docDr. Keith Baker - Designer (Dirty) Drugs
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Dr. Keith Baker - Designer (Dirty) Drugs
Designer Drugs Keith Baker, MD PGY3, Emergency Medicine St. Luke’s University Health Network Let’s Head Down to the Speakeasy!! Outline Define “designer drugs” and the problem they present 2) Discuss basics of how drugs work 3) Go over specific ways various illicit drugs affect the body 4) Go over specific classes of designer drugs and their effects 5) Recognition and Prevention 1) What are designer drugs? “ A designer drug is a structural or functional analogue of a controlled substance that has been designed to mimic the pharmacological effects of the original drug, while at the same time avoiding being classified as illegal, and/or avoid detection on standard drug test” History International Opium Convention of 1925 Morphine banned Diacetyl ester of morphine manufactured and sold History 1980’s: DEA emergency scheduling powers 1986: Drug Analogue Act 1990’s to Present: Explosion in new drugs and sales over the internet Regulation Difficulties Analogue act applies only to compounds intended for human consumption Products marketed as “bath salts”, “plant food”, “ladybug attractant” Many compounds are useful and important in day-to-day life Sheer Number of Drugs Opioids α-methylfentanyl, became well known as "China White" on the heroin market parafluorofentanyl 3-methylfentanyl, extremely potent opioid, allegedly used as a chemical weapon by the Russian military in the Moscow theater hostage crisis MPPP, especially infamous due to an impurity in some batches called MPTP, which caused permanent Parkinsonism with a single use[32][33] 4'-Nitromethopholine O-Desmethyltramadol Nortilidine 4,4-Diphenyl-6-(pyrrolidin-1-yl)-heptan-3-one, the pyrrolidine analogue of dipipanone and phenadoxone. Psychedelics Lysergamide-based ALD-52, N-acetyllysergic acid diethylamide, famously believed to have been the active ingredient in the "Orange Sunshine" acid of the 1960s ETH-LAD, which has been sold by some research chemical suppliers. AL-LAD, which has been sold by some research chemical suppliers. PRO-LAD, which has been sold by some research chemical suppliers. LSB LSZ Tryptamine-based 4-Acetoxy-DiPT, N,N-diisopropyl-4-acetoxytryptamine 4-Acetoxy-DMT, 4-acetoxy-dimethyltryptamine 4-HO-MET, 4-hydroxy-N-methyl-N-ethyltryptamine 4-HO-MiPT, 4-hydroxy-N-methyl-N-isopropyltryptamine 5-MeO-AMT, 5-methoxy-alpha-methyltryptamine 5-MeO-DiPT, 5-methoxy-di-isopropyltryptamine (also known as "Foxy" or "Foxy Methoxy") 5-MeO-MiPT, 5-methoxy-methylisopropyltryptamine DiPT, N,N-diisopropyl-tryptamine DPT, N,N-dipropyltryptamine 5-MeO-DALT (N-allyl-N-[2-(5-methoxy-1H-indol-3-yl)ethyl]prop-2-en-1-amine) Sheer Number of Drugs Phenethylamine-based 2C-C, 2,5-dimethoxy-4-chlorophenethylamine 2C-D, 2,5-dimethoxy-4-methyl-phenethylamine 2C-E, 2,5-dimethoxy-4-ethyl-phenethylamine 2C-G, 3,4-dimethyl-2,5-dimethoxyphenethylamine 2C-I, 2,5-dimethoxy-4-iodophenethylamine 2C-T-2, 2,5-dimethoxy-4-ethylthiophenethylamine 2C-T-4, 2,5-dimethyoxy-4-(i)-propylthiophenethylamine 2C-T-7, 2,5-dimethoxy-4-(n)-propylthiophenethylamine 2C-T-21, 2,5-dimethoxy-4-(2-fluoroethylthio)phenethylamine 2CB-FLY Bromodragonfly DOB, 2,5-dimethoxy-4-bromoamphetamine DOC, 2,5-dimethoxy-4-chloroamphetamine DOI, 2,5-dimethoxy-4-iodoamphetamine DOM, 2,5-dimethoxy-4-methylamphetamine TMA-2, 2,4,5-Trimethoxyamphetamine TMA-6, 2,4,6-Trimethoxyamphetamine NBOMe-2C-C, 25C-NBOMe, "Pandora" NBOMe-2C-I, 25I-NBOMe, "Solaris" NBOMe-2C-D, 25D-NBOMe, "Divination" Dissociatives 3-MeO-PCP 4-MeO-PCP [34] Dizocilpine (MK-801; (+)-5-methyl-10,11- dihydro-5H-dibenzo[a,d]cyclohepten-5,10-imine) Eticyclidine (PCE; CI-400; N-ethyl-1-phenylcyclohexylamine) Methoxetamine (2-(3-methoxyphenyl)-2-(ethylamino)cyclohexanone) PCPr (N-propyl-1-phenylcyclohexylamine) Rolicyclidine (PCPy; 1-(1-phenylcyclohexyl)pyrrolidine) Tenocyclidine (TCP; 1-(1-(2-Thienyl)cyclohexyl)piperidine) 3-MeO-PCE (2-(3-methoxyphenyl)-2-(ethylamino)cyclohexane) Ethylketamine (2-(2-chlorophenyl)-2-(ethylamino)cyclohexanone) Methoxyketamine (2-(2-methoxyphenyl)-2-(methylamino)cyclohexanone) Sheer Number of Drugs Piperazine-based BZP, 1-benzylpiperazine mCPP, 1-(3-chlorophenyl)piperazine MeOPP, 1-(4-methoxyphenyl)piperazine pFPP, 1-(4-fluorophenyl)piperazine TFMPP, 3-trifluoromethylphenylpiperazine, has the unique distinction of being the only drug in the USA to be emergency scheduled into Schedule I and then allowed to become legal because the DEA was unable to justify permanent scheduling Entactogens 4-MTA, 4-Methylthioamphetamine 5-Me-MDA 5-APB, 5-(2-aminopropyl)benzofuran 6-APB, 6-(2-aminopropyl)benzofuran AET, α-ethyltryptamine Butylone, β-keto-N-methylbenzodioxolylpropylamine Ethylone, 3,4-methylenedioxy-N-ethylcathinone IAP MBDB MDAT (5,6,7,8-tetrahydrobenzo[f][1,3]benzodioxol-7-amine) MDEA, 3,4-methylenedioxy-N-ethylamphetamine Methylone, 3,4-methylenedioxy-N-methylcathinone MMA, 3-Methoxy-4-methylamphetamine PMA, a highly dangerous amphetamine derivative responsible for many accidental deaths PMMA, similar to PMA PMEA, also similar to PMA Stimulants α-Pyrrolidinopropiophenone (α-PPP) 2-Fluoroamphetamine 3-Fluoroamphetamine 4-Fluoroamphetamine 4-Methylaminorex (4-MAR) Buphedrone Camfetamine (N-methyl homologue of Fencamfamine) Sheer Number of Drugs Desoxypipradrol Dimethocaine Diphenylprolinol Ethcathinone Ethylphenidate Flephedrone (4-FMC), and its 3-fluoro isomer 3-FMC Geranamine MDPV, Methylenedioxypyrovalerone, commonly known by its street name "bath salts" Mephedrone, 4-methylmethcathinone Methedrone Methiopropamine Naphyrone Pentedrone Pentylone Sedatives 1,4-Butanediol, another GHB analogue 2-Methyl-2-butanol, a more potent analogue of ethanol GBL, gamma-butyrolactone, both a precursor to and substitute for GHB GHV, gamma-hydroxyvaleric acid (4-methyl-GHB) GVL, gamma-valerolactone Methylmethaqualone, an analogue of the sedative methaqualone Mebroqualone Benzylbutylbarbiturate Phenazepam, a benzodiazepine that was not listed by the Convention on Psychotropic Substances and so is not regulated internationally Premazepam Etizolam Cannabinoids Benzoylindoles AM-630 AM-679 AM-694 AM-1241 AM-2233 RCS-4 Sheer Number of Drugs Naphthoylindoles AM-1220 AM-1221 AM-1235 AM-2201 AM-2232 JWH-007 JWH-015 JWH-018 JWH-019 JWH-073 JWH-081 JWH-098 JWH-116 JWH-122 JWH-149 JWH-182 JWH-193 JWH-198 JWH-200 JWH-210 JWH-398 JWH-424 MAM-2201 Nonclassical cannabinoids CP 47,497 and its (C8) homologue cannabicyclohexanol CP 55,940 HU-308 Phenylacetylindoles JWH-167 JWH-203 JWH-250 JWH-251 JWH-320 RCS-8 Sheer Number of Drugs Adamantoylindoles AB-001 AM-1248 Anabolic Steroids Madol (sometimes referred to as "DMT") Methasterone Norbolethone Prostanozol THG, "The Clear" Erectile dysfunction Aildenafil Acetildenafil Aminotadalafil Gendenafil Homosildenafil Hydroxyacetildenafil Hydroxyhomosildenafil Hydroxythiohomosildenafil Nitrosoprodenafil[35] Piperidino-acetildenafil Piperidino-vardenafil Sulfoaildenafil Thiosildenafil Covering “The Basics”…. How Do Drugs Work? 1) 2) 3) 4) Absorption Distribution Metabolism Excretion The drug can have effects during any of these processes (and sometimes at multiple points) Cell Receptors Cell Receptors Cell Receptors Neurotransmitters Designer Drugs…. Or Dirty Drugs? Can change effect on target receptors Can end up affecting different receptors or (more often) multiple receptors Often have unintended and unexpected side effects What Happens To Someone When They Take Drugs? Opioid Toxidrome CLASSIC TRIAD: Pinpoint pupils, respiratory depression, coma ALSO: Bradycardia, hypotension, hypothermia Sympathomimetic Toxidrome Tachycardia Hypertension Anxiety/ Agitation/ Psychosis Dilated pupils Hyperthermia DIAPHORESIS HYPERACTIVE BOWEL SOUNDS Anticholinergic Toxidrome Tachycardia Hypertension Anxiety/ Agitation/ Psychosis Dilated pupils Hyperthermia DRY SKIN HYPOACTIVE BOWEL SOUNDS Cholinergic Toxidrome Salivation Lacrimation Urination Defication Gastrointestinal upset Emesis KILLER B’s – Bronchorrhea, Bronchospasm, Bradycardia Hallucinogenic Toxidrome Hallucinations Psychosis Tachycardia Hypertension Hyperactive bowel sounds Dissociatives Marijuana Designer Drugs…. Or Dirty Drugs? 1) 2) 3) 4) Designer Cannabinoids Designer Opiates Designer Stimulants Designer Psychedelics/ Dissociatives Designer Cannabinoids Marijuana Designer Drugs…. Or Dirty Drugs? Can change effect on target receptors Can end up affecting different receptors or (more often) multiple receptors Often have unintended and unexpected side effects Designer Cannabinoids Usually smoked or vaporized Slang Terms: Spice, K2, Black mamba, Bombay blue, Genie, Zohai, Herbal incense Effects can be very different than seen with THC Psychosis, sympathomimetic toxidrome, muscle breakdown, kidney failure, heart attack, seizure, coma, death Designer Cannabinoids Effects generally limited to about 6 hours Treatment is aimed at symptoms and toxidrome Education is critical Designer Opioids Designer Opioids Designer Stimulants Synthetic Cathinones Artificially engineered derivatives of the active chemical found in the plant Khat Synthetic Cathinones “Bath salts, Meow-meow, M-cat, NRG, White rush, White lightning, Zoom, Ivory wave, White horse, Cloud nine, etc” Affects multiple neurotransmitters Primarily sympathomimetic toxidrome, also some hallucinogenic effects Synthetic Cathinones Can be ingested, snorted, or injected Popular as a party drug Multiple reports in infants Synthetic Cathinones High rate of death and disability Piperizines Synthetic substances Common Names: Rapture, Legal X, Legal E, Frenzy, Charge Long duration of action, often > 24 hours Psychedelics/ Dissociatives Psychedelics Multiple classes Act via multiple neurotransmitters Primarily via serotonin N-Bomb (25I-NBOMe) - Sublingual, Buccal, Inhaled, Ingested, Snorted - Lasts 4 to 10 hours Dissociatives Several classes with similar mechanisms These are starting to hit the street Designer Drugs - In Summary Pre-hospital bullet points - Try to get packaging, pills, etc and bring to the emergency department - Get a list of medications and supplements - Can look up the drug(s) in your abundant spare time (haha) Pre-hospital bullet points - ABC’s - Supportive Care Pre-hospital bullet points - Consider high dose naloxone for unresponsive opioid toxidrome - Give benzos liberally for agitation, seizures, sympathomimetic toxidrome, etc - Rehydration with normal saline - Consider starting aggressive cooling if needed Questions?
