10/11/22

Striving After Wind with NPS

A few years ago, the problem with new psychoactive substances seemed to predict a dire future. The United Nations Office on Drugs and Crime (UNDOC) launched the Early Warning Advisory on NPS in June of 2013 to address the growing emergence of NPS at the global level. The term “new” can be misleading, as many NPS were first synthesized decades ago, but only recently became recreational drugs. As of December 2021, data reported to the UNDOC Early Warning Advisory 1,124 substances have been reported by governments, laboratories and partner organizations. All told, 134 countries and territories globally have reported one or more NPS.

NPS are not controlled under the International Drug Control conventions, so their legality can vary widely from country to country. By 2021, over 60 countries had implemented legal responses to control NPS. Many countries amended existing legislation, while others used innovative legal instruments. Several countries where a large number of NPS rapidly emerged, adopted controls on entire substance groups of NPS, or introduced analogue legislation that invokes the principle of “chemical similarity” to an already controlled substance explicitly mentioned within the legislation.

The World Drug Report 2021 (Executive Summary, Book 1) indicated these measures helped the number of NPS emerging on the global market to fall from 163 in 2013 to 72 in 2019. But this occurred primarily in high-income countries. “However, the NPS problem has now spread to poorer regions, where control systems may be weaker.” Seizures on synthetic NPS in Africa rose from less than 1 kg in 2015 to 828 kg in 2019. A similar trend was seen in Central and South America, where seizures rose from 60 kg to 320 kg over the same period of time.

Responses that have helped to contain the supply of NPS and reduce negative health consequences can be expanded to lower-income countries, some of which are increasingly vulnerable to the emergence of NPS. Those responses include early warning mechanisms that ensure a continuum of evidence-based measures from early detection to early action, post-seizure inquiries, including the formation of joint investigation teams, and training of emergency health workers on how to address cases of acute NPS intoxication. The expansion of services for people who use drugs and people with drug use disorders to people who use NPS can also help addressing the harm posed by those substances.

The use of NPS is often linked to health problems. Side effects range from seizures to agitation, aggression, acute psychosis and the potential for drug dependence. NPS users have frequently been hospitalized with severe intoxications. Information on long-term adverse effects is still largely unknown, and safety data on toxicity is limited or nonexistent. “Purity and composition of products containing NPS are often not known, which places users at high risk as evidenced by hospital emergency admissions and deaths associated with NPS, often including cases of poly-substance use.”

Effect Groups of New Psychoactive Substances

Up to December of 2021, there were six main pharmacological ‘effect’ groups of NPS: stimulants, synthetic opioids, synthetic cannabinoids, dissociatives, classic hallucinogens and sedatives/hypnotics. Stimulants (36%) and synthetic cannabinoids (30%) were the most common, while sedative/hypnotics, mimicking the effects of benzodiazepines (4%) and dissociatives (3%) were the least common. Synthetic opioids accounted for 8% and psychedelics or classic hallucinogens 15% of NPS. See the following graphic presentation of these groups.

Van Hout et al described health and social consequences of recent NPS use among a survey of 3,023 users in six European countries. Socially marginalized respondents (who are also high-risk drug users), were often unemployed, homeless and/or in care. They were the oldest, with an average age of 33.5 years. A substantial proportion of them lived in homeless shelters or hostels (32.3%) or other living arrangements (12.3%), including living on the streets. The education achievement of most marginalized respondents (55.2%) was only up to the equivalent of high school. Among marginalized respondents, 75.7% were unemployed or living on benefits.

The other two groups of those surveyed, nightlife NPS respondents and online respondents, tended to live with relatives or in rented accommodations. They were better educated and significantly less likely to be unemployed or living on benefits (10.8% and 8.1% respectively). Within all three subsamples, a majority of recent NPS users had experienced acute unpleasant side effects. See Table 4 in Van Hout et al.

In terms of reporting of acute side effects, experiences of increased heart rate and palpitation, dizziness, anxiety and horror trips and headaches were reported as most common across all three categories. The proportion who had experienced these effects was substantially larger in the marginalised sample (85.3%), than in the night life and online community samples (58.8 and 51.0%). When looking at the separate side effects, there are significant differences between the three groups in every symptom, with mostly much higher proportions of marginalised users reporting these effects. When comparing night life users and online community users, night life users reported more unpleasant effects, especially head and stomach aches and dizziness. However, in all categories, marginalised users show much higher rates than the two other groups. Increased heart rate or palpitation was the most reported side effect in all three samples.

Benzodiazepine-Type NPS

Benzodiazepines and benzo-type NPS, primarily etizolam, flualprazolam and flubromazolam are often detected in drug overdose cases and can contribute to serious adverse health effects, particularly when used in combination with opioids. “Current NPS threats”, vol. 3 reported that benzo-type NPS were identified in 48% of post-mortem cases as having been the cause of death or contributing to the cause of death.

The analysis presented here reveals that benzodiazepine-type NPS can play an important role in contributing to serious harm, either alone or in combination with other psychoactive substances. Thus, forensic laboratories should ensure that they have appropriate analytical methods available for their detection in case work.

NPS with Opioid-Like Effects

NPS opioids seem to be a fast-growing category of NPS over the past five years. They include a range of fentanyl analogues and research opioids that were developed by the pharmaceutical industry, beginning in the 1960s, as alternatives to morphine for pain management. “Some of these substances were not developed further and were subsequently considered ‘not suitable for human consumption.’” Some of these opioids have been rediscovered. Others have been developed by modifying their chemical structure, which creates a “new” chemical compound and circumvents existing legislation. While they are dissimilar in their chemical structure, the common action of NPS opioids is they act on the mu opioid receptor. The harms associated with NPS opioids other than fentanyls vary considerably.

NPS with opioid-like effects continue to emerge on illicit drug markets, and “Current NPS threats” highlighted three. Isotonitazene, a synthetic opioid has been seen in Europe and North America. Since June of 2019, there were eight incidents of fatalities associated with isotonitazene in the US reported to UNODC. In seven cases it was assessed to be the cause of death. Because of its novelty and opioid-like effects, it could have been misinterpreted as a heroin overdose, masking other cases of fatality.

Kratom, usually involving the concomitant use of other substances, has shown a potential to cause serious harm, including fatalities. Ninety percent of all kratom cases involved the concomitant use of other substances. Since July of 2019, at least 14 cases have been identified where kratom caused (n=7) or contributed (n=7) to a fatality.

Brorphine was first identified in the US recreational drug supply in July of 2020. Its emergence seems to be directly linked to the DEA’s scheduling of isotonitazene. It is commonly found with fentanyl and flualprazolam. “Current NPS threats” said it appears to have a long half-life and high potency when compared to medicinal opioids like hydromorphone. “Despite having structural similarities to fentanyl, brorphine differs in key aspects from fentanyl and falls outside the scope of generic legislation aimed at covering fentanyl analogues.” Between June and November 2020, 120 overdose deaths attributed to brorphine were reported in the US.

Reflecting on the evolving history of NPS, I’m reminded of the book of Ecclesiastes, which says: “Is there a thing of which it is said: ‘See this is new’?” It has been done already and is a vanity—a striving after wind.

What is crooked cannot be made straight, and what is lacking cannot be counted. (Ecclesiastes 1:15)

08/10/18

You Can’t Ask Alice About NPS

New/novel psychoactive substances (NPS) continue to grow in number at the rate of about 100 new ones each year. As of December 2017, there were more than 800 NPS substances reported to the United Nations Office on Drugs and Crime (UNODC) Early Warning Advisory on NPS. Sometimes they are called “legal highs” because they are substances of abuse not controlled by either the 1961 Single Convention on Narcotic Drugs or the 1971 Convention on Psychotropic Substances. Over 110 countries from every region of the world have reported one or more NPS. And you can’t always Ask Alice (or anyone else) to help you sort out what you’ve taken and how it effects you because there is very little known on their risk factors and long-term harm from their use.

UNDOC launched an “Early Warning Advisory” in June of 2013 to address the emergence of NPS at the global level. The goal of the EWA is “to monitor, analyze and report trends on NPS.” It also acts as a compilation of information on these substances. If you don’t know much about NPS, it’s a good place to begin your education on them. Information on the adverse health effects and social harms of NPS are often hard to come by, making treatment and prevention efforts difficult. The following graphic, found in the UNDOC Early Warning Advisory, illustrates how NPS have rapidly become a global concern over the past 10 years.

The majority of NPS are either stimulants (synthetic cathinones, methedrone, MDPV and others) or synthetic cannabinoids, followed by hallucinogens and others. The various NPS also include plant-based substances like kratom, khat and salvia (salvia divinorum). Fentanyl analogues (opioids) are a growing concern with 34 synthetic opioids registered in the EWA by the end of 2017. “In June 2018, UNODC launched an integrated strategy responding to the global opioid crisis.” The following graphic, also found in the UNDOC Early Warning Advisory, illustrates the main substance groups of NPS.

The Mental Elf posted an article, “Novel Psychoactive Substances: bridging the knowledge gap” by Derek Tracy, who said: “We are experiencing fast shifting sands in the world of substance misuse, with a clear current need to pitch some way-markers and determine research and clinical priorities.” NPS have altered how drugs are obtained, adding Internet and ‘dark web’ purchases to the traditional drug-dealing model. He said the vast amount of NPSs creates an enormous problem keeping up to date with the field. He pointed out there is no universally agreed way to categorize NPS. In two papers written for the BMJ, he and others suggested four major categories that combined benzodiazepine (sedatives/hypnotics) and opioids into Depressants and classic hallucinogens and dissociatives into Hallucinogens, while retaining Stimulants and Cannabinoids.

Tracy noted how the UK law, “Psychoactive Substances Act 2016,” was an attempt to restrict the production, sale and supply of NPS. The law defined a psychoactive substance as anything which “by stimulating or depressing the person’s central nervous system … affects the person’s mental functioning or emotional state”. The act makes it an offense “to produce, supply, offer to supply, possess with intent to supply, possess on custodial premises, import or export psychoactive substances; that is, any substance intended for human consumption that is capable of producing a psychoactive effect.” Exemptions included: alcohol, tobacco or nicotine-based products, caffeine, food and drink and medicinal products.

He also described the work of the NPS-UK project. which set out to summarize and evaluate what is known about NPS use, harms and responses; develop a conceptual framework for a public health approach; and make recommendations on evidence gaps and future priorities. “The authors systematically reviewed the existing literature up to June 2016, and used these findings to produce both the conceptual framework and key recommendations on future priorities.” They included 995 studies in their analysis. There was limited data on social and other risk factors, population risk factors, long-term harm, intervention effectiveness and treatment outcomes. The limited harms data available meant it was not possible to build a good population risk assessment. “The conceptual framework notes the need for better long-term data on harms and intervention effectiveness, and the wider societal burdens involved.”

NPS use remains a ‘minority’ amongst those who consume drugs, but the area is important. Some are being shown to be especially potent, with localised bursts of hospitalisations and deaths; the novel fentanyls seem a particular worry. Even more so than is usually the case, there are some very marginalised and vulnerable people who seem disproportionately involved, notably those who are homeless, in prisons, and forensic psychiatric units. Issues of detectability and cost may be playing a role, but when we think of the social space in which harmful drug use is treated and lives rehabilitated, these may be very difficult people to reach.

The World Drug Report 2018 said the NPS market continues to be dynamic. New substances emerge, while others seem to disappear after a short time. Around 70 of the 130 NPS reported when UNODC began global monitoring in 2009 have been reported every year since then. “On the other hand, about 200 NPS reported between 2009 and 2014 were no longer reported in 2015 and 2016 and may have disappeared from the market.” Yet this may not be accurate, given the complexity of identifying NPS in many parts of the world.

The comparison of epidemiological data on the use of NPS in different countries is not easy because the definition of NPS may differ from country to country and may include substances that have been placed under national or international control. There are limited data available to make comparisons of the prevalence of NPS use over time and limited survey tools for capturing NPS use, and NPS users have limited knowledge about the substances they use.

While the data on NPS trends is limited to a few countries, it seems in the past three years there has been a shift away from smoking herbal mixtures to using NPS in tablet or liquid form. In the U.K. NPS packaging changed after the new NPS legislation was implemented. Before they was in bright, colorful packages and gave the perception of being legal alternatives to illegal drugs. But since 2016 NPSs have been in plastic wraps or bags with no detailed information on what they contain. A disturbing trend is the pattern of NPS use among vulnerable and high-risk groups including homeless people and individuals struggling with mental health issues.

“The use of new psychoactive substances among homeless people has been documented in Czechia, Finland, Hungary, Ireland, the United Kingdom and the United States.” A study of 53 homeless people in Manchester England found that 79% had used NPS in the past year. Of those who reported using NPS in the past year, 64% said they used them daily, and another 14% used them five or six days per week. “Synthetic cannabinoids were the substances most often reported.”

In Scotland, 22% of admissions on general adult psychiatric wards between July and December of 2014 reported using NPS. A diagnosis of drug-induced psychosis was significantly more likely than depression among those reporting NPS use. Stimulant NPSs (analogues of amphetamine, methamphetamine, MDMA, methcathinone) were used three times more often than synthetic cannabinoids. A study in England found 12% of patients admitted to a secure mental health setting had used NPS beforehand. “About 20 per cent of mental health units had required an emergency response to assist with NPS use in the past 12 months.”

There are also increases in the use of benzodiazepine-type NPS and overdose deaths related to their use. “In Scotland, of the reported 867 drug-related deaths in 2016, 286 deaths were related to NPS use, and in most cases, benzodiazepine-type NPS were found to have been implicated in, or to have potentially contributed to, the cause of death.” Most cases found etizolam; there were a few related to diclazepam or phenazepam.

We mustn’t forget NPSs with opioid effects. “Between 2009 and 2017, a total of 34 synthetic opioids, including 26 fentanyl analogues, were reported to UNODC early warning advisory by countries on all continent.” Most of those were reported after 2016. The most frequently reported fentanyl analogues reported included: furanylfentanyl, acetylfentanyl, ocfentanil and butyrfentanyl.

Over the past few years kratom has gained popularity as a plant-based NPS in North America and Europe. Globally, 31 countries reported finding kratom between 2012 and 2017. The scientific literature links high doses of kratom with several adverse health events, including tachycardia, seizures and liver damage. “In North America in particular, a variety of products have been marketed as kratom, which may actually contain kratom in combination with other, often unknown, substances.” It was speculated the severe adverse health effects could be the result of the powdered, refined form of kratom instead of the traditional forms used in South-East Asia.

Currently, neither kratom nor the psychoactive substances contained in its leaves are under international control. Given the scarcity of data on the potential pharmacological, therapeutic and toxicological effects of kratom and kratom products, and the lack of controlled laboratory studies, it is difficult to understand the health risks and potential benefits associated with their use.

Concerns with NPSs are growing both locally and globally. I’ve been writing about problems related to them for almost four years now. NPSs have been linked to terrrorists (See “Strange Bedfellows: Terrorists and Drugs”). They are sold in some convenience stores, some tobacco or vape shops, as well as “head” shops selling water pipes and other paraphernalia (See “Gone Wild”). A stimulant-based NPS known as flakka had people stripping off their clothes and running naked through traffic a few years ago (See “Flack from Flakka”). It’s a problem among the poor and homeless (See “Weaponized Marijuana”). You can also read previous articles on this website by doing a search for “NPS”. Try: “The New Frontier of Synthetic Drugs”; “This Stuff Is Not Weed”; “Not Meant for Human Consumption”; or “Is Ketamine Really Safe & Non-Toxic?”

07/28/17

The Open Secret of K2 in Prisons

Early Wednesday morning on April 19, 2017, Aaron Hernandez was found dead in his prison cell. He hung himself by wrapping a bed sheet around his neck and tying it to a bar on the window of his cell. The former tight end for the New England Patriots was found guilty of first-degree murder in 2015 and was sentenced to serve life in prison without the possibility of parole. Investigators suggested Hernandez killed Odin Lloyd because he didn’t want information about his bisexuality to become public knowledge. He had slicked the floor of his cell with liquid soap, probably in case he lost his nerve in the midst of his suicide attempt.

While the eternal spiritual state of his soul can’t be known with any certainty, what is known for sure is there was K2, a form of synthetic marijuana, in him when he died. Writing for Newsweek, Michelle McPhee reported Hernandez had a Bible open to John 3:16 in his cell and had scrawled the verse in red ink on his forehead. He also made red ink marks on his hands and feet, mimicking the stigmata of the crucifixion of Christ. He wrote three notes—one to his fiancée, the mother of his daughter, one to his daughter and one to a man identified as his prison boyfriend.

In a second article, McPhee said verifying the presence of K2 in Hernandez’s system led to a State Police raid at the Souza Baronwski Correctional Center (SBCC), the prison facility where Hernandez died. Department of Correction sources confirmed a wide-scale investigation was underway at the prison, as well as a warehouse used to store dry goods before they went into the prison. But this is not just freak occurrence within a single Massachusetts state prison. Aaron Hernandez’s tragic death spotlighted a serious problem with synthetic marijuana in prisons.

Writing for The Fix on April 19th, Seth Ferranti described how the U.S. Bureau of Prisons (BOP) has a synthetic marijuana problem. The problem is twofold. First, the BOP doesn’t regularly test for synthetic marijuana. Prisoners are tested for illicit drugs such as heroin and marijuana, but the standard urines tests don’t screen for the metabolites from synthetic marijuana. However, there is technology available to test for synthetic marijuana. Google “synthetic marijuana urine tests.” You can even order the kits through Amazon.

Second, if an inmate is caught with synthetic marijuana, it is a relatively minor offense—a 300 series incident report—equivalent to illicit tobacco possession. Possession of illicit drugs like heroin or marijuana or a positive urine test for those substances is a series 100 offense, the most serious incident report. A series 100 offense could result in 60 days in Disciplinary Segregation (the hole), or the loss of good time, commissary, or visiting and phone privileges for up to one year. The punishment for synthetic marijuana is essentially a slap on the wrist. “By switching their illicit smuggling ventures to K2 or Spice they’re lessening the consequences that they’ll face when caught.”

The Federal Correction Institution (FCI) in Forrest City Arkansas was given as an example. A prisoner said after the 9:30 pm count, the bathrooms and shower stalls fill up with prisoners smoking some version of K2 or Spice. It can be hard to find an open shower stall to take a shower. On the recreation yard at dusk, clouds of smoke appear over the bleachers from all the people smoking K2. “With endless amounts of time and little fear of consequences, inmates are smoking nonstop.”

The effects of synthetic marijuana on an individual can vary widely. One man began to dance around like a ballerina. As guards tried to subdue him, he resisted yelling that it was their fault. “You let it in, you bring it in. It’s all a conspiracy to get everyone to tell on each other.” Another person started hugging his bunk, while “screaming like a banshee.” When other prisoners tried to quiet him, it only became worse.

I talked to one dude and he said he hit it and he started rapping. He told me he never rapped in his life, but that was all he could do to not lose his mind. Then another dude smoked some and crawled under the bunk. When we got locked down this guy went totally … crazy. He kicked a C/O and went absolutely insane, screaming and running, all kinds of crazy shit. Another guy thought he was God and that the end of the world was coming, slobbering and acting like a five year old. It’s all bad man.

Smuggling K2 into prisons is done by a variety of methods, but visitation is the primary method. Guards will smuggle K2 in, seeing it as a lesser evil and as a way to make some easy money. The main way it came into Forrest City was over the fences, which are low. “Campers or free world people throw packages over the recreation yard fence.” At FCI Beckley in West Virginia the regular smuggling gauntlet is through the mailroom. K2 begins as a liquid that can be sprayed on any kind of paper product, like letters. Inmates then smoke or ingest pieces of the soaked paper, or sell it to other inmates. Chris said: “It’s becoming an issue at every institution. It’s crazy here.”

While U.S. media coverage of this problem was scarce before Hernandez’s death, it has been regularly noted as a concern in U.K. prisons for several years. In October of 2015, BBC News reported how investigators concluded the use of Spice in an Oxfordshire prison contributed to an increase in violence. A November 2016 article in The Daily Mail described a documentary, the “Secret Life of Prisons,” that said drugs (particularly Spice) are widely available. The drugs are smuggled in with drones, hidden in trainers, and even on children’s drawings.

A Vice article on January 29, 2016, reported how prison officers said they are getting involuntary hallucinations after entering cells where inmates had recently smoked Spice (it’s odorless). Another BBC News article reported officers at HMP Holme House complained of feeling dizzy after entering cells where inmates had smoked Spice. One officer they believe was exposed had a fierce burning sensation in his head, “which felt like his head was covered with nits, and [he] spent the night tearing at the top of his head.” One former inmate said he’s seen men go berserk, turning on their best friends. “I’ve also seen it where lads have dropped down dead, had heart attacks, gone into comas, gone loopy and ended up being sectioned because of it.”

An April 19, 2017 article on Devon Live described the problem with synthetic marijuana at another British prison, HMP Dartmoor. Here, like the U.S. prison in Forest City Arkansas, the drugs mostly come into the prison is as “throwovers” tossed over the prison wall. An ex-offenders’ organization called User Voice surveyed nine jails on their use of Spice. One third reported using Spice in the previous month. User Voice said the use and popularity of Spice contributed to an increase of violence, bullying, mental and physical ill health concerns, and even death within British prisons.

Writing for the Pittsburgh Post-Gazette, Rich Lord described the K2 problem at the Pennsylvania State Correctional Institution – Huntingdon. Inmates have written to the Post-Gazette, saying they don’t like seeing their neighbor passed out from the drugs they buy in the prison yard. A member of the security team at the prison said these guys who use K2 are often zombie-like: “They’re just groaning, moaning and not able to understand anything that’s being said to them.” SCI Huntingdon first noticed K2 about eighteen months ago.

When an inmate’s belongings test positive for K2, he typically gets 90 days in restricted housing, meaning he spends 23 hours a day locked in a Spartan cell. The restricted housing unit at Huntingdon is largely filled with prisoners whose belongings tested positive for K2. Some inmates claim they were wrongly identified as having K2. One prisoner wrote how he received a misconduct report accusing him of having K2 in a bottle he said held only shampoo. The misconduct could stymie his bid for boot camp and early parole. He said: “I’ve made mistakes, but I don’t deserve this.”

There is regular reporting on the growing presence of K2, Spice and other new psychoactive substances in the U.S. So the apparent silence on the extensive the use of synthetic marijuana use in U.S. prisons is curious to me. It was encouraging to see the coverage given to it by the Pittsburgh Post-Gazette. But it seems the methods used to uncover K2 use need to be more accurate, as the negative consequences to inmates for false positives are so serious. The ready availability of these substances in prisons seems to be an open secret—we know they are in there, but just don’t want to think about it.

See other articles on new psychoactive substances (NPS) on this website such as: “Not Meant for Human Consumption.”

03/24/17

Not Meant for Human Consumption

In September of 2015 federal and city authorities raided around 80 locations throughout NYC in a crackdown on the importation, distribution and sale of synthetic cannabinoids. Ten people were indicted and a minimum of 100 kilograms of illegal synthetic compounds was confiscated. This was enough to produce 260,00 retail packets with a street value of near $30 million. The operation imported the compounds in powdered form from China through commercial delivery services (like UPS and Federal Express). Then in a Bronx processing facility, the compounds were mixed with solvents and sprayed onto tea leaves.

Most of the ten individuals indicted were of Yemeni descent; four were still at large at the time of the raid. One of the indicted, but at large, individuals seems to have tipped off his operation in July of 2014 when he was stopped for using a cell phone while driving. He consented to a search of his vehicle, where DEA agents found $644,338 IN CASH. When his Queens home was searched, they found an additional $150,935.

The agents say they then read Deiban his Miranda rights but that he nonetheless told them the greater sum came from the sale of synthetic narcotics and was bound for a store in the Bronx. They also say Deiban said the smaller sum came from Bronx and Queens stores that sell his synthetic pot.

He also boasted about selling his products over eBay. He was questioned about a number of keys he had on his person, some of which he said belonged to a warehouse where he stored his synthetic marijuana. But he was not willing to tell DEA agents the warehouse’s address unless the DEA agents guaranteed he would not go to jail. The case was settled in November of 2014. Under the terms, Deiban did not admit to any of the allegations and he was repaid $477,163.80 of the seized money.

Instead of counting his blessings, Deiban allegedly sought to make more dough. The September 2015 complaint says that in the past year, Deiban and his cronies imported at least 220 pounds of banned powdered substances used to make K2 or “spice”—enough to manufacture at least 260,000 packets.

The above incidents really happened, even though they seem to be suspiciously like an Onion satire of really dumb drug dealers. You can read the Department of Justice announcement of the September 2015 indictments here. Additional information noted above can be found in an article on The Daily Beast here and a New York Daily News article here.

This isn’t the first time there has been a Yemeni connection to the sale and distribution of synthetic cannabinoids in the U.S. In 2014, a raid on a Birmingham Alabama warehouse found hundreds of thousands of Spice (synthetic marijuana) packets. Sales of the product were linked to $40 million in wire transfers to Yemen. Read more about this in “Strange Bedfellows: Terrorists and Drugs.”

If you aren’t too familiar with Spice and other so-called new psychoactive substances (NPS), here are some key facts from a World Health Organization “fact file on new psychoactive substances.” There are more than 500 different types of NPS recorded as of March of 2016. The number of NPS as of October 2015 was 602, 55% higher than in 2014. By December 2015, that total would rise to over 644, according to the UNODC Global SMART Update. The most common NPS are synthetic cannabinoids, which mimic the effects of THC, the main psychoactive ingredient in marijuana. “Collecting information on new psychoactive substances is difficult due to the sheer number and speed with which they appear on the market.”

The UN Office on Drugs and Crime (UNODC), the lead agency in international drug control, has identified nine groups of new psychoactive substances. These include synthetic cannabinoids, which mimic the effects of the main psychoactive substance of cannabis, THC; synthetic cathinones, which have stimulant properties and induce feelings of empathy; and phenthylamines, which have stimulant and hallucinogenic properties. Of new psychoactive substances reported in 2014, 39 per cent were synthetic cannabinoids; 18 per cent were phenethylamines and 15 per cent were synthetic cathinones.

UNODOC publishes a Global SMART (Synthetics Monitoring: Analyses, Reporting and Trends) Update twice a year. Volume 16, published in September of 2016, said that synthetic drugs were one of the most significant global drug problems. As noted above over 644 NPS were reported from 102 different countries. “New NPS continue to emerge every year at an average rate of about one substance per week, making research and monitoring activities critical in improving understanding of the dynamic nature of the problem.” You can download a copy here.

NPS are diverse in terms of their effects and chemistry. Those identified so far seem to mimic the effects of the six main groups of substances controlled under international drug conventions. The six groups are: opioids, synthetic cannabinoid receptor agonists, dissociatives, like PCP, classical hallucinogens like LSD, sedatives/hypnotics like diazepam, and stimulants like cocaine and amphetamine-type stimulants. The following pie chart from the Global SMART Update illustrates the proportion of NPS by their pharmacological effect. The chart indicates how the three NPS noted above, synthetic cannabinoids, synthetic cathinones, and phenthylamines account for 88% of the total proportion of NPS indentified by December of 2015.

A major area of concern is with the unknown adverse health risks associated with using NPS. Obtaining health-related and toxicological data is crucial for making scheduling decisions with NPS. Synthetic cannabinoids have been linked to both fatal and non-fatal intoxications, along with seizures, tachycardia and hypertension. Synthetic cathinones like MDPV have been associated with severe agitation, violent behavior, tachycardia, psychosis paranoia and fatal intoxications. Dangers are accentuated by intentional mislabeling of products, as was noted above, as well as their unknown purity and composition.

The internet is an important distribution channel. It provides easy, anonymous and low-risk supply of NPS. Not to mention the high rewards to suppliers and retailers. Websites may be in different countries from those where the NPS are manufactured and/or where they are supplied. “The disparity of laws in various regions poses a challenge in adopting a comprehensive approach for the prosecution of violations.” Then there is the sale of products on the darknet, which is only accessed by anonymizing software.

The number of NPS and the rapidity with which new ones emerge presents a challenge to drug control systems. Placing a potentially harmful substance under legal control can be a lengthy process of evidence-gathering and a scientific review of its harms. This means there is a time lag between emergence of an NPS and when legal control is implemented. “NPS manufacturers o en exploit this inevitable me lag by developing and marketing alternative substances to circumvent established controls. “

In the U.S., the 2016 National Drug Threat Assessment (NDTA) reported that NPS are available throughout the U.S. The two most common are synthetic cannabinoids and synthetic cathinones. Although synthetic cannabinoids are usually ingested by smoking, they are also available as a liquid or oil to use in e-cigarettes or vape pens. In 2015, synthetic cannabinnoids were found in counterfeit Xanax bars. Calls to the AAPCC, the American Association of Poison Control Centers, totaled 7,779. This was a 111% increase over 2014. This was the highest number of calls recoded since the drugs first appeared on the market. See the following figure taken from the 2016 NDTA.

Inmates in prisons and jails use synthetic cannabinoids because they aren’t typically tested for in mandatory drug screens. “The drugs are also difficult to detect during screenings by prison officials and narcotics dogs.” Liquid cannabiniods are sprayed onto paper products, like greeting cards or letters, and then dried. When successfully smuggled into a prison, the drug-saturated pages are torn into small squares, then chewed or smoked. In October of 2015, the FBI issued a warning that synthetic cannabioids in prisons may result in inmates becoming agitated and aggressive.

The foil packets used to package synthetic cannabinoids can be purchased in bulk. The empty packets are already branded with various cartoon logos and brand names. The contents of the packets can vary widely. A DEA forensic lab tested 28 identical packets from one seizure in 2015. “The packets contained a total of seven different synthetic cannabinoids.” Many contained more than one variety of synthetic cannabinoid.

Ironically, the synthetic cannabinoid problem seems to have originated by classifying marijuana as a Schedule I controlled substance. In 1970, marijuana and its cannabinoids were given a Schedule I designation. This meant that marijuana was difficult to obtain for research on its therapeutic effects. Then John W. Huffman and his team of researchers at Clemson began developing cannabinoid compounds to aide in the research of multiple sclerosis, HIV/AIDS, and chemotherapy. Their research was funded by: the National Institute on Drug Abuse (NIDA).

Over the next twenty years, they developed 450 synthetic cannabinoid compounds. Some of those, including: JWH-018, JWH-073, JWH-210, JWH-250, and JWH-081 are among the dozens of synthetic cannabinoids on the streets today. Notice the compound names begin with Huffman’s initials: “JWH.” Like any self-respecting scientist, he published his research, which included step-by-step instructions on how to recreate the substances. Then around 2008, JWH-018 appeared in Germany as a recreational alternative for marijuana known as “Spice” and “K2.” Huffman said: “I always had a hunch that someday somebody would say, ‘Hey, let’s try smoking them.’ … These things are dangerous—anybody who uses them is playing Russian Roulette. . . . We never intended them for human consumption.”

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.”

07/13/15

Getting High is an Global Problem

Package with a drug against the passports and U.S. dollars — © blinow61 | stockfresh.com

Looking at information gleaned from the 2014 World Drug Report suggests two drug trends to expect over the next few years. A bumper crop of opium poppies globally (particularly in Afghanistan), points to an increased worldwide problem with heroin. Afghanistan grew about 80% of the world’s opium poppies in 2013. Second, the development of new psychoactive substances (NPS) has accelerated and doesn’t appear to be slowing down anytime soon. By December of 2013, there were 348 known NPS, an increase of 200% since 2009. There are now more NPS than the number of substances under international control (234).

Globally, an estimated 243 million people aged 15-64 used an illicit drug in 2012. The three primary groups of illicit drugs were: cannabis, opioids, and cocaine or amphetamine-type stimulants (ATS). Generally, men are two to three times more likely than women to have used an illicit substance. While there are regional trends to consider, overall global drug use seems to be stable. The extent of problem drug use, determined by the number of regular drug users and those with drug use disorders, was also stable globally, at around 27 million people. The estimated number of global drug users by drug type is in the table below.

Global Drug Use by Drug Type

	Cannabis	Amphetamine-like stimulants	Cocaine	Opiates (heroin, opium)	Opioids (opiates and synthetics)
	Cannabis	Amphetamines	Ecstasy	Opiates (heroin, opium)	Opioids (opiates and synthetics)
Users in millions	177.6	34.4	19.36	17.20	16.40	33.00
% of global population 15-64	3.80%	0.70%	0.40%	0.40%	0.40%	0.70%

There has been an increase in global opioid and cannabis use since 2009, while the use of opiates, cocaine and ATS has either remained stable or decreased. Reports on the types of drugs individuals seek treatment for can provide information on which drugs have the highest impact on health in the various geographic regions. Cannabis treatment is prevalent in Africa, the Americas and Oceania. It should be noted that between 2003 and 2012 that those seeking treatment for cannabis increased in Western and Central Europe (19% to 25%), Eastern and South Eastern Europe (8% to 15%), Latin America and the Caribbean (24% to 40%) and Oceania (30% to 46%).

Opioids dominate treatment requests in Eastern and Southern Europe and Asia. Cocaine is major treatment factor in the Americas, especially in Latin America and the Caribbean. ATS use disorders are responsible for a significant proportion of the treatment demand in Asia and Oceania.

Global estimates are that one in six problem drug users got treatment in the past year. However, there are large regional differences. One in 18 problem drug users receive treatment in Africa (mostly for cannabis use), while one in five problem users in Europe, one in four in Oceania and one in three in North America receive treatment.

Drug-related deaths were estimated to be around 183,000 in 2012. Overdose deaths from opioids (heroin and non-medical use of prescription opioids) are the main drug type implicated in those deaths. Most overdoses occur when opioids are mixed with other sedating substances, like alcohol and benzodiazepines. See the global data in the table below from the 2014 World Drug Report.

North America continues to be a major market for illicit drug use. It has the largest percentage of opioid users, cocaine users and cannabis users. It was second in percentage of ATS users. Cocaine use has been declining since 2006, partly because of a sustained shortage. Yet there has been a slight increase in prevalence recently. Columbia’s recent decision to stop spraying coca crops could stimulate a greater resurgence in cocaine use.

In the United States, opioid-dependent drug users are increasingly turning to heroin because of its greater availability and lowered cost to regular users. The greater availability of heroin in the United States is likely due to higher levels of heroin production in Mexico and Mexican traffickers expanding into “white heroin” markets. Anecdotal evidence is that Mexican drug cartels are switching from growing marijuana to opium poppies due to the lower demands for marijuana in the United States. See “The Economics of Heroin.”

The rapid growth of NPS has led to a key supply control strategy of restricting the availability of the precursor chemicals necessary to manufacture them. Most drugs, whether they plant-based or synthetic, require chemicals to change them into the final product. While chemical are only one of the components required for the illicit manufacture of plant-based drugs like heroin and cocaine, ‘they constitute the essential components of illicitly manufactured synthetic drugs.”

NPS are found throughout the globe. Of the 103 countries that gave information for the World Drug Report, 94 countries reported the emergence of some kind of NPS in their markets. The increase from August 2012 to December 2013 of newly identified NPS was mostly due to new synthetic cannabinoids (50% of newly identified new psychoactive substances) followed by new phenethylamines (17%), other substances (14%) and new synthetic cathinones (8%). See the following chart from the 2014 World Drug Report.

Reviewing this report on worldwide drug use reminds me that getting high is an everywhere problem. This year the transition from pharmaceutical painkillers to heroin and the higher cultivation levels of opium poppies suggests a pending increase in heroin addicts and overdose deaths. The rapid explosion of new psychoactive substances onto the drug scene in the past few years feels like a “back to the future” move to the days of patent medicines, when heroin was a cough suppressant and cocaine was a toothache cure. Teething medications contained morphine. Coca-Cola (with cocaine) was a temperance drink and tonic, “a cure for all nervous affections.”

Cannabis is becoming more potent and toxic just as legalization movements gain steam and increase its use and availability. Coca eradication efforts that seemed to have had an effect on the cocaine market are to be suspended—perhaps leading to a resurgence in cocaine use. Getting high is an everywhere problem and it seems like it’s not going away anytime soon.

05/11/15

Flack from Flakka

There’s a new drug in town—Flakka! A news report in January of 2015 from Broward County Florida’s WPBF 25 reported a disturbance call at a local nightclub that led to an arrest of an individual who was in possession of a bag of flakka. It looks like a cross between crack cocaine and meth. It can be snorted, smoked, ingested or shot up. And, “It has a strong odor like a sweaty sock.” Sounds inviting.

On March 13, 2015, there was a report by NBC South Florida that a fifty year-old man was trying the BREAK INTO the Fort Lauderdale Police Department because he thought 25 cars were chasing him down Broward Boulevard. He was kicking the hurricane glass with enough force that both the glass and the door were shaking. Again, he was high on flakka. Here is a security video of the man in the act of trying to break into the locked door of the department.

A thirty-four year-old man wearing only sneakers and socks was running on Broward Boulevard (again). He thought that people had stolen his clothes and were trying to kill him. He said he’d rather die than be caught by these people. He told police he was running down the middle of the street because if he was hit by a car, they would stop chasing him. You guessed it: high on flakka. Here is a video and report on the streaker.

In addition to these incidents, there was a naked man with a loaded gun on the roof of a building in Lake Worth shouting that someone was trying to kill him. When he saw the responding police officers approaching, he placed the pistol to his head and pulled the trigger. He misfired. Again, he’d smoked (vaped) flakka. And a twenty-six year-old man faces attempted murder charges after attacking an 86-year-old woman when he was high on flakka. You can access reports and videos on these two incidents here.

Now this flakka story is just too weird. Police in Melbourne Florida responded to a burglary call and discovered a naked man (of course) who claimed he was God before he got into a “tussle” with a police officer. This was after the officer hit the man TWICE with a taser. But he pulled out the probes and attacked the officer with his fists. Aleksander Chan for Gawker quoted a report by WKMG saying: “The officer punched Crowder in the face and a scrum ensued, with Crowder saying that he was Thor and trying to stab the officer with the officer’s badge, police said.”

Flakka is a new psychoactive substance (NSP) typically made from alpha-PVP, a synthetic cathinone. Cathinones are chemicals from the khat plant grown in the Middle East and Somalia. Effective February 27, 2014, the DEA listed alpha-PVP and 9 other synthetic cathinones as Schedule I controlled substances with a temporary ban. How it works (pharmacologically) is not known. It is believed to be similar to MDPV, which acts as a norepinephrine-dopamine reuptake inhibitor (NDRI). But no substantive research has been conducted yet on alpha-PVP.

In 2012, an Australian man died after injecting alpha-PVP. He stripped off his clothes, jumped a barbed wire fence into a shipping yard and smashed a window in a psychotic fit. He was restrained by several security guards inside the shipping yard and went into cardiac arrest. His girlfriend, also high on alpha-PVP, was covered in blood as she fell from their truck. She then took her top off and ran away, yelling, “Help me, help me.”

Jim Hall, an epidemiologist, said in a CBS News report that cathinones like flakka are the next—and more potent—class of drugs taking over after MDMA. They are designed to flood the brain with dopamine, and then block the pre-synaptic neuron from removing the dopamine from synapse. The result is an intense feeling of euphoria. Hall said that “snacking,” taking more flakka or other drugs while high, often leads to serious health problems, such as rapid heart rate, agitation, extreme aggression and psychosis. He said they are starting to see cases of excited delirium with flakka, as noted in the above reports.

[Excited delirium] is where the body goes into hyperthermia, generally a temperature of 105 degrees. The individual becomes psychotic, they often rip off their clothes and run out into the street violently and have an adrenaline-like strength and police are called and it takes four or five officers to restrain them. Then once they are restrained, if they don’t receive immediate medical attention they can die.

The drug’s name has several meanings. The word flaca in Spanish means skinny. But flakka is also a Hispanic colloquial word that means a “beautiful, elegant woman who charms all she meets.” It has been reported in other parts of the country, such as Ohio and Houston. Outside of Florida it’s often sold under the street name of “gravel” because it looks like the grainy pebbles or gravel in an aquarium.

Flakka and other cathinone-based drugs are produced in China and sold online to individuals and drug gangs in the US. An investment of a few thousand dollars can make a dealer as much as $75,000. These drugs aren’t always pure, meaning neither the dealer nor the customer actually knows what is in them, or how strong the dose is. Hall said: “We’re referring to these as the guinea pig drugs. Often the dealer might not even know what they’re selling.” In 2013 there were 126 reported deaths due to synthetic cathinones in Florida.

Then on April 10, 2015 the Broward Sheriff’s office were called to the scene of what appears to have been an accidental fatal shooting. A 31 year-old man was on a three-day flakka and molly (MDMA) binge when his friend came over. They added vodka and more molly to the mix. After spending the rest of Friday morning selling heroin, they decided to go to the home of the one man’s sister. When one individual was trying to unload a shotgun, it accidentally fired, ripping through the side of a car and hitting the other man in the face. The shooter is in jail on manslaughter charges and possession of a firearm by a felon.

CBS News in Chicago did a story on April 24, 2015: “Scary new designer drug flakka hits Chicago.” And again, there was a naked man running around southwest Chicago. He had no memory of what he did while on flakka. “I went to jail, and I don’t remember anything until my third day in jail. I was completely out of my mind.” There is a whole new world of mind-altering substances and the problems associated with them out there. I don’t think we have not heard the end of flakka. And as long as there are willing guinea pigs, there are more NPSs to come.

12/8/14

The New Frontier of Synthetic Drugs

In 1988, Gary Henderson, a professor of pharmacology at the University of California-Davis Medical School, predicted the coming global problem with synthetic drugs. He wrote that the scientific literature was full of potential synthetic routes and pharmacological properties for a wide variety of drugs. He said that information was readily available for “clandestine chemists” to exploit. Restricting access was not feasible and controlling the chemicals needed to make these drugs would only have a minimal effect. Henderson prophetically said:

It is likely that the future drugs of abuse will be synthetics rather than plant products. They will be synthesized from readily available chemicals, may be derivatives of pharmaceuticals, will be very potent, and often very selective in their action. In addition, they will be marketed very cleverly.

Today, news about the problems with synthetic drugs or new psychoactive substances (NPS) is hard to avoid. The parents on a 19-year-old who died after smoking synthetic marijuana started a facebook page in his memory. The governor of New Hampshire declared a state of emergency because of the overdose deaths from “Smacked,” a synthetic marijuana sold in convenience stores.

A Minnesota teen pled guilty to third-degree murder when the N-Bomb, a synthetic form of LSD, he supplied to several other teens resulted in an overdose death. The DEA reported that N-Bomb was responsible for at least 19 deaths between March of 2012 and November of 2013. A survey of 15,000 high school students in Minnesota revealed that 12% had used synthetic drugs. Minnesota has responded by launching a synthetic drug awareness website, KnowTheDangers.com. Drug WarFacts.org has a page devoted to information on NPS.

The problem is truly a worldwide one. By 2013, NPS had been identified in every region of the world. The majority of NPS worldwide were in three basic groups: synthetic cathinones, synthetic cannabinoids and phenethylamines. Together they accounted for 70% of the total number of reported NPS. See the following chart found in the 2014 Global Synthetic Drugs Assessment:

Japan introduced new laws to combat its growing synthetic drug problems. “Speckled Cross” resulted in 20 deaths in Northern Ireland. Synthetic cannabis is a growing problem in UK prisons. One prison reported that 85% of its inmates were using or supplying Spice. The chief inspector of prisons in the UK said: “What we can say for definitive is that spice is a significant problem in a number of prisons and it is rising.” DrugScope put together a status report on NPS and ‘club drugs’ in the UK.

A DEA spokesperson, Rusty Payne, called synthetic drugs the new frontier: “As chemistry and science advances, we’re seeing more and more drugs, designer drugs, new derivatives, new compounds that are making their way into the Unites States and across the world.”

“Effects and Risks Associated with Novel Psychoactive Substances” gathered together helpful information on the pharmacology, clinical effects and adverse effects of the more common classes of NPS. See the original article for more details than the following summary.

Synthetic cathinones or “bath salts” can have both stimulant and hallucinogenic effects. They can cause severs intoxication. Their adverse effects include cardiovascular problems such as tachycardia—a faster than normal heart rate (22-56%), arterial hypertension (4-25%), palpitations (11-28%), dyspnea—shortness of breath (8-11%), and others. Psychiatric adverse effects include: agitation (50-82%), aggression (57%), hallucinations (27-40%), confusion (14-34%), anxiety (15-17%), and others. The psychotic adverse effects often consist of paranoia and hallucination (auditory and visual) that can persist for up to four weeks.

“Spice” or synthetic cannabinoids are much more potent, longer-acting and have worse adverse effects than THC. These adverse effects include: cardiovascular problems such as tachycardia (36-76%), arterial hypertension (10-34%), ECG changes (2-14%), chest pain (7-10%) and others. Neurological effects are present and can include: dizziness (9-24%), loss of consciousness (2-17%), somnolence—sleepiness (17-19%) and others. Psychiatric adverse effects include: agitation (19-41%), hallucinations (11-38%), anxiety/panic attacks (21%), and others.

Effects and Risks” also had some information on a phenylethylamine first synthesized in 1998, “Bromo-dragonfly.” It has a LSD-like effect that could last up to six hours. The effect includes visual and auditory hallucinations and a feeling of well-being that could last up to three days. It is highly toxic and has been associated with a number of deaths from overdose (study abstract here). A pro-drug website, Erowid, has a page of information (positive and negative) on Bromo-Dragonfly that included difficult experiences, bad trips and health problems. One report was titled: “Thankful That I’m Alive.” Probably the most disturbing piece I saw was a YouTube video, “My Bromo-DragonFLY Trip” by a young woman who sounded like she was describing an exciting, unexpected encounter while on a road trip with friends.

The 2014 Global Synthetic Drugs Assessment said it was still not clear if NPS were replacing other controlled substances. Maybe they are simply supplements to the existing bevy of drugs under international control. Then again, maybe we ain’t seen nothing yet.

11/3/14

Strange Bedfellows: Terrorists and Drugs

© Hurricanehank | Dreamstime.com - Terrorist In Mask With A Gun Photo — © Hurricanehank | Dreamstime.com – Terrorist In Mask With A Gun Photo

This past May, the DEA raided a Birmingham Alabama warehouse as a part of Project Synergy. Inside, agents found hundreds of thousands of “Scooby Snax” baggies containing spice (synthetic marijuana). Sales of the product were also linked to $40 million in wire transfers to Yemen. Yemen is the home base for Al-Qa‘ida in the Arabian Peninsula (AQAP). While not able to directly link the money to a particular group or organization, DEA spokesperson Rusty Payne said: “It doesn’t take a rocket scientist to figure out that people aren’t sending $40 million to their struggling relatives overseas.”

Derek Maltz, the director of the Special Operations Division of the DEA said: “There’s a significant, long history between drug trafficking and terror organizations.” More than 50 percent of the State Department’s designated foreign terrorist organizations (FTOs) are involved with the drug trade. While the Obama administration has been successful in cutting off state-sponsored funding for terrorist organizations, they have looked for other sources of revenue. The $400 billion annual international drug trade is the most lucrative illicit business in the world and a tempting “investment opportunity” for terrorists.

Maltz went on to say that the synthetic drug market is a “two-for-one deal” for terrorists—they undermine Western countries with the drugs and make millions in the process. We’ve put a bull’s-eye on our back, he said. “When you see a designer synthetic drug industry as lucrative as this in the U.S., it would only be natural that it would be a huge target for those trying to finance their terrorists.”

The world of narcoterrorism has some diversity in its investers. The Taliban in Afghanistan distribute heroin; FARC in Columbia deals in cocaine; and al Shabab in West Africa is alleged to sell khat. While the association of al Shabab and khat may be questionable (here and here), the links between the Taliban and heroin as well as FARC and cocaine are well documented.

While Afghanistan and growing opium have been linked for thousands of years, it has only been in the last three decades that it has become the center for worldwide opium cultivation. Since 2001, opium production in Afghanistan has increased from 70 percent of the overall global opium production to 92 percent. To give you a sense of the size of this, the 2013 World Drug Report indicated that in 2011, Afghanistan produced 5,800 tons of opium, down from 7,400 tons in 2007. The next largest opium producer in 2011 was Myanmar with 610 tons of opium.

The World Bank estimated that the opium GDP of Afghanistan is between $2.6 and $2.7 billion. This amounts to 27 percent of the country’s total GDP, both licit and illicit. And yet, only 3 percent of the natural agricultural land in Afghanistan is used for its production. Poverty is widespread in Afghanistan and many of farmers are compelled by economics and force to grow opium. “Opium is valued at over $4,500 per hectare, as opposed to only $266 for wheat.” Because of this potential profit, many farmers are pressured to cultivate opium by various organizations, warlords and landowners.

The provinces of Helmand and Kandahar, which were regularly in the news during the war in Afghanistan, are also the primary opium producing provinces in the country. As former Afghan president Hamid Karzia said: “The question of drugs . . . is one that will determine Afghanistan’s future. . . . [I]f we fail, we will fail as a state eventually, and we will fall back in the hands of terrorism.”

According to sources in Spanish intelligence, the Islamic State and other jihadist groups are using their connections in the illegal drug market to finance their operations in Iraq and Syria. Jihadists use their knowledge of drug smuggling routes to export arms, contraband and new recruits from Europe to Iraq and Syria. Ironically, the pressure to dry up legal fundraising for terrorist organizations has contributed to their increased trade with illegal arms and drugs.

According to reports from Spain’s recently established government intelligence and counter-terrorism unit CITCO, 20% percent of those detained in Spain under suspicion of working with Islamic State and other jihadist groups have previously served prison sentences for offences such as drug trafficking or document counterfeiting.

FARC rebels control over 60 percent of Columbia’s drug trade, including overseas trafficking. The Revolutionary Armed Forces of Columbia (FARC) earns about $1 billion annually from the production and sale of cocaine in Columbia. According to General Jose Roberto Leon, the head of the Columbian national police force, “We have information found on computers after operations that have captured or killed FARC leaders, and it’s involvement in drug trafficking is evident.” The Columbian anti-narcotics police chief, General Ricardo Restrepo, said that officials fear that if a peace deal with FARC is successfully negotiated, thus cutting into cocaine production, that new gangs producing synthetic drugs will emerge. “It will be our next battle.”

The connection between terrorism and drug trafficking does not currently get much attention in the news media, in part, because the connections are difficult to make. But it does exist and seems to be a growing trend. Spanish intelligence sources have reported that European jihadist groups are using drug smuggling routes to export drug contraband and new recruits from Europe to Iraq and Syria. And most of the cocaine entering Europe is reportedly going through territories controlled by the Islamic State.

The Birmingham bust discussed above is particularly disturbing to me as it connects the making and distribution of the newest addictive danger, new psychoactive substances (NPS), with terrorism. This combination truly is a two-for-one threat. But we can have a two-for-one response to that threat. Both the war on drugs and the war on terrorism can be fought by social policies as well as drug treatment and education that aim for the reduction of drug use. Who would have thought that the slogan in the war on drugs would someday be: Fight Terrorism by Becoming Drug Free.

08/4/14

Playing Chemical Whack-a-Mole

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.

Tag: NPS