Material by: Paul L. Cary Toxicology Laboratory

University of Missouri

Suman Rana Redwood Toxicology Laboratory

Dr. Barry Logan NMS Labs

Presented by: Vinnie Happ Redwood Toxicology Laboratory,

An Alere Company.

Designer Drugs and Pain Killers

Spice/K2, Bath Salts, Molly, Oxy etc.

Problems & Challenges Posed By

December 11, 2013

NORMAN — A husband and wife are accused of selling synthetic substances that have an effect similar to marijuana when smoked, police Capt. Tom Easley said Tuesday. Christie Leigh England, 36, and Dennis Kirby England, 41, were charged Friday in Cleveland County District Court with possession of a controlled synthetic substance with the intent to distribute within 2,000 feet of a school or park. Dennis England faces one count, while Christie England is charges with two counts. Norman Police began investigating the Englands' business, Ancient Aromatherapy, 230 W Gary St., after three people were arrested by a patrol officer for possessing synthetic drugs. The substances — commonly known as “K2” or “Spice” — are sold as herbal incense or potpourri. Undercover officers paid $10 per gram for the products, Easley said.

Norman OK couple charged with selling synthetic drugs A Norman couple who own an aromatherapy business have been charged with selling synthetic drugs. Published: March 26, 2013

DEA announces 'largest-ever' synthetic drug bust; 11 arrested in Louisiana By Michelle Hunter, NOLA.com | The Times-Picayune June 26, 2013 ...officials on Wednesday announced the results of the "largest-ever" synthetic drug takedown, a bust that included suspects in 35 states and five countries. The Louisiana arrests were in Terrebonne Parish."We executed 10 search warrants, three at businesses and seven at residences," Bryan said. "We seized a large quantity of synthetic marijuana, $500,000 to $600,000 in cash and four vehicles.” Synthetic drugs are lab-created designer narcotics often marketed as herbal incense, bath salts, jewelry cleaner or plant food. Users of synthetic marijuana and bath salts have reported addiction, overdoses, seizures, violent hallucinations, elevated blood pressure, loss of consciousness and in some cases, death. Agents with Project Synergy uncovered a "massive flow" of drug-related proceeds heading to Middle Eastern countries, according to the DEA. "The case and the investigation led to money transfers going to the Middle East," Bryan said. "There are money laundering and racketeering charges involved.”

Six in Arkansas charged in nationwide synthetic drug probe “Operation Spicy Possum” This article was originally published June 26, 2013 The group is suspected of distributing synthetic cannabinoids and cathinones from businesses in Little Rock, including Sunshine Food, Sunshine Mart and Hip Hop Sportswear, according to information released at a news conference at Drug Enforcement Administration headquarters in Little Rock. The suspects are described as owners of the businesses. ..."Many people have the misconception that these drugs are not dangerous or that they are not illegal," U.S. Attorney for the Eastern District of Arkansas Christopher Thyer said. "Both of those two assertions are categorically false.” The arrests are part of Project Synergy, a 35-state investigation that authorities are calling the largest-ever probe into designer drugs. More than 75 arrests have been made nationwide and more than $15 million in cash and property has been seized, officials said. The local investigation, named Operation Spicy Possum, involved 75 law enforcement officers searching the businesses and making arrests early Wednesday. The local investigation's name, is a combination of a slang term for one of the drugs and a reference to how possums play dead. "I don't name these," Bryant said. "I just get stuck explaining them.”

18 arrested in alleged synthetic marijuana operation in Oklahoma, Texas AUSTIN, Texas — At least 18 people have been arrested in an alleged synthetic marijuana production and distribution ring operating in Texas and Oklahoma. BY THE ASSOCIATED PRESS • Published: June 27, 2013 AUSTIN, Texas — At least 18 people have been arrested in an alleged synthetic marijuana production and distribution ring operating in Texas and Oklahoma. Federal investigators say the cases involve synthetic marijuana and bath salts sold in San Antonio, Houston, Austin, Dallas and Laredo, plus Oklahoma City and Tulsa, Okla. Prosecutors say a five-count federal indictment unsealed Wednesday in Austin charges six people with conspiracy to possess with intent to distribute synthetic marijuana — known as cannabinoids.

D.C. launches zombie-themed campaign to fight synthetic marijuana use By Sam Ford May 3, 2013 – Washington DC

The D.C. Health Department has launched an interactive zombie-themed campaign and website to warn about the dangers of various forms of synthetic marijuana. “Recent focus group findings in partnership with DOH and local youth-based organizations indicate that synthetic marijuana is seen as an alternative to marijuana, as a result of its cheap cost and ability to go undetected in routine drug testing,” the statement reads. According to a statement from the department, the average age of synthetic marijuana users is 13. It looks like marijuana and it's marketed with names like Spice, K2, Scooby Doo and Dopey Dwarf. A 2011 survey released by the National Institute on Drug Abuse found that one in nine high school seniors had used Spice or K2. Synthetic marijuana is the second most commonly used illicit drug, after marijuana, among high school seniors, according to the DOH statement.

Designer Drugs:

drugs, which are created (or reformulated, if the drug already existed) to get around existing drug laws CSA (controlled substance act), usually by modifying the molecular structures of existing drugs to varying degrees

Sources of Incense (k2) Products:

  internet/on-line sources   “head” shops/alternative medicine stores /

convenience stores/flea markets   1-(800) phone ordering services   individual distributors

Preparation of the “incense”:

 Botanical plants/herbs are sprayed with liquid preparations of:  HU-210  HU-211  CP 47,497  JWH-018  JWH-073

 JWH-250  JWH-081  JWH-210  XLR-11, UR-144  And many

more

Origins of Synthetic Cannabinoids   CP 47,497 - developed by Pfizer in 1980 as an

analgesic (pain reliever)   HU-210 & HU-211 - synthesized at Hebrew

University, Israel in 1988. HU-210 is an anti-inflammatory; HU-211 as an anesthetic

  JWH-018 & JWH-073 - synthesized by a researcher at Clemson (1995) for use in THC receptor research - John W. Huffman

  more than 200 different synthetic cannabinoids have been created

How K2/Spice works: Synthetic Cannabinoids act as THC agonists

-An agonist is a chemical that binds to a receptor and triggers a response – often mimicking the action of

the naturally occurring substance. Receptor

Drug (agonist)

Why Change the Key? • prolong the effect of the drug •  increase the potency of the drug • “select” the desired effect • avoid patent infringement • make the drug more difficult to detect • make an illegal drug “legal”

Drug

Pharmacological Effects of Synthetic Cannabinoids are Similar to THC   increase heart rate & blood pressure   altered state of consciousness, mild euphoria   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   Sickness   kidney damage

Synthetic Marijuana Use Linked to Kidney Damage Such designer drugs, called Spice or K2, may have toxic additives, researchers say By Mary Elizabeth Dallas - Tuesday, February 12, 2013

(HealthDay News) -- Case studies analyzed by doctors from the University of Alabama at Birmingham found that this designer drug, which mimics the effects of marijuana, has been directly linked to serious kidney damage. The researchers suggested that doctors should suspect the use of synthetic marijuana when patients, particularly young adults, have unexplained acute kidney damage "Cases of acute coronary syndrome associated with synthetic marijuana use have been reported, but our publication is the first to associate use with acute kidney injury," study co-author Dr. Gaurav Jain, an assistant professor in the nephrology division, said in a university news release. Abnormally rapid heart rate and seizures have also been reported with synthetic marijuana use, he noted.

Reported Effects of Synthetic Cannabinoids are different to THC

  production inconsistencies   herbal incense blends are harsher to inhale   effect on appetite is non-existent   increased restlessness & aggressive behavior   herbal incense produces a shorter “high” (perceptual

alterations & sensory effects are limited)   doesn’t mix well with alcohol (hangovers)   incense costs more than marijuana?

Cannabis vs. Cannabinoids: Effects Seen in Clinical Cases Most symptoms are

similar to cannabis intoxication:

-Abnormally rapid heart rate – Reddened eyes – Anxiousness – Mild sedation – Hallucinations – Acute psychosis – Memory deficits

Symptoms not typically seen after cannabis intoxication:

– Seizures – Potassium deficiency – Hypertension – Nausea/vomiting – Agitation – Violent behavior – Coma

SOURCES: Hermanns-Clausen et al . (In Press), Addiction; Rosenbaum et al . (2012). Journal of Medical Toxicology; Forrester et al. (2011). Journal of

Addictive Disease; Schneir et al . (2011). Journal of Emergency Medicine.

Can synthetic THC chemicals be detected by

drug testing?

Drug Testing: Synthetic THC / K2   Rapid, onsite instant test (as of 3/1/12)

  Laboratory-based screening test (limited)   Most Laboratories are employing LC/MS/MS

technology   Primarily via urine, however some labs can test via

oral fluid and blood   $$$ varies greatly   Onsite vs Lab is very different testing methodology

On-site vs Laboratory testing for K2

On-site K2

  JWH-018 & JWH-073 primarily

  Cut-off at 25 or 50ngs/ml   Testing limited metabolites   Much higher threshold to

trigger positive   Screening technology

Laboratory K2

  JWH-018, 073, plus *17 other synthetic cannabinoid structures

JWH-019, 081, 122, 200, 203, 210, 250, 398, AM2201, MAM2201, RCS4, RCS8, AM-694, AM-1248, AKB-48,UR-144, XLR-11   Cut-off 1ng/ml or less   Testing for hydroxy acid & other

components/metabolites   Detecting presence

  Confirmatory technology

*Redwood Toxicology Laboratory

Issues of Concern

  What synthetic compounds (or metabolites) are being tested by the laboratories?

  no standardized urine cutoff levels   no standardized methods (LC/MS/MS)   tests detect metabolites   no independent quality control materials   no proficiency testing   keeping up with molecular changes

CESAR FAX U 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

•  The majority of synthetic cannabinoid users reported that they used the drug to avoid positive drug tests, either because they were under community correctional supervisions, seeking employment, residing in a sober living facility, or joining the military. According to one user, “Spice would give you a weed like effect without the positive test”

•  “Most of the users of Spice-type products in this study consumed these products as a substitute for marijuana during drug-testing periods, and returned to marijuana use once that period ended”. According to one user, “I was trying to get a job where they were going to drug test . . . so I got that stuff [Spice], and I liked it enough. I enjoyed it. I did it for a while . . . Then, my job search ended ‘cause I wasn’t going to do any of them. So I went back to the regular stuff”

•  Nearly all the SC users learned of the drug from someone who was using SC to avoid detection on drug tests. For example, one user reported that he “was talking to some kids that went to a Christian school, and they get drug tested. So, all the kids there would smoke Spice instead of weed”

•  All the SC users also used marijuana, and half had a history of drug problems, such as sobriety attempts, drug-related offending, and negative drug experiences.

July 8, 2013 Vol. 22, Issue 27

Synthetic Cannabinoid Users Report Using the Drug to Avoid Positive Drug Tests; Return to Marijuana Use When Not Being Tested

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

NOTE: Findings are from in-depth, semi-structured interviews with 25 Southern California adults who had used K2, mephedrone, bath salts, or Salvia divinorum at least once. Participants were recruited using flyers distributed to head shops, cafes and other businesses; advertisementsp osted in free weekly newspapers; and snowball sampling.

.

Synthetic cannabinoids, also known as K2 or Spice, are not included in most routine drug test panels because they require specialized, more expensive testing. Furthermore, studies have shown that the types and amounts of synthetic cannabinoid (SC) metabolites can vary greatly between products, lots, and even within the same package1, making it difficult to decide which specific SC metabolite should be included in drug testing programs. Some SC users use the drug as a substitute for marijuana to avoid positive drug tests, according a qualitative study of SC users in Southern California. The study found that:

CESAR Pilots New Community Drug Early Warning System in Criminal Justice System; Finds Synthetic Cannabinoids in All Populations Studied

UR-144 and XLR-11

31%

XLR-11Only4%

UR-144 Only60%

UR-144 and JWH-018

3%3+ Metabolites

2%

•  SCs were detected in the specimens from all participating sites in the District of Columbia, Maryland, and Virginia. Furthermore, all of the SC positive specimens contained one or two of the metabolites (UR-144 and XLR-11)

•  SCs were most likely to be detected in younger men. What was not expected was the level of use that was found. For example, one-quarter to one-third of young men in the three populations studied in DC tested positive for SC.

•  Unlike other prescription and illicit drugs, SCs were as likely to be found in persons who had failed the limited CJS screen as in persons who had passed. In other words, current drug testing screens which do not test for SCs are likely missing significant drug use (and users) in the populations they monitor. One possibility is that persons who know they will be tested use SC products because they know that the drug is not included in most test panels.

Metabolites Found in All Synthetic Cannabinoid Positive Specimens from

Five CJS Populations, 2013 (N=118)

Detection Window ???

  testing for metabolites   educated guess - same as real marijuana?  many labs advertise “up to 72 hours”   limited studies  passive inhalation?   fact is - we don’t know all the answers

Wet Marijuana   Embalming Fluid-Soaked Marijuana: smoking marijuana soaked in embalming fluid is gaining popularity throughout the United States. The syndrome of intoxication looks nearly identical to that seen following phencyclidine (PCP) use, with agitation, disorganized speech, and thoughts, and diminished attention. This new trend in drug use involving marijuana also presents a resurgence in PCP use.   Soaked in water – uneven burn   Mixed with PCP: wet, fry, crystal joint, supergrass   Mixed with codeine containing cough syrup   Mixed with methamphetamines

Bath Salts - Sold Under the Names:   Ivory Wave   Ivory Coast  Purple Wave  Vanilla Sky  Pump it

  Plant food/fertilizer

What’s in Bath Salts:

  MDPV (Methylenedioxypyrovalerone) - a psychoactive drug with powerful stimulant properties which acts as both a norepinephrine & dopamine reuptake inhibitor (NDRI). “A two for”

  usually snorted like cocaine   duration of effect 2-3 hours /adverse effect 6-8 hrs   MDPV - no history of FDA approved medical use   Sold as a “research chemical”   adverse medical or psychiatric ramifications

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

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

Mephedrone (Methylmethcathinone)

Methylone (3,4-methylenedioxy-N-methylcathinone)

 very similar to MDMA   stimulant  phenethylamine, amphetamine, and

cathinone properties   euphoria and increased sociability   insomnia and restlessness  hallucinations and psychosis

    

   Bath Salts and beyond!!! Expanded Synthetic Stimulant Panel α-PVP BZP     Butylon Buphedrone   Cathinone     Ethylone     Flephedrone MBDB      mCPP MDA

MDEA  MDMA MDPV Mephedrone  Methcathinone 4-Methylethcathinone  Methylone Pentedrone Pentylone Pyrrolidinopentiophenone TFMPP

MDMA – Molly / Ecstasy - Molly is not new, exactly. - MDMA, or 3,4-methylenedioxy-N-methylamphetamine, was patented by Merck pharmaceuticals in 1914 - did not make much news until the 1970s, when psychotherapists began giving it to patients to get them to open up.

-arrived at New York nightclubs in the late 1980s, and by the early ’90s it became the preferred drug at raves, inducing feelings of euphoria, closeness and diminished anxiety,

- Ecstasy was quickly embraced by Wall Street traders and Chelsea gallerinas. as demand increased, so did the adulterants in each pill (caffeine, speed, ephedrine, ketamine, LSD, talcum powder and aspirin, to name a few), and by the new millennium, the drug’s reputation had soured. - in the last decade, it returned to clubs as Molly, a powder or crystalline form of MDMA that implied greater purity and safety: Ecstasy re-branded as a gentler, more approachable drug.

- thanks in part to that new friendly moniker, MDMA has found a new following in a generation of conscientious professionals who have never been to a rave and who are known for making careful choices in regard to their food, coffee and clothing. - -

Molly - continued   common side effects, include teeth grinding, dehydration, anxiety, insomnia,

fever and loss of appetite.   more dangerous ones include hyperthermia, uncontrollable seizures, high blood

pressure and depression caused by a sudden drop in serotonin levels in the days after use, nicknamed Suicide Tuesdays.

  capsules sell for $8 to $40.   the most common Molly additives are bath salts, including methylone and

mephedrone. Bath salts are chemically similar to MDMA.   A report recently released by the 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, a type of bath salt, and 20% were methylone.

  Veteran MDMA users say they ask that drugs be tested before they buy them, using kits that can be bought online. "If I'm getting more than a gram, they'll test it right in front of you," said a 27-year-old ad salesman from Oakland, Calif. DanceSafe, an organization that promotes safety at raves, sets up testing tables at some events.

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 sleep   death

Naked, covered in his own blood and screaming “like an animal,” a Bucks man attacked a woman in northeastern Pennsylvania and gnawed on her head after breaking into a home and jumping from a second-floor window, state police said.   Richard Cimino Jr., 20, of Buckingham, first pulled his car behind a residence on Hudson Street in Hawley, Wayne County, early Friday morning, got out and stripped to his underpants, said state police. When the resident at that home awoke to Cimino’s break-in attempt, Cimino fled to a neighboring property, took off his underpants and broke into that home, which was empty, state police said. Cimino walked up to the home’s second floor, jumped out a window and severely injured his arms and legs when he hit the ground, police said. Bleeding profusely, Cimino went through the home’s garage, then approached two women from Hawley who were walking down the street.   Cimino tackled one woman and, bleeding all over her, “began to gnaw” at her head, all while “screaming like an animal,” according to a state police press release. The two women escaped and called police. Police found an injured Cimino lying in the road covered in blood. When Cimino — who state police described as acting delusional and confrontational — lunged at a trooper, another trooper used a stun gun, though Cimino continued to act aggressively, even punching an emergency medical technician treating him. He was then taken to Geisinger Community Medical Center in Scranton.  

Police: Naked, bloody, screaming Doylestown-area man gnawed woman's head Posted: Friday, September 14, 2012 5:00 am

Can “Bath Salts” be Detected by Drug

Testing?

Testing for Bath Salts?? Yes! However:

  No on-site, rapid, instant tests   No laboratory-based screening tests   Laboratories employing GC/MS and

LC/MS/MS technologies   Detection times remain unknown   Best procedure for detecting

metabolites vs parent drug unknown

Legal Status of Synthetics with the (DEA) Fed - Update

  June, 2012 DEA added 26 compound to the CSA   “9 different 2C chemicals and 15 synthetic cannabinoids   cannabamimetic agents”or similar compounds

  July 9, 2012 bill signed into Law -   Synthetic Drug Abuse Prevention Act of 2012

  45 States have some type of legislative ban   Synthetic cannabinoids and stimulants treated as Schedule 1

drugs   a high potential for abuse

  no currently accepted medical use

  lack of accepted safety for use of the drug under medical supervision

'Bath Salts' Pose a Hurdle for Prosecutors Chemical Tweaks Can Keep Synthetic Drugs From Being Linked to Banned Substances WSJ August 14, 2013 The Drug Enforcement Administration last year launched a nationwide sweep to charge sellers and distributors of the products. But to get a conviction in such cases, in addition to proving a defendant sold drugs, prosecutors have to prove the drug was substantially similar to a specifically banned substance. Because synthetic drugs are created from chemicals in a lab, with nearly endless possible variations, tweaks to chemistry are all that is needed to keep them from automatically being considered analogues—chemical compounds that are banned by the Controlled Substances Act because they are similar to prohibited drugs. "There's no way that the DEA can keep up with the sophisticated chemists around the world who are making this stuff," said Timothy Heaphy, U.S. attorney for the Western District of Virginia, whose office won a bath-salts conviction earlier this year—just the second such prosecution. Added Joe Platania, one of the prosecutors at that trial: "The bad guys know what we do and they just tweak another molecule. They're changing faster than we can write our names.” In the case prosecuted by Mr. Heaphy's office, the government sought to convict a New York City man accused of supplying synthetic drugs to a store in Charlottesville, Va. The federal district judge required a jury to first find that three substances the defendant was accused of selling—3,4-methylenedioxymethcathinone, also known as MDMC, 3,4-methylenedioxypyrovalerone, also known as MPDV, and 4-methyl-ethylcathinone, also known as 4-MEC—have "an actual, intended, or claimed stimulant, depressant, or hallucinogenic effect…that is substantially similar" to a drug listed in two sections of the Controlled Substances Act. Second, the jury had to conclude that the chemical structure was "substantially similar" to a controlled substance listed in federal law. The defendant, Stephen McFadden, was convicted and sentenced to more than two years in prison, after jurors rejected his defense that he sold the items for use in incense and potpourri burners. Prosecutors in Arizona used a similar approach to win another conviction in an analogue case this year, but it still will take time for federal precedents to build up.

Other Emerging Drugs

2C-I Nicknamed “Smiles”   popular among teens, responsible for dozens of overdoses

and deaths especially in Midwest.   white crystalline powder, typically snorted or ingested.   High & Effects can last a few hours to a few days,

described as being a “roller coaster through hell”   a combination of MDMA and LSD, only more intense.   2C-I is being made by dealers and “hobbyists,”   chemicals can be obtained over the internet   2C-I overdoses can cause seizures, kidney failure, and fatally

high blood pressure.

Pharmacological Effects

 Dilated pupils   Sweating  Dry mouth  Rapid speech  Rapid/frequent mood swings  Hyperactivity/ Elevated BP  Hair standing on end  Nasal passage irritation

Behind the Krokodil Panic by Abby Haglage Nov 7, 2013- The Daily Beast Relax! The home-brewed Russian drug isn’t invading America. Here’s how the media got duped into mistaking an old existing epidemic for a new outbreak. Over the past several weeks, a wave of apparent users of Krokodil—a highly addictive morphine derivative brewed in rural Russia—appeared to herald a chilling new age in America’s drug wars. Cases popped up in at least six states. 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.

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

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

well

An additional challenge beyond the Synthetics:

Opiates &

Suboxone/Buprenorphine

The Opiate Family

Opiates: Heroin Morphine Codeine Hydrocodone - (Vicodin, Loratab) Hyrdomorphone -(Dilaudid) Oxycodone – (Oxycontin, Percocet, Roxicodone) Oxymorphone - (Opana)

By TIMOTHY W. MARTIN

The epidemic in painkiller-abuse gripping the Southern and Eastern U.S. is tightening its hold on the Western part of the country, having blindsided law enforcement and public health authorities.

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

USA TODAY September 10, 2013 By  THOMAS CATAN And  TIMOTHY W. MARTIN  Federal regulators ordered tougher warnings on widely used painkillers responsible for what they called an epidemic of addiction and overdose deaths, saying the drugs should be reserved only for severe pain. 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. Extended-release painkillers like OxyContin have been heavily abused since they were introduced in the late 1990s, because they contain a much bigger load of the drug, designed to trickle into the bloodstream over several hours. Drug abusers learned to break the time-release mechanism by crushing, snorting or injecting the pills to get all the drug at once for a heroin-like high. More than 16,500 people died after taking the drugs in 2010, according to the Centers for Disease Control and Prevention, more than from heroin, cocaine and all illegal drugs combined. The FDA is also considering whether to tighten restrictions on hydrocodone products like Vicodin. Lynn Webster, president of the American Academy of Pain Medicine, said "I am doubtful this will have much impact on diversion or the number of overdose deaths."

Heroin Makes a Comeback This Time, Small Towns are Increasingly Beset by Addiction, Drug-Related Crimes Thursday, August 8, 2013 As of 12:23 AM EDT - WSJ ELLENSBURG, Wash.—This small city east of the Cascade Mountains is known for its hay farms, rodeos and, increasingly, something more sinister: a growing heroin problem. The fatal overdose of a state trooper's son in May convulsed the town—especially when the two men arrested and charged with selling him heroin turned out to be a county official's sons. Heroin use in the U.S. is soaring, especially in rural areas, amid ample supply and a shift away from costlier prescription narcotics that are becoming tougher to acquire. Much of the heroin that reaches smaller towns such as Ellensburg comes from Mexico, where producers have ramped up production in recent years, drug officials say. Heroin seizures at the Southwest border, from Texas to California, ballooned to 1,989 kilograms in fiscal 2012 from 487 kilograms in 2008, according to figures from the Drug Enforcement Administration. The heroin scourge has been driven largely by a law-enforcement crackdown on illicit use of prescription painkillers such as oxycodone and drug-company reformulations that make the pills harder to crush and snort, drug officials say. That has pushed those who were addicted to the pills to turn to heroin, which is cheaper and more plentiful. A 21-year-old recovering addict said she made the switch from pain pills to heroin after her dealer one day held out both options in his hands and encouraged her to choose the cheaper one Drug experts say the heroin sold today is generally purer and thereby more potent than the varieties prevalent in past decades, increasing the risk of overdose. A baggie "may be 15% pure one day, and the next day it's 60%," said Skip Holbrook, the police chief in Huntington, W.Va., which sits in an area of Appalachia where heroin is spreading. "It's like playing Russian roulette."

Opiate vs Oxycodone Screen why you should consider splitting them out when testing

Opiate Screen @ 300ng

  Primarily targets morphine and codeine

  Oxycodone – 30,000ng   Needed to trigger a positive   Miss the chippers, O.O.U.

  Opana – Oxymorphone   100,000ng needed to trigger

positive on onsite Opiate test

Oxycodone Screen @ 100ng

  Oxycodone – 100ng   Needed to trigger a positive   Detect the chippers

  Will detect oxymorphone and hyrdocodone at 1562ngs

  Opana – Oxymorphone   Oxycodone lab EIA screen has

100% cross reactivity to Oxymorphone

  Opana (ER) – time release

Opana Information   Opana is more potent, per milligram, than Oxy   Users vulnerable to O.D, kidney failure, death   Street names: "stop signs," ”Obomb,”new blues”   crushed - either snorted or injected.   Endo Pharmaceuticals, announced in Dec 2011

that it would reformulate Opana. The new pill is being manufactured

  Old form of Opana is still available -$90 per bill   Opana ER (Extended Release)   Small blood clots under the skin/cause blood

disorders

Take away comments

  If positive on an Opiate screening test – an Opiate family member most likely detected

  If confirmed for 6-AM (6-Acetylmorphine )at the Lab:  Heroin use

  If confirmed positive just for Morphine  Metabolized heroine to morphine and or  morphine use i.e. from a prescription,  poppy seed use

Suboxone-Buprenorphine   FDA approved in 2002   used to treat opiate addiction   alternative to methadone   partial agonist (ceiling)   in pill, film, patch   2mg & 8mg doses   will not test positive on an opiate test   significant diversion   contains naloxone- guard against misuse   Individuals will get high on this stuff

What’s the attraction to Bup?

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

alcohol, sleeping pills(ambien) or benzodiazepines (clonopin)- extreme sedation, drowsiness, unconscious, or even death may occur

  Method of ingestion – typically sublingual (under the tongue), pill format going away, reports of snorting

  injected?   only test positive if specifically testing for buprenorphine

Under-the-stamp drug smuggling foiled by errant prison letter Posted: Thursday, November 3, 2011 1:30 pm

An errant letter led to the discovery of an under-the-postage-stamp prison drug smuggling scheme, police said. Bucks County detectives and prison investigators filed charges Wednesday against Michael Romeo Taurino, Ryan Neil Stephenson, Charles Frederick Shaffer and Jesse Michael Conklin. All incoming mail to inmates is opened and checked for contraband, according to prison policy. On Oct. 11, prison investigators received a letter marked “Undeliverable/return to sender,” according to court records. In the letter, inmate Jesse Conklin, 22, wrote to a Morrisville man that he was getting “Suboxine strips in here through the mail under large stamps,” police said. “I don’t want to pay 40$ a strip. I’ll give you 25$ a strip. I can send you money orders straight from here,” it continued.

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