Presented by

Vinnie Happ

Redwood Toxicology Laboratory

Problems & Challenges Posed by

Spice/K2, Bath Salts, Heroin, Painkillers, Oxy, Bup, etc.

Synthetic Drugs: Dangers, Detection, & Trends

October, 2014

Drug Testing: Synthetic THC / K2

Rapid, onsite instant test Rapid, onsite instant test Laboratory-based screening test Laboratory-based screening test (becoming more (becoming more

widespread)widespread)

Most Laboratories are employing LC/MS/MS Most Laboratories are employing LC/MS/MS technologytechnology

Primarily via urine, however some labs can test via Primarily via urine, however some labs can test via oral fluid and or bloodoral fluid and or blood

$$$ varies greatly$$$ varies greatly Onsite vs Laboratory testing is very differentOnsite vs Laboratory testing is very different

On-site vs Laboratory testing for K2

On-site K2 testOn-site K2 test JWH-018 & JWH-073 JWH-018 & JWH-073

primary strucutureprimary strucuture

Cut-off at 25 or 50ngs/mlCut-off at 25 or 50ngs/ml Higher threshold to trigger Higher threshold to trigger

++ Greater chance for false +/-Greater chance for false +/- Screening technologyScreening technology

Laboratory K2 testLaboratory K2 test JWH-018, 073, JWH-018, 073, plus *28 other plus *28 other

synthetic cannabinoid structures:synthetic cannabinoid structures:JWH-019, 081, 122, 200, 203, 210, 250, 398, AM2201, JWH-019, 081, 122, 200, 203, 210, 250, 398, AM2201,

MAM2201, RCS4, RCS8, AM-694, AM-1248, AKB-MAM2201, RCS4, RCS8, AM-694, AM-1248, AKB-48, 48, UR-144, XLR-11UR-144, XLR-11, 5-Fluro AB-PINACA,5-Fluoro , 5-Fluro AB-PINACA,5-Fluoro ADB-PINACA5-Fluoro ADBICA,ADB-PINACA5-Fluoro ADBICA,5-Fluoro AKB-48, 5-5-Fluoro AKB-48, 5-Fluoro PB-22, AB-PINACA, AB-FUBINACA, ADB-Fluoro PB-22, AB-PINACA, AB-FUBINACA, ADB-PINACA, ADBICA, PB-22, BB-22PINACA, ADBICA, PB-22, BB-22

Cut-off 1ng/ml or lessCut-off 1ng/ml or less

Detecting presenceDetecting presence Confirmatory technologyConfirmatory technology

*Redwood Toxicology Laboratory*Redwood Toxicology Laboratory

CESAR FAXU n i v e r s i t y o f M a r y l a n d , C o l l e g e P a r k

A Publication from the Center for Substance Abuse Research

September 8, 2014Vol. 23, Issue 13

Study of Patients in a Midwestern Residential Treatment Program Finds 71% of Those Reporting Synthetic Cannabinoid Use Report Using to Avoid

Positive Drug Test

0% 20% 40% 60% 80% 100%

91%

89%

71%

71%

63%

59%

59%

48%

39%

32%

30%

Curiosity

To Feel Good or Get High

To Relax or Relieve Tension

To Get High Without Having a Positive Drug Test

Liked the Effects

Boredom

To Have a Good Time with Friends or to Fit In

Anger or Frustration; To Get Away from Problems or Troubles

To Help Deal with Pain

To Increase or Decrease the Effects of Some Other Drugs

Because It Is Safer Than Other Drugs

Self-Reported Reasons for Using Synthetic Cannabinoids(N=150 Adult Residential Substance Use Disorder Treatment Patients Reporting Lifetime Synthetic Cannabinoid Use)

SOURCE: Adapted by CESAR from Bonar, E.E., Ashrafioun, L., and Ilgen, M.A, “Synthetic Cannabinoid Use Among Patients in Residential Substance Use Disorder Treatment: Prevalence, Motives, and Correlates,” Drug and Alcohol Dependence, In Press, 2014. For more information, contact Erin Bonar at erinbona@med.umich.edu.

301-405-9770 (voice) 301-403-8342 (fax) CESAR@umd.edu www.cesar.umd.edu

The CESAR FAX is independently funded by CESAR and may be copied without permission. Please cite CESAR as the source.

MDPV (Methylenedioxypyrovalerone) a psychoactive drug with powerful stimulant a psychoactive drug with powerful stimulant

properties which acts as both a norepinephrine & properties which acts as both a norepinephrine & dopamine reuptake inhibitor (NDRI). “A two for”dopamine reuptake inhibitor (NDRI). “A two for”

usually snorted like cocaineusually snorted like cocaine duration of effect 2-3 hours /adverse effect 6-8 duration of effect 2-3 hours /adverse effect 6-8

hrshrs MDPV - no history of FDA approved medical useMDPV - no history of FDA approved medical use adverse medical or psychiatric ramificationsadverse medical or psychiatric ramifications

amphetamine-like properties, powerful stimulantamphetamine-like properties, powerful stimulant ““rediscoveredrediscovered”” by synthetic chemists in 2003 by synthetic chemists in 2003 reformulation of cathinone, a chemical found in reformulation of cathinone, a chemical found in

the khat plant of Eastern Africathe khat plant of Eastern Africa khat existence traced to 15th C. Ethiopiakhat existence traced to 15th C. Ethiopia khat is banned in the U.S.khat is banned in the U.S.

Mephedrone (Methylmethcathinone)

Methylone

(3,4-methylenedioxy-N-methylcathinone) very similar to MDMAvery similar to MDMA

stimulant stimulant phenethylamine, amphetamine, and phenethylamine, amphetamine, and

cathinone propertiescathinone properties euphoria and increased sociabilityeuphoria and increased sociability insomnia and restlessnessinsomnia and restlessness hallucinations and psychosishallucinations and psychosis

MDMA – Ecstasy / Molly• MDMA, was patented by Merck pharmaceuticals

in 1912

• Used in the 70/80’s as a psychotheraputic tool

• Became popular “club drug” in 90’s then fell out of favor, too may additives. Come back in last couple of years

• capsules sell for $8 to $40.

• the most common Molly additives are bath salts, including methylone and mephedrone.

• DEA's New York division highlighted the results of 143 lab tests over the past four years of substances suspected of being Molly. Only 13% of the drugs were MDMA, while 41% were 4-MEC, and 20% were methylone (bath salt materials).

Pharmacological Effects of “Bath Salts”

increase heart rate & blood pressure pupil dilation, rapid speech hyperactivity, arousal, & over stimulation increased energy & motivation euphoria - agitation dizziness, nausea hallucinations, seizures, convulsions breathing difficulties!!! diminished perception of the requirement for food and diminished perception of the requirement for food and

sleepsleep

Testing for Bath Salts??Yes! However:

No on-site, rapid, instant testsNo on-site, rapid, instant tests No laboratory-based screening No laboratory-based screening

teststests Laboratories employing GC/MS Laboratories employing GC/MS

and LC/MS/MS technologiesand LC/MS/MS technologies Detection times remain unknownDetection times remain unknown

    

  Bath Salts and beyond!!!Expanded Synthetic Stimulant Panelαα-PVP-PVP

BZPBZP      

ButylonButylon

BuphedroneBuphedrone   

CathinoneCathinone      

EthyloneEthylone       

FlephedroneFlephedrone

MBDBMBDB        

mCPPmCPP

MDAMDA

MDEA MDEA 

MDMAMDMA

MDPVMDPV

Mephedrone Mephedrone 

MethcathinoneMethcathinone

4-Methylethcathinone- (4MEC4-Methylethcathinone- (4MEC) ) 

MethyloneMethylone

PentedronePentedrone

PentylonePentylone

PyrrolidinopentiophenonePyrrolidinopentiophenone

TFMPPTFMPP

0

100

200

300

400

500

600

700

800

Synthetic Marijuana

Synthetic Cathinones

2010 2011 2012 2013

Number of Exposure

Calls

Number of Calls to U.S. Poison Control Centers About Exposure to Synthetic Marijuana and Synthetic Cathinones Stable at Lower Levels Than Recent Years

CESAR FAXU n i v e r s i t y o f M a r y l a n d , C o l l e g e P a r k

A Weekly FAX from the Center for Substance Abuse Research

August 12, 2013Vol. 22, Issue 32

.

Narcotics / Opiate Family

Opiates and Opioids: Opiates and Opioids: HeroinHeroin

MorphineMorphine

CodeineCodeine

Hydrocodone - (Vicodin, Loratab, ZohydroER, Hydrocodone - (Vicodin, Loratab, ZohydroER, TarginiqER)TarginiqER)

Hyrdomorphone - (Dilaudid) Hyrdomorphone - (Dilaudid)

Oxycodone – (OxyContin, Percocet, Roxicodone)Oxycodone – (OxyContin, Percocet, Roxicodone)

Oxymorphone – (Opana, OpanaER)Oxymorphone – (Opana, OpanaER)

FentanylFentanyl

MethadoneMethadone

Buprenorphine – (Suboxone)Buprenorphine – (Suboxone)

Tramadol – (Ultram)Tramadol – (Ultram)

- Philip Seymour Hoffman's heroin overdose exposes 100 percent RISE in 'epidemic' across US since 2007

- More than 660,000 Americans used heroin in 2012

- Resurgence attributed to crackdown on illegal 'pill mills' producing prescription drugs like OxyContin, which gives same high as heroin

- Pill addicts have turned to heroin because its cheaper and available

- Popular in rural and suburban areas, not just inner city

- Users buying single hits of heroin for as little as $4

- Drug cartels pushing ever-larger amounts across the Southwest border

New York hospital pharmacist charged in theft of 200,000 pillsJULY 9, 2014

Tuesday, June 8, 2014 photo shows Anthony D'Alessandro.

The former pharmacy chief for Mount Sinai Beth Israel hospital in Manhattan allegedly stole nearly 200,000 oxycodone pills from the medical center over more than five years.

Prosecutors are still investigating what became of the drugs but believe the medications ended up on the thriving black market for prescription narcotics,

where the more than 193,000 missing pills could fetch a total of about $5.6 million.

Ex-sheriff's wife released from prison earlyJul 08, 2014  

WAUSAU (WI) – A one-time state probation agent and wife of a former Marathon County sheriff has been released from prison about seven months early, according to the state Department of Corrections.

Last August, Kim Hoenisch, now 42, was sentenced to 18 months in prison and six years probation after she was convicted of three felonies -burglary, misconduct in office and possession of narcotic drugs - and two misdemeanors.

Hoenisch was fired from her job after a state investigation concluded she had stolen prescription drugs, including Vicodin and oxycodone, from one of her clients.

One in Four Americans Admits Abusing Prescription Drugs, Says FindLaw.com Survey EAGAN, Minn., Aug. 5, 2014 - One in four Americans admits that they have abused prescription drugs, according to a new national survey by FindLaw.com, the most popular legal information website.

Prescription drug abuse involves taking a drug for reasons other than the drug's intended usage or use of a drug by someone other than the person listed on the prescription. The drug abuse can either be an attempt to self-medicate a medical condition, or for purposes such as getting high. 

How bad is the painkiller prescription problem??

FDA Toughens Warning on Pain DrugsAgency Cites Serious Risks Associated With Pills Such as OxyContin

USA TODAY - September 10, 2013

The FDA said that long-acting forms of "opioid" painkillers, such as OxyContin, should be used only when there is no alternative. The new drug label drops the word "moderate" and says it should be used only to manage "pain severe enough to require daily, around-the clock, long-term treatment.”

The new warnings only relate to extended-release forms of the drugs, which are often prescribed for months or years to treat chronic pain. They don't affect immediate-release forms, which include Vicodin or Percocet and are often used to treat acute pain, such as after surgery.

The FDA is also considering whether to tighten restrictions on hydrocodone products like Vicodin.

Doctors urge FDA to reverse approval of Zohydro, controversial new pain drug The potent drug has drawn widespread concern from addiction experts and state attorneys general, who fear it will fuel opioid abuse and overdose.FEBRUARY 28, 2014REUTERS

ZohydroER contains a higher dosage of pure hydrocodone than Vicodin. Unlike Vicodin, the drug does not contain aspirin or acetaminophen. Acetaminophen was removed because of liver-damage concerns.Zohydro's labeling will feature warnings about abuse, addiction and misuse. Zogenix is working on an abuse-deterrent version of Zohydro that should become available in three years

March/April, 2014Purdue Pharma announces & then submits NDA to FDA for its abuse-resistant, extended-release hydrocodone product.

July 2, 2014 -- Zogenix, Inc. (ZGNX) today announced an update on its development programs focused on the introduction of abuse deterrent formulations of Zohydro(R) ER Application for Next Generation of Zohydro(R) ER to be filed by October 2014

 July 24, 2014The Food and Drug Administration (FDA) announced its approval of Targiniq ER, an extended-release opioid combining the effects of oxycodone and a drug commonly used to reverse the effects of opioid overdose, known as naloxone. 

Purdue Pharma L.P., which originally marketed a harder to crush version of their opioid OxyContin in 2010, created Targiniq ER. When Targiniq ER is crushed and snorted, or dissolved and injected, the typical euphoric effects of oxycodone are blocked by naloxone. 

Extended-Release Opioid Receives FDA Approval

April 2014 -The Washington Post has printed a grim exposé on the shift from Mexican marijuana to Mexican heroin. 

Mexican marijuana has dropped from $100 per kilogram to just $25 per kilogram. Said Rodrigo Silla, 50, a lifelong cannabis farmer. “I wish the Americans would stop with this legalization.” 

The DEA paints a picture of shrewd Mexican cartels reacting to their cut in marijuana business by sowing more heroin addicts. DEA claims cartels send their heroin pushers to work in the cities with the worst prescription pill epidemics and have them “set up right outside the methadone clinics.” 

Mexico Trades Marijuana for Heroin

Heroin-fentanyl mix plaguing many statesJanuary 31, 2014 Pittsburgh Post-Gazette

July 2014 - Authorities in Athens, Tenn., say two of three men who died Friday of apparent drug overdoses had misused the pain medication Fentanyl.

Harold “Marty” Coleman, 48, of 1004 South Jackson Street, Athens, was found lying in the driveway at his mobile home. He had a pain patch in his mouth. Coleman had a prescription for the patches and other narcotics found inside the residence.

While emergency medical officials were preparing to transport Coleman's body, authorities found 46-year-old Donald Sturdivant in the laundry room of the home unconscious but breathing, the detective said.

Sturdivant died a short time later after he was taken to the hospital.

Police: 2 dead after chewing on pain patches to get high

Screening vs Confirmation testing of Opiates

Typical Screening test Typical Screening test Primarily targets: Primarily targets:

Morphine/CodeineMorphine/Codeine

Confirmation Testing Confirmation Testing (GC/MS)(GC/MS)

MorphineMorphine CodeineCodeine HydrocodoneHydrocodone HydromorphoneHydromorphone 6-MAM (heroin marker)6-MAM (heroin marker) OxycodoneOxycodone

Drugs not detectedDrugs not detected BuprenorphineBuprenorphine MethadoneMethadone FentanylFentanyl Tramadol - UltramTramadol - Ultram SomaSoma

Opiate vs Oxycodone Screenwhy you should consider splitting them out when testing

Opiate Screen @ 300ngOpiate Screen @ 300ng Primarily targets Primarily targets

morphine and codeinemorphine and codeine Oxycodone – 30,000ngOxycodone – 30,000ng

Needed to trigger a positiveNeeded to trigger a positive Miss the chippers, O.O.U.Miss the chippers, O.O.U.

Opana – OxymorphoneOpana – Oxymorphone 100,000ng needed to 100,000ng needed to

trigger positive on onsite trigger positive on onsite Opiate testOpiate test

Oxycodone Screen @ 100ngOxycodone Screen @ 100ng Oxycodone – 100ngOxycodone – 100ng

Needed to trigger a positiveNeeded to trigger a positive Detect the chippersDetect the chippers

Will detect oxymorphone Will detect oxymorphone and hydrocodone if and hydrocodone if 1562ngs1562ngs

Oxymorphone – Opana / Oxymorphone – Opana / ERER Oxycodone lab EIA screen Oxycodone lab EIA screen

has 100% cross reactivity to has 100% cross reactivity to OxymorphoneOxymorphone

From: Tracy, CarrieSent: Tuesday, August 05, 2014 11:31 AMTo: Happ, VinnieSubject: false positive question

Hi Vinnie-

Wondering if someone that is prescribed Vicodin and taking it regularly would all of the sudden test positive for Oxycodone on 3 occasions and then miraculously test negative for Oxycodone when confronted about possible use.Thanks-Carrie

Carrie L. TracySenior Probation Officer

Take away comments If positive on an Opiate screening test – an Opiate If positive on an Opiate screening test – an Opiate

family member most likely detectedfamily member most likely detected Confirmation testing will specifically identify the Confirmation testing will specifically identify the

membermember If 6-AM (6-Acetylmorphine) detected at the Lab: If 6-AM (6-Acetylmorphine) detected at the Lab:

heroin useheroin use If confirmed positive just for MorphineIf confirmed positive just for Morphine

metabolized heroine to morphine and ormetabolized heroine to morphine and or morphine use i.e. from a prescription medication, morphine use i.e. from a prescription medication, poppy seed usepoppy seed use

Sharp rise in ER visits tied to abuse of sedative

May 22, 2014 (HealthDay News) -- There's been a steep increase in the number of Americans being treated at emergency departments for abuse of the sedative alprazolam, best known as Xanax.

The number of emergency department visits related to abuse of climbed from more than 57,000 in 2005 to nearly 124,000 in 2011, according to the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA).

Xanax abuse "is especially concerning in light of the dramatic rise in nonmedical use of opioid painkillers like oxycodone [OxyContin] and Vicodin, because these increases in nonmedical use parallel the rapid rise in accidental overdose deaths in our country," Collins said.

Suboxone-Buprenorphine FDA approved in 2002FDA approved in 2002 used to treat opiate addictionused to treat opiate addiction alternative to methadonealternative to methadone partial agonist (ceiling)partial agonist (ceiling) in pill, film, patchin pill, film, patch 2mg & 8mg doses2mg & 8mg doses will not test positive on an opiate testwill not test positive on an opiate test significant diversion significant diversion contains naloxone- guard against misusecontains naloxone- guard against misuse subutex – no naloxonesubutex – no naloxone individuals will get high on this stuffindividuals will get high on this stuff

What’s the attraction to Bup?

user’s experience euphoria effectuser’s experience euphoria effect if taken in conjunction with other sedative drugs like if taken in conjunction with other sedative drugs like

alcohol, sleeping pill (ambien) or a benzodiazepine alcohol, sleeping pill (ambien) or a benzodiazepine (klonopin)- extreme sedation, drowsiness, unconscious, or (klonopin)- extreme sedation, drowsiness, unconscious, or even death may occureven death may occur

method of ingestion – typically sublingual (under tongue), method of ingestion – typically sublingual (under tongue), pill format going away, reports of snorting & injectingpill format going away, reports of snorting & injecting

self medication and or currency in W/R or C/R settingself medication and or currency in W/R or C/R setting only test positive if specifically testing for buprenorphineonly test positive if specifically testing for buprenorphine incredibly easy to smuggleincredibly easy to smuggle

Endo and BioDelivery Sciences announce positive top-line results from the Phase III clinical trial of BEMA® buprenorphine in opioid-experienced patients with chronic pain

July 7, 2014 /PRNewswire/ -- Endo Pharmaceuticals Inc. and BioDelivery Sciences International, Inc. announced today positive top-line results from its pivotal Phase III efficacy study of BEMA buprenorphine in opioid-experienced patients.

BEMA buprenorphine is being developed for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate in both patients who are opioid naive and opioid experienced.  

OxyContin- oxycodoneSuboxone - buprenorphineAmbien - sedativeRitalin - stimulantZoloft – antidepressantLunesta -sedativeAdderall -amphetamineOpana - oxymorphoneXanax - benzodiazepineKlonopin – benzodiazepineFentora - fentanylPercocet - oxycodoneAtivan - benzodiazepineSoma - sedativeValium - benzodiazepineVicodin -hydrocodone

Top 17 Abused Prescription Drugs of 2013

Below is a list of 17 abused prescription drugs as listed by CDC, FDA, the U.S. Drug Enforcement Agency (DEA), and non-government nonprofit sources on

public websites. 

July 2, 2014SUMMARYWith the issuance of this final rule, the Deputy Administrator of the Drug Enforcement Administration places the substance 2-[(dimethylamino)methyl]-1-(3-methoxyphenyl)cyclohexanol (tramadol), including its salts, isomers, and salts of isomers, into schedule IV of the Controlled Substances Act. 

Corrective measures in other States

Emerging Drugs or

Media Hype??Smiles, NBOMe, Krokodil, and Smiles, NBOMe, Krokodil, and

KratomKratom

(2C-I) Nicknamed Smiles

popular among teens, responsible for dozens of overdoses popular among teens, responsible for dozens of overdoses and deaths. and deaths.

white crystalline powder, typically snorted or ingested.white crystalline powder, typically snorted or ingested. high and effects can last a few hours to a few dayshigh and effects can last a few hours to a few days a combination of MDMA and LSD, only more intense.a combination of MDMA and LSD, only more intense. 2C-I is being made by dealers and “hobbyists,”2C-I is being made by dealers and “hobbyists,” chemicals can be obtained over the internetchemicals can be obtained over the internet 2C-I overdoses can cause seizures, kidney failure, and fatally 2C-I overdoses can cause seizures, kidney failure, and fatally

high blood pressure.high blood pressure.

NBOMe – Synthetic LSDBRAND NAMES2C-C-NBOMe = (25C-NBOMe; NBOMe-2C-C);2C-I-NBOMEe = (25I-NBOMe; NBOMe-2C-I);

EFFECTS CLASSIFICATIONPsychedelic; Stimulant; Euphoriant

DESCRIPTIONThe NBOMe series of chemicals are primarily N-o-methoxybenzyl analogs of the 2C-X family of phenethylamines, and are (serotonin 2A) receptor agonists. This group are active at very low sub-milligram doses. These chemicals have nearly no history of human use prior to 2010 when they first became available online.

DEA declared three N-bomb variants—25I-NBOMe, 25C-NBOMe and 25B-NBOMe to be illegal Schedule I drugs under the Controlled Substances Act.

Pharmacological Effects Dilated pupilsDilated pupils SweatingSweating Dry mouthDry mouth Rapid speechRapid speech Rapid/frequent mood swingsRapid/frequent mood swings Hyperactivity/ Elevated BPHyperactivity/ Elevated BP Hair standing on endHair standing on end Nasal passage irritationNasal passage irritation

Behind the Krokodil PanicNov 7, 2013- The Daily Beast

Relax! The home-brewed Russian drug isn’t invading America.

Cases popped up in at least six states and the media went wild.

But here’s the catch: not one of the dozens of suspected cases tested positive for desomorphine, the drug's official name. In fact, according to public-health experts and federal officials, the great Krokodil scare of 2013 is really just the latest symptom of a true epidemic long in the making: American’s growing dependence on heroin and prescription painkillers.

The drug, a morphine analogue that acts similarly to heroin but with a shorter high, is made by combining codeine, paint thinner, and lighter fluid (among other things) in small batches. An April 2013 article from the International Journal of Drug Policy titled “Breaking Worse” explains the dangers of the homemade drug. “Desomorphine may be the opioid that the cooks intend to produce, but it is not what they necessarily end up with,” the article reads. The “bootleg chemistry” results in a drug that is notoriously impure and often contains a lethal mix of toxins. But for American’s who can buy heroin much more easily than they can codeine, Krokodil use just doesn’t make sense.

OP/ED 1/10/2014 Forbes

Krokodil Crock: How Rumors Of A 'Flesh-Eating Zombie Drug' Swept The Nation

“A lot of people want to call it a trend, but we’re not seeing it,” says Joseph Moses, a spokesman for the Drug Enforcement Administration (DEA). In fact, Moses says, “I’m not aware of any forensic laboratory that has come up with a desomorphine sample.

A report by two St. Louis doctors who claimed to have treated a man with krokodil-related symptoms, published online by The American Journal of Medicine in November 2013, was removed from the journal’s website a week later after the paper received strong scientific criticism

NMS Labs has had approximately forty toxicology cases of suspected Krokodil from around the US submitted in the last six months. All have been negative. “To our knowledge there is not a single confirmed Krokodil death through either toxicological testing or through testing of associated paraphernalia, in the US.”

not a synthetic but a plant derived drug not a synthetic but a plant derived drug main alkaloids responsible for the effect are main alkaloids responsible for the effect are

mitragynine and 7-hydroxymitragynine. mitragynine and 7-hydroxymitragynine. at low doses causes a stimulating effect at low doses causes a stimulating effect at high concentrations causes an opiate like at high concentrations causes an opiate like

sedative effect sedative effect

KRATOM

From the website: buykratom.us

Your Price:$14.99

This is our newest addition and we are very excited about offering another

Bali'esque type strain. This strain is harvested from the Kalimantan Region, using only mature leaves and

then finely ground.

You must be 18 years of age to purchase any products on the website. All products on the website are sold not for human consumption, and are for incense or ethnobotanical research purposes only.

Kratom Products: The Best Option to Wean Off Opiate and Heroin AddictionJune 11, 2014 Livermore, CA –

To clarify the majority’s misconceptions on kratom (Mitragyna Speciosa), it is not an opiate. It is not a drug, and it does not give that high that one is getting from heroin. Kratom soothes the “needy” receptors, easing through natural stimulation back into a more balanced state.

The use of kratom for opiate withdrawal began to appear in 1987, when Henry Nicholas Ridley published the book “Malay Plant Names” and stated that the plant can be used to wean opium addicts. Nowadays, kratom is often used in methadone detox programs. Hospitals like the National Institute of Thai Traditional Medicine in Bangkok are endorsing kratom as a course of action against drug addiction withdrawal. Recent research points to the plant’s alkaloids, 7-hydroxymitragynine as possibly the major agonist accountable for soothing withdrawing receptors. 

 

Erowid.org“Documenting the complex relationships between humans and psychoactives”

Great resource for informationGreat resource for information Take with a grain of saltTake with a grain of salt Your clients are probably aware of this Your clients are probably aware of this

site as wellsite as well

Vinnie Happ - vhapp@redwoodtoxicology.com

Thank you for your time.