Novel Psychoactive Substances

& an analysisof the 2015 PSA

Cookin’ With Molly

Nick Boyce, May 25, 2015

thedrugswheel.com

• Feel free to share or adapt this information, though please do credit us.

• This slide deck was created in May 2015. – All of the URLs linking to external content were

active at that time; if any external content now missing or out-of-date, please let us know.

• Please contact if you have questions or concerns.

Before we startlet’s get a sense ofwho’s in the room…

I work in…

I primarily work with…

I primarily work in…

Caffeine…

In Canada, a small amount of cannabis (< 5grams) for personal use is legal.

No amount of cannabis has ever been legal to possess in Canada; except if you have a medical license (MMAR) or prescription (MMPR)

Why Are You Here?

• What questions do you have? • What are you hoping to learn? • What are you seeing or hearing?

Halifax, Nova Scotia, Canada

Jamie Britten, 23Died from overdose. Totally preventable death… What if he had been more aware of risks and friends had known how to help?

Just Say Know

• PLUR… +R– Peace. Love. Unity. Respect. (The Rave Mantra)– As overdoses and deaths started happening:• +R = Responsibility

– Informed: you can’t manage risks if you don’t know about them

Know your Body, Know your Mind, Know your Source

www.tripproject.ca

Why are we here?

• Overdoses (fatal and non-fatal) are still a happening• As service providers (and in our personal lives)– If we are better informed, know where to find info, and

can challenge our assumptions and biases, we can raise awareness and effect positive individual (and systemic) change.

• A lot has changed in the last few years– (Music and the culture)– The drugs people are using– How they access them

Overview

• The last 20 years, especially the last 5• Proliferation of many new substances. Let’s

focus on:– Molly / Ecstasy / MDMA• Toronto Police PSA

– Drug Checking– Zombies• “Newer” class of stimulant drugs – cathinones

– IZMS… synthetic cannabis

Background & Terminology

• Rave Drugs / Party Drugs– 1970’s - 1980’s:

• New York and Chicago discos• Ibiza, Spain (UK Tourists)

– 1980’s - 1990’s:• Underground Raves (U.K.); Warehouse Parties (New York, Chicago, Detroit,

Toronto); Gay Nightclubs

– 1990’s - 2000’s:• Nightclubs (U.K.)• Raves, Nightclubs, Gay Circuit Parties (North America)

– 2000’s:• Nightclubs; Gay Clubs; all-ages-all-night events• “Parties”

– 2010’s:• Smaller nightclub events; Big EDM festivals

• Ecstasy / MDMA• Meth (ice/jib) /Amphetamine (speed)• GHB• Ketamine• Mushrooms / LSD• Mescaline• Nitrous• Cannabis• Nicotine• Powdered Cocaine• Poppers• Viagra• Energy Drinks• Alcohol

• Stigma Sponsorship

“Rave/Party Drugs”

MDMA - erowid

https://www.erowid.org/chemicals/mdma/mdma.shtml

MDMA – M.A.P.S.

Founded in 1986, MAPS is a U.S. non-profit research and educational organization that develops medical, legal, and cultural contexts for people to benefit from the careful uses of psychedelics and marijuana.https://www.maps.org/

Ecstasy Pills

• Some Ecstasy Pills are simply MDMA pressed into pill, as opposed to powder format

• Often Ecstasy Pills are “adulterated”:– Sometimes to mimic MDMA; sometimes to “add a little

extra”• MDMA on it’s own may not give the energy to dance until

8:00am

– Common additives in the past were: • Caffeine; amphetamine/meth; ketamine; ephedrine

Ecstasy Pills

• Pills are far less common now; more often people are taking capsules of loose powder

• Pills were “branded”, so you could ask around for certain batches based on anecdotal experiences:– e.g., people might report the ‘green 007’ was good; the ‘red TTs’ were bad

• It was also easier to take half a pill instead of the whole one, as you could bite or break it

• *When pills were more popular, you could also buy “pure MDMA” in capsules (twice the price of pills)

Changing Drugs & Terminology

• MDMA / Ecstasy / Molly

Molly Capsules

Molly• Substances are often sold packaged in gel capsules

(“caps”), or sometimes just as loose powder in a “baggie”• Some people may have a misconception that Molly is

safer, or pure MDMA– Some caps are just MDMA (like you could always buy) – Many caps contain adulterants, misrepresented as

MDMA• Other people wouldn’t know the difference: “It’s just

Molly”– They don’t know of, or have never experienced, MDMA

Molly• Far more adulterants now:– Methamphetamine; BZP; methylmethcathinone

(mephedrone); 5-MeO-DiPT; MDPV; and many more

• The capsules are not branded in the same way, making it much more difficult to recognize good or bad batches

• Harder to take half a dose

“Pure MDMA isn’t an ideal party drug for a lot of people. You feel very cuddly, very chatty, but actually not super energized or hyped up. It’s often described as more of a chill time. This isn’t what a lot of partiers want for their cray exciting night out! This leads to molly being anywhere from a mix of MDMA and amphetamines to just plain old speed sold as molly.”

5 Myths about Molly: http://www.tripproject.ca/trip/?q=node/2032

European Monitoring Centre forDrugs and Drug Addiction

In 2013, 81 new psychoactive substances were notified to the EU Early Warning System, bringing the number of substances monitored to more than 350.

European Drug Report (2014) - Trends and Developments:http://www.ab.gov.tr/files/ardb/evt/european_drug_report_2014.pdf

How did we get here?

DemandDrug Policy / Law Enforcement

Scheduling / Precursor Restriction Molecular Chemistry

NeurobiologyWorld Wide ConnectionResearch / Sales

+

What’s most cost effective for dealers?

European Monitoring Centre for Drugs and Drug Addiction

In the last 5-10 years• Designer drugs – produced in illegal laboratories, falsely sold as illicit drugs

such as MDMA, cannabis, and heroin

• Legal Highs – aimed at recreational users, sold openly in head shops and online

• Research chemicals – advertised as intended for scientific research, sold openly online

• Food supplements – targeted at people looking to enhance their body or mind (nootropics). Sold openly online

• Medicines – Diverted from patients or illegally imported and sold on the illicit drug market

Novel Psychoactive SubstancesNPS can be sub-divided roughly into the following:

• Synthetic cannabinoid receptor agonists (SCRAs)– Traded under such names as Spice, K2, Izms. These bear no relation to the cannabis plant except

in that the chemicals which are blended into the plant matter, act on the brain in a similar way to cannabis.

• Stimulant-type drugs – BZP, mephedrone, MPDV, NRG-1, Benzo Fury, MDAI, ethylphenidate. The effects of these drugs

replicate across the range of those encountered with amphetamine and MDMA.

• Hallucinogenic – 25i-NBOMe, Bromo-Dragonfly and the more ketamine-like methoxyetamine.

• Opiates– There are some opiate type NPS in Europe such as kratom; a recent reported UK death caused

by a synthetic morphine product called AH-79217. O-desmethyl tramadol, an opioid – In North America seeing illicit fentanyl production.

Adapted from “Not for Human Consumption”, DrugScope

www.thedrugswheel.com

Ontario, Canada - Student Data

Novel Psychoactive Substances

• At some level there has been greater experience in Europe (e.g., the UK).

• So far, relatively few people are coming forward to treatment services citing an NPS as their primary drug problem.

• However, this may well be a reflection of the way the services are set up.

• Those areas with ‘club drug’ or similar services, by contrast, report high demand.

• An exception would be mephedrone which is causing problems across a range of user cohorts, from young people, to those on the ‘chem sex’ party scene through to traditional service clients.

Adapted from “Not for Human Consumption”, DrugScope

Context for the use of some of these drugs…

“Rave” on…

• Underground raves and the associated culture peaked in the late 90’s early 00’s in Toronto (and globally).

• Smaller fractured scenes centred around specific music genres continue to this day.

• In the last few years “EDM” has gained in popularity…

Electronic Dance Music

• EDM events– Grew out of rave culture – Often massive scale

with tens of thousands of participants

– Corporate sponsorship, often alcohol companies

• Indoor productions & outdoor festivals

“Sensation”Click image to view on YouTube…

https://www.youtube.com/watch?v=omjMBXyT2MU

“VELD Music Festival”Click image to view on YouTube…

https://www.youtube.com/watch?v=-Z7F9WmPMc4

Not just Toronto; events are diffusing into smaller regions

Have to acknowledge all the positive experiences people have at events.

May 2014, Toronto

Alcohol or drug use sent 29 people to hospital with various degrees of illness on Saturday night after an Avicii concert at Toronto’s Rogers Centre.

Rogers Centre had its own medics for the sold out, all-ages electronic dance concert and EMS was not on standby, paramedics said. But staff at the 20,000-seat venue quickly became “overwhelmed” by the number of sick patrons, and that’s when they called EMS to take over.

August 2014, Toronto

http://www.theglobeandmail.com/news/toronto/deaths-at-veld-festival-shed-light-on-party-drug-scene/article19942954/

Annie Truong-Le & Willard Amurao

20 and 23 years old

https://www.youtube.com/watch?v=U2zlPSCZDmE

• Who is it aimed at?

• What was the message or some key points?

• What did you like about the video?

• What didn’t you like?

• Was there anything wrong or that could have been different?

Craig Ferguson, senior art director at DDB Canada

• "The greatest challenge we faced was the ability to speak to young people about the topic of drugs. We felt a heavy-handed 'don't do drugs' message would only deter our target audience from engaging with our communications. How could we do it in a way that they would listen? Ultimately, the answer was simple enough: Talk to them. Don't judge them."

Source: THUMP Magazine

“This audience, maybe more than most, is a bit wary of a preachy or judgemental tone,” he says. “We’re being a little bit more open and informational versus a straight up ‘don’t do drugs’ message, which this audience can see coming from a mile away and just tune out. Putting together the lighthearted frivolity of a cooking show with this dark menacing content just shakes things up enough that we can get on their radar a bit.”

“Those old anti-drug ads are so judgmental and moral, and the goal is never to put Crime Stoppers forward as a moral authority,” he says. “Their goal is to save lives, so it’s about being relevant and effective, not about occupying a moral high ground. It’s about saving a kid and making them think twice before choosing that particular drug.”

Source: http://strategyonline.ca/2015/01/09/a-new-recipe-for-drug-awareness/#ixzz3azbyBHoi

Concerns

• Would showing capsules be more credible than pills?

• “Almost never see MDMA anymore”– Simply not true (look at ecstasydata.org results)– MDMA, or “Ecstasy” has always been adulterated,

but now there are just more substitutes

Concerns

• “Next week’s ingredient… Heroin”– Practically no instances of this as an adulterant• Makes no sense pharmacologically or financially

– Lose credibility

• Could go further… No practical risk reduction!– It’s not a hard “Just Say No” message, but it

doesn’t provide resources or strategies for safety

May be onPolice/Public radar now, but…

http://www.tripproject.ca/trip/?q=node/1980

Drug Checking.Why?

https://www.youtube.com/watch?v=U2zlPSCZDmE

Methylone

• bk-MDMA• Structurally similar to MDMA• Similar effects; novice users may not differentiate• Often need higher dose than MDMA• Higher heart rate and body temp than MDMA• Increased jaw clenching• Confirmed police seizures and home test results

in Toronto (2013)

Methylone

• "[Methylone] has almost the same potency of MDMA, but it does not produce the same effects. It has an almost antidepressant action, pleasant and positive, but not the unique magic of MDMA.“ - Schulgin

• MOLLY: EVERYTHING BUT THE GIRL– http://

www.mixmag.net/read/molly-everything-but-the-girl-features

Methylone maybe one of the “better” substitutes…

http://www.cbc.ca/news/canada/calgary/8-alberta-deaths-linked-to-ecstasy-like-drug-1.1166437

What’s in Pills and Capsules?

pillreports.net• URL was changed to “.net”• SUBJECTIVE reports!

http://www.projectknow.com/discover/jagged-little-pill/

Home Drug Checking

Reagents can only determine the presence, not the quantity or purity, of a particular substance. Dark color reactions will tend to override reactions to other substances also in the pill. A positive or negative reaction for a substance does not indicate that a drug is safe. No drug use is 100% safe. Make good decisions. [https://dancesafe.org/testing-kit-instructions/ ]

View the substance colour change chart:

http://testkitplus.com/wp-content/uploads/pdf/pill-test-kit-color-reaction-chart-TestKitPlus.pdf?pdf=Reaction-Chart

www.dancesafe.org

A similar chart from US-based DanceSafe:

Common drugs from previous generations like LSD, mushrooms, cocaine and opiates are still popular, but they’ve been joined by the likes of MDMA and ecstasy, amphetamines, ketamine, and a massive array of others.

In fact, there are so many different psychoactive substances floating through our country that people don’t even realize how complicated things have gotten.

We quickly discovered that the majority of the time, people were surprised to find that their bag of drugs was not what they paid for.

https://www.youtube.com/channel/UCVGL-1H6tK9PFUrgFkvCtfg

http://www.bbc.com/news/health-23069825

Inventory of on-site pill-testing interventions in the EU http://www.emcdda.europa.eu/html.cfm/index1577EN.html

Zombies…

I remember, about three years ago…

Media and police reported the attacker was intoxicated on…

Miami Zombie Attack, May 2012

• May 26, Miami Florida– Police shoot and kill a man who was attacking another person and

“chewing his face”. Police suspect the attacker was high on “bath salts”.

• May 30– Miami's 'Naked Zombie' Proves Need to Ban Bath Salts, Experts Say

• http://www.usnews.com/news/articles/2012/05/30/miamis-naked-zombie-proves-need-to-ban-bath-salts-experts-say

• June 02– Drug Linked To Cannibalism Case Hits Edmonton Streets

• http://www.huffingtonpost.ca/2012/06/02/bath-salts-drug-edmonton-cannibalism_n_1565046.html?utm_hp_ref=rudy-eugene

“Bath Salts”

• May refer to a number of compounds that are synthetic substances based on the (cathinone) compounds that exist in the Khat plant of East Africa.– Examples: mephedrone, methylone, and methylenedioxypyrovalerone

• Packaged as “bath salts” or “plant food” and labelled “not for human consumption”, to minimize attention

• Primarily sold online; sometimes in some head shops or convenience stores

“Bath Salts”

Bath Salts – Cathinone Derivatives

• Structurally related to cathinone, a chemical found in the khat plant

Catha edulis (khat, qat)Is a flowering plant native to the Horn of Africa and the Arabian Peninsula. Among local communities, khat chewing is a social custom dating back thousands of years. Khat contains a chemical alkaloid called cathinone, an amphetamine-like stimulant, which can cause excitement, loss of appetite and euphoria.

Coca leaves in South America, contain the alkaloid ecgonine, a pre-cursor to cocaine.

The alkaloid content of coca leaves is low, between 0.25% and 0.77%, so chewing the leaves or drinking coca tea does not produce the intense high you can get with cocaine.

Leaves are chewed or brewed to overcome fatigue, hunger, and thirst. It is useful against altitude sickness.

Numerous cathinone derivatives

http://kinesis.co.uk/synthetic-cathinones-bath-salts-detection

/

“Bath Salts”

• Typically they have strong stimulant effects and require a smaller dosage than drugs like methamphetamine or cocaine.

• In higher doses, or with extended use, may cause strong “psychiatric effects” (psychosis).

• TRIP! Info: www.tripproject.ca/trip/?q=node/1939

“Bath Salts” in the media

• Numerous stories in the media of people acting very bizarrely after suspected use of “bath salts”.

• Stories from the UK started 4-5 years ago and over the last 2-3 years in Canada and the United States.

• Sometimes toxicology reports show that “bath salts” were actually not ingested.

• The extreme cases are the ones reported; many people have used the substances with no problems at all.

Miami Zombie Attack, May 2012

• “No Bath Salts in Miami Case”– Miami-Dade Medical Examiner, Bruce Hyma

"The department's toxicology laboratory has identified the active components of marijuana... The laboratory has tested for but not detected any other street drugs, alcohol or prescription drugs, or any adulterants found in street drugs. This includes cocaine, LSD, amphetamines (Extasy, Meth and others), phencyclidine (PCP or Angel Dust), heroin, oxycodone, Xanax, synthetic marijuana (Spice), and many other similar compounds."

Closer to home…

Have you heard of MDPV?• Mystery drug causing freakouts

Toronto Sun posted: January 19, 2012http://www.torontosun.com/2012/01/19/mystery-drug-causing-freakouts

• Owen Sound, Ontario, Canada

“Four people have showed up at the hospital within a 24-hour period suffering from extreme paranoia, vivid hallucinations and thoughts of killing themselves after smoking or injecting a mysterious brown powder…”

• In this case, lab analysis by Health Canada confirmed the use of MDPV.

“Bath Salts”

• Canadian Centre on Substance Abuse– CCENDU Alert June 2012 – “Bath Salts”

http://www.ccsa.ca/2012%20CCSA%20Documents/CCSA-CCENDU-Drug-Alert-Bath-Salts-2012-en.pdf

http://www.owensoundsuntimes.com/2012/09/27/city-cops-applaud-criminalizing-bath-salts

“It’s positive news for us for sure. If that substance shows up again, then we’ll be able to take action,” Owen Sound Police Services Det-Sgt. Mark Kielb said.

The drug has been found by city police only once since back-to-back raids in January, he said. A small amount was seized in May.

“I believe it’s out of the community. I believe it was a one-time thing,” he said.

UK Mephedrone Ban May Have Done More Harm Than Good

• http://www.telegraph.co.uk/news/uknews/law-and-order/8320316/Ban-on-miaow-miaow-may-have-done-harm-rather-than-good-report-suggests.html

• The ban, which came after mephedrone had been linked to a number of deaths, which were later found not to be attributable to the drug, could be driving demand for other new drugs.

• The ban comes after recent research revealed that 40 new synthetic drugs have flooded into the UK during the past year.

"One of the dangers of the approach that has been taken is that if we ban every new drug without a balanced view, then people will keep making more new drugs to replace them and eventually they will make something that is extremely toxic which, when kids take it, they will die.”

- Professor David Nutt, Independent Scientific Committee on Drugs

“The New '$5 Insanity' Drug Is Making Bath Salts Look Like Aspirin” (ibtimes)

Flakka / Gravel• Alpha-PVP (α-Pyrrolidinopentiophenone)• Another derivative of cathinone• norepinephrine-dopamine reuptake inhibitor (NDRI)• Extremely dose sensitive; small doses that should be

weighed

http://www.forbes.com/sites/robertglatter/2015/04/04/flakka-the-new-drug-you-need-to-know-about/

Flakka / Gravel• “Scary” stories are likely cases where people have:– Taken too high a dose– Mixed with other substances– Have pre-existing mental health concerns

• Have we seen toxicology reports? – Remember Miami Zombie case

• Never see media reports of people having “good” and relatively safe experiences, such as: – https://www.erowid.org/experiences/exp.php?ID=99718

Legal Highs / Research Chemicals - Concerns

• False sense of security

• Mislabelling• Bad batches• Dosage• Long-term effects

unknown

Legal Highs / Research Chemicals

• Come in “waves” through the “dance music scene”… and now other communities or social networks.

• Scheduling of these substances (making them illegal) causes “blow-out sales” by manufacturers, who want to get rid of them quickly:– Easy to sell through the internet;– Easy to buy if you have a credit card;– Bulk sales to dealers:

• who re-package for end user, sometimes selling as traditionally known drugs such as “Ecstasy”, or now, “Molly”.

Legal Highs / Research Chemicals

• Little is known of these substances, particularly regarding their long-term effects and potential contraindications with medications and other drugs.

• Not a very high “success rate”: – With many substances, 50% of users will get the

desired high, the other 50% will have vomiting and diarrhea.

Safety

• “There really is no safe way – it’s all a gamble...”

• What exactly are you taking?!– Mass spectrometry (cost prohibitive)– Home test reagent kits (not definitive)– User reports (subjective)– One person try sub-threshold dose before

everyone else (guinea pig)

Key Messages

• Legal = safe• Stick to “classic” drugs if you haven’t tried new ones• You can never be sure what you are getting from an

in-person drug deal, or by purchasing online• Check your drugs with online databases and

chemical reagents• Be extremely cautious with dosing – Some drugs require a .000 decimal scale to measure

accurately

The importance ofmeasuring your dose…

1,3,7-Trimethylxanthine

Caffeine

http://www.coolinfographics.com/caffeine-poster/

Caffeine Powder• A teaspoon of caffeine powder is

roughly equal to 16 to 25 cups of coffee.

• A 12-ounce can of Coke uses 34 milligrams, about one-64th of a teaspoon.

• 3 - 20 grams (150 - 200 mgs per kg of body mass) can be a lethal dose for an adult (less than a tablespoon).

• A 100-gram package (~$10) equals:– 400 “tall” cups of Starbucks

coffee– 1,250 Red Bulls, or – 3,000 cans of Coke

Ref: http://well.blogs.nytimes.com/2015/05/18/caffeine-powder-poses-deadly-risks-2/?_r=1

http://www.thestar.com/news/world/2014/07/19/ohio_teens_death_puts_focus_on_dangers_of_unregulated_caffeine_powder.html

Cannabis / Weed

Joints / Pipes / Bongs

Vaporizers

Hashish / Hash Oil

Concentrates – “Dabbing”

Cannabis Concentrates• Butane Honey Oil (BHO); Wax; Dabs; Shatter– Cannabinoids extracted into a concentrated product,

typically with gasses such as butane or carbon dioxide– Usually heated and inhaled, or ingested

• Concerns:– High Concentrations of Cannabinoids

• Think hard liquor vs. beer• Can lead to easier overdose (-ve) • Though may mean you inhale less (+ve)

– Left over contaminants from production– Production dangers (explosive chemicals)– http://www.hightimes.com/read/dab-or-not-dab

According to police, unusually high levels of tetrahydrocannabinol, or THC, make shatter very toxic and addictive. "Marijuana could be anywhere between five and eight per cent THC," said Insp. Sam Theocharis. "This is closer to 70 or 80 per cent.“

Reality Check: Perhaps more “toxic”; it is more concentrated so potentially easier to overdose. BUT… does not mean “more addictive”. Also, people may actually inhale less as it is more potent.

A marijuana infused lollipop found in Toronto (2013).

Media report with several misleading statements and no mention of the cannabis psychosis connection!

http://www.ctvnews.ca/video?clipId=162909&playlistId=1.1232631&binId=1.810401&playlistPageNum=1

Source: flipper.diff.org/app/items/info/6025

Synthetic Cannabinoids• Synthetic chemicals

that mimic natural cannabinoids found in the cannabis plant

• Existing ones such as Nabilone, prescribed to chemotherapy and other patients

• Newer “legal” or recreational versions sprayed on smoke-able herbs, branded and sold, such as IZMS, K2, and Spice

• Synthetic Cannabinoid FAQ: So Do I Smoke It? (TRIP)– http://www.tripproject.ca/trip/?q=node/2016

• Synthetic cannabinoids and 'Spice' drug profile (EMCDDA)– http://www.emcdda.europa.eu/publications/drug-profiles

/synthetic-cannabinoids

• Why Synthetic Marijuana Is More Toxic To The Brain Than Pot (Forbes)– http

://www.forbes.com/sites/alicegwalton/2014/08/28/6-reasons-synthetic-marijuana-spice-k2-is-so-toxic-to-the-brain/

Ontario, Canada - Student Data

In the past couple of months, U.S. states have seen a sudden increase in severe harms thought

to be related to synthetic cannabinoids.• American Association of Poison Control Centers

– “From Jan. 1, 2015, through April 22, 2015, poison centers have received 1,900 exposure calls from people seeking help for adverse reactions to these drugs [synthetic cannabinoids]; this is almost four times the rate of calls received in 2014.” http://www.aapcc.org/press/43/

• Mississippi State Department of Health– Since April 2, 2015, there have been 511 reports of spice-related emergency room visits

from Mississippi hospitals” http://healthyms.com/msdhsite/_static/23,16273,195.html • Alabama Department of Public Health

– “…is aware of at least 98 people that have presented at hospitals in Alabama within the past month with drug overdoses suspicious of being caused by synthetic cannabinoids…” http://www.adph.org/news/assets/150415.pdf

• Governor Cuomo Issues Health Alert: – “Illegal Synthetic Marijuana Sends More Than 160 New Yorkers to the Hospital Since April

8” http://www.governor.ny.gov/news/governor-cuomo-issues-health-alert-illegal-synthetic-marijuana-sends-more-160-new-yorkers

Acknowledgement:

Contact UsNick BoyceDirectornboyce@ohsutp.ca

CC SappProvincial Trainer/Acting Directorccsapp@ohsutp.ca

Websitewww.ohsutp.ca

Presentationshttp://www.slideshare.net/OHSUTP/presentations