Transcript Session 59 – Shoults, Stefanie

Spice, not everything nice…
Synthetic Drug Use
Continued: Focus on
Clinical Presentation and
Intervention
Stefanie Shoults RN MSN
April 22, 2016
The purpose of this presentation is
to
• Provide an overview of synthetic cannabinoid
known on the street as K2/Spice
• Define key terms
• Discuss potent and dangerous side effects
• Explain reason Spice may produce a stronger
reaction than marijuana
• Review Scenarios of adolescent Spice users and
the devastating health effects and long-term
effects of using synthetic cannabinoids
• Discuss clinical implications of synthetic drug
use
Introductions
This presentation will be delivered through the eyes of
a mother and as an educator.
I am
• Parent
• School Nurse
• Mental Health
Nurse
• An Advocate
•Where do you
work and what
you do there?
•What is one
reason you
decided to attend
this training
session?
Educational Objective
At the end of this presentation, participants will be able to:
• Identify the key characteristics and effects of
synthetic cannabinoids.
• Identify at least five reported side effects from
synthetic drug use.
• Identify the reason spice may produce a stronger
reaction than marijuana .
“People high on these drugs can get
very agitated and violent, exhibit
psychosis, and severe behavior
changes…some have been admitted to
psychiatric hospitals and have
experienced continued neurological
and psychological effects.”
(Dr. Rick Dart, AAPCC President)
SOURCE: Dimond, D. This Spice Can Kill You. Posted 8/8/12 at 2:49 p.m.
What we know
• Unlike the drugs we are more familiar with, such as
heroin or cocaine, these synthetic drugs have only
appeared in the last few years and because they are
constantly changing, our knowledge of them is not
as comprehensive as we would like.
• Unlike other drugs, which have been subjected to
years of toxicological and pharmaceutical testing
and numerous clinical trials and research on the
users, what we know about synthetic drugs is often
based on newspaper stories, pro-drug websites, and
“street” information from users or from individuals
who really do not know the facts.
Terminology
Throughout the presentation, the terms Spice,
synthetic marijuana, and synthetic cannabinoids
will be used interchangeably.
Marijuana (Cannabis)
• Delta-9-tetrahydrocannabinol (THC) is the main active
ingredient in marijuana
• THC acts upon specific sites in the brain, called
cannabinoid receptors, kicking off a series of cellular
reactions that ultimately lead to the "high" that users
experience when they smoke marijuana.
• Some brain areas have many cannabinoid receptors;
others have few or none. The highest density of
cannabinoid receptors are found in parts of the brain that
influence pleasure, memory, thinking, concentrating,
sensory and time perception, and coordinated movement.
• Cannabinoid receptors are found in mammalian brain and
spleen tissue.
‘Zombie’ attack Texas-style: Man
tripping on ‘synthetic pot’ goes wild,
attacks family and neighbors, then
eats family dog ALIVE’
Michael Daniel smoked synthetic marijuana,
known as 'spice' or 'K-2, then started his attacks,
while running around on all fours and barking
and growling like an animal.
BY Philip Caulfield
NEW YORK DAILY NEWS
Published: Tuesday, June 26, 2012, 10:44 AM
Synthetic Cannabinoids (SCs)
(a.k.a. Spice)
• Synthetic cannabinoids, "Spice“ are marketed as "safe,"
legal alternatives to marijuana.
• Synthetic cannabinoids, are a large family of
chemically unrelated structures that are designed to be
functionally similar to THC, the principal psychoactive
constituent of marijuana.
• These products contain dried, shredded plant material
and chemical additives that are responsible for their
psychoactive (mind-altering) effects.
• People who smoke synthetic cannabinoids may
experience adverse health effects affecting the
psychological, neurological, cardiovascular, metabolic,
gastrointestinal, and autonomic systems.
Synthetic Cannabinoids (SCs)
(a.k.a. Spice)
• Sold under many names, including K2, fake
weed, Yucatan Fire, Skunk, Moon Rocks
• Marketed as natural “herbal incense” or
“potpourri.”
• Labeled Not for human consumption
• Available convenience stores, smoke shops,
Internet, as well as their promotion on
discussion boards
Spice and K2
• Cost: $30-45 per 3gm
• Route: by smoking (alone
or with marijuana) pipes,
water pipes or rolled
cigarettes; may also be
prepared as an herbal
infusion for drinking.
Origin of Synthetic Cannabinoids (SCs)
(a.k.a. Spice)
• Dr. John Huffman, Clemson
University, organic chemistry
professor was researching effects
of cannabinoids on the brain
when his work resulted in a 1995
paper that contained the methods
and ingredients used to make the
compound (JWH-018, his
initials) Dubious Honor of
Being the Creator of Synthetic
Cannibinoids.
• Was synthesizing analogues and
metabolites of THC
∆9tetrahydrocannabinol, the
principle active component of
marijuana, for research purposes.
JWH-018 is one
of these
analogues, with
studies showing
an affinity for the
cannabinoid
(CB1) receptor
five times greater
than that of THC.
What is Synthetic Cannabinoids (SCs)
(a.k.a. Spice)
• Structurally diverse class of mostly synthetic substances
that bind to cannabinoid receptors in the brain
• CB1, CB2 receptors primarily affect the central nervous
system
JWH-018
JWH-073
HU-210
HU-211
CP47,497
• There are around 100 known synthetic
cannabinoids and 250 chemical compounds
found in the substances.
Synthetic Cannabinoids:
The Major Compounds
a) Naphthoylindoles
b) Cyclohexylphenoles
R1
OH
OH
R3
O
R2
N
JWH-018
JWH-073
JWH-398
JWH-200
JWH-081
JWH-015
JWH-122
JWH-210
JWH-019
JWH-007
AM-2201
JWH-020
JWH-387
AM-1220
JWH-412
5-Fluoropentyl-JWH-122
R1
R2
R3 R
4
CP-47,497-C8
SOURCE: Agudelo et al. (2012). Effects of Synthetic Cannabinoids on the Blood Brain Barrier, Presented at 74th Annual CPDD.
The Emergence of
Synthetic Cannabinoids
JWH-018/073 arrived early and have come and gone.
JWH-250 arrived a little later and has also cycled out.
JWH-081 was part of a second wave that has already completed its cycle.
JWH-122 was part of the same wave but has persisted in popularity and is
part of the current scene.
AM-2201 was part of the same second wave and has gained in popularity,
probably currently the most prevalent.
JWH-022 and JWH-210 are showing signs of increasing popularity.
Recent emergent drugs are the adamantoyl (AM-1248) and
tetramethylcyclopropyl (XLR-11 and UR-144) indoles which are ahead of the
latest attempts to schedule these drug classes.
SOURCE: Logan, B.K. (2012). Testing Strategies to Monitor Novel/Emerging/Designer Drug Use in AtRisk Populations,
Timeline of Synthetic
Cannabinoids and Spice Products
SOURCE: Fattore & Fratta. (2011). Frontiers in Behavioral Neuroscience, 5(60), 1-12.
Factors Associated with Spice
Products’ Popularity
• They induce psychoactive effects
• They are readily available in retail
stores and online
• The packaging is highly attractive
• They are perceived as safe drugs
• They are not easily detectable in
traditional urine and blood samples
• Users express their experience as a
full body high, more intense than
marijuana
SOURCE: Fattore & Fratta. (2011). Frontiers in Behavioral Neuroscience, 5(60), 1-12.
Side Effects of SC Products
•
•
•
•
•
•
•
•
Anxiety
Paranoia
Headache
Vomiting
Psychosis
Diaphoresis
HR/BP increase
Seizures
Cannabis vs. Cannabinoids:
Effects Seen in Clinical Cases
• Most symptoms are
similar to cannabis
intoxication:
–
–
–
–
–
–
–
Tachycardia
Reddened eyes
Anxiousness
Mild sedation
Hallucinations
Acute psychosis
Memory deficits
• Symptoms not typically
seen after cannabis
intoxication:
–
–
–
–
–
–
–
Seizures
Hypokalemia
Hypertension
Nausea/vomiting
Agitation
Violent behavior
Coma
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.
Federal Efforts to Ban Synthetic Drugs
•Mar 2011: Five synthetic cannabinoids were temporarily
categorized as Schedule I substances under the CSA.
•Oct 2011: DEA exercised its emergency scheduling authority to
control some of the synthetic substances used to manufacture bath
salts; these synthetic stimulants are now designated as Schedule I
substances.
•Dec 2011: House of Representatives approves the Synthetic Drug
Control Act (HR 1254).
•July 2012: Congress passed and President Obama signed the
Synthetic Drug Abuse Prevention Act.
•At least 41 states and Puerto Rico have legislatively banned
synthetic cannabinoids.
Drug Enforcement
Administration (DEA) has
designated the five active
chemicals most frequently
found in Spice as Schedule I
controlled substances,
making it illegal to sell, buy,
or possess them.
Manufacturers of Spice
products attempt to evade
these legal restrictions by
substituting different
chemicals in their mixtures.
NM SB 134 (2011)
SENATE BILL 134
50TH LEGISLATURE - STATE OF NEW MEXICO FIRST SESSION, 2011
INTRODUCED BY
Sue Wilson Beffort
AN ACT RELATING TO CONTROLLED SUBSTANCES; AMENDING THE
CONTROLLED SUBSTANCES ACT; MAKING IT A CRIME TO POSSESS AND
DISTRIBUTE SYNTHETIC CANNABINOIDS; PROVIDING PENALTIES; DECLARING
AN EMERGENCY.
NEW MEXICO SB 134 (2011)
JWH-122; JWH-073; JWH-019; JWH-018; JWH-250; CP
47,497 and homologues; HU-210; JWH-298; JWH-015;
and 5-(1,1-dimethylheptyl)-2-(3-hydroxycyclohexyl)phenol.
Challenges with
Chromatography Screening
•
•
•
•
•
•
•
•
Lack of availability of the reference standard for new drugs limited number of banned chemicals on books.
Hundreds of potential compounds used in manufacturing process
Moving target – Spice industry responds to bans, laboratories must
respond in kind
Lack of complete understanding of metabolism
Variable quality of reference standards
Lack of purity and labeled internal standards
Chemical similarity of new drugs within a class requires
great care with identification
Sensitivity (correctly IDs the drug)
SOURCE: Logan et al. (2012). Journal of Forensic Sciences, 57(5), 1168-1180.
Detection
• JWH-018 usage is readily detected in urine using "spice" screening
immunoassays from several manufacturers focused on both the
parent drug and its omega-hydroxy and carboxyl metabolites. JWH018 will not be detected by older methods employed for detecting
THC and other cannabis terpenoids.
• Detection period roughly 24-72 hours in urine.
▫ Only metabolites are detected in urine
▫ Typically JWH metabolites analyzed due
Detection approximately 12-48 hours in blood and oral fluid.
Comprehensive epidemiological data regarding the extent of
synthetic drug use in the United States remains quite limited.
Most of the data available originates from law enforcement
reports, poison control calls, toxicology results, case reports.,
and new questions added to existing survey instruments.
Calls Received by U.S. Poison Control Centers for
Human Exposure to Synthetic Marijuana, 2010 to
Dec. 2012
The number of calls in 2011 were
more than double that in 2010
6,968
5,202
2,906
2010
2011
Jan-Dec 2012
SOURCE: American Association of Poison Control Centers, Spice Data, updated August 2012.
Usual “SPICE” Presentation to
Health Office
•
•
•
•
•
•
•
Psychotic
Vomiting – clear and non odorous
Temperature 101 F – 106 F
Tachycardia 150-200+
Dilated pupils greater than 7mm
Agitated
Paranoid/fearful
Case Scenarios –
Reason I speak to you today
High School Senior
•
•
•
•
•
•
•
•
No history of drugs or alcohol
No disciplinary history
Top ten percent of academic class
Eagle Scout
Active with church
Engaged in extracurricular activities
Presents to school “God is commanding him”
Sudden psychotic break after using synthetic
marijuana
High School Senior
• “I had a normal child on a Tuesday and a not
normal child on a Friday” – mom of student
• Two years later now 20, has been
institutionalized 17 times for psychiatric care
and has made 3 suicide attempts
• Is homeless living in the tent he had for Boy
Scout Trips
• Graduated early with a 504 plan in place
• Second senior of that graduating class to require
support and early graduation due to spice and
psychosis
A case of Dependence
• 17 year old patient reported he had smoked “Spice Gold” daily for 8
months.
• He developed a tolerance and rapidly increased the dose to greater
3g per day. He felt a continuous desire for the drug and kept using
it despite the development of persistent cognitive impairment.
• Urinary drug screens were negative on admission to the local
hospital, as they were again on discharge.
• On hospital day 4-7, he developed inner unrest, drug craving,
nocturnal nightmares, profuse sweating, nausea, tremor, and
headache.
• His blood pressure was elevated for two days, with a maximal value
of 180/90mm Hg accompanied by a resting heart rate of 125/mm.
Anthony
• 28 Year Old
• No previous medical- cardiac history
• Died February 2014 as a result of heart failure secondary
to Infective Endocarditis with Vegetation
• Carried a mental health diagnosis r/t SPICE
• Addicted to Spice X 3-5 years
• Initial cardiac admission Oct 2012; next admission Oct
2013 when he was told he was terminal
• Colin Kane, a pediatric cardiologist at UT Southwestern
& Children's Medical Center in Dallas confirms there is
something in the K2 that can cause heart attacks and
cardiac damage
Long term impact: DEATH
• Anthony was released October 2012 from Lubbock Hospital in less
than a week to his biologic father – who could not understand
smoking fake weed could cause illness being seen in 25 year old son.
• At behest of biologic mother, grandparents, … Anthony was
transported to Midland Heart Hospital for evaluation =findings of
normal cardiac function with a review of initial presentation to
Lubbock, unknown sought clarification of any congenital problem,
injury, …
• Taken to inpatient mental health facility near Midland Texas… He
discharged AMA within 24 hours. Picked up by his biologic father
due to all other family being afraid of him. He begged to stop and
purchase SPICE all the way home, 100 miles. Drug seeking
behavior, no acknowledgement that he had just been released from
CCU.
Final months – SPICE takes all
• Anthony continued to use SPICE from Oct. 2012 – Oct. 2013
growing increasing psychotic, agitated, unmanageable. No
compliance with medication or therapy recommendations.
• He was admitted to various hospitals, treatments centers, rehabs.
• Oct. 2013 readmitted to Lubbock almost one year to the day of
original admission: cardiac damage beyond repair, unless willing to
comply with daily medication regime, dietary and water restrictions,
being managed with a cardiac port for medication for next 6
months.
• He was lucid, organized, friendly, funny, and normal once detoxed –
hospitalized for two weeks, then he went home without needed
treatments.
• Sporadic spice use until his death
Why I speak to you today
• Anthony’s funeral was Valentine’s Day 2014. At
his funeral, I made a promise to my husband of
28 years that I would speak out to make other
parents aware of the dangers and educate
persons working with adolescents.
• Anthony was my step son. Even with 30 years
of nursing experience, four years of spice
recognition, and endless resources in friends
who are also in the field, Anthony succumbed to
this drug and died a painful death.
In honor of
ANTHONY REY GOMEZ 11-1-1985 –2- 10-2014
Questions
I have continued slides for your information on other common
synthetic drugs and more detailed information on them. These
Slides can be used as to familiarize you and your work site
with other substances
Synthetic Cathinones:“Bath Salts”
•Synthetic cathinones are structurally and pharmacologically
similar to amphetamine, Ecstasy, and other related
substances, which stimulate the central nervous system.
•Synthetic cathinones are related to the parent compound
cathinone, one of the psychoactive principals in khat. (“cot”)
•Synthetic cathinones are sold in retail stores and on the
internet as “bath salts,” “plant food,” and “jewelry cleaner.”
•People who have consumed synthetic cathinones may
experience adverse health effects affecting the
cardiovascular, psychological, neurological, musculoskeletal,
gastrointestinal, pulmonary, and otolaryngological
systems.
Khat
• Pronounced “cot”
• Stimulant drug derived from a shrub
(Catha edulis) native to East Africa and southern
Arabia
• Use is considered illegal, because one of its
chemical constituents, cathinone, is a Schedule
I drug
• Khat found in the U.S. often comes in by mail
from Africa
SOURCE: NIDA. (2011). NIDA DrugFacts: Khat.
“Tales of Bath Salts and
Zombie Cannibalism”
•Bath Salts made headlines in summer 2012 when a
story of possible cannibalism was reported in
Miami, FL
•The Miami-Dade Medical Examiner found no
traces of bath salts, LSD, or synthetic marijuana in
the perpetrator's system
•The sole psychoactive substance detected was
cannabis (marijuana)
Synthetic Cathinones:
“Bath Salts”
•
•
•
•
•
•
•
Could be MDPV, 4-MMC,
mephedrone, or methylone
Sold on-line with little info on
ingredients, dosage, etc.
Advertised as legal highs, legal meth, cocaine, or ecstasy
Taken orally or by inhaling
Serious side effects include tachycardia, hypertension,
confusion or psychosis, nausea, convulsions
Labeled “not for human consumption” to get around
laws prohibiting sales or possession
CNS Stimulants
SOURCE: Wood & Dargan. (2012). Therapeutic Drug Monitoring, 34, 363-367.
Product Marketing
•
•
•
•
•
•
•
•
•
Mtv
MDPK
Magic
Super Coke
Peevee
Energy-1 (NRG1)
Charge Plus
White Lightning
Scarface
• Cloud 9
• Ocean
• Ivory Wave
MDPV –
Developed in the 60’s for chronic fatigue and
appetite suppression.
Similar in structure to MDMA, but more of a stimulant.
MDMA
• Route: Intranasal most common
• Also: oral, smoking, rectal, and IV
• White to light brown crumbly powder
• Degrades if exposed to air for significant
periods of time
Pharmacology of MDPV
• CNS stimulant similar to methamphetamine,
MDMA, or cocaine
• Norepinephrine-dopamine reuptake inhibitor
(NDRI)
• Increased alertness, arousal, anxiety, agitation,
diminished requirement for food and sleep,
sexual arousal
• Tachycardia, hypertension, vasoconstriction,
diaphoresis
Effects of MDPV
• “High” lasts 2-4 hours
• Physical effects may last 6-8 hours
• May cause seizures, panic attacks, or psychosis
with high doses or increased frequency of use
• Avg dose: 5 to 20mg
Other Sequelae of MDPV
•
•
•
•
•
Trismus (inability to open mouth) or bruxism
Panic attacks
Psychosis with sleep deprivation
Hallucinations, delusions, suicidal ideation
Abstinence syndrome: depression, lethargy,
anxiety, postural hypotension
• Leads to frequent re-dosing
Mephedrone –
Originally developed 1929
• 4-methylmethcathinone
(4-MMC)
• Meow Meow
• MCAT
• Miaow
• Drone
• Plant Feeder
• Bubbles
Routes of Administration
• Oral ingestion
▫ Swallowing capsules
▫ Bombing (swallowing powder
wrapped in cigarette paper)
• Inhalation (snorting)
• Rectally (either plugging or
enema)
• IV (use 1/2 to 1/3 dose)
Pharmacology
• NE-DA reuptake inhibitor
• Similar to MA/MDMA (Ectasy)
▫ Reportedly less potent, shorter duration
• Oral dose: 20-50mg
• “Come up”: 10-20 min
Amphetamine
• Peak: 45-60 min
• “Comedown”: 60-120 min
• Re-dosing: common, can
result in crushing chest pain
• Mephedrone reduces to 4-methylephedrine
– a known Cardiotoxic compound
Mephedrone
Synthetic Cathinones are b-keto
(‘bk’) Analogs of Amphetamine
Effects of Mephedrone
• Euphoria
• Sociability
• Stimulation
• Sexual Arousal
• Music Appreciation
• Hallucinations
Mephedrone Side Effects
• Loss of appetite
• Increase in body temperature,
sweating, hot flushes
• Tense jaw, bruxism, stiff neck,
muscle clenching
• HR/BP elevation, chest pains
• Dehydration
• Mydriasis, nystagmus
• Painful nasal drip/ulcers in
mouth (after inhalation)
• Insomnia, paranoia, anxiety,
dysphoria, psychosis
Calls Received by U.S. Poison Control
Centers for Human Exposure to Bath
Salts, 2010 to July 2012
The number of calls in 2011 were over 20
times that in 2010
6,138
6,138
304
2,078
2,078
304
2010
2011
Jan-July 2012
SOURCE: American Association of Poison Control Centers, Bath Salts Data, updated August 30, 2012.
Clinical Symptoms of Synthetic Cathinone Use
in Patients Admitted to the Emergency
Department (N=236)
Agitation
82%
Combative/Violent behavior
57%
Tachycardia
56%
Hallucinations
40%
Paranoia
36%
Confusion
34%
Myoclonus/Movement disorders
19%
Hypertension
17%
Chest pain
17%
CPK elevations
SOURCE: Spiller et al. (2011). Clinical Toxicology, 49, 499-505.
9%
Emerging Drug Items Identified in
U.S. NFLIS Tox Labs: 2010 – 1/2 2012
(1/2 2012 incomplete)
SOURCE: U.S. DEA, Office of Diversion Control, NFLIS data,
2012.
Current and Future Epidemiology
• No data on prevalence of use
• American Association of Poison Control Centers:
Bath Salts:
▫ 2010: 292 calls
▫ 2011: 469 calls (2/14/11), a projected14-fold increase
How Psychoactive Substances Work
• Because of their chemical
structure, alcohol and
drugs have dramatic
effects on
neurotransmitters in CNS.
• Effects on:
– Mental processes
– Behavior
– Perception
– Alertness
SOURCE: NIDA. (2010). Drugs, Brains, and Behavior: The Science of Addiction.
Commonly Used Psychoactive Substances
SUBSTANCE
EFFECTS
Alcohol
(liquor, beer, wine)
euphoria, stimulation, relaxation, lower
inhibitions, drowsiness
Cannabinoids
(marijuana, hashish)
euphoria, relaxations, slowed reaction
time, distorted perception
Opioids
(heroin, opium, many pain meds)
euphoria, drowsiness, sedation
Stimulants
(cocaine, methamphetamine)
exhilaration, energy
Club Drugs
(MDMA/Ecstasy, GHB)
hallucinations, tactile sensitivity, lowered
inhibition
Dissociative Drugs
(Ketamine, PCP, DXM)
feel separated from body, delirium,
impaired motor function
Hallucinogens
(LSD, Mescaline)
hallucinations, altered perception
SOURCE: National Institute on Drug Abuse.
“Designer” Psychoactive Substances
SOURCE: http://www.drugs-forum.com.
62
MDMA (Ecstasy)
• 3, 4-methylenedioxy-methamphetamine
• Street terms: Adam, E, X, XTC, love drug, Molly
• A synthetic, psychoactive drug with both
stimulant and hallucinogenic properties similar
to methamphetamine and mescaline
• Adverse effects: enhanced physical activity,
sweating, lack of coordination, mental confusion,
jaw clenching, hyperthermia, and agitation
NIDA. (2010). NIDA InfoFacts: MDMA (Ecstasy).
Party Drugs Identified by U.S.
Toxicology Labs: 2005-2011
SOURCE: U.S. DEA, Office of Diversion Control, NFLIS data analysis by J.C. Maxwell.
2C-Phenethylamine
• A broad range of compounds that share a common
phenylethan-2-amine structure.
• Some are naturally occurring neurotransmitters
(Dopamine and Epinephrine), while others are
psychoactive stimulants (Amphetamine),
entactogens (MDMA), or hallucinogens (the 2C-X
series of compounds).
• 2 C-X can be snorted or dissolved into a liquid and
placed on blotter paper under the tongue.
• May last 6-10 hours; onset takes 15 min to 2 hours.
• Reports of seizures and renal failure.
SOURCE: U.S. DEA, Office of Diversion Control. (2012). National Forensic Laboratory Information System Special Report:
Emerging 2C-Phenethylamines, Piperazines, and Trypamines in NFLIS, 2006-2011.
Spread of 2C-Phenethylamine
throughout the United States
SOURCE: U.S. DEA, Office of Diversion Control. (2012). National Forensic Laboratory Information System Special Report:
Emerging 2C-Phenethylamines, Piperazines, and Trypamines in NFLIS, 2006-2011.
Piperazines
• Frenzy, Bliss, Charge, Herbal ecstasy, A2, Legal Z, Legal E.
• Mainly available over internet and sold as ecstasy pills that
are “safe.”
• Two classes: (1) benzylpiperazines (BZP) and (2)
phenylpiperazines (TFMPP).
• Mimics effects of ecstasy (MDMA); dangerous with seizure
disorders, psychiatric illness, or coronary disease.
• Adverse events included hypertension, reduced
consciousness, psychotic episode, hallucinations,
tachycardia, hyperthermia, coma. Could be toxic if
combined with MDMA or amphetamines.
SOURCE: Arbo, Bastos, & Carmo. (2012). Drug and Alcohol Dependence, 122(3), 165-258.
BZP & TFMPP
Benzylopiperazine (BZP) and trifluoromethylphenylpiperazine (TFMPP) identified in US
Toxicology Labs (NFLIS).
2007
2008
2009
2010
2011
½ 2012
BZP
274
4,252
8,943
5,216
3,536
1,082
SOURCE: U.S. DEA, Office of Diversion Control, NFLIS data analysis by J.C. Maxwell.
TFMPP
106
1,532
2,825
1,647
1,225
367
What is
DXM?
Dextromethorphan is a psychoactive drug
found in common over the counter cough medicines.
SOURCE: NIDA. (2001). NIDA Research Report Series: Hallucinogens and Dissociative Drugs.
Dextromethorphan (DXM)- Triple C
• Dextromethorphan’s slang names include Orange Crush,
Triple C's, C-C-C, Red Devils, Skittles, DXM or dex (for
dextromethorphan), Vitamin D, Robo, Robo-trippin', Candy and
Robo-dosing
• At high doses, produces dissociative hallucinations
(distance from reality, visual effects with eyes open and closed;
perceptual changes, drug liking, mystical-type experiences similar to
use of psilocybin.)
• Can also produce tachycardia, hypertension, agitation,
ataxia, and psychosis at high doses.
• Users of DXM engage in “dose dependent” behaviors in
which they try to gauge the amount of the drug they take
to produce the desired effects, which they call “plateaus”.
Plateau is the mildest effect and the 5th plateau will
guarantee a trip to the hospital.
Past Month Use of Coricidin®:
Texas Secondary School Survey
2004-2010
SOURCE: Texas Department of State Health Services (DSHS), data analysis by J.C. Maxwell.
A Few Other Psychoactive
Substances to Throw in the Mix…
• Kratom – opioid-like effects
• Salvia divinorum – hallucinogenic
effects
• Methoxetamine – “legal ketamine”
• Methcathinone – synthesized 1928 , used
in Soviet Union in the 1930’s and1940’s as an anti-depressant.
SOURCE: Rosenbaum et al. (2012). Journal of Medical Toxicology, 8(1), 15-32.
Synthetic Cannabinoid Varieties
2010
SOURCE: U.S. DEA, Office of Diversion Control, NFLIS data,
Synthetic Cannabinoid Varieties
2011
JWH250
12%
SOURCE: U.S. DEA, Office of Diversion Control, NFLIS data,
Synthetic Cannabinoid Varieties
2012 (through 8/27/12)
SOURCE: U.S. DEA, Office of Diversion Control, NFLIS data,
Synthetic Cathinone Varieties
2010
SOURCE: U.S. DEA, Office of Diversion Control, NFLIS data,
Synthetic Cathinone Varieties
2011
SOURCE: U.S. DEA, Office of Diversion Control, NFLIS data,
Synthetic Cathinone Varieties
2012 (through 8/27/12)
SOURCE: U.S. DEA, Office of Diversion Control, NFLIS data,
References
• Brunt, T.; Poortman, A.; Niesink, R.; Van Den Brink, W. (2010). "Instability of
the ecstasy market and a new kid on the block: mephedrone". Journal of
psychopharmacology.
• Drug Enforcement Administration: Office of Diversion Control; Drug and
Chemical Evaluation Section. Methylenedioxypyrovalerone [(MDPV) (1-(1,3Benzodioxol-5-yl)-2-(1-pyrrolidinyl)-1-pentanone]. Available at:
www.deadiversion.usdoj.gov/drugs_concern/mdpv.pdf.
• EMCDDA (2009). Action on new drugs briefing paper: Understanding the
‘spice’ phenomenon. A report from an EMCDDA expert meeting, 6 March,
2009, Lisbon.
• Wehrman J. U.S. Poison Centers Raise Alarm about Toxic Substance
Marketed as Bath Salts; States Begin Taking Action. AAPCC. February 14,
2011. Available at:
http://www.aapcc.org/dnn/Portals/0/prrel/FEB14BATHSALTSUSE.pdf
• Winstock, A.; Mitcheson, L.; Deluca, P.; Davey, Z.; Corazza, O.; Schifano, F.
(2010). "Mephedrone, new kid for the chop?". Addiction 106 (1).
Resources for Continued Learning
• American Association of Poison Control Centers,
www.aapcc.org
• Drug Enforcement Administration,
www.dea.usdoj.gov
• European Monitoring Centre for Drugs and
Drug Addiction, www.emcdda.europa.eu
• National Institute on Drug Abuse,
www.nida.nih.gov
• Office of National Drug Control Policy,
www.ondcp.org
• Refer to the Synthetic Drugs Reference List**
81
Thank you for your time!
Contact Information
Stefanie Shoults RN MSN
Hobbs High School
575-433-0204
[email protected]