File

Lisa Booze, PharmD, CSPI
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Psychoactive drugs created to avoid existing laws
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Modify existing drugs or new drugs with different
chemical structures
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>200 new drugs and 8 classes of drugs since 2009
 80 new drugs since July 2012
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Unknown toxicities
JWH-018
 JWH-073
 HU-210
 CP-47,497
 Cannabicyclohexanol
 UR-144
 XLR11
 AKB48
 AM 2201
 ADB-PINACA
And many more!
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Synthetic cannabinoids
 More potent than THC
 Most made in SE Asia, China
 Sprayed on leafy material or
potpourri
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K2
Spice
Zohai
Genie
Mr. Nice Guy
Blueberry Haze
Black Mamba
Crazy Clown
Scooby Snax
AND MANY MORE!
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
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J Emerg Med 2013;44:360-6
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
Nausea, vomiting
Synthetic
Marijuana
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Cathinone in Khat plant
 Native to East Africa, SW Arabian Peninsula
 Leaves chewed for stimulant and euphoric effects
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Synthetic cathinones: methcathinone, MDPV,
mephedrone, methylone, naphyrone, butylone,
flephedrone & many more!
 Stimulants, similar to ecstasy,
amphetamines, or cocaine
Ivory Wave
 Vanilla Sky
 Cloud 9
 White Dove
 Red Dove
 Blue Silk
 Zoom
 Tranquility
 Ocean Snow
and many others!
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“Not for human
consumption”
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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.
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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.
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Sedated
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Returned to baseline 9 days later
NEJM 2013;369:2536-45
Psychosis, confusion, paranoia,
agitation, violent behavior, depression,
hallucinations, insomnia
Dilated pupils
Dry mouth, teeth grinding,
nose bleed, “nose burns”
Rapid heart rate, high blood
pressure, shortness of breath,
chest pain, heart attack
Fever, sweating
Tremors,
numbness, seizures
Synthetic
Cathinones
Nausea,
vomiting
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Methylenedioxy methamphetamine (MDMA)
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Tablets, powder, liquid
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Euphoria, increased empathy & self-confidence,
increased intensity of lights & sound
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Toxicity similar to synthetic cathinones (“bath
salts”.)
 Teeth grinding, agitation, paranoia, increased heart rate
and blood pressure, sweating, fever, kidney failure,
seizures
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Erowid.org: >60% “ecstasy” tablets don’t contain
MDMA
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“Molly” promoted as a pure “molecular” form of
MDMA
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Oct 2009 – Sept 2013: 143 “Molly” samples tested
by Northeast region lab/DEA; only 13% were
MDMA
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Many samples are the same drugs as “bath salts”
 4-Methylethcathinone (4-MEC)
 Methylone, butylone, MDPV (“Bath salts”)
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PMA (paramethoxyamphetamine), PMMA
(paramethoxymethamphetamine)
 slow onset
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2C drugs (2C-I, 2C-E, 2C-P…)
 “Smiles”
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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
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
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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)
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Euphoria, drowsiness, confusion, slow
reaction time, altered perceptions, lack
of coordination and alertness