Synthetic Drugs of Abuse:

Spice, K2 and Bath Salts

Erik Gunderson, MD
Assistant Professor
Department of Psychiatry and Neurobehavioral Sciences
and Department of Medicine
Director, Clinical Pharmacological Research Unit
University of Virginia

April 14, 2011

 Synthetic Cannabinoids (SCs)
Spice/K2 brands
marketed as natural
herbal incense
Not for human
consumption
Available convenience
stores, gas stations,
Internet
Cannabis substitute Psychonaut Web Mapping Research Group
(2009.) Spice Report. Institute of Psychiatry,
Kings College London: London UK.
 Spice and K2
Cost: $30-45 per 3gm

Route: pipes, water pipes

or rolled cigarettes

Contents: inert plant

material sprayed with SCs
JWH-018, JWH-073, JWH-
250, CP-47,497, HU-210
http://buyherbalspice.com/spice_reviews/categ
ory/news/
 Pharmacology
delta-9 tetrahydro-
cannabinol (9-THC)
agonism of cannabinoid
receptor type 1 (CB1)
9-THC
SCs more potent
Typical doses are often
less than 1mg
Not readily detectable
JWH-018
 Psychoactive Effects
Marketed as similar to cannabis:
Euphoria

Sociability

Anxiolytic

Relaxation

Stimulant
http://buyk2spice.net/

Cross tolerance with THC?

 Side Effects of SC Products
Anxiety
Paranoia
Headache
Vomiting
Psychosis
Diaphoresis
HR/BP increase
Seizures http://investigationmiami.blogspot.com/2011/01/be-afraid-really-afraid.html
 Legal Timeline for SCs
2009: Restricted in the UK, EU
11/2010: DEA Notice of Intent to temporarily
ban 5 SCs
3/1/2011: Five SCs Designated Schedule I
JWH-018, JWH-073, JWH-200, CP-47,497, and
cannabicyclohexanol
Effective for one year
 Current and Future Epidemiology?

No data on prevalence of use

American Association of Poison Control
Centers:
Synthetic cannabinoids:
2009: 13 calls
2010: 2304 calls (Nov), a projected 200x increase
Marijuana:
2008: 4009 calls, with 1020 for marijuana alone
 Synthetic Stimulants
Methylenedioxypyrovalerone (MDPV) and
Mephedrone
Sold as bath salts or plant fertilizer

Currently legal in the United States

Available online and in convenience stores

 MDPV and Mephedrone
CNS stimulants
Related to cathinone, an active alkaloid
found in the khat plant (N. Africa)
Previously abused
primarily in
Europe and
Australia

http://www.herbalextracts.net/library/supplements/khat_uses.html
 Product Marketing
Mtv Cloud 9
MDPK Ocean
Magic Ivory Wave
Super Coke
Peevee
Energy-1 (NRG1)
Charge Plus
White Lightning
Scarface
http://www.helphopehealing.org/
 MDPV
Route: Intranasal most
common
Also: oral, smoking,
rectal, and IV MDMA
White to light brown
crumbly powder
Degrades if exposed to
air for significant periods
of time
http://www.stompin-gardeners.com/index.
 Pharmacology of MDPV
CNS stimulant similar to methamphetamine,
MDMA, or cocaine
Norepinephrine-dopamine reuptake inhibitor
(NDRI)
Increased alertness, arousal, anxiety, agitation,
diminished requirement for food and sleep,
sexual arousal
Tachycardia, hypertension, vasoconstriction,
diaphoresis
 Effects of MDPV
High lasts 3-4 hours
Physical effects may
last 6-8 hours
May cause seizures,
panic attacks, or
psychosis with high
doses or increased
frequency of use
Avg dose: 5 to 20mg http://www.tradevv.com/chinasuppliers/chwhtltd_p_198b58/c
hina-Mdpv-by-pevukka.html
 Other Sequelae of MDPV
Trismus (inability to open mouth) or
bruxism
Panic attacks
Psychosis with sleep deprivation
Hallucinations, delusions, suicidal ideation
Abstinence syndrome: depression,
lethargy, anxiety, postural hypotension
Leads to frequent re-dosing
 MDPVs Legal Status
UK: MDPV regulated
under the Misuse of
Drugs Act 1971

US: Not scheduled but

banned in some states

DEA: controlled by the

Federal Analogue Act?
http://addiction-dirkh.blogspot.com/2010/11/dea-slaps-
temporary-ban-on-spice-and.html
 Mephedrone
4-methylmethcathinone
(4-MMC)
Meow Meow
MCAT
Miaow
Drone
Plant Feeder
Bubbles http://www.synchronium.net/2010/01/05/mephedrone-cat/
 Pharmacology
NE-DA reuptake inhibitor
Similar to MA/MDMA
Reportedly less potent, shorter
duration Amphetamine
Oral dose: 20-50mg
Come up: 10-20 min
Peak: 45-60 min
Comedown: 60-120 min Mephedrone
Re-dosing: common
 Routes of Administration
Oral ingestion
Swallowing capsules
Bombing (swallowing
powder wrapped in
cigarette paper)
Insufflation (snorting)
Rectally (either plugging http://www.guardian.co.uk/society/mephedrone

or enema)
IV (use 1/2 to 1/3 dose)
 Effects of Mephedrone
Euphoria
Sociability
Stimulation
Sexual Arousal
Music Appreciation
Hallucinations

http://www.drugs.org.im/campaigns.htm
 Mephedrone Side Effects
Loss of appetite
Increase in body temperature,
sweating, hot flushes
Tense jaw, bruxism, stiff neck,
muscle clenching
HR/BP elevation, chest pains
Dehydration
Mydriasis, nystagmus
Painful nasal drip/ulcers in mouth
(after insufflation)
Insomnia, paranoia, anxiety,
dysphoria, psychosis
http://theblackheartofgrahamquirk.blogspot.com/
 Mephedrones Legal Status
2008-2010: Banned in many European counties

December 2010: Illegal throughout the EU

Mephedrone is not specifically banned in the United

States
However, some states have banned mephedrone

DEA: may be controlled by the Federal Analogue

Act as an analogue of methcathinone
 Current and Future Epidemiology?

No data on prevalence of use

American Association of Poison Control
Centers:
Bath Salts:
2010: 292 calls
2011: 469 calls (2/14/11), a projected14-fold
increase
Questions?
 References
Brunt, T.; Poortman, A.; Niesink, R.; Van Den Brink, W. (2010). "Instability of the ecstasy market and a new kid on the
block: mephedrone". Journal of psychopharmacology.
Drug Enforcement Administration: Office of Diversion Control; Drug and Chemical Evaluation Section.
Methylenedioxypyrovalerone [(MDPV) (1-(1,3-Benzodioxol-5-yl)-2-(1-pyrrolidinyl)-1-pentanone]. Available at:
www.deadiversion.usdoj.gov/drugs_concern/mdpv.pdf. Accessed February 7, 2011.
EMCDDA (2009). Action on new drugs briefing paper: Understanding the spice phenomenon. A report from an
EMCDDA expert meeting, 6 March, 2009, Lisbon.
"Europol - MCDDA Joint Report on a new psychoactive substance: 4-methylmethcathinone (mephedrone)". European
Monitoring Centre for Drugs and Drug Addiction. 27 May 2010.
Psychonaut WebMapping Research Group (2009). MDPV report. Institute of Psychiatry, Kings College London:
London UK. Available at: www.nascsa.org/news/psychonautmdpvreport.pdf. Accessed February 23, 2011.
Psychonaut WebMapping Research Group (March 2010). "Mephedrone Report." Institute of Psychiatry, King's
College: London UK.
Psychonaut Web Mapping Research Group (2009.) Spice Report. Institute of Psychiatry, Kings College London:
London UK.
United States Drug Enforcement Agency. Office of Diversion Control. Drugs and Chemical of Concern: 4-
methylmethcathinone [Mephedrone, 4-MMC, meow meow, m-CAT, bounce, bubbles, mad cow]. July 2010.
United States Drug Enforcement Agency. Office of Diversion Control. Rules 2011:Schedules of Controlled
Substances: Temporary Placement of Five Synthetic Cannabinoids Into Schedule I. Federal Register Volume 76,
Number 40 (Tuesday, March 1, 2011).
Wehrman J. U.S. Poison Centers Raise Alarm about Toxic Substance Marketed as Bath Salts; States Begin Taking
Action. AAPCC. February 14, 2011. Available at:
http://www.aapcc.org/dnn/Portals/0/prrel/FEB14BATHSALTSUSE.pdf
Winstock, A.; Mitcheson, L.; Deluca, P.; Davey, Z.; Corazza, O.; Schifano, F. (2010). "Mephedrone, new kid for the
chop?". Addiction 106 (1).
Acknowledgement

Laura Willing, BS

Contact Information

Erik Gunderson, MD
434-924-8013 office
ewg2n@virginia.edu