11/8/16

This Stuff Is not Weed

38945846 - illustration of a not allowed icon with a marijuana leaf

© Juan Pablo Gonzalez | 123rf.com

Like a snowball that begins rolling down from the very top of a hill, negative consequences from synthetic drugs have been building momentum for several years. LiveScience posted an article based on a CDC report that highlighted the increase of synthetic-cannabinoid overdoses. Between 2010 and 2015 there were a total of 456 synthetic-cannabinoid intoxications recorded by 101 US hospitals and clinics included in the study. While the overdoses from these substances are still a fraction of all drug overdoses in the US, their percentage has increased every year since 2010.

The CDC report was based on data gathered from the Toxicology Investigators Consortium (ToxIC), a toxicology surveillance and research tool. The ToxIC Registry was established by the American College of Medical Toxicology in 2010. Of the 456 cases of synthetic-cannabinoid intoxication treated by physicians in the ToxIC, 277 reported synthetic cannabinoids were the only substance used. The findings of the CDC report are representative of what doctors in emergency departments from around the country are seeing.

Among the 456 cases, 70.6% were in persons aged 19-65 and 27.4% were in persons aged 13-18; 83.1% were male. The reported adverse effects were primarily cardiovascular-related (17.0%), pulmonary-related (7.6%) or central nervous system-related (66.1%).  The CNS symptoms included agitation, CNS depression or coma, and delirium/toxic psychosis. The annual percentage of cases increased significantly in all four US Census regions, except the South. “The largest overall increases during these periods took place in the Northeast, primarily driven by increases at the New York City sites.” See the chart below which was taken from the CDC report:

toxicThe CDC report mentioned a June 2015 Morbidity and Mortality Weekly Report (MMWR) for June 12, 2015 that found a 300% increase of telephone calls to poison centers related to synthetic cannabinoid use from January 2015 to April 2015. The report suggested that synthetic cannabinoids posed an emerging public health threat. The number of calls spiked dramatically in mid-April. Look at the report for a chart showing the spike from less than 100 calls per week in the third week of March 2015 to over 500 weekly in the third week of April 2015.

Then there are the “bath salts.” The New York Times published an article referring to Brooklyn users of K2, a synthetic cathinone (bath salts), as “zombies.” In an area around the subway station at Myrtle Avenue and Broadway, emergency workers transported 33 people with suspected K2 overdoses to the hospital in ONE DAY. Brian Arthur, who filmed and then posted what he saw on online said: “It’s like a scene out of a zombie movie, a horrible scene . . . . This drug truly paralyzed people.” While responders helped an unsteady man into an ambulance, another man nearby was slumped against a fire hydrant.

Pairs of police officers walked the blocks around Broadway and Myrtle Avenue, checking the vital signs of men they found unconscious. Anyone who was unresponsive was loaded onto a stretcher and taken away in an ambulance.

Keep in mind this was after legislation by The New York City Council last Fall banned synthetic cannabinoids and threatened businesses and owners who sold K2 with closings, hefty fines and jail time. So it seems that the synthetic drug trade in NYC simply switched to synthetic cathinones.

A 2012 article in the Journal of Medical Toxicology, “The Toxicology of Bath Salts,” provides some background information on the emergence of synthetic cathinones as a drug of abuse. Synthesis of cathinone derivatives occurred as early as the late 1920s. Methcathinone was synthesized in 1928 and mephedrene in 1929. While a few of the derivatives have been investigated for medical use, only bupropion (Wellbutrin, Zyban) have been approved for a medical use in the US and Europe. Wellbutrin is approved to treat depression; Zyban is used as a smoking-cessation aide.

Numerous synthetic cathinone derivatives have become popular for use as “legal highs.” Exactly when these derivatives gained popularity amongst club goers and others seeking new drugs of abuse is difficult to pinpoint, but mentions in Internet drug forums began in 2007.

In “Synthetic Cathinones: A New Public Health Problem,” Karila et al. described the major clinical effects of synthetic cathinones and their impact on public health. Together with synthetic cannabinoids they account for more than two thirds of the New Psychoactive Substances (NPS) available. Again, cardiac psychiatric and neurological adverse effects are the most common ones requiring medical care. “These drugs, still not controlled by international laws, are often produced and used to mimic the effects of controlled drugs such as cocaine, methylenedioxymethamphetamine (MDMA, ecstasy), and methamphetamine.”

If you’re skeptical about what I’ve written so far, try this article from High Times, “What’s in Synthetic Cannabis and Why Is It So Dangerous?” In order to study the endocannabinoid system in the body, scientists created these compounds for research purposes. The author is quick to point out that synthetic cannabis does not contain cannabis or synthetic cannabinoids. While the compounds bind to cannabinoid receptors in the brain, they only have a “slight relation” to natural THC. “Doctors do not fully understand how most of these compounds interact with the body, and some can be extremely harmful and even deadly.”

The author suggested they would be better named: synthetic cannabinoid receptor agonists (SCRA). THC is only a partial agonist of CB1 and CB2,the cannabinoid receptors, where SCRAs are designed to bind strongly to the receptors and exert THC-like effects. These effects can be 100 times more potent than cannabis. The unusually strong binding of SCRAs to cannabinoid receptors can produce unforeseen downstream effects in the brain and nervous system.

If you consume any of these chemicals, you are literally performing an experiment on your body, and a dangerous one at that. People have suffered from seizures, cardiac arrest, kidney failure, severe reduction in body temperature, etc. and doctors don’t know how it happens or who is more susceptible.

Not only are there many different classes of these compounds, each one of the general classes of compounds contains dozens of different related compounds. “Regulatory agencies play a game of cat and mouse with designer drug manufacturers as they constantly use different compounds to bypass laws.”  While the Us government continues to make different groups of SCRAs illegal, underground chemists seem to be one step ahead, making newer compounds that tend to be more toxic and harmful than the previous generation.

Steer clear of these dangerous substances, treat them like dangerous addictive drugs on par with methamphetamine, ecstasy pills and prescription narcotics. This stuff is not weed, and when your friends smoke it you should confront them about it and make them understand they are putting their lives at risk. Even if you need to pass a drug test, don’t use this stuff; even one toke of Spice can land you in intensive care and put you on a dialysis machine with kidney failure.

Let the fact sink in that what we just reviewed was a clear warning from High Times to avoid synthetic cannabinoids. Alternately, there are synthetic cathinones that can turn you into a zombie. Think about the consequences before you try some.

09/14/15

High on Flakka

P14296870603635738mFlakka continues to make the news and it seems to be spreading beyond its popularity in South Florida. A Fusion article showed that while 48% of the confirmed cases of flakka in the first half of 2014 were from Southern states, 27% were in the North East and 23% in the Midwest. “In 2015, individuals have been arrested for dealing Flakka in Illinois, Iowa, New York, and Minnesota.”

But the largest epicenter outside of Florida may be southern Ohio around the town of Ironton. In January of 2015, two brothers, residents of Ironton, were arrested and charged with trafficking in alpha-PVP (flakka). Detective Joe Ross said they were having a lot of complaints from citizens about the sale of Alpha-PVP.  “It’s been a big problem here in the city and in the county.”

In Broward County, Florida, flakka accounted for 34% of their crime lab reports. In the ten months prior to August 2015, 33 people died from flakka-related overdoses in Broward County alone. Hospitals in Broward County reported seeing up to 20 flakka-related patients a day. Two men in Broward County pleaded guilty in August 2015 to importing more than 24 pounds of the main ingredient in flakka from China. Also see “Flack from Flakka” and this article by McCarton Ackerman on The Fix.

Flakka is more than just fodder for crazy news stories about naked people running around saying they are Satan, or trying to break into police stations to avoid get away from 20 cars chasing them and trying to kill them. It has also caught the attention of respected addiction professionals—Terence Gorski and researchers at The Scripps Research Institute.

Scientists at The Scripps Research Institute (TSRI) have found that flakka (alpha-PVP) seems to be equivalent to MDPV (bath salts). The study was a classic animal pressing a drug-delivery lever study; and the rats increased their lever pressing for the drug as the 20 daily sessions progressed. “When the researchers increased the number of lever presses required to get one dose, the animals kept pressing—for up to hundreds of presses per dose.” Those rats must have REALLY like their flakka. Head-to-head tests of flakka and bath salts showed an almost identical potency for inducing lever presses. This suggested to the researchers that the horror stories about flakka may have been overblown. An abstract for the 2015 study discussed by Aarde et al., is here.

They noted how a 2013 study, also by Aarde et al., found that bath salts induced far more drug-seeking lever presses among rats than crystal meth. In a TSRI News & Views report of the 2013 study, researchers said the rats worked more than ten times harder to get bath salts instead of crystal meth. “Animals will self-administer MDPV like no drug I have ever seen.” Where rats would emit about 60 presses on average for a dose of meth, they would emit around 600 for bath salts. “Some rats would emit 3,000 lever presses for a single hit of bath salts.”

Another study, Aarde et al. (2015b), found that bath salts could induce rats to forgo other rewarding behaviors. Rats will almost always respond more to food and tasty flavors than drugs. In this study, wheel running, a normally rewarding activity for rats, declined significantly as they self-administered more bath salts. A subset of the rats didn’t gradually increase their intake of bath salts. Rather, they went from occasional sampling to binging on as much as they could get during a session. “That was when they stopped using the wheel—that very day they binged.” An abstract of the Aarde et al. (2015b) binge study is here.

Terence Gorski wrote an informative summary about flakka on his blog: “Flakka: What You Need to Know.” He said it can cause extreme behavioral reactions and there have been reports of long-lasting neurological damage. “It is definitely a dangerous drug that is rapidly entering the drug-using culture.” Citing Jacob Sullim on reason.com, he suggested his readers read his blog to get a balanced view on flakka. Here is a link to Sullum’s article.

Gorski noted how flakka was a relatively new drug, initially available in South Florida in the spring of 2015. It’s a variation of bath salts (MDPV). The active ingredient, alpha-PVP, is a synthetic cathinone, the active ingredient in the khat shrub. Flakka is a stimulant and induces paranoia, psychosis and aggression. In high doses, it leads to “excited delirium,” with high body temperatures rising up to 107F. This leads to many users stripping off their clothes because they feel like they are on fire. When restrained, individuals on flakka scream, flail and struggle to free themselves. The struggling causes high core body temperatures, called hyperthermia, which needs immediate medical treatment to prevent disability and death. The struggling can also cause dehydration.

Flakka can be injected, swallowed, smoked or snorted. Especially when smoked or vaped, individuals can overdose on flakka. Remember the overdose deaths in Broward County noted above. It looks like a white or pink crystal; and smells like sweaty socks. Flakka users can become very agitated, making them verbally aggressive and irrational. Muscle tissue begins to break down, releasing proteins and other cellular products into the bloodstream, a condition referred to as rhabomolysis. It can lead to complications such as renal (kidney) failure and in rare cases, death. Gorski also provided this link to the Drudge Report Archives, which tracks news stories on flakka.

If understanding the danger from this drug hasn’t gone from your head to your gut yet, watch a few of these YouTube videos of people on flakka: “Flakka drug effects;” “High on Flakka;” Crazy! Woman High on “Flakka;” “Woman in Florida on Flakka.” Here is a 6 minute video from Fusion: “We spent 24 hours living through Florida’s flakka crisis.”

08/4/14

Playing Chemical Whack-a-Mole

image credit: iStock

image credit: iStock

Eight people at a Friday night party in Oklahoma took a liquid version of the drug 2C-E, a chemical cousin to “Smiles” (a synthetic imitation of ecstasy). They all began having seizures and coughing up blood after about an hour. A 22 year-old woman—one of eight—died. “She just kept having one seizure after another.” The 20-year-old guy who bought the drug off the internet from a company in China, was charged with first-degree murder.

A naked 35 year-old mother died of cardiac arrest after she was tasered by police. High on bath salts, she had tried to chock her three-year old son. She was seen chasing her partner and the three year-old through the neighborhood. The police initially tried unsuccessfully to restrain her with pepper spray, but she was violently combative, so they tasered her.

I’ve been following reports and news stories about the new psychoactive substances (NPS) for awhile, and found a Facebook page, “Synthetic Marijuana and Bath Salts Deaths,” that posted links to the above two stories. The insanity of individuals willing to ingest these unknown and largely untried chemicals amazes me; and I’ve been counseling addicts for over thirty years.

The synthetic drug market is booming worldwide. By 2013, 348 new psychoactive substances (NPS) had been reported to the United Nations Office on Drugs and Crime (UNODC), most of which were identified between 2008 and 2013. They exist in every region of the world; 94 countries have reported their existence. See the graphic below, found in the 2014 Global Synthetic Drugs Assessment. Roughly five NPS enter the market every month.

NPS graphThe greatest percentage of the NPS fall within three groups: synthetic cannabinoids (28%), synthetic cathinones (25%), and phenethylamines (17%). Synthetic cannabinoids mimic THC. Synthetic cathinones mimic stimulants and other ATS, including MDMA. Phenethylamines have effects that range from stimulant to hallucinogenics.

Easy to obtain, NPS are increasingly popular with teens and young adults. When they become known and are under legal scrutiny, a domino-like effect triggers the creation of newer, and often more potent, versions. A detective with the Grand Forks police department said that: “Anytime we try to figure something out it changes.” Another problem is that synthetic drugs typically don’t show up on drug tests, which makes them popular with anyone who gets treated for drugs—like military personnel and college athletes.

The U.S. and Canada are among the largest and most diversified markets for NPS in the world. Synthetic cannabinoids first appeared in 2008 and were marketed as “legal alternatives to marijuana.” The American Association of Poison Control Centers reported that between 2010 and 2012, the number of calls about synthetic marijuana rose by almost 80 percent.

There is some evidence that local “hobby chemists” are making batches of these drugs from chemical products shipped from China. “ Two California men are facing life sentences for their role in the production and distribution of synthetic drugs made from 660 pound of chemical products (worth $1.4 million) smuggled into the U.S. from China. Their arrests were the result of a three-year federal investigation.

“Anybody with a little money to front can import chemicals, mix, and sell it.” China’s new chemical entrepreneurs have also become involved in direct-to-the-consumer sales. A recent report confirmed that last November Eric Chang of Shanghai was arrested by Chinese officials and charged with producing ecstasy. Investigators said he made around $30 million selling drugs to the U.S. and Europe.

Erica Larsen captured the growing problem of NPS beautifully in the closing comments of her AfterPartyChat blog post, “Chem-Sex: Europe’s Synthetic Madness”:

Oh brave new world. You know the future has arrived when even former junkies haven’t heard of half the drugs on the market. Will 12-step groups of the next decade be filled with recovering Miaow Miaow [a synthetic cathinone] addicts? How many arcade tokens will it take before authorities give up on whack-a-mole?

Do you have any thoughts on what could be done to stem the tide of this growing problem with NPS?