Transcript 2016 Recreational Drugs PPS946 K Smithx

Recreational Drugs –
The Latest and Greatest
Kelly M. Smith, PharmD
PPS946 – April 2016
Objectives
• Recognize novel recreational drugs of
abuse by their product availability,
pharmacological effects, slang terminology,
and product risks
• Identify major treatment considerations for
acute exposure
• Identify the substance
– Context clues
– Specimen drug screen
– Likely “cocktails”
• Pharmacology / pharmacodynamics
– Desired AND undesired effects
– Timeline for response
INFORMATION
NEEDED
Airway
Breathing
Circulation
Decontamination
Enhanced elimination
Focused therapy (antidote)
Get help (toxicology consultation)
GENERAL
MANAGEMENT
Adapated from: http://www.kfx.org.uk/drug_facts/drug_facts_images_and_pdfs/rcb9.jpg
Synth Cath
Codeine /
Promethazine
N-Bomb
Synth MJ
GHB
Codeine/Promethazine Syrup
• Euphoriant
– Consumed in a mixture of soda and candy
– Popularized by hip-hop culture
• Street names: Syrup, Purple Drank,
Sizzurp, Lean
• In KY, must be > 18 to purchase
• Seizures, cardiac arrest, respiratory arrest
• Acute Treatment Considerations
– Support vitals; anticipate seizures
http://www.drugabuse.gov/drugs-abuse/emerging-trends
http://www.drugfree.org/newsroom/rapper-lil-wayne-released-from-hospital-after-seizures-linked-to-reported-use-of-sizzurp
GHB
• Gamma hydroxybutyrate
– Dose-related CNS depressant
• CIII prescription drug for cataplexyassociated narcolepsy (sodium oxybate;
Xyrem®)
– CI without prescription
• Gamma butyrolactone (GBL) and 1,4
butanediol (BD) are structurally similar
Smith KM et al. Am J Health-Syst Pharm 2002; 1067-76.
GHB
• Administered orally, with rapid absorption
• Euphoria is desired effect of users
– Drowsiness, confusion, dizziness, loss of
consciousness
• Slang names
– G, Georgia Home Boy
– Liquid Ecstasy
– Easy Lay
Smith KM et al. Am J Health-Syst Pharm 2002; 1067-76.
GHB
• Respiratory arrest, aspiration and other
effects typical of ethanol overdose
• Acute Treatment Considerations
– Supportive care (vitals)
Smith KM et al. Am J Health-Syst Pharm 2002; 1067-76.
Synthetic Marijuana
• Herbs, spices sprayed with a synthetic
material similar to THC
• Street names: K2, Spice, Bliss, Black
Mamba, Blaze, Bombay Blue
• Often marketed as incense
• Smoked in joints or pipes, occasionally
consumed as a tea
• Temporarily categorized as Schedule I
http://www.drugabuse.gov/drug-guide/k2-spice
Synthetic Marijuana
• Pale skin, seizures, diaphoresis,
hypertension, tachycardia
• Dysphoria, paranoia, delusions,
hallucinations, agitation
• Acute Treatment Considerations
– Support vitals
– Minimize stimulation
http://www.drugabuse.gov/drug-guide/k2-spice
Ketamine
• Dissociative anesthetic with hallucinogenic
properties
– Chemical cousin of PCP
• Street names: Cat Valium, Kit Kat, Special K
• Drug facilitated sexual assault
• Prescription solution for injection
– Tablets in other countries
• Controlled substance (CIII)
Smith KM et al. Am J Health-Syst Pharm 2002; 1067-76.
Ketamine
• Swallowed, snorted or injected
• Dizziness, sedation, hypersalivation
• Respiratory depression, seizures, cardiac
arrest
• Acute Treatment Considerations:
– Support vitals
– Reduce stimuli
Smith KM et al. Am J Health-Syst Pharm 2002; 1067-76.
N-Bomb or 2C Drugs
• Synthetic hallucinogens sold as “legal”
forms of LSD and mescaline
– 25I-NBOMe, 25C-NBOMe, and 25B-NBOMe
– Street names: legal acid, smiles, 25I
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Powder, liquid, blotter
Schedule I
Seizures, cardiac arrest, respiratory arrest
Acute Treatment Considerations
– Support vitals
http://www.drugabuse.gov/drugs-abuse/emerging-trends
MDMA
• Methylenedioxymethamphetamine
• Ecstasy, X, E,
Molly, Lover’s
Speed,
• “Rolling”
• Manufactured illicitly; classified as CI
• “Combo” methamphetamine / mescaline
• Tolerance may develop
Smith KM et al. Am J Health-Syst Pharm 2002; 1067-76.
http://www.drugabuse.gov/drugs-abuse/emerging-trends
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“Ecstasy”
Increased energy
Talkative, open-minded
Intimacy and libido
Distorted senses
Decreased fear, aggression,
defensiveness
• Hallucinations
Smith KM et al. Am J Health-Syst Pharm 2002; 1067-76.
http://www.drugabuse.gov/drugs-abuse/emerging-trends
MDMA – Acute Response
• Hyperthermia, rhabdomyolysis
• Cerebral edema, seizures, serotonin
syndrome
• Hypertension, tachycardia, arrhythmias
• Trismus, bruxism
• Acute Treatment Considerations
– Support vitals
– Prepare to treat hyperthermia, rhabdo,
Smith KM et al. Am J Health-Syst Pharm 2002; 1067-76.
seizures
http://www.drugabuse.gov/drugs-abuse/emerging-trends
Synthetic Cathinones
• Suggested “uses” - bath salts, plant food,
herbal incense
– “Not for human consumption”
• Marketed under a number of brand names
(e.g., Ivory Wave, Purple Wave)
– Flakka is common street name; ”zombie” drug
• Desired effects – CNS stimulation,
hallucinations
– Superior “high” to cocaine
http://www.drugabuse.gov/publications/drugfacts/synthetic-cathinones-bath-salts
Synthetic Cathinones
• Schedule I substance
• Structurally similar to methcathinone (CI), an
amphetamine-like alkaloid
• Stimulate release and inhibit reuptake of
norepinephrine, serotonin and dopamine
• Crystals or powder usually inhaled, but can
be ingested or injected
http://www.drugabuse.gov/publications/drugfacts/synthetic-cathinones-bath-salts
Synthetic Cathinones
• Extreme agitation, aggressive behavior and
paranoia
• Tachycardia, anxiety, tremor, hypertension,
hyperthermia
• Acute Treatment Considerations:
– Minimize stimuli
– Prepare to control agitation
– Support vitals
http://www.drugabuse.gov/publications/drugfacts/synthetic-cathinones-bath-salts
The “Educated” Consumer
• Concomitant use is likely
• “Customize” the social experience
– Combinations of hallucinations, stimulation,
euphoria, etc.
– Paraphernalia as enhancements
– Attempts to combat side effects