Clinical Pearl:
An Update on Designer Drugs
Gabriela Dimitrievski, PharmD
PGY2 Psychiatric Pharmacy Resident
Purdue University/Eskenazi Health
gabriela.dimitrievski@eskenazihealth.edu
September 18, 2014
This speaker has no actual or potential conflicts of interest to
disclose in relation to this presentation
Objectives
• Identify the importance of being aware
of new, popular, and upcoming
“designer drugs”
• Describe the methods of use, effects,
and dangers associated with several
popular designer drugs
• Detail ways in which pharmacists can
help with substance abuse issues
Impact of Substance Use
• Drug use linked to more deaths than
suicides, firearms, or school violence
• 40,239 drug-induced deaths in the United
States in 2011
– Additional 26,256 alcohol-induced deaths
• Substance abuse as the single largest
contributing factor to U.S. crime
• Cost of drug abuse estimated at
$52 billion
US Dept. of Justice Drug Enforcement Agency. “Drugs of Abuse.” Available at:
http://www.justice.gov/dea/docs/drugs_of_abuse_2011.pdf
National Vital Statistics Report. “Deaths: Preliminary Data for 2011.” Available at:
http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_06.pdf
Indiana Statistics
• Annually, 154,000
individuals aged 12 years or
older abused or were
dependent on illicit drugs
from 2008-2012
• Equivalent to 2.9% of the
population
• 52,000 (9.7%) of
adolescents in Indiana used
an illicit drug in the past
month
SAMHSA. Behavioral Health Barometer, Indiana, 2013. Available at:
http://www.samhsa.gov/data/StatesInBrief/2k14/Indiana_BHBarometer.pdf
SAMHSA. Indiana Adolescent Behavioral Health In Brief. Available at:
http://www.samhsa.gov/data/StatesInBrief/2k9/OASTeenReportIN.pdf
• 35,000 used marijuana
• 27,000 used other illicit
drugs
Popular Media –
Deaths Due to Designer Drugs
Common Drugs of Abuse
• Narcotics
– Heroin
– Opioids
– Crocodile
• Stimulants
– Cocaine
– Bath salts/synthetic
cathinones
– Methamphetamine
– Caffeine
• Marijuana/Cannabis
– K2/Spice
– Wets
• Depressants
– Alcohol
– Benzodiazepines
– GHB
• Hallucinogens
– Synthetic
phenethylamines
• Smiles, Nexus, Blue Mystic,
Europa, N-Bomb
–
–
–
–
–
Ecstasy
Molly
LSD
Mushrooms
PCP
Molly
• What is it?
– “Purified” MDMA
• Often combined or substituted with caffeine, dextromethorphan,
amphetamines, cocaine, or PCP
• Desired Effects
– Both hallucinogenic and stimulant properties
• Mental stimulation, emotional warmth, decreased anxiety,
euphoria, enhanced perceptions
• Dangers
– Muscle tension, increased heart rate and blood pressure,
tremors, teeth clenching, depression
– Neurotoxicity, nephrotoxicity, cardiovascular toxicity,
hyperthermia, seizures, intracranial hemorrhage
Steinhardt et al. Ment Health Clin. 2014;4(5):64.
NIDA for Teens. Drug Facts: MDMA. Available at:
http://teens.drugabuse.gov/drug-facts/mdma-ecstasy-or-molly
Powdered Alcohol
• What is it?
– Freeze-dried powder formulation of alcohol
– Most notably marketed in the US under the name
Palcohol
• Labeling originally approved by the Alcohol and Tobacco
Tax and Trade Bureau, but withdrawn days later
• Desired Effects
– Discreet means of intoxication
– Use on food products for “an extra kick”
– Snorting powder as a means of
immediate intoxication
• Dangers
– Over-consumption of alcohol,
addictive potential, attractiveness
to young children
http://time.com/71664/powdered-alcohol-palcohol-error/
http://www.cbsnews.com/news/palcohol-powdered-alcohol-may-present-serious-health-risks/
N-BOMe Substances
• What is it?
– 25I-NBOMe, 25C-NBOMe, and 25B-NBOMe
• Street names: N-bomb, Smiles, Boom, Gnome,
Dime, 25I, 25C, 25B
– Synthetic phenethylamines with effects
similar to LSD
– Powders, liquids, edibles, blotter papers
• Desired Effects
– Potent hallucinogenic activity
– Euphoria, loving feelings, enhanced
awareness, sexual sensations/desires
• Dangers
– Psychosis, agitation, erratic behavior,
depression, anxiety, paranoia
– Seizures, cardiac arrest, respiratory arrest,
death
http://www.etcada.com/events/designer-psychedelics-new-class-of-designer-drugs-in-harris-county
http://www.deadiversion.usdoj.gov/drug_chem_info/nbome.pdf
http://www.addictiontreatmentmagazine.com/synthetic-drugs/teen-seizures-and-deaths-linked-to-dangerous-designer-drug-n-bomb-part-1/
Powdered Caffeine
• What is it?
– Powdered form of pure caffeine
– One teaspoon is equivalent to
approximately 25 cups of coffee
– Marketed as a dietary supplement
• Desired Effects
– Energy boost, weight loss
• Dangers
– Vomiting, diarrhea, stupor,
disorientation
– Rapid and abnormal heartbeat,
seizures, death
http://www.fda.gov/Food/RecallsOutbreaksEmergencies/SafetyAlertsAdvisories/ucm405787.htm
http://nypost.com/2014/07/19/powdered-caffeine-scrutinized-after-prom-king-dies/
http://seattletimes.com/html/health/2024115386_apxcaffeinepowderwarning.html
What Can I Do?
• ASHP Statement on the Pharmacist’s Role in
Substance Abuse Prevention, Education, and
Assistance
– Pharmacists as having unique knowledge, skills,
and responsibilities to take on an important role
with substance abuse
– Roles centered around:
• Preventing
• Educating
• Assisting
• http://www.ashp.org/doclibrary/bestpractices/
specificstsubstance.aspx
Gabriela Dimitrievski, PharmD
PGY2 Psychiatric Pharmacy Resident
Purdue University/Eskenazi Health
gabriela.dimitrievski@eskenazihealth.edu