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Transcript of Legal highs cardiff lecture
Herbal Highs: Effects and
Consequences
Andrea Zangara
Flordis Natural Medicines
Medicinal Plant Research Centre (Newcastle University, UK)
Brain Science Institute (Swinburne University, AU)
Embracing Diversity, Drugs and Differences
15th October 09
Marriott Hotel, Cardiff
Classification of
Psychoactive Drugs:
drugs which alter
mood states and
consciousness
drugs used in the
treatment of
psychopathology
stimulants
hallucinogens
depressants anxiolytics
anti-depressants
antipsychotics
Cocaine: background
• isolated from coca plant (Erythroxylon coca)
• historical use in Colombia and Bolivia (largely
to aid strenuous manual work)
Cocaine: history
• cocaine itself isolated in
mid nineteenth century
• historical use in various
beverages and tonics
advertisement 1885
Vin Mariani introduced 1863
Cocaine: properties
• 0.6 - 1.8% in coca leaves
• usually administered as powder (cocaine hydrochloride) or crystalline rocks
Administration
• oral ingestion
– slow rate of absorption
– relatively steady state
• onset from other routes
– snorting - 3 mins
– injection - 15 secs
– smoking - 5 secs
‘rush’ ‘crash’
Acute behavioural effects
• increased confidence, exhilaration and
alertness
• decreased fatigue and boredom
• delays onset of REM sleep
• facilitates sustained effort
• enhances athletic performance
Cocaine risks and damages
• psychological addiction, compulsion
• breathing troubles, risk of stroke, heart attack,
seizures
• insomnia, weight loss, depression, irritability,
exhaustion, incoherence, delusions aggression
• toxic psychosis (similar to paranoid psychosis)
• symptoms caused by ‘crack’ may be more persistent
• large doses can directly damage neurons
• physical damage
Cocaine mix • Alcohol: cocaethylene extends effects and increases
cardiovascular toxicity
• Amphetamines: rare, similar effects; increase toxicity and cardiac stress
• Cannabis: smoked to relax (might increase blood pressure and heart rate)
• Ecstasy: popular mix as ‘dance drug’; increases physical and mental stress
• Heroine: ‘speedball’, the 2 drugs amplify each other and the heart can ‘lose rhythm’
• Ketamine: popular mix for dancing
• Viagra: can be dangerous (cardiovascular)
Amphetamine: background
• 1924 ephedrine isolated from Chinese ma
huang (Ephedra vulgaris)
• replaced by synthesised amphetamine in
1927
– rediscovered from 1887 as ephedrine substitute
• chemical structure related to adrenaline and
noradrenalin
• widely used in military scenarios (to this day)
• popular recreational drug in certain
subcultures
Amphetamines
• Speed (amphetamine sulphate)
• Base
• Methamphetamine
• Ritalin
Amphetamines: effects
• snorted, injected, smoked, ingested
• administration influences onset
• effects similar to cocaine but longer
• CNS continually stimulated
• suppression of appetite, sleep, increased concentration, confidence
• grinding teeth
• ‘crash’, in 3-8 hours
Amphetamines: risks and
consequences • risk of overdose (injection)
• chronic use: paranoia, tension, depression, fatigue, total exhaustion
• chronic use and large acute intake can trigger amphetamine psychosis (paranoia, obsessions)
• highly addictive
• tolerance is rapid
• withdrawal = opposite symptoms
Amphetamines mix
• Additional strain on the heart and increased blood pressure
• Alcohol: very popular, can drink more
• Cannabis: to relax
• Cocaine: similar effects, increase cardiovascular risk
• MDMA: extend and intensify; body temperature up
• Heroine: popular mix, decreases paranoia
• Ketamine: perception changes (time)
• Magic mushrooms: more paranoia
• Tobacco: more cigarettes
LSD (acids, trips)
• Lysergic Acid Diethylamide
• Synthetic, with profound effects on perception and cognition at very low doses (40-150 mcg)
• LSD has main effects on 5-HT (serotonin) neurons
• Colourless, odourless, tasteless: generally LSD is typically delivered orally, usually on a substrate such as absorbent blotted paper, sugar, or gelatine
• Difficult to understand quality and quantity as it rapidly degrades
Effects
• effects appear from 20 mins to 2 hours
• initially euphoria, goose bumps, increase in heart rate, jaw clenching, perspiration, pupil dilation, hypothermia, nausea
• between 30-45 minutes to reach their peak
• profound modification of consciousness, synaesthesia
• 8-12 ore in total
• after effect: tiredness, positive or negative feelings
• set e del setting very important
LSD: risks and
consequences
• bad trips
• excessive dose
• irresponsible actions
• flashbacks
• insomnia
• extreme paranoia
• personality disintegration / psychosis
MDMA (Ecstasy) (3,4-methylenedioxymethamphetamine)
• Related to both amphetamines and hallucinogenic (DA e
5HT)
• Empathogens as first ‘designer drugs’
• MDMA, MDA, MDE, 2CB, 2CT, 4-MTA, DOB....
• In pills and powder form (md)
• Effects starts after 20-40 mins, and last 4-5 hours
• Physiological effects similar to amphetamine
• Positive feelings of elation, euphoria, and closeness to others, appreciation of music and touch; replaced by depression and lethargy in the days afterwards
• Regular use may be neurotoxic, with prolonged serotonergic damage
Self-reported memory deficits in
recreational drug users:
findings from web-based studies Andrew Scholey, Jacqui Rodgers, Tom Buchanan,
Tom Heffernan, Jonathan Ling and Andy Parrott 1Human Cognitive Neuroscience Unit, University of Northumbria
2Doctorate in Clinical Psychology, University of Newcastle 3Department of Psychology, University of Westminster
4Psychology Department, Keele University 5Department of Psychology, University of Swansea
Human Cognitive Neuroscience Unit www.hcnu.com
Sydney ICOM July 2006
Summary • self-report data are consistent with laboratory
studies of memory deficits and other impairment
• internet provides insights into perceived problems and motivations
• future studies should include – online cognitive testing
– use of PRMQ
– relationship between subjective and objective measures
– prospective longitudinal studies starting in schools?
Gender effects
• Recent reports have
suggested that women
are more susceptible
than men to acute and
sub-acute effects of
ecstasy
• We found no gender
differences
– chronic effects equivalent
in males and females?
– chronic effects lead to
poorer calibration?
males females
RE
PO
RT
ED
ER
RO
RS
0
1
2
3
males females
ER
RO
RS
0.0
0.5
1.0
PMQ-LT
ERRORS COMPLETING FORM
Rodgers et al (2003) J Psychopharmacology 17, 379-386
Heat, ecstasy and LT-PM
• animal literature
indicates contribution
of hyperthermia to
MDMA serotonergic
toxicity
• here individuals who
stated that they
danced and became
hot while on ecstasy
reported more PM-LT
difficulties
Parrott et al (2006) Hum Psychopharmacology In press
Chronic physiological
effects of MDMA
• Demonstrated to
cause serious 5-HT
neurodegeneration
• In humans regions
of destruction
– Hippocampus
– Frontal cortex
Ketamine
• Dissociative anaesthetic : sense of
detachment from one's physical body
• Appearance: powder, tablets, liquid
• Effects last 45-60 minutes: from mild stimulation to out-of-body and near-death experiences
• Ketamine blocks glutamate activity, the result
is a temporary shut down of some brain areas
(K-hole)
Ketamine: risks and
consequences • ketamine can be extremely habit forming
• relatively safe
• dangerous in combination with other depressants
• danger of physical harm
• chronic use: troubles in digesting properly, urinating, memory weakening, alienated and dissociated states
• tolerance develops quickly, but no withdrawal (restlessness)
The use of psychoactive
plants
Humans have a natural drive to pursue
ecstatic experiences
All cultures have developed methods
for inducing such experiences
Every culture in the world (has) used
psychoactive plants
Cannabis
• The most used drug (illegal)
• Hashish 10-20% THC
• Marijuana 5-15%
• Smoked
• Ingested
• Over sixty active cannabinoids identified
• most prominent intoxicant
- D9-tetrahydrocannabinol (D9-THC)
– also e.g. D8-THC (relatively little)
• up to 20% of dry weight leaf
• also cannabinol (CBN) and cannabidiol (CBD)
– not themselves active
– may alter potency of active ingredients
• burning also modifies CBD into THC
• content is variable and changing historically
• Modern strains contains up to 3 times THC
Active ingredients
Cannabis and psychosis
• International Cannabis and Mental Health
Conference (2007): CBD as anti psychotic;
THC seems to interact with brain areas
related to paranoia and anxiety
• amisulpride and CBD in 42 psychotic
patients: improvement of symptoms and less
side effects with CBD (Leweke, 2007)
• CBD modulates THC?
• New strains unbalanced?
Legal / Herbal Highs
• Legal mind-altering substances, which cause similar
effects to illegal drugs
• Processed and unprocessed psychoactive
herbal/vegetable products (mushrooms, plants, cacti,
seeds, roots etc…)
• Synthetic products
• Various mixes and extracts (5x…)
• Categories:
– Energy (stimulants)
– Relaxant
– Aphrodisiacs
– Psychedelics
– Detox/ Prepare/ Repair
Contexts and Typologies
Contexts • Prohibition
• Harm reduction
• Globalisation
• New musical trends
• Other contexts without music
Typologies
• Sensation seeker (psychonauts)
• Experimental drug users attracted by media
• Those wanting a legal alternative to illegal drugs
• Poli drug users
•Curious
Smart Drugs and Smart Shops
• Eighties: nootropics
• Nineties: detox, prepare and repair,
herbal ecstasy, ‘herbal highs’
• Smart shops: from Netherlands to EU
• Today: synthetic legal highs, increasing
strength, Internet
Number of the total identified online shops
by country
selling legal alternatives to illegal drugs
Country Number of sites
Austria 3
Ireland 1
Portugal 1
Germany 4
Netherlands 25
UK 35
Total 69
7 out of 27 selected for further analysis offered more than one language version
A total of 8 different European languages were covered by the 27 online shops
Source: European Monitoring Centre for Drugs and Drug Addiction
(EMCDDA) 2008
How Safe?
• NZ: Survey of patients and relatives
presenting to an emergency department
(n=1043)
• 11.9% had taken herbal party pills (30%
among 14-25 year olds)
• 84.8% had felt effects from party pills
• 50.4% described effects as “good”
• 4.8% had sought medical attention for effects
Source: Nicholson, T.C. (2006), Prevalence of use, epidemiology and Toxicity of “herbal
party pills” among those presenting to the emergency Department.
60 times than nature!
Herbal Highs: Policies
• ‘Herbal highs’ — pose a range of difficult questions
for drug control policies:
• Conceptual: how to define which products are of
interest
• Practical and methodological: how to monitor the
products sold, identify the synthetic compounds that
they may contain and assess their health risks
• Little knowledge about the pharmacology, toxicology
and safety profile in humans, the type and amount of
synthetic substances added may vary considerably
The Smart Alternative (harm
reduction) • Herbal XTC → MDMA/Stimulants
• Magic mushrooms → LSD
• GHB → Opiates
The ban on them had as consequence:
BZP – Amanita muscaria – Synthetic
cannabinoids – Research chemicals
Herbal ecstasy (ephedra/ ma
huang/ sida cordifolia /sinephrine)
• Sympathomimetic amine acting on adrenergic
receptor system
• Similar in structure and effects to the synthetic
derivatives amphetamine and methamphetamine
• Euphoria, stimulant, appetite suppressant,
bronchodilator, thermogenesis
• Can cause insomnia, nervousness, heart-problems
and high blood pressure, stroke, and seizures
• Cardiovascular risk increases when combined with
other stimulants
• Can increase tolerance to alcohol effects
Synthetic Stimulants/ Legal
Highs
Not so smart ingredients (little or unknown long term risks)
• Butylone
• Methylone
• Methedrone
• Mephedrone
• Methcathinone
• Dimethylcathinone
• Synthetic cannabinoids
• Piperazine
• Benzylpiperazine
• 3-Trifluoromethylphenylpiperazine
Benzylpiperazine (BZP)
• Piperazines, not herbal but sold due to
amphetamine-like effects and legal
• Benzylpiperazine (BZP) is the most common
derivative
• Piperazine was originally used as an
antihelmintic to treat round worm
• Derivatives were further investigated in the
1970’s but trials stopped when abuse
potential was clear
Benzylpiperazine (BZP)
The effects
• Loss of appetite, increased heart rate, tingling skin and flushing ,sense of
euphoria and increased alertness;
• Sense of taste, sound and colour may be enhanced;
• Such effects can last between four to eight hours, depending on the amount
taken, the user's mood, metabolism and environment.
The risks
• Users report an inability to sleep for as long as 10 hours after the effects have
subsided
• Can leave users with symptoms similar to a hangover, such as headache,
fatigue, reduced appetite and nausea
• Possibility of slight memory loss
• BZP has been linked to cases of seizure, renal failure and acute psychosis in
some studies. Mixing BZP with other drugs, including alcohol, may increase risk
of negative effects.
• The law:
• At present, a loophole in the UK law allows BZP to be sold as a soil fertiliser.
Containing 180mg of BZP
and TFMP. Plus lots of
other nutrients and
minerals
• The combination of BZP and TFMPP has been associated with
a range of side effects (insomnia, anxiety, nausea and vomiting,
headaches and muscle aches similar to migraine, seizures,
impotence, rarely psychosis), as well as a prolonged and
unpleasant hangover effect similar to that produced by alcohol.
These side effects tend to be significantly worsened when the
BZP/TFMPP mix is consumed alongside alcohol (Wilkins C. Et
al., 2007)
Doves
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• Now available BZP & TFMPP free.
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strong root development. Doves Feeder is suitable for use on indoor and outdoor plants.
DOVES are available to customers outside USA, Australia and New Zealand.
Doves are available in 2 packs and 5 packs.
• Recommended dosages
DIRECTIONS: Use one Dove feeder per square meter around garden beds. For potted plants use half a Dove
feeder toward outer edge of the pot. Use half this amount for Violets and ferns.
ALWAYS WATER IN WELL AFTER APLICATION.
•
Do not contain methylone/ethylone
NOT FOR HUMAN CONSUMPTION SOLD AS PLANT FOOD The Dove pills are a state of the art product.
They don't contain the DOMS but a beta ketone.
Structurally this ketone is very similar to MDMA, but while that is controlled under the Misuse of Drugs Act
1971 the ketone isn't. Nor does it fall into any of the Analogue Laws or sub clauses of the Misuse Act. It is not
a phenethylamine
•
Magic
Mushrooms
• Active ingredients: psilocybin and psilocin (varies)
• Both mimic serotonin action - so effects may be through serotonin receptors.
• Over 90 species of magic mushrooms worldwide
• Similar effect to LSD, but shorter, less intense
• Eaten (fresh or dry) or drank as tea
• Dose: 2 gr (dry), 20 gr (fresh)
• Modification of perception dose-dependent
• Effects after 20 mins, peak at 30-45 for 1-2 hours, total 4-6 hours
Risks and consequences
• Exaggerate negative feelings
• Wrong setting
• ‘Bad trip’: fear, nausea, anxiety, confusion, fainting
• Memory impairment
• Latent or pre existent psychosis
• Poisonous mushrooms
• High turnover UK Treasury sales tax on
hallucinogenic mushrooms: 255,000 Euro per year on
a turnover of approx. 1.46 million Euro per annum
(estimations)
Fly Agaric (Amanita
muscaria)
• Ibotenic acid converted to muscimol on
drying or in the body; same effects, but
muscimol is 5-10 times more potent
Effects
• Psilocybe and Amanita are not chemically related with regard to their psychoactive properties: markedly different psychoactive effects
• Effects can be felt 30-120 minutes after ingestion.
The peak will start 1-3 hours after ingestion and can
last 6-10 hours. After effects can last another 1-6
hours. Alcohol can intensify intoxication
• Marijuana can ease any feelings of nausea and
intensify intoxication.
Effects cont.
• Low dose = 1-5 grams dried (1-2 fresh mushrooms)
medium dose = 5-10 grams dried (2-4 fresh
mushrooms) high dose = 10-30 grams dried (4-10
fresh mushrooms)
• Visual distortions, mood changes, euphoria, relaxation, delirium, inebriation, spasms.
• High doses give swollen features, high rage and madness, characterized by bouts of mania, followed by periods of quiet hallucination.
• Fatal dose = 10 mushrooms (ca. 100 g fresh mushroom).
• No antidotes! - stomach pumped
Synthetic Cannabinoids
(Spyce) • Herbal blend that claims to be a legal substitute for
cannabis
• Advertised as an ‘exotic incense blend which
releases a rich aroma’ and ‘not for human
consumption’
• Some of the declared ingredients are plants
traditionally known as ‘marijuana substitutes’
• Most of the ingredients listed on the packaging are
actually not present in the Spice products
• It is assumed effects described by users are due to
added synthetic cannabinoids
Information fom Dr. R. Sedefov, Lisbon, 15 June 2009
Synthetic Cannabinoids
(Spyce) • In 2008 a new psychoactive substance JWH-018 a
cannabinoid receptor (CB) agonist identified in Spice
products in Austria
• Chemical structure differs substantially from THC, but
it produces similar effects and more potent
• Several synthetic cannabinoids discovered
afterwards across EU
• No pharmaceutical product has emerged, no human studies carried out
• Little is known about metabolism and toxicology. The health risk of the inhaled smoke is unknown
Synthetic Cannabinoids
(Spice) • In the case of JWH-018 it can be assumed that due to
structural features there may be a certain carcinogenic potential?
• Active in low doses; accidental overdosing with a risk of severe psychiatric complications because the type and amount of cannabinoid may vary considerably
• In general, there may be a risk for the appearance of a full CB receptor agonists; leading to life threatening conditions if overdosed?
• Seems that tolerance may develop fairly fast; arguably this might be associated with relatively high potential to cause dependence
Salvia divinorum
• The Salvia genus is part of the Lamiaceae family (more commonly called the Mint family). The Mint family contains over 200 genera and 3,500 species
• Salvia has a long history of use by the by the
Mazatec people of Oaxaca, Mexico for divination,
entheogenic, and healing purposes
• Dried leaves: smoked (bong), chewed; solid or liquid
extracts (5x-100x)
• The main active chemical in Salvia divinorum is
called salvinorin A
Salvia: Effects and
Consequences • Salvinorin A is an extremely powerful consciousness
altering compound
• When the herb is consumed either by smoking the
dried leaf or chewing the fresh leaves the effects are
usually (but not always) pleasant
• When the dose goes above 500 - 1000 mcg the
effects can be excessive –always need a ‘sitter’
• Hallucinogenic – psychedelic effect, but short (3’5
min), powerful, immediate; not a ‘dance drug’
• May trigger latent psychological and mental problems
• Illegal from 2005 in some EU
Salvia: Effects and
Consequences
• Most harms resulting from the use of psychoactive
drugs like salvia occur as a result of people injuring
themselves when under the influence of the drug
• There is some concern that salvia could trigger
psychotic episodes particularly in young people and
vulnerable individuals with latent mental health
problems
Hawaiian Baby Woodrose
(Argyreia nervosa)
• LSA, simile a LSD (also Ipomoea)
• Medical use: bronchitis, cough, diabetes,
syphilis, tuberculosis, and other maladies. Also
as aphrodisiacs, tonics, cognitive enhancer
• Dose: 3-8 seeds in little pieces
• Effect similar to LSD but more narcotic
• Nausea (remove coating)
• Overdosing is rare
• Trigger psychosis or psychotic states
Kratom
• Mitragyna speciosa is the botanical name of the plant
• From South East Asia; Kratom has been used as medicine in Thailand since ancient times
• The primary active chemicals in kratom are mitragynine
• At lower doses, has physically stimulating effect. At larger doses it is more sedating, with a relaxed, euphoric cerebral sensation, with some pain relieving properties (similar to those of a mild opioid like codeine)
Effects and Consequences
• Can ease the discomfort of withdrawl from opium and
opium based substances like heroin, morphine
• There is a chance of becoming addicted (if only
psychologically) to kratom if abused
• When taken orally, the effects of kratom can be felt
about 30-60 minutes after ingestion, and the peak
lasts 2-3 hours. When smoked, the effects start
quicker and last about 60-90 minutes
• The only common negative comment about kratom is
that it causes nausea at high doses
Other natural psychedelics
• Cacti: Peyote / San Pedro (mescaline)
• Ayahuasca (dmt / armaline)
• Yopo (dmt)
• Iboga (ibogaine)
• Generally not considered ‘trendy’ and
used only by experienced people
RESULTS Sample characteristics
The average age of the interviewees was 24±5 years, 65 (64.4%) of whom were males, 36 (35.6%) females. Female smartshop customers were significantly younger than males (22.6±3.6 vs. 24.9±4.7, p=0.014). The average age at first visit to a smartshop was 20±3.8.
80.2% of the interviewees had bought energy drinks from a smartshop, 76.2% magic mushrooms, 58.4% herbs, 49.5% herbal XTC, 47.5% smart nutrients, 33.7% nootropics, and 20.8% strong psychoactive herbs. The strongest the product, the more the customer tend to be older and informed on the effects and consequences
Conclusions: a missed
chance? • Psychedelic herbs when out of their context or in forms different
from traditional use may produce dangerous and unwanted effects
• Smartshops should be honest source of information and literature
on the contents, effect and safety of legal highs, never instigate or
push use of anything
• The original concept was not to provide completely safe products,
but safer than illegal drugs and identifiable, and to give enough
information for the safest use
• The smart concept should include health and safety monitoring,
quality and purity of products, liaison with health and regulatory
authorities
• Today’s trend seems only to get easy and fast money, and trick the
law with new and potentially dangerous synthetic molecules,
representing a serious hazardr to public health
• A new and effective legal framework is urgently needed
Have conscious dreams
and remember:
You can fly also without drugs!