Synthetic Drugs of Abuse: ‘Spice,’ ‘K2’ and ‘Bath Salts’

Erik Gunderson, MD

Assistant Professor

Department of Psychiatry and Neurobehavioral Sciences and Department of Medicine

Director, Clinical Pharmacological Research Unit

University of Virginia

April 14, 2011

Synthetic Cannabinoids (SCs) Spice/K2 brands

marketed as natural herbal incense

“Not for human consumption”

Available convenience stores, gas stations, Internet

Cannabis substitute Psychonaut Web Mapping Research Group (2009.) Spice Report. Institute of Psychiatry, King’s College London: London UK.

Spice and K2

Cost: $30-45 per 3gm

Route: pipes, water pipes or rolled cigarettes

Contents: inert plant material sprayed with SCs

JWH-018, JWH-073, JWH-250, CP-47,497, HU-210

http://buyherbalspice.com/spice_reviews/category/news/

Pharmacology

delta-9 tetrahydro-cannabinol (∆9-THC) agonism of cannabinoid receptor type 1 (CB1)

SCs more potent

Typical doses are often less than 1mg

Not readily detectable JWH-018

∆9-THC

Psychoactive Effects

Marketed as similar to cannabis: Euphoria Sociability Anxiolytic Relaxation Stimulant

Cross tolerance with THC?

http://buyk2spice.net/

Side Effects of SC Products

Anxiety Paranoia Headache Vomiting Psychosis Diaphoresis HR/BP increase Seizures http://investigationmiami.blogspot.com/2011/01/be-afraid-really-afraid.html

Legal Timeline for SCs 2009: Restricted in the UK, EU

11/2010: DEA Notice of Intent to temporarily ban 5 SCs

3/1/2011: Five SCs Designated Schedule I

JWH-018, JWH-073, JWH-200, CP-47,497, and cannabicyclohexanol

Effective for one year

Current and Future Epidemiology?

No data on prevalence of use

American Association of Poison Control Centers:

Synthetic cannabinoids: 2009: 13 calls 2010: 2304 calls (Nov), a projected 200x increase

Marijuana: 2008: 4009 calls, with 1020 for marijuana alone

Synthetic Stimulants

Methylenedioxypyrovalerone (MDPV) and Mephedrone Sold as “bath salts” or “plant fertilizer”

Currently legal in the United States

Available online and in convenience stores

MDPV and Mephedrone CNS stimulants Related to cathinone, an active alkaloid

found in the khat plant (N. Africa) Previously abused

primarily in

Europe and

Australia

http://www.herbalextracts.net/library/supplements/khat_uses.html

Product Marketing Mtv MDPK Magic Super Coke Peevee Energy-1 (NRG1) Charge Plus White Lightning Scarface

Cloud 9 Ocean Ivory Wave

http://www.helphopehealing.org/

MDPV Route: Intranasal most

common Also: oral, smoking,

rectal, and IV White to light brown

crumbly powder Degrades if exposed to

air for significant periods of time

http://www.stompin-gardeners.com/index.

MDMA

Pharmacology of MDPV CNS stimulant similar to methamphetamine,

MDMA, or cocaine Norepinephrine-dopamine reuptake inhibitor

(NDRI) Increased alertness, arousal, anxiety, agitation,

diminished requirement for food and sleep, sexual arousal

Tachycardia, hypertension, vasoconstriction, diaphoresis

Effects of MDPV “High” lasts 3-4 hours Physical effects may

last 6-8 hours May cause seizures,

panic attacks, or psychosis with high doses or increased frequency of use

Avg dose: 5 to 20mg http://www.tradevv.com/chinasuppliers/chwhtltd_p_198b58/china-Mdpv-by-pevukka.html

Other Sequelae of MDPV Trismus (inability to open mouth) or

bruxism Panic attacks Psychosis with sleep deprivation Hallucinations, delusions, suicidal ideation Abstinence syndrome: depression,

lethargy, anxiety, postural hypotension Leads to frequent re-dosing

MDPV’s Legal Status UK: MDPV regulated under the Misuse of Drugs Act 1971

US: Not scheduled but banned in some states

DEA: controlled by the Federal Analogue Act?

http://addiction-dirkh.blogspot.com/2010/11/dea-slaps-temporary-ban-on-spice-and.html

Mephedrone 4-methylmethcathinone (4-MMC)

Meow Meow MCAT Miaow Drone Plant Feeder Bubbles

http://www.synchronium.net/2010/01/05/mephedrone-cat/

Pharmacology NE-DA reuptake inhibitor Similar to MA/MDMA

Reportedly less potent, shorter duration

Oral dose: 20-50mg

“Come up”: 10-20 min

Peak: 45-60 min

“Comedown”: 60-120 min

Re-dosing: commonMephedrone

Amphetamine

Routes of Administration Oral ingestion

Swallowing capsules Bombing (swallowing

powder wrapped in cigarette paper)

Insufflation (snorting) Rectally (either plugging

or enema) IV (use 1/2 to 1/3 dose)

http://www.guardian.co.uk/society/mephedrone

Effects of Mephedrone

Euphoria

Sociability

Stimulation

Sexual Arousal

Music Appreciation

Hallucinations

http://www.drugs.org.im/campaigns.htm

Mephedrone Side Effects Loss of appetite Increase in body temperature,

sweating, hot flushes Tense jaw, bruxism, stiff neck,

muscle clenching HR/BP elevation, chest pains Dehydration Mydriasis, nystagmus Painful nasal drip/ulcers in mouth

(after insufflation) Insomnia, paranoia, anxiety,

dysphoria, psychosishttp://theblackheartofgrahamquirk.blogspot.com/

Mephedrone’s Legal Status

2008-2010: Banned in many European counties

December 2010: Illegal throughout the EU

Mephedrone is not specifically banned in the United States However, some states have banned mephedrone

DEA: may be controlled by the Federal Analogue Act as an analogue of methcathinone

Current and Future Epidemiology?

No data on prevalence of use

American Association of Poison Control Centers:

Bath Salts: 2010: 292 calls 2011: 469 calls (2/14/11), a projected14-fold

increase

Questions?

References Brunt, T.; Poortman, A.; Niesink, R.; Van Den Brink, W. (2010). "Instability of the ecstasy market and a new kid on the

block: mephedrone". Journal of psychopharmacology. Drug Enforcement Administration: Office of Diversion Control; Drug and Chemical Evaluation Section.

Methylenedioxypyrovalerone [(MDPV) (1-(1,3-Benzodioxol-5-yl)-2-(1-pyrrolidinyl)-1-pentanone]. Available at: www.deadiversion.usdoj.gov/drugs_concern/mdpv.pdf. Accessed February 7, 2011.

EMCDDA (2009). Action on new drugs briefing paper: Understanding the ‘spice’ phenomenon. A report from an EMCDDA expert meeting, 6 March, 2009, Lisbon.

"Europol - MCDDA Joint Report on a new psychoactive substance: 4-methylmethcathinone (mephedrone)". European Monitoring Centre for Drugs and Drug Addiction. 27 May 2010.

Psychonaut WebMapping Research Group (2009). MDPV report. Institute of Psychiatry, King’s College London: London UK. Available at: www.nascsa.org/news/psychonautmdpvreport.pdf. Accessed February 23, 2011.

Psychonaut WebMapping Research Group (March 2010). "Mephedrone Report." Institute of Psychiatry, King's College: London UK.

Psychonaut Web Mapping Research Group (2009.) Spice Report. Institute of Psychiatry, King’s College London: London UK.

United States Drug Enforcement Agency. Office of Diversion Control. Drugs and Chemical of Concern: 4-methylmethcathinone [Mephedrone, 4-MMC, meow meow, m-CAT, bounce, bubbles, mad cow]. July 2010.

United States Drug Enforcement Agency. Office of Diversion Control. Rules 2011:Schedules of Controlled Substances: Temporary Placement of Five Synthetic Cannabinoids Into Schedule I. Federal Register Volume 76, Number 40 (Tuesday, March 1, 2011).

Wehrman J. U.S. Poison Centers Raise Alarm about Toxic Substance Marketed as Bath Salts; States Begin Taking Action. AAPCC. February 14, 2011. Available at: http://www.aapcc.org/dnn/Portals/0/prrel/FEB14BATHSALTSUSE.pdf

Winstock, A.; Mitcheson, L.; Deluca, P.; Davey, Z.; Corazza, O.; Schifano, F. (2010). "Mephedrone, new kid for the chop?". Addiction 106 (1).

Acknowledgement

Laura Willing, BS

Contact Information

Erik Gunderson, MD434-924-8013 officeewg2n@virginia.edu