08/31/18

A Spectacularly Bad Idea

credit: DEA photo

Fox News and The Washington Post reported that over the course of 24 hours in New Haven Connecticut on August 15, 2018, more than 70 people overdosed on synthetic marijuana. Most of the overdoses happened on the New Haven Green, a historic park bordering the Yale University campus. By late morning on Friday August 17^th, the Hartford Courant reported the overdose figure had increased to 114. Some individuals were taken to the hospital four or five times for overdose treatment. After the number of overdoses reached thirty, the New Haven police chief told a local TV station to warn residents to not come down to the Green to purchase K2. Although his announcement makes good common sense, I wonder if a few individuals went down to the Green to see if they could get some K2 after hearing the warning to stay away.

The New Haven Fire Chief said even while they were trying help people, others nearby would pass out or fall to the ground. The situation was unlike anything the emergency workers had faced before. “This is the highest number of victims in the shortest amount of time.” The Washington Post reported that at one point, a shout interrupted a news conference with the fire chief to alert authorities of another overdose. Reporters were tweeting from the Green about the number of people falling “down of the green.” An EMT lieutenant said:

This was a particularly odd, rare occasion where (there was) call after call for man down, obviously with symptoms of some kind of overdose, and at the time of getting that patient packaged and transported to the hospital, we’d see another immediately fall down, right there. . . . At that point, we’d go help that patient, and while helping that patient, another person went down.

Most people were treated at local hospitals, but a few individuals refused to be transported. Fortunately, no deaths had been reported by late Wednesday. As people left the park Wednesday night, things quieted down. A police officer said most of the people who overdosed were lower-income or homeless (K2 is cheap). Officials speculated someone might have been passing around free samples. “One of our fears is that this isn’t over.”

By Thursday night, police had arrested three suspected dealers. The police chief said it appeared at least one individual was passing out free samples in an attempt to stir demand and build a clientele. Early reports said the K2 was mixed with fentanyl, but emergency medical personnel said some patients treated at the Green did not initially respond to naloxone, and had to be given a higher dose of the drug at the hospital. The police chief said Friday that samples they collected and tested contained Fubinaca, a novel synthetic cannabinoid. By midday Friday the 17^th, new reports of overdoses had come to a halt.

AB-Fubinaca was originally synthesized by Pfizer in 2009 as an analgesic, but then never developed for human use. In 2012, it was found to be an ingredient in synthetic marijuana being sold and consumed in Japan. The U.S. designated Fubinaca as a Schedule I controlled substance in January of 2014. It has a similarly illegal status in the U.K. and Germany.

The physical effects from Fubinaca include sedation, loss of motor control, vertigo and a sense of falling, dehydration, dry mouth and nausea. Users can experience anxiety, paranoia, psychosis, auditory hallucinations or distortions. Negative cognitive effects can include unconstrained wandering thoughts (thought connectivity problems), thought deceleration, and difficulty processing information logically (analysis suppression). There have been previous reports of multiple hospitalizations and deaths due to its use.

The New England Medical Journal published an article on a “zombie” outbreak caused by Fubinaca in Brooklyn on July 12, 2016. First responders reported bystanders described multiple persons at the scene as zombielike. Media reports said 33 persons were exposed to Fubinaca, 18 of whom were transported to two local medical centers. Pharmacologic studies indicate Fubinaca is 85 times as potent as THC and 50 times as potent as JWH-018, another synthetic cannabinoid found in earlier outbreaks of K2 products. “The potency of the synthetic cannabinoid identified in these analyses is consistent with strong depressant effects that account for the ‘zombielike’ behavior reported in this mass intoxication.”

The Harford Curant reported the Fubinaca-laced K2 was very short acting. People who used it went down fast, “almost right in their tracks.” Drug users who are regulars at the Green described what happens as “falling out.” Many of them had to be resuscitated, but the effects did not last long, and so they were quickly discharged from the hospital. “Which meant they were able to return to the green and seek another high.”

The Guardian reported the director of homeless care at a local health center, Phil Costello, often works in the Green from a temporary office in a tent. He said: “That batch that came in yesterday, with all the people falling out, has just made this basically a mass casualty incident.” Costello is a nurse, but is known as “Dr. Phil” by the hundreds of homeless who frequent the Green. “Everybody knows each other and they try to take care of each other the best they can.” He said on a normal day, perhaps one or two people would need emergency medical care because of drug use.

This is not just a New York and New Haven problem. In July of 2018 the FDA warned there were reports of severe illnesses and deaths from synthetic marijuana products containing brodifacoum, “a very long-acting anticoagulant commonly used in rat poison.” Brodifacoum poses a severe health risk because it can cause severe bleeding. Hundreds of individuals across 10 states—many in the Midwest—have been hospitalized or died. The Chicago Tribune reported on April 10, 2018 that more than 100 persons were sickened and at least three people died from synthetic marijuana containing brodifacoum. More than half the stricken people were from the Peoria area.

People using synthetic marijuana products should be vigilant for signs of bleeding and should immediately seek medical treatment. The FDA is also concerned with potential harm of donated blood products, as they have received several reports of donors who used synthetic cannabinoids containing brodiacoum. “Because of its long half-life, the bleeding risk from brodifacoum, which prevents vitamin K from being reused within the body, can persist for weeks.”

Scientifc American reported a brodifacoum expert said there have been previous reports in the scientific literature of drug users ingesting the rat poison to prolong their high with marijuana or cocaine. “The toxin ties up liver enzymes that metabolize drugs, extending their effects.” The adverse symptoms experienced by users indicate high levels of exposure to brodifacoum, making accidental contamination unlikely. “We don’t know the exact doses these people are getting, but it’s a lot.”

Authorities have arrested a convenience store owner in Chicago for allegedly selling some of the contaminated material linked to the current poisoning outbreak. Bruce Anderson, executive director of the Maryland Poison Center, says he was told the poisoned Maryland resident purchased the product that made them ill “at a local store.” He warns these substances are poorly understood, and can be perilous even when not tainted; the new cases comprise the latest chapter in an ongoing public health crisis, as people increasingly chase a buzz from numerous chemicals developed for scientific research and readily available on the internet or dark web. “None of these products have ever been tested on humans,” Anderson notes. “Using them is a spectacularly bad idea.”

11/8/16

This Stuff Is not Weed

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

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:

The 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.

03/15/16

Gone Wild

It surprised me not only to see that a synthetic marijuana bust occurred 30-minutes from where I live; but that it made both the local and national news. ABC News, The Fix, a small local paper called The Cranberry Eagle among others reported on the joint operation by the PA State Attorney General’s bureau of Narcotics Investigation and the state police Southwest Strike Force. About 360 pounds in total of synthetic marijuana with an estimated street value of $1.6 million was seized. Intriguingly, three of the four individuals arrested were senior citizens. Talk about putting away something for your retirement.

Two of the individuals owned and operated several tobacco and drug-paraphernalia shops in the tri state area of Pennsylvania, Ohio and West Virginia. According to court records, they would receive shipments of synthetic marijuana from out-of-state suppliers at their Cranberry Township shop, where they would allegedly break down the packages for resale. They were both charged with multiple offenses, including dealing in unlawful proceeds, criminal conspiracy and possession with intent to deliver synthetic marijuana. They were released on $50,000 bail.

In October of 2013 investigators seized about 73 pounds of synthetic marijuana at the UPS facility in Jackson Township. A few days later they seized two additional packages containing another 109 pounds of the drug. Multiple packages had been shipped to the Cranberry Township shop between December 2012 and October 2013 from the same individual in Tampa Florida. The grand jury received testimony that the shop’s owners also imported 3,000 to 4,000 packets of synthetic marijuana from New York and Massachusetts suppliers between October 2013 and November 2014. Search warrants obtained in November of 2014 led to the discovery of another 148 pounds of synthetic marijuana.

The Cranberry shop is one of six retail stores within a company known as “Glass Gone Wow.” All six stores are in the tri state area of Ohio, Pennsylvania and West Virginia. They are all upscale head shops. The home page for “Glass Gone Wow” highlights areas for Elite Glass, Electronics and Wellness. Also look at the Glass Gone Wow facebook page. The Elite Glass products are from several glass and water pipes companies. Yes, you can technically smoke tobacco in them, but I don’t think that is what the vast majority of Glass Gone Wow customers put in their pipes.

When I was on their website, there wasn’t any content under the Electronics link, but it would be for products like e-cigarettes, e-juice flavors and vaporizers. The Wellness Center sells CBD Hemp products, and ‘exotic’ herbs such as Kratom, Kava, Blue Lotus and Damiana. The herbs are all legal, but three of them—Kratom, Kava and Blue Lotus—have psychoactive properties. Kratom is used as an opium substitute. Kava and Blue Lotus will produce mild psychoactive effects alone and more intense effects if mixed with other drugs. Look up these substances on Erowid, if you want to confirm what I’ve said here. Erowid is a pro-drug website offering extensive information on the history, effects and dangers of various psychoactive plants and chemicals.

CBD or cannabidiol is one of the 85 or so cannabinoids found in cannabis. THC or tetrahydrocannabinol is the primary psychoactive cannabinoid in marijuana, while CBD has the greatest medical potential. See “Let’s Not Get Ahead of Ourselves,” or “Clearing Away the Medical Marijuana Smoke” for more on medical marijuana. But the CBD Hemp products may not have the therapeutic effects they claim. First, any CBD product cannot make a medicinal claim without FDA approval. So the products are sold as dietary supplements, which the FDA has limited control over.

In order to force a company to remove a dietary supplement from the market, the FDA has to complete scientific studies and undertake complex legal procedures to support its recommendation. Simply put, it is usually more trouble than it’s worth. So dietary supplements abound, with little or no reliable scientific evidence to support their claims. We are largely going back to the days of the bogus claims of snake oil salesmen when it comes to these “dietary supplements.”

For example, there is a company named GreenGardenGold that sells “CBD-Rich products.” Their “About Us” page said it is one of the first companies to market CBD rich edibles. The company says their products are infused with CBD obtained from reliable providers and are legally shipped in all 50 states. They direct the reader to Project CBD for more information on the “potential therapeutic use of CBD. ” There is then a list of 51 “Potential Therapeutic Uses of Hemp.” In the small print at the bottom of the list is the following:

Green Garden Gold makes no claim as to the efficacy of our products of the use of CBD in treating or combating the symptoms of the above list of medical conditions. We encourage our customers to sample our products for taste and quality. If, as a result of improved health is experienced, then we are delighted for the added bonus our products have provided.

Writing for Forbes, on March 9, 2016, Debra Borchardt indicated that the FDA sent out a number of warning letters to companies that make and sell products containing CBD. A spokesman for the FDA said the companies receiving the warning letters were in part selected because of the flagrant claims made about their products. He said:

Many of these products are claiming in their marketing and promotional materials that they are intended for the use in the diagnosis, cure, mitigation, treatment or prevention of diseases, including, for example: cancer, various infections, psychiatric disorders, multiple sclerosis, arthritis and diabetes.

The companies were told in their letters that they had 15 days to notify the FDA about how they were going to take steps to correct their violations, which include products with little or no CBD in them. Borchardt wrote: “No consumer should be sold an expensive product that claims to have CBD, but then has none whatsoever. Consumers should also get truthful information on the products they buy, i.e. the labels need to be correct.”

Looking at the FDA announcement, it seems that products from “Cali Stores” tested by the FDA were found to have no CBD in them at all. Green Garden Gold was one of the companies who received a warning letter from the FDA. You can read a copy of the letter sent to them by the FDA here. The levels of CBD in the two products tested by the FDA indicated there had .096% and .079% CBD. The range of CBD within the tested products went from 0% to 35%. The Green Garden Gold products were on the lower end of that range. The FDA announcement said:

In February 2016, FDA issued eight warning letters to firms that market unapproved new drugs that allegedly contain cannabidiol (CBD). FDA had previously issued six such letters in February 2015. FDA has tested these products, and many were found to not contain the levels of CBD they claimed to contain. It is important to note that these products are not approved by FDA for the diagnosis, cure, mitigation, treatment, or prevention of any disease. Consumers should beware purchasing and using any such products.

In October of 2014, writing for High Times, Mike Adams wrote about the proliferation of “knockoff CBD treatments.” He noted how CBD has become “rock star” popular in the medical marijuana industry because it can treat a variety of medical conditions. But CBD is still illegal in most of the U.S. This has resulted in “an opportunity for some hemp businesses to market a variation of knockoff CBD treatments that they claim have the same healing power as popular strains such as Charlotte’s Web.” Adams then noted where Project CBD launched a “full-blown investigation” into the matter.

He went on to say these products were only technically similar and “do not provide the same health benefits as high-CBD cannabis strains.” Martin Lee, the director of Project CBD, wrote in the introduction of the report: “We believe that industrial hemp is not an optimal source of CBD, but it can be a viable source of CBD if certain hemp cultivars are grown organically in good soil and safe extraction and refinement methods are employed.”

The report focused on three companies that were operated by the same controlling interest. You can read a copy of the report here. On page 13 of the report is a quote from a press release of the Hemp Industries Association stating its position on CBD Extracts Misbranded and Marketed as “Hemp Oil”.

It is important for America farmers and processors of hemp to understand that most CBD in products mislabeled as ‘hemp oil’ is a co-product of large-scale hemp stalk and fiber processing facilities in Europe where the fiber is the primary material produced at a large scale. CBD is not a product or component of hemp seeds, and labeling to that effect is misleading and motivated by the desire to take advantage of the legal grey area under federal law. Hemp seed oil does not contain any significant quantity of CBD.

The Glass Gone Wow shops were apparently used as fronts to sell synthetic marijuana. At least that is what the grand jury indictment of their owner-operators implies. The shops legally sell water pipes and other paraphernalia commonly used in smoking marijuana. Although I don’t know if the vape pens sold at Glass Gone Wow can be used with hash oil or marijuana, there are e-cigarettes that can be modified to do so. See “E-Cigarettes and E-Joints.” It is also evident that the CBD Hemp Products sold there do not contain high-CBD from medical marijuana. According to High Times, Project CBD and the Hemp Industries Association, their hemp products will only have a serendipitous effect on your health, as was implied in the Green Garden Gold advertisement: “If, as a result improved health is experienced, then we are delighted for the added bonus.”

But there is one final piece of information to leave you with. All six of the Glass Gone Wow stores are located within 2 miles of a high school, middle school or elementary school. This seems to be more than just coincidental, when teenagers are prime consumers of the company’s products. The webpage “About Money” gave the following tip for finding the right location for a retail store: “You know who your customers are, so make sure you find a location where your customers live, work and shop.”

This location claim is easily verified. Go to the Glass Gone Wow location page. Use Google maps to get directions between each site location and local schools. Gateway High School is 1.7 miles from the Monroeville store. There is a middle school 1.5 miles from the Cranberry store. There is an elementary school and a park just across the street from the Robinson store. There was even some concern voiced about this by the Montour Elementary PTA. There is a school 1.9 miles from the South Side store. In Morgantown West Virginia, a school is .8 miles away; and in Boardman Ohio, a school is 1.6 miles away.

02/23/16

Emerging Public Health Threat

I’m almost positive that a guy I saw was high on Flakka. I’d been to Fort Lauderdale Florida for a training conference on relapse prevention. The conference finished early on Friday, so my friend and I decided to catch lunch down by the beach. We were getting a recommendation for lunch from a woman renting Segways, when a man walked by. He was barefoot, shirtless and wearing sweat pants cut off at the knees. He was also busy arguing with someone who wasn’t there. He walked right by us, caught up in his own world.

The reason I suspected he was high on Flakka, was because Fort Lauderdale is in Broward County Florida, which has been ground zero for Flakka. After I commented that I thought the guy was on Flakka, the woman told us that Clearwater was where most of the Flakka problems were at the time. She added that people high on Flakka usually kept to themselves and weren’t violent or aggressive. Then she added that Flakka caused problems because it opened (or activated) the third eye and users were then able to see into the future. We thanked her for her lunch recommendation and left. The guy on Flakka had moved on as well.

We are entering a brave new world of mind-altering substances with NPS—new psychoactive substances—coming to market faster than governments around the world can ban them. See “The New Frontier of Synthetic Drugs” and the “2014 Global Synthetic Drugs Assessment” for more information on the growing problem with NPS. Synthetic cannabinoids (synthetic marijuana), with names like K2 and Spice, are available everywhere. Sold online or in small retail outlets like convenience stores (I’ve heard there’s one that sells it within a mile of my home), synthetic marijuana is popular among younger drug users. After cannabis, synthetic marijuana was the most frequently reported illicit substance used by teenagers in 2012. No longer is finding a pipe in a teenager’s jeans an automatic indication that they are smoking cannabis, the marijuana of their parents’ generation.

The Synthetic Drug Abuse Prevention Act (SDAPT) was signed into law in 2012, but keeping up with the ever-changing chemical formulas used in the manufacturing process is difficult. “The chemical compositions of synthetic drugs are frequently altered in an attempt to avoid government bans.” SDAPT permanently placed 26 types of synthetic cannabinoids and cathinones into Schedule 1. The total number of NPS identified in 2012 was 158.

A CDC report in 2012 said that multiple states found there was an association between synthetic marijuana and unexplained acute kidney injury that was diagnosed after severe nausea, vomiting and flank or abdominal pain brought them to emergency departments. Additional side effects can include tachycardia (faster than normal heart rate) and hypertension.

Synthetic cannabinoid compounds originally were developed to facilitate study of cannabinoid receptor pharmacology, but in recent years have emerged as drugs of abuse. In 2005, SC products marketed as “Spice” first emerged in European countries, before appearing in the United States in 2009, where they were marketed initially as “K2.” Today, SC products are distributed worldwide under countless trade names and packaged in colorful wrappers designed to appeal to teens, young adults, and first-time drug users. Products often are packaged with disingenuous labels such as “not for human consumption” or “incense,” but health professionals and legal authorities are keenly aware that these products are smoked like marijuana. Despite federal and state regulations to prohibit SC sale and distribution, illicit use continues, and reports of illness are increasing.

A 2015 CDC report indicated that poison control centers had 3,572 calls related to synthetic cannabinoid use, which was a 299% increase over the same January-May period in 2014. The number of calls spiked in mid-April before decreasing to 2014 levels by the end of May. The number of reported calls stayed under 100 all throughout 2014. They rapidly increased to 500 calls by April 16th and did not decrease to near 100 until May 28th. See the figure in the 2015 CDC report.

The most commonly reported adverse health effects were: agitation (35.3%), tachycardia (29.0%), drowsiness or lethargy (26.3%), vomiting (16.4%), and confusion (4.2%). Eighty-three percent of the poison center calls had a medical outcome and 11.3% of those had a major adverse event—signs or symptoms that were life threatening or that could in substantial disability or disfigurement. There were 1,407 (47.5%) with a moderate effect—signs or symptoms were not life threatening, and no threat of disability or disfigurement, but did require some form of treatment. “A total of 1,095 (37.0%) had a minor effect (signs or symptoms that are minimally bothersome and generally resolve rapidly with no residual disability or disfigurement).” Fifteen deaths were reported.

This is a fast growing problem and we can’t afford to see it get out of hand. Synthetic cannabinoids were first reported to be in the US in December of 2008 when a shipment of “Spice” was seized by U.S. Customs and Border Protection in Dayton, Ohio. And now, the CDC is saying: “The increasing number of synthetic cannabinoid variants available, higher toxicity of new variants, and the potentially increased use as indicated by calls to poison centers might suggest that synthetic cannabinoids pose an emerging public health threat.”

12/28/15

Weaponized Marijuana

William Wells, a homeless man living in New York City, first started using K2 about a year ago. “My brain is connected to the chemicals,” he said. “It will have you running down the block. It will have you fighting yourself. It will have you getting very violent. It will have you living like a bum. . . . I wish I could stop, but I can’t stop. I can’t stop.” An East Harlem resident said that K2 was being sold 24 hours a day in the area. “Every day I see people doing it right there on the street. It makes them stuck. They stand in one place for hours at a time.” Read more from the original article by Matthew Speiser here.

New York City Mayor Bill de Blasio signed legislation recently that banned the sale of synthetic cannabinoids, commonly known as K2 or spice. The law also bans the sale of synthetic stimulants known as bath salts. Not only are there possible civil and criminal penalties, the legislation authorizes the city to close down businesses that violate the law twice in a three-year period. The New York Times reported in September 2015 that the proposed ban would include selling any drug marketed as synthetic marijuana and any imitations with effects similar to the synthetic cannabinoids.

Authorities did begin to crack down on the sale and distribution of these new psychoactive substances (NPS). Ten defendants were charged and 90 bodegas (convenience stores) were raided. These included six retail outlets on 125th Street in Harlem, which has become ground zero for K2 use among the homeless in the City. Nicholas Casey wrote how:

Crowds of up to 80 or 100 homeless people come in on buses from a nearby shelter on Randalls Island, drawn by heroin recovery clinics nearby, and spend the day there under the influence of this cheaper narcotic. The block between Park and Lexington Avenues appears at times to be a street of zombies.

Police raids on 125th Street in July of 2015 led to confiscations of more than 8,000 packets of K2. But many of the stores continued selling the drug. The sheer number of users on the block has left police officers edgy. “It quickly can become a kind of group mentality where the officers, or even multiple officers, are outnumbered,” according to Tom Harnisch, commander of the 25th Precinct. NYPD Commissioner Bill Bratton described the drugs as “weaponized marijuana.” He said: “This is a scourge on our society, affecting the most disadvantaged neighborhoods and our most challenged citizens. It affects teenagers in public housing, homeless in the city shelter system, and it’s quite literally flooding our streets.”

The New York Daily News filmed a six-minute documentary,”K2 in New York City.” It opens with a 20 second shot of a guy catatonically zoned out on K2. A homeless man who sells K2 held up a packet of “Trippy,” saying: “I want Obama to see this too.” Another person said it was ten times worse than heroin. Against the background of two police officers standing by a person crying out on the sidewalk, a graphic noted that: “Between April 2015 and September 2015 there were more than 4,700 K2-related emergency room visits in NY state compared to just 230 during the same period in 2014.” Another man said that was how he got through the day, dealing with his misery and pain by doing the drug.

A woman said: “Don’t do it. If people haven’t done it … if I know for a fact that you haven’t smoked it, I will not let you smoke it. I wouldn’t ruin somebody’s life like that.” NYC paramedic Robert Kelly said it seems to be effecting mentally ill homeless people in the shelter systems; people that are known drug users. “Unfortunately it’s cheap; it’s easy to get.” US Attorney Preet Bharara announced an operation that seized over 200 kilograms of chemicals and an estimated 275,000 packets of finished product that would have totaled more than 2,700 kilograms of spice. A conservative estimate of the street value of that amount of spice is over $30 million dollars.

The Fix described this joint DEA and NYPD operation as targeting the sale of the drugs in all five NYC boroughs. Part of the operation raided five processing facilities and warehouses used to store and distribute the drugs. More than 80 bodegas were searched as part of the overall operation. DEA Special Agent in Charge, James Hunt said: “Synthetic cannabinoids are anything but safe. They are a toxic cocktail of lethal chemicals. . . . By investigating and arresting manufacturers and distributors of ‘spice’ in the city, we have cut off the accessibility for those feeding the beast.”

The NYC Department of Health and Mental Hygiene has an information page on K2 that describes some of the risks associated with K2 use. “Information for Consumers” said the most common adverse effects of K2 reported include: lethargy, confusion, drowsiness, respiratory depression, nausea, vomiting, tachycardia (increased heart rate), paranoid behavior, agitation, irritability, headache seizures, and loss of consciousness. Severe side effects could include acute renal failure and cardiovascular and central nervous system complications. “In rare instances, use of cannabinoids has been linked to death.”

John Lavitt opened his article for The Fix with a comment on how synthetic drug sales have allegedly fueled terrorism, a claim which has some clear evidence for it. One of the name brands of synthetic marijuana named in The New York Daily News video described above, Scooby Snax, was involved in a DEA raid on a Birmingham Alabama warehouse in May of 2013. Sales from the product were linked to $40 million in wire transfers to Yemen. See “Strange Bedfellows: Terrorists and Drugs.” Also see “The Double-Edged Sword of Narco-Terrorism.”

08/4/14

Playing Chemical Whack-a-Mole

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.

The 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?

Faith Seeking Understanding

Charles Sigler, D.Phil.

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