Designer Drugs What Drug Court Practitioners Need

Designer Drugs – What Drug Court Practitioners Need to Know By: Paul L. Cary Toxicology Laboratory University of Missouri

2 C-I NBOME

History of Designer Drugs

Designer Drugs Aren’t New n n n n n morphine invented in early 1800 s from opium in 1925 morphine was chemically altered to create heroin 1960 s hallucinogens (LSD, STP) late 1970 s illicitly synthesized fentanyl (China White) 1980 s - MDMA (Ecstasy) around this time the term “Designer Drugs” was coined 2006 - everything changes introduction of synthetic cannabinoids (Spice & K 2) quickly followed by the introduction of bath salts today - newer, bolder, experimental cocktails

Internet Transformed Designer Drug Trade

What is a Designer Drug: n n n legitimate pharmaceuticals/research chemicals botanicals (plants with psychoactive properties) illicit compounds already banned via reformulation of molecular structure in clandestine labs newly created chemicals are formed (“Designer Drugs”) effects to mimic the “original” drug/compound

Why Create a Designer Drug? • • • prolong the effect of the drug increase the potency of the drug “select” the desired effect make the drug more difficult to detect make an illegal drug “legal” PROFIT! Make $$$$$

Unknowns Associated with Designer Drugs n n n inconsistencies in production (variable drug concentrations) purity of the product (contaminates) mislabeling of packages false, misleading & deceptive sales Russian roulette

Source of Designer Drugs

Synthetic Cannabinoids (Spice/K 2)

Preparation of “herbal incense”: n botanicals are sprayed with liquid preparations of: u. HU-210 u. HU-211 u. CP 47, 497 u. JWH-018 u. JWH-073

Smoking Cannabinoids What does CB 1 receptor control? § § § BG: motor control, learning Hippo: memory, spatial navigation CB: cognitive functions attention, language, emotions

Pharmacological Effects of Synthetic Cannabinoids are Similar to THC § § § § § increase heart rate & blood pressure altered state of consciousness mild euphoria and relaxation perceptual alterations (time distortion) intensification of sensory experiences pronounced cognitive effects impaired short-term memory reduction in motor skill acuity increase in reaction times

Public Perception of “Legal Highs” Synthetic cannabinoids are as safe as marijuana.

Forensic Science Review Volume: Twenty-Six Number One January 2014 25 pages

Synthetic Cannabinoids: Physical Effects § § § § kidney damage (XLR-11) pulmonary effects (lung dysfunction) cardiovascular issues (tachycardia), increases in blood pressure GI problems (pain, nausea, vomiting) seizures (6 cases) chemically-induced psychosis ** DUID (12 reported cases) ** three reported deaths (cardiac, suicide, OD)

Gurney Report conclusions: “A review of the literature that exists to date suggests that synthetic cannabinoids may have side effects that are more severe than that of marijuana. ”

Evolutionary Landscape appearing & disappearing n what’s popular today cycles out to be replaced by new synthetic THC analogs n labs testing for common compounds a few months ago may not be testing for same chemicals now n difficult to keep pace using legal remedies n

Acknowledgment: Dr. Barry Logan National Medical Services Willow Grove, PA

Evolutionary Landscape

Lab-Based Drug Testing:

Designer Stimulants (Synthetic Cathinones)

Designer Stimulants: bath salts/bath bubbles n plant foods/plant vitamins n glass cleaners/computer screen cleaners n soft drink additive n “novelty collectors item” n

What are Designer Stimulants? § § illegal psychoactive drugs that induce temporary improvements in either mental or physical functions enhanced alertness, wakefulness, locomotion § produce a characteristic "up" feeling § similar to amphetamine & cocaine

MDPV: Methylenedioxypyrovalerone (MDPV) - a psychoactive drug with stimulant properties which acts as both a norepinephrinedopamine reuptake inhibitor (NDRI). n often snorted - similar to cocaine n considered extremely addictive n adverse medical/psychiatric ramifications n

Methylmethcathinone (Mephedrone) § § § designer drug chemically similar to cathinone first synthesized in 1929 amphetamine-like properties powerful synthetic stimulant adverse medical/psychiatric ramifications

Summer, 2014 - Bath Salt Data

25 I-NBOMe Substituted phenethylamine psychedelic 2 C-I stimulant hallucinogen 20 linked deaths In US

Adverse Effects of Designer Stimulants: n n surge in neurotransmitters: u dopamine u serotonin u norepinephrine psychiatric symptoms: u severe paranoia u hallucinations u panic attacks u “excited pr de n& sio es delirium” ici su l th da hts oug

Adverse Effects of Designer Stimulants: § dehydration § skeletal muscle degeneration § kidney failure § breathing difficulties § seizures § death

Miscellaneous Designer Drugs

n n n n n Tryptamine-Based Drugs (e. g. , Foxy, AMT, and DMT)— hallucinogenic Mitragynine (Kratom)— sedative Desomorphine (Krokodil)— heroin-like Benzofurans (6 -APB, or Benzo Fury)— stimulation to hallucinogenic Piperazine-Based Drugs (e. g. , BZP, TFMPP, and Me. OPP)— stimulants Phenethylamine-Like Drugs (e. g. , Bromo Dragonfly, B-Fly, and 3 CB-Fly)— synthetic hallucinogen Sedative-Class Drugs (1, 4 -B and BDO)— derivatives of GHB Dissociative Psychedelic Class (e. g. , 3 -Me. O-PCP, 4 -Me. O-PCP) Methoxetamine, MXE, Mexxy, Roflcopter)—Synthetic dissociative psychedelics like PCP and ketamine. FAAH Inhibitors– enzyme is responsible for regulating brain chemicals

Legal Controls

Legal Controls n Controlled Substances Analogue Enforcement Act of 1986 n Scheduling of Synthetic Drugs: Controlled Substances Act n DEA’s Temporary Scheduling

Drug Testing for Designer Drugs

Drug Testing for Designer Drugs § designer drugs have made most detection methods obsolete § on-site, point of care devices § laboratory-based (LC/MS/MS) § not all labs are equal § urine remains the specimen of choice

Unfortunate Truisms: legal controls that prohibit designer drugs will always lag behind their production n drug detection methods for the identification of designer drugs may also not be available when these compounds become popular n

Drug Courts Response n Step 1: acknowledge the problem uunderstanding the complexity and challenges n Step 2: ban designer drugs ueven if purchased “legally” ufalse pretenses - “not for human consumption”

Drug Courts Response n Step 3: put it in writing ubest practices research n Step 4: abstinence monitoring uacknowledge limitations udevelop a drug testing plan uidentify appropriate lab ulimited amnesty initiative

Drug Courts Response n Step 5: community supervision u“eyes & ears” of the court u. PO, law enforcement, marshals, case workers, etc. u. Fourth Amendment waivers usearch & seizure

Drug Courts Response § Step 5: community supervision continued: § be proactive § home visits (announced & unannounced) § persons, places, vehicles, etc. § under participants control

Drug Courts Response § Step 5: community supervision continued: § computer & smart phones § text messages, social network § Internet ordering practices § shipping labels, receipts

Conclusion n escalating public health issue n accept unfortunate truisms n challenge of designer drugs will require creativity & vigilance n fidelity to the Drug Court model n follow best practices n we know how to do this!

email address: carypl@health. missouri. edu