designer drugs - Maryland Addictions Directors Council

Current Trends
K2/Spice, “Bath Salts” &
Ken Dickinson, M.S., R.Ph.
[email protected]
Rodney & Ken
• Attendees
– Experience with “Bath Salts” and K2/Spice
– Expectations or goals for this workshop
• History and background of “new
synthetic designer drugs”
• Epidemiology and current trends
• Effects and dangers of these drugs
• How sold, what they look like and how
• Legal, prevention and treatment issues
Designer Drugs: Background
• Trend started in late 1970’s
• Drugs of abuse are classified by DEA
• Drugs of abuse work according to
• Analogs
– Can “design” an analog to have same or
similar activity but not listed as a “controlled
– Not subject to legal penalties and restrictions
Mephedrone &
Federal Drug Schedules
Federal Controlled Substances Act (CSA) of 1970
• Schedule I: No medical use, high abuse
potential (heroin)
• Schedule II: Accepted medical use, high abuse
potential (OxyContin, Ritalin)
• Schedule III: Accepted medical use, less abuse
potential than I or II (Vicodin)
• Schedule IV: Accepted medical use, less abuse
potential than I-III (Valium, Xanax)
• Schedule V: Accepted medical use, lowest
abuse potential (Robitussin AC)
SOURCE: ATTC National Office, CONNECT to Fight Prescription Drug Abuse.
Designer Drugs
• designer drugs (in designer drugs
(chemistry)) see a marginally different
version appear, using substances not
covered in the original law. In the United
States this problem was addressed in the
Anti-Drug Abuse Act of 1986, which
contained a Controlled Substance Analogue
Enforcement Act (commonly called the
Designer Drug Act), which prohibited the
manufacture of “substantially similar”
analogues of banned chemicals.
Designer Drugs: Evolution
• Internationally do not have such laws
– Being manufactured in other countries
• Many “designer drugs” do not test (+)
• A way to “Beat the Bladder Police”
Designer Drugs
• Today’s trend
– Make an analog that is not listed in laws
– Since legal can make an distribute as an
everyday household product e.g. “Bath Salts”
“Plant Food”, potpourri, incense, jewellery
cleaner, hummingbird attractant, etc.
– Then label “not for human consumption”
– Market via social media and retail outlets
Web Sites
K2 Products
Herbal Incense
• Crushed non-psychoactive herbal plant
matter treated with one or more synthetic
– First generation: “K2”, “Spice”, “Black Mamba”
– Second generation “K3”, “Splice”,
“Apocalypse”, “Cloud 10”, “Destiny”
Synthetic Marijuana (JWH- 018)
• Known as Spice or K2
• K2 originated at Clemson University,
where researchers developed synthetic
cannabinoids in an effort to create
therapeutic drugs. But the cannabinoids
also have effects akin to THC, the key
ingredient in marijuana
• K2 is largely created by individual sellers,
it's anyone's guess what else is added to
the mix.
• For $35, users can buy 3 grams of K2
"incense" with nothing more than a credit
card or PayPal account.
• Did not have drug test or it
• Now do but extra expense and only some
• Smokable herbal blends marketed as
"legal highs" have become increasingly
popular and as easy to buy as cigarettes.
(before 03.01.11)
K2 Spice
• K2 contains synthetic chemicals, known as
JWH-018 and JWH-073, that mimic THC
by acting on the cannabinoid receptors in
the brain
• Other analogs detected
– HU-210
– AM-2201
– CP-47, CP-497, C6, C8, C9
K2 Data
• American Association of Poison Control
• Reported in article June 2012
• Year 2010
#2, 906
• Year 2011
• Year 2012 up to May 31
Description of the Drug
• Mixture of herbal and spice plant products
– Leaf can be: marshmallow leaf, parsley, etc.
• Sprayed with synthetic cannabinoids
• Marketed as incense and “not for human
• No regulations to list ingredients or age
requirements to purchase
Alarming Fact
• Tests show that even the same brand may
have different drugs– in different amountsat different times
• User has no way of knowing what or how
much they are taking
• Dr. Huffman & Dr. Huestis (Chief of Chemistry/Drug
Metabolism at National Institute for Drug Abuse) indicate
that when taking these drugs, it is “hijacking the part of
the brain important for many major functions:
temperature control, food intake, perception,
memory and problem solving.
– Many people taking these high-potency drugs are affecting
important functions throughout their body’s-hormone
functions for example.”
Doctors also express concern that the drugs may
involve acute toxicity levels, possibly long term, as well
as impacting cannabinoid receptors that regulate body’s
immune system.
K2 Impact
• Retailers selling the drugs report a recent (2011)
increase in sales from app. $1000 daily up to
$10, 000 daily.
• Medical reports indicate that K2/Spice drugs
potentially result in users developing a rapid and
powerful addiction on a level not usually found
among smokers of “real” marijuana.
• Recently linked (Dec 2011) to over 352
nationwide emergency room incidents-includes
suicide attempts, extremely elevated heart
rate/blood pressure, comas, seizures, and
anxiety attacks.
Incense Emporium
Online K2/Spice Ad (Current):
• Note from the owners: On Dec 24, the federal
government banned certain ingredients commonly found
in K2 - our products have been scientifically analyzed
and certified not to contain any of the controlled
ingredients, for more information please click on the
"Contact Us" above. Thanks for being loyal Incense
Emporium customers!
• Buy 1 Get 1 FREE on all Herbal Incense!!! Buy
whatever you HERBAL INCENSE would like and we will
automatically double it when we package it for
shipping. It's that simple! Buy 2, Get 4...Buy 5, Get
10...Buy 100, Get 200...No Limits!!!
• $129.99 for 2 ounces...that's only $65 per ounce!!! Our
be 18 to purchase
HU-211 and HU-2101
JWH-073 and JWH-0181
JWH-018 and JWH-073
•JWH-018 and JWH-073 are
synthetic cannabinoid agonists
without the classical cannabinoid
chemical structure
•In vitro studies show that JWH-018
and JWH-073 binds to the brain
cannabinoid receptor CB1 with
higher affinity than Δ9-THC which
binds with almost equal affinity to
CB1 and CB2 receptors
•Behavioral pharmacology studies
show that JWH-018 and JWH-073
both have Δ9-THC-like activity in
Missouri K2 Administration Study
Bob Welsh- PI
IRB Human subjects approval
Six subjects smoked K2 Summit
Each contained JWH-018 & JWH-073 or
CP47, 497
• Subjects performed Standardized Field
Sobriety Tests, cognitive tests & Drug
Recognition Expert Exam
• Blood, urine and oral fluid collected
K2 Study (cont’d)
• Onset of effects in about 2-3 minutes
– Dry mouth
– Light headedness
– Blurred vision
– Agitation, Motor restlessness
– Time dilation (?)
• Theory in physics, time travel
K2 Study (cont’d)
• Drug Recognition Expert Exam
– Increased pulse and blood pressure
– Lack of convergence
• Movement of the two eyes so coordinated that the
images of a single point fall on corresponding
points of the two retinas
– No horizontal or vertical gaze nystagmus
– Pupils normal, muscle tone normal
K2 Study (cont’d)
• Field Sobriety Tests
– 3 to 4 inches of sway, leg body tremors
– Loss of balance
– Loss of motor coordination
Missouri Study Self Reported K2
• Tachycardia
• Dry Mouth
• Felt Impaired, subjective thought
• Changes in perception
• Impaired sense of time
• Mild anxiety, paranoia
• Sedation & Post-intoxication exhaustion
On Line Reported K2 Effects
• Strong dysphoria
-Panic attacks
-Heavy body load
-Extreme nausea
-Fear, Panic, Anxiety
-Strong aural hallucinations
--Racing heart (higher doses)
– Heart attack
On Line Reported K2 Effects
Self mutilation
Auditory & visual hallucinations
On Line Reported K2 Effects
• Marijuana-like effects
– Euphoria
– Giddiness
– Silliness
– Impaired short-term memory and
– Increased appetite
• “Most angiogenic substance I ever ingested”
K2 Products
K2 Products
How Diagnosis is Made
• Mainly supported by clinical history rather
than presentation or mental status exam
• Duration of intoxication or “high” is
relatively short (30 min. or less)
– Do not typically present acutely intoxicated to
an outpatient visit
• Unlike marijuana do not have a typical or
signature smell
How Diagnosis is Made
• Usually access “system” via behavioral
– Criminal Justice system
– Crisis Centers, ER’s & Psychiatric Hospitals
• ER’s are seeing and identifying more due
to acute intoxication
• Toxicology testing continues to improve
User Report #1
This is the worst experience I have ever had
The most angiogenic substance I have ever
Nausea, vomiting, heart pounding like I am
going to have a heart attack
Not sure if I just said that, thought it, or read
Two hours later will never take this again
User Report #2
Three individual hits from a small pipe
Organic, no chemical odor or taste
Five minutes feels like cannabis
Ten minutes like an intense cannabis high
More than three puffs might be too much
Why the Discrepancy in
Use of other drugs with incense
Varying potency
Presence of different cannabinoids
User/environment characteristics
– Set & setting, etc.
K2 Overview
• No quality control
• Manufacturing process may be associated with
adverse effects
• Subjective effects most closely resemble those
of very powerful marijuana
• Almost complete lack of scientific study
• Street information very inconsistent
K2 Treatment Issues
• High rates of addiction (
• Withdrawal due to physical addiction
– Treated with sedatives and clonidine
• Before D/A treatment need to be medically
and psychiatrically safe and stable
• Residual effects for weeks (or months)
due to long half-life & fat storage
Withdrawal Case Study
• German male 20 y.o. used Spice Gold
daily for 8 months
• Due to tolerance increased dose 10 fold
• Felt need to continue use daily
• When unable to get drug experienced:
– Unrest, drug craving, nightmares, sweating,
nausea, tremor, headache, high BP,
Withdrawal Case Study
• Began using again
• When wanted to stop checked into
• Experienced classic withdrawal that lasted
7 days
K2 Harm Reduction Tips
Not all incense blends are created equal.
JWH-018 is more expensive than real pot
Herbal incense blends are harsh
JWH-018 does not mix well with alcohol
The high last no more than 30 minutes
K2 Testing
• Many labs have a test for the first
generation JWH chemicals
• In February 2010, Redwood Labs,
California developed a saliva test for JWH018, JWH-073 and JWH-250
• Saliva and urine tests recently developed
for second generation JWH’s
K2 Testing
• Following a single low dose exposure,
synthetic cannabinoids can be detected up
to 72 hours in human urine.
• In case of chronic exposure the window of
detection is much longer
Maryland Law: K2 & Bath Salts
• On March 1, 2011, the possession and
distribution of 5 synthetic cannabinoid
compounds became illegal in the U.S. per an
emergency ban by the U.S. Drug Enforcement
• Maryland no enactment yet for K2 as of Sept 25,
– Local bans such as Ocean City
• July 21, 2012 Bath Salts now Schedule I in
Mitragyna Speciosa
• Used in:
– Malaysia
– Thailand
– Indonesia
• Local names:
– Ithang
– Biak Biak
– Ketum
– Kakuam
Kratom Pharmacology
Structurally similar to some hallucinogens
No hallucinogenic activity or effects
Acts on opioid receptors
Kratom & Opioid Treatment
• Currently used for heroin and methadone
dependence in some countries
– New Zealand
– Thailand
• Used in detox to manage withdrawal
symptoms from opioids
• Seems to be a stimulant in lower doses
– Mitragynine
• Seems to be sedative in higher doses
– 7 hydroxymitragynine
• Often produces a mixed effect
• Onset 5 t o 10 minutes
• Duration several hours
Kratom Side Effects
• Short term (immediate)
– Dry mouth
– Increased or decrease urination
– Loss of appetite
– Nausea and/or vomiting
• Side effects
– Anorexia/weight loss
– Depression
– Addiction
Bath Salts
• Toxic psychoactive drugs “disguised” or
“pretending” to be “Bath Salts”
• They are NOT
• Some people have snorted real BS’s
“Bath Salts” Are
What are Synthetic Cathinones?
• Synthetic cathinones are related to the parent
compound cathinone.
• Since the mid-2000s, unregulated ringsubstituted cathinone derivatives have appeared
in the European and American recreational
drugs market.
What are Synthetic Cathinones?
• The most commonly available synthetic
cathinones sold on the recreational market in the
period up to 2012 appear to be 3, 4Methylenedioxypyrovalerone (MDPV),
mephedrone, and methylone.
• These products are usually encountered as
highly pure white or brown powders. Cathinone
derivatives are claimed to have effects similar to
those of cocaine, amphetamine or MDMA
(ecstasy), but little is known of their detailed
• Native to tropical East Africa and the
Arabian Peninsula
• Fresh Leaves/tops chewed or consumed
as tea
• Stimulation and euphoria
• Part of social culture in many countires
(coffee, tea, coca or khat)
• Coca ---------------cocaine
• Khat ----------------cathinone (Schedule I)
• Cathinones: Structure similar to
– Euphoria
– Anorexia
– Stimulation
– Dilated pupils
– Hypnagogic hallucinations when wearing off
Mephedrone Background
Discovered 1929
Rediscovered 2003 web site “The Hive”
Was a replacement for Ecstasy
Sold as “plant food” & later “bath salts”
Manufactured in clandestine labs
Methylenedioxypyrpvalerone (MDPV)
Known as substituted cathinones
MDPV Timeline
• MDPV was developed in the 1960s, and has been
used for the treatment of chronic fatigue, but
caused problems of abuse and dependence.
• 1969: Boehringer Ingelheim files a patent
application for MDPV.
• 2005: MDPV appears as a recreational drug; first
mention on Drugs-Forum.
• 2007: First seizure of MDPV as a recreational
drug, by customs officials in the German state of
Saxony. The drug had been shipped from China.
• 2008: First seizure of MDPV in the United States.
MDPV Timeline
• 2009: MDPV made illegal in Denmark.
• 2010: MDPV made a controlled drug in the UK, Sweden,
Germany, Australia and Finland. First reports of the
widespread retail marketing of 'bath salts' containing
MDPV in the US. The US considers both Mephedrone
(July, 2010) and MDPV (December, 2010) "a drug and
chemical of concern".
• 2011& 2012: MDPV sale and possession are banned in
most US states with legislation being introduced in
Maryland an other states.
• Distinctive odor
– Fishy
– Vanilla
– Stale urine
– Bleach
– Circuit boards
Mephedrone & MDPV Use
• Capsules, tablets or white granuels
• Can be swallowed, smoked, snorted,
• Prominent use in Europe
• Out of 70 Dutch users of mephedrone, 58
described it as an overall pleasant
experience and 12 described it as an
unpleasant experience
Mephedrone/MDPV Effects
• Duration
– Total 2 – 5 hours
– Onset 15-45 minutes
– Coming up 15 – 30 minutes
– Plateau 15 – 30 minutes
– Coming down 30 – 90 minutes
– After effects 2 – 4 hours
Mephedrone/MDPV Desired
Mental and physical stimulation
Euphoria, mood lift
Feelings of empathy, openness
Increase in sociability, desire to talk with
• Pleasurable rushing
• Sense of being sped up
Mephedrone/MDPV General
• General change in consciousness (as with most
• Decreased appetite
• Pupil dilation
• Unusual body sensations (facial flushing, chills,
goosebumps, body energy)
• Change in body temperature regulation
• Sweating
• Increase in heart rate and blood pressure
Mephedrone/MDPV Toxic Effects
• Strong desire to re-dose, craving to
recapture initial euphoric rush
• Uncomfortable changes in body
temperature (sweating/chills)
• Heart palpitations, sense of racing heart
• Impaired short term memory
• Insomnia
Mephedrone/MDPV Toxic Effects
Severe paranoia
Anxiety and depression
PA Criminal Intelligence Center
• February 2011, Schuylkill County: PSP,
Schuylkill Haven members were attempting to
serve a mental health warrant and noticed the
subject was fidgety and talking very fast.
• The subject admitted to taking
methamphetamine earlier in the day and
snorting two lines of TranQuility bath salts
approximately three hours prior to PSP arrival.
• The subject related he felt no pain, was
invincible, and likened the effects to that of a
cocaine overdose. He was unable to perform
any field sobriety tests
PA Criminal Intelligence Center
• February 2011, Lebanon County: PSP,
Jonestown members responded to a burglary
where a subject broke a window and jumped
through a glass door.
• After he was confronted by the occupant, the
subject ran outside and kicked in a garage door.
• While being interviewed by troopers, he jumped
onto the hood of the patrol car, rolled off, and
went into a fetal position. The subject was
incoherent, claimed he was being electrocuted,
and was eventually transported to the hospital.
Another PA Story
• March 2011, two Pennsylvania men were
found dead in the woods after missing for
two weeks. Toxicology reports indicate
that they had taken bath salts prior to their
deaths. The bath salts probably led to their
disorientation and they died from exposure
and hypothermia.
More Bath Salts Tragedy
• January 2011, a 48 year old Florida
woman was jailed after shed attacked and
attempted to behead her 710 Y.O. mother
with a machete. The woman was high on
bath salts she purchased from a local
head shop
• Remember they are:
– Potent
– Lethal
– Highly addictive
One More Story
• November 2010-a 21 year old Louisiana
man snorts a packet of Cloud 9 Bath salts
and endures several days of delirium and
paranoia. He cuts his own throat with a
kitchen knife only to survive and then
shoots himself later when he had visions
of army soldiers swarming his house.
Bath Salt Data
• American Association of Poison Control
Centers # of calls
• June 9, 2012 report
• Year 2010
• Year 2011
• Year 2012 to May 31 #1,320
Berks PA County Head Shop Bust
Same Head Shop
Mephedrone/MDPV Treatment
• Similar to strong amphetamine addiction
• Similar to PCP abuse/addiction
• Stabilization and Safety highest priority
– Safety of client
– Safety of staff and others
Mephedrone/MDPV Treatment
• If psychotic or dissociated need to
– Neuroleptics:
• Haldol for emergency stabilization
• Atypicals (Seroquel/Respirdol/etc.) for ongoing
• Decease sensory exposure
– “Rock or Rave” medicine
– Talking down bad trips
– De-escalation techniques
Excited Delirium
• Delirium Defined:
– Acute change in mental status
characterized by impairment of
• Excited Delirium Defined:
– Delirium with continuous agitation
Excited Delirium
• Diagnostic Criteria for Delirium
– Disturbance of consciousness with
reduced ability to focus, sustain, or shift
– A change in cognition such as memory
deficit, disorientation, language
– The disturbance develops over a short
period of time (usually hours to days)
and tends to fluctuate.
ED: Research Findings
• Excited Delirium often involved psychostimulant drugs
– Amphetamines
– amphetamine derivatives
– Cocaine
• Sometimes even the lack of having
taken certain prescription drugs could
cause a similar response behavior
– i.e. lithium in the case of manic
ED: Research Findings
• Psycho-stimulant drugs can produce a
number of potentially lethal effects
• Psycho-stimulant overdoses can cause
– cardiovascular compromise
– Seizures
– hyperthermia.
Mephedrone & MDPV Treatment
• Once stable and safe be aware of
cognitive impairment
• May need “tincture of time” to grasp
• Supportive non threatening environment
• Screen for COD (high probability)
Bath Salts Overview
• They are sold mostly on the internet, but can also be found in
select shops locally.
• They're known by a variety of names, including “Red Dove,”
“Blue Silk,” “Zoom,” “Bloom,” “Cloud Nine,” “Ocean Snow,”
“Lunar Wave,” “Vanilla Sky,” “Ivory Wave,” “White Lightning,”
“Scarface” “Purple Wave,” “Blizzard,” “Star Dust,” “Lovey,
Dovey,” “Snow Leopard,” “Aura,” and “Hurricane Charlie.”
• While they have become popular under the guise of selling as
‘bath salts’, they are sometimes sold as other products such
as insect repellant, or plant food with names like “Bonsai
Grow” among others.
Effects of MDPV
• MDPV is sometimes labeled online as legal cocaine
or legal amphetamines.
• The effects have a duration of roughly 3 to 4 hours,
with after effects such as tachycardia, hypertension,
and mild stimulation lasting from 6 to 8 hours.
• High doses have been observed to cause intense,
prolonged panic attacks in stimulant-intolerant
users, and there are anecdotal reports of psychosis
from sleep withdrawal and addiction at higher doses
or more frequent dosing intervals.
Synthetic Cathinones Effects
Summary Sheet
Breathing difficulty
Bruxism (grinding
Extreme anxiety
progressing to violent
Fits and delusions
Hypertension (high
blood pressure)
Increased body
temperature, chills,
Kidney pain
Lack of appetite
Liver failure
Loss of bowel control
Muscle spasms
Muscle tenseness
(narrowing of the
blood vessels)
Nausea, stomach cramps,
and digestive problems
Psychotic delusions
Pupil dilation
Renal failure
Rhabdomyolysis (release
of muscle fiber contents
[myoglobin] that could
lead to kidney problems)
Severe paranoia
Suicidal thoughts
Tachycardia (rapid
Dangers/Legal Issues
• Dr. Volkow, the NIDA Director stated: “Because
these products are relatively new to the drug abuse
scene, our knowledge about their precise chemical
composition and short- and long-term effects is
• In February, 2011, Congressman Charles Schumer
(D-NY) introduced legislation that would add bath
salts to a list of federally controlled substances.
September 7, 2011, finally saw this legislation in the
form of a proposed temporary DEA ban.
Federal Ban Proposed on
• The United States Drug Enforcement Administration
(DEA) is using its emergency scheduling authority to
temporarily control three synthetic cathinones
(Mephedrone, 3,4 methylenedioxypyrovalerone
(MDPV) and Methylone).
• Except as authorized by law, this action will make
possessing and selling these chemicals or the products
that contain them illegal in the U.S. for at least one year
while the DEA and the United States Department of
Health and Human Services (DHHS) further study
whether these chemicals should be permanently
Synthetic Drug Abuse Prevention
Act of 2012
• July 10, 2012 President signed Law
making temporary law permanent
• October 1, 2012 Synthetic Drugs now
listed as Schedule I
• All substituted cathinones now Schedule I
• Chemists working on making noncathinone stimulants
National vs. State-by-State
• Just because a federal ban is enacted on a
drug, it does not mean local authorities will take
action on this drug.
• States still need to enact legislation to ban the
substances in order for state (then local)
authorities to take action.
• Federal bans will go after larger distributors, but
it will be locally determined as to whether users
and smaller, local distributors (such as nonchain convenience stores and gas stations) will
be sought after without a state ban.
Prevention For K2 & Bath Salts
• Heighten awareness via Education
– Schools, parent groups, community groups, law
enforcement, medical & treatment, etc.
• Legislation against precursor chemicals
• Legislation making drugs Schedule I
– Patrick Meehan “Synthetic Drug Control Act”
• Goes into effect October 1 2012!!!
• “Hit the retailers in their pocket book”
– Civil suits by victims (users and families)
– Authorities appealing to retailers with amnesty if stop
and destroy
Urine Detection Information
• Redwood Toxicology Laboratory shows
currently they have detection for MDPV and
Mephedrone. (see
• June 11, 2012 Redwood expanded to test
for #21 designer stimulants
• Atlantic Labs- Bensalem, PA Bath Salts
$20.00 and K2 $15.00.
• Most labs now testing
– Check with your lab
Urine Detection Information
(Expanded to #21 June 2012)
Redwood has a 2 panel drug test (MDPV, Mephedrone) and a 14 panel
drug test which tests for the following drugs:
1. BZP (Benzylpiperazine)
2. Butylone (β-keto-N-methylbenzodioxolylpropylamine, bk-MBDB)
3. Cathinone (Khat or Benzoylethanamine)
4. Ethylone (3,4-methylenedioxy-N-ethylcathinone, MDEC, bk-MDEA)
5. MBDB (Methylbenzodioxolylbutanamine, Methyl-J, “Eden”)
6. mCPP (meta-Chlorophenylpiperazine)
7. MDA (3,4-Methylenedioxyamphetamine, tenamfetamine)
8. MDEA (3,4-Methylenedioxy-N-ethylamphetamine, MDEA, MDE, “Eve”)
9. MDPV (Methylenedioxypyrovalerone, Cloud 9, Ivory Wave, White
10.MDMA (3,4-Methylenedioxymethamphetamine, ecstasy, “E”, “X”)
11.Mephedrone (4-methylmethcathinone [4-MMC], 4-methylephedrone,
“Meph”, “MCat”)
12.Methcathinone (α-methylamino-propiophenone, may be confused with
13.Methylone (3,4-methylenedioxy-N-methylcathinone, bk-MDMA, MDMC,
On-Site Testing
• Many labs now have available
• On site may be useful in treatment
• Problem: labs report as high as 35-40%
false negatives with on-site
– On-site shows no use but when testing for
accuracy they send to lab for confirm and up
to 40% tested positive.
You May Ask What’s Next?
• Krokodil?
– In Russia and Europe
• 2C-1 or “Smiles”
– Yahoo reports 09/19/2012
• Kratom
– Here today in Maryland & Mid-Atlantic States
– Marketed as “Natural” substitute for K2 & K3
Opioid- desomorphine
Result of attempt to extract codeine
Injected can be used by other routes
Russia & spreading through Europe
Tissue breakdown
Highly addicting- Usually fatal
Points to Ponder
– Did I learn so far?
– What do I think about it?
– How do I feel about it?
– Does this information mean to me
professionally and personally?????
• History and background of “new
synthetic designer drugs”
• Epidemiology and current trends
• Effects and dangers of these drugs
• How sold, what they look like and how
• Prevention and treatment issues

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