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.  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, King’s College London: London UK.

3.  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 JWH-018 ∆ 9 -THC

4. Marketed as similar to cannabis:  Euphoria  Sociability  Anxiolytic  Relaxation  Stimulant Cross tolerance with THC? http://buyk2spice.net/

5.  Anxiety  Paranoia  Headache  Vomiting  Psychosis  Diaphoresis  HR/BP increase  Seizures http://investigationmiami.blogspot.com/2011/01/be-afraid-really-afraid.html

6.  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.  Methylenedioxypyrovalerone (MDPV) and Mephedrone  Sold as “bath salts” or “plant fertilizer”  Currently legal in the United States  Available online and in convenience stores

8.  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

9.  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 http://www.stompin-gardeners.com/index. MDMA

10.  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

11.  “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_198b58/c hina-Mdpv-by-pevukka.html

12.  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

13.  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-slaps- temporary-ban-on-spice-and.html

14.  4-methylmethcathinone (4-MMC)  Meow Meow  MCAT  Miaow  Drone  Plant Feeder  Bubbles http://www.synchronium.net/2010/01/05/mephedrone-cat/

15.  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 Mephedrone Amphetamine

16.  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

17.  Euphoria  Sociability  Stimulation  Sexual Arousal  Music Appreciation  Hallucinations http://www.drugs.org.im/campaigns.htm

18.  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/

19.  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

20.  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

22. Contact Information Willie A. Hamilton, BC-FNP LIVEfit Medicine 1901 Brookside Dr. Kingsport, TN 37660 (423)765-9500