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Designer Drugs:

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Title: Understanding Abused Drugs Testing Results Author: Microsoft Corporation Last modified by: Abby Shockley Created Date: 1/10/2000 3:43:08 PM – PowerPoint PPT presentation

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Title: Designer Drugs:


1
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

2
Sources of Incense Products
  • internet/on-line sources
  • head shops/alternative medicine stores /
    convenience stores/flea markets
  • 1-(800) phone ordering services
  • individual distributors

3
Preparation of the incense
  • Botanical plants/herbs are sprayed with liquid
    preparations of
  • HU-210
  • HU-211
  • CP 47,497
  • JWH-018
  • JWH-073
  • JWH-250
  • JWH-081
  • JWH-210
  • XLR-11, UR-144
  • And many more

4
Origins of Synthetic Cannabinoids
  • 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
    anti-inflammatory 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

5
How K2/Spice worksSynthetic 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)
6
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
7
Pharmacological Effects of Synthetic Cannabinoids
are Similar to THC
  • 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

8
Reported Effects of Synthetic Cannabinoids are
different to THC
  • 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)
  • doesnt mix well with alcohol (hangovers)
  • incense costs more than marijuana?

9
Cannabis vs. Cannabinoids Effects Seen in
Clinical Cases
  • Most symptoms aresimilar to cannabisintoxication
  • Symptoms nottypically seen aftercannabis
    intoxication
  • Seizures Potassium deficiency
    Hypertension Nausea/vomiting Agitation
    Violent behavior Coma
  • -Abnormally rapid heart rate Reddened eyes
    Anxiousness Mild sedation Hallucinations
    Acute psychosis Memory deficits

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.
10
Drug Testing Synthetic THC / K2
  • 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

11
On-site vs Laboratory testing for K2
  • On-site K2
  • Laboratory K2
  • JWH-018 JWH-073 primarily
  • Cut-off at 25 or 50ngs/ml
  • Testing limited metabolites
  • Much higher threshold to trigger positive
  • Screening technology
  • 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
  • Cut-off 1ng/ml or less
  • Testing for hydroxy acid other
    components/metabolites
  • Detecting presence
  • Confirmatory technology
  • Redwood Toxicology Laboratory

12
Issues of Concern
  • 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

13
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 dont know all the answers

14
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

15
Whats in Bath Salts
  • 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

16

Mephedrone (Methylmethcathinone)
  • 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.

17

Methylone (3,4-methylenedioxy-N-methylcathinone)
  • very similar to MDMA
  • stimulant
  • phenethylamine, amphetamine, and cathinone
    properties
  • euphoria and increased sociability
  • insomnia and restlessness
  • hallucinations and psychosis

18
Bath Salts and beyond!!!Expanded Synthetic
Stimulant Panel
       
  • a-PVP
  • BZP    
  • Butylon
  • Buphedrone  
  • Cathinone    
  • Ethylone    
  • Flephedrone
  • MBDB     
  • mCPP
  • MDA
  • MDEA 
  • MDMA
  • MDPV
  • Mephedrone 
  • Methcathinone
  • 4-Methylethcathinone 
  • Methylone
  • Pentedrone
  • Pentylone
  • Pyrrolidinopentiophenone
  • TFMPP

19
Synthetic Seizures Cathinone Varieties (through
8/27/12)
SOURCE U.S. DEA, Office of Diversion
Control,NFLIS data, 2012
20
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 drugs 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. - -

21
Molly - continued
  • 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.

22
Pharmacological Effects of Bath Salts
  • 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

23
Testing for Bath Salts??Yes! However
  • 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

24
2C-I Nicknamed Smiles
  • 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.

25
Pharmacological Effects
  • Dilated pupils
  • Sweating
  • Dry mouth
  • Rapid speech
  • Rapid/frequent mood swings
  • Hyperactivity/ Elevated BP
  • Hair standing on end
  • Nasal passage irritation

26
Erowid.comDocumenting 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

27
The Opiate Family
  • Opiates
  • Heroin
  • Morphine
  • Codeine
  • Hydrocodone - (Vicodin, Loratab)
  • Hyrdomorphone -(Dilaudid)
  • Oxycodone (Oxycontin, Percocet, Roxicodone)
  • Oxymorphone - (Opana)

28
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 townespecially 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."
29
Opana Information
  • 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

30
Take away comments
  • If positive on an Opiate screening test an
    Opiate family member most likely detected
  • If confirmed for 6-AM (6-Acetylmorphine )at the
    Lab
  • Heroin use
  • If confirmed positive just for Morphine
  • Metabolized heroine to morphine and or
  • morphine use i.e. from a prescription,
  • poppy seed use

31
Suboxone-Buprenorphine
  • 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

32
Whats the attraction to Bup?
  • users 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

33
Thank you for your time.
Presented by Vinnie HappRedwood Toxicology
LaboratoryAn Alere Companyvhapp_at_redwoodtoxicolo
gy.com
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