Emerging Drug Trends

Heidi Denton Substance Abuse Prevention

Allegan CMH March 15, 2012

Topics covered today: Explore the problems about:

K-2 Spice (Synthetic Marijuana) Bath Salts Prescription Drugs Over the Counter Drugs Learn who is abusing

Solutions & resources

Every Generation of youth Looks for New Ways to Get “High”

Scope of the Problem Alcohol use-declining among teens Marijuana use-rising among teens Prescription drug use-rising among teens Over the Counter-rising among teens K2 and Bath Salts—Limited Data Source: Monitoring the Future Study-

2010 www.monitoringthefuture.org

Why Should We Care? The long term health

effects are unknown for RX abuse, OTC abuse, K2 spice & Bath Salts

Kids generally go on to other drugs or use them in combination with alcohol and other drugs once they start abusing

Addiction is possible Legal involvement

What Drug am I?What Drug am I?Police Report Highlights:Police Report Highlights:

•Crossed raised median 3 times, hit concrete Crossed raised median 3 times, hit concrete wall 2x, driving on sidewalk w/ broken axle / wall 2x, driving on sidewalk w/ broken axle /

tiretire•.000 BAC.000 BAC

•HallucinatingHallucinating•““Death is all around meDeath is all around me””

•Threatening to kill the OfficerThreatening to kill the Officer•Hallucinating, vomiting, paranoidHallucinating, vomiting, paranoid

“K2” or “Spice”

History of K2/Spice origin JWH-018 & other synthetic cannibinoids (chemicals) were

created in an attempt to find a drug that would help ease cancer patients’ nausea & pain.

Historically THC has been known to relieve these symptoms. Researchers were hoping to develop an alternative to THC

that wouldn’t have any of the psychoactive side effects.

History… Dr. John H Huffman- a chemist at Clemson

University created JWH-018 and hundreds of other synthetic cannabinoids.

Dr. Huffman & his team published a book on his findings in 1998.

No human testing was conducted- only tested on lab mice.

JWH-018 was detected in a smoke able herbal blend sold in Germany in 2008.

The chemical was found in the herbal blend and had several reports of adverse reactions in users.

The chemical eventually found its way back to the U.S. in the form or K2/Spice herbal incense.

K2 Spice “not for human K2 Spice “not for human consumption”consumption”

Plant material (herbs, flowers, spices).Plant material (herbs, flowers, spices). Marketed as incense- the package saysMarketed as incense- the package says ““not for human consumption”not for human consumption” Laced (sprayed) with various synthetic Laced (sprayed) with various synthetic compounds that behave like THCcompounds that behave like THC Smoked or mixed in drink or foodSmoked or mixed in drink or food Sold LEGALLY and LOCALLY up until recent Sold LEGALLY and LOCALLY up until recent Michigan Law banned the chemical components.Michigan Law banned the chemical components. 1g -5g packages. Cost approximately $20 per 1g -5g packages. Cost approximately $20 per 3gm package.3gm package.

Who is using this? High School Students

Local access, hard to detect use “These products are so readily available-there’s no age restriction for buying them on the internet or in stores, that kind of accessibility for a drug is unique.” Dr. Vandrey-Drug and Alcohol Dependence-Join Together

18-24 year old “group” Not as much social stigma as using “harder

drugs”

Strong clove smell Coffee grinder – finer the powder, easier

to smoke Drug paraphernalia (pipes, screens, etc.) Typically smoked

Signs of UseSigns of Use

Ingredients: Baybean, Blue Lotus, Lion's Tail, Lousewort, Indian Warrior, Dwarf Scullcap, Maconha Brava, Pink Lotus, Marshmallow, Red Clover, Rose, Siberian Motherwort, Canavalia Maritime, Leonotis Leonurus, Leonurus Sibiricus, Pedicularis Densiflora, Scuttellaria Nana, Vanilla Planifolia, Zorinia Latifolia, Magnolia Officinalis, Rosa Gallica, Trifolium

Other common brands or flavors:

(remember, not for human consumption)

Psychoactive Compounds Psychoactive Compounds Solid (white powder) or Oil Solid (white powder) or Oil

Over 100 Synthetic Over 100 Synthetic Cannabinoids Cannabinoids (chemical compounds) (chemical compounds) “out there” “out there”

7 main Cannabinoids 7 main Cannabinoids have been found in have been found in ‘Spice’ by Volker ‘Spice’ by Volker Auwarter (2008)Auwarter (2008) Not all samples Not all samples

tested contained all tested contained all of them howeverof them however

DEA Lab had DEA Lab had similar findings similar findings making this drug’s making this drug’s effects even more effects even more unpredictableunpredictable

Chemical compounds in K2Chemical compounds in K2 CP-47,497CP-47,497

Not structurally related Not structurally related to THCto THC

Created by Pfizer 1995Created by Pfizer 1995 JWH-073JWH-073

Not structurally related Not structurally related to THCto THC

JWH-018JWH-018 5x more potent then 5x more potent then

THCTHC

JWH-200JWH-200 3x more potent then 3x more potent then

THCTHC HU-210 HU-210

100-800x more potent 100-800x more potent than THC than THC

SStructurally and tructurally and pharmacologically pharmacologically similar to similar to THCTHC

HU-211HU-211 No THC- like effectsNo THC- like effects

K2 Spice vs. K2 Spice vs. Marijuana Marijuana Unregulated mixture of Unregulated mixture of

you name it (higher you name it (higher potential for overdose)potential for overdose)

Mixed / Unpredictable Mixed / Unpredictable symptomssymptoms

Longer half-life Longer half-life (prolonged high)(prolonged high)

Never tested on humansNever tested on humans

Same basic chemical compound in marijuana

Well-known symptoms

Well-known duration

K2 Spice vs. K2 Spice vs. Marijuana Marijuana Reports of Addiction / Reports of Addiction /

Withdrawal Withdrawal Not able to detect in Not able to detect in

blood or urine until blood or urine until recentlyrecently

On set 5- 10 MinOn set 5- 10 Min HallucinationsHallucinations Intense paranoiaIntense paranoia AnxietyAnxiety Increase heart / BPIncrease heart / BP

Not considered Not considered physically addictivephysically addictive

Able to detect in blood Able to detect in blood /urine/urine

Almost immediateAlmost immediate No Hallucinations*No Hallucinations* No paranoia*No paranoia* RelaxingRelaxing Increase heart rate /BPIncrease heart rate /BP

*In pure marijuana plants*In pure marijuana plants

Calls Received by Poison Control Centers for Human Exposure to Synthetic Marijuana, 2010 to January 2012

Michigan banned K2 chemicals in Oct. 2010

2/2012

Proj

ectio

n ba

sed

on

prel

imin

ary

Janu

ary

data

2011 2012

Source: American Association of Poison Control Centers, Synthetic Marijuana Data, Updated February 8, 2012 (Preliminary data)

Deaths and Hospitalizations related to Spice and K2

<iframe width="420" height="315" src="http://www.youtube.com/embed/0kTpxbHS8Vw" frameborder="0" allowfullscreen></iframe>

Long Term Effects of K2 Evidence is lacking on the long-term

effects of synthetic marijuana on the brain and body. However, since it is smoked, it can affect the lungs negatively. Scientists warn that there is no data about the toxicity of the JWH-018 chemical used in synthetic marijuana. Therefore, they warn against using this drug.

““MI House bill 6038”MI House bill 6038”As of Friday Oct 1, 2010; K2 and As of Friday Oct 1, 2010; K2 and several similar products were made several similar products were made illegal in Michigan.illegal in Michigan.Chemicals banned include HU-210, Chemicals banned include HU-210, JWH-018, JWH-015, JWH-200, JWH-JWH-018, JWH-015, JWH-200, JWH-250, CP47, CP497250, CP47, CP49790 day misdemeanor (same 90 day misdemeanor (same penalties as possession of marijuana)penalties as possession of marijuana)

K2 legal status in the U.S.

The smokable herbal products were designated as Schedule 1 substances, the federal government’s most restrictive category, ostensibly reserved for drugs with “no accepted medical use for treatment in the United States and a lack of accepted safety for use of the drug under medical supervision.” *Marijuana is also a Schedule 1 drug, along with heroin, Ecstasy, and LSD

Drug testing is now availablewww.redwoodtoxicology.com

Will a standard drug test detect synthetic cannabinoids?Conventional drug test panels will not detect the broad range of synthetic cannabinoids. They pass undetected in standard urine testing for such drugs as cocaine, marijuana, heroin and amphetamines. RTL’s Synthetic Cannabinoid Test can be ordered with your standard panel to ensure JWH-018 and JWH-073 are detected.

Resources www.mdch.gov (type K2 in the search) www.dea.gov www.cadca.org www.drugfree.org/join-together

Questions/Discussion Any questions/thoughts on K-2 spice?

Calgon, don’t take me away…Calgon, don’t take me away…““Bath Salts” aka “Molly”, Ivory Bath Salts” aka “Molly”, Ivory

Snow…Snow…

Bath SaltsBath Salts Fake bath salts are not

typically found at the standard bath and body store but are available over the counter at convenience stores, head shops and over the internet.

The substance is usually sold in small containers with exotic names like Tranquility, Red Dove, Ivory Snow or Vanilla Sky.  

How can you tell?

If it says it is “Not For Human

Consumption”

Or it is not illegal Or it is only for 18+ Adults Only

It is probably for ingestion, not a hot bath

Many Brands and Names and Not Always Sold as Bath Salts

Plant Feeder

Insect Repellent

Stain Remover

““Bath Salts”Bath Salts” Found to contain:Found to contain: 3,4 -3,4 -

MethylenedioxmethcathiMethylenedioxmethcathinone (methylone)none (methylone)

3,4 -3,4 -MethlenedioxypryovalerMethlenedioxypryovalerone (MDPV)one (MDPV)

3 –Fluoromethcathinone3 –Fluoromethcathinone 4- Methylmethcathinone4- Methylmethcathinone

(Mephedrone)(Mephedrone)

““Bath Salts”Bath Salts”Ingested orally, snorted (most common), Ingested orally, snorted (most common), smoked, inserted rectally smoked, inserted rectally Amphetamine Type highAmphetamine Type highSold in wallet sized packets and clear jars Sold in wallet sized packets and clear jars for about $25 per 250 milligramsfor about $25 per 250 milligrams

Signs and Symptoms of Bath Salt Abuse

Extreme Paranoia Violent Behavior High Blood Pressure Hyper Alertness Sleep Deprived Extreme Anxiety Compulsive Water Drinking Motor Automatisms (compulsive repeated

hand washing) Many are Symptomatic for 2-3 days

Health Effects of Bath Salt Abuse

Mimics the effect of cocaine, LSD, Ecstasy and or methamphetamine.

Impaired perception Reduced motor control Disorientation Extreme paranoia and violent episodes Rapid Heart Rate Chest Pain Suicidal Thoughts Nose bleeds

Health Effects of Bath Salt Abuse-Cont

MDCH “Patients ingesting these chemicals can be extremely paranoid and may not respond to usual calmatives. Some have been involved in homicides and suicides while under the influence. Many describe being chased by demons, gods, aliens, or foreign solders. Severe cases may require long term psychiatric care.” 2/4/11-Press release by MDCH

Who is abusing? MDCH is reporting that the majority of

people who are abusing bath salts are in their 20’s and early 30’s.

Why? Easy Access Less social stigma than using “heavier

drugs” It’s new!

Intervention- Bath Salts <iframe width="560" height="315"

src="http://www.youtube.com/embed/crnD2vsQq48" frameborder="0" allowfullscreen></iframe>

Poison Control National call volume to Poison Control

due to Bath Salts dramatically increased from 2010 to 2011.

Michigan: (January –June 16, 2011) 86 cases of “bath salts” in the ER, up from 65 for all of 2010.

Calls To Poison Control Centers Nationwide for Human Exposure to Bath Salts, 2010 to January

2012 DEA ban July 2011

2/2012

Source: American Association of Poison Control Centers, Bath Salts Data, Updated February 8, 2012 (Preliminary data).

*Numbers may change as cases are closed and additional information is received.

Proj

ectio

n ba

sed

on

prel

imin

ary

Janu

ary

data

In early 2011, calls closed in each month* spiked through June, then

gradually declined and is level in the past 3 months.

The number of calls closed in 2011 are over 20 times that in

2010.

2011 2012

Legal status of bath salts The ingredients, including mephedrone

& MDPV are Schedule 1 drugs in Michigan.

HB 4565 was signed on July 15, 2011-banning the hallucinogenic drug methylenedioxypyrovalerone—”bath salts” along with the other main “components” found in the drug.

DEA ban September 8, 2011- DEA is temporarily

banning three “bath salt” ingredients as of October 1st, lasting at least one year.

The government will study three stimulants: Mephedrone, MDPV, and Methylone to see if they should be permanently banned.

Word of Caution…. Bath Salts have recently been given a lot of

national attention on shows such as Good Morning America

Be sure to check your local data sources to find out if this really is a problem in your community. Don’t bring attention to something if it isn't an issue in your community!

*We don’t have “use” numbers for Allegan or Ottawa specifically yet, but local law enforcement have started to track arrests and incidents

Resources www.mdch.gov (type Bath Salts in the

search) www.inspirationsyouth.com/Synthetic-C

ocaine-Ivory-Wave-Bath-Salt.asp http://en.wikipedia.org/wiki/MDPV www.dea.gov

Questions Any questions or thoughts on Bath

Salts??

Prescription Drug Abuse

Rx Medications are All Around Us…and Teens Notice

The Teen – Rx Abuse Connection

Patients leave the doctor’s office with a prescription in hand in 7 out of 10 visits.

Direct-to-consumer advertising on TV and in magazines is pervasive.

Many people don’t know how to safely use these medications or ignore their doctor’s instructions.

Rx drugs are part of teen culture. Teens:

As a result…

Normalize this form of drug abuse. Take these meds for legitimate reasons –

with or without a prescription – to stay awake, remain alert or to go to sleep.

Purposely abuse these drugs to get high. They participate in “pharming” and “skittle” parties.

Are often unaware that these activities can lead to disastrous results.

Next to marijuana, the most common illegal drugs teens are abusing are prescription medications.

Twenty percent of U.S. high school students say they have taken Rx drugs without consulting a doctor.

1 in 5 teens has abused Rx drugs. 1 in 3 teens say there is “nothing wrong” with

abusing Rx medications “every once in a while.” Every day, almost 2,500 teens abuse an Rx

medication for the first time.RX ABUSE PREVENTION TOOLKIT - from awareness to action

As a result…

Access to RX Drugs Where are they getting these from?

Medicine Cabinet Home Friends Other relatives (grandparents)

School Kids at school sell and share Recent focus group results found that Allegan &

Ottawa County youth report they can get RX medications at anytime during the school day

Teens’ Rx Drugs of Choice For Abuse

How they work Abused by teens to:

Drug names

Strong pain relievers

Used to relieve moderate-to-severe pain, these medications block pain signals to the brain

Get high, increase feelings of well being by affecting the brain regions that mediate pleasure

Vicodin, OxyContin,Percocet, Lorcet, Lortab, Actiq, Darvon, codeine, morphine,methadone

Stimulants Primarily used to treat ADHD type symptoms, these speed up brain activity causing increased alertness, attention, and energy that comes with elevated blood pressure, increased heart rate and breathing

Feel alert, focused and full of energy—perhaps around final exams or to manage coursework, lose weight

Adderall, Dexedrine, Ritalin, Concerta

Sedatives or tranquilizers

Used to slow down or “depress” the functions of the brain and central nervous system pressure, increased heart rate and breathing

Feel calm, reduce stress, sleep

Valium, Xanax, Ativan, Klonopin, Restoril, Ambien, Lunesta, Mebaral, Nembutal, Soma

RX ABUSE PREVENTION TOOLKIT - from awareness to action

RX ABUSE PREVENTION TOOLKIT - from awareness to action

Rx Access Points— Friends & Family Source of

Concern

SAMHSA. (2008). Results from the 2007 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series: H-34, DHHS Publication No. SMA 08-4343). Rockville, MD.Available at: www.oas.samhsa.gov/nsduh/2k7nsduh/2k7Results.pdf

OxyContin Effects OxyContin Effects High similar to Heroin rushHigh similar to Heroin rush Prescription Oxycontin designed for a Prescription Oxycontin designed for a

12 hour release to patient.12 hour release to patient. Abusers are crushing up tablets and Abusers are crushing up tablets and

snorting them getting all the opiates at snorting them getting all the opiates at once.once.

This quickly leads to addictionThis quickly leads to addiction

OxyContin Facts Cont..OxyContin Facts Cont.. 1 in 20 High School Seniors admit trying 1 in 20 High School Seniors admit trying

Oxycontin.Oxycontin. Highly addictive with severe Highly addictive with severe

withdrawals sweats, chills, vomiting, withdrawals sweats, chills, vomiting, headache headache

Often a Gateway drug to heroin Often a Gateway drug to heroin because its cheaper.because its cheaper.

Several drug companies are launching Several drug companies are launching crush proof alternatives to Oxycontin.crush proof alternatives to Oxycontin.

Watch for Physical Warning Signs

Sudden mood changes, including irritability, negative attitude, personality change.

Extreme changes in groups of friends or hangout locations.

Lying or being deceitful, unaccounted time away from home/missed school days, avoiding eye contact.

Losing interest in personal appearance, extracurricular activities or sports.

Poor performance at school. Borrowing money or having extra cash. Visiting and even purchasing from pro-drug abuse

(illegal) web sites.

EDUCATE

RX ABUSE PREVENTION TOOLKIT - from awareness to action

Watch for Physical Warning Signs in the Home or at School

Excessive sweating, urination or thirst Nausea and vomiting Uncontrollable diarrhea Spastic shaking Drowsiness, dizziness and insomnia Loss of consciousness Physical dependence Addiction

RX ABUSE PREVENTION TOOLKIT - from awareness to action

Talking to teens“DENORMALIZE” THE BEHAVIOR While 1 in 5 teens are abusing Rx drugs, 4

in 5 are not.

DEBUNK COMMON MYTHS: Rx abuse is just as dangerous as abusing other

substances; it can be addictive; and it’s not OK to misuse these drugs

even “once in a while.”

PROVIDE CLEAR GUIDELINES If you’re a parent, let teens know you will be

disappointed if they abuse Rx medications and watch how you use

medicines in front of teens.

GIVE TEENS ESCAPE ROUTES Teach them how to get out of bad situations;

and suggest responses they can use so they don’t feel “uncool.”

“No, thanks – not into it.”

“Not today.”

“I’m not interested.”RX ABUSE PREVENTION TOOLKIT - from awareness to action

ONDCP's Prescription Drug Abuse Prevention Plan The 2011 Prescription Drug Abuse Prevention Plan expands upon

the Obama Administration's National Drug Control Strategy and includes action in four major areas to reduce prescription drug abuse:

Education. A crucial first step in tackling the problem of prescription drug abuse is to educate parents, youth, and patients about the dangers of abusing prescription drugs, while requiring prescribers to receive education on the appropriate and safe use, and proper storage and disposal of prescription drugs.

Monitoring. Implement prescription drug monitoring programs (PDMPs) in every state to reduce “doctor shopping” and diversion, and enhance PDMPs to make sure they can share data across states and are used by healthcare providers.

Proper Medication Disposal. Develop convenient and environmentally responsible prescription drug disposal programs to help decrease the supply of unused prescription drugs in the home.

Enforcement. Provide law enforcement with the tools necessary to eliminate improper prescribing practices and stop pill mills.

Older Adults Persons 65 years of age + make up 13% of

the population but account for 33% of all medications prescribed in the US.

Hospital admissions rose 96% from 1997-2008 for conditions related to RX medications in those aged 65-84. (Source-SAMHSA)

At great risk for abuse by taking pills that are not medically necessary

At a higher risk for health consequences than younger generations

What You Can Do… Because prescription drugs are legal, they are easily accessible. Parents,

law enforcement, the medical community, and all levels of government have a role to play in reducing prescription drug abuse. Here are some things you can do to reduce the abuse of prescription drugs:

Follow disposal guidelines: No matter who you are, you can help address this issue in your home. By following the guidelines, you reduce the risk of unintentional diversion or harm.

Talk to your kids: It's important that our children learn about the use and abuse of prescription drugs.

Take advantage of community take-back programs: Call your city or county government's household trash and recycling service or your local police or sheriff's department to see if a take-back program is available in your community.

For a list of permanent disposal sites in West Michigan- www.wmtakebackmeds.org 

Seek treatment and support individuals in recovery: If you or a loved one needs help with substance abuse, find a treatment center near you today. Thousands of individuals who have struggled with addition have now living healthy and happy lives with the help of treatment and recovery services.

Prescription Drug Abuse Resources-General www.cadca.org www.theantidrug.com/resources www.whitehousedrugpolicy.gov www.nida.nih.gov www.samhsa.gov www.dea.gov Streetdrugs.org www.talksooner.org

Prescription Drug Abuse Resources-Parents www.theantidrug.com Parent Toolkit

www.nasn.org/Portals/0/resources/pd_toolkit_parents_advice.pdf

www.talksooner.org

Prescription Drug Abuse Resources-Schools Smart Moves, Smart Choices

www.pbs.org/newshour/thenews/themedic/list.php

Lesson plan for 6-8th graders http://school.discoveryeducation.com

Handouts for teens www.kidshealth.org

Over The Counter Drug Abuse-Cough Medicine Dextromethophan (DXM)-active ingredient FDA approval 1950’s to relieve cough

symptoms. Over 100 OTC medicines that contain DXM

Alka Seltzer cough and cold Coricidin Robotussin Dimetapp Sudafed cough products

Slang terms for Cough Medicine Abuse Skittling Tusssing Robo tripping Triple cs Dex Dex trip

Cough Medicine Abuse- Side Effects Delusions Panic attacks Memory problems Blurred vision Stomach pain, nausea, and vomiting High blood pressure and rapid heartbeat Numbness of fingers and toes Drowsiness and dizziness Fever and headaches Rashes and itchy skin Loss of consciousness

Cough Medicine Abuse Access Points Local grocery stores, pharmacies, chain

stores, gas stations, etc. Buy them from several different stores Friends Medicine Cabinets Local Story- ”Care Baskets”

Cough Medicine abuse Scope of the Problem

3.8% of 8th graders, 6% of 10th graders, and 5.9% of 12th graders are abusing cough medicine (National Institute on Drug Abuse, 2009)

Becoming very common in teen culture, especially on the internet. Hundreds of websites that promotes DXM-containing medicine telling how to achieve the best highs based on their height and weight!

Cough Medicine Abuse: Warning Signs Empty cough medicine boxes or bottles in the

trash, backpack, school locker Purchase or use of large amounts of cough

medicine when not ill Missing boxes or bottles of medications from

the cupboard Changes in friends, physical appearance, or

sleeping, or eating patterns Declining grades Loss of interest in hobbies

Social Networking Web Sites Spread Information about DXM Abuse Detailed instructions and conversations

about DXM abuse Blogs and videos (You Tube) of how and

when kids will take DXM-containing cough medicines

Footage of kids while “high”

““Lean” – “Purple Drank”Lean” – “Purple Drank”

““Lean” or “Purple Lean” or “Purple Drank”Drank”

RecipeRecipeRx Cough Syrup with Codeine and Rx Cough Syrup with Codeine and Promethazine.Promethazine.Cherry Bubble up or Cherry Bubble up or SpriteSpriteTwo watermelon Jolly Two watermelon Jolly Ranchers Ranchers Ice cubesIce cubes

Urban Dictionary Definition of Lean

3. purple drank Purple Drank is an illegal recreational drink popular in the Southern United States rap community, whose main ingredients originally consisted of prescription strength cough syrup, containing codeine and promethazine, and either a carbonated soft drink (generally Sprite) or fruit juice. The purple-ish hue of Purple Drank comes from the dyes in the cough syrup. Recently, the term has expanded to cover mixtures including over-the-counter cough syrup and vodka in place of prescription cough syrup. Other terms for Purple Drank include Barre, Oil, Purple Tonic, Lean (or Southern Lean,) Drank, and Syrup (which is sometimes slangly pronounced as Sizzurp.)

““Lean” or “Purple Drank” Lean” or “Purple Drank” Effects Effects

Altered level of consciousnessAltered level of consciousnessSedative EffectSedative EffectAlcohol often addedAlcohol often addedOut of body experience, euphoriaOut of body experience, euphoriaSweats, fever, confusionSweats, fever, confusion

Legal update: California became the 1st state to

prohibit the sale of OTC cough medicines containing the active ingredient DXM to minors on September 1, 2011

More information www.dxmstories.com www.stopmedicineabuse.org www.doseofprevention.org Fivemoms.stopmedicineabuse.org www.whitehousedrugpolicy.gov www.nida.nih.gov www.abovetheinfluence.com (Teen

based)

Questions Any questions, comments, or thoughts?