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Episode 33

  • What are synthetic drugs?

  • Are synthetic drugs legal?

  • Have people really become cannibals from synthetic drugs?

Synthetic drugs were all over the headlines for years. What’s fact and what’s fiction? Are they dangerous or is that just hype? Tune in to this week’s episode of All Things Substance.

Helpful Links

Synthetic Cannabinoids (K2/Spice) DrugFacts | National Institute on Drug Abuse (NIDA)

Synthetic cannabinoids: What are they? What are their effects? | HSB | NCEH

About synthetic cannabinoids

Synthetic Cannabinoids (Spice): An Overview for Healthcare Providers | CDC

Synthetic Marijuana: Myths, Effects, Risks, and How to Get Help

Synthetic Cannabinoids (Synthetic Marijuana, Spice, K2) – Drugs.com

Synthetic cannabinoids | Effects and Risks | FRANK

Synthetic Marijuana: A Short History

How K2 and Other Synthetic Cannabinoids Got Their Start in the Lab | The Scientist Magazine®

A Trip on “Bath Salts” Is Cheaper Than Meth or Cocaine But Much More Dangerous | Addiction Medicine | JAMA | JAMA Network

Bath Salts Drug: Effects, Abuse & Health Warnings – Drugs.com

What are “bath salts?” | Drug Policy Alliance

Methylenedioxypyrovalerone (“bath salts”), related death: case report and review of the literature – PubMed

“Bath Salts” intoxication with multiorgan failure and left-sided ischemic colitis: a case report

‘Bath Salts’ Drug Suspected In Miami Face-Eating Attack : The Two-Way : NPR

The Bizarre Behaviors of Bath Salt Addicts | Technology Networks

The Drug That Never Lets Go | PBS NewsHour | Sept. 20, 2012 | PBS

Rapist took psychosis-inducing ‘bath-salt’ drug before bizarre terror rampage near Tampa – Orlando Sentinel

Heavy Use of ‘Bath Salts’ Reported Among Some Teens, Study Says | CADCA

Flakka Side Effects, Drug Complications & Symptoms

New Designer Drug Flakka Works Like ‘Bath Salts,’ Causes ‘Excited Delirium’ | CADCA

Scientists Find Hyped New Recreational Drug ‘Flakka’ Is As Addictive As ‘Bath Salts’

Meth-like ‘bath salts’ still legal in places – The Minnesota Daily

Duluth grapples with real damage from synthetic drugs | MPR News

Synthetic drug crackdown yields arrests in 30 states | MPR News

No, “Bath Salts” Won’t Turn You Into a Cannibal | Science | Smithsonian Magazine

Flakka Is a Dangerous Drug, but it Doesn’t Turn You Into a Zombie | National News | US News

Did a Man High on Bath Salts Cut Off His Genitals and Microwave Them? | Snopes.com

Synthetic Cathinones (“Bath Salts”) DrugFacts | National Institute on Drug Abuse (NIDA)

Free Treatment Tool https://betsybyler.com/treatment-tool/

Transcript

You’re listening to the All Things Substance podcast, the place for therapists to hear about substance abuse from a mental health perspective.  I’m your host, Betsy Byler and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor.  It is my mission to help my fellow therapists gain the skills and competence needed to add substance use to their scope of practice.   So join me each week as we talk about All Things Substance.

Welcome back to the all thing substance podcast. This is episode 33. Today we’re going to be talking about synthetics. Synthetics are sometimes called “legals” as in being legal ways to get high. There was a time where you could buy them legally in places like head shops, but even places like gas stations in the United States. Synthetics have since fallen out of popularity because of the big side effects and the problems that occurred with it. 

The big deal with synthetics was that you could smoke them and still pass a drug test. There are lots of people who get drug tested often for work,  contractors, people in unions and other types of professions. But in my experience, those weren’t really the main people using them. At least where I live, it was mostly people on probation or parole or people who wanted a cheaper alternative to be able to use drugs and get high and without the legal ramifications.

Around 2010 to about 2014, synthetic drugs were everywhere. Poison control centers and treatment centers across the United States got calls all the time. There were sensational headlines all over the place, including one in Florida, where a man was reported to have eaten part of a person’s face in response to being on  one of these synthetic drugs. It was proposed that he was taking what was called bath salts.

Bath salts are one of two main synthetic drugs. It’s supposed to be a synthetic methamphetamine, but it’s not. It’s way more potent in a lot of ways and has some unique characteristics. Now that report that he was on bath salts turns out to be false. The main chemicals that are in bath salts were not found in his toxicology report. The reports don’t really give us an idea of what drove this man to try to eat another man’s face, but we just know it wasn’t bath salts.

It hasn’t just been Florida though. There have been reports all over the country of bizarre behavior. A lot of those do happen to be true, just not necessarily the cannibal and or zombie effect that gets described.

One of the reasons that synthetic drugs don’t show up on drug tests is that a drug test is a predefined set of parameters looking for specific chemicals. Those chemicals are not listed on standard drug tests. Now, when you order drug tests you can order a certain number of panels, so to speak. You could have a 6 panel or up to a 13 panel and anything in between, depending on how much money you want to spend per test. Each panel is a drug that is represented.

When I worked in a treatment center, we had a 13 panel drug test that included everything from THC to benzodiazepines, to alcohol and the other drugs that you could imagine getting tested. Getting someone’s urine or blood tested for a synthetic drug was a separate test that you had to send to the lab and had a significant cost to it. We did it on occasion when we were pretty sure somebody was using, but wasn’t being straight about it and they weren’t coming up on the other drug tests. But it wasn’t something we did regularly. Our local probation and parole office wasn’t able to do those kinds of tests.

The other factor is that as soon as synthetic drugs started to become a problem legislatures all over the country started banning those compounds. Well,  what happened was the manufacturers decided to change the formula, slightly making it legal again. New legislation would get passed and it was sort of this cat and mouse game of trying to figure out how to keep these things from being on shelves. .

The issue with these chemicals is the way that they’re created and how they impact the different receptors in our brain. First, we’re going to talk about bath salts. These are called synthetic cathinones.

These synthetic cathinones affect the dopamine system, which is to be expected because most drugs work on the dopamine system.  Normally, dopamine gets released when we do something pleasurable, like eating a piece of cake or having sex. The feeling fades and the dopamine gets taken back up into the receptor. The re-uptake. When this process is changed, it can really lead to addiction.

This is where the cathinones  come in. The cathinones  called mephedrone and methylome function a lot like ecstasy. They make nerve cells produce more dopamine. So these two cathinones are busy making our dopamine receptors fire off more dopamine.  The main other part of the compound though, is doing something really different.

The other ingredient, which has an incredibly long name and is initialed M D P V acts like cocaine and it blocks the reuptake of dopamine. In addition, it also blocks the reuptake of norepinephrine. This leaves the two neuro-transmitters free to circulate in the space between nerve cells and by itself, the second compound, the MDPV is about 10 times more potent than cocaine.

When these two different processes work together the excess dopamine starts a cascade of reward signals while the norepinephrine speeds up the heart rate. This gives the user an altered state of consciousness, high energy that can often escalate to delirium and then transform into agitation.

The MDPV part of it also can last more than a day. It’s like putting a plug in a particular receptor and that leaves the person feeling the effects of the drug for longer than would be typical for other drugs. Other drugs have a general path to them. You take them, you feel it, it starts to fade. This however keeps going.

With the brain being flooded by these neuro-transmitters it’s logical to conclude that there are certain parts of the brain that can’t communicate with each other. This is what scientists believe is responsible for some of the bizarre behavior. Scientists also believe that MDPV is more addictive than meth.

So I saw a graphic that explained it pretty well. I’m going to try to explain it here and hopefully it will translate.  I want you to imagine a faucet, just a standard bathroom sink faucet. I want you to imagine that the dopamine is coming out of the faucet at a drip. Sort of when you forget to turn the faucet all the way off and there’s just a drip, not a huge flow, not just to drop every minute or so, but a drip that’s pretty consistent.

The dopamine drips out of the faucet and goes down into the sink and it gets reabsorbed as it goes down the drain. This is the normal process. When we do something pleasurable, the dopamine stream becomes stronger and we feel more of an effect, but it eventually goes down the drain and goes back up into the receptor. That’s the reuptake process.

What cocaine does is it plugs the sink. So imagine that this dopamine is dripping out of the faucet and someone puts the plug in the sink and so the dopamine is collecting. That’s what cocaine does in our bodies. Now, of course, eventually it does drain.

When you put meth into somebody’s system, it’s like turning the faucet on high blast. Meth is the strongest in terms of releasing dopamine of any drug. We’ll get to that in a few weeks when we cover meth more thoroughly. With bath salts we have a combination of the effect from cocaine and meth. Now, while those two substances are not in bath salts, the substances that are  the cathinones and the MDPV act in similar ways. So the first part turns the faucet on full blast and the second plugs the sink.

What we have is this liquid in our case, dopamine flooding the open area. This is what happens  and the sink or the dopamine receptors are being pushed  to produce more and more dopamine.

The effects can last a day or so longer. It depends on the dose and it depends on the tolerance of the person as well as a number of other personal factors. Dopamine  has profound effects on memory, learning, motivation and motor control. When the balance gets upset, it can cause a huge amount of problems in the brain.

The chemical components of the drug trace back to the seventies when a chemist named Richard Glennon was studying what it would take to convert a stimulant drug to a hallucinogen and vice versa. He wanted to figure out how these substances work in the brain. He knew that small modifications to a drug’s molecular structure could result in a major change in its effects. 

I’ll spare you the details of how it was done, but he didn’t expect that he would find the kind of activity that he found .In doing these modifications he found that the drug was at least as potent, if not more potent than an amphetamine.

So after NIDA, the National institute for Drug Abuse visited his lab one of the scientists pointed out that the main chemical that was in this drug  was identical to the active ingredient of a plant commonly called Khat that’s K-H-A-T. Now we’ll be talking about Khat next week when we turn towards Khat and Kratom.

For our purposes today this was a huge discovery because if they were able to have this data in the lab that also could be translated to what Khat was like, this was a big deal for them.

Glennon had dubbed this new compound methcathinone. Interestingly soon after the main paper on this was published Glennon received a letter in the mail from a scientist at a Lensoviet Technological Institute in St. Petersburg, Russia. The scientists told him that this had already existed in the Soviet Union, and it was a major drug of abuse in the seventies and had increased even more so in the eighties. They were calling it effedrone or Jeff on the streets.

The scientist went on to say that the 1987 article that Glennon wrote was the only published reference he could find to methcathinone. He went on to say that even though it was popular in the Soviet Union, the widespread drug problem had been kept quiet by the authorities for quote political motives.

How or why this started coming to the forefront of the drug culture no one’s really saying what we know is that in the early two thousands, it started popping up and became a real problem near 2008 to about 2013 across the United States.

Some people have described that you take the bad attributes of ecstasy, PCP, LSD, cocaine, and meth, and lump them together. So that includes hyperthermia like ecstasy, has agitation and a propensity for violent behavior. As in PCP. For LSD it’s also going to have some hallucinogen effect in terms of causing major bouts of psychosis, interfering with your ability to really look at time and space and reality in a typical way.

And then there’s the cocaine and meth connection that has to do with the amount of dopamine and whether or not it’s getting taken back up into the receptors. It is an incredibly powerful drug and pretty cheap and was widely available and not illegal. You can imagine why all of a sudden we had outbreaks all over different places in the United States.

Some of the reasons people were taking this drug is yes, because it wouldn’t show up on a drug test, but also because the high that they got from it, the good part of it, they felt like was really enjoyable.

People reported euphoria,  increased concentration and feeling awake and having energy, elevated sex drive, talkativeness, getting huge rush. And a lot of times they felt like that was going to overcome the downsides, which were rapid heart rate, chest pain, high blood pressure hyperthermia. Remember that’s an elevated body temperature. Excessive sweating, pupil, dilation, vessel constriction, reduced appetite, muscle spasms, or seizures. The thing about this drug though, is that it is really dangerous. The outcomes of it were really random and it could be something like just having some severe panic attacks, which I know sounds like not a lot of fun, but on the list of bad outcomes, having a severe panic attack is sort of mild.

The most common signs of toxicity were agitation,  tachycardia and delusions or hallucinations. In more severe cases,  seizures. Multi-system organ failures and death. Bath salts has been linked  as a direct cause of death, as well as to indirect causes of death, where people have committed suicide while on the drug, this is not necessarily a rare occurrence. I wouldn’t say that these outcomes are necessarily common as in happening more often than not, but they aren’t rare by any stretch.

I can’t overstate the impact that the psychosis has on people.  This is not the same cause psychosis. Or the same level that we have in the people that we work with, who have schizophrenia or other psychotic disorders.

This is intense and rapid and coupled with this propensity for violence and agitation, it’s a really different thing. It is not the same psychosis either that we’re talking about with LSD or Ayahuasca or peyote or any of those things.

For instance, there was a man near Tampa, Florida in 2013, who burst into an apartment where there were men and women there. Tied up the men and sexually assaulted the women. After which he went to a nearby apartment and had planned on doing that again but some interaction between the two of them ended with him leaving. The cops were then on his tail and caught up with him outside. He died in a gun battle with the police. When they did the autopsy, they found a high level of methylone  in his system. And methylone in large amounts can cause psychotic episodes and  are worsened by chronic use.

You might hear the word Flakka , F-l-a-k-k-a. This is sometimes used synonymously with bath salts. And I suppose it’s fine. In the context. There are slight differences and there’s some debate over whether they’re exactly the same thing but Flakka as a drug functions in the same way as bath salts.

The assumption is that this arose out of the need to find an alternative that could still be legal and be sold. So lots of copycat drugs were being produced in really not scientifically based situations.  The problem with synthetics was also that you didn’t really know what you got. There have been studies done where people thought they were taking ecstasy  or taking some other kind of drug, but actually what they found was the MDPV or the methylone in their system.

It’s a cheap alternative that can get cut with other drugs. I know that as we’ve talked, I keep saying that. Well, drug dealing is a business, a hundred percent of business. It is to make money. Dealers want to be able to spread their product farther and so if they can water something down, well, that’s better for them.

Think about something simple, like vanilla extract. Vanilla extract in and of itself. Isn’t actually vanilla extract, unless it says it’s pure.  I grew up using imitation vanilla extract, and I had no idea what it was. I thought it was just vanilla. It wasn’t until someone pointed it out to me as an adult, that I realized that it was something really different.

Well, this is something similar.  Certainly, there are parts of the real thing in imitation vanilla extract, but it is not the pure thing. Same thing with drugs. There are ways to cut many, many drugs to try to get them to spread farther. This is why currently we’re finding fentanyl in everything. At least in my neck of the woods. Even the meth has fentanyl in it. When those two things are totally opposite. One’s a downer, one’s an upper, but you can’t tell and it sells more product. So that’s what was happening here too, is that bath salts were getting used to cut into other drugs and were  causing these adverse outcomes from what people thought they were taking versus what they were actually taking.

Bath salts are usually snorted, but it can also be injected, smoked, or swallowed.  I saw places where people were talking about using it rectally, but I can’t imagine that that’s super common. There’s a peak rush to this drug, just like other drugs where it starts out and then it gets more intense. The total experience might last eight hours or longer, but it could be shorter depending on how much they’re taking. Remember, these are all really different and so from one batch to the next, you could have varying amounts of different compounds, which will change the duration and the impact.

Bottom line is they are addictive. It is dangerous. It can kill you. You do develop a tolerance and the long-term effects we don’t really know.  There are certainly lots of reports of lasting damage, kidney failure, multisystem, organ failure, or continuing psychosis, even though the person isn’t using anymore.

There’s another synthetic drug that we need to talk about and that is K2 or spice or synthetic marijuana. Synthetic cannabinoids, that’s what K2 or spice is,  human made and they’re typically sprayed on dried or shredded plant material. This is so they can be smoked  or it could be sold as liquids that could be vaporized in an e-cig or vape or those sorts of products. In the  beginning of when this became popular, they were being sold as incense typically. Yeah, 

They’re called cannabinoids because they’re similar to the chemicals found in the marijuana plant. It’s because of that similarity that people sometimes call it synthetic marijuana or fake weed. Well, it is not the same at all. People who smoke weed typically don’t care for the synthetic cannabinoid. It’s a really different high and it’s a really different feeling  and it is not safe in the slightest.

A chemist named John Huffman created the compound that was labeled J W H 18. Those are his initials.  It was a chemical that he had created in a lab in’04  and wrote a paper about in’05.  His intent, like other scientists who’ve generated synthetic cannabinoids,  was not to create a recreational drug. It was to study the effects of cannabis in the body and how the cannabinoid system worked.

There should be a theme here that you’re hearing that many things that were developed in a lab ended up becoming recreational drugs, like MDMA, LSD, synthetic cathinones. It’s been hard for these scientists because they’ve been unwitting  participants in a growing synthetic cannabinoid, drug epidemic. Not their fault, certainly, but it’s their chemicals that they’re either created or synthesized that are being used.

The first scientists to study cannabis and create synthetic cannabinoids were back in the 1940s. We didn’t know at that time that cannabinoid receptors even existed. We didn’t know how marijuana  phytochemicals interacted with other molecules in the body.

The University of Manchester and University of Illinois at Champaign-Urbana we’re building analogs at the time using organic compounds to try to tease apart the bioactive elements of the drug and the effects they had on the body. These two places were the first to produce the synthetic molecules that mimic the effects of cannabis.

In the 1960s and seventies, a chemist at Hebrew university in Israel, isolated THC, which was the active ingredient in marijuana. He and others started to make synthetic compounds based on the structure of THC. In the nineties and the early two thousands this is when the effort to create new synthetic cannabinoids was taking place.

 

As these papers and journals went online chemists who were looking to make illegal drugs, could access chemical compounds, but also the data on their potency. They believe that these rogue chemists were taking recipes of these synthetic cannabinoids right out of the journals.

There’s some belief that these street drugs were originally generated in China, but no one knows for sure. The drug enforcement agency in the United States started to notice these drugs turning up in raids, on shipping containers coming from Europe.

One of the main differences between synthetic marijuana and actual marijuana is that actual marijuana first of all is a plant rather than man made.  Secondly, synthetic marijuana is a full agonist of the cannabinoid receptors whereas plant based marijuana is a partial agonist.

The reason this matters  is that the full agonist effect is going to create very different effects from THC. Scientists consider that this might be one possible reason for the higher rates of some extreme side effects that are only occasionally seen in adverse reactions to marijuana.

Some of the effects of K2 or Spice are feeling stimulated and energetic, increased appetite, producing a dream-like state, but can also include nausea, vomiting, seizures, aggression, agitation as well as respiratory failure and loss of consciousness.

K2 as I mentioned before, was originally being marketed as incense. Came in, colorful three ounce pouches or vials labeled, not for human consumption. It was increasingly popular with high school students and young adults in the mid two thousands because it was legal and you could easily obtain it from convenience stores, smoke shops, and online. In 2012, a national ban was enacted against the sale of synthetic cannabinoids, local and state laws also regulate synthetic cannabinoids  but it depends on the state. For communities who live on borders between States, it was easy to just cross over the border and pick them up in a state where it was legal. 

They did testing on a bunch of different batches of this synthetic weed. What they found was that  some of them contained an anticoagulant or a blood thinner.  There were people who were having issues with bruising, excessive bleeding, nosebleeds, that kind of thing. And that was causing even more issues and ended up in several deaths.

Again, the reason people were taking it was because it was legal and it wasn’t showing up on drug tests. The idea that you can get high and that it was supposed to be like weed, but not get in trouble was kind of a big deal. It wasn’t really anything like weed, but that didn’t really matter to a lot of folks who are using it.

The feeling that they would get in at least a good batch was being happy, euphoric, relaxed, hungry, becoming talkative, that kind of thing. The high from K2 or spice last about the same amount of time as a high for marijuana. Of course, it’s going to greatly depend on and in the type and quantity of chemicals that are in each batch.

The same thing happened with K2 and spice as did with the bath salts in that once they got banned, the chemical compounds started changing and each batch was going to be really different.  From what I noticed in my area this is what partially began to lead to increase in negative outcomes. 

This isn’t to say that the original batches of K2 or spice were safe by any stretch, but as the compounds got more and more irregular and more varied. In the population I worked with,  I started seeing more negative outcomes. In Particular, I worked with a young man who ended up having a stroke. He was in his early twenties at the time and was permanently paralyzed on his left side. I worked with other people who had developed what seemed like permanent psychosis because of their use  of the synthetic drug.

While the two synthetics bath salts and spice are really different they’re lumped together because of the fact that they were legal and being produced as not for human consumption or being sold in kind of non-traditional ways like at convenience stores.

The different state governments in the United States and the federal government acted quickly to try to ban these substances. Over the years, the popularity has waned. I haven’t seen anyone come in in a while who has this as their drug of choice.

I do always ask about it though, when I’m doing a drug use history. Sometimes the younger crowd doesn’t really know what I’m talking about, especially if they’re in high school right now. But that’s not always the case. So I encourage you when you’re doing a drug history that you ask about synthetics.

If you find someone who’s coming in with psychosis or other kinds of issues in that area, make sure you ask about this too. A lot of the people that I’ve talked to who have used synthetics used it once or twice and hated it. Especially your diehard pot smokers. I have not met one of them that liked the synthetic version because it really is quite different.

Keeping up with the new versions of these drugs has been hard for the government and for the scientists. When a new batch comes out, typically it’s because the poison control center in the hospitals have been getting calls. That’s usually how we find out that something has become popular again. There have been outbreaks as recently as 2018 and 2019 in different parts of the United States.

Other countries in the world have also seen their struggles with synthetics and it usually depends on the area. Typically, we’re talking about use happening from teenagers through probably 30 or so. Not to say that other people don’t abuse these things, but that’s generally the statistics that I’ve seen.

These sorts of drugs are really interesting to me. When the synthetics became popular, running a treatment program became really difficult. We couldn’t test for synthetics and there wasn’t any way to really tell. Except that somebody wouldn’t be getting better and they would be swearing up and down that they were clean. Drug test them, they come out clean and so it was really hard to track down. 

At a local head shop in our area, the lines would extend down and around the block for people waiting to get these drugs. It became a huge problem to the point that the city council was looking at how to deal with the place that was selling them.

I think that for my area of the country, it was about three to four years that synthetics had our people in, its grip. It loosened and I am grateful for that. The number of really severe negative health outcomes, not to mention the overdose deaths and suicides is a lot.

While bath salts and spice aren’t necessarily the most popular drugs right now. I wanted to make sure that we covered them because they are still around, although not as prevalent and it’s something that could easily come back around in another form.

Next week, we’re going to move on to talking about Khat and Kratom. Hope you’ll join me for that podcast. Until then have a great week.

Thank you for listening to the All Things Substance podcast. For show notes, links and downloads, please visit betsybyler.com/podcast. If you loved what you heard today, it’d be great if you would share those with your therapist friends and colleagues. If there are topics that you think would be useful and you’d like to hear me cover them, please let me know.  Just send a message to podcast@betsybyler.com. I’ll see you on next week’s podcast. And until then have a great week.

This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, clinical or any other professional information.