Lisa Booze, PharmD, CSPI

Transcription

1 Lisa Booze, PharmD, CSPI

2 Psychoactive drugs created to avoid existing laws Modify existing drugs or new drugs with different chemical structures >200 new drugs and 8 classes of drugs since new drugs since July 2012 Unknown toxicities

3 JWH-018 JWH-073 HU-210 CP-47,497 Cannabicyclohexanol UR-144 XLR11 AKB48 AM 2201 ADB-PINACA And many more! Synthetic cannabinoids More potent than THC Most made in SE Asia, China Sprayed on leafy material or potpourri

4 K2 Spice Zohai Genie Mr. Nice Guy Blueberry Haze Black Mamba Crazy Clown Scooby Snax AND MANY MORE!

5 19 year old F with jerking motions (seizure?) after smoking Bayou Blaster. Paramedics arrived: Awake, agitated, required physical restraints. BP 153/84, P 116 In emergency dept: would not answer questions, kept repeating Is this real? Admitted for 4 days due to depression and suicidal thoughts J Emerg Med 2013;44:360-6

6 Glazed, red eyes, dilated pupils Psychosis, confusion, paranoia, agitation, depression, suicidal thoughts, hallucinations, stroke Unable to speak Fever Rapid heart rate, high blood pressure, chest pain, heart attack Kidney failure Tremors, seizures Synthetic Marijuana Nausea, vomiting

7 Cathinone in Khat plant Native to East Africa, SW Arabian Peninsula Leaves chewed for stimulant and euphoric effects Synthetic cathinones: methcathinone, MDPV, mephedrone, methylone, naphyrone, butylone, flephedrone & many more! Stimulants, similar to ecstasy, amphetamines, or cocaine

8 Not for human consumption Ivory Wave Vanilla Sky Cloud 9 White Dove Red Dove Blue Silk Zoom Tranquility Ocean Snow and many others!

9 36 yo M drinking and snorting bath salts x 3 days; agitated with auditory and visual hallucinations, paranoia ran outside naked, thought someone was trying to strangle him. Restrained by police. EMS: Confused, rambling speech, being attacked by animals, people and monsters. Rapid pulse, dilated pupils, skin flushed, warm, sweaty. Possible seizure enroute to ED. Sedated Returned to baseline 9 days later NEJM 2013;369:

10 Dilated pupils Psychosis, confusion, paranoia, agitation, violent behavior, depression, hallucinations, insomnia Dry mouth, teeth grinding, nose bleed, nose burns Fever, sweating Rapid heart rate, high blood pressure, shortness of breath, chest pain, heart attack Tremors, numbness, seizures Synthetic Cathinones Nausea, vomiting

11 Methylenedioxy methamphetamine (MDMA) Tablets, powder, liquid Euphoria, increased empathy & self-confidence, increased intensity of lights & sound Toxicity similar to synthetic cathinones ( bath salts.) Teeth grinding, agitation, paranoia, increased heart rate and blood pressure, sweating, fever, kidney failure, seizures

12 Erowid.org: >60% ecstasy tablets don t contain MDMA Molly promoted as a pure molecular form of MDMA Oct 2009 Sept 2013: 143 Molly samples tested by Northeast region lab/dea; only 13% were MDMA Many samples are the same drugs as bath salts 4-Methylethcathinone (4-MEC) Methylone, butylone, MDPV ( Bath salts )

13 PMA (paramethoxyamphetamine), PMMA (paramethoxymethamphetamine) slow onset 2C drugs (2C-I, 2C-E, 2C-P ) Smiles 25I NBOMe ( N-Bomb, 25C-NBOMe, 25B-NBOMe) Related to 2C; potent stimulant, hallucinations Powder; blotter paper At least 19 deaths, Mar 2012-Aug 2013

14 Acetyl fentanyl or fentanyl mixed with heroin or alone Outbreaks of overdose cases in IV drug abusers since Spring 2013 Maryland: 37 deaths Sept 2013 Jan 2014 Acetyl fentanyl is > 5 times more potent than heroin Fentanyl is > 50 times more potent than heroin Euphoria, drowsiness, confusion, unconsciousness, constricted pupils, decreased respirations

15 Rx analgesics (opioids, e.g. morphine, oxycodone, hydrocodone, methadone, fentanyl ) No increased risk of MVA if on chronic opioids with no change in dosage Anti-anxiety agents (benzodiazepines, e.g. alprazolam, diazepam, clonazepam ) Sleeping pills (e.g. zolpidem, ezoplicone ) Antipsychotics (e.g. quetiapine) Euphoria, drowsiness, confusion, slow reaction time, altered perceptions, lack of coordination and alertness

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