Tales of Bath Salts and Zombie Cannibalism

January 14, 2015
Maureen Fitzgerald
Communications Coordinator, ATTC Network Coordinating Office
Editor, NIATx

The ATTC Network’s November iTraining, “Will they Turn You into a Zombie? An Overview of Synthetic Drugs” was packed with information on synthetics, including the major classes of synthetic drugs, the acute and chronic effects of using them, and the extent of use in the United States.

Beth Rutkowski, Associate Director of Training for the Pacific Southwest ATTC  and UCLA Integrated Substance Abuse Programs presented the webinar, which is based on the Synthetic Drug Training Package-2nd Edition that the PSATTC developed in partnership with the South Southwest ATTC.

You can watch “Will they Turn You into a Zombie?” on the ATTC Network’s Vimeo site. The presentation included time for audience questions, but we ran out of time to answer them all.

Here, we provide Beth’s in-depth replies to the remaining questions

Q: You mentioned psychosis as a side effect of designer cathinones. Is paranoia or psychosis a side effect of Spice?

A: Short-term effects of synthetic cannabinoids include: loss of control, lack of pain response, increased agitation, pale skin, seizures, vomiting, uncontrolled spastic body movements, elevated blood pressure, elevated heart rate, and heart palpitations. Additional symptoms of synthetic cannabinoid intoxication that are similar to cannabis intoxication include: tachycardia, reddened eyes, anxiousness, mild sedation, hallucinations, acute psychosis, and memory deficits. Symptoms of synthetic cannabinoid intoxication that are not typically seen after cannabis intoxication include: seizures hypokalemia, hypertension, nausea/vomiting, agitation, violent behavior, and coma. (Refer to slides 59-60 for more details).

Because we do not really know all of the ingredients in these drugs, the paranoia or psychosis could be an effect of spice or an effect of some other drug added to spice. Recent DEA seizures of spice showed that the merchants bought raw chemicals from overseas and mixed them in the back of their shop with varying recipes and amounts, so there is actually no “spice” on which to blame the paranoia. Based on the reports from the DEA National Forensic Laboratory System, there were 18 variations of spice in 2010; as of the end of December, 2014, there are 64 different chemical variations.

Q: How does the cost of these drugs compare to what you buy on the street?

A: The exact cost of synthetic drugs will depend on the region of the country and source (head shop, online, etc.). On average, synthetic cannabinoids (spice) and synthetic stimulants (bath salts) can cost anywhere from $25-50 per packet. Packets/containers usually range in size from 1-5 grams. Unlike data we receive on street drugs like cocaine and heroin, there is no good data source on the price of these synthetic drugs or the cost per gram.

Q: Are the effects permanent after heavy use of the substances?

A: Because the synthetic drugs most prominently featured in this presentation have only been available in the United States for a few years, researchers have not yet had a chance to study the long-term impact of synthetic drugs such as spice and bath salts on the user’s brain and body.

Q: Are people using real bath salts in an attempt to get high? If yes, can people die or be poisoned from it?

A: Data does not exist to substantiate this question. Legitimate bath salts, such as those marketed by Calgon, do not contain any psychoactive ingredients.

Q: Are synthetic components often used in combination with traditional street drugs without lower level sellers' and buyers' awareness?

A: Anecdotal evidence does support the notion that many synthetic drug users use synthetic drugs in combination with other illicit drugs, prescription medications, or alcohol (e.g., a poly-drug use pattern.) We have also heard anecdotal evidence that some users who wanted stronger ecstasy were adding mephedone to the mix to increase the effect.

Q: Are all synthetic psychoactive drugs illegal, or just specific types?

A: Not all synthetic drugs are illegal. Congress has taken steps to ban many of these substances at the Federal level, and the Obama Administration has supported such efforts. The Synthetic Drug Abuse Prevention Act is part of the FDA Safety and Innovation Act of 2012, signed into law by President Obama. The law permanently places 26 types of synthetic cannabinoids and cathinones into Schedule I of the Controlled Substances Act (CSA). It also doubled the maximum period of time that the Drug Enforcement Administration (DEA) can administratively schedule substances under its emergency scheduling authority, from 18 to 36 months. On April 12, 2013, DEA used its emergency scheduling authority to schedule three more types of synthetic cannabinoids, temporarily designating them as Schedule I substances. At least 43 states have taken action to control one or more synthetic cannabinoids.

Prior to 2010, synthetic cannabinoids were not controlled by any state or at the Federal level. In addition, at least 44 states have taken action to control one or more synthetic cathinones. Each of these states and local municipalities can pass controlling regulations and given how quickly these substances change, they are constantly changing the laws. The National Alliance for Model State Drug Laws works with the states to improve their regulations, but this is an ever-changing situation. On December 12, 2014, DEA banned three more synthetic cannabinoid combinations. (SOURCE: http://www.whitehouse.gov/ondcp/ondcp-fact-sheets/synthetic-drugs-k2-spice-bath-salts).

Q: In the Monitoring the Future Study, were the same youth surveyed in 2012 and 2013?

A: No. The data from students are collected during the spring of each year. Each year's data collection takes place in approximately 420 public and private high schools and middle schools selected to provide an accurate representative cross section of students throughout the coterminous United States at each grade level. A multi-stage random sampling procedure is used for securing the nationwide sample of students each year at each grade level. Within each school, up to 350 students may be included. In schools with fewer students, the usual procedure is to include all of them in the data collection. In larger schools, a subset of students is selected either by randomly sampling entire classrooms or by some other random method that is judged to be un-biased. Sampling weights are used when the data are analyzed to correct for unequal probabilities of selection that occurred at any stage of sampling. (SOURCE: http://www.monitoringthefuture.org/purpose.html).

What is important about the findings is that the younger students in 2012 did not think these drugs were dangerous, and the perceptions of the older students were also low. Kids often learn from the bad experiences of their elders and their elders (older siblings) knew nothing about the drugs. Within a year, all of their attitudes had changed and they all saw the drugs as more dangerous.

Q: Are you looking at Suboxone in rural areas?

A: There are most certainly efforts underway to increase the use of Suboxone (a combination of buprenorphine and naloxone) in both rural and urban areas across the United States. Buprenorphine is an opioid medication that is used to treat narcotic (opiate) addiction. It can be prescribed by any local physician who has completed the required training course and can be obtained at a local pharmacy, so a daily visit to a drug treatment or methadone program is not necessary. Suboxone is not effective in treating cannabis or stimulant addiction. More information is available at: http://buprenorphine.samhsa.gov/.

Q: What areas of the US are these drugs most prevalent? Is there concurrent drug use with these synthetic drugs?

A: The vast majority of epidemiological data that can be accessed to describe the extent of synthetic drug use is only available at the national level, so it is difficult to say whether there are areas within the United States in which synthetic drugs are more prevalent. There is, however, anecdotal information to support the statement that there is concurrent use of synthetic drugs with other illicit substances, alcohol, and prescription medications. Unfortunately, the traditional data sources, such as overdose deaths, treatment admissions, etc. are not yet collecting information about these drugs. Some maps in a NDLIS publication shows how quickly the drugs spread, but they can vary over time. (SOURCE: https://www.nflis.deadiversion.usdoj.gov/DesktopModules/ReportDownloads/Reports/NFLIS_SR_CathCan_508.pdf).

Q: What is the direct effect of synthetic drugs to the fetus/baby with prolonged use by the mother during pregnancy? Do they present the same issues/risk as regular drugs? Will the baby suffer from withdrawal symptoms?

A: At this time, I am unaware of any research that has been conducted on the direct effect of synthetic drugs on the fetus with prolonged use by the mother during pregnancy.

Q: Is there continuing education available for the full-length synthetic drugs training?

A: Availability of continuing education is determined by the ATTC regional center that offers the full-length Synthetic Drugs Training Package. At this time, there is not a self-paced version of the full curriculum.

Q: I am currently treating two patients in a behavioral health clinic with ongoing psychotic symptoms and agitation following use of synthetic drugs. Are there studies currently regarding long-term damage to the brain?

A: Because the synthetic drugs most prominently featured in this presentation have only been available in the United States for a few years, researchers have not yet had a chance to study the long-term impact of synthetic drugs such as spice and bath salts on the user’s brain and body. The Texas Poison Center has reported that between 2010 and 2014, 8 percent of the synthetic cannabinoid cases and 12 percent of the synthetic cathinone cases resulted in “major effects” (life-threatening,” in which the patient did not return to the same state mentally or physically before taking the drug. Also see Hondebrink, L. et al. (in press). Monitoring new psychoactive substances (NPS) in the Netherlands: Data from the drug market and the Poisons Information Centre. Drug and Alcohol Dependence.

Viewers also asked about two brief You Tube videos that Beth recommended. "It's not a Fad, It's a NIGHTMARE," produced by the U.S. Navy:

And a video about synthetic marijuana, What is Spice, AKA Synthetic Marijuana, is available at: http://www.youtube.com/watch?v=d_6WW0lZkLo.
An infographic from Lakeview Health also gives some key facts about synthetics in a visual format:
Synthetic Drugs: Who's Using and the Dangers

Many thanks to Beth Rutkowski for presenting the November Third Thursday iTraining webinar and for the follow-up responses to additional audience questions.

Beth Rutkowski received her Master of Public Health degree, with an emphasis on epidemiology and quantitative methods, from the University of Medicine and Dentistry of New Jersey, School of Public Health. She has been associated with UCLA’s Integrated Substance Abuse Programs (ISAP) since December 2000,and currently serves as the Associate Director of Training. The majority of Ms. Rutkowski’s time is devoted to the SAMHSA-supported Pacific Southwest Addiction Technology Training Center,where she develops training packages based on evidence-based substance use disorder research and targeted to the community at large. In addition, she organizes and conducts conferences and trainings throughout the Pacific Southwest region (Region 9, covering AZ, CA, HI, NV, and the six U.S. Affiliated Pacific Jurisdictions) on scientifically validated interventions and topics, such as substance use disorders research and policy, methamphetamine abuse, synthetic drugs, process improvement strategies to improve client engagement and retention in treatment, SBIRT, HIV and drug abuse, substance abuse epidemiology, medication-assisted treatment, and best practices in addiction treatment.

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