Objectives Review new synthetic substances of abuse Discuss
pharmacology and clinical presentations Identify EMS and ER
treatment options for care
Slide 3
Bath Salts synthetic product contains hallucinogenic,
mind-altering chemicals similar in structure to those also found in
cocaine and ecstasy depending on which brand or form is
purchased.
Slide 4
Bath Salts Sold as: a bath salt, or plant food Labeled: for
novelty use only not for human consumption to by- pass FDA
regulations-not being sold as food or drug product. Sold in: either
250 or 500 mg packets depending on brand or form purchased.
Slide 5
Bath Salts Ivory Wave is the most popular brand of this product
Vanilla Sky Fly Snow Ivory Charge Ivory Coast Purple Wave
Cristalius Magic Ocean Blue Columbian Salts Bolivian Salts Ocean
Burst Lunar Wave Lady Bubbles Arctic Blast Sextacy Disco Snow
Leopard Natural NRG Tranquility
Slide 6
Whats in it? MDPV (methylene-dioxy-pyro-valerone) usually
referred to as pyro-valerone, (Super Coke) powerful psychoactive
chemical similar to Ritalin acts as a stimulant that inhibits
re-uptake of dopamine & norepinephrine minimal effects on
serotonin levels. most versions of these products as containing
Lidocaine may also contain similar components to 2-DPMP or MDMA
(aka ecstasy).
Slide 7
Purposely designed in a way that will mimic the effects of:
Cocaine Crack Ecstasy Most often used by snorting.
Slide 8
Where can I find it? It is sold most frequently on-line
tobacco/smoke shops as a novelty item not for human consumption $30
for a small package in bulk (50-100 packets) for a discount rate.
Bath salts have increased in club scene use as ecstasy availability
and use have declined
Slide 9
Whats the prevalence? Poison Control calls 20090 Poison Control
calls 2010 303 Poison Control calls 20114,100
Slide 10
Whats the purity? Samples seized from different regions reveal
a great deal of variance despite the same labels and producers
Slide 11
Pharmacology Multiple manufactures sources Vary in purity,
concentration, and fillers Sold in packages 50mg to 200mg vials
500mg Consumed orally, rectal, insufflated, injected, or
smoked
Slide 12
Phamacology Effects Onset, peak, and duration depends upon
route Major source seems to be China, routed through New Orleans
and out I-10 corridor Houston #1 Montgomery County Top 10
Slide 13
Why is it popular? Effects of amphetamines, cocaine, and
ecstacy without hangover, comedown, or depression commonly
following the use of those drugs Elevates mood, decreases
hostility, raises energy levels, improves sense of well-being,
improves attentions span and attention to detail, euphoria,
empathy, and sexual stimulation.
Slide 14
Appears to be extremely addictive with many users reporting an
almost uncontrollable urge for another hit immediately, stating
that its effects are several times stronger than cocaine when
snorted.
Slide 15
Downside Acute psychosis Severe anxiety, paranoia, agitation,
bizzarre behavior, tremors, persecutory hallucinations Sympathetic
overdrive Palpitations, shortness of breath, diaphoresis, hot
flashes, headaches, hyperthermia, overwhelming thirst Bruxism
Slide 16
Side effects muscular pain/spasms emotional fragility acute
paranoid psychosis sore jaw kidney failure loss of bowel control
intense high followed by painful hangover suppressed appetite
Slide 17
Its legal K2
Slide 18
K2/Spice products are a mixture of herbal/spice plant products
sprayed with potent psychotropic drugs often contaminated with
unidentified toxic substances which contribute to various adverse
health effects cause hallucinogenic effects similar to effects of
PCP. Marketed under variety of names K2, Spice, Pep Spice, Spice
Silver, Spice Gold, Spice Diamond, Smoke, Sence, Skunk, Yucatan
Fire, Genie & Zohai sold in variety of colors/flavors- usually
sold in foil packaging
Slide 19
K2/Spice Health Risks Symptoms/Side-Effects may include: mimics
marijuana high (often induced more quickly/more intense than real
marijuana) hallucinations seizures/tremors coma/unconsciousness
vomiting numbness/tingling
Slide 20
K2/Spice Health Risks Symptoms/Side-Effects may include:
increased respiration rate elevated blood pressure (reported up to
200/100) elevated heart rate (reported up to rate of 150) increased
level of anxiety/agitation leading to panic attacks (possible
suicide attempts)
Slide 21
Depending on synthetic compound in specific commercial brand,
can be anywhere from 4 times to over 100 times more potent than
marijuana (THC) Sold in tobacco shops, head shops, and convenience
stores Sold as incense marked not for human consumption
Slide 22
Price averages $45 for 3 grams (about equal to 3 sugar
packets)-higher than good grade marijuana Most often smoked but can
be mixed in with food or drink Most likely users: 14-27 yr. olds
Prisoners/probationers Military (use now banned by all military
branches)
Slide 23
Creation of K2/Spice Developed by Dr. John W. Huffman, a
Clemson University professor, as part of research for National
Institute for Drug Abuse (NIDA) on endogenous cannabinoid
receptors-but never tested on humans nor approved by FDA It is like
Russian roulette to use these drugs. We dont know a darn thing
about them for real. It shouldnt be out there. JWH-018 & many
of its cousins such as HU-210/211, JWH-073 & CP 47/497 found in
these drugs have a chemical structure shared with known
cancer-causing agents. All effects of K2/Spice drugs may not be
known for very long time because of long time period that body
stores them.
Slide 24
????????????????????? Nothing is known about metabolism of the
chemical compounds in K2/Spice drugs some may be toxic
pharmacologically active-differing from batch to batch in
kind/amount applied higher risk of accidental overdosing which has
already been seen increase numbers of ER incidents reported
Slide 25
????????????????????? There are hundreds more of these chemical
compounds containing strong, active cannabinoid receptors agonists
so can be safely assumed that further such substances will appear
on market soon if not banned Increasing challenges for toxicology
testing, law enforcement and medical professionals. Causing
difficulties for law enforcement agencies, probation & parole,
as well as drug courts due to difficulties in testing for presence
one lab test now known to detect it in system but at cost of $50
& will probably not test positive for all the known
variations
Slide 26
National Institute for Drug Abuse hijacking the part of the
brain important for many major functions: temperature control, food
intake, perception, memory and problem solving. Many people taking
these high-potency drugs are affecting important functions
throughout their bodies-hormone functions for example. Drugs may
involve acute toxicity levels, possibly long term, as well as
impacting cannabinoid receptors that regulate bodys immune
system.
Slide 27
On the rise Source primarily Mid-West US Recent increase in
sales from app. $1000 daily up to $10, 000 daily. Rapid and
powerful addiction on a level not usually found among smokers of
real marijuana. Recently linked to over 352 nationwide emergency
room incidents suicide attempts, extremely elevated heart
rate/blood pressure, comas, seizures, and anxiety attacks.
Slide 28
What about your patient?
Slide 29
Is this Excited Delirium? An imminently life threatening
medical emergency Massive release of epinephrine, norepinephrine,
dopamine, serotonin in the body and brain. Severe delirium and
agitation 29
Slide 30
Recognizing Excited Delirium Agitation or Excitement =
Increased activity and intensity Aggressive, threatening or
combative gets worse when challenged or injured Amazing feats of
strength Pressured loud incoherent speech Sweating (or loss of
sweating late) Dilated pupils/less reactive to light Rapid
breathing 30
Slide 31
Recognizing Excited Delirium Delirium = Confusion Disoriented
Person, place, time, purpose Rapid onset over a short period of
recent time He just started acting strange Easily distracted/lack
of focus Decreased awareness and perception Rapid changes in
emotions (laughter, anger, sadness) 31
Slide 32
Recognizing Excited Delirium Psychotic = bizarre behavior
Thought content inappropriate for circumstances Hallucinations
(visual or auditory) Delusions (grandeur, paranoia or reference)
Flight of ideas/tangential thinking Makes you feel uncomfortable
32
Slide 33
Bad Behavior: Other Reasons Alcohol intoxication or withdrawal
Other drug use problems Example: Cocaine psychosis Pure psychiatric
disease Head injury Dementia (Alzheimers Disease) Hypoglycemia
Hyperthyroidism 33
Slide 34
ED presentations Combative Self destructive Homicidal/suicidal
Agitation followed by severe depression
Slide 35
ED presentations Differential PCP LSD Cocaine Methamphetamines
Alcohol Hypoglycemia Hypoxia Head trauma CNS infection
Slide 36
The Work Up Urine Tox r/o routine street drugs + polypharmacy
BMP Hypoglycemia, metabolic acidosis CBC Infection and anemia CT
Head Intracranial hemorrhage, hydrocephalus 12 lead EKG Biomarkers,
myoglobin, lactic acid Temperature monitoring
Slide 37
Treatment Options No Antidote Supportive therapies Sympathetic
Overdrive Alpha and beta receptor stimulation Sustained endogenous
norepinephrine release Beta blocker caution? Metabolic dysfunction
Hepatic metabolism of bath salts Hyperthermia
Disposition Unpredictable dose and duration Psychiatric
evaluation when clear Home Jail Psychiatric facility
Slide 40
Status of K2/Spice Many European countries ban sale and use
Kansas was first state to ban use 15 states so far to officially
ban the sale & use of these products statewide. October 2011
DEA made it illeagal to possess or sell the chemicals or products
containing the chemicals found in bath salts in the US for 1 year
pending a review of permanently banning them Bath Salts are a
Schedule 1 substance
Slide 41
Texas May 2011 The Texas House passed a bill banning K2 or
spice, a synthetic marijuana The Texas Department of State Health
Services outlawed the fake pot last month after the Drug
Enforcement Agency issued an emergency ban for a year. The
possession of K2 a misdemeanor, but manufacturers and sellers would
be charged with a felony effective September 2011
Slide 42
HB 2118, SB 331 Certain synthetic compounds deceptively labeled
as bath salts and synthetic marijuana products (K2 or spice) have
been added to Penalty Group 2 of the Texas Controlled Substances
Act.
