Transcript
DESIGNER & CLUB DRUGS IN OUR COMMUNITY
Patricia Junquera, MD
Daniel Castellanos, MD
Assistant Professor, Department of Psychiatry & Behavioral Health Herbert Wertheim College of Medicine, Florida International University Founding Residency Program Director Department of Psychiatry, Citrus Health Network in affiliation with FIU Herbert Wertheim College of Medicine
Professor and Founding Chair, Department of Psychiatry & Behavioral Health Herbert Wertheim College of Medicine, Florida International University
Student Services Mini-Conference Miami Dade County Public Schools February 7, 2014
Designer & Club Drugs Objectives: Participants will identify the names of the most commonly used designer and club drugs Participants will recognize the psychoactive and physical effects of the most commonly used designer and club drugs Participants will identify the signs and symptoms of persons using designer and club drugs
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Overview of the Problem Designer and club drug use has increased in popularity
over the past few years Serious medical consequences can result We have seen an increase in ED visits associated with use of these drugs
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High School Students Who Reported Current Alcohol Use, 2011
* Had at least one drink of alcohol on at least 1 day during the 30 days before the survey.
Source: National Youth Risk Behavior Survey, 2011 Junquera & Castellanos, 2014
High School Students Who Reported Current Marijuana Use, 2011
* Used marijuana one or more times during the 30 days before the survey.
Source: National Youth Risk Behavior Survey, 2011
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Nonmedical use of prescription drugs The 2011 National Youth Risk Behavior Survey
(YRBS) (www.cdc.gov/yrbss) found that 1 in 5 high school students in the US have ever taken a prescription drug, such as OxyContin, Percocet, Vicodin, Adderall, Ritalin, or Xanax, without a doctor’s prescription.
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Percentage of High School Students Who Ever Took Prescription Drugs Without a Doctor's Prescription,* by Type of Grades Earned , 2009
Source: United States, Youth Risk Behavior Survey, 2009
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Percentage of High School Students Who Ever Used Ecstasy, 2011
* Used ecstasy/MDMA one or more times during their life.
Source: National Youth Risk Behavior Survey, 2011
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Annual Prevalence of Designer Drug Use by US 8th, 10th & 12th Graders, 2013 8
7.9 7.4
7 6 5
8th 10th
%
4
4
12th
4 3.6
3 2 1.4
1.1
1
1
0
Synthetic Marijuana
MDMA
GHB
Ketamine
Source: Johnson LD et al, Monitoring the Future National Survey on Drug Use, 2014
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% of Florida High School Students who used Club Drugs* & Synthetic Marijuana, 2013 16 14.8
14 12 10
8th 10th
8
%
12th
6 5.3 4.6
4
2
2.1 1.1
1.8
0.3
0
Lifetime
Past 30 Days
Club Drugs*
1.8 unk
unk
Lifetime
unk
unk
Past 30 Days
Synthetic Marijuana
*Ecstasy, Rohypnol, GHB, Ketamine Source: 2013 Florida Youth Substance Abuse Survey
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Emergency Room Visits, Miami-Dade County
Source: DAWN Report, 2012; http://www.samhsa.gov/data/2k12/DAWN096/SR096EDHighlights2010.htm
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Emergency Room Visits, Miami-Dade County 398 MDMA -involved ED visits for Miami-Dade County
during 2011 Represents 2 percent of all ED visits among 6 categories of substances (cocaine, cannabinoids, illicit stimulants, MDMA, nonmedical use of prescription opioids & BZs The 2011 total represented a 91 percent increase over the 209 MDMA reports in 2004
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Designer & Club Drugs
Synthetic Marijuana GHB MDMA Ketamine N-Bomb Bath Salts Kratom Dextromethorphan DMT Sizzurp Junquera & Castellanos, 2014
Synthetic Cannabinoids
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Introduction Product line marketed as incense, herbal or aromatic
incense or potpourri “Not for human consumption” All ingredients don’t have to be listed Not “intended” for smoking but most of the products are smoked in hand-held pipes, water pipes or rolled in cigarette paper Synthetic cannabinoid is sprayed on the product Manufacturers are substituting more potent synthetic cannabinoid products every day
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Source for syn cann chart: Data extracted from NMS Labs Laboratory Information Management System. Synthetic Cannabinoid confirmed positive blood samples. Oct 2010-Jan 2013. (n=155)http://www.nmslabs.com/uploads/PDF/Designer%20Drug%20Testing%20March%202013.pdf
Introduction II After marijuana, synthetic canniboids are the
most frequently used illicit drugs by 12th graders One of 9 US high school students reported having used an SCP in 2012. Sold in Europe since 2006, possibly as early as 2004 Can be purchased: Online Head shops Convenience stores Gas stations Junquera & Castellanos, 2014
2/11/2014
Draft
Synthetic Cannabinoids Physical Effects Gastrointestinal: Nausea, vomiting Appetite changes Conjunctival injection / Red eyes Tremors Numbness Dry mouth Paleness of skin Listlessness / Lack of interest Sweating Tachycardia Increased blood pressure Junquera & Castellanos, 2014
Synthetic Cannabinoids Psychoactive Effects Mood changes:
Euphoria Anxiety Irritability Depression
Cognitive changes:
Impaired short term memory Confusion Cognitive dulling Impairment of linear thinking
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Synthetic Cannabinoids Psychoactive Effects II Changes in activity: Sedation Excitability Agitation
Sleep Changes
Psychosis: Disorganized thinking Paranoid delusions Auditory and visual hallucinations
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Dangers of Synthetic Cannabinoids Psychosis New onset Exacerbation of previously stable psychotic disorders
Extreme mood changes
Effects persist beyond acute intoxication Tolerance, withdrawal & dependence may be
associated with long term use.
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GHB
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Overview of GHB Hypnotic (non analgesic) anesthetic Epileptogenic agent in animals Increases growth hormone Promotes slow wave sleep Trials for the treatment of opiate and alcohol
withdrawal Treatment of narcolepsy/cataplexy
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History of GHB 1960: induce a sleeplike state with cardiovascular
stability 1960’s anesthetic was abandoned because of poor analgesic effects 1970’s: first studied for treatment of narcolepsy/cataplexy 1980’s: marketed as a “fat burner and muscle developer” 1990: FDA ordered it to be removed from store’s shelves 2000: Federally classified as a 'Schedule I' drug
Source: am, PC, & Yoong, FF. (1998). Gamm a-hydroxybutyric acid: an emerging recreational drug. Anaesthesia, 53(12), 1195-8
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Reasons for use Sense of improved sleep
Sense of improved dancing Antidepressant (mood lifting) Anxiolytic Socialization increases (disinhibiting)
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GHB Street Names Blue Nitro
Revivarant
Blue Nitro Vitality
Serenity
G3
Solar Water
Gamma G
SomatoPro
GHRE
Thunder Nectar
Invigorate
Verve
Jolt
Weight Belt Cleaner
Remforce
ZEN
Renewtrient Revitalize Plus
www.ashesonthesea.com/ GHB/analogs.htm#trinka2 Junquera & Castellanos, 2014
GHB Often sold as clear salty liquid, taken in capsules or in drinks (Often carried in Visine containers) Capsule concentration varies 500mg-5g
Rapidly absorbed, peak concentration 20-60 min Half life is 20 min. Almost completely oxidized to carbon dioxide Readily crosses the blood brain barrier and
placenta
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Psychoactive and Physical effects of GHB Euphoria
Optimism
Increased sexuality
Increased energy
Wellbeing
Giddiness
Relaxation Talkative
Increased sensitivity to sound
Tranquility
Silliness
Drowsy
Sweaty Loss of consciousness
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Dangers of GHB GHB has an incredibly small therapeutic index: Difficult for enforcement officials to detect as it may be smuggled in vessels like Visine containers Overdose may result in: Decreased respiration Death due to carbon
dioxide poisoning Junquera & Castellanos, 2014
Ecstasy - MDMA
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Overview of Ecstasy MDMA 3,4 methylenedioxymethamphetamine Hallucinogenic amphetamine
Historical use in research and psychotherapy DEA ban on MDMA in 1985
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History of MDMA/Ecstasy 1914: E. Merck Pharmaceutical company developed MDMA
in Germany 1950's: briefly evaluated as an adjunct to psychotherapy based
on a reported ability to produce a state of consciousness that promotes willingness towards emotional self-disclosure 1970's: and early 1980's: again investigated as an adjunct to
psychotherapy 1985: Drug Enforcement Agency in US placed MDMA on
Schedule I of controlled substances, citing increasing recreational use and concern over potential neurological damage Junquera & Castellanos, 2014
Psychoactive and physical effects of MDMA Altered time perception
Increased ability to interact with others Decreased defensiveness
Changes in visual perceptions Increased awareness of emotions Decreased aggression Decreased restlessness Less impulsive Leister M et al, J of Nerv Ment Dis, 1992; 180 345-352 and McDowell & Kleber, Psychiatric Annals 1994; 24 127-130
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Adverse Effects of the Use of MDMA Decreased desire to
perform mental or physical task Bruxism Decreased libido Increased restlessness Increased anxiety
Depressed mood
Nystagmus Motor tics
Headaches Anhedonia Lethargy
Anorexia Decreased motivation
Leister M et al, J of Nerv Ment Dis, 1992; 180 345-352 and McDowell & Kleber, Psychiatric Annals 1994; 24 127-130 Junquera & Castellanos, 2014
Ecstasy- MDMA Dose concentration 50 to 300 mg
Cost $25 per tablet Onset 20 to 40 minutes
Effects less than 24 hours Street names: e, Adam, X, XTC, purest form MOLLY( Usually white pill or powder)
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Dangers of MDMA / Ecstasy Memory problems for at least 2 weeks after use Functional consequences Reduction in number of serotonin transporters - PET Studies
(can leads to depression) Damage of serotonin nerve endings Hyperthermic Syndrome: elevated temperature tachyarrhythmia's hypertension muscle rigidity, rhabdomyolysis Hepatotoxicity Neurotoxicity Bolla, McCann & Ricaurte Neurology 51, 1998
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“Molly” Hundreds of “Molly” capsules tested in two
South Florida crime labs in 2012, for example, contained: methylone, a dangerous stimulant commonly
found in “bath salts” News reports elsewhere have reported “Molly” capsules containing: cocaine Heroin and other substances. Junquera & Castellanos, 2014
Ketamine Take a little ‘K’ and
Meet the “K-Monster”
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Overview of Ketamine Central nervous system depressant Usually snorted or insufflated Rapid acting-acting dissociative anesthetic
Sedative-hypnotic, analgesic and hallucinogenic properties Structurally similar to PCP N-methyl-D-Aspartate (NMDA) antagonist
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History of Ketamine 1962: developed and initially promoted as a fast acting
general anesthetic 1970’s: approved for human use by federal government, and as a result became late 1970’s and early 1980’s: abuse began to increase across the country 1999: classified as a Schedule III controlled substance in August 1999, creating more stringent controls of the drug 2012: Being studied for adjunct treatment in patients with Major depressive disorder University of Maryland, http://www.cesar.umd.edu/cesar/drugs/ketamine.asp Junquera & Castellanos, 2014
Subjective Psychoactive and physical effects of Ketamine Muscle spasm Blurred vision Dizziness Slurred speech Visual “flashbacks” Psychological effects Tolerance Agitation Increased temperature Junquera & Castellanos, 2014
Ketamine – “Special K” Snorted or insufflated Dissociative effects called a “K-hole” – your
brain is active but your body isn’t, “like you’re in a tunnel, your hear echoes, you’re in a semiconscious state” Used at rave/dance club scene, not as popular as in past “like living inside a big cotton ball,” “everything is in slow motion”
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Ketamine Administration: injected, intranasal, oral 10 ml vials provide 5 illicit doses Sell for $20 a dosage unit Rapid onset of effects Duration of effects 4-6 hours
Street names: Special K, Vitamin K, KitKat, Blind squid, Super acid
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Dangers of Ketamine Paralyzing agent Flammable Confusion
Loss of Consciousness With Chronic use: Brain damage in the form of vacuoles Personality changes
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N-Bomb
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Overview of N-Bomb It affects the serotonin receptors in the
brain It is considered a powerful synthetic hallucinogen They are being sold as LEGAL substitutes for LSD and mescaline.
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History of N-Bomb Discovered in 2003 by a chemist in Berlin
It was further investigated by a team of researchers in 2007 by a research team in Perdue University The compound was labeled as 25I-NBOMEe It was classified as a radiotracer used in PET
scans 2013 this compound is being sold in the internet as a designer drug. Junquera & Castellanos, 2014
Psychoactive and Physiological effect of N-Bomb Agitation
Visual & Auditory hallucinations Seizures Increased body temperature Muscle breakdown Aggression Acute kidney injury
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N-Bomb 25I-NBOMe usually taken sublingually or
by mouth The effects usually last 4-6 hours could be up to 12 hours Liquid more potent faster acting Stamps with caricatures usually laced with the substance
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N-Bomb Street names 25I
Smiles Legal acid
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Dangers of N-Bomb Confusion
Seizure Cardiac arrest Respiratory arrest Death
At least 19 young people are reported to have died after taking 25I- 25C- or 25B-NBOMe between March 2012 and August 2013. Junquera & Castellanos, 2014
Bath Salts
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Overview of Bath Salt Abuse Patients report: “It’s like a poor man’s cocaine
that’s legal” Poison Control Center has received over 4,000 call last year MDPV (methylenedioxypyrovalerone) Mephedrone Increased Blood Pressure, Heart Rate, Agitation, Hallucinations, Paranoia, Delusions Junquera & Castellanos, 2014
History of Bath Salts First synthesized in the 1920s
In 2009-2010: they became popular in the underground market 2010: started to be marketed as “ not for
human consumption” 2011:New York was one of the first states to ban the sale of Bath salts 2012: President Obama signed a bill that amended the Federal drug policy of the United States to ban “bath salts” Junquera & Castellanos, 2014
Psychoactive and Physiological effects of Bath Salts Agitation Hypertension Increased temperature
Muscle breakdown Impulsivity
Lack of Judgment and Insight Bruxism Muscle spasm Increased body strength Junquera & Castellanos, 2014
Bath Salts Powder packets of 50 mg $20-$40 Latest Designer Drug Used as synthetic stimulant; snort/insufflate,
smoke, inject Illegal in 41 states and pending legislation in the others Deaths reported Some call it a Mini Crack
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Bath Salts Street Names Ivory Wave Bliss White Lightning
Vanilla Sky Cloud 9
Hurricane Charlie (most popular) Zoom Purple wave Junquera & Castellanos, 2014
Dangers of Bath Salts Overstimulation of the central nervous system Body temperature dysregulation Seizures due to temperature Supernatural aggression
Death
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Kratom
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Overview of Kratom Opiate like sedation Coca like stimulation Stimulating at low dose levels Higher doses more opiate like
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Psychoactive and Physiological effects of Kratom Sedation at higher doses Stimulation at low doses
Low acting anesthetic Depression after use or in withdrawal Nausea, vomiting
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Kratom Effects noticeable in 20-30 minutes Effects can last 2-6 hours. Physical dependency can occur
Withdrawal symptoms: irritability, yawning, diarrhea, pain Street names: Kakaum, Ithang, Thom
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Dangers of Kratom Same as those of Heroin and Cocaine Low doses much like Cocaine (upper) Higher doses much like Heroin (downer)
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Dextromethorphan
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Dextromethorphan Over the counter cough and cold remedies Street names: “DXM” “Triple-C” “Skittles” “Robo-tripping”
PCP or ketamine-like
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Psychoactive and Physiological effects of Dextromethorphan Hallucinations Delirium
Hypertension Tachycardia Ataxia Agitation Seizures
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DMT (Dimethyltryptamine)
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Overview of DMT A psychoactive chemical in the tryptamine family Present in thousands of species of plants Used traditionally in South America
Intense visuals and strong psychedelic Mental effects when smoked, injected, snorted or
when swallowed orally (usually with an MAOI) Standard Dose (15-60mg) Hit ($10-30)
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Psychoactive and physiological effects of DMT Hallucinations
Delirium Agitation Confusion Palpitations
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Sizzurp
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Overview of Sizzurp It’s a concoction which includes: Cough syrup with codeine Promethazine Jolly Rancher candy or Skittles Soda pop Usually served in Styrofoam cup but also drank out of the soda bottle
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History of Sizzurp Originated in Houston, Texas 1960: It was first used by Blues singers in the in order to perform
and continue to work. They used Robitussin with beer and then when wine coolers
became popular they replaced it. 1980-1990: The recipe was changed to use it with codeine
promethazine cough syrup with a lemon lime soda and Jolly Ranchers 1990s: Made popular by a DJ in Houston and his music being
played in a slow tempo as if they were on codeine and promethazine This concoction caused his early death and it was then that is
caught the attention of law enforcement 2012: It became popular in the hip hop community Junquera & Castellanos, 2014
Psychoactive and physiological effects of Sizzurp Slow reaction time Sedation Relaxation Decreased respiratory rate Weight gain Tooth decay Dizziness Lethargy Dissociative feeling Motor skill impairment Junquera & Castellanos, 2014
Sizzurp Street Names Purple drank Purple lean Purple jelly
Texas Tea Syrup
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Dangers of Sizzurp Seizures when mixed with alcohol or if person prone to seizures Shut-off of the respiratory center in the brain
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What can we do? Education to: Young Adults Parents Educators Community at large
Decrease stigma about substance used disorders in order to increase the users from seeking help. Arm ourselves with a “First Aid Kit” to recognize intoxication with these substances and get them help. Junquera & Castellanos, 2014
Edible Cannabis
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Closing Remarks Designer drug use will not go away New drugs will continue to emerge
No matter how designer drugs evolve, we need to be ready
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References Galloway, GP, Frederick Osborne, SL, Seymour, R, et al. (2000).
Abuse and therapeutic potential of gammahydroxybutyric acid. Alcohol, 20(3), 263-9. Kam, PC, & Yoong, FF. (1998). Gamma-hydroxybutyric acid: an
emerging recreational drug. Anaesthesia, 53(12), 1195-8. Koesters, SC, Rogers, PD, & Rajasingham, CR. (2002). MDMA
('ecstasy') and other 'club drugs'. The new epidemic. The Pediatric clinics of North America, 49(2), 415-33. Rochester, JA, & Kirchner, JT. (1999). Ecstasy (3,4-
methylenedioxymethamphetamine): history, Neurochemistry, and toxicology. The journal of the American Board of Family Practice, 12(2), 137-42. www.clubdrugs.org NIDA’s “Initiative to Combat Club Drugs Junquera & Castellanos, 2014