This presentation aims to describe and compare the new designer drugs, #KratomEffects or sometimes referred to as "legal highs" (kratom, bath salts and k2, among others) to the opiates and cocaine from the good old days.

1. Not Your Mother’s Drugs:
The New Designer Drugs
1
Diane A. Tennies, Ph.D., LADC
Lead TEAP Regional Health Specialist
Humanitas, Inc.

2. Learning Objectives
 Describe the different designer drugs including
synthetic cannabinoids, bath salts and kratom
 Discuss why the designer drugs are increasing in
popularity
 Articulate the physiologic effects associated with
their use
 Discuss the current status of federal and state
laws surrounding designer drugs 2

3. Remember When?
Simpler and Easier Times
3

4. ‘The Good Ole Days’
 Opiates
 Cocaine
 Phencyclidine (PCP)
 Extensive scientific literature (clinical and
experimental)
 Kinetics (the chemical process)
 Toxicological effects (on humans)
4

5. Designer Drugs
 Synthetic drugs produced by underground
chemists
 Labeled ‘designer drugs’ as same changes to
chemical structures so are specifically ‘designed’
or altered
 They are technically legal by chemical
formulation
 Commonly used by young people and adults (ages
21-30)
 Originally called “club drugs”
5

6. Designer Drugs (Continued)
 Marketed as having similar effects of the illegal
counterpart
 Easily obtain instructions for mixing, making, dosing
and ingesting synthetic drugs on line (Erowid.org)
 Easily obtained as Internet is flourishing marketplace
 Dangerous and unpredictable side effects because:
 More potent
 Last longer
 Never tested on humans
 No regulatory oversight or quality control
 More addictive potential (intentionally designed)
6

7. Our Brave New World
 K2/Spice – “Fake Pot” – A synthetic cannabinoid
which mimics marijuana
 Bath Salts – The “New Cocaine” – a synthetic
stimulant whose affects last 3 to 4 hours
 Kratom – The “latest” designer drug – A plant
from Thailand with opiate-like properties which
is legal in most areas of USA
7

8. But Is This REALLY a Problem?
American Association of Poison Control Centers Report
For synthetic cannabinoids:
 2009: 15 cases with adverse reactions to Spice
 2010: Over 2500 calls from all 50 states
 2011: 6600 calls through 06/2011*
For bath salts:
 2009: No data
 2010: 303 calls
 2011: 3740 calls through 06/2011*
For research chemicals (2C-E – drugs which mimic LSD and other
drugs):
 2009 : No data
 2010: 22 calls
8
 2011: 75 calls*
*preliminary data as not all centers have reported fully

9. Mother dies after smoking spice: A mother of
two is dead after using a synthetic-marijuana
laced incense known as spice (Middletown,
Indiana 08/04/2010)
Bangor police chief says bath salts
creating crisis – Bangor Daily News
08/01/2011
Never heard of Kratom? Trust Us, You Will –
08/02/2011 In the Fix: Addiction and Recovery
Straight Up
“Bath Salt” Abuse Hits Epidemic Proportions - Emergency
9
Physician’s Monthly Report 04/13/2011

10. Designer Drugs Have a Long History
 Morphine and Heroin made illegal in 1925 =
legal alternatives remained available until 1968
 Synthetic hallucinogen = LSD
 MDMA (Ecstasy) initially introduced in 1912 by
Merck as appetite suppressant. 1970’s became
‘club drug’ and unregulated until 1985
 Crystal methamphetamines
Conclusion: Most illegal drugs have an unregulated
"research chemical”
10

11. Synthetic Cannabinoids
11

12. So If They Are Popular and Legal
Then Sales Can Be Tracked
 “Herbal Incense” (synthetic cannabinoids)
accounted for nearly…..
 Five billion dollars in sales*
12
*Retail Compliance Association (2010)

13. Spice (Named From the Frank
Herbert books)
 Spice gold  K2
 Spice silver  Solar flare
 Spice diamond  K2 summit
 Yucatan fire  PEP Spice
 Sence  Fire n’ Ice
 Chill X  Zombie World
 Genie  Bad to the Bone
 Algerian blend  Black Mamba
 Dark Night
 G-Force
13

14. More Spice
14

15. Let’s Review Marijuana
isted in US Pharmacopea
until 1944 when removed
due to political pressure to
ban social use in USA
annabis preparations have
been used for over 4000 to
6000 years
15

16. Cannabinoids 101
 Occurs naturally in dried flowering/fruiting tops
of Cannabis sativa plant
 Cannabinoids active compounds extracted from
cannabis
 Renewed interest in using cannabinoids for
medicinal purposes
 Discovery of cannabinoids receptors and
endocannabinoids opened new era in research on
pharmaceutical applications of cannabinoids
16

17. What is This Eminent Professor Best
Known For?
 Dr. John W. Huffman,
(JWH) professor of
organic chemistry at
Clemson University in
South Carolina for 50
years
 Ph.D. from Harvard
and the National
Institutes of Health's
Senior Scientist
Award
17

18. Dubious Honor of Being Creator of
Synthetic Cannibinoids
 Researching the
effects of cannabinoids
on the brain (For
NIDA in 1990’s)
 Developed chemical
compounds to mimic
effects of marijuana
(like JWH-018)
 1995 paper contained
the
method/ingredients
and was published 18

19. The Spread of K2/Spice
 K2/Spice is unintended result of scientific research on
marijuana's effects
 2008 - German pharmaceutical company THC Pharm
developed three versions of the herbal incense brand Spice
with JWH-018 as primary ingredient
 By summer of 2009, packets of dried herbs sprayed with
JWH compounds were sold throughout the world as
"herbal incense" products
 March 2011 Drug Enforcement Agency exercises its
emergency scheduling powers and bans five of the
synthetic cannabinoids (JWH-018; JWH 073; JWH 200;
CP47,497; and cannabicyclohexanol)
19

20. 20

21. 21

22. Dr. Hoffman Says:
 The materials to make JWH-018 are available from laboratory
chemical suppliers. A good college senior chemistry major could
probably make them with some supervision and decent lab
equipment. JWH-018 was made by a summer undergraduate
research student, with supervision
 There are no valid, peer-reviewed studies of the effects of this
compound in humans, nor are there any data regarding its toxicity…
it’s like playing Russian Roulette. You don't know what it's going to
do to you. You're a potential winner of a Darwin award (referring to
the tongue-in-cheek awards given to people who “do a service to
humanity by removing themselves from the gene pool”)
 I emphasize that this compound was not designed to be a super-THC.
It should absolutely not be used as a recreational drug
 I’ve lived around the world a long time [79 years old] and come to the
conclusion that if an enterprising person wants to find a new way to
get high, they’re going to do it
 People who use it are idiots
22

23. Physical Form of K2/Spice
 Pure state – either solids or oils
 Smoking mixtures – usually sold in metal-foil
sachets
 Solution of the cannabinoids sprayed onto herbal
mixture
 Contain 3 g dried ‘vegetable matter’
 Price comparable to marijuana (with the ban
price seems to have increased)
23

24. Effects of Synthetic Cannabinoids:
Research Says…
 Behavioral pharmacology studies show JWH-018
has Δ9-THC-like activity in animals
 In mice, it decreases overall activity, produces
analgesia, decreases body temperature and
produces catalepsy
 A search in the literature found no published
studies of the effects of JWH-018 in humans
24

25. Pharmacology
 Cannabinoids receptor agonists mimic effects of
THC by interacting with CB1 receptors in brain
 Synthetic compounds bind more strongly than
THC (up to 100 x’s more tightly)
 Little known about pharmacology & toxicology
 Long half-lives = prolonged psychoactive effect
25
 Considerable batch variability = highly potential
for overdose

26. Same or Different Chemical
Structures?
JWH-018 THC
26

27. So if Synthetic Cannabinoids and THC
Are Chemically Different…That Means?
27

28. 28

29. Countries That Control Synthetic
Cannabinoids
 Denmark  Austria
 Germany  Poland
 Estonia  Romania
 France  Sweden
 Ireland  UK
 Italy  Chile
 Latvia  Finland
 Lithuania  South Korea
 Luxembourg  Switzerland
29

30. In the United States
 In May 2010, the Department of Defense banned
synthetic cannabinoids from all U.S. military
bases
 Kansas first state to criminalize in 5/2010
 Patchwork of local and state laws current exist
 16 states have laws regulating, in addition to the
federal ban of 03/2011
30

31. So its just ‘fake pot’ right?
What’s the big deal??
When I was young I knew plenty of
people who….
31

32. 32

33. Pharmacological Short-Term Effects
of Smoked Synthetic Cannabinoids
 Altered state of  Panic attacks
consciousness  Severe agitation*
 Mild euphoria and  Numbness and tingling
relaxation (less common)  Severe GI upset/vomiting*
 Perceptual alterations (time
distortions)  Long term altered depth
perception
 Intensification of sensory
experiences  “Flash backs”
 Impaired short-term  Hallucinations/delusions
memory  Tremors and seizures*
 Increase in reaction times  Tachycardia*
 Altered depth perception  Hypertension*
 Death*
*Symptoms NOT consistent
with cannabis intoxication 33

34. Severe Symptoms Are Not Consistent
with Cannabis Use
o Symptoms
 Severe agitation
 Severe GI upset/vomiting*
 Hallucinations/delusions
 Tremors and seizures*
 Tachycardia
o New speculation is these symptoms caused by myriad
on contaminants in the K2/Spice
o (Remember no regulatory oversight or control)
o Long term symptoms: NO RESEARCH on humans
o Withdrawal symptoms: drug craving, nightmares,
sweating, nausea, tremor, headaches, HBP, and 34
racing heartbeat

35. “This isn’t Jerry Garcia’s Marijuana”
(Rep. Jeff Roorda (D), Missouri)
35

36. Bath Salts
36

37. Is It Really Legal?
 As of July 2011 = 28 states have ban possession
of the drug
 There is no federal law prohibiting sale, although
the Federal Drug Enforcement Agency is
considering another emergency scheduling
 The European Union ban bath salts products in
April 2010
37

38. Availability
 Retail outlets include:
 Head Shops
 Truck stops
 Gas stations
 Readily available via Internet
 Benign names
 Ivory Wave, Bliss, White Lightning, Hurricane Charlie, Zoom 2
 50 to 500 milligram packets
 Relatively inexpensive: $25 to $50 per 50-milligram
packet*
 Disclaimer: ‘Not for human consumption’
*According to US Department of Justice 38

39. Bath Salts 101
 Active ingredients are:
 MDPV (methylenedioxypyrovalerone)
 Mephedrone (4-methylmethcathinone or 4-
methylephedrone)
 Classified as synthetic stimulant – central
nervous system stimulant
 Method of Use:
 Injection
 Smoking
 Snorting
 Liquid form mixed into alcoholic drinks
39
 Atomizer – occasionally

40. Symptoms Associated With Bath
Salt Use
 Agitation
 Extreme energy
 Paranoia
 Tachycardia
 Sweating/dry mouth
 High blood pressure
 Hallucinations
 Combative behaviors
 Rapid onset of suicidal ideation – can remain for
days/weeks
40

41. Extreme Behaviors Associated With
Bath Salts
 Panama City, Florida: Several officers needed to
subdue a man who tore out a radar unit out of
police car with his teeth*
 Women attached her mother with a machete
because “she was a monster”*
 Another user hospitalized after attempting to
remove his own liver with a mechanical pencil*
 ABC News reported on 06/29/2011 that Federal
DEA agented arrested ten people in first ever
“bath salts” bust
41
*Emergency Physicians Monthly 04/13/2011

42. Kratom
42

43. Kratom
 Latest designer drug to hit America
 Common name for the plant Mitragyna speciosa
Korthals
 Originated South-East Asia
 In Thailand the leaves of this tree-like plant have
been used for centuries for their medicinal and
psychoactive qualities
 Comparable to opiates in symptoms
43

44. Kratom (Continued)
 Kratom is unique because effects depending dose
 Both stimulant and sedative-like qualities
(nicknamed Nature’s Speedball)
 Activates mu- and delta-opioid receptors
 Effects within 5 to 10 minutes of ingesting (typically
in “tea”)
 Lasts 4 to 6 hours
 Include:
 Relaxation and sedation
 Analgesia and euphoria
 More talkative/sociable/energetic
 Not extremely dangerous and rarely lethal 44
 Interacts with other medications for harmful effects

45. Our Brave New World: Revisited
 K2/Spice – “Fake Pot” – A synthetic cannabinoid
which mimics marijuana and undetectable on
drug screens.
 Bath Salts – The “New Cocaine” – a synthetic
central nervous stimulant with highly
unpredictable and dangerous side-effects
resulting in escalating ED visits with no clear
recommended treatment
 Kratom – The latest designer drug – while no
serious concerns yet the opiate-like properties
are of significant potential for abuse
45

46. Comments, Questions, and Concerns
46