Novel Psychoactive Substances: Overview and Impact on Mental Health

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1 Novel Psychoactive Substances: Overview and Impact on Mental Health MAUREEN SWEENEY CNP ASSOCIATE MEDICAL DIRECTOR FRONTLINE SERVICE JULIE DAVIDOV CNP FRONTLINE SERVICE

2 Disclosures Neither provider has any known conflict of interests or disclosures to be made at this time

3 Objectives Understand composition of novel psychoactive substances Synthetic cannabinoids Synthetic Cathinones Synthetic Opioids Pharmakokinetics of novel psychoactive substances Effects: physical and mental Treatment Outcomes

4 What are Synthetic Cannabinoids? Names: Spice, K2, potpourri, tucci The are a chemical The plant material in the packages has been sprayed with the synthetic cannabinoids unlike marijuana in which the plant contains THC THC is active ingredient in marijuana Synthetic cannabinoids were developed by researchers to work on the same receptors in the body as THC Many times they are THC derivatives Bind to cannabinoid receptors in the body High affinity (they stay there for a long time)

5 Understanding chemical structure in relation to THC ElSohly, M.A., Gul, W., Wanas, A., Radwan, M. (2014)

6 Pharmacokinetics: How does the body process them? Ingestion: Usually smoked Binds to cannabinoid receptors (binds over 100 times more tightly to the CB 1 receptor than THC) Long half life (i.e. it can make you psychotic for a long time) Has active metabolites: i.e. it can have effects even after the body starts to break it down. Excreted by the kidneys (can cause acute kidney injury/ failure)

7 Type of Affects Psychosis Mood Anxiety Cogntive Neurologic Effects of Use Symptoms Agitation, aggression, catatonia, paranoia, hallucinations, depersonalizations, dissociation, prolonged psychosis, perceptual alterations Euphoria, negative mood, suicidal ideation Panic Attacks Memory impairment, concentration difficulties, attention difficulties, amnesia Drowsiness, dizziness, sensation changes, seizures, tremor, ataxia, nystagmus Spaderna, M, Addy, P.H., D Souza, D.C., (2013)

8 Effects cont. Type of Effects Cardiovascular GI Neuromuscular Other Symptoms Tachycardia, hypertension, palpitations, ECG changes, myocardial infarction, death, arrhythmias, chest pain Nausea, emesis, appetite changes Fasciculations (tremors), hypertonicity, hyperflexion, hyperextension Conjunctival injections (red eye), acute kidney injury, miosis (pupil constriction), mydriasis (pupil dilation), xerstomia (dry mouth), warm dry skin, low-grade hyperthermia, rhabdomyolysis Spaderna, M, Addy, P.H., D Souza, D.C., (2013)

9 Effects Cont. Picture attributed to:

10 Draw of Synthetic Cannabinoids The have a higher high The do not show up on a random drug screen Easily obtained Depending on the environment they can be cheaper than other drugs

11 Synthetic Cannabinoids vs Marijuana Clinical Presentation Bassier Nia, A., Medrano, B., Perkel, C., Galynker, I., Hurd, Y.L. (2016)

12 Treatment Usually low dose antipsychotics are recommended until resolution of psychotic sx s- resolution may never occur if use continues If they are tx ing the catatonic features on in-pt unit there have been anecdotal trials of benzodiazepines with limited effects Counsel client about affects of continued use including increase risk for permanent psychotic illness and neg. physical health outcomes Refer to substance abuse tx

13 ??? Questions/Discussion

14 Synthetic Cathinones Substitutes for Psychostimulants: amphetamines, MDMA and methamphetamines Commonly known as: Bath Salts Types: More than 80 derivatives

15 How Do They Work Increased extracellular levels of noradrenaline, dopamine, and serotonin Two known mechanisms of Action Interact with monoamine transporter proteins, namely NET, DAT, and SERT inhibiting reuptake of noradrenaline, dopamine, and serotonin Some act as transporter subtrates and promote the release of neurotransmitters from intracellular stores

16 How it is Taken Orally Sublingually Insuffilation Smoking/inhalation IV Rectally

17 Adverse Effects Tachycardia Mydriasis (pupil dilation) Hallucinations Anxiety Agitation Tremor Hyperthermia Diaphoresis Paranoia Mora than 100 confirmed fatalities related to synthetic cathinones

18 Synthetic Opioids Developed in 1978 as an opioid analgesic 7.5 X more potent than morphine but about 10 X less potent than fentanyl Narrow therapeutic window Common synthetic opioids : U or Pink

19 How it is used Primarily orally Can be taken Nasally, sublingually, rectally and IV injection

20 Reported affects Euphoria Analgesia Nausea Myosis Respiratory depression Cough sepression constipation Drowsiness Occassional itching Tremor Fatal OD s have been confirmed

21 Chemical Structures

22 Pharmacology Limited data Works on opioid receptor Onset: 5-10min Peak at 1-2 hrs Total Duration: 2-4 hrs Unclear whether metabolites are pharmcologically active OD s can be reversed by Narcan

23 Ohio and Federal Ban U Ohio Banned in May 2016 DEA scheduled it I in Nov Due to over a dozen deaths across the US in a 12 month period

24 The Law Regulation is difficult because of different composition and avoidance of FDA by displaying on packaging that these products are not for human consumption Some laws have prohibited the sales of any of these products in gas stations and head shops but they are still easily obtained online Mostly produced overseas in China and Japan

25 Legal Status

26 Resources Bassir Nia, A., Medrano, B., Perkel, C., Galynker, I., & Hurd, Y. (2016). Journal of Psychopharmacology. 30 (12) ElSohly, M., Gyl, W., Wanas, A., & Radwan, M. (2014). Synthetic cannabinoids: Analysis and metabolites. Life Sciences. 97, Nikolauo, P., Katselou, M., Papoutsis, I., Spliopoulou, C. & Athanaselis, S. (2017). U An old opioid becomes a recent danger. Forensic Toxicol. 35: Spaderna, M, Addy, P.H., D Souza, D.C. (2013). Spicing things up: synthetic cannabinoids. Psychopharmacology. 228, Zawilska, J., & Andrzejczak, D. (2015). Next generation of novel psychoactive substances on the horizon- A complex problem to face. Drug and Alcohol Dependence, 157, 1-17

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