Current Trends in Recreational Drugs Abuse

Transcription

1 Current Trends in Recreational Drugs Abuse Javier C. Waksman, MD, FACMT, FACCT Associate Clinical Professor Department of Medicine University of Colorado Denver

2 Topics Herbal Marijuana Alternatives Synthetic Cathinones ( Bath Salts ) MDMA Methoxtamine Kratom Dextrometorphan Salvia Divinorum

3 Herbal Marijuana Alternatives (HMA) Marketed as incense and potpourri and labeled not for human consumption Sold in blends that contain >10 herbal additives with brand names which may vary widely K2, spice, chill zone cherry, chaos mint, zen, zen ultra HMA are intentionally adulterated with synthetic cannabinoid chemical compounds DEA gave schedule I status to the most frequently found synthetic cannabinoids (JWH-018, JWH-073, JWH-200, CP , CP C8) HMA are available on the Internet and local head shops

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5 HMA pharmacology, clinical effects, toxicity, and treatment The pharmacologic effects of HMAs are derived from the herbal ingredients and added synthetic cannabinoids Herbs: Psychotropic effects Synthetic cannabinoids: structurally different than THC but are agonists of the cannabinoid receptor s CB1 and CB2 (do not show up in DOA screen) Onset: fast after smoking with resolution within an hour Anxiety, paranoia, avoidant eye contact agitation, delusions, and psychosis Tachycardia, diaphoresis, conjuctival injection, xerostomia Possible withdrawal syndrome in chronic users Supportive care, BZD for agitation

6 AM-2201 Synthetic Putative cannabinoid Created by Alexandros Makriyannis in 2004 CB1 receptor agonist CB2 receptor agonist Structurally different from THC Many times more potent (10-30)

7 AM2201

8 Synthetic Cathinones ( Bath( Salts ) Cathinone has been used recreationally for centuries Cathinone and the metabolite cathine are responsible for the euphoric effects achieved by chewing the Khat plant The first synthetic cathinone, methcathinone, was first produced in 1928 Cathinone is classified schedule I since 1993

9 Synthetic Cathinones ( Bath( Salts ) In 2009 mephedrone showed up in the US followed by methylone, and MDPV (3,4- methylenedioxypyrovalerone) Manufacturers of synthetic cathinones describe the drugs as bath salts, plant food, insecticides Many packages warn that contents are not for human consumption in an attempt to escape legal regulation Sold over the Internet, head shops or gas stations These substances are not yet scheduled

10 National Epidemic NPDS data through September 8, 2011 Bath Salts ,720

11 Synthetic Cathinones

12 Forms Available (multiple) Bangor, ME Police Department

13 Forms Available Bangor, ME Police Department

14 Bath Salts $30 Bangor, ME Police Department

15 Synthetic Cathinones: pharmacology Ecstasy (MDMA) MDPV Cathinone / /0/ /Meth ylenedioxypyrovalerone_mdpv_mdp K_ jpg a/b/dl206.png Methcathinone Mephedrone Membership/Sections_of_Membership/tox/new s/tox%20discussion.jpg /B/dl206.png ages/news%20articles/4_methylmet hcathinone_2d.gif

16 Synthetic Cathinones: pharmacology Multiple routes of exposure Nasal insufflation, oral ingestion, rectal insertion, IV/IM injection Typical doses of mephedrone and methylone are mg orally Onset of effects: minutes Duration: 2-5 hours MDPV Onset of effects: minutes after typical dose of mg Duration: 2-7 hours

17 Synthetic Cathinones: Clinical effects and toxicity Euphoria, heightened alertness, increased energy, increased sexual arousal, talkativeness. Aggressiveness and psychotic behavior Palpitations, headache, chest pain, trismus, bruxism, tremors, insomnia, paranoia Compulsion to re-dose to prolong drug effects Physical exam: sympathomimetic toxicity HTN, tachycardia, hyperthermia, dehydration, agitation Case reports of MI, mephedrone-induced myocarditis Multiple deaths were reported in the setting og bath salts use

18 Synthetic Cathinones: diagnosis and management None of the synthetic cathinone derivatives are detected in the DOA screen Cathinone derivatives may cause a FP methamphetamine screen Supportive care BZD for agitation, seizure, tachycardia, hypertension Beta blockers should be avoided due to potential exacerbation of hypertension due to unopposed alpha adrenergic stimulation Significant hyperthermia may require passive or active cooling

19 Bath Salt Bong

20 Methylenedioxymethamphetamine (Ecstasy, MDMA)

21 Synthesized in 1912 Appetite suppressant Adjunct in psychoanalysis Ecstasy 3,4-methylinedioxymethamphetamine Increased use in raves 1985 Schedule I High abuse potential No medical use Illegal

22 Adam, XTC, hug drug, X Can be snorted, smoked, injected, most commonly ingested in tablet form Can be cut with LSD, amphetamines, or other drugs Onset mins Peak mins Duration ~5 hours Ecstasy

23 Ecstasy-Clinical Presentation Desired effects enhanced empathy & insight feelings of closeness mood alteration with sensual overtones euphoria altered visual perceptions Neurologic effects Dysphoria, Confusion, Delirium, Paranoia, Irritability, Nystagmus, Psychosis, Seizures, Coma Sympathetic NS Diaphoresis,Mydriasis,Tachyc ardia, HTN, Psychomotor drive Serotonergic Psychedelic effects, Sensory enhancement, Distortions, Hallucinations

24 Case 34 year old male Bought a research chemical off a website (China) 5 grams at $30 per gram Snorted three 100 mg lines at 8pm, 11pm and??pm Awoke on the couch the next morning when the sun was already pretty high. No recollection of previous evening except facial bruises & contusions Came to ER become he just wasn t feeling better

25 Case 34 yo male - continued Abnormal EKG Elevated troponin Elevated CK (2400) rhabdomyolysis Recovered with supportive treatment, IVFs, benzodiazepines Echocardiogram normal

26 Case 34 yo male - continued Methoxetamine is a research chemical (MXE, Mket, 2-(3- methoxyphenyl)-2-(ethylamino)cyclohexanone It is a new research chemical that has recently appeared on the market and that is available only from few chemical suppliers. New non Cathinone research chemical. Legal all over the world! Chemical companies that supply MXE remind you that this research chemical should not be used by inexperienced researchers as chemical research with substance is very specific and demands great experience with research chemicals. Methoxetamine is a new substance and is more expensive if compared to the others research chemicals, but it really works. Methoxetamine is not for human consumption should be used for chemical research purposes only. MXE is legal in all countries.

27 Methoxetamine N-ethyl derivative of Ketamine Dissociative analgesic NDMA antagonist Dopamine Reuptake Inhibitor Dissociative/Catatonic state Sympathomimetic features

28 Kratom Kratom, (Mitragyna speciosa korth), is a tropical tree indigenous to Thailand, Malaysia, Myanmar and other areas of South East Asia Has dual properties of stimulation (lower dose) and analgesia (opioid effect at higher dose) Traditionally, kratom was mostly used as a stimulant by Thai and Malaysian laborers and farmers to overcome the burdens of hard work It was also used in Southeast Asia and by Thai natives to substitute for opium when opium is not available. It has also been used to manage opioid withdrawal symptoms by chronic opioid users

29 Kratom The plant is made up of > 25 alkaloids with mytragina being the most abundant It is Structurally distinct from opiates Alternative measure to avert withdrawal symptoms for opioid tolerant patients with no access to opioids. Murine models suggests mytragina acts at supraspinal mu- and delta receptors and serotonergic and noradrenergic pathways in the spinal cord Kratom is widely available on the Internet and is not controlled under the Controlled Substances Act Reported benefits: analgesia, anti-inflammatory, anti-pyretic, muscle pain reliever, etc.

30 Kratom Supportive care Naloxone if exposure results in hypoventilation

31 Dextromethorphan Slang: DXM, RoboTrip or Triple C Robitussin DM, Coricidin HBP for Cough and Cold, others Dissociative analgesic/anesthetic in overdose Caused by metabolite dextrorphan Drowsiness or agitation Coma or seizures possible but not common Vertical or rotary nystagmus may be present Large or small pupils possible

32 Salvia divinorum Hallucinogen/Dissociative Names: Diviner s sage, magic mint, Maria Pastoria Use: Ceremonial healing Divination rituals An entheogen - that which causes god to be within a person Component: salvinorin A Type:?dissociative hallucinogen Similar to: PCP, ketamine and DXM Mechanism: Opioid kappa agonist Similar to: butorphanol (Stadol ) and pentazocine (Talwin ) Dose: mcg (smoking), chewing It is widely available on the Internet and is not controlled under the Controlled Substances Act

33 Internet Sources