Emerging Trends in Drug Abuse Joshua Pruitt, MD, FAAEM February
6, 2014
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Whats New E-Cigarettes Krokodil N-bomb Syrup, Purple Drank,
Sizzurp, Lean Molly Salvia Divinorum
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Whats Sort-of New K-2/Synthetic Cannabinoids Bath Salts, MDPV,
Khat Energy drinks
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E-cigarettes Battery-operated devices marketed as safer than
traditional cigarettes Produce flavored nicotine aerosol/steam that
looks and feels like tobacco smoke No tar or other chemicals from
burning tobacco leaves Still require a chemical diluent that has an
unknown safety profile
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E-cigarettes
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Krokodil Cheap heroin substitute Desomorphine (Heroin is
diacetylmorphine) Made by combining codeine tablets with toxic
chemicals (i.e., lighter fluid, industrial cleaners) More powerful
than heroin with a shorter duration Causes gray/green scaly flesh
at site of injection, thus the name Injection sites often become
gangrenous Average life-span after beginning use is 2 years
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Krokodil
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N-bomb, Legal Acid, Smiles, 25I, 25C, 25B Three closely-related
synthetic hallucinogens Substitute for LSD or mescaline Serotonin
stimulant, more powerful than LSD Can cause seizure, MI,
respiratory depression/arrest, death 19 related deaths in US
between 3/2012 and 8/2013
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N-bomb, Legal Acid, Smiles, 25I, 25C, 25B
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Syrup, Purple Drank, Sizzurp, Lean Phenergan w/codeine plus
soda (Actavis) May include hard candies Celebrated in rap music
High risk of respiratory depression and CNS depression Deaths from
prescription opioids now outnumber deaths from all other drugs
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Syrup, Purple Drank, Sizzurp, Lean Implicated in the deaths of
DJ Screw and Pimp C
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Syrup, Purple Drank, Sizzurp, Lean Overdose symptoms related to
promethazine and codeine Promethazine CNS depression,
anticholinergic Tachycardia, altered mental status, delirium
Codeine CNS depression, respiratory depression Miosis,
bradypnea/apnea, hypoventilation Seizures highly unusual and
usually related to hypoxia
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Syrup, Purple Drank, Sizzurp, Lean
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Molly
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Slang for molecular Refers to pure crystalline powder form of
MDMA (Ecstasy) Sold in capsules Celebrated in rap/hip-hop music
Produces energy and euphoria May cause hyperthermia, confusion,
depression, sleep problems
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Molly Symptoms often mixed toxidrome due to co- ingestions CNS
effectsCV effectsGI effectsDerm effects AMSPalpitationsDry
mouthDiaphoresis SeizuresChest painNausea/vomitingPiloerection
RestlessnessCramping AgitationDental effectsAnorexiaGU effects
HyperthermiaBruxismUrinary retention SyncopeEnamel erosionSexual
dysfunction Ataxia
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Molly
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Salvia Highly selective kappa-opioid receptor agonist
Originated with Mexican Mazatec shamanism Hallucinogen with
psychedelic/dissociative effects Taken by smoking, no real effects
from ingestion
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Salvia Intoxication effects Uncontrollable laughter Vivid
reliving of past memories Sensation of motion or being pulled by
something Visions of membranes or other 2-D surfaces Merging with
or becoming objects Overlapping realities, such as being in two
places at once
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Salvia
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K-2, Spice, Synthetic Cannabinoids Very diverse class of drugs
Bind to the cannabinoid receptor Similar effects to marijuana Often
more intense effects Include hallucinogenic and psychedelic
effects
Bath Salts, MDPV, Khat Synthetic cathinones Function as
dopamine-norepinephrine reuptake inhibitors Four times more potent
than Ritalin or Concerta Duration of action 3-4 hours, with
after-effects lasting as long as 6-8 hours
Bath Salts, MDPV, Khat Amateur chemists change the chemical
composition of the bath salt and make it nearly impossible for
regulation to keep up with production. Mortality rate from excited
delirium estimated at 8-14%, most die while in police custody
Treatment is supportive Benzos, restraints if necessary, watch for
rhabdo
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Bath Salts, MDPV, Khat Elevated temperature Agitated delirium
Respiratory arrest DEATH
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Bath Salts, MDPV, Khat
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Energy Drinks Drinks like Red Bull, Rock Star, Monster Contain
caffeine and other legal stimulants (guarana, ginseng) Can contain
75 to >200 mg of caffeine per serving 34 mg per serving in Coke
55 mg per serving in Mt. Dew If it says no caffeine, then it uses
guarana, which is the same as caffeine
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Energy Drinks 5-hour energy advertises no crash, but that
relates to the sugar crash Contains artificial sweeteners Short
term problems Increased heart rate, palpitations Hypertension
Dehydration Sleep problems
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Energy Drinks Some may have 2 servings per can When used
occasionally, not necessarily dangerous Think of them as highly
caffeinated drinks Combination with alcohol The stimulant effect of
the energy drink can mask how intoxicated someone is Can give the
drinker the impression they are not impaired Research shows that
people drink more and have higher BALs when they combine alcohol
and caffeine
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Energy Drinks ER visits related to energy drink consumption
10,068 in 2007; 20,783 in 2011 60% of patients drank energy drink
alone 27% of patients combined with prescription drugs 13% combined
with alcohol 10% combined with illegal drugs 9% combined with
prescription stimulants