Clinical Pearl: An Update on Designer Drugs Gabriela Dimitrievski, PharmD PGY2 Psychiatric Pharmacy Resident Purdue University/Eskenazi Health [email protected].

Clinical Pearl:An Update on Designer Drugs

Gabriela Dimitrievski, PharmDPGY2 Psychiatric Pharmacy ResidentPurdue University/Eskenazi Health

[email protected] 18, 2014

This speaker has no actual or potential conflicts of interest to disclose in relation to this presentation

Objectives

• Identify the importance of being aware of new, popular, and upcoming “designer drugs”

• Describe the methods of use, effects, and dangers associated with several popular designer drugs

• Detail ways in which pharmacists can help with substance abuse issues

Impact of Substance Use

• Drug use linked to more deaths than suicides, firearms, or school violence

• 40,239 drug-induced deaths in the United States in 2011– Additional 26,256 alcohol-induced deaths

• Substance abuse as the single largest contributing factor to U.S. crime

• Cost of drug abuse estimated at $52 billion

US Dept. of Justice Drug Enforcement Agency. “Drugs of Abuse.” Available at: http://www.justice.gov/dea/docs/drugs_of_abuse_2011.pdf

National Vital Statistics Report. “Deaths: Preliminary Data for 2011.” Available at: http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_06.pdf

Indiana Statistics

SAMHSA. Behavioral Health Barometer, Indiana, 2013. Available at: http://www.samhsa.gov/data/StatesInBrief/2k14/Indiana_BHBarometer.pdfSAMHSA. Indiana Adolescent Behavioral Health In Brief. Available at: http://www.samhsa.gov/data/StatesInBrief/2k9/OASTeenReportIN.pdf

• Annually, 154,000 individuals aged 12 years or older abused or were dependent on illicit drugs from 2008-2012• Equivalent to 2.9% of the

population

• 52,000 (9.7%) of adolescents in Indiana used an illicit drug in the past month• 35,000 used marijuana• 27,000 used other illicit

drugs

Popular Media – Deaths Due to Designer Drugs

Common Drugs of Abuse

• Narcotics– Heroin– Opioids– Crocodile

• Stimulants– Cocaine– Bath salts/synthetic

cathinones– Methamphetamine– Caffeine

• Marijuana/Cannabis– K2/Spice– Wets

• Depressants– Alcohol– Benzodiazepines– GHB

• Hallucinogens– Synthetic

phenethylamines• Smiles, Nexus, Blue Mystic,

Europa, N-Bomb

– Ecstasy– Molly– LSD– Mushrooms – PCP

Molly

• What is it?– “Purified” MDMA

• Often combined or substituted with caffeine, dextromethorphan, amphetamines, cocaine, or PCP

• Desired Effects– Both hallucinogenic and stimulant properties

• Mental stimulation, emotional warmth, decreased anxiety, euphoria, enhanced perceptions

• Dangers– Muscle tension, increased heart rate and blood pressure,

tremors, teeth clenching, depression– Neurotoxicity, nephrotoxicity, cardiovascular toxicity,

hyperthermia, seizures, intracranial hemorrhage

Steinhardt et al. Ment Health Clin. 2014;4(5):64.NIDA for Teens. Drug Facts: MDMA. Available at:

http://teens.drugabuse.gov/drug-facts/mdma-ecstasy-or-molly

Powdered Alcohol

• What is it?– Freeze-dried powder formulation of alcohol– Most notably marketed in the US under the name Palcohol

• Labeling originally approved by the Alcohol and Tobacco Tax and Trade Bureau, but withdrawn days later

• Desired Effects– Discreet means of intoxication– Use on food products for “an extra kick”– Snorting powder as a means of immediate intoxication

• Dangers– Over-consumption of alcohol,

addictive potential, attractiveness to young children

http://time.com/71664/powdered-alcohol-palcohol-error/

http://www.cbsnews.com/news/palcohol-powdered-alcohol-may-present-serious-health-risks/

N-BOMe Substances

• What is it?– 25I-NBOMe, 25C-NBOMe, and 25B-NBOMe

• Street names: N-bomb, Smiles, Boom, Gnome, Dime, 25I, 25C, 25B

– Synthetic phenethylamines with effects similar to LSD

– Powders, liquids, edibles, blotter papers

• Desired Effects– Potent hallucinogenic activity – Euphoria, loving feelings, enhanced

awareness, sexual sensations/desires

• Dangers– Psychosis, agitation, erratic behavior,

depression, anxiety, paranoia– Seizures, cardiac arrest, respiratory arrest,

deathhttp://www.etcada.com/events/designer-psychedelics-new-class-of-designer-drugs-in-harris-county

http://www.deadiversion.usdoj.gov/drug_chem_info/nbome.pdfhttp://www.addictiontreatmentmagazine.com/synthetic-drugs/teen-seizures-and-deaths-linked-to-dangerous-designer-drug-n-bomb-part-1/

Powdered Caffeine

• What is it?– Powdered form of pure caffeine– One teaspoon is equivalent to

approximately 25 cups of coffee– Marketed as a dietary supplement

• Desired Effects– Energy boost, weight loss

• Dangers– Vomiting, diarrhea, stupor,

disorientation– Rapid and abnormal heartbeat,

seizures, death

http://www.fda.gov/Food/RecallsOutbreaksEmergencies/SafetyAlertsAdvisories/ucm405787.htmhttp://nypost.com/2014/07/19/powdered-caffeine-scrutinized-after-prom-king-dies/

http://seattletimes.com/html/health/2024115386_apxcaffeinepowderwarning.html

What Can I Do?

• ASHP Statement on the Pharmacist’s Role in Substance Abuse Prevention, Education, and Assistance– Pharmacists as having unique knowledge, skills,

and responsibilities to take on an important role with substance abuse

– Roles centered around:• Preventing• Educating• Assisting

• http://www.ashp.org/doclibrary/bestpractices/specificstsubstance.aspx

Gabriela Dimitrievski, PharmDPGY2 Psychiatric Pharmacy ResidentPurdue University/Eskenazi Health

[email protected]