“Party Drugs”North Eastern Opening Doors

HIV/AIDS Conference

October 2013

The Growing Alphabet…

E, K, G, BZP, 2CB, 5MeO-DIPT...

“Party Drugs” such as Ecstasy, Ketamine and GHB have not gone away. However, there have been significant changes to purity and associated risks. As well, a proliferation of new substances are quickly appearing.

What are some of the current substances being used and the risk reduction messages we should be sharing, particularly with today’s youth?

Before we start…

• Why did you come? • What are you interested in?• Questions as we go:

– If we’re not sure about something we can look it up.

• What we know changes:– New issues; new science.

• If you are going to take drugs:– Do your homework.– Treat drugs, and your body, with respect.

Overview

• Terminology– Street Drugs Rave Drugs Club Drugs

Party Drugs Novel Psychoactive Substances• Current Data & Trends• Specific substances:

– What they are; How they work– Immediate risks; Longer-term concerns– Risk reduction strategies

• Websites

Order of information about Specific Substances

• Bath Salts• Research Chemicals

• MDPV; Mephedrone• Phenethylamines• Tryptamines

• Ecstasy• Pills; MDMA; Molly

• Synthetic Cannabinoids• Cannabis• Salvia• Cocaine• Methamphetamine

• Ketamine• GHB• Viagra• Poppers(amyl nitrite)• LSD• Magic Mushrooms• Cough Syrup• Inhalants/Solvents • Alcohol• Opiates• Other Pharmaceuticals

Note: The drugs are ordered in the flow of a typical workshop discussion and are not grouped by class, effect, or any particular categorization.

Disclaimer• Information is presented on some of the more commonly

used and discussed substances and is collected from a variety of sources, including trusted websites and from people who have used these drugs.

• More information is available about certain substances than others -this is not an exhaustive list or document.

• We have attempted to consolidate as much accurate information as possible, but not all of it is scientifically backed-up or proven.

• Substance use involves inherent risks and no information provided here can eliminate all risks. Take drugs with caution and consult healthcare professionals, such as a doctor, before engaging in use.

What do I think of as “Street Drugs”?

“Street Drugs”• Heroin; Oxy; Crack Cocaine

– Including injection drug use• Alcohol

– Including non-palatable• “Meds” (psychiatric; opioids)

These stereotypical images are used to illustrate primary Hep C / HIV transmission concerns and to prompt discussion about attitudes and stigma.

What do I think of as “Party Drugs”?

Rave Drugs / Club Drugs

• 1970’s - 1980’s:– New York and Chicago discos– Ibiza, Spain (UK Tourists)

• 1980’s - 1990’s:– Underground Raves (U.K.); Warehouse Parties (New York,

Chicago, Detroit, Toronto); Gay Nightclubs• 1990’s - 2000’s:

– Nightclubs (U.K.)– Raves, Nightclubs, Gay Circuit Parties (North America)

• 2000’s:– Nightclubs; Gay Clubs; all-ages-all-night events– “Parties”

“Party Drugs”

• A generalized term for substances that have historically been associated with raves and all night dance-clubs.

• These drugs are used by many kinds of people in all kinds of settings.

• Some of these drugs are illegal, some have no classification

• Examples:– Ecstasy, Ketamine, GHB, Acid, Cocaine, Crystal

Methamphetamine– Newer Classes and Research Chemicals

• Ecstasy/MDMA• Amphetamine / Methamphetamine• GHB• Ketamine• Mushrooms / LSD• Cannabis• Nicotine• Powdered Cocaine• Poppers• Viagra• Energy Drinks• Alcohol• Research/unclassified chemicals• Pharmaceuticals

• anti-depressants/anxiety; opioids

“Party-Drugs”

Research Chemicals/Legal Highs• Popularized by “fringe scientist” and doctor, Alexander

Shulgin.• Examples

– 2CI, 2CB, 2CT2, 2CT7, 5-meo-DiPT, 5-meo-AMT, BZP, TFMPP, mephedrone

• Some are legal, many are increasingly scheduled.• Have been easily obtained over the internet the last few

years.• Often the ones with psychedelic properties are sought.• Some mimic amphetamine type substances.

Novel Psychoactive Substances

What’s been happening over the last decade?• Molecular Chemistry Geeks• “Psychonauts”• Internet• BAD DRUG POLICY

What are we actually seeing?

• Data is limited.• Data is time delayed.• Researchers and health/social services

aren’t asking the right questions and can’t keep up.

Ontario Student Drug Use and Health Survey

Survey of 9,288 Ontario students in grades 7 to 12 during the 2010-2011 school year.

http://www.camh.ca/en/research/news_and_publications/ontario-student-drug-use-and-health-survey/Pages/default.aspx

*Remember this survey is administered IN SCHOOL, so does not represent all youth in Ontario, and likely under reports use.

DATIS – Drug Treatment Admission Data, Ontario

Drug Treatment Numbers

• Only reflect people that actually made it to treatment:– geography; housing; mental health; stigma; types or

treatment available

• Do people honestly report all use stigma?• More people in treatment does not necessarily

mean more people using.– Long-term users presenting now?

• Are people voluntarily coming or being “forced” (by courts/families)?

TRIP! survey data 2008

Trends (2008)

• Of greatest concern was the re-emergence of crystal meth use over the past year. In 2007, only 15% of respondents identified using this substance in the last year or month. In 2008, the number rose to 26%.

• Also of concern was the number of people using prescription medication for psychoactive purposes. This question was not asked in the previous survey and has not been a focus for TRIP! in the past, but with more than 20 percent of people using these substances, more work needs to be done to address this in the coming year. Other than Oxycodone and Codeine, respondents identified using Adderal, Ritalin, Dexedrine, Diluadid, Concerta, Valium and Morphine.

Trends (2008)

• Small numbers of people indicated use of research chemicals such as DOB, DOI, DOC, 2CE, 2CC, 2CB, 2CI, 5-MeO-MiPT, and AMT, nitrous oxide, poppers, pcp, hasish, over the counter disassociative DXM, a variety of plant based hallucinogenics such as Kratom, Salvia, DMT, morning glory seeds, Mugwort T. Peruvianus (a cactus), and other amphetamines such as TMA, BZP, and MDA.

“Bath Salts”

• Canadian Centre for Substance Abuse– CCENDU Alert June 2012 – “Bath Salts”

http://www.ccsa.ca/2012%20CCSA%20Documents/CCSA-CCENDU-Drug-Alert-Bath-Salts-2012-en.pdf

Specific Drugs

What should we talk about?

Things I would focus on:• Bath Salts• Synthetic Cannabis• Ecstasy/“Molly” adulterant screening kits• Sizzurp• GHB/Ketamine

Have you heard of MDPV?

• Mystery drug causing freakoutsToronto Sun posted: January 19, 2012

http://www.torontosun.com/2012/01/19/mystery-drug-causing-freakouts

• Owen Sound, Ontario, Canada

“Four people have showed up at the hospital within a 24-hour period suffering from extreme paranoia, vivid hallucinations and thoughts of killing themselves after smoking or injecting a mysterious brown powder…”

• In this case, lab analysis by Health Canada confirmed the use of MDPV.

Miami Zombie Attack, May 2012

• May 26, Miami Florida– Police shoot and kill a man who was attacking another person and

“chewing his face”. Police suspect the attacker was high on “bath salts”.

• May 30– Miami's 'Naked Zombie' Proves Need to Ban Bath Salts, Experts

Say• http://www.usnews.com/news/articles/2012/05/30/miamis-naked-zombie-pr

oves-need-to-ban-bath-salts-experts-say

• June 02– Drug Linked To Cannibalism Case Hits Edmonton Streets

• http://www.huffingtonpost.ca/2012/06/02/bath-salts-drug-edmonton-cannibalism_n_1565046.html?utm_hp_ref=rudy-eugene

June 28, 2012

• “No Bath Salts in Miami Case”– Miami-Dade Medical Examiner, Bruce Hyma

"The department's toxicology laboratory has identified the active components of marijuana... The laboratory has tested for but not detected any other street drugs, alcohol or prescription drugs, or any adulterants found in street drugs. This includes cocaine, LSD, amphetamines (Extasy, Meth and others), phencyclidine (PCP or Angel Dust), heroin, oxycodone, Xanax, synthetic marijuana (Spice), and many other similar compounds."

“Bath Salts” in the media

• Numerous stories in the media of people acting very bizarrely after suspected use of “bath salts”.

• Stories from the UK started 3-4 years ago and over the last year or two in Canada and the United States.

• Sometimes toxicology reports show that “bath salts” were actually not ingested.

• The extreme cases are the ones reported; many people have used the substances with no problems at all.

“Bath Salts” and other newer drugs

• The next few slides provide information on newer drugs that have come to market in the last few years.

• The media has paid particular attention to “bath salts”:– Much of the reporting has been inaccurate and

sensationalized.– However, there can be some serious side effects with

these new substances.

“Bath Salts”

• May refer to a number of compounds that are synthetic substances based on the (cathinone) compounds that exist in the Khat plant of East Africa.– Examples: mephedrone, methylone, and MDPV

(methylenedioxypyrovalerone)

• Typically they have strong stimulant effects and require a smaller dosage than drugs like methamphetamine or cocaine.

• In higher doses, or with extended use, may cause strong “psychiatric effects” (psychosis).

• TRIP! Info: www.tripproject.ca/trip/?q=node/1939

“Bath Salts”

The next few slides are adapted from:

• “Characterization of Methylenedioxypyrovalerone (MDPV) and Mephedrone in “Legal High” Products by Chemical Color Tests, Microcrystalline Tests, with Confirmation by LC/MS”

• Emmi Slivka• The Center for Forensic Science Research and Education

Willow Grove, PA

Mephedrone and MDPV

• Structurally related to cathinone, an illegal stimulant drug extracted from the khat plant

Mephedrone

• Mephedrone, 4-MMC, Meow, M-Cat, Bubbles• 2-Methylamino-1-p-tolylpropan-1-one• Stimulant; Euphoriant• A synthetic stimulant with empathogenic effects

that some people report being a “cross between ecstasy and cocaine”.

• Between 2007 and 2009, it became available for purchase online, was used increasingly in Europe, Australia, and New Zealand, associated with several deaths, and then controlled in some countries as a result.

Mephedrone

• Duration of 2 to 3 hours, depending on the quality of the drug as well as the user; comedown is said to last an hour but some users have reported not be able to sleep for several hours.

• It is a stimulant:– Some users report heart palpitations and irregular or

racing heartbeat which may last for quite some time after taking the drug.

– Be careful mixing with other stimulants (e.g., energy drinks)

How it is used

• Routes of administration:– Snorting and swallowing (in gel caps or “parachuting”)– Less common methods include smoking, rectal

administration and intravenous use

• Common Doses: – MDPV: Range from 5mg-25mg – Mephedrone

• Snorting- 25 to 75mg; >90mg considered high dosage• Oral- 150 to 250mg

Pharmacology

Mephedrone: • Promotes the release of monoamine

neurotransmitters as well inhibiting their reuptake– norepinephrine, serotonin and dopamine

MDPV: • Increases levels of dopamine and

norepinephrine – Reuptake inhibitor

Effects of Mephedrone and MDPV

• Desired Effects – Euphoria – Sociability – Elevated Mood – Hallucinations – Increased Insight – Increased Energy

• Adverse Effects - High Heaet Rate- High Blood Pressure - Arrhythmia - Seizures - Paranoia - Agitation

UK Mephedrone Ban May Have Done More Harm Than Good

• http://whyprohibition.ca/blogs/jesse-wentzloff/uk-mephedrone-ban-may-have-done-more-harm-good

• The [ban], which came after mephedrone had been linked to a number of deaths, which were later found not to be attributable to the drug, could be driving demand for other new drugs.

• It comes after recent research revealed that 40 new synthetic drugs have flooded into the UK during the past year

"One of the dangers of the approach that has been taken is that if we ban every new drug without a balanced view, then people will keep making more new drugs to replace them and eventually they will make something that is extremely toxic which, when kids take it, they will die.”

- Professor David Nutt, Independent Scientific Committee on Drugs

“Bath Salts”

• The term “Bath Salts” is problematic:– So many different substances– No standard definition– Creates false sense of safety– Confusion with other substances such as

solvents like hair spray and nail polish• Better to use terms like “Research

Chemicals” or “Novel Psychoactive Substances”

“Bath Salts” and otherResearch Chemicals

• As with all substances, these newer drugs have inherent risks.

• Generally, it is probably better to encourage people to avoid “bath salts” and stick to substances they are already familiar with.

• However, if people are going to use them, they should be careful with dosing, the unpredictability of the effects, and be aware that nothing is really known of the long-term consequences.

Research Chemicals

• Popularized by fringe scientist and doctor, Alexander Shulgin.

• 2CI, 2CB, 2CT2, 2CT7, 5-MeO-DiPT. 5-meo-AMT, BZP, TFMPP, mephedrone.

• Some are legal; many are increasingly are scheduled.

• Can easily be obtained over the internet.• Typically the ones with psychedelic and/or

stimulant properties are sought.

Research Chemicals

• Typically white crystalline powder sold in plastic baggies or gel capsules.

• Often sold in packages marked “not for human consumption” and labelled “Bath Salts” or “Plant Food” to deceive customs.

• Common Product Names: – Meow Meow; Tranquility; Blue Silk; Cloud 9; Bolivian

Bath; Ivory Wave; Bliss; Lunar Wave

Research Chemicals - Concerns

• Mislabelling• Bad batches• Dosage• Long-term effects unknown• False sense of security

Research Chemicals

• Come in “waves” through the “dance music scene”… and now other communities or social networks.

• Scheduling of these substances (making them illegal) causes “blow-out sales” by manufacturers, who want to get rid of them quickly:– Easy to sell through the internet;– Easy to buy if you have a credit card;– Bulk sales to dealers:

• who re-package for end user, sometimes selling as traditionally known drugs such as “Ecstasy”, or now, “Molly”.

Research Chemicals

• Little is known of these substances, particularly regarding their long-term effects and potential contraindications with medications and other drugs.

• Not a very high “success rate”: – With many substances, 50% of users will get

the desired high, the other 50% will have vomiting and diarrhea.

Research Chemicals - Safety

• “There really is no safe way – it’s all a gamble...”

• What exactly are you taking?!– Mass spectrometry (cost prohibitive)– Home test reagent kits (not definitive)– User reports (subjective)– One person try sub-threshold dose before

everyone else (guinea pig)

Phenethylamines

• A family of chemicals structurally similar to the amphetamines that are naturally occurring plant and animal enzymes. Synthetic phenethylamines are also made by chemists.

• Examples– 2C-I, 2C-B, 2C-T-2, 2C-T-7, mescaline and others– MDMA, mephedrone

• http://www.tripproject.ca/trip/?q=node/65

2C-* Effects

• Visuals• Stimulation• Sensory and Tactile Effects • Synaesthesia• Memory Flooding and Thought Cross-

Referencing

Phenethylamines: 2-CB

• White powder or tablet

• $30 per dose• MDMA/LSD effect• Open and closed eye visuals• Mild stimulant and mood enhancer• Can cause cramps and diarrhoea• Lasts 4 to 6 hours• “Life altering”• Tolerance develops quickly

Phenethylamines: 2-CT-7

• Powder or tablet• 7 mg tabs sometimes sold as “E”• Change in perception & time• Increased sociability• Dissociative effect• May cause anxiety, confusion or panic attacks• Nausea and vomiting• Has resulted in death

2C-* Risk Reduction• Although each phenethylamine has its own distinct signature, there are

some general concerns.• Dosages for each (most are around 10mg) are very small and as powder it

cannot be ‘eyed’ out accurately. Weigh it out on a milligram scale.• Dosing more than 20milligrams can get really intense. Every few milligrams

over 25 will double the intensity, but will most likely just increase the unwanted effects and any toxicity.

• Don’t snort any 2Cs! Death and OD cases seem to all have come when users snorted 2C-T-7 or 2C-B, and in any case it burns so badly that most of the your first hour high will be in pain and tears. Not good for sinuses!

• The first time, any of the 2Cs will be extra-intense; try a half dose by itself at home or somewhere safe.

• Wait at least 2 weeks or a month between trips. Frequent 2C trips will get less interesting even with increasing the dosage. Higher dosages often lead to more side-effects than wanted effects.

2C-* Risk Reduction• Phenethylamines are prone to causing mystical or life-changing

experiences.  Make sure that you are in a comfortable environment (mentally and physically) and have everything you’ll need with you.  

• The onset of 2Cs can vary widely. On an empty stomach and swallowed as powder out of the capsule or dissolved in a drink, the onset will be quick (15-45 minutes.) Left inside the capsule or as a pill, or if taken on a full stomach, the onset will be delayed, sometimes up to 3 hours!

• That said, don’t take more if you aren’t high.  You may still be coming up 3 hours after dosing.

• 2C-B has a rather brief duration, usually entirely over within 5 or 6 hours but other 2Cs will keep you up all night like E or speed.

• 2C compounds can be dangerous in combination with MAO inhibitors such as syrian rue/harmaline or certain antidepressants (MAOIs and otherwise)

• Be careful! Very little is known about these compounds. Make sure someone knows exactly what you’re taking when you dose in case you need help. (medical or otherwise!)

Tryptamines

• A family of chemicals that are found in animals, plants and fungi.

• Neurotransmitters serotonin and melatonin are tryptamine-based structures.

• Can be synthesized in laboratories– Foxy, LSD and melatonin sleeping pills have all come from the

human imagination

• Examples– AMT, DMT, “Foxy” (5-meo DIPT), “Moxy” (5-MeO-MIPT)

• http://www.tripproject.ca/trip/?q=node/44

Tryptamines: AMT

• (Alpha-methyltryptamine)– Lasts 16 hours– Effect like combining MDMA & LSD– Wide range of experiences– Comes in a white powder– Can be swallowed, snorted or smoked– $20 – 25– Only a small amount needed– Narrow dose range 10 – 15 mg.– Can cause unpleasant trips

Tryptamines: 5-MeO-DiPT

• 5-MeO-DiPT Foxy Methoxy “Foxy”• Synthetic tryptamine first developed by Alexander

Shulgin in 1980. • It may be sold as a small amount of loose powder in a

gel cap, or as a pressed pill. • Effects are wide-ranging and last 4 - 8 hours.

“Foxy” 5-MeO-DIPT

• White powder or tablet• Dose: 5 – 12 mg• $30 – 40 per dose (? Toronto 2011)• Causes body buzz, mood lift, euphoria,

increased sex drive, and enhanced visuals• Long lasting• Can cause acute vomiting, long come down

(12 hours), diarrhoea, a widely varied experiences.

Foxy - Effects

• Audio distortions– Your own voice might sound strange, as will others; music you

know may seem unfamiliar or different

• Tactile sensitivity– Your skin may seem extra-sensitive; response to touch may

range from feeling very good not so good, or just plain odd

• Enhancement of visual textures– Brightening of colours, trails and visual distortions

• Nausea, diarrhoea, or an uneasy feeling

Tryptamines – Risk Reduction

• Recreational use of Tryptamines requires only minute amounts of the substance, making it impossible to eyeball’ out doses.– Differences of 5 or 10mg between small lines of powder are

impossible to judge. The difference between a good trip and bad time relies on DOSAGE.

– Use a scale to measure doses. – (MDMA, a phenethylamine, dose is typically ~100mg).

• Use the buddy system and have a sober ‘sitter’.• Tryptamines aren’t necessarily party drugs; better to use

at home.

Tryptamines – Risk Reduction

• Avoid mixing tryptamines with any other drugs such as downers, amphetamines or other stimulants.

• MAOIs seriously potentiate their effects, and generally should be avoided when using tryptamines.

• Most doctors and medics have no idea these drugs even exist, let alone what to do in an overdose situation. In case of an overdose, let the medics know exactly what has been ingested as well as any info like websites.

• Tryptamines should be treated with a great deal of respect and only called on when your mind is clear before diving into the depths of your psyche.

Ecstasy takers in hospitalCBC News Posted: Apr 8, 2011 http://www.cbc.ca/news/canada/nova-scotia/story/2011/04/08/ns-ecstasy-halifax.html

The pills in this case were analysed in a lab and contained Foxy.

Unfortunately no information is provided regarding the appearance of the pills (not the ones pictured).

Ecstasy• E, X, pills, disco biscuits– Specific pills named by colour,

size, shape, stamp/logo– Sometimes powder in a gel cap

• Newest term “Molly”• Price per pill or capsule:

– $5-10 (Toronto 2013)– $5-20 (Toronto 2009)– $10-20 (Toronto 2005)– $20 “E” pill / $30 MDMA capsule

(Toronto 1999)

“Green Mercedes”

“White Happy Face”

Ecstasy• Predominately swallowed

– Pills may be crushed into powder and snorted– Rarely hooped or smoked

• Main neurotransmitter: Serotonin – Though with adulterated pills others maybe effected (e.g., more

dopamine if methamphetamine is in pills)• Primarily stimulant effects; “upper”

– Though overwhelming sense of “bliss” may leave you feeling lethargic (affecting serotonin)

• Physical effects:– Increases in heart rate, body temperature and energy– Jaw clenching/tightening, dilated pupils, nausea

• Psycho/behavioural effects:+ve: empathy, openness, peace, caring, open-hearted

communication–ve: anxiety, paranoia, “bad mood”

Ecstasy• Immediate risks:

– Not knowing what you get• Ecstasy pills are one of the most adulterated illicit

substances– Dehydration; overheating; stroke

• Particularly when used in hot nightclubs and parties– Say or do something you regret

• Tendency to talk openly and “feel connected” may not last the next day

– Rough comedown• Can be hard to fall asleep• You may feel sad, blue, and easily irritated for a couple of

days after

Ecstasy• Longer-term concerns:

– Tolerance• Many longer-term users report taking more to get a similar

effect (e.g., “½ a pill used to get me high, now I take 2 in a night”).

– Psychological Dependency• If you have always taken ecstasy when going out dancing, it

may be hard to not think about using when going out, even though your body isn’t physically needing it.

– Depression• What goes up, must come down. Serotonin, one of the

neurotransmitters ecstasy effects, is part of your eat/sleep patterns and mood cycles - it may be depleted after use.

– Anxiety & panic attacks• Stimulant drugs can create a sense of urgency or paranoia in

some people, especially with the more you take or the longer you stay high.

Ecstasy: Pills vs. MDMA

• MDMA – 3,4-methylenedioxy-N-methylamphetamine

• Historically found pressed into a pill form.• Pills are usually “cut” with other drugs.• Never know what you are getting!• Each pill is different, even if it looks the

same. - Duration of high: 4-6hrs (pure MDMA), 2-

10 hrs (Ecstasy pills)

Ecstasy Pills• Observations and conversations with partiers

and clubbers using E, show a wide variety of experiences.

• Toronto, 2004:– 7 of 21 Ecstasy users showed methamphetamine in

hair samples.

• BC Centre for Excellence in HIV/AIDS and UBC Dept. of Health Care and Epidemiology, 2004:– 94 pills tested: 44 (47%) contained methamphetamine

• Case Report: Halifax, N.S. 2011 – Ectasy pills contain “Foxy”

Ecstasy Pills

• The Pink Heart or the Orange Pig?– Ketamine; DXM; Caffeine; Crystal Meth; BZP

Ecstasy – Before You Use• Remember, ecstasy is illegal and has tough penalties for

possession.– You can also be charged for trafficking if you buy for friends.

• Ask around… Try to get the latest buzz on good and bad E’s circulating. – Pill websites and pill testing may help be useful.

• Buy from someone you know, or someone whose pills you’ve tried and like.

• Be careful if you are feeling down before using.• Be very careful if you are using anti-depressants; better

to avoid using.• Be cautious if mixing with other drugs.• Eat and sleep lots before and after partying.

• Good to see the variety of pill contents.• Cost prohibitive.

• Lots of local reports.• Subjective experiences can vary – be careful!• Similar looking pills can vary.

Ecstasy – When You Use• It’s nearly impossible to know the purity

and quality of the pill until after you take it.– Kicks in, 20-60 mins (swallowed) – wait to get

high!– Start with half a pill. Wait about 45 minutes

after you’ve dosed before deciding to do more.

• Less is more. You will likely feel worse, after using, if:– You do more at one time (e.g., 2 ½ pills vs. 1

pill)– You stay high longer (e.g., 20 hrs vs. 7 hrs)

Ecstasy – When You Use• If you are physically exerting yourself

(dancing; sex) take breaks and chill out.• Stay hydrated:

– YES: water; Gatorade; – NO: alcohol; energy drinks– Don’t overhydrate:

• Drink more if you are sweating a lot and your pee is dark in colour

• Drink less if you are peeing a lot.• You still need energy, even though you

may not be hungry. Eat! – Fruits (esp. bananas), protein shakes, juices,

yogurt, are all good (and easier) to eat.

• Don’t over-hydrate.

• U.K. case ofLeah Betts: http://en.wikipedia.org/wiki/Leah_Betts

What goes up, must come down…

• Lack of sleep. Lack of food. Physically exhausted.– Accept the comedown; chill out with friends.

• Depressed; irritable; cranky– Need time for recovery– Eat! Sleep!

• Spread out the partying… not every weekend.– Serotonin takes a few weeks to be replaced.

Canadian results from ecstasydata.org

Most recent tests from ecstasydata.org(not all Canadian results)

MDMA Purity

• New substances are being developed all the time – some of these are easier to make than MDMA; some are easy to acquire through the internet; and some are not illegal, though can be quite harmful.

• Increased global restrictions on the pre-cursor chemicals used in the synthesis of MDMA are making production more difficult and, therefore, people are turning to new substances as substitutes for MDMA, or mixing them with poor quality MDMA to achieve more potent results.

Home Testing KitsHome testing kits do NOT demonstrate an accurate picture of what is in pills and capsules. They only serve to indicate the SUSPECTED presence, or non-presence, of certain chemicals. The kits do not show a complete chemical picture and in no way show the quantity (or dose) or any ingredients. • www.dancesafe.org (US)• www.eztest.com (Europe)

Mandelin Reagent Test

• http://youtu.be/cmGNMA6sRyY

Home testing results of capsules sold as MDMA in Toronto• Acquisition dates: #1 (June 2010); #2-5 (May-June 2011)• From left: 1, 3 & 4 +ve for MDMA; 2 not tested; 5 not +ve for MDMA

(possibly DXM)

1 2 3 4 5

Home testing kits do NOT demonstrate an accurate picture of what is in pills and capsules. They only serve to indicate the SUSPECTED presence, or non-presence, of certain chemicals. The kits do not show a complete chemical picture and in no way show the quantity (or dose) or any ingredients.

Canadian Test Kit Supplierwww.testkitplus.ca

Pure Pillz• Piperazine class of drugs.• Combination of BZP and TFMPP.• First popularized as “Social Tonics” in New Zealand and

marketed as a “harm reduction” alternative to street laced ecstasy pills.

• Were available in Canada online and in Toronto store-fronts around 2007/2008.

• Did not become too popular as decent quality MDMA was widely available and Pure Pillz only crudely mimic effects of MDMA.

• BZP and TFMPP often show up in lab analysis of current ecstasy pills.

• Sildenafil (Viagra) is a synthetic piperazine derivative.

Pure Pillz

Health Canada Advisory – Pure Pillz

Have you heard of “Izms”?

Synthetic Cannabinoids

• Contain synthetic cannabinoids JWH-018, JWH-073 and JWH-122.

• Produce effects similar to tetrahydrocannabinol (THC), the primary active ingredient in marijuana.

• Resembles crushed marijuana, except it’s brown in colour and smells fruity instead of skunk-like

• Health Canada says these are “controlled substances” and therefore illegal.

• Little is known about short or long-term effects, so probably safer to avoid using these substances.

Cannabis• In March 2013 a teenager presented to a

Toronto area Emergency Room hallucinating and very tachycardic. He had been consuming an “MJ Lollipop”. Analysis revealed the lollipop contained only marijuana and a comprehensive urine screen showed only marijuana in his system.

Teenagers really should try to avoid marijuana until later in life and this is why...

http://www.cbc.ca/documentaries/natureofthings/2010/downsideofhigh/

Cannabis• Marijuana, pot, weed.• Commonly smoked or eaten. • Concentrated resinous form called hashish, and

as a sticky black liquid called hash oil. • Synthetic (pharmaceutical) versions.• Three distinct species

– Cannabis sativa, Cannabis indica, and Cannabis ruderalis

• The term 'hemp' is generally used to describe low-THC varieties of cannabis which are grown for industrial uses.

Cannabis• Price = ~ $40 for 1/8 ounce (a “half quarter”, 3.5 grams)

• Green leaf plant with buds, with orange/brown fibers and sometimes coated in crystals.

Cannabis• The active ingredients are called cannabinoids

– THC (Delta-9-tetrahydrocannabinol) is thought to be responsible for most of the psychoactive effects.

• Effects– Onset: When smoked, the effects of cannabis begin

almost immediately. When eaten the effects can take 1 to 2 hours to manifest.

– Duration: Effects of smoked cannabis peak after about 20 minutes and last for 1-2 hours. When eaten, the effects will peak more slowly and primary effects may last for 3-4 hours.

Cannabis Experience• Primary effects with recreational use:

– Euphoria, relaxation, and changes in perception.– Effects vary depending on dosage.

• Low doses: – Sense of well-being, mild enhancement of senses

(smell, taste, hearing), subtle changes in thought and expression, talkativeness, giggling, increased appreciation of music, increased appetite, and mild closed-eye visuals.

• Higher doses:– Visuals may become more prominent, sense of time is

altered, attention span and memory are frequently affected, and thought processes and mental perception may be significantly altered.

Cannabis Experience• Primary reasons for medicinal use:

– Appetite stimulation– Pain reduction– Many other benefits reported for a wide variety

of conditions.• Can get a federal permit:

– To possess– To grow– To be a designated grower

Cannabis Concerns• Negative effects can include:

– Paranoia, dry mouth, respiratory problems and nervousness/racing heart.

– Reduced ability to concentrate, impaired memory, tiredness, and confusion.

– Side effects tend to increase with lifetime use.

Cannabis Concerns• Relative potential for dependency:

– Regular use can lead to psychological habituation making it difficult to quit.

– Most people do not experience signs of physical addiction.

– Withdrawal somewhat difficult but in no way dangerous.

– Benzodiazepines can be used to treat withdrawal.

Cannabis Concerns• Long Term Health Problems:

– Smoking: lung and throat problems: coughing; increased throat and lung infections; reduced lung capacity; carcinogenic effects.

– Amotivational syndrome.

– Not (or slightly) toxic to the liver, but…• Increasing concern around heavy/chronic use and

HepC.

Cannabis Concerns• Heart Issues:

– Because cannabis increases heart rate, it could potentially increase risks of heart problems in those at risk of heart disease.

• Mental Illness:– Can precipitate neuroses or psychoses in

those who are already at risk.

Cannabis Risk Reduction• Know your source.

• Be careful about mould and bacteria.

• Eating poses lowest health risks, though harder to titrate (manage) dose.

• Use with people you trust.

• Be mindful of smoking public spaces.

• Avoid getting high and driving.

• Smoking increases risks of pulmonary disease.– Try a vaporizer instead of smoking.

Cannabis Risk Reduction• Vaporizers offer and alternative to smoking.• Cannabis is heated to the point THC vaporizes but the

plant material is not burned.

Cannabis before (left) andafter (right) vaporization.

This vaporizer relies on convection rather than conduction.

Vaporizer vs. Smoking• Vaporizer after 2 months use (left)• Pipe after 2 weeks use (right)

Synthetic (prescription) THC

• Synthetic THC, available on prescription– Cesamet (nabilone); Marinol (dronabinol)

• Reduced psychoactive effects.

Salvia• Salvia divinorum is a soft-leaved green plant,

native to Southern Mexico, • Contains a powerful psychoactive chemical

“Salvinorin”.• Many species and varieties within the genus

'Salvia' – Plants commonly found in garden stores are almost

certainly not S. divinorum unless specifically labeled.

• Traditionally used by chewing pairs of leaves.• Strong effects can be difficult to attain from

smoking dried leaf, but extracts and potency-bred leaves can cause dramatic, sometimes frightening, psychedelic mind-states.

• Many people choose not to repeat the experience.

Salvia• Depending on dosage, the experience can vary from a

subtle to a full-blown psychedelic experience. – At higher doses users report dramatic time distortion, vivid imagery,

encounters with beings, travel to other places, planets or times, living years as the paint on a wall or experiencing the full life of another individual.

– These can be extremely powerful experiences and should only be attempted with a sitter.

• When smoked, the first effects are noticed between 20-60 seconds, increasing to peak effects within 1-2 minutes. The high is short with primary effects lasting 5-15 minutes and a 20-40 minute comedown.

• On Feb 19, 2011, a Notice to Interested Parties proposing that Salvia divinorum and Salvinorin A be controlled in Canada was published.

Salvia Risk Reduction

• Many people that have tried Salvia say they will never do it again. • Do not operate heavy machinery. Do not drive. • Use a Sitter.

– Some users will attempt to stand up and move around while in a completely dissociated state. Having a sitter present can reduce the chances of injury or other problems.

• People with existing emotional or psychological concerns should be careful about choosing to use strong psychoactives.

• Individuals with a family history of schizophrenia or early onset mental illness should be extremely careful; strong psychoactives have been known to trigger psychological and mental health problems.

• Salvia is unlikely to be physically addicting or likely to cause psychological dependence.

Cocaine (powder)• Coke, Blow, Charlie,

Whitney• White to cream chunks or

powder• $40 ½ gram; ~$240 8-ball

[3.5 grams] (Toronto 2011)• Typically snorted up the

nose

Cocaine (powder)• Main neurotransmitter: dopamine• Stimulant• Physical effects:

– Increase in heart rate, body temperature, blood pressure

– Numbs tissues it touches (nose, gums, lips)– Jaw grinding, dilated pupils, upset stomach

• Psycho/behavioural effects:+ve: increased wakefulness; confidence; chatty-ve: cravings; anti-social; anxious; “edgy”

or sex drive

Cocaine biochemistry

• Peak blood cocaine levels in approximately: – 30 to 45 minutes (snorted)– 5 minutes (smoked)– Almost instantly (injected)

• Duration of action: 45 to 90 minutes•  Short half life (1-2 hours)

– Short high… Quick come down desire to do more and to keep going

Cocaine biochemistry

Cocaine• Immediate risks:

– Stroke; heart attack (esp. with high concentrations from high doses or extended “runs”)

– Anxiety / panic attacks– Dehydration– Push boundaries and take unintended risks– Spend more than you intend– Disease (esp. with snorting)

Cocaine• Longer-term concerns:

– Tolerance– Psychological / physical dependency– Sinus infections– Weight loss or gain– Finances

Cocaine Risk Reduction• Use a new straw

– Don’t snort with dirty dollar bills and keys.– Avoid sharing straws or bumpers. – Try colour coding or marking your straws when using

with other people.

• Having a nasal spray of clean water, that you could use shortly after snorting each line.– This can help reduce the damage to your nose.

• Leave money and bank cards at home.

Cocaine (crack)• Rock; Free base cocaine; • Powdered cocaine dissolved and boiled in

a mix of ammonia or baking soda.• Looks like rocks or chunks• Price: varies by region; 1 hit for <$5• Smoked or injected• Makes a cracking sound when burned

Cocaine (crack)

Taken from erowid.org

Crack Risk Reduction• Use your own equipment:

– Pipes, needles, cookers, filters, tourniquets… etc.

• Find a safe space to use.• Carry condoms / lube.• Moisturize lips with non-oil based products.

Safer Crack Kit•Alcohol swabs•Pyrex-glass pipe•Rubber mouth piece

•Heat resistant metal screens

•Chopstick• Helps prepare

screens• (Lip Balm)

Video: Step-by-step demonstration of safer crack smoking: http://hepcinfo.ca/videoplayer_e/safer_smoking_e.flv

Cocaine – New Concerns• Cocaine is notoriously cut with adulterants; it is rarely

good quality. • Recently an adulterant known as Levamisole is showing

up in many samples throughout North America. • This is of particular concern for people who are already

susceptible to autoimmune disorders:– Levamisole can significantly reduce the number of white blood

cells in the body, a condition called agranulocytosis. – Symptoms include fever, swollen glands, painful sores in the

mouth and anus, and an infection that won't go away. – Because many of the symptoms of the illness are the same as

the flu, it is important that people who are using cocaine be aware that they aren't sick with something more serious than influenza.

Cocaine – New Concerns• If you use cocaine watch out for:

– High Fever – Chills – Painful anal, oral sores – Skin abscess / lung infection that

appears to be developing more rapidly than usual.

• Seek Medical Attention Immediately!

Methamphetamine• Crystal, Meth, Jib, Crank, Ice, Tina• Price = $ 50-60 / bag (0.25 – 0.3 gram)• White to off white powder; crystal shards

(like glass)

MethamphetamineIt can also look like…

Methamphetamine• Strong stimulant; “upper”• Releases dopamine, serotonin, norepinephrine

(adrenalin)• Long half-life (12 hours)• Physical effects:

– Increase in heart rate, body temperature; decreased appetite and sleep; dry mouth; loss of erection

• Psycho/behavioural effects:– Increase in alertness, confidence, euphoria– Paranoia; anxiety; decreased self control / inhibitions

The Role of Dopamine• While all stimulants release some dopamine,

crystal meth releases much larger amounts: – Cocaine releases 400% more dopamine– Crystal meth releases almost 1500% more

dopamine

Methamphetamine

• Immediate risks:– Dehydration– Lack of food / sleep– Loss of inhibitions– Paranoia / psychosis

Methamphetamine

• Longer-term risks:– Physical/psychological dependency– Weight loss– Tooth decay– Strains on heart– Depression– Loneliness– Loss of friends, school, job

Methamphetamine Risk Reduction• Plan ahead before partying; you may need a few days to

recover. • Try to eat something while you're high

– Protein shakes or fruit juices with healthy supplements are better than nothing. Feed your body the fuel it needs.

• Limit what you buy.– The longer you party the rougher you’ll feel.

• Use extra lube if having sex.• Lack of sleep. Lack of food. Physically exhausted.

– Accept the comedown• Spread out the partying… not every week.

– Dopamine and all those other neurotransmitters take time to be replaced.

Ketamine• Special K, K, kitty• Price: $20 - $30 / vial• White powder

– Looks similar to table salt or a fluffy powder

• Typically snorted– Can be smoked or

injected (IM)

Ketamine

Source: wikipedia

Ketamine• Anesthetic; “downer”• Lower dose:

– mild, dreamy effect; numbness in extremities• Higher dose:

– difficult to move; hallucinogenic effect: out of body feeling; separation of mind and body (“K-hole”)

• Duration of high: 30-60 minutes (K-hole) but after effects last longer

Ketamine• Immediate risks:

– Falling (breaking a limb)– Assault– Nausea (aspiration) – Disease (esp. with snorting)

Ketamine• Longer-term risks:

– Tolerance– Psychological/physical dependency– Sinus infections (if snorting)– Bladder infections– Kidney problems– “k-pains”

Ketamine Risk Reduction

• Caution with eating before using.– Anesthetics often make people throw-up.

• Caution should be exercised when measuring doses.– Best to start with small doses, working your way toward the

desired levels.

• Mixing with alcohol often results in nausea, vertigo, and "the spins“.

• K often “over-powers” the high (but not necessarily the physical effects) of other drugs.

• Better to use your own straws and bumpers.

Ketamine Risk Reduction

• Be careful using in public environments (e.g., nightclubs) so that you don’t “K-out”.– Tell friends you are doing K and try to have a sober friend that

can help if you do too much.

• Anaesthesia-levels of ketamine (K-holes) in certain settings could lead to serious accidents, such as falling from a balcony or bathtub drowning.

• If someone passes out lay them on their side in case they vomit.

• Tolerance builds quickly; take breaks from use to bring it back down.

• Bladder/urinary tract infections and damage from excessive/extended use.

Ketamine Injecting

GHB• G, GHB• Price = ~ $10 / vial• Clear liquid with slight

“chemically” smell and taste which can easily be masked in a drink

GHB• Sedative; depressant; “downer”• Lower dose:

– similar effect to alcohol… relaxed, happy sociable

• Higher dose:– dizzy, sleepy, vomiting, muscle spasms, loss

of consciousness (“G-d out”), depressed breathing

• Duration of high: 1-4 hours

GHB• Immediate risks:

– Very dose dependant– Can be extremely dangerous when mixed with

alcohol– Vomit pass out aspiration– Coma

• Longer-term risks:– Psychological dependency– Physical dependency

GHB Risk Reduction• Store liquid G in a container that could

never be mistaken for drinking water.• Colour the mixture BLUE using food

colouring, so as to avoid it being mistaken for water, juice or alcohol.

• Shake that bottle!– GHB is heavier than water.

“Hard-Ons”• Sildenafil®• Tablets come in doses of 25, 50 and 100 mg. • Other similar substances:

– Levitra– Cialis (the “weekender”; longer half life)

• Physical effects:– Blood vessels relax; erection; lowered blood pressure

• Immediate risks: – Stroke / heart attack

• Duration high: – drug lingers in body for several hours

ViagraSymptoms of Viagra, Cialis or Levitra toxicity:• Chest or jaw pain• Irregular heartbeat• Nausea• Respiratory problems• Visual disturbances (blue colour)• Prolonged erection > 4 hours

– Get to emergency room!

Viagra Risk Reduction• Use the smallest dose necessary• Be extra cautious if using blood pressure

medications• Don’t take with grapefruit juice

– Absorption of Viagra increased by 23% when taken with grapefruit juice instead of water. Grapefruit juice also delayed the absorption of Viagra. (Jetter A, et al. Clinical Pharmacology and Therapeutics 2002; 71:21-29.)

• Be careful when - or try to avoid - mixing with poppers (amyl nitrite)

• If erection lasts longer than 4 hours, go to emergency room

Viagra

Viagra?

Off-prescription “Viagra”, Fall 2007, Toronto, Canada

Poppers• bolt, climax, poppers, rush, Zbest, and others • Butyl / amyl nitrite; vapor inhaled• Physical effects:

– Relaxation of blood vessels and smooth muscle tissue

– Drop in blood pressure; flushed face• Psychological effects:

+ve: head rush; horny; less inhibited-ve: anxiety; nausea

• Duration high: 30-60 seconds

Poppers

• Immediate risks:– Flammable; chemical burns– Nausea; headaches– Stroke (esp. mixed with other substances that

lower blood pressure such as Viagra)• Long-term risks:

– Psychological addiction; carcinogenic?

LSD (d-lysergic acid diethylamide)

• Potent hallucinogen • White crystalline powder that dissolves in water,

is odourless, and has a slightly bitter taste.• An effective dose is too small to see. (20 - 80

micrograms)• It is usually packaged in squares of LSD soaked

papers (blotters) or miniature powder pellets called microdots

• Usually taken by mouth and held on the tongue or swallowed

LSD

h Examples of LSD blotter paper

h colourful designs often added to mask impurities

h street names may vary according to blotter designs

LSD

• LSD trips are unpredictable• Produces vivid visual effects• Affects your senses, mood and thoughts• People can become paranoid and feel a

loss of control which can lead to a state of panic

• Judgement is affected and people may put themselves in danger

LSD

• Alters the persons perception of reality.• Can vividly distort the senses. • “Trip” - perceptual changes, altered time

sense, feeling detached from self, synesthesia (“hearing” colours), dizziness, “pins and needles”

• Not addictive• Can cause flashbacks

PsilocybinStreet names: Magic Mushrooms, shrooms

• Hallucinogen, similar to LSD• Mushrooms or in powder capsules • Sniffed, smoked or injected, or ingested

orally• Onset 1/2 hour • Effects last 4 to 5 hours

Effects of Psilocybin

• Sensations of relaxation or fatigue; separation from surroundings; heaviness or lightness

• Perceptual distortions, visual hallucinations, dizziness, shivering

• Can cause tension and anxiety shortly after ingestion

Is Psilocybin Dangerous?• One danger is misidentification, as some

mushrooms are poisonous• PCP and LSD are often sold as psilocybin• Can impair judgement• Can trigger underlying mental health

problems and cause schizophrenic-type symptoms

• User can have “bad trips”

Sizzurp / Purple Drank

• Ingredients: –Promethazine w/Codeine syrup –Any fruit flavored soda –A jolly rancher

The codeine is mainly responsible for the euphoria felt after drinking sizzurp. Promethazine causes motor skill impairment, lethargy, and extreme drowsiness.

DXM is not a component of sizzurp, although it may produce vaguely similar effects to the above recipe in doses ranging from 150 - 250 mg.

DXM• Dextromethorphan is found in over-the-

counter cough and cold medicines.• In high doses it acts as a "dissociative

anaesthetic" like ketamine or PCP. May feel very spacey and "out of it“. May lose motor control (your legs may feel wobbly or at very high doses you won't be able to move much).

• It can also produce audio and visual hallucinations, and can sometimes cause nausea and itchy skin.

• It can also be quite dangerous. Watch Out!

• High doses of DXM have contributed to numerous cases of rave-related heatstroke.

Inhalants / Solvents

Inhalants / Solvents

• Inhalants are a diverse group of volatile substances whose chemical vapors can be inhaled to produce psychoactive (mind-altering) effects.

• While other classes of substances can be inhaled, the term “inhalants” is used to describe substances that are rarely, if ever, taken by any other route of administration.

• Inhalants are either chemicals in gaseous form or volatile solvents (liquids) that becomes gas at the time of use, which are inhaled by people for their psychoactive effects.

• A variety of products common in the home and workplace contain substances that can be inhaled to get high: Gasoline; Acetone; Mineral Spirits; Freon; Computer Duster; Glue

Inhalants generally fall into the following categories:

• Volatile solvents: liquids that vaporize at room temperature• Industrial or household products, including paint thinners or removers, degreasers, dry-

cleaning fluids, gasoline, and lighter fluid• Art or office supply solvents, including correction fluids, felt-tip marker fluid, electronic

contact cleaners, and glue

• Aerosols: sprays that contain propellants and solvents• Household aerosol propellants in items such as spray paints, hair or deodorant sprays,

fabric protector sprays, aerosol computer cleaning products, and vegetable oil sprays

• Gases: found in household or commercial products or medical anesthetics

• Household or commercial products, including butane lighters and propane tanks, whipped cream aerosols or dispensers (whippets), and refrigerant gases

• Medical anesthetics, such as ether, chloroform, halothane, and nitrous oxide (“laughing gas”)

• Nitrites: a special class of inhalants that are used primarily as sexual enhancers

• Organic nitrites are volatiles that include cyclohexyl, butyl, and amyl nitrites, commonly known as “poppers.” Amyl nitrite is still used in certain diagnostic medical procedures. When marketed for illicit use, organic nitrites are often sold in small brown bottles labeled as “video head cleaner,” “room odorizer,” “leather cleaner,” or “liquid aroma.”

Inhalants / Solvents

• Inhalants can be breathed in through the nose or mouth in a variety of ways (known as “huffing”), such as sniffing or snorting fumes from a container, spraying aerosols directly into the nose or mouth, or placing an inhalant-soaked rag in the mouth. Users may also inhale fumes from a balloon or a plastic or paper bag that contains an inhalant.

• The intoxication produced by inhalants usually lasts just a few minutes; therefore, users often try to extend the “high” by continuing to inhale repeatedly over several hours.

Inhalants / Solvents

• Immediate Effects:– May include slurred speech, lack of coordination,

euphoria, lightheadedness, and dizziness. – With repeated inhalations some people feel less

inhibited and less in control. Some may also experience hallucinations, and delusions.

– Some users may feel drowsy for several hours and experience a lingering headache.

– Chemicals found in different types of inhaled products may produce a variety of additional effects, such as confusion, nausea, or vomiting.

Inhalants / Solvents• Immediate Risks:

– Sniffing highly concentrated amounts of the chemicals in solvents or aerosol sprays can directly induce heart failure and death within minutes of a session of repeated inhalation.

– This syndrome, known as “sudden sniffing death,” can result from a single session of inhalant use by an otherwise healthy young person.

– Sudden sniffing death is particularly associated with the abuse of butane, propane, and chemicals in aerosols.

– Some solvents have effects at a cellular level, increasing the susceptibility to HIV infection.

– Nitrites are sometimes used to enhance sexual pleasure and performance and maybe associated with unsafe sexual practices, increasing the risk of HIV or other STI transmission.

Hypoxia

• By displacing air in the lungs, inhalants deprive the body of oxygen, a condition known as hypoxia.

• Hypoxia can damage cells throughout the body, but the cells of the brain are especially sensitive to it.

• The symptoms of brain hypoxia vary according to which regions of the brain are affected: for example, the hippocampus helps control memory, so someone who repeatedly uses inhalants may lose the ability to learn new things or may have a hard time carrying on simple conversations.

Solvents

• All have the ability to cause asphyxia, arrhythmias, cardiovascular depression, neurologic dysfunction, and mucosal, pulmonary, and skin irritation following acute exposure and permanent neurologic damage with chronic exposure. The acute effects of alkyl halides and alkyl nitrites also include carbon monoxide poisoning and hepatorenal toxicity, and methemoglobinemia, respectively. Chronic exposure to aromatic hydrocarbons and ketones can result in liver, kidney, and bone marrow injury; myopathy, rhabdomyolysis, metabolic acidosis, and electrolyte abnormalities are further complications of chronic aromatic hydrocarbon inhalation. – Emerg Med Clin North Am (1990 Aug) 8(3):559-78

Inhalants / Solvents

• Longer term risks: – Long-term inhalant use can also break down

myelin, a fatty tissue that surrounds and protects some nerve fibers. Myelin helps nerve fibers carry their messages quickly and efficiently, and when damaged, can lead to muscle spasms and tremors or even permanent difficulty with basic actions such as walking, bending, and talking.

Alcohol

• Neurotransmitters: – GABA (inhibits brain activity)

• Alcohol stimulates GABA receptors, making them more inhibitory and further inhibiting brain activity

– Glutamate (brain’s general purpose excitatory transmitter)• Binds to glutamate receptors preventing glutamate from

exciting the cell

– Alcohol particularly effects areas involved in memory formation, decision making and impulse control

Alcohol Risk Reduction

Alcohol does not mix well with many substances.Be cautious, and better to avoid, the following:

• Alcohol + Benzos

• Alcohol + Ketamine

• Alcohol + Opiates

• Alcohol + GHB– This can be a particularly dangerous combination

Alcohol Risk Reduction

• Eat something before drinking• Pace yourself• Hydrate as you drink• Prearrange transportation; leave car keys behind• Take only the money you intend to spend• Make your own drinks• Only accept drinks from people you trust• Monitor how often you’re drinking; take breaks• “Liquor before beer, you’re in the clear; beer before

liquor, never been sicker”• (Nearly all liquor is quality and potency assured)

Non-palatable alcohol• Initiate a non-judgmental, factual

discussion about the harms of using these substances.

• Encourage the use of safer alcohols – beer, wine and liquor.

• Discuss the use of less harmful, non-palatable alcohols (e.g., mouthwash rather than hand sanitizer).

• Discuss options to reduce the amount of non-palatable alcohol consumed, and other strategies to reduce the potential for harm,

• Illicit: Heroin; Opium (derived from the poppy plant)• Pharmaceutical (prescription or street):

• Codeine (e.g., Tylenol 3)• Oxycodone (e.g., Percocet)• Oxycontin (time release oxycodone)• Morphine• Hydromorphone (e.g., Dilaudid)• Hydrocodone (e.g., Hycodan)• Meperidine (e.g., Demerol)• Fentanyl (transdermal patch)

• Substitutes: • Methadone• Bubrenorphine/Suboxone

Opiate Based Substances

• All are “downers”• Primary risks are slowed breathing and heart rate.• High potential for addiction with many.

• Heroin use has become an increasingly marginal form of drug use among illicit opioid users in Canada, particularly outside of Vancouver and Montréal.

• Most of the pharmaceuticals are prescribed for pain management but have increasingly become the predominant form of illicit opioid use.

• “Opioid-rich" environment:• Canada is a world per capita consumer of a number of

pharmaceutical opioids.

Opioids

Ontario Student Drug Use and Health Survey 2009

• Poppy derivative• Mainly administered IV• Also snorted and smoked• ± $50 a point (1/10 of a gram)• Intense feeling of euphoria and well-

being• Sedation, analgesia• Tolerance builds and ceasing use may

result in withdrawal symptoms

Heroin

• OxyContin contains oxycodone in a controlled-release tablet (5 mg, 10 mg, 20 mg, 40 mg, and 80 mg)

• 12-hour pain relief. • In Canada, OxyContin was manufactured by Purdue

Pharma.• Introduced in 1996; Oxycodone-based products have been

used illicitly for the past 30 years.• When used illicitly, OxyContin can be taken in pill form, or

crushed and then ingested, snorted, or injected, delivering the whole time released dose at once.

• In 2012, Oxycontin was discontinued and replaced by OxyNEO.

• OxyNEO is still Oxycodone but in a supposedly harder to tamper with pill.

Oxycontin

• Extremely potent pain medication.• Usually prescribed as a trans-dermal, time

release patch.• 5 strengths with 1.25, 2.5, 5.0, 7.5, 10 mg.• Delivers 12, 25, 50, 75, 100 mcg/hr for 72 hours.

• When used off prescription, people may scrape the patch and inject the fentanyl.

• One patch can give about 10 injections.• People can easily inject too much and

overdose.

Fentanyl

Percocet 5 mg tabs $5

Oxycocet 5 mg tabs $3

Morphine 30 mg tabs $4

Morphine 100 mg tabs $8

Oxycontin 10 mg tabs $7-8

Oxycontin 40 mg tabs $20-30 ($20 Renfrew Cty)

Oxycontin 80 mg tabs $45-60 ($40 Renfrew Cty)

Fentanyl 50 mcg patch $30

“Underground Economy”South East LHIN – North Hastings

From presentation: “Below the Radar: Exploring Substance Use In Rural Ontario”. Kathy Hardill and Sean Lee-Popham (North Hastings Harm Reduction Network), Canada Harm Reduction 2011 Conference , Ottawa

*In Northern Ontario, in some First Nation’s communities, 80mg pills can be sold for $200-$500.

Opiate Risk Reduction and Treatment• Basic risk reduction strategies, particularly using new equipment when

injecting.• Be cautious when using after periods of abstinence, as tolerance may

have dropped and risk of overdose is increased. • Naloxone may be used in cases of overdose to provide temporary

relief but person should still be taken to hospital.• Snorting and injecting opioid painkillers can result in a quicker and

stronger effect. • These methods can be dangerous as they release several hours

worth of opioid painkillers into your body at once.• Mixing with other substances, particularly depressants such as alcohol

and narcotics, can be dangerous.• Some opioid painkillers (such as codeine and hydrocodone) also

contain acetaminophen, which can cause liver toxicity with regular use and high doses.

• Medications (Methadone; Buprenorphine) can assist with detoxification, in combination with other therapeutic interventions.

Some people struggling with opioid dependence are unable to maintain a state of abstinence. Prolonged methadone treatment can lead to:

• A decrease and often the cessation of opioid use.• A decrease in the use of other substances. • A substantial decrease in crime and prostitution.• Improved health.• An improvement in living conditions.• Better conditions for the continuation of pregnancy.

Methadone Maintenance Programs

What is methadone?Methadone is an effective and legal substitute for opioid drugs such as heroin, codeine, morphine, Dilaudid® and Percodan®. Methadone is a long-acting opioid drug. This means it acts more slowly in the body, for a longer period of time, than most other opioids. By acting slowly it can prevent withdrawal and eliminate or reduce drug cravings, without causing a person to get high. People who are dependent on opioid drugs can take methadone to help stabilize their lives and to reduce the harms related to their drug use. It has been used in treatment programs since the early 1960s. Methadone is available through specialized drug treatment clinics or it may be prescribed by family physicians and dispensed by community pharmacists, in accordance with Canadian regulations. Only physicians who have received an exemption under Section 56 of the Controlled Drugs and Substances Act are allowed to prescribe methadone.

Methadone Maintenance Programs

How does it work?Methadone can be used to replace the opioid drug that a person is dependent on. It prevents withdrawal symptoms and cuts down on the person’s drug cravings. It does not alter someone’s ability to work, go to school or care for their family.Users usually need one dose every 24 hours. When methadone is diluted in juice, it does not have a euphoric effect or interfere with a person’s thinking, however, it does block the euphoric effect of heroin and other opioid drugs, so it makes the idea of using those drugs much less attractive. Methadone works best when it is combined with drug counseling.

Methadone Maintenance Programs

Is methadone safe?When taken as prescribed, methadone is very safe and will not cause damage to the body or mind, even if it is taken daily for many years. On the other hand, methadone is a powerful drug and can be extremely dangerous if not taken properly.

How is methadone taken?Your doctor will give the pharmacy a prescription for your methadone. This prescription must be renewed regularly by your doctor. He or she will determine how often you come for appointments, depending on your needs and progress. Your dose of methadone is usually mixed with orange juice. When you first start on methadone, you will be asked to go to your pharmacy each day to drink the medication. After two months you may be able to begin to take home some doses. These are called “carries.”

How long do people stay on methadone?People stay on methadone as long as they need to. Some health care providers promote short-term methadone detoxification, where the dependent person is stabilized on methadone and then tapers off using it over the next one to six months. Others may stay on it for up to twenty years. Whether short-term or long-term, research has shown that methadone maintenance is the most effective treatment for opioid dependence.

Methadone Maintenance Programs

Given the costs of untreated opioid dependence, methadone maintenance treatment offers significant benefits to society, which far outweigh the costs of providing treatment. American researchers have found:• The annual costs of methadone maintenance treatment are much lower than the

annual costs of either untreated heroin use, incarceration or drug-free treatment programs;

• Criminal activities related to heroin use resulted in social costs that were four times higher than the cost of methadone maintenance treatment;

• For every dollar spent on methadone maintenance treatment there is a savings to the community of between US$4-$13.

Similar cost benefits are being identified in Canada. In Toronto, the average social cost of an untreated person who is dependent on illicit opioids has recently been estimated to be $44,600 per year. According to an estimate from the Centre for Addiction and Mental Health in Toronto, methadone maintenance treatment can be provided for approximately $6,000 per year. (2000)

In Canada, methadone maintenance has increased five-fold since the mid-1990s.

Methadone Maintenance Programs

192

Methadone and HIV

• Some HIV meds decrease the strength of methadone, which means you could go into methadone withdrawal.

• Not a lot is known about how HIV meds interact with substances - it’s a good idea to talk with your doctor, nurse or pharmacist about what is known so you can stay as healthy as possible.

Methadone Interactions

• Viramune: methadone up to 60%

• Sustiva: methadone up to 60%

• Rescriptor: Not studied

Methadone Interactions

• Crixivan: None• Norvir: Decreases methadone levels• Invirase/ Fortovase: Minimal effects on

methadone• Agenerase: Decreases methadone by 13%• Viracept: methadone 35-45%

– ( NFV 50%)

• Kaletra: methadone up to 50%

Buprenorphine/Suboxone• Buprenorphine hydrochloride is one of the first new treatment options

for opioid dependence since methadone was introduced in Canada over 40 years ago.

• Physicians do not have to obtain a section 56 methadone exemption1 from Health Canada in order to prescribe buprenorphine.

• While international clinical evidence indicates that buprenorphine is a much safer drug than methadone, it is important to keep in mind that the opioid-dependent patient population presents special risks and challenges.

• Two formulations of buprenorphine – Subutex® and Suboxone® – have been approved by Health Canada for use in treating opioid dependence.

Buprenorphine• Is efficacious as substitution therapy in the treatment of opioid dependence.• Is an alternative to, but not a substitute for, methadone maintenance treatment.• Is considered safer in overdose than methadone, although if combined with other

CNS depressant drugs (e.g., benzodiazepines) respiratory depression can occur. If clinical symptoms of overdose occur it may require higher doses of naloxone or other measures for treatment.

• May have a lower potential for abuse and dependence than pure agonists such as morphine, although abuse does occur.

• Can be titrated to an effective dose within days, in contrast to methadone which typically may take weeks to achieve.

• May induce withdrawal in patients dependent on opioids if administered too soon after last use of full opioid agonists.

• May be easier to taper from than methadone.• May be associated with less stigma than methadone.• Suboxone (Buprenorphione plus Naloxone) is a sub-lingual tablet, available in two

different doses. The Naloxone is intended to deter injection.• Coverage for Suboxone is currently not universal in Ontario.

Source: (CAMH 2008)

Prescription Medications

• Opioids include pain medications with active ingredients such as morphine, oxycodone and codeine.– Tylenol 3s; Percocets; Oxycontin

• Tranquillizers are often prescribed to reduce stress and panic attacks.– benzodiazepines such as diazepam (Valium®) and alprazolam (Xanax)

• Stimulants are often used to treat ADD/ADHD.– dextroamphetamine (Adderall); methylphenidate (Ritalin)

Prescription Medications

• Antidepressant are used to alleviate mood disorders, such as major depression and dysthymia.– selective serotonin reuptake inhibitors (SSRIs: Celexa; Zoloft; Prozac);

serotonin-norepinephrine reuptake inhibitors (SNRIs: Effexor); monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs)…

• Barbiturates treat anxiety, sleep disorders and seizures– pentobarbital sodium (Nembutal) and mephobarbital (Mebaral).

• Anitpsychotics are primarily used to manage psychosis particularly in schizophrenia and bipolar disorder: – haloperidol (Haldol) olanzapine (Zyprexa), quetiapine (Seroquel),

risperidone (Risperdal), and aripiprazole (Abilify)

Pharmaceutical Drugs

• The following few slides come from: not4me.org

• We have divided the pharmaceutical facts into three common categories:

• Opioid Painkillers• Stimulants• Tranquilizers, Barbiturates

Pharmaceutical Opioid Painkillers

• What it is• Category: Opioid analgesic• Examples of generic names (and their respective trade names) include:

codeine (Tylenol III), meperidine (Demerol), hydrocodone (Vicodin), oxycodone (OxyContin, Percocet) and morphine.

• Pharmaceutical painkillers are usually prescribed medically for the purposes relieving pain, but they are also used recreationally or outside of their prescribed use. Most opioid painkillers that are used recreationally are diverted from prescription use, rather than being illegally manufactured.

• Most come in pill form in various dosages, which can be taken orally, ground up and snorted nasally or diluted into a liquid and injected. Snorting and injecting result in a quicker and stronger effect (though these methods can be very dangerous as they release several hours worth of opioid painkillers into your body at once).

Pharmaceutical Opioid Painkillers

• What will likely happen *Reactions and experiences may vary dramatically from person to person.*

• Effects on brain:• Short term: Opioid painkillers activate opioid receptors in the brain, increasing the release of the

neurotransmitter dopamine, interfering with the transmission of pain signals to the brain and causing feelings of intense happiness, warmth and pleasure.

• Effects on body:• Short term: Possible immediate effects include (pain relief), sleepiness, constricted pupils,

sweating, loss of appetite, constipation, nausea, vomiting, dizziness, headache, itchiness, dry mouth, fatigue, weakness, insomnia, fever, diarrhea, difficulty urinating, abdominal pain, rash, difficulty breathing and convulsions. When snorted, nasal discomfort or damage can occur.

• Long term: Possible long term effects include physical addiction and withdrawal symptoms if drug use is stopped. Some opioid painkillers (such as codeine and hydrocodone) also contain acetaminophen, which can cause liver toxicity with regular use and high doses.

• Effects on behaviour:• Short term: Possible immediate effects include improved mood, euphoria, feelings of relaxation,

unfocused thoughts, confusion, and nervousness.• Long term: Possible long-term effects include cravings for more opioid painkillers and decreased

interest in sex.

Pharmaceutical Opioid Painkillers

• Dependency• Addiction: Opioid painkillers can be both physically and

psychologically addictive. The addictive potential is strong in recreational users as well as in medical users, especially if the drug is used on a daily basis.

• Tolerance: Tolerance to opioid painkillers can develop over a matter of weeks, with higher doses needed to achieve the same desired effect (both recreationally and medically).

• Withdrawal Symptoms: Symptoms can occur when regular pharmaceutical painkiller use is stopped, and include insomnia, restlessness, muscle spasms, muscle aches, tremors, sweating, fever, nausea, vomiting, diarrhea and anxiety.

Pharmaceutical Opioid Painkillers

• If you choose to use... Harm Reduction Tips• Recreational use of pharmaceuticals is illegal; therefore if you are caught possessing

pharmaceuticals without a prescription from your doctor, or exchanging, buying or selling them, it can result in criminal charges.

• Drug use affects the developing mind and body differently than developed ones. Waiting until your mind and body have more fully developed before using substances can have long term health and mental benefits.

• Opioid painkillers have very strong addictive potential! Do not assume that a drug prescribed by a doctor to a friend will be safe for you to take as well. Opioid painkillers are prescribed only for individuals who need it, and can have adverse and dangerous effects on individuals for whom they are not prescribed.

• Similarly, if you have been prescribed opioid painkillers, avoid taking more than the prescribed dosage. Always talk to your doctor or a health professional before taking prescribed painkillers with other substances.

• Some of the negative effects of opioid painkillers can be alleviated by lying down. Negative side effects generally increase with higher doses.

Pharmaceutical Opioid Painkillers

• Some opioid painkillers (such as codeine and hydrocodone) also contain acetaminophen, which can cause liver toxicity with regular use and high doses.

• If injecting, use new, clean syringes and equipment. Prepare your shot on a clean surface. Clean the area you are planning to inject with soap and water or an alcohol pad. You can get clean injection supplies from a syringe exchange, a pharmacy, or your local health department. If you can’t get new needles, try snorting instead. Cleaning needles and works is not risk-free; it’s a last resort. Rinse with cool water 3 times, bleach for 30 seconds, then clean water 3 times.

• Regular injection can cause abscesses, collapsed veins, infections and other complications. • Regular snorting can cause serious damage to the nose such as a chapped, runny nose, sinus

infections, nose bleeds and developing a hole in the cartilage wall between nostrils.• Avoid sharing equipment (straws, syringes, spoons) since this could lead to transmission of

Hepatitis B, Hepatitis C and HIV• Snorting and injecting opioid painkillers can result in a quicker and stronger effect. These

methods can be very dangerous as they release several hours worth of opioid painkillers into your body at once.

• Avoid using opioid painkillers with other substances, particularly depressants such as alcohol and narcotics.

Pharmaceutical Stimulants

• What it is• Category: Stimulants• Examples of chemical names (and their respective trade names)

include: amphetamine (Adderall) and methylphenidate (Ritalin, Concerta). Pharmaceutical stimulants are most commonly prescribed in the treatment of Attention Deficit Disorder (ADD) and Attention Deficit Hyperactive Disorder (ADHD), but they have also been used in the treatment of narcolepsy and mild depression. Pharmaecutical stimulants are also used recreationally or outside of their prescribed use by many individuals.

• For more information about amphetamines, click here.

Pharmaceutical Stimulants

• What will likely happen *Reactions and experiences may vary dramatically from person to person.*

• Effects on brain:• Short term: Stimulants cause an increased release of the neurotransmitter dopamine which

causes increased feelings of pleasure. • Long term: can cause permanent changes to some areas of the brain, though the brain is quite

adept at rewiring and compensating for changes• Effects on body:• Short term: Possible immediate effects include sweating, dilated pupils, decreased appetite,

difficulty sleeping, tremors, increased heart rate, increased blood pressure, narrowing of blood vessels causing decrease in blood flow and flow of oxygen to the heart.

• Long term: Possible long term effects include weight loss, insomnia, exhaustion, heart problems, seizures, physical addiction and withdrawal symptoms is drug use is stopped.

• Effects on behaviour:• Short term: Possible immediate effects include increased concentration, panic, anxiety,

aggression, hostility, violence and paranoia.• Long term: Possible long-term effects include paranoia, aggression, panic, hostility, violence and

triggering of underlying psychological problems.

Pharmaceutical Stimulants

• Dependency• Addiction: Physical and psychological addiction can occur.• Tolerance: can develop tolerance • Withdrawal Symptoms: Withdrawal symptoms occur when

stimulant use is stopped and include, depression, loss of appetite, difficulty sleeping.

Pharmaceutical Stimulants

• If you choose to use... Harm Reduction Tips• Recreational use of pharmaceuticals is illegal; therefore if you are caught possessing pharmaceuticals without a

prescription from your doctor, or exchanging, buying or selling them, it can result in criminal charges.• Drug use affects the developing mind and body differently than developed ones. Waiting until your mind and body

have more fully developed before using substances can have long term health and mental benefits.• Do not assume that a drug prescribed by a doctor to a friend will be safe for you to take as well. Pharmaceutical

stimulants are prescribed only for individuals who need it, and can have adverse and dangerous effects on individuals for whom they are not prescribed.

• Similarly, if you have been prescribed pharmaceutical stimulants, avoid taking more than the prescribed dosage. Always talk to your doctor or a health professional before taking prescribed stimulants with other substances.

• Avoid sharing equipment (straws, syringes, spoons) since this could lead to transmission of Hepatitis B, Hepatitis C and HIV

• If injecting, use new, clean syringes and equipment. Prepare your shot on a clean surface. Clean the area you are planning to inject with soap and water or an alcohol pad. You can get clean injection supplies from a syringe exchange, a pharmacy, or your local health department. If you can’t get new needles, try smoking or snorting instead.

• Cleaning needles and works is not risk-free; it’s a last resort. Rinse with cool water 3 times, bleach for 30 seconds, then clean water 3 times.

• Regular injection can cause abscesses, collapsed veins, infections and other complications. Regular snorting can cause serious damage to the nose such as a chapped, runny nose, sinus infections, nose bleeds and developing a hole in the cartilage wall between nostrils.

Pharmaceutical Tranquilizers, Barbiturates

• What it is• Category: Sedative, tranquilizer• Examples of generic names (and their respective trade names)

include: diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax), clonazepam (Klonopin), amobarbital (Amytal) and pentobarbital (Nembutal).

• Pharmaceutical tranquilizers and barbiturates are usually prescribed medically for the purposes of treating anxiety, sleep problems, muscle spasms and seizures, but they are also used recreationally or outside of their prescribed use. Most tranquilizers and barbiturates that are used recreationally are diverted from prescription use, rather than being illegally manufactured.

• Most come in pill form in various dosages, which can be taken orally, ground up and snorted nasally or diluted into a liquid and injected.

Pharmaceutical Tranquilizers, Barbiturates

• What will likely happen *Reactions and experiences may vary dramatically from person to person.*

• Effects on brain:• Short term: Pharmaceutical tranquilizers and barbiturates increase the activity of the

neurotransmitter GABA, resulting in decreased brain activity and causing feelings of calmness and drowsiness.

• Effects on body:• Short term: Possible immediate effects include dilated pupils, drowsiness, slurred

speech, loss of coordination, fatigue, irregular breathing, decreased heart rate, decreased blood pressure.

• Long term: Possible long term effects include slower reflexes, chronic tiredness, problems with vision, difficulty sleeping, sexual dysfunction, respiratory difficulties and liver damage.

• Effects on behaviour:• Short term: Possible immediate effects include feelings of calmness and relaxation,

lowered inhibitions, impaired judgment and paranoia.• Long term: Possible long-term effects include mood swings and aggression.

Pharmaceutical Tranquilizers, Barbiturates

• Dependency• Addiction: Pharmaceutical tranquilizers and barbiturates can be both

physically and psychologically addictive. The addictive potential is strong in recreational users as well as in medical users, especially if the drug is used on a daily basis.

• Tolerance: Tolerance to pharmaceutical tranquilizers and barbiturates can develop very quickly, for both medical and recreational use, particularly when taken on a daily basis.

• Withdrawal Symptoms: Withdrawal symptoms do occur when regular use or high doses are stopped and include restlessness, insomnia, anxiety, depression and delirium. One severe withdrawal symptom is brain activity rebound, as the tranquilizers or barbiturates wear off, resulting in the brain racing out of control. This can sometimes cause seizures.

Pharmaceutical Tranquilizers, Barbiturates

• If you choose to use... Harm Reduction Tips• *Disclaimer! Nothing you do can make using unprescribed pharmaceuticals completely safe. All drug use has

inherent risks and dangers. The suggestions in this section can only help you reduce some of the associated risks. The best way to avoid the harms related to drug use is to not take the drug at all.*

• Recreational use of pharmaceuticals is illegal; therefore if you are caught possessing pharmaceuticals without a prescription from your doctor, or exchanging, buying or selling them, it can result in criminal charges.

• Drug use affects the developing mind and body differently than developed ones. Waiting until your mind and body have more fully developed before using substances can have long term health and mental benefits.

• Avoid sharing equipment (straws, syringes, spoons) since this could lead to transmission of Hepatitis B, Hepatitis C and HIV

• If injecting, use new, clean syringes and equipment. Prepare your shot on a clean surface. Clean the area you are planning to inject with soap and water or an alcohol pad. You can get clean injection supplies from a syringe exchange, a pharmacy, or your local health department. If you can’t get new needles, try snorting instead.

• Cleaning needles and works is not risk-free; it’s a last resort. Rinse with cool water 3 times, bleach for 30 seconds, then clean water 3 times.

• Regular injection can cause abscesses, collapsed veins, infections and other complications. Regular snorting can cause serious damage to the nose such as a chapped, runny nose, sinus infections, nose bleeds and developing a hole in the cartilage wall between nostrils.

• Do not assume that a drug prescribed by a doctor to a friend will be safe for you to take as well. Tranquilizers and barbiturates are prescribed only for individuals who need it, and can have adverse and dangerous effects on individuals for whom they are not prescribed.

• Similarly, if you have been prescribed tranquilizers or barbiturates, avoid taking more than the prescribed dosage. Always talk to your doctor or a health professional before taking prescribed medications with other substances.

Pharmaceutical Risk Reduction

• Harm Reduction Guide to Coming Off Psychiatric Drugs: – http://theicarusproject.net/downloads/ComingOffPsyc

hDrugsHarmReductGuide1Edonline.pdf

Resources

• General:• www.erowid.org/psychoactives/psychoactives.shtml (all about every drug)• www.tripproject.ca (Toronto based “party drug” harm reduction)• www.not4me.org (Fear and abstinence only drug education?

It's not enough 4 me.)• www.torontovibe.com (AIDS Committee of Toronto’s party drug info page)• www.dancesafe.org (U.S. based “party drug” harm reduction info)• www.cssdp.org (Canadian Students for Sensible Drug Policy)

• Ecstasy:• www.ecstasy.org• www.ecstasydata.org (chemical analysis of pills)• www.pillreports.com (qualitative user reports of pills)

• Crystal Meth: (gay/bi men focused)• www.himynameistina.com • www.tweaker.org / www.crystalneon.org

www.knowcrystal.org

Contact Us

Nick Boyce, Directornboyce@ohsutp.ca

CC Sapp, Trainerccsapp@ohsutp.ca

Websitewww.ohsutp.ca

Presentationshttp://www.slideshare.net/OHSUTP/presentations

Research Chemicals

• Crystalline powder; Pill form • “Bath salts”; “Plant food” • Sold in packages labeled “not for human

consumption” • Common Product Names:

– Meow Meow; Tranquility; Blue Silk; Cloud 9; Bolivian Bath; Ivory Wave; Bliss; Lunar Wave