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9/19/2012
POISONS HAVE BECOME THE LEADING CAUSE
OF ACCIDENTAL DEATH
Polypharmacy
Narcotics-Oxy,Methadone,Opana
Benzos-Xanax,Rope
Purple Drink
Internet Designer Drugs
Chemicals are legal until legislated as illegal
Chemists in Eastern Europe and Russia are employed
High school kids can buy on the internet
“Legal” drugs for sale at the corner store
Old friends like Methamphetamine and Cocaine are still around
SOURCES OF TEEN DRUGS
The Pusher Man
ƒ Out of vogue
ƒ Classmates
ƒ Home brew
Home
EROWID
DOCUMENTING THE COMPLEX RELATIONSHIP BETWEEN HUMANS AND PSYCHOACTIVES
Teen source of bad drug abuse information
E.g. DXM Jello recipe
ƒ PreRx with dramamine
ƒ 200mg DXM in agar with vodka
ƒ Advertised: Minimal vomiting/maximal existential insight
ƒ Liberal prescribing
ƒ Poor medicine cabinet accounting
ƒ Parental inattentiveness
The Internet
ƒ “legal” chemicals
DESIGNER DRUGS
MECHANISMS
Cannabinoid Agonists
ƒ JWH018, K2, Spice
Cannabinoids
ƒ CB2 > CB1 receptor affinity
Phenylethylamine derivatives
ƒ MDMA, Methamphetamine, 2CE
ƒ BromodragonFly
Phenylethylamines
ƒ Dopaminergic/Serotonergic/Noradrenergic Reuptake inhibitors
ƒ Some presynaptic release
Methcathinone Derivatives
ƒ Mephedrone, methedrone
Tryptamines
ƒ Serotonin Reuptake
Benzylpiperazines
ƒ BZP, TFMPP
Tryptamines
ƒ Psilocybin, LSD, DMT
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9/19/2012
K2 SPICE JWH018
MARIJUANA
Mountain in India
“Fake” Marijuana
ƒ THC Homologs
ƒ Cannabis-like
ƒ Some MJ screens will not show +
ƒ Patients are scared and have a high heart rate
ƒ Who knows what you buy on the Internet!
ƒ Blueberry Spice- renal failure
STRUCTURAL RELATIONSHIPS
BREAKING BAD-STILL A PROBLEM
Alpha PVP 40
AM2201 24
AKB 48 2
JWH081 3
JWH122 10
JWH203 3
JWH210 3
JWH250 1
MAM2201 3
MDPV 11
4-MEC 3
5-MeODALT 4
5-MeoDIPT 2
4-MePPP 5
Methylone 3
25I-NBOME 1
Pentedrone 10
TFMPP 4
UR144 25
URB754 3
XLR11 48
IOWA IN AUGUST 2012
METHAMPHETAMINE
The Drug of the new millenium
ƒ Speed, Meth, Crank,
ƒ Ice, Crystal, Glass
Easy to synthesize
Horribly addicting stimulant when abused
Long duration of action
Prescription forms used for ADHD
ƒ Entrepreneurs on the school bus
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9/19/2012
MDMA 3,4-
MDMA DERIVATIVES
METHYLENEDIOXYMETHAMPHETAMINE
Phenylethylamine derivatives
2C-E, 2C-B, 2C-P, DOC, DOI
Ecstasy, The Love drug
Bromo-DragonFLY- multiple fatalities in OK- sold as 2C-E
ƒ Disorientation followed by a rush then happy sociability
ƒ Crash with confusion, depression, anxiety
ƒ Crash may last for weeks
Benzylpiperazine (BZP) – identified at autopsy
16 y/o took a single tablet at school
ƒ Driving home and had a low speed collision with a phone
pole
ƒ Found by EMS with jaw clenched and started having
seizures
ƒ Comatose for 18 hours in ICU
TOXIC EFFECTS
Stimulant effects like methamphetamine including seizures/hyperthermia
Hallucinations and agitation resembling paranoid schiophrenia
Speech and Parkinsonian effects like serotonin syndrome
18 year old was with friends and started acting like “the bad guys” were coming.
Given benzos in ER. Hypertensive, tachycardia. Got intubated X 24 hours.
Tox screen negative. Was still acting paranoid and crazy after extubation.
Transferred to psych for 4 days and considered Paranoid Schizophrenic.
Prognosis poor.
Suddenly cleared and admitted to smoking some stuff a friend had given him.
RECENT ARRIVALS
Bromo DragonFly / MDPV / mCPP / ???
Bromo DragonFLY
4-Fluoroamphetamine
XLR 11-aminoalkylindole
UR 144-aminoalkylindole
25I-NBOMe (phenethylamine)
25B-NBOMe (phenethylamine)
2C-C-NBOMe (phenethylamine)
Methoxetamine (arylcyclohexylamine)
N,N-Dially-5-Methoxytryptamine (5-MethoxyDalt) (tryptamine)
2, 5 Dimethoxy-4-chloroamphetamine
(phenethylamine/amphetamine)
URB 754 (2-arachidonoyl glycerol)1
Phenazepam (benzodiazepine)
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9/19/2012
MANAGEMENT
METHCATHINONE
No antidote or specific recommendations
Cat
Not likely to identify toxin during hospitalization
Khat bush
Benzos Benzos Benzos
Russia- “Jeff”
Aggressive management of seizures and hyperthermia
Ephedrine-like
For continued agitation/confusion/hallucinations, atypical antipsychotic such as
olanzapine
Mephedrone
Has morphed
Cyproheptadine for serotonin syndrome (?)
Marketed as Bath Salts
Number
BATH SALTS EXPOSURES REPORTED
TO THE TEXAS POISON CENTER
NETWORK DURING 1/1/10-7/12/11
(N=217)
50
45
40
35
30
25
20
15
10
5
0
BATH SALTS- BEYOND BED AND BATH
“Plant food”
Sold on the internet
Methylenedioxypyrovalerone MPV
Smoke it, drink it, insufflate it, any orifice.
44
40
Legal until its illegal.
Derivatives like crazy.
31 32
Heavenly Soak - Energy - Novelty Powder 500mg
20
14
16
9
0
0
0
0
Jan10
Feb10
Mar10
Apr10
2
May10
5
0
Jun10
1 1
Jul-10
Aug10
Sep10
Bath Salt Of The Week: Fine China
1
1
Oct10
Nov10
October 8th, 2011 Posted at 50 state legal bath salts, bath salt reviews, bath salts, bath salts drug
| 6 Comments
Dec10
Jan11
Feb11
Mar11
Apr11
May11
Jun11
Jul-11
Month
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AG I TAT I O N
H A L L U C I N AT I O N S
MYDRIASIS
RENAL DYSFUNCTION
H Y P E R V E N T I L AT I O N
DIAPHORESIS
R H A B D O M YO LY S I S
TAC H YC A R D I A
Blue Lotus Anti-Anxiety
Presented with status epilepticus.
HYPERTENSION
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9/19/2012
PURPLE DRANK
METHADONE
Synthetic opiate
Very long acting
Taken by mouth is used to treat heroin addiction
Taken IV is very lethal
Variable pharmacogenetics- therapeutic to toxic in same dose range
100 fold variability?
Cyp3A4, Cyp2D6
Being replaced by Suboxone (buprenorphine/naloxone) to avoid diversion
Phenergan with Codeine
Shows up in many autopsies
OXYCONTIN
DEXTROMETHORPHAN
Killers, OC, OXY, Oxycotton
DXM, Dex, Skittles, Rob, DM
Sustained release form of oxycodone
Cough suppressant in many OTC cough meds
Very safe- unless crushed
Has opiate and hallucinatory properties
Large dose intended to last all day
Many strange concoctions to concentrate and abuse
Opiate for pain control
Very popular
Lethal when injected
Can stop respirations, cause seizures
Has insoluble excipients-pulmonary emboli
Diversion problem
Robotripping
DATE RAPE DRUGS
ROPE/RUFIES
Combination of submission and amnesia
Date Rape Drug
Potent Benzo available in Mexico
Amnesia may be profound
Difficult to understand unless you see the level of anesthesia
Usually a group of drugs called “benzos” or benzodiazepines.
Flunitrazepam = Rohypnol
ƒ Amnesia
ƒ Cooperation
Synergistic with Alcohol and tasteless
Message of “The Hangover” should have been:
Don’t trust a dealer and don’t trust your
lunatic friends.
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9/19/2012
TO PEE OR NOT TO PEE?
SALVIA
Urine Drug Screens in the home now readily available
Workplace: Highly Regulated/Highly Accurate
Sally D or Sage of the Diviners
ƒ Require confirmation usually GC/MS
Magic Mint
Home versions may miss some narcotics (oxy), show PCP for DXM, Meth
Herb in the sage family from Oaxaca
ƒ Used in a religious context
Will not show GHB, hallucinogens, plants
Hallucinogen-but not a fun one!
Rapidly being outlawed
for Cold Meds, TCA’s for Benadryl
Second hand or Passive MJ will not show.
ƒ If + pretty accurate that it is real
MJ may show + for 6 weeks after heavy use
ƒ Many disappointed dopehead job seekers
Read the instructions
What is the wisdom of doing this?
ƒ Not a substitute for conversation
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