Designer Drugs:
drugs, which are created (or reformulated, if
the drug already existed) to get around
existing drug laws CSA (controlled
substance act), usually by modifying the
molecular structures of existing drugs to
varying degrees
Sources of Incense Products:
internet/on-line sources
 “head” shops/alternative medicine stores
/ convenience stores/flea markets
 1-(800) phone ordering services
 individual distributors
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Preparation of the “incense”:
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Botanical plants/herbs are sprayed
with liquid preparations of:
HU-210
JWH-250
HU-211
JWH-081
CP 47,497
JWH-210
JWH-018
XLR-11, UR144
JWH-073
And many
more
Origins of Synthetic Cannabinoids
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CP 47,497 - developed by Pfizer in 1980 as an
analgesic (pain reliever)
HU-210 & HU-211 - synthesized at Hebrew
University, Israel in 1988. HU-210 is an antiinflammatory; HU-211 as an anesthetic
JWH-018 & JWH-073 - synthesized by a researcher at
Clemson (1995) for use in THC receptor research John W. Huffman
more than 200 different synthetic cannabinoids have
been created
How K2/Spice works:
Synthetic Cannabinoids act as THC agonists
-An agonist is a chemical that binds to a receptor
and triggers a response – often mimicking the action of
the naturally occurring substance.
Receptor
Drug (agonist)
Why Change the Key?
• prolong the effect of the drug
• increase the potency of the drug
• “select” the desired effect
• avoid patent infringement
• make the drug more difficult to detect
• make an illegal drug “legal”
Drug
Pharmacological Effects of Synthetic
Cannabinoids are Similar to THC
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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
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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 are
similar to cannabis
intoxication:
-Abnormally rapid heart rate
– Reddened eyes
– Anxiousness
– Mild sedation
– Hallucinations
– Acute psychosis
– Memory deficits
Symptoms not
typically seen after
cannabis intoxication:
– Seizures
– Potassium deficiency
– Hypertension
– Nausea/vomiting
– Agitation
– Violent behavior
– 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
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Rapid, onsite instant test (as of 3/1/12)
Laboratory-based screening test (limited)
Most Laboratories are employing LC/MS/MS
technology
Primarily via urine, however some labs can test via
oral fluid and blood
$$$ varies greatly
Onsite vs Lab is very different testing methodology
On-site vs Laboratory testing for K2
On-site K2
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JWH-018 & JWH-073
primarily
Laboratory K2
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JWH-018, 073, plus *17 other
synthetic cannabinoid structures
JWH-019, 081, 122, 200, 203, 210, 250, 398, AM2201, MAM2201,
RCS4, RCS8, AM-694, AM-1248, AKB-48,UR-144, XLR-11
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Cut-off at 25 or 50ngs/ml
Testing limited metabolites
Much higher threshold to
trigger positive
Screening technology
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Cut-off 1ng/ml or less
Testing for hydroxy acid & other
components/metabolites
Detecting presence
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Confirmatory technology
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*Redwood Toxicology Laboratory
Issues of Concern
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What synthetic compounds (or metabolites) are
being tested by the laboratories?
no standardized urine cutoff levels
no standardized methods (LC/MS/MS)
tests detect metabolites
no independent quality control materials
no proficiency testing
keeping up with molecular changes
Detection Window ???
testing for metabolites
 educated guess - same as real marijuana?
 many labs advertise “up to 72 hours”
 limited studies
 passive inhalation?
 fact is - we don’t know all the answers
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Wet Marijuana
Embalming Fluid-Soaked Marijuana:
smoking marijuana soaked in embalming fluid is gaining
popularity throughout the United States. The syndrome of
intoxication looks nearly identical to that seen following
phencyclidine (PCP) use, with agitation, disorganized
speech, and thoughts, and diminished attention. This new
trend in drug use involving marijuana also presents a
resurgence in PCP use.
 Soaked in water – uneven burn
 Mixed with PCP: wet, fry, crystal joint, supergrass
 Mixed with codeine containing cough syrup
 Mixed with methamphetamines
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What’s in Bath Salts:
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MDPV (Methylenedioxypyrovalerone) - a psychoactive
drug with powerful stimulant properties which acts as
both a norepinephrine & dopamine reuptake inhibitor
(NDRI). “A two for”
usually snorted like cocaine
duration of effect 2-3 hours /adverse effect 6-8 hrs
MDPV - no history of FDA approved medical use
Sold as a “research chemical”
adverse medical or psychiatric ramifications
Mephedrone
(Methylmethcathinone)
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amphetamine-like properties, powerful stimulant
“rediscovered” by synthetic chemists in 2003
reformulation of cathinone, a chemical found in the
khat plant of Eastern Africa
khat existence traced to 15th C. Ethiopia
khat is banned in the U.S.
Methylone (3,4-methylenedioxy-Nmethylcathinone)
very similar to MDMA
 stimulant
 phenethylamine, amphetamine, and
cathinone properties
 euphoria and increased sociability
 insomnia and restlessness
 hallucinations and psychosis
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Bath Salts and beyond!!!
Expanded Synthetic Stimulant Panel
α-PVP
BZP
Butylon
Buphedrone
Cathinone
Ethylone
Flephedrone
MBDB
mCPP
MDA
MDEA
MDMA
MDPV
Mephedrone
Methcathinone
4-Methylethcathinone
Methylone
Pentedrone
Pentylone
Pyrrolidinopentiophenone
TFMPP
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
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common side effects, include teeth grinding, dehydration, anxiety, insomnia,
fever and loss of appetite.
more dangerous ones include hyperthermia, uncontrollable seizures, high blood
pressure and depression caused by a sudden drop in serotonin levels in the
days after use, nicknamed Suicide Tuesdays.
capsules sell for $8 to $40.
the most common Molly additives are bath salts, including methylone and
mephedrone. Bath salts are chemically similar to MDMA.
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 the drugs were MDMA, while 41% were 4-MEC, a type of
bath salt, and 20% were methylone.
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 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.
Pharmacological Effects of “Bath Salts”:
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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 sleep
death
Testing for Bath Salts??
Yes! However:
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No on-site, rapid, instant tests
No laboratory-based screening tests
Laboratories employing GC/MS and
LC/MS/MS technologies
Detection times remain unknown
Best procedure for detecting
metabolites vs parent drug unknown
2C-I Nicknamed “Smiles”
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popular among teens, responsible for dozens of overdoses
and deaths especially in Midwest.
white crystalline powder, typically snorted or ingested.
High & Effects can last a few hours to a few days,
described as being a “roller coaster through hell”
a combination of MDMA and LSD, only more intense.
2C-I is being made by dealers and “hobbyists,”
chemicals can be obtained over the internet
2C-I overdoses can cause seizures, kidney failure, and fatally
high blood pressure.
Pharmacological Effects
Dilated pupils
 Sweating
 Dry mouth
 Rapid speech
 Rapid/frequent mood swings
 Hyperactivity/ Elevated BP
 Hair standing on end
 Nasal passage irritation
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Erowid.com
“Documenting the complex relationships between humans and psychoactives”
Great resource for information
 Take with a grain of salt
 Your clients are probably aware of this site as
well
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The Opiate Family
Opiates:
Heroin
Morphine
Codeine
Hydrocodone - (Vicodin, Loratab)
Hyrdomorphone -(Dilaudid)
Oxycodone – (Oxycontin, Percocet, Roxicodone)
Oxymorphone - (Opana)
Heroin Makes a Comeback
This Time, Small Towns are Increasingly Beset by Addiction, Drug-Related Crimes
Thursday, 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
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Opana is more potent, per milligram, than Oxy
Users vulnerable to O.D, kidney failure, death
Street names: "stop signs," ”Obomb,”new blues”
crushed - either snorted or injected.
Endo Pharmaceuticals, announced in Dec 2011
that it would reformulate Opana. The new pill is
being manufactured
Old form of Opana is still available -$90 per bill
Opana ER (Extended Release)
Small blood clots under the skin/cause blood
disorders
Take away comments
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If positive on an Opiate screening test – an Opiate family
member most likely detected
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If confirmed for 6-AM (6-Acetylmorphine )at the Lab:
 Heroin use
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If confirmed positive just for Morphine
 Metabolized heroine to morphine and or
 morphine use i.e. from a prescription,
 poppy seed use
Suboxone-Buprenorphine
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FDA approved in 2002
used to treat opiate addiction
alternative to methadone
partial agonist (ceiling)
in pill, film, patch
2mg & 8mg doses
will not test positive on an opiate test
significant diversion
contains naloxone- guard against misuse
Individuals will get high on this stuff
What’s the attraction to Bup?
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user’s experience a euphoria effect
if taken in conjunction with other sedative drugs like
alcohol, sleeping pills(ambien) or benzodiazepines
(clonopin)- extreme sedation, drowsiness, unconscious, or
even death may occur
Method of ingestion – typically sublingual (under the
tongue), pill format going away, reports of snorting
injected?
only test positive if specifically testing for buprenorphine
Thank you for your time.
Presented by: Vinnie Happ
Redwood Toxicology Laboratory
An Alere Company
vhapp@redwoodtoxicology.com