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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 Out of vogue Classmates Home brew Home EROWID DOCUMENTING THE COMPLEX RELATIONSHIP BETWEEN HUMANS AND PSYCHOACTIVES Teen source of bad drug abuse information E.g. DXM Jello recipe PreRx with dramamine 200mg DXM in agar with vodka Advertised: Minimal vomiting/maximal existential insight Liberal prescribing Poor medicine cabinet accounting Parental inattentiveness The Internet “legal” chemicals DESIGNER DRUGS MECHANISMS Cannabinoid Agonists JWH018, K2, Spice Cannabinoids CB2 > CB1 receptor affinity Phenylethylamine derivatives MDMA, Methamphetamine, 2CE BromodragonFly Phenylethylamines Dopaminergic/Serotonergic/Noradrenergic Reuptake inhibitors Some presynaptic release Methcathinone Derivatives Mephedrone, methedrone Tryptamines Serotonin Reuptake Benzylpiperazines BZP, TFMPP Tryptamines Psilocybin, LSD, DMT 1 9/19/2012 K2 SPICE JWH018 MARIJUANA Mountain in India “Fake” Marijuana THC Homologs Cannabis-like Some MJ screens will not show + Patients are scared and have a high heart rate Who knows what you buy on the Internet! 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 Speed, Meth, Crank, Ice, Crystal, Glass Easy to synthesize Horribly addicting stimulant when abused Long duration of action Prescription forms used for ADHD Entrepreneurs on the school bus 2 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 Disorientation followed by a rush then happy sociability Crash with confusion, depression, anxiety Crash may last for weeks Benzylpiperazine (BZP) – identified at autopsy 16 y/o took a single tablet at school Driving home and had a low speed collision with a phone pole Found by EMS with jaw clenched and started having seizures 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) 3 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 This is a new personal favorite of mine; Fine China. With all the recent federal and state bans on the common ingredients, it has become harder and harder to find an ENJOYABLE 50 state legal salt. Home > 100 % Legal 50 States - Worldwide > Moby Shine Scratch Remover - 100% Legal - 500 gram unit - DEA contain PV or M1 Shop By Price FOX RETAIL - FOXY DEALS DEAL of the DAY - Uber Deal of the Day Brand Name LED - LCD TVs LOW PRICES This product is intended for iphone, ipad, blackbe touch screen phones, mp4 & mp3 List Price: $39,995.00 Our Price: $16,420.99 Save $23,574.01! Call 702-430-9247 To Order Blinky, LED, Glow, Flashing, Sparkling Toys, and Rave / Dance Clothes / Wear / Gear iRenew Power Energy Balance Bracelett Availability:: Usually Ships in 24 to 48 Hours Product Code: 500059 Kratom - Xtra Strength Kratom Purified Kratom Extreme Energy Supplements 100% All Natural Herbal Incense Blends All Herbal Incense Blends Amazing Grace Incense Blends Comatose Candy Herbal Incense Blends Mr. Nice Guy Incense Blends All Products Cheap Quality Knives At Home Drug Tests 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 4 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 Amnesia 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. 5 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 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 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. If + pretty accurate that it is real MJ may show + for 6 weeks after heavy use Many disappointed dopehead job seekers Read the instructions What is the wisdom of doing this? Not a substitute for conversation 6