2. Disclaimer
This presentation is meant to provide basic awareness
information on herbal incense products and bath
salts.
There are hundreds of products being smoked for
cannabis-like effects
Manufacturers constantly change product ingredients
and market products under new names to circumvent
the law.
Constantly moving target
Product names and lists, as well as the list of synthetic
cannabinoids, in this presentation are not all
inclusive.
4. “SMILES”
2C-1 HalluCinogen syntHetiC drug
Part of tHe 2C family of drugs
Powder or Pill form
often mixed witH CHoColate and Candy
sCHedule 1 Class of drug in July 2012
According to LAPD, there has been an increase of overdose
deaths from this drug recently. Popular with teens and college
students.
Formulas were published in book “PiHKAL: A chemical
Love Story” (Transform Press, 1991)
5. “Smiles”
Dessa Bergen-Cisco, a Professor of Public Health at
Syracuse University stated, “Basically, it’s a pure and
potent form of estacy or MDMA”.
Effects are compared to a potent combination of
MDMA and LSD with terrifying hallucinations and
superhuman strength.
Overdoses have been reported in California, Ohio,
and other states.
6.
7. “SMILES”
Recently in the news due to Johnny Lewis, 28, who
was known for his role in the television show, “Sons of
Anarchy” killed 81 year old landlady and her cat before
jumping to his death. No evidence of drugs were
found in his system.
One guy began beating his head into the ground.
One 17 year old in North Dakota overdosed and was
observed shaking, growling, and foaming at the
mouth. Another teen died the night before from the
drug.
Does not show up on drug screens
8. Effects
Anxiety leading to panic attacks, seizures, distortions
of time. Hyperventilation
Nausea and Vomiting
Terrifying auditory and visual hallucinations and
feelings of fear and panic. Last hours to days.
Increased heart rate (arrhythmia). Can cause strokes
Can cause seizures and kidney failure
Causes muscles to contract
Elevated body temperatures
Giddiness and relaxed state
9.
10. BATH SALTS
• Refers to products
containing synthetic
cathinones, that are
chemically similar to
cathinone, an organic
stimulant, that occurs
naturally in the Khat plant.
Highly pure white or brown
powder or crystal form.
Mostly seen in powder form.
11. BATH SALTS
First developed in research labs and became a popular
party drug in Europe and UK
Spread overseas around 2010 and began to show up
mostly in states like Louisiana, Kentucky, and
Tennessee. Some had regional names like “Hurricane
Charlie” and “Bayou”.
Other product names include Bliss, Blizzard, Blue
Silk, Ivory Snow, Vanilla Sky and Ivory Wave.
Highly publicized as of late with the cannibalistic
attack in Miami.
15. Marketing
Sold commercially as bath salts, plant fertilizer, toy cleaner,
pond cleaner, cell phone cleaner, jewelry cleaner, insect
repellant, glass cleaner, and toilet cleaner. Newest is ladybug
attractant.
Chemicals imported mainly from China.
Sold mainly on the internet buy also in “head shops”,
convenience stores, and gas stations.
It is not the stuff you find at Bath and Body Works!!!
16.
17. Chemical Makeup
There are several synthetic cathinones. The most
common found in “Bath Salts” are MDPV
(methylenendioxypyrovalerone), mephedrone(4-
MMC), or methylone. The primary ingredient in
most bath salts is MDPV, which is a CNS stimulant
and increases dopamine and serotonin.
MDPV – at least 4x potency of ritalin or concerta.
15-30 minutes to onset, peak effect around 1.5
hours and last around 6 – 8 hours.
18. Bath Salts
People can get an effect from 3 – 5 mg. The average
dose is 5 – 20 mg.
Taken orally, IV, nasal inhalation, or rectally.
Snorting and swallowing are the most common
methods of use.
High risk for overdose due to packages containing as
much as 500 mg. Each packet contains varying
amounts of the chemical.
19. BATH SALTS
Marketed as legal
alternative to LSD,
cocaine, ecstacy, and
methamphetamine.
Chemists say it has the
worst attributes of
these.
Labeled not for human
consumption but the
sole purpose is for
human consumption.
20. Bath Salts – Generation 2
New type of bath salt called Amped has been reported
by users in Virginia.
Six people recently reported to hospitals in
Virginia that they ingested this drug.
It is being marketed as ladybug attractant.
21. Naphyrone
Referred to as “Cosmic Blast” and marketed as
jewelry cleaner. Contains MDPV and
Naphydrone, which is 0-2482 and
Naphthylpyrovalerone derived from Pyrovalerone.
Reuptake inhibitor of serotonin.
Stays in system for long periods. Body
temperatures of up to 107 degrees have been
reported.
22. BATH SALTS
Users do not know how
much or what they are
getting. Cost about $25
- $50 per 50 mg packet.
Very inexpensive and
readily available high.
23.
24.
25.
26. EFFECTS
Adrenaline rush for hours and superhuman strength.
Users often become paranoid that they are being attacked
and experience a “excited delirium”. This includes
fearlessness, rage, and strength, as well as, delusions of
invulnerability.
Stops neurons in the brain from reabsorbing dopamine
and norephinephrine immediately after secreting them so
leads to triggering of survival behaviors.
27. WHAT DO THEY DO?
“MDP V increases the body’s concentration of adrenaline-
like hormones that prepare the heart and muscle tissue for
“flight or fight” response”, explained Thomas Penders an
associate professor at ECU.
"One system of circuits in our brains are wired to detect
and respond to threats. Overstimulation of this circuit
leads to overestimation of actions by others as threatening.
When the system becomes overwhelmed, as it does [from
an overdose of] 'bath salts,' a condition develops known as
'excited delirium,'" he said
28. WHAT DO THEY DO?
Overdoses of crack cocaine, methamphetamine,
ecstasy and PCP can also induce "excited delirium."
It's a state of paranoid fearfulness and rage mixed with
seemingly superhuman strength, as more oxygen is
delivered to muscles, increasing their power. "This, to
some extent, explains the bizarre aggressive behaviors
we have seen during the recent rash of 'bath salt'
cases," Penders said *
“Science” on nbcnews.com 6/4/2012
29. EFFECTS
Increased dopamine and serotonin and affects mood
and perception.
Cold fingers and an intolerance to pain
Body temperatures of up to 107 degrees have been
reported. Often people take their clothes off.
Jerking eye movements and foaming at the mouth
have been reported.
Restlessness and inability to sit still.
30. EFFECTS
Increased heart rate and blood pressure.
Panic attacks and chest pains are often why people
show up in ER’s.
Auditory and Visual Hallucinations with common
themes of monsters, demons, aliens, and God.
Irritability, suicidal thoughts, and self-harm
behaviors.
Diminished thirst
Can relapse into hallucinations and paranoia weeks
after last use.
33. Concerns
A Marquette County, Michigan ER reported 35 admissions
from November 2010 to March 2011. This prompted Law
Enforcement to seize all bath salts from a local
convenience store. The products tested all contained
MDPV.
17 out of 35 were hospitalized. Median age was 28 years
(range 20 -55 years). 54
54% were Men, 69% self-reported a history of drug abuse,
46% or 16 patients had a history of mental illness, and 17%
reported suicidal thoughts/attempts related to use of bath
salts.
34. Concerns
US Army Medic, David Stewart, killed his wife and 5 year
old son in April 2011 after he and his wife were using bath
salts. He shot his wife and suffocated his son the day
before. He was using “Lady Bubbles” bath salts.
7 people under the age of 27 died in 2 Cleveland Hospitals
after using the drug.
According to the Bangor Daily News, domestic violence
calls have increased in Maine due to use of Bath Salts.
Cookeville Regional Medical Center in TN has treated 160
people since 2010.
Store was broken into four times in one month.
35. Dangers and Dependency
A research study led by UNC professor CJ Malanga,
MD found that mephedrone, like cocaine, has a high
potential for abuse and addiction.
“The effects on the brain’s reward circuit are
comparable to similar doses of cocaine”
The rodents in the study worked harder to get less
reward. The drug activated the brain’s reward circuit
involved in positive reinforcement.
NIDA.org 2012
36. Legality
The Synthetic Drug Prevention Act signed by
President Obama on July 9, 2012. This act bans the
synthetic compounds found in synthetic THC and
Bath Salts, and makes them Schedule I.
States will have to incorporate these into their drug
scheduling list and update the list as new substances
are discovered.
37.
38. Poison Control Center Data
CALLS TO POISON CONTROL: 304 in 2010, 6,138 in
2011, and 2,468 as of October 31, 2012. Ages <6 to over
59. Most ages 20 – 29.
January – 228/301 July – 361/680
February – 230/487 August – 173/602
March – 264/639 September – 119/512
April – 285/600 October – 98/401
May – 295/720
June – 415/743
www. aapnc.org 1-800-222-1222
40. TREAMENT
Often eat up Emergency Room resources as it takes
multiple nurses and doctors to treat users.
Difficult to know what someone has taken unless they
self-report or someone else reports.
Does not show up on typical toxicology screens and
can not be detected by drug dogs. There are now
drug tests that do test for Bath Salts. Ammon labs,
Redwood Toxicology, and Dominion Diagnostic offer
these drug screens.
41. TREATMENT
Antipsychotics to treat psychosis
Benzodiazepines to decrease agitation
Ten to twenty times the normal dose of sedatives have
been used.
Try to avoid using restraints, but speak reassuringly to
people who are agitated and paranoid
Move to a quiet room with low light to help calm
patient.
Avoid loud noises and try medications prior to
restraint.
42. TREATMENT
Monitor the person for suicidal ideation even after
they have stopped using the drug. Address both
mental health and addiction issues.
Psychotic symptoms often persist after treatment
Enhance coping skills to assist the person in dealing
with anger and other emotions.
No standard treatment protocol for MD’s or others so
treat symptoms of the individual.
Train staff to deal with specialized issues and
incorporate questions into intake and assessment.
43. Movie Madness
BATH SALT ZOMBIES
Available on DVD February 19
Bath Salt Zombies is a new horror film directed and
co-written by Dustin Wayde Mills (Puppet Monster
Massacre, Zombie A-Hole, Ballad of Skinless Pete) and
produced and co-written by Clint
Weiler of Aggronautix. The movie sensationalizes the
recent bath salt epidemic and the attacks
surrounding them
44. “Zombie Apocalypse”
The shocking wave of attacks associated with Bath
Salts has sparked fears of a real-life zombie outbreak
in the south. This led to The Center for Disease
Control and Prevention releasing a statement saying it
is not aware of any virus that can cause zombie-like
behavior.
45. What next?
Partnerships and networks between the community
and law enforcement have made an impact in the sale
and distribution of this drug.
Education regarding the dangers of Bath Salts.
47. What is Spice and K2?
Spice and K2 refer to commercially available products
sprayed with chemicals called synthetic cannabinoids.
These products claim to be a mixture of herbs but
often do not have herbs in them. They include other
ingredients that are unknown and not listed.
Many have warning labels as not intended for human
consumption, but are solely intended for human
consumption. Marketed as incense. Resembles
potpourri.
48. Synthetic Cannabinoids
Synthetic Cannabinoid products are manufactured in
Asia and sold in US in many different arenas (gas
stations, liquor stores, smoke shops and internet)
Sold under different brand names: “K2, Spice, Spice
Gold, Spice Black, Mr. Nice Guy, Yucutan Fire and
many others”
Since the national ban on five synthetic cannabinoids,
new brand names have developed, such as K2 Sky, K3,
and K4
49. What is a Synthetic Cannabinoid?
A class of synthetic substances that bind to the
cannabinoid receptors(CB1 and CB2) in the body.
When used they create a high similar to THC. Bind
more strongly than THC. There are hundreds of
synthetic cannabinoids.
Used in an attempt to avoid laws that make marijuana
illegal. National Ban on five cannabinoids began in
March 2011.
50. History of Spice and K2?
The cannabinoid-like chemicals were first developed
in research laboratories to study receptors in the body
and brain and for other research purposes. The five
banned cannabinoids are JWH-018, 073, 200, CP 47,
and 497.
JWH-018 was first made in 1995 by Dr. John Walter
Huffman at Clemson University. Manufacturers read
research and copied it to produce this cannabinoid
and marketed it for commercial distribution.
Brand “Spice” was released in 2004 and gained
popularity in 2006.
51. Spice and K2
The company that started the “Spice” line went from
assets of 65,000 Euros in 2006 to 899,000 Euros in
2007. Spice was the dominant brand until 2008.
Then competing brands like “K2” hit the market. Now
there are many distributors of these products.
Rick Broider with North America Herbal Incense
Trade Association estimates profits at 5 billion per
year.
In 2011, Redwood Toxicology Lab developed testing
for six synthetic cannabinoid chemicals. 72 hours for
urine and 24 – 48 for saliva.
56. Other Herbal Incense Products
Genie Spike 99
Yucatan Fire Blaze
Dream Spark
Ex-ses Fusion
Blaze MANY others!
57. Spice Ingredients
One or more synthetic cannabinoid compounds. Can
be different mix each time.
JWH-018, CP 47, 497, C8, JWH-073, and JWH-250 have
been found most often in spice products.
Other legal substances such as Pink Lotus,Dwarf
Skullcap, Indian Warrior, and Lion’s Tail
Potentiate or add to effects
Create different effects between products
Many have psychoactive effects on their own
Some used as marijuana substitutes in the past.
Cost $30 - $40 per 3 gram bag.
58. Other Synthetic Cannabinoids
HU named after Hebrew University where they were created.
HU-210
Various studies show it is anywhere from 66-800 times more
potent than ∆9 THC1
Schedule I under CSA: Illegal in U.S.
HU-211
Studies tentatively show no ∆9 THC-like effects
Used to research treatment of brain damage related to stroke,
brain trauma, glaucoma, and multiple sclerosis
HU-311
Has potent antineoplastic and antiproliferative activity
(cancer fighting drug)
1
J. Med. Chem.35 (11): 2065–9.
59. Synthetic Cannabinoids
CP 47,497 and analogues (CP Created by Pfizer)
3 to 28 times more potent than ∆9 THC
CP 55,940
45 times more potent than ∆9 THC
JWH-015
JWH-018 4-5 x more potent than THC and same chemical
structure shared with known cancer causing agents.
JWH-073
WIN 55,212-2 (WIN is for Sterling Winthrop)
Used to research treatment for Alzheimer's
Effects milder and don’t last as long as ∆9 THC
60. Other Herbal Incense Ingredients (Not all inclusive)
Baybean Pink Lotus
Blue Lotus Marsh Mallow
Lion's Tail Red Clover
Lousewort Rose
Indian Warrior Vanilla and Honey
Dwarf Scullcap Fly Agaric
Maconha Brava Siberian Motherwort
Indian Pennyworth Damiana
Clove Stevia Leaf
Hops Lemon Grass
Tribulus Terrestris Turnera diffusa
Many other legal herbs and herbal extracts are used to enhance aroma, potency
61.
62. Why Do People Use It?
Herbal incense products are smoked or snorted for
marijuana-like effects
Legal substitute to marijuana
Other reasons: increase creativity, reduce stress,
experience euphoria, increase personal insight, and
increase appreciation for the arts
There are numerous blogs and websites the provide
users the opportunity to share experiences.
63. Effects
Marijuana-like effects: euphoria, giddiness, silliness,
bloodshot eyes, impaired short-term memory and
concentration, and “munchies.”
Other common effects: cotton mouth, light
sensitivity, a warm sensation in the limbs, dry eyes,
paranoia, light headedness, auditory and visual
hallucinations, painless head pressure, time
distortion, panic attacks, delirium, impaired
coordination, and sleeplessness
Onset/duration: 5-10 minutes, and effects vary from 2
hours for JWH and 5-6 for CP. Can get high off a hit
or two.
64. Effects
A number of users experience hangover-like effects
the morning after use including dry mouth, intense
headaches
Depending on the product, inhaled smoke is as harsh
as marijuana smoke
Taste can vary from a very bad to sickly sweet.
65. Effects
One hospital reported a patient with a 1-3 gram a day
habit and severe withdrawal symptoms (tremors,
headache, nausea, vomiting and depression).
One person reported spending $2000 in the last
month on Spice and Bath Salts.
66. Dangers
A Boston University School of Medicine study
suggests that use may cause increase in paranoia,
hearing voices, disorganized behavior, and panic
symptoms.
Psychotic symptoms may last for a few days to
months.
Another study found these products may create
psychosis in patients with no history of psychiatric
disorder.
Overdose potential from unknown amounts and
ingredients in products.
68. Dangers
Poison Control Centers had 112 calls in 2009, 2906 in
2010, 6,959 in 2011, and 4,161 by September 10, 2012.
Users are experimenting with combining different
products, which can dramatically change or increase the
effects. These cannabinoids were created for
experimental use. Not tested on people. No one knows
long term effects of these products.
Public health concern over possible metal residue in
these products.
69. Dangers
JWH-018 and others, have a shared chemical structure
with cancer causing agents, according to NIDA.
A hospital in Kansas reported 8-10 people
hospitalized in past month after smoking the
products with hallucinations, seizures and bleeding
from the nose and mouth.
Three teens ages 16 and 18, showed up in ER with
anxiety, agitation, excessive sweating, and inability to
speak.
70. Dangers
Kids’ brains are still developing.
Across the US, people are showing up in emergency
rooms with aggressive and unusual behavior. Suicides
have been reported.
A NIDA study stated 11% of school seniors have used
Spice/K-2 in 2011. Second most frequently used drug
after THC.
Medical personnel often don’t know what they are
dealing with unless the person self-reports.
73. Paraphenalia
Herbal incense smokers will use the same or similar
products used by marijuana smokers
Pipes, bongs, hookahs
Rolling papers
Blunts (hollowed out cigars packed with product)
Herbal incense specific paraphernalia
Vapor Genie
Grinders (to further grind into a finer mixture)
76. Controlled Substances Act
In Nov. 2010, the USDEA moved to ban 5 synthetic
cannabinoids, placing them in Schedule I status due
to high potential for abuse, and no known medical
benefits. The ban would be in effect for one year.
The ban was delayed due to companies stating the
ban was unconstitutional.
On March 1, 2011 the National Ban was enacted.
This means that is illegal to possess and sell products
containing these.
Before the ban, 15 states had already taken action to
control one or more of these five chemicals.
77. Challenges - Manufacturing
Manufacturing occurs in countries where synthetic
cannabinoids are legal.
As detection catches up with manufacturing, makers
will alter ingredients. They are using new ingredients
which are not illegal at this time.
Federal bans target larger distributors. States will
need to go after smaller distributors.
78. Challenges - Marketing
Product will not cause positive drug test
“There's never been a case reported by our clients that
any of our Herbal Smoke Blends caused them to fail a
test”
“YOU'LL NEVER FAIL A DRUG TEST”
Why would this be an issue for a product marketed as
incense and not for human consumption?
79. Challenges - Marketing
Ingredients1
Synthetic cannabinoids not listed
Listed ingredients are not necessarily in the product
Consumers don’t know what they are actually getting
Raises questions of consumer protection and product
misrepresentation
1
Understanding the ‘Spice’ Phenomenon Thematic Paper, European Monitoring Centre for Drugs
and Drug Addiction, 2009, Portugal
81. ENERGY DRINKS
American Association of Poison Control Centers –
(www.aapnc.org) urges the public to use caution
using these products.
Highly concentrated amounts of sugar, caffeine, and
other ingredients. Was mixed with alcohol in the past
and sold next to bath salts.
Caution for children and adolescents. Children
should not have it and adolescents should not have
more than 100 mg of caffeine per day = one cup of
coffee*
*Journal of Pediatrics
82. Energy Drinks
Due to labels, it is often hard to know how much
caffeine is in the drink.
Drinks contain natural caffeine-containing
ingredients that are not separately listed, such as,
yerba mate, cacao, and guarana.
These drinks are considered dietary supplements and
not regulated by the FDA so there is no limit to
amount of caffeine that can be in them.
Drinking too many at one time or too fast ……..
83. EFFECTS
Nausea and vomiting Seizures
Insomnia Kidney Problems
Delirium Mood Changes
Headache Increased BP
Altered and increased heart rhythm
Withdrawal
Chest Pains
Dehydration
Sweating
84. BATH SALTS & ENERGY DRINKS
A 28 year old man was found passed out in a random
person’s driveway, and was taken to the hospital. It was
discovered that the man had overdosed on energy drinks
and bath salts.
According to a report by the Caledonia Police, officers
found the man lying on the floor of his van.
An individual said he found the van in his own driveway.
The individual stated the the engine was off and that no
keys were found in the ignition. The victim was found
slouched over the steering wheel. There was a cell phone
in the man’s possession, and the last dialed contact was
that of his mother.
85. POISON CONTROL CENTER
2607 calls to Poison Control Centers
related to the use of Energy Drinks through
October 31, 2012
86. Resources
Life Center of Galax is equipped
to treat persons using these
substances. Our confidential
referral and assessment number is
1-800-345-6998. We are available
24/7 to speak with anyone.
