Synthetic Drugs of Abuse: ‘Spice,’ ‘K2’ and ‘Bath Salts’Side effects and Long term

consequences

Willie A. Hamilton, BC-FNPBoard Certified in Sports Medicine & Nutrition

Spice/K2 brands marketed as natural herbal incense

“Not for human consumption”

Available convenience stores, gas stations, Internet

Cannabis substitutePsychonaut Web Mapping Research Group (2009.) Spice Report. Institute of Psychiatry, King’s College London: London UK.

delta-9 tetrahydro-cannabinol (∆9-THC) agonism of cannabinoid receptor type 1 (CB1)

SCs more potent

Typical doses are often less than 1mg

Not readily detectable JWH-018

∆9-THC

Marketed as similar to cannabis: Euphoria Sociability Anxiolytic Relaxation Stimulant

Cross tolerance with THC?http://buyk2spice.net/

Anxiety Paranoia Headache Vomiting Psychosis Diaphoresis HR/BP increase Seizures

http://investigationmiami.blogspot.com/2011/01/be-afraid-really-afraid.html

No data on prevalence of use

American Association of Poison Control Centers:

Synthetic cannabinoids: 2009: 13 calls 2010: 2304 calls (Nov), a projected 200x increase

Marijuana: 2008: 4009 calls, with 1020 for marijuana alone

Methylenedioxypyrovalerone (MDPV) and Mephedrone Sold as “bath salts” or “plant fertilizer”

Currently legal in the United States

Available online and in convenience stores

CNS stimulants Related to cathinone, an active

alkaloid found in the khat plant (N. Africa)

Previously abused primarily in Europe and Australia

http://www.herbalextracts.net/library/supplements/khat_uses.html

Route: Intranasal most common

Also: oral, smoking, rectal, and IV

White to light brown crumbly powder

Degrades if exposed to air for significant periods of time

http://www.stompin-gardeners.com/index.

MDMA

CNS stimulant similar to methamphetamine, MDMA, or cocaine

Norepinephrine-dopamine reuptake inhibitor (NDRI)

Increased alertness, arousal, anxiety, agitation, diminished requirement for food and sleep, sexual arousal

Tachycardia, hypertension, vasoconstriction, diaphoresis

“High” lasts 3-4 hours

Physical effects may last 6-8 hours

May cause seizures, panic attacks, or psychosis with high doses or increased frequency of use

Avg dose: 5 to 20mg http://www.tradevv.com/chinasuppliers/chwhtltd_p_198b58/

china-Mdpv-by-pevukka.html

Trismus (inability to open mouth) or bruxism

Panic attacks Psychosis with sleep deprivation Hallucinations, delusions, suicidal

ideation Abstinence syndrome: depression,

lethargy, anxiety, postural hypotension Leads to frequent re-dosing

UK: MDPV regulated under the Misuse of Drugs Act 1971

US: Not scheduled but banned in some states

DEA: controlled by the Federal Analogue Act?

http://addiction-dirkh.blogspot.com/2010/11/dea-slaps-temporary-ban-on-spice-and.html

4-methylmethcathinone (4-MMC)

Meow Meow MCAT Miaow Drone Plant Feeder Bubbles

http://www.synchronium.net/2010/01/05/mephedrone-cat/

NE-DA reuptake inhibitor Similar to MA/MDMA

Reportedly less potent, shorter duration

Oral dose: 20-50mg “Come up”: 10-20 min Peak: 45-60 min “Comedown”: 60-120

min Re-dosing: common

Mephedrone

Amphetamine

Oral ingestion Swallowing capsules Bombing (swallowing

powder wrapped in cigarette paper)

Insufflation (snorting)

Rectally (either plugging or enema)

IV (use 1/2 to 1/3 dose)

http://www.guardian.co.uk/society/mephedrone

Euphoria Sociability Stimulation Sexual Arousal Music Appreciation Hallucinations

http://www.drugs.org.im/campaigns.htm

Loss of appetite Increase in body

temperature, sweating, hot flushes

Tense jaw, bruxism, stiff neck, muscle clenching

HR/BP elevation, chest pains Dehydration Mydriasis, nystagmus Painful nasal drip/ulcers in

mouth (after insufflation) Insomnia, paranoia, anxiety,

dysphoria, psychosis http://theblackheartofgrahamquirk.blogspot.com/

2008-2010: Banned in many European counties

December 2010: Illegal throughout the EU

Mephedrone is not specifically banned in the United States However, some states have banned mephedrone

DEA: may be controlled by the Federal Analogue Act as an analogue of methcathinone

No data on prevalence of use

American Association of Poison Control Centers:

Bath Salts: 2010: 292 calls 2011: 469 calls (2/14/11), a projected14-fold

increase

Contact Information

Willie A. Hamilton, BC-FNPLIVEfit Medicine

1901 Brookside Dr.Kingsport, TN 37660

(423)765-9500