves patient-reported spasticity symptoms.
• For these conditions the effects of cannabinoids are modest;
for all other conditions evaluated there is inadequate information
to assess their effects.
A Report of The National Academies Sciences, Engineering, Medicine
The National Academies Press, Washington, DC
Copyright 2017 by the National Academy of Sciences. All rights reserved
“while the use of cannabis for the treatment of pain is supported
by well-controlled clinical trials as reviewed above, very little is
known about the efficacy, dose, routes of administration, or side
effects of commonly used and commercially available cannabis
products in the United States.
Given the ubiquitous availability of cannabis products in much
of the nation, more research is needed on the various forms,
routes of administration, and combination of cannabinoids.”
“The Health Effects of Cannabis and Cannabinoids”
A Report of The National Academies Sciences, Engineering, Medicine
The National Academies Press, Washington, DC
Copyright 2017 by the National Academy of Sciences. All rights reserved
p90
Discussion
• Please discuss the pros and cons of legalization (medical)• Please report out your conclusions.
Raphael
Mechoulam, Ph.D.
Professor of Medicinal Chemistry,
Hebrew University of Jerusalem
Researcher in Cannabinoid
Chemistry since the 1960’s
• First to identify and synthesize
delta-9-tetrahydrocannabinol,’64
• 1992-discovered
endocannabinoid,
anandamide(supreme joy),
which primarily acts within CB1
system, located in brain.
Raphael
Mechoulam, Ph.D.
• Dr. Mechoulam and his Team have
profoundly advanced the understanding
of the endocannabinoid system and the
phytocannabinoids, and have led
research efforts into the medical use of
specific Synthetic Cannabinoids.
• The research is focused upon studying
the endocannabinoid system, and
developing Synthetic Cannabinoids to
enhance the functioning of the
endocannabinoids in promoting health
and the treatment of disease, while
minimizing side effects.
Raphael
Mechoulam, Ph.D.
HU211 –
Neuroprotective Synthetic
Cannabinoid with potential for
treating head trauma2AG
Research
Research
Research
Not
Research
Synthetic Cannabinoids:
K2, Spice
• Synthetic Cannabinoids are often more potent than naturally occurring THC…
• They can often act on multiple receptor systems in the brain in addition to cannabinoid receptors. Effects can be unpredictable and extreme. Chemists refer to some SynCans as “promiscuous” agonists, “they will go with any receptor”…(Synthetic Cannabinoid Receptor Agonists)
• Research on Synthetic Cannabinoids began in the ’80s. Developed by academic institutions in an attempt to harness the therapeutic effects and mitigate the psychoactive side-effects of natural cannabinoids. Spread into the black-market often times by these same researchers’ students…
Synthetic Cannabinoids
Synthetic Cannabinoids
• JWH compounds (Aminoalkylindoles) John W Huffman
• JWH 018, JWH 073, JWH 200, JWH 250
• CP compounds (Cyclohexylphenols) Pfizer• CP47,497, Cannabicyclohexanol
• Classical Cannabinoids (Dibenzopyrans) Hebrew University• HU 210, HU 243
JWH 018 -
“Spice/K2”
• Appeared in Europe in
2006
• By 2011, 11% US High
School Seniors had
used SynCans
• Over 20% surveyed
have used since ban
JWH - 018
JWH - 018
• Full CB1 Agonist
• Effects similar to THC X 5
• Prohibited in Germany in 2008
• Analysis of Spice products four weeks later revealed JWH-018
had been replaced by JWH-073
“Spice/K2”
Serious Adverse
Effects:• Anxiety
• Psychosis
• Seizures
• Dependence
• Death
• Elevated Heart Rate
• Panic Attacks
• Suicidal Ideation
HU - 210
HU - 210
• Synthesized in 1988 by a group at Hebrew University
• 100 to 800x more potent than natural THC
• Discovered by US Customs in Spice Gold, 2009
• Classified by DEA as Schedule 1
• Other HU Cannabinoids:HU-211, HU-239, HU-243, HU-308, HU-320, HU-331, HU-336, HU-345
Populations
• Probation/Parole
• Military
• Regulated Industries ( DOT )
• Anyone being Substance Use Tested for THC
CDC MMWR, June 12, 2015
• Between 1/1/15 and 4/1/15: 330% increase in Poison Control Center calls related to Synthetic Cannabinoids
• 349 calls in January 2015
• 1501 calls in April 2015
• Agitation, tachycardia, lethargy, nausea/vomiting, confusion
• 11% life threatening
Emerging Threat Report DEA 3rd Quarter 2016
Emerging Threat Report DEA 4th Qtr 2016
Emerging Threat Report DEA 2nd Qtr 2017
ZOMBIE
• “Zombie” Outbreak Caused by AMB - FUBINACA
• July, 2016 – Mass intoxication of 33 people in Brooklyn, New York
• FUB-AMB identified in AK-47 24 Karat Gold Synthetic Cannabinoid
• AMB-FUBINACA is one of an emerging class of ultra-potent synthetic cannabinoids
• Very strong depressant effects cause “zombielike” symptoms
N Engl J Med 2017; 376:235-242January 19, 2017DOI: 10.1056/NEJMoa1610300
• Are you seeing synthetic cannabinoid receptor agonists in your area?
• What are your observations, treatment indications?
Group Sharing Out
QUESTIONS
????????????????
Ed Baker LISCW, LADCAddiction Education Specialist
802 793 9252
