Designer Drug Update 2014
Michael P. Frost MD, MS
Medical Director, Eagleville Hospital
President, The Frost Medical Group
Objectives
Identify synthetic drugs as emerging threats in the diseases
of addiction
Recognize the physical and mental effects of these drugs
Become familiar with available drug testing
Understand the current legal standing of these substances
Understand aspects of treatment related to synthetic drugs
Synthetic drugs:
-
Easy to make
- Cheap to buy
-
Easier to get than cocaine, heroin
-
“Legal high”
-
Harder to detect, monitor
-
Presumed to be safer
Since 2009, DEA has seen rise in reports from
poison control, hospitals, law enforcement
Widely available in convenience stores, smoke
shops, gas stations, and the internet
Mistakenly thought to be safe because of the
way they are obtained
synthetic drug use on the rise
Bath Salts
Bath Salts
Methylenedioxypyrovalerone (MDPV,
Methadrone)
Cathinone family of stimulants
Synthetic analogue of Cocaine
Norepinephrine/Dopamine reuptake inhibitor
Intoxication with MDPV
Euphoria
Increased wakefulness/arousal
Increased energy
Increased mental focus
Increased empathy
Adverse Effects
Tachycardia
Hypertension
Vasoconstriction
Arrhythmia/MI
Nausea
Bruxism
Hyperthermia
Adverse Effects
Violent behavior
Suicidality
Rhabdomyolysis
Hepatorenal failure
Sleep disturbance
Detection
GC/MS becoming more widely available
Multiple labs now offering on-site testing kits
for most common cathinones
Testing lags behind the compounds on the
market.
Detection window/half life not well known.
Legal Status
PA Bath Salt ban June 2011
DEA has made most common compounds
Schedule I
Illegal to manufacture, sell or possess MDPV
Placed in same category as heroin
Case #1 - “Face-Eating zombie”
On May 26, Miami police shot and killed a homeless man who was allegedly feasting on the face of another homeless man in a daylight attack on a busy
highway. Before now-infamous "face-eating cannibal" Randy Eugene was stopped by four police bullets, say authorities, he had gnawed the face of
victim Ronald Poppo down to his goatee. "The forehead was just bone," said a witness. "No nose, no mouth." Police said that Eugene, 31, who had
ripped off his clothes and refused police orders to stop eating Poppo's flesh, showed behavior consistent with ingesting the synthetic cocaine substitute
known as bath salts. Bath salts have been connected to a range of violent incidents and a spike in emergency room visits since they became popular
several years ago. Last fall, the Drug Enforcement Administration banned three chemicals used in bath salts, and 38 states have enacted their own bans,
but incidents continue.
Synthetic Cannabinoids
K2
Spice
Mr Nice Guy
Herbal Incense
Black Diamond incense
K2
Have chemical names such as
canabicyclohexanol, JWH-018, JWH-073
Very high affinity for cannabinoid receptors
Similar “high” as THC
Greater intensity of adverse effects
Adverse Effects
Agitation
Anxiety
Paranoia
Psychosis
Tremor
Hyperthermia
Sweating
Detection
Urine and blood immunoassays readily
available from most labs
GC/MS confirmation
Designers changing compounds rapidly to
evade detection
Will not show up on test as THC
DEA schedule I
Kratom
•
Mitragyna tree native to Southeast Asian
•
Opiate-like compounds in leaves
•
Used in Thai traditional medicine as pain reliever and
anti-diarrhoeal and to treat opiate withdrawal.
•
Low dose is stimulating
•
High dose is sedating/analgesic
Kratom Side Effects
Agression
Hallucinations
Nervousness
Decreased libido
Weight loss
Hyperpigmented skin
Somnolence
Kratom Withdrawal
•
Similar to Opiate withdrawal
•
Myalgias/bodyaches
•
Irritability
•
Runny nose
•
Diarrhoea
•
Muscle twitching
•
Lacrimation
Kratom
•
Showing up in ER’s
•
More common in southern states
•
Little known about duration of effects
•
Little known about drug-drug interaction
•
Has some potential interest in preventing
opiate dependence (appears to reduce activity
of NMDA receptors)
•
Illegal in Thailand (same category as THC) and
throughout most of Asian, Australia
•
Not expressly illegal in U.S. except in Indiana
•
•
Is on DEA list of “Drugs & Chemicals of
Concern”
Individual states considering bans (Iowa,
Hawaii, Vermont)
Drug Testing
•
Urine and oral fluid testing widely available
•
Does not show up as opiate on standard UDS
krokodil
Developing problem in Russia/Eastern Europe
Codeine mixed with gasoline/paint
thinner/hydrochloric acid/red phosphorus
Cheap and easy to make
Cases now reported in Lehigh
Valley/Northern/Western PA, Ohio &Tennessee
krokodil
•
Desmomorphine - derivative of morphine
•
8-10 x more potent than morphine
•
simple to synthesize from morphine/codeine
•
First seen in Siberia 2003
•
In Russia, Codeine products were OTC until 2012
•
Legal form of desmomorphine produced in Switzerland
as pain medication
Injection site becomes scaly and resembles
crocodile skin
Necrosis and sepsis often develops
Average user only lives 2-3 years
Effects last only 90 min
“Krokodil houses” need full-time cook
This highly addictive drug causes peoples skin to rot and start falling off. It has become an epidemic in russia. It seems like it must be fake, but it is real. Some peop
thing is is the beginning of a zombie Apocalypse.
krokodil
GRAVEL
gravel
•
Synthetic stimulant - alpha-pyrolidinopentiophenone
(alpha-PVP)
•
Cathinone class
•
Sold as “Gravel” or “Plant fertilizer”
•
Has been diluted with rat poison and ammonium nitrate
(fertilizer)
Adverse effects
•
Hypertension
•
Tachycardia
•
Violence
•
Paranoia
•
Hallucinations
•
Brain damage
•
Skin deterioration/necrosis
gravel
•
Tissue necrosis causes permanent deformity
•
DEA Schedule I
•
Cases reported in Tennessee as of Aug-Nov 2013
gravel
summary
Legality gives false sense of safety
Patients use synthetic drugs to help avoid
detection
Providers need to stay informed about current
trends
When one drug is made illegal/detectable, a
new drug will take it’s place