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