Transcript Bath Salts and Spice

Synthetic Drugs of Abuse:
‘Spice,’ ‘K2’ and ‘Bath Salts’
Erik Gunderson, MD
Assistant Professor
Department of Psychiatry and Neurobehavioral Sciences
and Department of Medicine
Director, Clinical Pharmacological Research Unit
University of Virginia
April 14, 2011
Synthetic Cannabinoids (SCs)
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Spice/K2 brands
marketed as natural
herbal incense
“Not for human
consumption”
Available convenience
stores, gas stations,
Internet
Cannabis substitute
Psychonaut Web Mapping Research Group
(2009.) Spice Report. Institute of Psychiatry,
King’s College London: London UK.
Spice and K2
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Cost: $30-45 per 3gm
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Route: pipes, water pipes
or rolled cigarettes
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Contents: inert plant
material sprayed with SCs
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JWH-018, JWH-073, JWH250, CP-47,497, HU-210
http://buyherbalspice.com/spice_reviews/categ
ory/news/
Pharmacology
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delta-9 tetrahydrocannabinol (∆9-THC)
agonism of cannabinoid
receptor type 1 (CB1)
∆9-THC
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SCs more potent
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Typical doses are often
less than 1mg
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Not readily detectable
JWH-018
Psychoactive Effects
Marketed as similar to cannabis:
 Euphoria
 Sociability
 Anxiolytic
 Relaxation
 Stimulant
http://buyk2spice.net/
Cross tolerance with THC?
Side Effects of SC Products
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Anxiety
Paranoia
Headache
Vomiting
Psychosis
Diaphoresis
HR/BP increase
Seizures
http://investigationmiami.blogspot.com/2011/01/be-afraid-really-afraid.html
Legal Timeline for SCs
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2009: Restricted in the UK, EU
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11/2010: DEA Notice of Intent to temporarily
ban 5 SCs
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3/1/2011: Five SCs Designated Schedule I
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JWH-018, JWH-073, JWH-200, CP-47,497, and
cannabicyclohexanol
Effective for one year
Current and Future Epidemiology?
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No data on prevalence of use
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American Association of Poison Control
Centers:
Synthetic cannabinoids:
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2009: 13 calls
2010: 2304 calls (Nov), a projected 200x increase
Marijuana:
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2008: 4009 calls, with 1020 for marijuana alone
Synthetic Stimulants
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Methylenedioxypyrovalerone (MDPV) and
Mephedrone
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Sold as “bath salts” or “plant fertilizer”
Currently legal in the United States
Available online and in convenience stores
MDPV and Mephedrone
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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
Product Marketing
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Mtv
MDPK
Magic
Super Coke
Peevee
Energy-1 (NRG1)
Charge Plus
White Lightning
Scarface
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Cloud 9
Ocean
Ivory Wave
http://www.helphopehealing.org/
MDPV
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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
MDMA
http://www.stompin-gardeners.com/index.
Pharmacology of MDPV
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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
Effects of MDPV
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“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/c
hina-Mdpv-by-pevukka.html
Other Sequelae of MDPV
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Trismus (inability to open mouth) or
bruxism
Panic attacks
Psychosis with sleep deprivation
Hallucinations, delusions, suicidal ideation
Abstinence syndrome: depression,
lethargy, anxiety, postural hypotension
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Leads to frequent re-dosing
MDPV’s Legal Status
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UK: MDPV regulated
under the Misuse of
Drugs Act 1971
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US: Not scheduled but
banned in some states
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DEA: controlled by the
Federal Analogue Act?
http://addiction-dirkh.blogspot.com/2010/11/dea-slapstemporary-ban-on-spice-and.html
Mephedrone
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4-methylmethcathinone
(4-MMC)
Meow Meow
MCAT
Miaow
Drone
Plant Feeder
Bubbles
http://www.synchronium.net/2010/01/05/mephedrone-cat/
Pharmacology
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NE-DA reuptake inhibitor
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Similar to MA/MDMA
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Reportedly less potent, shorter
duration
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Oral dose: 20-50mg
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“Come up”: 10-20 min
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Peak: 45-60 min
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“Comedown”: 60-120 min
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Re-dosing: common
Amphetamine
Mephedrone
Routes of Administration
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Oral ingestion
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Swallowing capsules
Bombing (swallowing
powder wrapped in
cigarette paper)
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Insufflation (snorting)
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Rectally (either plugging
or enema)
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IV (use 1/2 to 1/3 dose)
http://www.guardian.co.uk/society/mephedrone
Effects of Mephedrone
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Euphoria
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Sociability
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Stimulation
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Sexual Arousal
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Music Appreciation
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Hallucinations
http://www.drugs.org.im/campaigns.htm
Mephedrone Side Effects
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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/
Mephedrone’s Legal Status
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2008-2010: Banned in many European counties
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December 2010: Illegal throughout the EU
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Mephedrone is not specifically banned in the United
States
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However, some states have banned mephedrone
DEA: may be controlled by the Federal Analogue
Act as an analogue of methcathinone
Current and Future Epidemiology?
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No data on prevalence of use
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American Association of Poison Control
Centers:
Bath Salts:
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2010: 292 calls
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2011: 469 calls (2/14/11), a projected14-fold
increase
Questions?
References
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Brunt, T.; Poortman, A.; Niesink, R.; Van Den Brink, W. (2010). "Instability of the ecstasy market and a new kid on the
block: mephedrone". Journal of psychopharmacology.
Drug Enforcement Administration: Office of Diversion Control; Drug and Chemical Evaluation Section.
Methylenedioxypyrovalerone [(MDPV) (1-(1,3-Benzodioxol-5-yl)-2-(1-pyrrolidinyl)-1-pentanone]. Available at:
www.deadiversion.usdoj.gov/drugs_concern/mdpv.pdf. Accessed February 7, 2011.
EMCDDA (2009). Action on new drugs briefing paper: Understanding the ‘spice’ phenomenon. A report from an
EMCDDA expert meeting, 6 March, 2009, Lisbon.
"Europol - MCDDA Joint Report on a new psychoactive substance: 4-methylmethcathinone (mephedrone)". European
Monitoring Centre for Drugs and Drug Addiction. 27 May 2010.
Psychonaut WebMapping Research Group (2009). MDPV report. Institute of Psychiatry, King’s College London:
London UK. Available at: www.nascsa.org/news/psychonautmdpvreport.pdf. Accessed February 23, 2011.
Psychonaut WebMapping Research Group (March 2010). "Mephedrone Report." Institute of Psychiatry, King's
College: London UK.
Psychonaut Web Mapping Research Group (2009.) Spice Report. Institute of Psychiatry, King’s College London:
London UK.
United States Drug Enforcement Agency. Office of Diversion Control. Drugs and Chemical of Concern: 4methylmethcathinone [Mephedrone, 4-MMC, meow meow, m-CAT, bounce, bubbles, mad cow]. July 2010.
United States Drug Enforcement Agency. Office of Diversion Control. Rules 2011:Schedules of Controlled
Substances: Temporary Placement of Five Synthetic Cannabinoids Into Schedule I. Federal Register Volume 76,
Number 40 (Tuesday, March 1, 2011).
Wehrman J. U.S. Poison Centers Raise Alarm about Toxic Substance Marketed as Bath Salts; States Begin Taking
Action. AAPCC. February 14, 2011. Available at:
http://www.aapcc.org/dnn/Portals/0/prrel/FEB14BATHSALTSUSE.pdf
Winstock, A.; Mitcheson, L.; Deluca, P.; Davey, Z.; Corazza, O.; Schifano, F. (2010). "Mephedrone, new kid for the
chop?". Addiction 106 (1).
Acknowledgement
Laura Willing, BS
Contact Information
Erik Gunderson, MD
434-924-8013 office
[email protected]