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2. Designer Drugs: A Practical Update
David A. Gorelick, M.D., Ph.D., DLFAPA
Professor of Psychiatry
University of Maryland School of Medicine

3. Overview of Designer Drugs
No intended therapeutic or medicinal use
Synthetic chemicals
Provides user with a positive subjective experience
Novel psychoactive substances (NPS)
NPS
United Nations Office on Drugs and Crime, World Drug Report United Nations publication, Sales No. E.17.XI.6).
Available at Accessed 02/20/2018.

4. Types of Designer Drugs
Synthetic cannabinoids
“Spice”
“K2”
Synthetic cathinones
“Bath salts”
Novel designer drugs with mixed stimulant and hallucinogenic actions
Novel synthetic opioids

5. Clandestine laboratories
Asia

6. Epidemiology of Designer Drugs
2016
Commonest designer drugs 
Synthetic cannabinoids
32%
Synthetic cathinones
19%
Use is less prevalent than plant-based drugs, such as
Cannabis
Cocaine
Opiates
Amphetamines

7. Past year use of designer drugs 0.9% 3%
2015 survey
2014 survey
Past year use of designer drugs
0.9% 3%
Age group
18-64 years old
15-25 years old 
Gomes de Matos, E., Hannemann, T. V., Atzendorf, J., Kraus, L., & Piontek, D. (2018). The Consumption of New Psychoactive Substances and Methamphetamine Analysis of Data From 6 German Federal States. Deutsches Ärzteblatt International, 115(4),
Weaver, M. F., Hopper, J. A., & Gunderson, E. W. (2015). Designer drugs 2015: assessment and management. Addiction science & clinical practice, 10(1), 8.

8. Other or unknown substance use disorder
Code
304.90
Other psychoactive substance
Code F19

9. The Growing Popularity of Designer Drugs1 2
Their synthesis does not require advanced chemical expertise.
Widely available from illicit sources and over the internet
The Growing Popularity of Designer Drugs 3
Not detected by routine drug screening tests; marketed as legal highs 
New tests are becoming available.
Kersten, B. P. and M. E. McLaughlin (2015). "Toxicology and management of novel psychoactive drugs." J Pharm Pract 28(1):

10. 739 designer drugs appeared between 2009 and 2016
About 80 have disappeared since 2013.

11. Signs and symptoms often overlap with other drugs.
Identification of acute intoxication or withdrawal syndromes may be difficult. 
Routine drug screening tests do not detect designer drugs.
Kersten, B. P. and M. E. McLaughlin (2015). "Toxicology and management of novel psychoactive drugs." J Pharm Pract 28(1):
Logan, B. K., A. L. A. Mohr, et al. (2017). "Reports of Adverse Events Associated with Use of Novel Psychoactive Substances, : A Review." J Anal Toxicol 41(7):

12. Signs and symptoms differ in Intensity Duration
Quality 
Signs and symptoms differ in
Intensity
Duration
The clinical care of  intoxication/withdrawal may be more difficult. 
Currently no available antidotes,
Clinical management is supportive and symptomatic.
except opioids
Kersten, B. P. and M. E. McLaughlin (2015). "Toxicology and management of novel psychoactive drugs." J Pharm Pract 28(1):
Logan, B. K., A. L. A. Mohr, et al. (2017). "Reports of Adverse Events Associated with Use of Novel Psychoactive Substances, : A Review." J Anal Toxicol 41(7):

13. Key Points Designer drug use is rapidly increasing around the world.
Designer drugs are not detected by routine drug screening tests.
Intoxication and withdrawal syndromes may be difficult to distinguish from those of other psychoactive substances.
Intoxication and withdrawal syndromes may be difficult to treat because the syndromes may be longer and more intense and because there are no currently available antidotes, except for opioids.

14. Next Presentation Synthetic Cannabinoids: History, Chemistry, and Pharmacology