Emerging Drugs of Abuse: From Ecstasy to Bath Salts, Synthetic Cannabinoids, and Beyond

Transcription

1 Emerging Drugs f Abuse: Frm Ecstasy t Bath Salts, Synthetic Cannabinids, and Beynd Petrs Levunis, MD, MA Chair, Department f Psychiatry Rutgers New Jersey Medical Schl 47 th Annual Natinal Assciatin f Scial Wrkers New Yrk City Addictins Institute Frdham University Graduate Schl f Scial Service June 3, 2015 Outline 1. Stimulants 2. Cannabinids 3. Hallucingens 4. Opiids 5. Sme Old and New 6. Summary 2 1

2 1 The Stimulants 3 Ecstasy Methylene-Dixy-Meth-Amphetamine (MDMA) 4 2

3 Effects Essentially partly a stimulant and partly a hallucingen: An attenuated frm f ccaine, plus An attenuated frm f LSD. Empathy (mre than ecstasy). Prfund feelings r relatedness t the rest f the wrld. In the 1970s, it was used in psychtherapy (unsuccessfully). 5 Freshmen lve it, Sphmres like it, Junirs are ambivalent, and Senirs are afraid. 6 3

4 Neurbilgy Acutely increases sertnin levels by: Blcking reuptake, and Directly releasing the neurtransmitter. Chrnically decreases sertnin levels by: Depleting sertnin stres Inhibiting the synthesis f new sertnin. Neurtxicity. 7 Intxicatin Disc dump and bruxism. Stimulant effects: Wakefulness, endurance, energy. Trismus, anrexia, diaphresis, ht flashes. Sertnin Syndrme: Treat with hydratin, cling, and sedatin. D nt use beta-blckers, which may wrsen vasspasm and hypertensin. 8 4

5 Withdrawal Anhednia and depressed md. Lethargy and fatigue fr several days. Frank suicidality in the absence f cccurring depressive disrder is rare. N indicatin fr treatment. 9 Lng-term Effects Assciated with: Depressin Anxiety Panic Disrder Increased impulsivity Sleep disturbances Cgnitive dysfunctin N FDA apprved medicatins. MET and CBT are the majr treatment mdalities. 10 5

6 Bath Salts 11 Effects Euphria Heightened alertness Elevated energy Increased sexual arusal 12 Levunis P and Herrn A. The Addictin Casebk

7 Hey, I just met yu, and this is crazy, but I m n bath salts, and yur face lks tasty The Cannabinids 14 7

8 Synthetic Cannabinids 15 Names Spice, Spice Gld, Spice Diamnd K2, K2 Blnde Arma Yucatan Fire XXX Black Bx Zmbie Skunk Mn Rcks Bizarr 16 8

9 Effects Mild euphria and relaxatin The giggles Increased sensitivity t external stimuli: Clrs seem brighter Smells are mre pungent Distrtin f time perceptin Frank, vivid hallucinatins 17 Why drink and drive, when yu can smke and fly. If we all had a bng, we d all get alng. 18 9

10 Neurbilgy Cannabinids activate the CB 1 and CB 2 cannabinid receptrs: CB 1 has high density in cerebellum, basal ganglia, hippcampus, cerebral crtex. CB 1 has lw density in the brainstem, hence lw risk f respiratry depressin. CB 2 is fund in spleen, hematpietic cell lines, mast cells. CB 2 activatin may be the primary cause f addictin t cannabis. Anandamide is the endgenus ligand. 19 SC Neurbilgy Synthetic Cannabinids (SCs) are full and ptent agnist f the CB 1 receptr. 4- t 5-fld higher affinity t CB 1 receptr. 10-fld higher affinity t CB 2 receptr. 2 t 3 times mre likely t be assciated with sympathmimetic effects. Apprximately 5 times mre likely t be assciated with hallucinatins. Frrester MB, Kleinschmidt K, Schwarz E, Yung A. Hum Exp Txicl 2012; 31:

11 Synthetic Drug Abuse Preventin Act f 2012 Cannabimimetic Agents are Schedule I. Unless specifically exempted r unless listed in anther schedule, any material, cmpund, mixture, r preparatin which cntains any quantity f cannabimimetic agents, r which cntains their salts, ismers, and salts f ismers whenever the existence f such salts, ismers, and salts f ismers is pssible within the specific chemical designatin The Hallucingens 22 11

12 Salvia Salvia Divinrum 23 Names Diviners Sage Magic Mint Maria Pastra Purple Sticky Sally D Salvia Zne 24 12

13 Effects Highly selective kappa piid receptr agnist Intense hallucinatins Heightened sensatins Synesthesia 25 Dextrmethrphan DXM 26 13

14 Effects Lw dse Opiid Higher dse Hallucingen 27 DXM Plateaus 1 st mg 2 nd mg 3 rd mg 4 th 800 1,800 mg 5 th Over 1,800 mg DXM.darkridge.cm Great fr cnversatin Great insights t everything Gd fr a party r cncert! Mre euphria Decreased sense f time Decreased sense f surrundings Visual hallucinatins, mstly spirals and fluids Ppping up f thughts and feelings f ne's wn life This is definitely nt a party plateau. Alien encunters Out f bdy experiences Nt fr beginners nt be dne withut clse access t a hspital and a smart trip-sitter. Very few reprts f a 5 th plateau Prfuse sweating, extreme nausea, blackuts Pint f n return. Unless yu want t g thrugh physical and mental hell, dn't try and hit this pint

15 The 2C Family e.g., 2,5-dimethxy-4-idphenethylamine 29 4 The Opiids 30 15

16 Kratm Mitragyna Specisa 31 Names Ithang Kakuam Ketum Kryptn Thm 32 16

17 Effects Lw dse Hallucingen/Stimulant Higher dse Opiid 13 times mre ptent than mrphine 33 Krkdil 4,5-α-epxy-17-methylmrphinan-3-l 34 17

18 5 Sme Old and New 35 6 Summary 36 18

19 GOOD BAD X Empathy Sertnin Lss Bath Salts Happiness Addictin SC Euphria Psychsis Salvia Visins Flashbacks DXM Insights Hell Kratm Pain Relief Respiratry Depressin Krkdil Nt Here Flesh Eating37 Thank yu NJMS.Rutgers.edu/Psychiatry 38 19