DRUGSBrittany Todd

ECPI University

10/26/2015

SCHEDULE I & II

SCHEDULE INO MEDICINAL USE

HIGH ADDICTION & DEPENDENCY

5-MeO-DMT

• Street Names

– 5MEO,

– DMT (common but wrong drug)

• Natural and fast-acting

hallucinogen

• It acts as a nonselective serotonin

(5-HT) agonist and causes many

physiological and behavioral

changes (Shen, et al., 2010)

– Increases neurotransmitters in the

body, releasing high amounts of

Serotonin and Dopamine

• Smoked, snorted, injected and

swallowed (pill and beverage)

5-Methoxy-N, N-Dimethyltryptamine

5-MeO Dosages• Most doses typically kept

under 20mg (Clark, et al., 2014)

– Inhalation (6 – 20 mg)

– Injection (0.7 – 3.1 mg)

– Snuffed (10 mg)

– Pill/ Beverage (30 mg)

• Commonly mistaken for DMT

– Dosage from 60 to 100mg (has been documented up to 200 mg)

– 5-Meo is FIVE times more potent

– Mistake can lead to overdose (if dealer gives DMT user 5-MeO)

• Street Price

– $2 – 3 a pill

Where is 5-MeO found?• The skin and venom of the

Sonoran Desert Toad (Incilius

Alvarius)

• Toads can be found in Mexico,

and in the South-West region of

the U.S.

• Harding Grass (Phalaris Aquatica)

• Sheep fell into “staggers” after

grazing on these plants and died

from lethal tremors and convulsions (Shen, et al., 2010)

Who uses 5-MeO?

• Hermosillo, Sonora

– Seri community, Mexico

– “El Propheta del Sapo” or The Toad Prophet

– Fluid is extracted from parotid glands of toad, dried and then turned into raw material for medicinal purposes (Fabregas, 2014)

Who uses 5-MeO?• Shamans in South America (Amazon

and Orinoco River)

• First documented in 18th Century by

Jesuit missionaries

– Ayahuasca

• Amazonian beverage traditionally used

for ritual, religious and healing (Riga, et

al., 2014)

– Soon Researched by botanist

Richard Spruce in 19th century

• Introduced as treatment for

Parkinson’s disease

• Recreational purposes in the U.S. and

in Europe – not as popular as other

hallucinogens like LSD (Barceloux,

2012)

Effect of 5-MeO on Humans• SHORT TERM:• Hallucinations• Nausea and Vomiting• Increased Heart Rate• Lung Irritation• Sweating• High Body Temperature

• LONG TERM:• Dysphoria / Paranoia

– “Bad Trip” Horrors

• Respiratory Depression• Anxiety/ Panic• Lack of Responsiveness• Coma (Clark, et al., 2015)

https://www.youtube.com/watch?v=SxaxvC3W6CQ

Effects start at 3-4 min, peak at 35-40 min, and end around 60-70 min (Shen, et al, 2010)

Is 5-MeO an inspiration?

• Many speculate that the drug is the inspiration behind the story, The Frog Prince

• In the story, a beautiful princess kisses a frog. She then hallucinates, thinking that the frog is her prince.

• No legitimate source for this information, but interesting idea.

Sentencing for 5-MeO

• Trafficking

– Up to 20 years incarceration

– Fine of $1 million for individual

– $5 million for non-individual (DEA, 2015)

Treatment for 5-MeO

• There have been insufficient studies on treatment.

• Testing is still being conducted on treatment methods– Labs are experimenting on

rats, humans and other animals that may come into contact with the substance (Shen, 2010)

Mephedrone

• Street Names

– Meow Meow, MCAT, Mad Cow

– Plant Food, 4-MM, Drone, Bounce, Bubbles,White Magic, Charge, Mugabe, and MMCHammer (Corkery, et al., 2012)

• Designer Synthetic Cathinone Stimulant that can be marketed as a bath salt.– Mixed with amphetamines

– Stimulates the central nervous system, increasing dopamine, energy and excitement levels and creates an intense state of euphoria (Mephedrone, 2012)

• Snorted, smoked, injected or taken orally. – Off-white or slightly yellow-colored powder and comes

in crystals, capsules and pills

• Illegal since 2011 but still being sold online and in head shops worldwide

• Sold as research chemical, bath salt, or plant food

4-methylmethcathinone

Meph Dosages

• Most common routes– Snorting (25 to 75 mg)

– Oral Administration (150 to 250 mg) (Corkery, et al., 2014)

• Cost:– £10 – 25 per gram in

Wales

– $10 – $30 per gram in US

Where is MCAT Found?

• Khat Plant (Catha edulis Forsk)– Originated in Ethiopia

– Leaves and stem tips chewed for effect

• Found in Africa, mainly Ethiopia and Somalia

– Somalians call plant “qaad” or “jaad” (Elmi, 1983)

• This derivative is why Mephedrone is more often called “Meow Meow.”

• It is also called “MCAT” due to its scientific name 4-MethylmethCAThinone and because of the plant

Who uses Bubbles?

• One of the most popular drugs in the UK (Farrell, 2014)– “Mephedrone is popular with

youths in urban environmentswith males appearing to use [it]more than females…[it] is usedby several population groupssuch as young adults, mid-to-lateadolescents, and older adults”(DEA, 2013)

• Used commonly within the LBGT community– More widely with men

Effect of Meow Meow on Humans

Effects begin 15 to 45 minutes after administration

Mind– Agitation– Insomnia– Irritability– Dizziness– Depression– Paranoia– Delusions– Suicidal thoughts– Panic attacks– Impaired perception– Reduced motor

control

Body

– Rapid heart rate

– Chest pains

– Nosebleeds

– Sweating

– Nausea

– Vomiting

– Seizures

– Sores take longer to heal

– Brown teeth stains

– Gastric Disorders

Overdose

– Limbs tingle and turn blue

– Respiratory failure

– Death

Long-Term

– Difficulty sleeping

– Muscle spasms

– Hallucinating

– High dependency

(DEA, 2013)

Sentencing for MCAT

• Maximum of five years incarceration for possession

• Up to 14 years for dealing (Mephedrone, 2012)

Treatment for Mephedrone• According to the Substance Abuse and Mental Health Services

Administration (SAMHSA), treatment for Mephedrone include:– Assessment (behavioral professionals should ask a series of specific questions

in regards to the use of bath salts)

– Monitoring Abstinence (routine urine testing for substances for up to 102 days)

– Detoxing• Benzodyatopines used to bring body temperature down

• Body is flushed out by drinking water and being put on an IV solution

– Educating

Ibogaine

• Street Names

– The Evoker, Bitter Grass, Leaf of God

• Natural psychedelic indole alkaloid

– isolated form of the Iboga plant

• 1939 – First marketed in France

– Lambarène – neuromuscular stimulant

• Legal in Mexico, Canada and Panama

• Taken orally

Endabuse or Tabernanthe iboga

Ibogaine Dosages

• One oral treatment of

6 to 19 mg

– effectively maintains

abstinence from drug abuse

up to 6 months

• Lethal dose – 213 mg

• Street Cost

– $60 – 100 per gram

(Amadon & Roecker, n.d.)

Where is Ibogaine found?

• Iboga Plant (Tabernanthe iboga)

– Native to Central Africa

– Iboga is the pure root form of the drug, which is used in ritualistic ceremonies

• Vocanga Seeds (Vocanga Africana)

– Native to West Africa

– Bark used as poison, cerebral stimulant, and aphrodisiac

Who uses Ibogaine?

• African and Mexican shamans– Rituals

– Religious ceremonies

• Users of Meth, Heroine, Cocaine and other substances who are looking for a “cure” to their habit

Who uses Ibogaine?

• Bwiti Tribe– Central African religious

group

– Religious practice based off Iboga• Initiation required to join,

• Iboga eaten on first night

• Supervised by “Nganga” priest

– 2-3 million members (D’Montford, 2014)

Ibogaine’s Medical Potential

• 1960’s Howard Lotsof– Discovered drug’s ability to

interrupt drug dependency– Has been effective in treatment

of withdrawal from:• Heroin• Meth• Cocaine• Amphetamines• Alcohol

• Not used medically in the U.S. or the U.K., but is used medically in legal areas– Used as anticonvulsant and as a

treatment for influenza (D’Montford, 2014)

Effects of Ibogaine on Humans

• Tremors

• Immobility

• Nausea

• High blood pressure

• Cardiac abnormalities

• Lacks water response

• Insomnia

• Chronic cellulitis

• Death

If not taken in controlled doses:

1990 – 200819 reported deaths

Users died 1.5 – 76 hours after taking Ibogaine(Alper, et al., 2001)

CIA, Ibogaine and Mind

Control • Studied by CIA in 1950s

– MKUltra program• Examined human responses to

chemical, biological, psychological and sociological drugs for intruments of mind control and brainwashing

• Subjects were administered drugs that had mind-altering effects

• National Institute on Drug Abuse (NIDA) shut down Ibogaine project after confidential records were made public (U.S. Supreme Court, 1983)

Treatment for Ibogaine

• Minimum withdrawal side-effects (not as intense as other schedule I drugs)

– Slowly weaning off drug is most effective

– Detoxing

Treatments using Ibogaine

• There are more treatments for USING Ibogaine in detox programs, rather than treatments for detoxing from the drug.

• Cost for a stay at a non-licensed facility is $1,300 to $2,000

• Cost for a stay at a facility licensed by government is up to $15,000

• Ibogaine University and Crossroads Treatment Center are the two most well known centers for Ibogaine treatments– Both located in Mexico

Sentencing for Ibogaine

SCHEDULE IISOME MEDICINAL USE

MODERATE TO HIGH ADDICTION &

DEPENDENCY

Fentanyl

• Street Names:

– Murder 8, Apache, Green Apples,

Shady 80’s, Greenies, Green Beans,

Goodfellas, Tango, Jackpot, Cash

• Synthetic opiate analgesic similar to

morphine and oxycodone (Fentanyl,

2012)

– Acts like Heroin

• Binds user’s opiate receptors and

increases dopamine levels

• Taken orally, transdermally, by

injection or by nasal spray

Fentanyl Citrate

• Brand Names:

– Duragesic®, Sublimaze®,

Actiq®, Abstral®, Fentora™,

Subsys®, Lazanda®, Onsolis®,

Ionsys®

Fentanyl History

• 1950’s– First synthesized in Belgium

• 1960’s – Created as an IV called Sublimaze®

– Approved by FDA in 1968

• 1970’s – Abuse of Fentanyl appears

• July 15, 2005– F.D.A. issues safety warnings

• 2005 – 2007 C.D.C. and D.E.A.

– C.D.C. and D.E.A. report 1,013confirmed non-pharmaceuticalfentanyl-related deaths (Miller,2002)

Fentanyl History• 2007 – 2011

– Drug Abuse Warning Network reports non medical hospital visits increased from about 16,000 to over 20,000 in Fentanyl abuse.

– DEA lists Fentanyl as a schedule II drug

• 2013 Florida’s Medical Examiner’s Annual Report– Fentanyl identified in 251 deaths in

2012

– Number increased 36% in 2013

Fentanyl Dosages100 times more potent than morphine (Fentanyl, 2015)

Uses micrograms v. milligrams due to this potency

100 mcg patch worth $60 – 70 on the streets (Brosnahan, 2011)

Injection

50 to 100 mcg every two hours

Lozenge “Lollipops”

Often given as 1600 mcg

Patch25 to 100 mcg

(protocol determined by patient’s current analgesic dosage)

How is Fentanyl used?• Used by

– Patients undergoing heart surgery or those with poor heart function

– Cancer patients

– Victims of chronic pain

• Lozenges and tablets

– used for management of cancer pain

• Patches

– Used for management of chronic pain patients

• Injection– Administered for both uses either

intravenously, intramuscularly, spinally or epidurally

Raised Fentanyl Awareness

• Fentanyl-laced Heroin– First thought to be the cause of death

for Oscar-winning actor Philip Seymour Hoffman. According to NY Medical Examiner, results were inconclusive, but acute mixed drug intoxication was a definite cause

• Fentanyl is 50 times more potent than Heroin– "It takes a very small amount of fentanyl to

kill. A few grains of powder by itself is probably enough.” -Dr. Melinda Campopiano, medical officer for the U.S. Substance Abuse and Mental Health Services Administration

• C.D.C. reports 1,000 people died of fentanyl-laced heroin from 2005 to 2007

(Pierson & Francescani, 2014)

Effects of Fentanyl on Humans

• Analgesia

• Sedation

• Respiratory Depression

• Nausea/ Vomiting

• Itching/ Scratching

• Headache and Blurred vision

• Seizures

• Constipation

• Fentanyl appears to produce muscle

rigidity over time

• Can cause death when overdosed or

cut with other drugs such as heroin,

caffeine, cocaine, alcohol, etc.

(Fentanyl, 2012)

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Sentencing for Fentanyl

• 40 – 399 grams of Fentanyl mixture or 10 –99 grams of Fentanyl Analogue mixture– 1st offense: 5 to 40 years

• If death or bodily injury– 20 years to life

• Fine from $5 – 25 million

• 400 grams or more– 1st offense: 10 years to life

• If death or bodily injury– 20 years to life

• Fine from $10 – 50 million (DEA, 2015)

Treatment for Fentanyl

• Overdoses should be

counteracted with an

opiate antagonist

such as Naloxone

(Fentanyl, 2012).

• Professional

treatment centers for

detoxing

Nabilone

• Brand Name

– Cesemet®

• Synthetic cannabanoid

• 1981 - Approved for use in Canada

– Used as an antiemetic (prevention of nausea and vomiting)

– Same effect as THC

• Main ingredient in marijuana

• Nabilone NOT made from cannabis plant and has more intense side-effects

Nabilone

Nabilone Dosages

• Different codes and

colors created for each

dose.

• No known street value

(Acton, 2012)

How is Nabilone used?

• Chemotherapy patients– experiencing nausea and

vomiting symptoms

• Motion sickness• Studies found drug to be

superior to:– Placebos– Prochloroperazyne

(Canadian spelling for prochlorperazine)

– Domperidone (Canadian spelling for droperidol)

Effects of Nabilone on

Humans• Dizziness

• Drowsiness

• Seizures

• Depression

• Anxiety

• Agitation

• Cardiac arrest

• Psychologic high

• Rapid heart rate

• Orthostatic hypotension

• Bronchial spasms

• Induced asthma(Kucharczyk, et al., 1991)

Side effects can last up to 72 hours

Sentencing for Nabilone

Treatment for Nabilone

• Treatment centers for

detoxification

– Many in California

– Professionals help

patient fight through

withdrawal symptoms

such as sweating,

tremors, aggression,

and drowsiness

Informational ReferencesActon, Q. (2012). Issues in Addiction and Eating Disorders: 2011 Edition. Atlanta, GA: Scholarly Editions

Alper, K.R., Glick, S.D. (2001). Ibogaine: Proceedings from the First International Conference. Orlando, FL: Academic Press.

Amadon, N., & Roecker, A. (n.d.) Ibogaine as an alternative and efficacious treatment for heroin addiction. Retrieved October 20,

2015 from https://www.onu.edu/files/amadon-ibogaine_article.pdf

Barceloux, D. (2012). Medical Toxicology of Drug Abuse: Synthesized Chemicals and Psychoactive Plants. Hoboken, NJ: John Wiley &

Sons, Inc.

Brosnahan, M. (2011). Fentanyl Pain Patch a Dangerous Street Drug. Retrieved October 25, 2015 from

http://www.cbc.ca/news/canada/fentanyl-pain-patch-a-dangerous-street-drug-1.978975

Clark, C., Clark, R., Clark, S. (2015). 5-MeO-DMT (DMT). Clark & Clark, LLC. Retrieved October 05, 2015 from

http://www.newjerseydruglawyer.com/glossary-of-drugs/5-meo-dmt.html

DEA. (2013). 4-Methylmethcathinone. Office of Diversion Control. Retrieved October 19, 2015 from

http://www.deadiversion.usdoj.gov/drug_chem_info/mephedrone.pdf

DEA. (2015). Federal Trafficking Penalties. U.S. Department of Justice. Retrieved October 19, 2015 from

http://www.dea.gov/druginfo/ftp3.shtml

D’Montford, S. (2014). Ibogaine – Freedom from Addiction Naturally. Gold Coast, AUS: Happy Medium Publishing

Drug Fact Sheet. (2015). Drug Enforcement Administration. Retrieved October 19, 2015 from

http://www.dea.gov/druginfo/drug_data_sheets/Bath_Salts.pdf

Informational ReferencesElmi, A. (1983). The chewing of khat in Somalia. U.S. National Library of Medicine and National Institutes of Health. Retrieved October 19,

2015 from http://www.ncbi.nlm.nih.gov/pubmed/6139513

Fabregas, S. (Producer). (2014). The Toad Prophet. VICE Media, Inc. Video retrieved October 19, 2015 from http://www.vice.com/video/the-

toad-prophet-464

Fentanyl. (2015). Drug Enforcement Administration. Retrieved October 23, 2015 from

http://www.deadiversion.usdoj.gov/drug_chem_info/fentanyl.pdf

Kucharczyk, J., Stewart, D., & Miller. A. (1991). Nausea and Vomiting. Boca Raton, FL: CRC Press, Inc.

Mephedrone. (2012). GMFA. Retrieved October 22, 2015 from http://www.gmfa.org.uk/mephedrone

Miller, R. (2002). The Encyclopedia of Addictive Drugs. West Port, CT: Greenwood Press.

Pierson R., & Francescani, C. Death of actor Philip Seymour Hoffman spotlights fentanyl scourge. Retrieved October 25, 2015 from

http://www.reuters.com/article/2014/02/05/us-usa-hoffman-drugs-idUSBREA1404S20140205

Riga, M., Guadalupe, S., Tudela, R., Francesc, A., & Pau, C. (2014). The natural hallucinogen 5-MeO-DMT, component of Ayahuasca, disrupts

cortical function in rats: reversal by antipsychotic drugs. Oxford University Press. Retrieved October 19, 2015 from

http://ijnp.oxfordjournals.org/content/17/8/1269

Shen, H., Jiang, X., Winter, J., Yu, A. (2010). Psychedelic 5-Methoxy-N,N-dimethyltryptamine: Metabolism, Pharmacokinetics, Drug

Interactions, and Pharmacological Actions. US National Library of Medicine and National Institutes of Health. Retrieved 10/19/2015

from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3028383/

U.S. Supreme Court. (1983). Petitioners v. John Cary Sims and Sidney M. Wolfe. Central Intelligence Agency. Retrieved October 19, 2015 from http://www.justice.gov/sites/default/files/osg/briefs/1983/01/01/sg830018.txt

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