Transcript What are designer drugs? - NH Providers Association

Designer Drugs,
Substance Use Disorders (SUD)
& Treatment
Reinhard Straub, LICSW, LCDCS
Cell (401) 741-5109
[email protected]
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Today’s Agenda
Substance Use Disorders (SUD)
Clinical treatment
Designer drugs
Cannabinoids
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In My Experience
SUD require chronic disease management
e.g. diabetes, asthma & hypertension
Communication between medical &
behavioral health treatment et al
Leverage – “Nudge from the judge”
Family involvement
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Experience (cont.)
Unless the psychiatric presentation is
historically primary Traditional psychotherapy, insight oriented
counseling & psychiatry can be ineffective &
even contraindicated
SUD primary = SUD TX is effective
Psych primary = Psych TX with SUD component
is effective
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Do No Harm Hippocrates
The physician must not only be
prepared to do what is right himself,
but also to make the patient, the
attendants and externals cooperate.
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“What is your rehab’s success rate?”
• Indicates a lack of
understanding of SUD
• Same rate of relapse as
diabetes, asthma &
hypertension.
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National Institute of Alcoholism and
Alcohol Abuse $27 million study
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After 6 months
45% were abstinent
After 18 mos.
38% were abstinent
After 36 mos.
27% were abstinent
Same rate as diabetes & asthma
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What Works
5 year monitoring programs for
physicians, nurses, pilots, etc.
48 physician health programs (PHP)
National PHP rate of recovery = 78%
NYS Medical Society = 88% for 5000 MD’s
FAA rate of recovery = 90% of pilots were
abstinent in 5 year program
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3-5 years Coordination
All prescribers including PCP need to aware
of and/or approve all prescribed and OTC
medications
Psychiatric care with experienced prescriber
re Dual Diagnosis & Substance-Induced
Disorders
Coordination of efforts with everyone
involved in participant’s recovery: TX, family,
work/education & all stakeholders
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3 to 5 Year Plan
Individual SUD/dual diagnosis therapy
Group therapy
Toxicology testing – urine, hair, PETH etc.
Documented self-help meeting attendance
Sponsor/mentor
Home Group
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Recovery Activities
Ongoing assessment re need for other
modalities of care e.g. marital, family,
trauma, neuro-psych testing, ED,
gambling, etc.
Holistic activity e.g. exercise, meditation,
yoga, volunteering
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Facts
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RX painkillers =$57 Billion Global sales
USA = 4.6% of the world’s population
Consumes 75% of the world’s RX meds
Consumes 99% hydrocodone
Consumes 81% oxycodone
Recent SAMHSA study - 80% of heroin addicts
started with RX opioids
• Heroin use has doubled in last decade for
young adults 18-25
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Denial
• Primary symptom of SUD
• Unconscious narcissistic
defense to avoid pain
• Normal & Pathological Denial
• Minimization, rationalization &
justification
• Unwilling to go to any lengths
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Denial
• Shame & guilt are the key motivating
factors
• Family denial is greater than the
addict’s denial
• Family & stakeholder denial must be
addressed
• Without external involvement, chances
of success are greatly diminished
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Mindset of the Patient
Immediate short-term objective
“I want what I want when I want it”
Psychotherapy on the way into the OR
Acceptance of the need for chronic
disease management requires
stabilization, TX and more importantly, a
lot of time & effort
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Have everything ready to go – backfill first
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Insurance
Admissions
Finances
Employment issues
Travel logistics
• Child care, pet care
• Remove the barriers
• Packed bag – cigarettes,
etc.
• Enabling?
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Who uses Designer Drugs?
• Average age is 26 & younger
• “To be ignorant of one's ignorance is
the malady of ignorance.” ~A. Bronson
Alcott
• Progressed Substance Use Disorder
• Primary Psychiatric Disorder
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Drug of choice DOC
• DOC is the focus during stabilization &
initial treatment
• DOC becomes increasingly irrelevant
over time
• Recovery activities become the focus
• Thinking or Behavior?
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What are designer drugs?
• A structural or functional equivalent of a
controlled substance that mimics the
pharmacological effects of the original
drug
• Profit
• Avoid being classified as illegal
• Avoid detection in standard drug tests
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Synthesis &
Manufacture
Synthesized for academic or
industrial research, then
“borrowed” for illicit use
Clandestine laboratories
Efficacy and safety unknown
Easy to obtain
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“Chinese labs modify deadly fentanyl to
circumvent ban on (Acetyl fentanyl)…”
AUGUST 26, 2016
“I know a young person who recently died from
furanylfentanyl. he had no idea what he had
gotten himself into. He had lied to a website from
China and said he was using it for his lab he did
not have a lab but just wanted a quick buzz it only
took him one time and he had a seizure and died
…”
https://www.statnews.com/2016/04/26/chinese-sellmodified-fentanyl
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Online Fentanyl Analogue
• “ Furanyl fentanyl online from Ching
Labs
• Furanyl fentanyl (Fu-F) is an opioid
analgesic that is an analog of fentanyl
and is offered from our company as a
research chemical for use in the lab”
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Very Easy to Obtain
Contact Person: Sara Zhang
Email: [email protected]
Website: http://chinglabs.com
Skype: ching.labs
Company: Hebina Higer Chemical Technology
Address: Qibin district,Xinghe street,Xinhua
building, Hebi, Henan, 458030, China
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“For Research Only”
Baofoo Korea,604-7
Digitalro 33 gil 48 Guro-gu
Seoul, South Korea
642-87-00085
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www.best-feel.com
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New Chemicals
Adrafinil Discontinued French stimulant
MDBP Discontinued due to liver damage
MDPH phenethylamine psychodelic
PCP, DXM
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Dissociatives
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Empathogens Entactogens
2-A1MP
6-EAPB coming
6-MAPB
bk-epdp(crystal)
bk-MAPB
Dibutylone(crystal)
Dibutylone(powderl)
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www.best-feel.com
JWH-018
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Naphthoylindo
EAM-2201
MAM-2201
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Pyrrolidin and Pyrrolidinophena
4F-PVP(crystal)
4F-PVP(powder)
a-PBP
a-PVP (powder)
a-PVP(crystal)
a-PVT
PV-8(powder)
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Quinolinylindolee
5F-PB-22
FDU-pb-22
FUB-pb-22
PB-22F
Flakka
Cannabinoid
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www.best-feel.com
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Methiopropamine(MPA)
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Tropanee and Piperidinee
Ethylphenidate(EPH)
Stimulant petroleum derivative
dopamine & norepinephrine reuptake
inhibitor
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psychodelics natural in magic mushrooms
Tryptamin
5-meo-dalt
5-meo-dipt
5-MEO-DMT
5-meo-Mipt
aMt
• Psychedelics
4-Ho-met
ZDCM-04
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www.best-feel.com
• Cannabinoids
5F-MN-18 coming
5F-MN-21(5F-PCN)
5F-MN-24(5F-NNE1)
ADB-CHMINACA
BB-22
EG-018
EG-2201
FAB-144
FU-PX-2
Fub-AKB-48
FUB-AMB
FUB-APINACA
MMB-2201
MMB-CHMINACA
NM-2201
PX-1
THJ-018
THJ-2201
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www.best-feel.com
• Stimulants
23b-PVP
2nmc(crystal)
4-C-PVP(crystal)
4-CDC
4-CEC
4-Cl-PVP(crystal)
4-CMM
4-CPrC
4-MEO-PV8 coming
4-MEO-PV9 coming
4-MPD
4-MPD(white)
4F-Pentedrone coming
4F-PHP
4F-PHP(crystal)
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• Sedatives
Alprazolam
Etizolam
U-47700
www.best-feel.com
XANAX
PCP
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Arylcyclohexylamin
Methoxetamine (MXE)
Methoxphenidine(MXP)
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Benzofurans
5-MAPB
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Cathinon
3-CMC
4-CMC(crystal)
4-CMC(powder)
4-EMC
Pentedrone
MDA Ectasy
Bath Salts
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www.best-feel.com
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Cannabinoids
Indazole based
5-fur-144
5F-AKB-48
AB-chminaca
AB-FUBINACA
AB-FUPINACA
AB-PINACA
ADB-FUBINACA
ADB-PINACA
AKB-48
AMB
MDMB-CHMINACA
PX-2
XLR-11
• Etc. Etc. Etc.
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Psychedelics/Hallucinogens
• LSD, psilocybin (magic mushrooms), mescaline,
peyote
• Potent hallucinogens
• Dangerous for people genetically predisposed for
psychiatric illness
• But these drugs are not directly toxic, even at high
doses.
• They do not interact with receptors that control
functions that cause death i.e. heart rate, temp
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Toxicity of New Drugs
• LSD and psilocybin have specific effects on serotonin
in the brain.
• Designer drugs are not nearly as specific. Besides
serotonin, they variously affect other vital chemical
signals i.e. dopamine and norepinephrine.
• Because these chemical messengers affect cells
throughout the body, they can have drastic,
unexpected effects on vital functions such as heart
rate and body temperature.
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Lack of Analysis
• DEA research lab In the last five or six years
almost 400 new drugs have emerged.
• Jenny Wiley, a behavioral pharmacologist at
RTI International
• “These drugs haven’t even been tested in
animals, much less in humans”
• “People are basically the guinea pigs.”
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“Every new drug is somewhat different”
• Michael Baumann, National Institute on Drug
Abuse in Baltimore
• “When a new drug appears, it’s up to chemists,
pharmacologists and researchers to quickly
develop tests that will detect the drug in a person’s
system and figure out how it works.”
http://cen.acs.org/articles/94/i28/Designer-drug-detectivework.html
• Impossible to stay ahead of secret labs in China,
India, Pakistan etc.
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Bath Salts
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Not traditional bath salts
Central nervous system stimulant drug
Marketed to avoid regulation
Popular among teens & young adults
Contains manmade chemicals such as:
• Methylenedioxypyrovalerone (MDPV)
• Mephedrone (4-MEC)
• Methylone
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Route of
Admission
Intranasal
Intravenous
Smoked
Mixed with food
Mixed with drink
Airborne mist
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Effects
• Similar to cocaine, methamphetamines,
MDMA (Ecstasy) or LSD
• Initial euphoria lasts longer
• Long terms effects unknown
• Users UTI – threat to public safety
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Signs & Symptoms
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Extreme paranoia •
Psychotic features•
Violent behavior •
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Tachycardia
Chest pain
Confusion
High blood pressure
Sweating
Hyper-alertness
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Product Names
Cosmic Blast, Red Dove, Aura,
Zeus 2, Zoom, White Dove, Wave,
Scarface, Hurricane Charlie, Pure
Ivory, Ivory Purple Wave, Vanilla Sky,
Bliss, White, Rush, Blow, Blue Silk,
White Lightening, Ocean, etc, etc.
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Testing Stimulants – Bath Salts
Alpha PVP, Butylone, 4-Bromo-2,5
dimethoxyphenethylamine, Cathinone, 3,4
Dimethylcathinone Norephedrine, DOB, 3,4 DMMC,
Ethylone, N-Ethylcathinone Ephedrine, 4Ethylmethcathinone, 3-Fluoromethcathinone, 4Fluoroephedrine,4-Fluoromethcathinone
(Flephedrone), MDPV, Mephedrone
Norpseudoephedrine, 4-Methylethcathinone (4MEC), 4- MEC Metabolite, Methcathinone,
Mephedrone, Methylone, Pentedrone, Pentedrone
Norephedrine, Pentylone, 2C-B-Fly, 2C-C, 2C-E, 2C-I,
2C-N, 2C-P, 2C-T-7, 2C-T-2, 2C-T-4, 25B-NBOMe, 25CNBOMe, 25I-NBOH, 25I-NBOMe, 25I-NBF,25I-NBMD
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Molly
Ecstasy
Initially popular at “raves”, but
now used by a broader range of
social groups.
Taken orally, usually as a
capsule or tablet.
Usually combined with other
drugs – cannabis, alcohol
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MDMA
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Faintness
Panic attacks
Loss of consciousness
Seizures
High Blood Pressure
Heart failure
Kidney failure
Arrythmia
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Blogosphere
"Does anyone know if Ethylphenidate (research chemical)
and alcohol are good together
I can't find any information on it. All i can find is
methylphenidate (Ritalin & Concerta) + alcohol as when
taken together they apparently form Ethylphenidate.
So i guess alcohol won't hurt?... lol. confusing...
a quick response would be brilliant.
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Dark Sites
“The Lycæum is committed to supplying honest
and unbiased information about all aspects of
visionary plants, fungi, and chemicals; as well as
providing a virtual meeting place for members of
the online psychedelic community. We consider
psychedelic drugs to be potentially valuable
teachers and allies.”
“The Lycæum is presently run by a team of
volunteers, and supported entirely by generous
donations of time, money, and bandwidth.”
http://www.lycaeum.org
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Blogs
• “Dr. D.M.T.: or How I Learned to Stop Reality and
Love Psychedelics”
• (MOA Inhibitor) "Sick as Dogs: Harmaline
problems”
• (Psychedelics) “A Wonderful Synergy: the
combined wisdom of Salvia and Ayahuasca”
• “Ayahuasca Dreams: Synergy with Nitrous? Of
course!”
• (DMT) “Botched Huasca: Nausea without any
pesky psychedelic effect? Learn how!”
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Blog Sites with Reviews
“SIMON’S ENDORSED LEGAL HIGH SHOPS”
“Simon’s Wall of Shame: Legal high shop
blacklist
I collect all my online headshop reviews and
legal high scams I know of and review them, so
you will not fall victim to them.”
HTTPS://SIMONSBLOGPARK.COM
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Flakka
• Illicit drug laboratories altered bath salts'
chemical composition slightly to get around
laws and, in the process, made it 30 times
more potent.
• Prevents the brain's neurons from
metabolizing the excitement hormones
• With hours of sustained hormone escalation,
the body temperature spikes as much as 10
degrees
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The next LSD? “Smiles”
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NBOMes – “En-Bombs”
• Chemically resemble mescaline
• Overdose can prompt paranoia, seizures, a racing
heart or high blood pressure.
• “…prone to stab themselves.”
• J. Suzuki et al. “My friend said it was good LSD”:
A suicide attempt following analytically
confirmed 25I-NBOMe ingestion.Journal of
Psychoactive Drugs. Vol. 46, November 2014
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Plant Food
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Cannabis
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NYC K2
Spice AK-47 Geeked up Smacked
Green Giant Scooby Snax Red Giant
Mr. Bad Guy iBlown Trippy
“Since 2015, there have been more than 6,000
synthetic cannabinoid-related emergency
department visits in NYC.”
http://www1.nyc.gov/site/doh/health/healthtopics/k2.page
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AAC Testing - Synthetic
Cannabinoids
A-796260, AB-CHMINACA – 2-Indole Isomer, ABFUBINACA Metabolite, ADBICA,ADBICA NPentanoic Acid Metabolite, ADBICA N-4,5
Hydroxypentyl) metabolite, ADBPINACA,
5FluoroADB-PINACA Isomer, AKB48 N-(4,5
Hydroxypentyl) metabolite, AKB48 5 fluoro Nhydroxypentyl metabolite, APP-FUBINACA, AM
694, AM 694 N-Pentanoic Acid Metabolite, AM 694
N-5 hydroxypentyl metabolite, AM-1248, AM 2201,
AM-2201 4 Hydroxypentyl metabolite, AM 2233,
BB-22, BB-22 3 carboxyindole metabolite, 5 –
Fluoro PB-22, Homologue, JWH-015, JWH -018,
JWH-018 4,5 Hydroxypentyl metabolite
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AAC Testing - Synthetic
Cannabinoids
• JWH-018 5 Pentanoic Acid Metabolite, JWH019, JWH-019 5-Hydroxyhexyl metabolite,
JWH-073, JWH-073 3-Hydroxybutyl Metabolite,
JWH-073 4-Butanoic acid Metabolite, JWH-081,
JWH-122, JWH-122 4,5 Hydroxypentyl
metabolite, JWH-200, JWH-203, JWH-210, JWH
210 4,5 Hydroxypentyl metabolite, JWH-250,
JWH 250 4,5 Hydroxypentyl metabolite, MAM
2201 N-(3,4 fluoropentyl Isomer), MAM 2201 NPentanoic Acid Metabolite, MAM 2201 N-4
Hydroxypentyl Metabolite, RCS-4, RCS-8, UR144, XRL-11 4-Hydroxypentyl metabolite
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What are Cannabinoids?
• Natural cannabinoids – only in plant
• Endogenous cannabinoids – in the body
• Synthetic cannabinoids – in the lab
• Half life of natural cannabis?
• Daily use = no detox
• New potency
• Half life of synthetic cannabinoids ?
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Chemicals in a hemp plant
• Delta-9-tetrahydrocannabinol (THC)
• THC is fat soluble
• THC storage in the body
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Does Pot Kill Brain Cells?
• Evidence
• Accumulation of THC in the body & brain
• Communication effects
• A-motivational Syndrome
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JWH
• John W. Huffman an organic chemist
at Clemson University synthesized analogues
and metabolites of THC, the principal active
component of cannabis.
• JWH-018 is one of these analogues, with
studies showing an affinity for the
cannabinoid (CB1) receptor five times greater
than that of THC.
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K2 Incense
66
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Disclaimer
Package says this is not intended for
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Any unlawful consumption of this
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“Spice” Analysis
• Analysis by the German government
• Mislabeled “harmless herbs” sprayed with
• JWH-018, JWH-073, JWH-200, AM-2201 UR144, XLR-11, AKB4, cannabicyclohexanol,
etc.
• Prescription drug phenazapam
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More Cannabinoids
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“Legal Herbal Bud”
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Hand Sanitizer
Drunken Gummies
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Meth Lab
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Red Dawn Party Enhancer
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Designer Drugs,
Substance Use Disorders (SUD)
& Treatment
Reinhard Straub, LICSW, LCDCS
Cell (401) 741-5109
[email protected]
80
References
“Marijuana and Medicine: Assessing the Science Base.” Janet E. Joy, Stanley J. Watson,
Jr., and John A. Benson, Jr., Editors Division of Neuroscience and Behavioral Health
INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C. 1999
http://spiceaddictionsupport.org/
https://en.wikipedia.org/wiki/Designer_drug
http://www.drugabuse.gov/publications/drugfacts/mdma-ecstasy-or-molly
https://www.erowid.org/chemicals/ghb/ghb.shtml
http://www.rxlist.com/suboxone-drug/medication-guide.htm
http://www.cbsnews.com/news/methadone-to-blame-for-one-third-of-us-prescriptionpainkiller-deaths-cdc-says/
http://www.drugs.com/suboxone.html
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References (cont.)
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J. Suzuki et al. “My friend said it was good LSD”: A suicide attempt following
analytically confirmed 25I-NBOMe ingestion. Journal of Psychoactive Drugs. Vol.
46, November 2014. doi: 10.1080/02791072.2014.960111
J. Suzuki et al. Toxicities Associated With NBOMe Ingestion—A Novel Class of
Potent Hallucinogens: A Review of the Literaturee.Psychosomatics.Vol. 56, March
2015. doi: 10.10166
M. Baumann et al. Powerful cocaine-like actions of 3,4methylenedioxypyrovalerone (MDPV), a principal constituent of psychoactive 'bath
salts' products. Neuropsychopharmacology. Vol. 38, March 2013. doi:
10.1038/npp.2012.204
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