Challenges of New Emerging Designer Drugs

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1 EDITORIAL Challenges of New Emerging Designer Drugs There is an emerging use of what are popularly called designer drugs (Bauman et al., 2014). In the media, they are often called motedop or synthetic drugs ; in the online stores, they are called legal highs or herbal highs while the medical community often refers to these as new psychoactive substances or novel psychoactive substances, (NPS) (Tuv et al., 2016). Some of these are newly synthesized compounds, while others are chemical modifications of existing drugs and still others are old drugs that have been re-launched. Some of these are classified as piperazines, cathinones (e.g., mephedrone, methylone and methylenedioxypyrovalerone, etc., popularly known as bath salts ), phenethylamines, tryptamines, synthetic cannabinoids (popularly known as spice, fake pot, legal weed, or new marijuana ) and others (Bauman et al., 2014; Tuv et al., 2016; Weaver, Hopper, & Gunderson, 2015). Bath salts and spice are among the more frequently used designer drugs. Synthetic cannabinoids (spice) are the second most-abused illicit substance in the United States after marijuana (Lisi, 2014). Low recreational doses of bath salts or spice usually produce a feeling of being high, but high doses or chronic use can lead to psychosis, violent behaviors, tachycardia, hyperthermia and even death (Bauman et al., 2014). The high experienced by these drugs varies from compound to compound and person-to-person and may include effects such as a stimulant, entactogenic, hallucinogenic, psychedelic or dissociative agent (Chavant, Boucher, Le Boisselier, Deheul, & Debruyne, 2015). The addictive potential of designer drugs is also substantial (Cottencin, Rolland, & Karila, 2014). One of the challenges confronting designer drugs is that new versions and variants of these drugs are coming up very fast. In 2010, the American College of Medical Toxicology (ACMT) founded the Toxicology Investigators Consortium (ToxIC) as its case Registry (Wiegand, Wax, Smith, Hart, & Brent, 2013). In this Registry all cases are entered prospectively and include suspected and confirmed toxic contacts treated at the bedside by medical toxicologists at all partici- 3

2 4 EDITORIAL - CHALLENGES OF NEW EMERGING DESIGNER DRUGS pating sites. The chief advantage of this Registry is the development of a toxico-surveillance system that can define trends in poisoning. This Registry revealed that while cases of common designer drugs, namely synthetic cannabinoids and cathinones showed no fluctuations from 2011 to 2012 but several other designer amphetamines and novel psychoactive substances were reported in the Registry in 2012 (Wiegand, Wax, Smith, Hart, & Brent, 2013). A related challenge to the increase of newer agents pertains to lack of tests for detection of designer drugs in the blood or urine of the users. Since these are newer drugs, tests to detect them have not yet been standardized. Furthermore, different analogs of designer drugs are constantly introduced to evade legislations and to enhance their pharmacological activity so that it becomes a big challenge for analytical toxicologists to develop tests to detect these (Concheiro, Castanet, Kronstrand, & Huestis, 2015). However, recent advancements in liquid chromatography coupled with high-resolution mass spectrometry (LC-HRMS) are helping analytical toxicologists detect many of these compounds in urine (Concheiro, Castanet, Kronstrand, & Huestis, 2015). But definitely, there is need for more advancement in this regard. Another challenge confronting use of designer drugs is that the Internet is becoming a channel for marketing and distribution of these compounds (Tuv et al., 2016). Anyone, including children, can buy these products over the Internet. Sales of bath salts and spice over the Internet have skyrocketed in recent years. Designer drugs are frequently labeled not for human consumption to evade drug abuse legislations (Cottencin, Rolland, & Karila, 2014). However, the users know of their potential for misuse, and in the absence of legal risks, the ease of obtaining these compounds, the relatively moderate cost (the author conducted an Internet search and was able to get bath salts for $4 to $25), these become popular choices for recreational use. There is a need for more education, stricter policies and regulations in this regard. Another challenge is that designer drugs are becoming popular among children and adolescents. There are several reasons for this trend. They are popular among young people because they are relatively inexpensive, easily available and are not easily detectable on routine drug screens (Lisi, 2014). With synthetic cannabinoids (spice) there are also misconceptions that these drugs are natural, legal, safe and produce less adverse effects than marijuana which contributes to their popularity (Lisi, 2014).

3 EDITORIAL - CHALLENGES OF NEW EMERGING DESIGNER DRUGS 5 Another challenge is that the Centers for Disease Control & Prevention (2015) administered the Youth Risk Behavior Surveillance System (YRBSS) that collected data since 1991 from high school students regarding (1) behaviors that contribute to unintentional injuries and violence; (2) tobacco use; (3) alcohol and other drug use; (4) sexual behaviors that contribute to unintended pregnancy and sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) infection; (5) unhealthy dietary behaviors and (6) physical inactivity and did not collect any data on use of designer drugs. This is very important since designer drugs are emerging threats, and data regarding these should also be collected in the YRBSS. Finally, the challenge with designer drugs lies in their management and treatment. Treatment of acute effects may be relatively easy and usually involves supportive care addressing manifesting signs and symptoms. However, long-term treatment of designer drug use disorder is often quite challenging. It is further complicated, as there is a lack of evidence to guide treatment (Weaver, Hopper, & Gunderson, 2015). Manoj Sharma, MBBS, MCHES, Ph.D., FAAHB Professor, Public Health School of Public Health Jackson State University 350 W. Woodrow Wilson Drive Jackson, MS (601) (Phone) (601) (Fax) manoj.sharma@jsums.edu ( )

4 6 EDITORIAL - CHALLENGES OF NEW EMERGING DESIGNER DRUGS REFERENCES Baumann, M. H., Solis, E. Jr, Watterson, L. R., Marusich, J. A., Fantegrossi, W. E., & Wiley, J. L. (2014). Baths salts, spice and related designer drugs: The science behind the headlines. The Journal of Neuroscience, 34(46), doi: / JNEUROSCI Centers for Disease Control & Prevention. (2015). Youth Risk Behavior Surveillance System (YRBSS). Retrieved from Chavant, F., Boucher, A., Le Boisselier, R., Deheul, S., & Debruyne, D. (2015). New synthetic drugs in addictovigilance. Therapie, 70(2), doi: /therapie/ Concheiro, M., Castaneto, M., Kronstrand, R., & Huestis, M. A. (2015). Simultaneous determination of 40 novel psychoactive stimulants in urine by liquid chromatography-high resolution mass spectrometry and library matching. Journal of Chromatography. A, pii:s (15) doi: /j.chroma Cottencin, O., Rolland, B., & Karila, L. (2014). New designer drugs (synthetic cannabinoids and synthetic cathinones): Review of literature. Current Pharmaceutical Design, 20(25), Lisi, D. M. (2014). Designer drugs. Patients may be using synthetic cannabinoids more than you think. Journal of Emergency Medical Services, 39(9), Tuv, S. S., Krabseth, H. M., Strand, M. C., Karinen, R. A., Wiik, E., Vevelstad, M. S., Vindenes, V. (2016). New designer drugs from the web. Tidsskrift for den Norske lægeforening (Journal of the Norwegian Medical Association), 136(8), Weaver, M. F., Hopper, J. A, & Gunderson, E. W. (2015). Designer drugs 2015: Assessment and management. Addiction Science & Clinical Practice, 10(1), 8. doi: /s Wiegand, T., Wax, P., Smith, E., Hart, K., & Brent, J. (2013). The Toxicology Investigators Consortium Case Registry--the 2012 experience. Journal of Medical Toxicology, 9(4), doi: /s

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