Emerging Trends in Drug Abuse
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Transcript of Emerging Trends in Drug Abuse
Emerging Trends in Drug Abuse
Joshua Pruitt, MD, FAAEMFebruary 6, 2014
What’s New
• E-Cigarettes• “Krokodil”• “N-bomb”• “Syrup,” “Purple Drank,” “Sizzurp,” “Lean”• “Molly”• Salvia Divinorum
What’s ‘Sort-of’ New
• K-2/Synthetic Cannabinoids• Bath Salts, MDPV, Khat• Energy drinks
E-cigarettes
• Battery-operated devices marketed as “safer” than traditional cigarettes
• Produce flavored nicotine aerosol/steam that looks and feels like tobacco smoke
• No tar or other chemicals from burning tobacco leaves
• Still require a chemical diluent that has an unknown safety profile
E-cigarettes
“Krokodil”
• Cheap heroin substitute• Desomorphine (Heroin is diacetylmorphine)• Made by combining codeine tablets with toxic
chemicals (i.e., lighter fluid, industrial cleaners)• More powerful than heroin with a shorter duration• Causes gray/green scaly flesh at site of injection, thus
the name• Injection sites often become gangrenous• Average life-span after beginning use is 2 years
“Krokodil”
“N-bomb,” “Legal Acid,” “Smiles,” “25I,” “25C,” “25B”
• Three closely-related synthetic hallucinogens• Substitute for LSD or mescaline• Serotonin stimulant, more powerful than LSD• Can cause seizure, MI, respiratory
depression/arrest, death• 19 related deaths in US between 3/2012 and
8/2013
“N-bomb,” “Legal Acid,” “Smiles,” “25I,” “25C,” “25B”
“Syrup,” “Purple Drank,” “Sizzurp,” “Lean”
• Phenergan w/codeine plus soda (Actavis)• May include hard candies• Celebrated in rap music• High risk of respiratory
depression and CNSdepression
• Deaths from prescription opioids now outnumber deaths from all other drugs
“Syrup,” “Purple Drank,” “Sizzurp,” “Lean”
• Implicated in the deaths of DJ Screw and Pimp C
“Syrup,” “Purple Drank,” “Sizzurp,” “Lean”
• Overdose symptoms related to promethazine and codeine
• Promethazine – CNS depression, anticholinergic– Tachycardia, altered mental status, delirium
• Codeine – CNS depression, respiratory depression– Miosis, bradypnea/apnea, hypoventilation
• Seizures highly unusual and usually related to hypoxia
“Syrup,” “Purple Drank,” “Sizzurp,” “Lean”
“Molly”
“Molly”
• Slang for “molecular”• Refers to pure crystalline powder form of MDMA
(Ecstasy)• Sold in capsules• Celebrated in rap/hip-hop music• Produces energy and euphoria• May cause hyperthermia, confusion, depression,
sleep problems
“Molly”
• Symptoms often mixed toxidrome due to co-ingestions
CNS effects CV effects GI effects Derm effectsAMS Palpitations Dry mouth DiaphoresisSeizures Chest pain Nausea/vomiting PiloerectionRestlessness CrampingAgitation Dental effects Anorexia GU effectsHyperthermia Bruxism Urinary retentionSyncope Enamel erosion Sexual dysfunctionAtaxia
“Molly”
Salvia
• Highly selective kappa-opioid receptor agonist• Originated with Mexican Mazatec shamanism• Hallucinogen with psychedelic/dissociative effects• Taken by smoking, no real effects from ingestion
Salvia
• Intoxication effects– Uncontrollable laughter– Vivid reliving of past memories– Sensation of motion or being pulled by something– Visions of membranes or other 2-D surfaces– Merging with or becoming objects– Overlapping realities, such as being in two places at
once
Salvia
“K-2,” “Spice,” Synthetic Cannabinoids
• Very diverse class of drugs• Bind to the cannabinoid receptor• Similar effects to marijuana• Often more intense effects• Include hallucinogenic and psychedelic effects
“K-2,” “Spice,” Synthetic Cannabinoids
• Reported effectsImpaired driving incidents Suicide attempts
Increased anxiety Panic attacks
Palpitations Respiratory “complications”
Aggression Mood instability
Altered perception Paranoia
K-2/Synthetic Cannabinoids
Bath Salts, MDPV, Khat
• Synthetic cathinones• Function as dopamine-norepinephrine reuptake
inhibitors• Four times more potent than Ritalin or Concerta• Duration of action 3-4 hours, with after-effects
lasting as long as 6-8 hours
Bath Salts, MDPV, Khat
CNS/Psych effects CV effects Respiratory effects Renal/GI effects
Aggression Hypertension Tachypnea Transaminitis
Agitation Vasoconstriction Respiratory alkalosis Urinary incontinence
Confusion Tachycardia Fecal incontinence
Extreme anxiety Chest pain Nausea/vomiting
Hallucinations Rhabdomyolysis
Hyperthermia AKI
Delusions
Paranoia
Suicidal ideations
Bath Salts, MDPV, Khat
• Amateur chemists change the chemical composition of the “bath salt” and make it nearly impossible for regulation to keep up with production.
• Mortality rate from “excited delirium” estimated at 8-14%, most die while in police custody
• Treatment is supportive– Benzo’s, restraints if necessary, watch for rhabdo
Bath Salts, MDPV, Khat
Elevated temperature
Agitated delirium
Respiratory arrest
DEATH
Bath Salts, MDPV, Khat
Energy Drinks
• Drinks like Red Bull, Rock Star, Monster• Contain caffeine and other legal stimulants
(guarana, ginseng)• Can contain 75 to >200 mg of caffeine per serving
– 34 mg per serving in Coke– 55 mg per serving in Mt. Dew
• If it says “no caffeine,” then it uses guarana, which is the same as caffeine
Energy Drinks
• 5-hour energy advertises “no crash,” but that relates to the sugar crash– Contains artificial sweeteners
• Short term problems– Increased heart rate, palpitations– Hypertension– Dehydration– Sleep problems
Energy Drinks
• Some may have 2 servings per can• When used occasionally, not necessarily dangerous• Think of them as highly caffeinated drinks• Combination with alcohol
– The stimulant effect of the energy drink can mask how intoxicated someone is
– Can give the drinker the impression they are not impaired– Research shows that people drink more and have higher
BALs when they combine alcohol and caffeine
Energy Drinks
• ER visits related to energy drink consumption– 10,068 in 2007; 20,783 in 2011– 60% of patients drank energy drink alone– 27% of patients combined with prescription drugs– 13% combined with alcohol– 10% combined with illegal drugs– 9% combined with prescription stimulants
Questions