Designer Drugs – What Drug Court Practitioners Need to Know By: Paul L. Cary Toxicology Laboratory University of Missouri.

Designer Drugs – What Drug Court Practitioners

Need to Know

By: Paul L. CaryToxicology LaboratoryUniversity of Missouri

2C-I NBOME

History of Designer Drugs

Designer Drugs Aren’t New

morphine invented in early 1800s from opium in 1925 morphine was chemically altered to create heroin 1960s hallucinogens (LSD, STP) late 1970s illicitly synthesized fentanyl (China White) 1980s - MDMA (Ecstasy) around this time the term “Designer Drugs” was coined 2006 - everything changes introduction of synthetic cannabinoids (Spice & K2) quickly followed by the introduction of bath salts today - newer, bolder, experimental cocktails

Internet Transformed Designer Drug Trade

What is a Designer Drug:

legitimate pharmaceuticals/research chemicals botanicals (plants with psychoactive properties) illicit compounds already banned via reformulation of molecular structure in

clandestine labs newly created chemicals are formed (“Designer

Drugs”) effects to mimic the “original” drug/compound

Why Create a Designer Drug?

• prolong the effect of the drugprolong the effect of the drug• increase the potency of the drugincrease the potency of the drug• ““selectselect”” the desired effect the desired effect• make the drug more difficult to detectmake the drug more difficult to detect• make an illegal drug make an illegal drug ““legallegal””• PROFIT! Make $$$$$PROFIT! Make $$$$$

Unknowns Associated with Designer Drugs

inconsistencies in production (variable drug concentrations)

purity of the product (contaminates) mislabeling of packages false, misleading & deceptive salesfalse, misleading & deceptive sales Russian rouletteRussian roulette

Source of Designer Drugs

Synthetic Cannabinoids

(Spice/K2)

Preparation of “herbal incense”:

botanicals are sprayed with liquid botanicals are sprayed with liquid preparations of:preparations of: HU-210HU-210 HU-211HU-211 CP 47,497CP 47,497 JWH-018JWH-018 JWH-073JWH-073

Smoking Cannabinoids

BG: motor control, learningBG: motor control, learning Hippo: memory, spatial Hippo: memory, spatial

navigationnavigation CB: cognitive functions - CB: cognitive functions -

attention, language, attention, language, emotionsemotions

What does CBWhat does CB11 receptor receptor control?control?

Pharmacological Effects of Synthetic Cannabinoids are Similar to THC

increase heart rate & blood pressure altered state of consciousness mild euphoria and 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

Public Perception of “Legal Highs”

Synthetic cannabinoids Synthetic cannabinoids are as safe as marijuana.are as safe as marijuana.

Forensic Science Review Volume: Twenty-Six

Number OneJanuary 2014

25 pages

Synthetic Cannabinoids: Physical Effects

kidney damage (XLR-11) pulmonary effects (lung dysfunction) cardiovascular issues (tachycardia), increases in

blood pressure GI problems (pain, nausea, vomiting) seizures (6 cases) chemically-induced psychosis ** DUID (12 reported cases) ** three reported deaths (cardiac, suicide, OD)

Gurney Report conclusions:

“A review of the literature that exists to date suggests that synthetic

cannabinoids may have side effects that are more severe than that of marijuana.”

Evolutionary Landscape

appearing & disappearingappearing & disappearing whatwhat’’s popular today cycles out to be s popular today cycles out to be

replaced by new synthetic THC analogsreplaced by new synthetic THC analogs labs testing for common compounds a labs testing for common compounds a

few months ago may not be testing for few months ago may not be testing for same chemicals nowsame chemicals now

difficult to keep pace using legal difficult to keep pace using legal remedies remedies

Acknowledgment:

Dr. Barry LoganNational Medical ServicesWillow Grove, PA

Evolutionary Landscape

Lab-Based Drug Testing:

Designer Stimulants (Synthetic Cathinones)

Designer Stimulants:

bath salts/bath bubblesbath salts/bath bubbles plant foods/plant vitaminsplant foods/plant vitamins glass cleaners/computer screen glass cleaners/computer screen

cleanerscleaners soft drink additivesoft drink additive ““novelty collectors itemnovelty collectors item””

What are Designer Stimulants?

illegal psychoactive drugs that induce temporary improvements in either mental or physical functions

enhanced alertness, wakefulness, locomotion

produce a characteristic "up" feeling

similar to amphetamine & cocaine

MDPV: Methylenedioxypyrovalerone (MDPV) - a Methylenedioxypyrovalerone (MDPV) - a

psychoactive drug with stimulant psychoactive drug with stimulant properties which acts as both a properties which acts as both a norepinephrine-dopamine reuptake norepinephrine-dopamine reuptake inhibitor (NDRI). inhibitor (NDRI).

often snorted - similar to cocaine often snorted - similar to cocaine considered extremely addictiveconsidered extremely addictive adverse medical/psychiatric ramificationsadverse medical/psychiatric ramifications

designer drug chemically similar to designer drug chemically similar to cathinonecathinone

first synthesized in 1929first synthesized in 1929 amphetamine-like propertiesamphetamine-like properties powerful synthetic stimulantpowerful synthetic stimulant adverse medical/psychiatric ramificationsadverse medical/psychiatric ramifications

Methylmethcathinone (Mephedrone)

Summer, 2014 - Bath Salt Data

25I-NBOMeSubstituted

phenethylaminepsychedelic 2C-I

stimulanthallucinogen

20 linked deathsIn US

Adverse Effects of Designer Stimulants:

surge in neurotransmitters: dopamine dopamine serotoninserotonin norepinephrinenorepinephrine

psychiatric symptoms:

severe paranoia

hallucinations

panic attacks

“excited delirium” depressio

n & suicidal th

oughts

Adverse Effects of Designer Stimulants:

dehydration skeletal muscle

degeneration kidney failure breathing difficulties seizures death

Miscellaneous Designer Drugs

Tryptamine-Based Drugs (e.g., Foxy, AMT, and DMT)— hallucinogenic Mitragynine (Kratom)— sedative Desomorphine (Krokodil)— heroin-like Benzofurans (6-APB, or Benzo Fury)— stimulation to hallucinogenic Piperazine-Based Drugs (e.g., BZP, TFMPP, and MeOPP)— stimulants Phenethylamine-Like Drugs (e.g., Bromo Dragonfly, B-Fly, Fly, and 3CB-

Fly)— synthetic hallucinogen Sedative-Class Drugs (1,4-B and BDO)— derivatives of GHB Dissociative Psychedelic Class (e.g., 3-MeO-PCP, 4-MeO-PCP) Methoxetamine, MXE, Mexxy, Roflcopter)—Synthetic dissociative

psychedelics like PCP and ketamine.

FAAH Inhibitors– enzyme is responsible for regulating brain chemicals

Legal Controls

Legal Controls

Controlled Substances Analogue Enforcement Act of 1986

Scheduling of Synthetic Drugs: Controlled Substances Act

DEA’s Temporary Scheduling

Drug Testing for Designer Drugs

Drug Testing for Designer Drugs

designer drugs have made most detection methods obsolete

on-site, point of care devices laboratory-based (LC/MS/MS) not all labs are equal urine remains the specimen of

choice

Unfortunate Truisms:

legal controls that prohibit legal controls that prohibit designer drugs will always lag designer drugs will always lag behind their productionbehind their production

drug detection methods for the drug detection methods for the identification of designer drugs identification of designer drugs may also not be available when may also not be available when these compounds become these compounds become popularpopular

Drug Courts Response Step 1: acknowledge the problemStep 1: acknowledge the problem

understanding the complexity understanding the complexity and challengesand challenges

Step 2: ban designer drugsStep 2: ban designer drugs even if purchased even if purchased ““legallylegally”” false pretenses - false pretenses - ““not for human not for human

consumptionconsumption””

Drug Courts Response Step 3: put it in writingStep 3: put it in writing

best practices researchbest practices research Step 4: abstinence monitoringStep 4: abstinence monitoring

acknowledge limitationsacknowledge limitations develop a drug testing plandevelop a drug testing plan identify appropriate labidentify appropriate lab limited amnesty initiativelimited amnesty initiative

Drug Courts Response Step 5: community supervisionStep 5: community supervision

““eyes & earseyes & ears”” of the court of the court PO, law enforcement, PO, law enforcement,

marshals, case workers, etc.marshals, case workers, etc. Fourth Amendment waiversFourth Amendment waivers search & seizuresearch & seizure

Drug Courts Response Step 5: community Step 5: community

supervision continued:supervision continued: be proactivebe proactive home visits (announced & home visits (announced &

unannounced)unannounced) persons, places, vehicles, persons, places, vehicles,

etc.etc. under participants controlunder participants control

Drug Courts Response Step 5: community Step 5: community

supervision continued:supervision continued: computer & smart phonescomputer & smart phones text messages, social text messages, social

networknetwork Internet ordering practicesInternet ordering practices shipping labels, receipts shipping labels, receipts

Conclusion escalating public health issueescalating public health issue accept unfortunate truisms accept unfortunate truisms challenge of designer drugs will challenge of designer drugs will

require creativity & vigilancerequire creativity & vigilance fidelity to the Drug Court modelfidelity to the Drug Court model follow best practicesfollow best practices we know how to do this!we know how to do this!

email address:

carypl@health.missouri.edu