NOT YOUR MOTHER’S DRUGS: SYNTHETIC CANNABINOIDS

Diane A. Tennies, Ph.D., LADC

Lead TEAP Health Specialist 1

LEARNING OBJECTIVES

Describe the synthetic cannabinoids and why they are increasing in popularity 

Articulate the physiologic effects associated with synthetic cannabinoids use

Discuss the current status of federal and state laws as applied to synthetic cannabinoids

Develop center-specific interventions to assist students identified as using synthetic cannabinoids

2

REMEMBER WHEN?SIMPLER AND EASIER TIMES

3

Opiates Cocaine Phencyclidine (PCP)

Extensive scientific literature (clinical and experimental)

Kinetics (the chemical process) Toxicological effects (on humans)

‘THE GOOD OLE DAYS’

4

MARIJUANA

Listed in US Pharmacopea until 1944 when removed due to political pressure to ban social use in USA

Cannabis preparations have been used for psychotomimetic effects for 4000 to 6000 years

5

PSYCHOTOMIMETIC??

Mimics the symptoms of psychosis (delusions and hallucinations)

Carl Sagan used ‘psychotomimetic’ (in his anonymous article “Mr.X”) to describe the effects of marijuana

Cannabinoids are psychotomimetic, especially delta-9-tetrahydrocannabinol (THC)

Psychotomimetic drugs affect: thought, perception and mood, without causing marked psychomotor stimulation or depression

6

CANNABINOIDS 101

Occurs naturally in dried flowering/fruiting tops of Cannabis Sativa plant

Cannabinoids active compounds extracted from cannabis

Renewed interest in using cannabinoids for medicinal purposes

Discovery of cannabinoids receptors and endocannabinoids opened new era in research on pharmaceutical applications of cannabinoids

7

HUMAN CHEMISTRY

Human body produces endogenous cannabinoids and the cannabis plant produced exogenous cannabinoids

We have complex cannabinoids receptor systems

Marijuana contains a variety of unique cannabinoids that bind with these receptors

8

DELTA-9-TETRAHYDROCANNABINOL (THC)

9

WHAT IS THIS EMINENT PROFESSOR BEST KNOWN FOR?

Dr. John W. Huffman, (JWH) professor of organic chemistry at Clemson University in South Carolina for 50 years

Ph.D. from Harvard and the National Institutes of Health's Senior Scientist Award

10

DUBIOUS HONOR OF BEING CREATOR OF SYNTHETIC CANNABINOIDS

Researching the effects of cannabinoids on the brain (For NIDA in 1990’s)

Developed chemical compounds to mimic effects of marijuana (like JWH-018)

1995 paper contained the method/ingredients and was published 11

The Spread of K2/Spice K2/Spice is unintended result of scientific

research on marijuana's effects

2008 - German pharmaceutical company THC Pharm developed three versions of the herbal incense brand Spice with JWH-018 as primary ingredient

By summer of 2009, packets of dried herbs sprayed with JWH compounds were sold throughout the world as "herbal incense" products

12

DR. HOFFMAN SAYS: The materials to make JWH-018 are available from

laboratory chemical suppliers. A good college senior chemistry major could probably make them with some supervision and decent lab equipment. JWH-018 was made by a summer undergraduate research student, with supervision

There are no valid, peer-reviewed studies of the effects of this compound in humans, nor are there any data regarding its toxicity…it’s like playing Russian Roulette

I emphasize that this compound was not designed to be a super-THC. It should absolutely not be used as a recreational drug

I’ve lived around the world a long time [78 years old] and come to the conclusion that if an enterprising person wants to find a new way to get high, they’re going to do it

People who use it are idiots13

LEGITIMATE USES FOR SYNTHETIC CANNABINOIDS

Nabilone – derivative of THC and in proprietary preparation Cesamet used for nausea in chemotherapy

Dronabinol/Marinol – used for nausea, vomiting

Rimonabant (Acomplia, Zimulti) – initially used for weight loss but pulled because of side-effects. NIDA investigating because it blocks the effects of THC in marijuana

Sativex – semi-synth used in Europe and Canada for pain

14

SYNTHETIC CANNABINOIDS – LATEST IN A LONG HISTORY OF DESIGNER DRUGS

Morphine and Heroin illegal in 1925

Synthetic hallucinogen LSD

MDMA (Ecstasy)

Every illegal drug has an unregulated "research chemical" that reputedly does the same thing

For instance, can buy MDAI, said to have similar effects to ecstasy, and mephedrone, a synthetic cousin of crystal methamphetamine

15

THE MANY VERSIONS

16

SPICE (FROM THE FRANK DUNE BOOKS)

AKA:

Spice gold Spice silver Spice diamond Yucatan fire Sence Chill X Genie Algerian blend

K2 Solar flare K2 summit PEP Spice Fire n’ Ice Zombie World Bad to the Bone Black Mamba Dark Night G-Force

17

MORE SPICE

18

PHYSICAL FORM OF K2/SPICE

Pure state – either solids or oils

Smoking mixtures – usually sold in metal-foil sachets

Solution of the cannabinoids sprayed onto herbal mixture

Contain 3 g dried ‘vegetable matter’

Enough for 8 joints

Price comparable to marijuana19

“HERBAL INCENSE” PRODUCTS CONTAIN A VARIETY OF HERBS AND

OTHER BOTANICALS Canavalia rosea: commonly known as beach bean or

bay bean - vine found in tropical and subtropical beach dunes

Nymphaea caerulea: also known as Blue Egyptian water lily

Scutellaria nana: perennial herb also known as Dwarf Skullcap

Pedicularis densiflora: known commonly as Indian Warrior - a perennial herb

Leonotis leonurus: also known as Lion's Tail and Wild Dagga - a perennial shrub native to southern Africa

Zornia latifolia: a perennial herb Nelumbo nucifera: known by a number of names

including Indian Lotus, or simply Lotus - aquatic perennial commonly found in China

Leonurus sibiricus: commonly called Honeyweed or Siberian Motherwort, herbaceous plant native to Asia

20

EFFECTS OF SYNTHETIC CANNABINOIDS: RESEARCH

SAYS…

Behavioral pharmacology studies show JWH-018 has Δ9-THC-like activity in animals

In mice, it decreases overall activity, produces analgesia, decreases body temperature and produces catalepsy

A search in the literature found no published studies of the effects of JWH-018 in humans

21

PHARMACOLOGY

Cannabinoids receptor agonists mimic effects of THC by interacting with CB1 receptors in brain

Synthetic compounds bind more strongly than THC (up to 100 x’s more tightly)

Little known about pharmacology and toxicology

Long half-lives = prolonged psychoactive effect

Considerable batch variability = highly potential for overdose 22

SAME OR DIFFERENT CHEMICAL STRUCTURES?

23

JWH-018 THC

SO IF SYNTHETIC CANNABINOIDS AND THC ARE CHEMICALLY DIFFERENT…

THAT MEANS?

24

GROWING POPULARITY

First appearance sold as herbal incense on internet 2004

Europe – first target market by 2008 Escalating use in USA by late 2008 Late 2008, first article appeared in scientific

literature DEA Office of Diversion Control published

one-page update on Spice in 2008 Poison Control Centers:

2009: 13 cases with adverse reactions to Spice 2010: 833 cases from 41 states through 9/1/2010 25

26

27

COUNTRIES THAT CONTROL SYNTHETIC CANNABINOIDS

Denmark Germany Estonia France Ireland Italy Latvia Lithuania Luxembourg Austria Poland Romania Sweden UK

Chile Finland South Korea Switzerland

28

IN THE UNITED STATES No federal ban but Federal Drug Czar Gil Kerlikowske stated

substance is “on our radar” and indicates state legislatures are dealing “well” with issue

Patchwork of local and state laws

In May, the Department of Defense banned synthetic cannabinoids from all U.S. military bases

Kansas first state in 5/2010

Also Oregon, Michigan, Virginia, Idaho, Missouri, Alabama, Arkansas, Georgia, Kentucky, Louisiana, North Dakota, Mississippi, Illinois, Michigan, and Tennessee

Found reference to bans being considered in Indiana, New York, Florida, Iowa, Ohio, and New Jersey

As of 12/24/2010 the DEA made possession and sale of five of the Synthetic Cannabinoids illegal (including JWH018)

29

PHARMACOLOGICAL EFFECTS OF SMOKED SYNTHETIC

CANNABINOIDS Increased heart rate

and blood pressure Altered state of

consciousness Mild euphoria and

relaxation Perceptual alterations

(time distortions) Intensification of

sensory experiences Impaired short-term

memory Increase in reaction

times

Panic attacks Agitation Numbness and

tingling Vomiting (severe

requiring sedation) Hallucinations Tremors and seizures

30

“THIS ISN’T JERRY GARCIA’S MARIJUANA”

(STATE REP. JEFF ROORDA, DEM – MISSOURI)

31

SYNTHETIC CANNABINOIDS

Users report effects last between 30 minutes and two hours

2009 – first scientific publication documenting a Dependence syndrome corresponding with DSM-IV

Physical withdrawal syndrome similar to MJ

32

SO WHAT DOES ALL THIS MEAN?

Ideas about intervening with students using synthetic cannabinoids?

What are the options?

33

SO THE ANSWER IS…DRUG TESTING?

Which of the 450+ synthetic cannabinoids would be detected?

Appropriate detection cutoff levels? Cost for testing? Reliability and validity concerns

Dominion Diagnostics: Detection of metabolites through urine or blood

On the horizon: As of June, California-based Redwood Toxicology

Laboratories made test available to detect metabolites from JWH-018 and JWH-073 up to 72 hours after use

Another drug-testing company, Drug Free Sport, (handles testing for the NFL and NCAA) announced developing test for JWH metabolites by 12/2010 34

BUT WAIT… IF WE JUST DO DRUG TESTING THEN WHAT ABOUT OTHER DESIGNER

DRUGS?

Bromo-Dragonfly – phenethylamine derivative sold as ‘plant food’ and is potent hallucinogen with delayed onset to peak (six hours) and prolonged duration (up to several days)

Nexus (Bees, Venus, Toonies) – synthetic phenothylamine can be sold as Ecstasy (white power/tablet), causes euphoria, and hallucinations

35

WHAT ABOUT OTHER DESIGNER DRUGS?(continued)

Mephedrone (Meow, Drone, Bubble, M-Cat) – structure similar to Cathinone (Khat) with symptoms including anxiety, panic and paranoia, as well as severe hallucinations (analog to Crystal Meth)

Salvia – perennial plant in mint family, causes vivid hallucinations and spinal anesthesia

36

COMMENTS, QUESTIONS AND CONCERNS

37