designer drugs: drugs, which are created (or reformulated, if the drug already existed) to get...
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Designer Drugs:
drugs, which are created (or drugs, which are created (or reformulated, if the drug already reformulated, if the drug already existed) to get around existing drug existed) to get around existing drug laws CSA (controlled substance act), laws CSA (controlled substance act), usually by modifying the molecular usually by modifying the molecular structures of existing drugs to varying structures of existing drugs to varying degreesdegrees
Sources of Incense Products:
internet/on-line sources “head” shops/alternative medicine stores
/ convenience stores/flea markets 1-(800) phone ordering services individual distributors
Preparation of the “incense”:
Botanical plants/herbs are Botanical plants/herbs are sprayed with liquid preparations sprayed with liquid preparations of:of: HU-210HU-210 HU-211HU-211 CP 47,497CP 47,497 JWH-018JWH-018 JWH-073JWH-073
JWH-250JWH-250 JWH-081JWH-081 JWH-210JWH-210 XLR-11, UR-XLR-11, UR-
144144 And many And many
moremore
Origins of Synthetic Cannabinoids
CP 47,497 - developed by Pfizer in 1980 as an CP 47,497 - developed by Pfizer in 1980 as an analgesic (pain reliever)analgesic (pain reliever)
HU-210 & HU-211 - synthesized at HU-210 & HU-211 - synthesized at Hebrew Hebrew UniversityUniversity, Israel in 1988. HU-210 is an anti-, Israel in 1988. HU-210 is an anti-inflammatory; HU-211 as an anesthetic inflammatory; HU-211 as an anesthetic
JWH-018 & JWH-073 - synthesized by a JWH-018 & JWH-073 - synthesized by a researcher at Clemson (1995) for use in THC researcher at Clemson (1995) for use in THC receptor research - receptor research - John W. HuffmanJohn W. Huffman
more than 200 different synthetic cannabinoids more than 200 different synthetic cannabinoids have been createdhave been created
How K2/Spice works:Synthetic Cannabinoids act as THC agonists
-An agonist is a chemical that binds to a An agonist is a chemical that binds to a receptor and triggers a response – often receptor and triggers a response – often mimicking the action of the naturally occurring mimicking the action of the naturally occurring substance.substance.
ReceptorDrug (agonist)
Why Change the Key?• prolong the effect of the drugprolong the effect of the drug• increase the potency of the drugincrease the potency of the drug• ““selectselect”” the desired effect the desired effect• avoid patent infringementavoid patent infringement• make the drug more difficult to make the drug more difficult to
detectdetect• make an illegal drug make an illegal drug ““legallegal””
Drug
Pharmacological Effects of Synthetic Cannabinoids are Similar to THC increase heart rate & blood pressure altered state of consciousness, mild euphoria relaxation, perceptual alterations (time distortion) intensification of sensory experiences pronounced cognitive effects impaired short-term memory reduction in motor skill acuity increase in reaction times Sickness kidney damage
Reported Effects of Synthetic Cannabinoids are different to THC
production inconsistencies herbal incense blends are harsher to inhale effect on appetite is non-existent increased restlessness & aggressive behavior herbal incense produces a shorter “high” (perceptual
alterations & sensory effects are limited) doesn’t mix well with alcohol (hangovers) incense costs more than marijuana?
Cannabis vs. Cannabinoids: Effects Seen in Clinical Cases
Most symptoms areMost symptoms aresimilar to cannabissimilar to cannabisintoxication:intoxication:
-Abnormally rapid heart rate-Abnormally rapid heart rate– Reddened eyes– Reddened eyes– Anxiousness– Anxiousness– Mild sedation– Mild sedation– Hallucinations– Hallucinations– Acute psychosis– Acute psychosis– Memory deficits– Memory deficits
Symptoms notSymptoms nottypically seen aftertypically seen aftercannabis intoxication:cannabis intoxication:
– – SeizuresSeizures– Potassium deficiency– Potassium deficiency– Hypertension– Hypertension– Nausea/vomiting– Nausea/vomiting– Agitation– Agitation– Violent behavior– Violent behavior– Coma– 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.
Drug Testing: Synthetic THC / K2 Rapid, onsite instant test Rapid, onsite instant test (as of 3/1/12)(as of 3/1/12)
Laboratory-based screening test (limited)Laboratory-based screening test (limited) Most Laboratories are employing LC/MS/MS Most Laboratories are employing LC/MS/MS
technologytechnology Primarily via urine, however some labs can Primarily via urine, however some labs can
test via oral fluid and bloodtest via oral fluid and blood $$$ varies greatly$$$ varies greatly Onsite vs Lab is very different testing Onsite vs Lab is very different testing
methodologymethodology
On-site vs Laboratory testing for K2
On-site K2On-site K2 JWH-018 & JWH-073 JWH-018 & JWH-073
primarilyprimarily
Cut-off at 25 or 50ngs/mlCut-off at 25 or 50ngs/ml Testing limited Testing limited
metabolitesmetabolites
Much higher threshold to Much higher threshold to trigger positivetrigger positive
Screening technologyScreening technology
Laboratory K2Laboratory K2 JWH-018, 073, plus *17 other JWH-018, 073, plus *17 other
synthetic cannabinoid structuressynthetic cannabinoid structuresJWH-019, 081, 122, 200, 203, 210, 250, 398, AM2201, JWH-019, 081, 122, 200, 203, 210, 250, 398, AM2201,
MAM2201, RCS4, RCS8, AM-694, AM-1248, AKB-48,UR-144, MAM2201, RCS4, RCS8, AM-694, AM-1248, AKB-48,UR-144, XLR-11XLR-11
Cut-off 1ng/ml or lessCut-off 1ng/ml or less Testing for hydroxy acid & other Testing for hydroxy acid & other
components/metabolitescomponents/metabolites Detecting presenceDetecting presence
Confirmatory technologyConfirmatory technology
*Redwood Toxicology Laboratory*Redwood Toxicology Laboratory
What synthetic compounds (or metabolites) What synthetic compounds (or metabolites) are being tested by the laboratories?are being tested by the laboratories?
no standardized urine cutoff levelsno standardized urine cutoff levels no standardized methods (LC/MS/MS)no standardized methods (LC/MS/MS) tests detect metabolitestests detect metabolites no independent quality control materialsno independent quality control materials no proficiency testingno proficiency testing keeping up with molecular changeskeeping up with molecular changes
Detection Window ???
testing for metabolitestesting for metabolites educated guess - same as real educated guess - same as real
marijuana?marijuana? many labs advertise many labs advertise ““up to 72 hoursup to 72 hours”” limited studies limited studies passive inhalation?passive inhalation? fact is - we donfact is - we don’’t know all the answerst know all the answers
Wet Marijuana Embalming Fluid-Soaked Marijuana:Embalming Fluid-Soaked Marijuana:
smoking marijuana soaked in embalming fluid is gaining smoking marijuana soaked in embalming fluid is gaining popularity throughout the United States. The syndrome popularity throughout the United States. The syndrome of intoxication looks nearly identical to that seen of intoxication looks nearly identical to that seen following phencyclidine (PCP) use, with agitation, following phencyclidine (PCP) use, with agitation, disorganized speech, and thoughts, and diminished disorganized speech, and thoughts, and diminished attention. This new trend in drug use involving attention. This new trend in drug use involving marijuana also presents a resurgence in PCP use.marijuana also presents a resurgence in PCP use.
Soaked in water – uneven burnSoaked in water – uneven burn Mixed with PCP: wet, fry, crystal joint, supergrassMixed with PCP: wet, fry, crystal joint, supergrass Mixed with codeine containing cough syrupMixed with codeine containing cough syrup Mixed with methamphetaminesMixed with methamphetamines
What’s in Bath Salts:
MDPV MDPV (Methylenedioxypyrovalerone) - a (Methylenedioxypyrovalerone) - a psychoactive drug with powerful stimulant psychoactive drug with powerful stimulant properties which acts as both a norepinephrine & properties which acts as both a norepinephrine & dopamine reuptake inhibitor (NDRI). “A two for”dopamine reuptake inhibitor (NDRI). “A two for”
usually snorted like cocaineusually snorted like cocaine duration of effect 2-3 hours /adverse effect 6-8 duration of effect 2-3 hours /adverse effect 6-8
hrshrs MDPV - no history of FDA approved medical useMDPV - no history of FDA approved medical use Sold as a “research chemical”Sold as a “research chemical” adverse medical or psychiatric ramificationsadverse medical or psychiatric ramifications
amphetamine-like properties, powerful stimulantamphetamine-like properties, powerful stimulant ““rediscoveredrediscovered”” by synthetic chemists in 2003 by synthetic chemists in 2003 reformulation of cathinone, a chemical found in reformulation of cathinone, a chemical found in
the khat plant of Eastern Africathe khat plant of Eastern Africa khat existence traced to 15th C. Ethiopiakhat existence traced to 15th C. Ethiopia khat is banned in the U.S.khat is banned in the U.S.
Mephedrone (Methylmethcathinone)
Methylone (3,4-methylenedioxy-N-methylcathinone)
very similar to MDMAvery similar to MDMA stimulant stimulant phenethylamine, amphetamine, and phenethylamine, amphetamine, and
cathinone propertiescathinone properties euphoria and increased sociabilityeuphoria and increased sociability insomnia and restlessnessinsomnia and restlessness hallucinations and psychosishallucinations and psychosis
Bath Salts and beyond!!!Expanded Synthetic Stimulant Panelαα-PVP-PVP
BZPBZP
ButylonButylon
BuphedroneBuphedrone
CathinoneCathinone
EthyloneEthylone
FlephedroneFlephedrone
MBDBMBDB
mCPPmCPP
MDAMDA
MDEA MDEA
MDMAMDMA
MDPVMDPV
Mephedrone Mephedrone
MethcathinoneMethcathinone
4-Methylethcathinone 4-Methylethcathinone
MethyloneMethylone
PentedronePentedrone
PentylonePentylone
PyrrolidinopentiophenonePyrrolidinopentiophenone
TFMPPTFMPP
Synthetic Seizures & Cathinone Varieties
(through 8/27/12)
SOURCE: U.S. DEA, Office of Diversion Control,NFLIS data, 2012
MDMA – Molly / Ecstasy- Molly is not new, exactly.
- MDMA, or 3,4-methylenedioxy-N-methylamphetamine, was patented by Merck pharmaceuticals in 1914
- did not make much news until the 1970s, when psychotherapists began giving it to patients to get them to open up.
-arrived at New York nightclubs in the late 1980s, and by the early ’90s
- Ecstasy was quickly embraced by Wall Street traders and Chelsea gallerinas. as demand increased, so did the adulterants in each pill (caffeine, speed, ephedrine, ketamine, LSD, talcum powder and aspirin, to name a few), and by the new millennium, the drug’s reputation had soured.
- in the last decade, it returned to clubs as Molly, a powder or crystalline form of MDMA that implied greater purity and safety: Ecstasy re-branded as a gentler, more approachable drug. (Molly for molecule)
- thanks in part to that new friendly moniker, MDMA has found a new following in a generation of conscientious professionals who have never been to a rave and who are known for making careful choices in regard to their food, coffee and clothing. - -
Molly - continued common side effects, include teeth grinding, dehydration, anxiety, insomnia, fever and common side effects, include teeth grinding, dehydration, anxiety, insomnia, fever and
loss of appetite. loss of appetite. more dangerous ones include hyperthermia, uncontrollable seizures, high blood more dangerous ones include hyperthermia, uncontrollable seizures, high blood
pressure and depression caused by a sudden drop in serotonin levels in the days after pressure and depression caused by a sudden drop in serotonin levels in the days after use, nicknamed Suicide Tuesdays.use, nicknamed Suicide Tuesdays.
capsules sell for $8 to $40.capsules sell for $8 to $40. the most common Molly additives are bath salts, including methylone and mephedrone. the most common Molly additives are bath salts, including methylone and mephedrone.
Bath salts are chemically similar to MDMA.Bath salts are chemically similar to MDMA. A report recently released by the DEA's New York division highlighted the results of 143 A report recently released by the DEA's New York division highlighted the results of 143
lab tests over the past four years of substances suspected of being Molly. Only 13% of lab tests over the past four years of substances suspected of being Molly. Only 13% of the drugs were MDMA, while 41% were 4-MEC, a type of bath salt, and 20% were the drugs were MDMA, while 41% were 4-MEC, a type of bath salt, and 20% were methylone. methylone.
Veteran MDMA users say they ask that drugs be tested before they buy them, using kits Veteran MDMA users say they ask that drugs be tested before they buy them, using kits that can be bought online. "If I'm getting more than a gram, they'll test it right in front that can be bought online. "If I'm getting more than a gram, they'll test it right in front of you," said a 27-year-old ad salesman from Oakland, Calif. DanceSafe, an organization of you," said a 27-year-old ad salesman from Oakland, Calif. DanceSafe, an organization that promotes safety at raves, sets up testing tables at some events.that promotes safety at raves, sets up testing tables at some events.
Pharmacological Effects of “Bath Salts”:
increase heart rate & blood pressure pupil dilation, rapid speech hyperactivity, arousal, & over stimulation increased energy & motivation euphoria - agitation dizziness, nausea hallucinations, seizures, convulsions breathing difficulties!!! diminished perception of the requirement for food and diminished perception of the requirement for food and
sleepsleep death
Testing for Bath Salts??Yes! However:
No on-site, rapid, instant testsNo on-site, rapid, instant tests No laboratory-based screening testsNo laboratory-based screening tests Laboratories employing GC/MS and Laboratories employing GC/MS and
LC/MS/MS technologiesLC/MS/MS technologies Detection times remain unknownDetection times remain unknown Best procedure for detecting Best procedure for detecting
metabolites vs parent drug unknown metabolites vs parent drug unknown
2C-I Nicknamed “Smiles”
popular among teens, responsible for dozens of popular among teens, responsible for dozens of overdoses and deaths especially in Midwest. overdoses and deaths especially in Midwest.
white crystalline powder, typically snorted or white crystalline powder, typically snorted or ingested.ingested.
High & Effects can last a few hours to a few days, High & Effects can last a few hours to a few days, described as being a described as being a “roller coaster through hell”“roller coaster through hell”
a combination of MDMA and LSD, only more intense.a combination of MDMA and LSD, only more intense. 2C-I is being made by dealers and “hobbyists,”2C-I is being made by dealers and “hobbyists,” chemicals can be obtained over the internetchemicals can be obtained over the internet 2C-I overdoses can cause seizures, kidney failure, and 2C-I overdoses can cause seizures, kidney failure, and
fatally high blood pressure.fatally high blood pressure.
Pharmacological Effects Dilated pupilsDilated pupils SweatingSweating Dry mouthDry mouth Rapid speechRapid speech Rapid/frequent mood swingsRapid/frequent mood swings Hyperactivity/ Elevated BPHyperactivity/ Elevated BP Hair standing on endHair standing on end Nasal passage irritationNasal passage irritation
Erowid.com“Documenting the complex relationships between humans and psychoactives”
Great resource for informationGreat resource for information Take with a grain of saltTake with a grain of salt Your clients are probably aware of this Your clients are probably aware of this
site as wellsite as well
The Opiate Family
Opiates: Opiates:
HeroinHeroin
MorphineMorphine
CodeineCodeine
Hydrocodone - (Vicodin, Loratab)Hydrocodone - (Vicodin, Loratab)
Hyrdomorphone -(Dilaudid) Hyrdomorphone -(Dilaudid)
Oxycodone – (Oxycontin, Percocet, Oxycodone – (Oxycontin, Percocet, Roxicodone)Roxicodone)
Oxymorphone - (Opana)Oxymorphone - (Opana)
Heroin Makes a ComebackThis Time, Small Towns are Increasingly Beset by Addiction, Drug-Related CrimesThursday, August 8, 2013 - WSJ
ELLENSBURG, Wash.—This small city east of the Cascade Mountains is known for its hay farms, rodeos and, increasingly, something more sinister: a growing heroin problem. The fatal overdose of a state trooper's son in May convulsed the town—especially when the two men arrested and charged with selling him heroin turned out to be a county official's sons.
Heroin use in the U.S. is soaring, especially in rural areas, amid ample supply and a shift away from costlier prescription narcotics that are becoming tougher to acquire. Much of the heroin that reaches smaller towns such as Ellensburg comes from Mexico, where producers have ramped up production in recent years, drug officials say. Heroin seizures at the Southwest border, from Texas to California, ballooned to 1,989 kilograms in fiscal 2012 from 487 kilograms in 2008, according to figures from the Drug Enforcement Administration.
The heroin scourge has been driven largely by a law-enforcement crackdown on illicit use of prescription painkillers such as oxycodone and drug-company reformulations that make the pills harder to crush and snort, drug officials say. That has pushed those who were addicted to the pills to turn to heroin, which is cheaper and more plentiful. A 21-year-old recovering addict said she made the switch from pain pills to heroin after her dealer one day held out both options in his hands and encouraged her to choose the cheaper one
Drug experts say the heroin sold today is generally purer and thereby more potent than the varieties prevalent in past decades, increasing the risk of overdose. A baggie "may be 15% pure one day, and the next day it's 60%," said Skip Holbrook, the police chief in Huntington, W.Va., which sits in an area of Appalachia where heroin is spreading. "It's like playing Russian roulette."
Opana Information Opana is more potent, per milligram, than Opana is more potent, per milligram, than
Oxy Oxy Users vulnerable to O.D, kidney failure, deathUsers vulnerable to O.D, kidney failure, death Street names: "stop signs," ”Obomb,”new Street names: "stop signs," ”Obomb,”new
blues” blues” crushed - either snorted or injected. crushed - either snorted or injected. Endo Pharmaceuticals, announced in Dec Endo Pharmaceuticals, announced in Dec
2011 that it would reformulate Opana. The 2011 that it would reformulate Opana. The new pill is being manufactured new pill is being manufactured
Old form of Opana is still available -$90 per Old form of Opana is still available -$90 per billbill
Opana ER (Extended Release)Opana ER (Extended Release) Small blood clots under the skin/cause blood Small blood clots under the skin/cause blood
disordersdisorders
Take away comments If positive on an Opiate screening test – an Opiate If positive on an Opiate screening test – an Opiate
family member most likely detectedfamily member most likely detected
If confirmed for 6-AM (6-Acetylmorphine )at the Lab: If confirmed for 6-AM (6-Acetylmorphine )at the Lab: Heroin useHeroin use
If confirmed positive just for MorphineIf confirmed positive just for Morphine Metabolized heroine to morphine and orMetabolized heroine to morphine and or morphine use i.e. from a prescription, morphine use i.e. from a prescription, poppy seed usepoppy seed use
Suboxone-Buprenorphine FDA approved in 2002FDA approved in 2002 used to treat opiate addictionused to treat opiate addiction alternative to methadonealternative to methadone partial agonist (ceiling)partial agonist (ceiling) in pill, film, patchin pill, film, patch 2mg & 8mg doses2mg & 8mg doses will not test positive on an opiate testwill not test positive on an opiate test significant diversion significant diversion contains naloxone- guard against misusecontains naloxone- guard against misuse Individuals will get high on this stuffIndividuals will get high on this stuff
What’s the attraction to Bup?
user’s experience a euphoria effectuser’s experience a euphoria effect if taken in conjunction with other sedative drugs like if taken in conjunction with other sedative drugs like
alcohol, sleeping pills(ambien) or benzodiazepines alcohol, sleeping pills(ambien) or benzodiazepines (clonopin)- extreme sedation, drowsiness, unconscious, (clonopin)- extreme sedation, drowsiness, unconscious, or even death may occuror even death may occur
Method of ingestion – typically sublingual (under the Method of ingestion – typically sublingual (under the tongue), pill format going away, reports of snorting tongue), pill format going away, reports of snorting
injected?injected? only test positive if specifically testing for buprenorphineonly test positive if specifically testing for buprenorphine
Presented by: Vinnie HappRedwood Toxicology Laboratory
An Alere Company
Thank you for your time.