Designer Drugs – What Drug Court Practitioners Need to Know By: Paul L. Cary Toxicology Laboratory University 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 drug increase the potency of the drug “select” the desired effect make the drug more difficult to detect make an illegal drug “legal” PROFIT! Make $$$$$

Unknowns Associated with Designer Drugs inconsistencies in production (variable drug concentrations) purity of the product (contaminates) mislabeling of packages false, misleading & deceptive sales Russian roulette

Source of Designer Drugs

Synthetic Cannabinoids (Spice/K2)

Preparation of “herbal incense”: botanicals are sprayed with liquid preparations of: HU-210 HU-211 CP 47,497 JWH-018 JWH-073

Smoking Cannabinoids What does CB1 receptor control? BG: motor control, learning Hippo: memory, spatial navigation CB: cognitive functions - attention, language, emotions

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 are as safe as marijuana.

Forensic Science Review Volume: Twenty-Six Number One January 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 & disappearing what’s popular today cycles out to be replaced by new synthetic THC analogs labs testing for common compounds a few months ago may not be testing for same chemicals now difficult to keep pace using legal remedies

Acknowledgment: Dr. Barry Logan National Medical Services Willow Grove, PA

Evolutionary Landscape

Lab-Based Drug Testing:

Designer Stimulants (Synthetic Cathinones)

Designer Stimulants: bath salts/bath bubbles plant foods/plant vitamins glass cleaners/computer screen cleaners soft drink additive “novelty 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 psychoactive drug with stimulant properties which acts as both a norepinephrine-dopamine reuptake inhibitor (NDRI). often snorted - similar to cocaine considered extremely addictive adverse medical/psychiatric ramifications

Methylmethcathinone (Mephedrone) designer drug chemically similar to cathinone first synthesized in 1929 amphetamine-like properties powerful synthetic stimulant adverse medical/psychiatric ramifications

Summer, 2014 - Bath Salt Data

25I-NBOMe Substituted phenethylamine psychedelic 2C-I stimulant hallucinogen 20 linked deaths In US

Adverse Effects of Designer Stimulants: surge in neurotransmitters: dopamine serotonin norepinephrine psychiatric symptoms: severe paranoia hallucinations panic attacks “excited delirium” depression & suicidal thoughts

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 designer drugs will always lag behind their production drug detection methods for the identification of designer drugs may also not be available when these compounds become popular

Drug Courts Response Step 1: acknowledge the problem understanding the complexity and challenges Step 2: ban designer drugs even if purchased “legally” false pretenses - “not for human consumption”

Drug Courts Response Step 3: put it in writing best practices research Step 4: abstinence monitoring acknowledge limitations develop a drug testing plan identify appropriate lab limited amnesty initiative

Drug Courts Response Step 5: community supervision “eyes & ears” of the court PO, law enforcement, marshals, case workers, etc. Fourth Amendment waivers search & seizure

Drug Courts Response Step 5: community supervision continued: be proactive home visits (announced & unannounced) persons, places, vehicles, etc. under participants control

Drug Courts Response Step 5: community supervision continued: computer & smart phones text messages, social network Internet ordering practices shipping labels, receipts

Conclusion escalating public health issue accept unfortunate truisms challenge of designer drugs will require creativity & vigilance fidelity to the Drug Court model follow best practices we know how to do this!

email address: carypl@health.missouri.edu