Smiles, Bath Salts, Spice, Molly, Foxey, Krokodil, Kratom, Dragonfly

SMILES, BATH SALTS,
SPICE, MOLLY, FOXEY,
KROKODIL,
KRATOM,
.
DRAGONFLY:
The New Vocabulary of
Drugs of Abuse
Christopher Welsh M.D.
University of Maryland
School of Medicine
DESIGNER DRUGS
 A term used to describe any drug produced
by making a slight change in the chemical
structure of a controlled substance
(Controlled Substances Act of 1970)
 The term “Designer Drug” was coined in 1988
by Henderson to describe attempts to
produce fentanyl analogues
 These newer substances were “legal” until 1986
when the government passed the Controlled
Substances Analogues Enforcement Act
which makes any drug “substantially similar
to” a schedule I or II drug illegal
 “Club Drugs” / “Synthetics” more common now
DESIGNER DRUGS
 Most are not truly new
 Based on chemicals synthesized by
chemists for legitimate reasons
 Some are marketed for legitimate medical
reasons but are diverted to illicit use
 Others have never been used medically but
synthesizing methods have been
published and are easily obtained
 100s of designer drugs have been made
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only a handful have become popular
 Relatively small problem compared to heroin, etc.
DESIGNER DRUGS:
NOT JUST “PARTY DRUGS”
DEATHS HAVE BEEN REPORTED FROM USE OF:
MDMA (Ecstasy)
GHB (Grievous Bodily Harm)
Rohypnol (Roofies)
Ketamine (Special K)
MPPP (China White)
Methcathinone (Khat)
MethylPemolines (U4Euh, Nexus)
MDPV; Mephedrone (Bath Salts)
PSYCHEDELIC/
STIMULANTS
 “methylated amphetamines”
 Over 1000 have been synthesized
 Chemically similar to mescaline & amphetamine
 Have physiologic and psychological
effects of stimulants and hallucinogens
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Dopamine, epinephrine,norepinephrine
• inhibition of re-uptake
Serotonin
• inhibition of re-uptake
• increased release from vesicles
MDMA: GENERAL
 3,4-methylenedioxy-n-methylamphetamine
 Chemically similar to amphetamine & mescaline
 Produces stimulant & “hallucinogenic” effects
 Use largely seen in adolescents and
young adults
 It has historically been associated with “rave”
parties and night clubs but is now becoming
more “mainstream”
MDMA: HISTORY
 Synthesized by Merck in Germany in 1912
? as an appetite suppressant
 Some military research in the 1950s
 Not really used until the early 1970s
(after MDA was made schedule I)
 Used in the 1970s and 1980s by
therapists to enhance psychotherapy
 Made Schedule I in 1985
 New research for PTSD
 “Molly”
MDMA:
STREET NAMES
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Ecstasy
X
Rave
XTC
X-ray
Adam
Adam pills
Hug drug
Love drug
Lovebug
Lover‟s Speed
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Clarity
Essence
Snide-E
E
Stacy
Beans
Rolls
Doctor
M&M
M
 MOLLY (Mol-E)
MDMA: STREET INFO
 Fairly easily synthesized
 Often cut with amphetamine, LSD, ketamine,
cocaine, heroin, dextromethorphan, sugar
 Usually a white powder
 A usual dose is 100-150mg
 Cost ranges from $20-50 per tablet or pill
 Usually ingested orally
 Can be snorted, injected or inserted rectally
MDMA: EPIDEMIOLOGY
 About 2 % of the U.S. population has used
Ecstasy at least once
 Rates of past month use are highest in 18-25
year olds (>5%)
 Use in high school and college students
increased through early to mid „90s and
leveled off in 96 and increased again until ‟02
when it leveled off again.
Some decline 2002-2010.
Some increase over past few years?
 Some reports that Ecstasy use is as prevalent
as marijuana use in Great Britain
Percent of Students Reporting
MDMA Use, (MTF; 2012)
8th Grade
10th Grade
12th Grade
Past
month
0.6%
1.6%
2.3%
Past year
1.1%
3.0%
3.8%
Lifetime
2.6%
6.6%
8.0%
MDMA:
DESIRED EFFECTS
 exhilaration
 increased energy
 increased empathy or “connectedness”
with others(“empathogen”; “entactogen”)
 sensory distortion
 euphoria
 “rush”
MDMA: CLINICAL
 Onset of action typically 20-60 minutes
 Effects typically last 4-8 hours
 It can produce a syndrome similar to
NMS and a Serotonin Syndrome
MDMA: SIGNS OF
INTOXICATION
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increased energy
dehydration
hyperthermia
diaphoresis
anxiety/panic
teeth grinding
sensory distortion
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tachycardia
chest pain
headaches
strokes
seizures
nausea/vomiting
death
OTHER METHYLATED
AMPHETAMINES
 MDA
synthesized in early 20th century
placed on Schedule I in 1970s
 MDEA
very similar to MDMA
 NEXUS/2C-B/2C-I/
much more potent than MDMA
prevalence seems to be increasing
 STP
reputation of being extremely potent
effects reported to last up to 24 hours
OTHER METHYLATED
AMPHETAMINES (CONT)
 PMA
some “epidemics” in U.S.
 U4Euh
more stimulant properties than others
used in 1960s as an appetite suppressant
made from phenylpropanolamine
 Aminorex
similar to U4Euh
marketed in Europe in the 1960s
withdrawn because of pulmonary edema
seen more recently in U.S. club scene
SMILES
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2C-I
2C class are phenethylamines
Discovered by Alexander Shulgin
Used illicitly since the mid-1990s
Available in Dutch shops in early 2000s.
Usually in a powder; occasionally a tablet.

Some reports of mixing with chocolate.
 Typically snorted or swallowed.
 Effects last 4-12 hours
 DEA Schedule I
Bromo-DragonFLY
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3C-Bromo-Dragonfly; DOB-Dragonfly; “Fly”
Synthesized in 1998.
Similar to phenethylamines.
Acts at several serotonin receptor types.
Very potent (1/5 that of LSD).
Effects can last several days.
May see vasoconstriction.
Usually a powder or on blotter paper.
Popular in Scandanavia but seen in U.S.
Deaths reported from seizures & vomiting blood.
Not DEA scheduled in the U.S.
PIPERAZINES
 Original research in 1970s as antihelminthics
 Most popular benzylpiperazine (BZP)

Schedule I in 2002
 Trifluoromethylphenylpiperazine (TFMPP)
 Very popular in Australia and New Zealand
 Cosmic Jet, Charge, Benzo Fury, Party Pills, MDAI,
Exotic Super Strong, XXX Strong as Hell, Head Rush
 Stimulant effects at lower dose
 Hallucinogenic effects at higher dose
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Effects serotonin reuptake, increases release & acts as agonist
Typically snorted or taken orally
Delayed onset of action (1-2 hours)
Effects last 6-8 hours.
Reports of seizures, QT prolongation, Serotonin Syndr.
METHCATHINONE
 A chemical analogue of methamphetamine
 Patented in 1957 as Ephedrone but never
marketed because of side effects
 Very popular in Russia in 1970s & 1980s
 Appeared in U.S. in 1990s
 Popular in Mid West (Michigan & Wisconsin)
 Labs have been found in Pennsylvania
 Street Names:Cat, Khat, Qat, Jeff
 Usually an off-white or yellowish powder
 Schedule I under analog laws of CSA
“BATH SALTS” “PLANT FOOD”
“LADY BUG ATTRACTANT”
 Often contain
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methylenedioxypyrovalerone (MDPV)
Mephedrone
 Similar to Methcathinone (Ephedrone)
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Ivory Snow, Red Dove, Cloud Nine, Vanilla Sky, Ivory Wave, Lunar Wave,
Bliss, White Lightning and Hurricane Charlie, Meow Meow, Bliss, Blast,
Bloom, PeeVee, Meph
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First reported in U.S. around 2009
20$-80$ per packet
MDPV 10X more potent than cocaine w/ stimulant effects
Typically snorted; occasionally injected
Effects last 2-8 hours
Reports of continued psychosis for weeks
Blocks DA & NE reuptake similar to cocaine
Not a transporter substrate
S. 3187 (112th): Food and Drug
Administration Safety and
Innovation Act
DEA's Operation Log Jam targeted alleged synthetic drug
distributors in 109 cities
Submitted by Howard Owens on July 26, 2012 - 2:18pm
Raids conducted in 109 cities around the United States yesterday were
the result of local law enforcement asking for help in dealing with an
exploding synthetic drug problem, the head of the Drug Enforcement
Adminsitration said today during a press conference in Washington, D.C.
"There was an outpouring of requests to the DEA from chiefs and
sheriffs throughout the country asking for our help," said DEA
Administrator Michele M. Leonhart.
The press conference was carried live on DEA's website.
While there is work to be done to cut off the supplies of synthetic drug
chemicals from China and other parts of Asia, it was the pleas for help
from people in the United States that prompted the DEA to lead the firstever nationwide crack down on the synthetic drug trade, called
"Operation Log Jam."
"In this first take down, we wanted to go after the locations that are most
impacting our communities," Leonhart said.
Operation Log Jam was a combined effort by the DEA, Immigration and
Customs Enforcement (ICE), with assistance from the Internal Revenue
Service Criminal Investigations, U.S. Postal Inspection Service, U.S.
Customs and Border Protection, the FBI, Food and Drug
Administration’s Office of Criminal Investigations, as well as countless
members of state and local law enforcement.
In total, 91 people were arrested, more than 4.8 million packets of
synthetic cannabinoids (ex. K2, Spice) and the products to produce
nearly 13.6 million more, were seized. Agents also confiscated 167,000
packets of synthetic cathinones, "bath salts," and the products to produce
an additional 392,000 packets.
Of course, part of Operation Log Jam was the raids on The 420
Emporium location in Batavia, as well as the other four stores in the
chain and the home in Greece of the stores' owner(s).
Bath Salts: Calls to Poison
Control Centers; U.S.
BATH SALTS
EPIDEMIOLOGY (MTF: 2012)
 Past Year Use:
8th grade
th grade
 10
th grade
 12

0.8%
0.6%
1.3%
 First year asked
“SPICE”/ “K-2”/
“Synthetic Marijuana”
 First seen in U.S. @ 2006
 Most popular in Britain, Germany, Romania, parts of U.S.
 Initially, several compounds banned in select states
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Federal Schedule I of 4 substances in 2011
Federal Schedule I of multiple substances 7/2012
 Generally marketed as incense/aromatic potpourri
 “Spice” listed ingredients: baybean, blue lotus, dwarf scullcap,
indian warrior, lion's tail, maconha brava, marshmallow, pink lotus,
red clover, rose, Siberian motherwort, vanilla, and honey.
 Cannabanoids:
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CP-47,497 homologue
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JWH-018; JWH-073
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HU-210; HU-211
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(1-(2-morpholinoethyl)-1H-indol-3-yl)(naphthalen-2-yl)methanone
 Do not test positive on THC drug test
 Additional effects on GABA system
Just Some Of Them
 Albino Rhino Buds, Aroma, Bombay Blue, Caneff 5
star, Chillin XXX, D-Raw, Dark Matter, Dream,
Everlast, Ex-ses (Platinum), Experience: Chill,
Experience: Ignite, Experience: Red Ball, Fruit
Punch, Fusion, Galaxy, Genie, Gorilla, Herb Dream,
Ice Bud Extra Cold, Kronic, Krypto Buds, Magic,
Mojo, Moon Rocks, Pep Spice, Scooby
Snacks,Sence, Smoke, Solar Flare, Space, Space
Truckin', Spice, Spice Arctic Synergy, Spice
Tropical Synergy, Spice Diamond, Spice Gold,
Spice Gold Spirit, Spice Silver, Spicey XXX,
SpiceWorld420, Spice99 (Ultra), Spike99, Smoke,
Splice Platinum, Star Fire, Yucatan Fire, Zohai,
Zohai SX
JWH-018, JWH-073, JWH-200, CP-47,497, and cannabicyclohexanol
SYNTHETIC CANNABANOIDS
EPIDEMIOLOGY (MTF; 2012)
 Past Year Use:
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8th grade
10th grade
12th grade
4.4%
8.8%
11.3%
 2nd to marijuana in 10th and 12th graders
 3rd to marijuana & inhalants in 8th graders
Synthetic Cannabanoids
DAWN ER Visits
Synthetic Cannabanoids
DAWN ER Visits
SYNTHETIC CANNABANOID
REPORTS
(MARYLAND POISON CENTER)
Number of
cases
).
Time
DESIGNER OPIOIDS:
GENERAL
 >10 different fentanyl analogues have been
found
alpha-methylfentanyl (AMF)
3-methylfentanyl (TMF)
 Generically referred to as “China White” (the
term reserved for very pure heroin)
 TMF 1000s of times more potent than morphine
 1-methyl-4-phenyl-propionoxy-piperidine
(MPPP) is the most well known meperidine
analogue
DESIGNER OPIOIDS:
HISTORY
 AMF appeared in late 1970s
15 deaths in California in 1979-1980
was placed on Schedule I of CSA in 1981
 TMF appeared in 1983
>100 deaths attributed to it through 1980s
spread to East Coast in late 1980s
30 deaths in Baltimore in 1993
 MPPP tested as an analgesic in 1970s
appeared on the streets in mid 1970s
1st MPTP induced Parkinson‟s syndrome
reported in „79
KROKODIL
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Synthesized in the U.S. in 1932
Contains desomorphine
Synthesized from codeine (OTC in some places)
Increase in popularity in Siberia in 2002,
spreading to rest of Russia since 2010.
More reports in rest of Europe
Few, but increasing, reports in U.S.
More potent than heroin
Shorter acting than heroin
Associated with significant abscesses, etc
KROKODIL
KROKODIL
Quincey, Mass
April, 2013
METHOXETAMINE
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Synthetic analog of ketamine
Aka: “MXE”; “M-Ket”; “Kmax”; “Mexxy”; “Roflcopter”
First reported in Europe in 2010
Typically a white powder
Usually snorted; occasionally ingested
Primarily inhibits NMDA; some effect on DA reuptake
Reportedly more intense than ketamine; less than PCP
Onset in 5-10 minutes
Duration 1-2 hours with a few reports of much longer
Unscheduled in U.S.
SALVIA DIVINORUM
 AKA: “Yerba Maria”, “The Shepherdess”, Magic Mint,
“la pastora”,“Diviner‟s Mint”,“Diviner‟s Sage”,Sally D
 Contains Salvinorin A
 Indigenous to Southern Mexico
 Used in traditional healing and divination
 Smoked, chewed, or made into tea
 Kappa opioid receptor agonist
 Rapid onset; short acting
 Currently not federally controlled
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Banned in 17 states
Banned in certain jurisdictions (Ocean City, Md.)
 Available in stores in 5X, 6X, and 10X conc.
 $50-$100/ounce leaves; $20-$50/gram conc.
SALVIA DIVINORUM
EPIDEMIOLOGY (MTF: 2012)
 Past Year Use:
8th grade
th grade
 10
th grade
 12

1.4%
2.5%
4.4%
 Down slightly from 2011
KRATOM
 Mitragyna speciosa
 aka: Ithang, Biak Biak, Ketum, Kakuam, Thom
 Native to Southeast Asia
Primarily used in Thailand, Malaysia, Indonesia
 Increase in U.S., especially Pacific Northwest; S.F.
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 Contains Mitragynine, mitraphylline, 7-hydroxymitragynine
 Structurally similar to hallucinogens like psilocybin
 Binds to mu opioid receptors
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Tolerance/withdrawal & respiratory depression reported
 On DEA‟s list of “drugs of concern”
KRATOM
 Some reports that it acts as a stimulant at low
doses and sedative at higher doses
 Effects usually within 10-15 minutes
 Effects last 2-6 hours
 Sometimes used to self-manage withdrawal
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Reports of use for opioid detox since the early 1800s
 Can chew leaves; make into tea; rarely smoked
 Often sold as capsules in foil packages
BORRACHERO
 AKA: “The Devils Breath”; hyoscine; “drunken
binge tree”; “get-you-drunk”
 Contains Scopolamine
 Popular in Central & South America (esp Colombia)
 Reports of it being used in robbery, assault, rape
 Slipped in drinks, sprinkled on food, blown in
persons face, spread on breasts
DEXTROMETHORPHAN
 AKA: DXM; Robo; Triple Cs; CCC
 Found in Robitussin, Dimetane, Comtrex,
Coricidin Cough & Cold HBP
 Use often referred to as “Robo dosing”,
“Roboing”, “Robo-fizzing”, “Skittling”or
“Smurfing”
 Users known as “Syrup heads” or “Robotards”
 Has been abused since the 1970s
 Abusers often take 300-900mg in a single dose
 Also typically in a preparation with ethanol
 Effects: euphoria, hallucinations, incoordination
SIZZURP
 Aka: “Purple Drank”
 Prescription strength cough syrup with codeine
and promethazine mixed with Sprite and Jolly
Ranchers
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Also made with hydrocodone and dextromethorphan syrups
Popular in hip-hop culture
Started in Houston, Texas
Some reports of use in 1960s but increase in1990s
Reported deaths from over-sedation and
respiratory depression
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Lil Wayne’s seizures?
 Effects: euphoria, incoordination
CATHA EDULIS
 AKA: “cat”, “catha”, “Kat”, “Khat”, “Arabian
tea”, “African tea”
 A large shrub that grows in much of East Africa
& Arabian Peninsula.
 Used in U.S. in areas with immigrants.
 Contains cathinone (which is Schedule I under
CSA)
 Very similar to methcathinone
 Typically chewed or brewed into a tea
 Effects: increased energy, decreased appetite,
decreased sleep, hyperactivity
TRYPTAMINES
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Psilocybin- most well known
100s of others
5-MeO-DIPT- growing popularity
“Foxy”; “Foxy Methoxy”
Discovered by Alexander Shulgin
Used illicitly since the mid-1990s
Available in Dutch shops in early 2000s.
Usually in a powder; occasionally a tablet.
 Some reports of mixing with chocolate.
 Typically snorted or swallowed.
 Effects last 4-12 hours
 DEA Schedule I in early 2000s
5-MEO-DMT
 5-methoxy-dimethyltryptamine
 Similar to DMT
 Works primarily on serotonin.
 Found in several South American plants and in
the venom of the Bufo alvarius toad
 Typically smoked, inhaled, swallowed or injected
 Can be extracted from plants or synthesized
 Used by The Church of the Tree of Life
 About $300 per gram through mail order
 DEA Schedule I as of 2011
BUFO ALVARIUS TOAD
TOXIN
 AKA: “Colorado River toad”, “desert toad”,
“Sonoran desert toad”, and “psychedelic
toad”
 Native to Arizona, California and Mexico
 Toad can way up to 4 pounds
 Secrtes bufotenin and 5-MeO-DMT
 Venom is dried and smoked (alone or with MJ)
it is not typically licked from the toad
 Effects: hallucinations, anxiety
 Legal to possess toad but illegal to extract venom
 Other species with venom that is weaker or toxic
Volume 356:529-530
February 1, 2007
Number 5
Intoxication of a Prison Inmate with an Ethyl Alcohol–Based
Hand Sanitizer
Suzanne Doyon M.D. & Christopher Welsh M.D.
To the Editor: The Maryland Poison Center was called about a 49-year-old, usually calm
prison inmate who was described as being "red-eyed," "loony," "combative," and
"intoxicated, lecturing everyone about life." Other inmates and staff reported seeing this
prisoner drinking from a gallon container of Purell hand sanitizer over the course of the
evening. It was discovered that this sanitizer contains 62% ethanol by weight (more than
70% alcohol by volume). The inmate's blood alcohol level was found to be 335 mg per
deciliter. It was later confirmed that he had not consumed any other forms of ethanol or other
illicit .
Prince Harry Prefers to Snort Vodka
―Depending on how persistent the drinker — or snorter — is, it could be fatal,‖said Dr.
Christopher Welsh, an addiction specialist at the University of Maryland School of
Medicine. ―It’s a much quicker way of getting a huge concentration of alcohol to your
brain,‖ he said. ―The trick would be keeping it in your nose long enough for it to be
absorbed.‖
The Examiner October 17, 2007
“EYEBALLING”
“Smoking”/ “Free-Basing”
Purity of
“ECSTASY”
 60% of samples in the Netherlands contain
MDMA
 1998 samples of putative MDMA found that 83%
contained no MDMA
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caffeine
ephedrine
ketamine
methamphetamine
dextromethorphan
FENTANYL PATCHES
SMOKED
BREWED INTO TEA
CHEWED
LICKED
SUCKED
SNORTED
INJECTED
INSERTED RECTALLY
“THE BOX”
DESIGNER OPIOIDS:
STREET INFO
 Appears identical to heroin
typically off-white powder
 An effective dose of pure TMF is 0.05mg
 The analogues are typically cut with
quinine or lactose (as is heroin)
 Many users can not distinguish the
analogues from heroin
 If the drug is not sufficiently diluted, it is
very likely to result in overdose
OTHER STUFF
(WHAT ARE PEOPLE
THINKING?)
 Camel dung
 C-4 explosive
 Embalming fluid
 Gasoline (“Montana Gin”)
 M-99 (Immobilion)