Bath Salts and Spice

1
Synthetic Drugs of Abuse Spice, K2 and
Bath Salts Side effects and Long term
consequences
Willie A. Hamilton, BC-FNP Board Certified in
Sports Medicine Nutrition

2
Synthetic Cannabinoids (SCs)

• Spice/K2 brands marketed as natural herbal
  incense
• Not for human consumption
• Available convenience stores, gas stations,
  Internet
• Cannabis substitute

Psychonaut Web Mapping Research Group (2009.)
Spice Report. Institute of Psychiatry, Kings
College London London UK.
3
Pharmacology

• delta-9 tetrahydro-cannabinol (?9-THC) agonism of
  cannabinoid receptor type 1 (CB1)
• SCs more potent
• Typical doses are often less than 1mg
• Not readily detectable

?9-THC
JWH-018
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Psychoactive Effects

• Marketed as similar to cannabis
• Euphoria
• Sociability
• Anxiolytic
• Relaxation
• Stimulant
• Cross tolerance with THC?

http//buyk2spice.net/
5
Side Effects of SC Products

• Anxiety
• Paranoia
• Headache
• Vomiting
• Psychosis
• Diaphoresis
• HR/BP increase
• Seizures

http//investigationmiami.blogspot.com/2011/01/be-
afraid-really-afraid.html
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Current and Future Epidemiology?

• No data on prevalence of use
• American Association of Poison Control Centers
• Synthetic cannabinoids
• 2009 13 calls
• 2010 2304 calls (Nov), a projected 200x increase
• Marijuana
• 2008 4009 calls, with 1020 for marijuana alone

7
Synthetic Stimulants

• Methylenedioxypyrovalerone (MDPV) and Mephedrone
• Sold as bath salts or plant fertilizer
• Currently legal in the United States
• Available online and in convenience stores

8
MDPV and Mephedrone

• CNS stimulants
• Related to cathinone, an active alkaloid found in
  the khat plant (N. Africa)
• Previously abused
• primarily in
• Europe and
• Australia

http//www.herbalextracts.net/library/supplements/
khat_uses.html
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MDPV

• Route Intranasal most common
• Also oral, smoking, rectal, and IV
• White to light brown crumbly powder
• Degrades if exposed to air for significant
  periods of time

MDMA
http//www.stompin-gardeners.com/index.
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Pharmacology of MDPV

• CNS stimulant similar to methamphetamine, MDMA,
  or cocaine
• Norepinephrine-dopamine reuptake inhibitor (NDRI)
• Increased alertness, arousal, anxiety, agitation,
  diminished requirement for food and sleep, sexual
  arousal
• Tachycardia, hypertension, vasoconstriction,
  diaphoresis

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Effects of MDPV

• High lasts 3-4 hours
• Physical effects may last 6-8 hours
• May cause seizures, panic attacks, or psychosis
  with high doses or increased frequency of use
• Avg dose 5 to 20mg

http//www.tradevv.com/chinasuppliers/chwhtltd_p_1
98b58/china-Mdpv-by-pevukka.html
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Other Sequelae of MDPV

• Trismus (inability to open mouth) or bruxism
• Panic attacks
• Psychosis with sleep deprivation
• Hallucinations, delusions, suicidal ideation
• Abstinence syndrome depression, lethargy,
  anxiety, postural hypotension
• Leads to frequent re-dosing

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MDPVs Legal Status

• UK MDPV regulated under the Misuse of Drugs Act
  1971
• US Not scheduled but banned in some states
• DEA controlled by the Federal Analogue Act?

http//addiction-dirkh.blogspot.com/2010/11/dea-sl
aps-temporary-ban-on-spice-and.html
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Mephedrone

• 4-methylmethcathinone (4-MMC)
• Meow Meow
• MCAT
• Miaow
• Drone
• Plant Feeder
• Bubbles

http//www.synchronium.net/2010/01/05/mephedrone-c
at/
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Pharmacology

• NE-DA reuptake inhibitor
• Similar to MA/MDMA
• Reportedly less potent, shorter duration
• Oral dose 20-50mg
• Come up 10-20 min
• Peak 45-60 min
• Comedown 60-120 min
• Re-dosing common

Amphetamine
Mephedrone
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Routes of Administration

• Oral ingestion
• Swallowing capsules
• Bombing (swallowing powder wrapped in cigarette
  paper)
• Insufflation (snorting)
• Rectally (either plugging or enema)
• IV (use 1/2 to 1/3 dose)

http//www.guardian.co.uk/society/mephedrone
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Effects of Mephedrone

• Euphoria
• Sociability
• Stimulation
• Sexual Arousal
• Music Appreciation
• Hallucinations

http//www.drugs.org.im/campaigns.htm
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Mephedrone Side Effects

• Loss of appetite
• Increase in body temperature, sweating, hot
  flushes
• Tense jaw, bruxism, stiff neck, muscle clenching
• HR/BP elevation, chest pains
• Dehydration
• Mydriasis, nystagmus
• Painful nasal drip/ulcers in mouth (after
  insufflation)
• Insomnia, paranoia, anxiety, dysphoria, psychosis

http//theblackheartofgrahamquirk.blogspot.com/
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Mephedrones Legal Status

• 2008-2010 Banned in many European counties
• December 2010 Illegal throughout the EU
• Mephedrone is not specifically banned in the
  United States
• However, some states have banned mephedrone
• DEA may be controlled by the Federal Analogue
  Act as an analogue of methcathinone

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Current and Future Epidemiology?

• No data on prevalence of use
• American Association of Poison Control Centers
• Bath Salts
• 2010 292 calls
• 2011 469 calls (2/14/11), a projected14-fold
  increase

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Questions?
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Contact Information Willie A. Hamilton,
BC-FNP LIVEfit Medicine 1901 Brookside
Dr. Kingsport, TN 37660 [phone]