“Will They Turn You into a Zombie?” – this eye-catching title was created by Beth Rutkowski, MPH, Associate Director of Traning at UCLA’s Integrated Substance Abuse Programs for a Special Lecture subtitled “What Substance Use Disorder Treatment Providers need to Know about Synthetic Drugs” held on March 15, 2013 in Alhambra, California. Ms. Rutkowski delivered the lecture about the types, characteristics and epidemiology of constantly changing synthetic drugs. A panel of service provider discussed experiences with these drugs in clinical practice. The panel included Diane Baker of CRI-Help, Inc., Brenda Wiewel, LCSW, Executive Director of Los Angeles Centers for Alcohol and Drug Abuse, Maja Trochimczyk, Ph.D., Senior Director of Planning and Research at Phoenix Houses of California and Johathan Whitfield, M.D., Medical Director and Psychiatrist at Phoenix House Academy of Los Angeles
What are Synthetic Drugs?
Synthetic drugs, known earlier as “designer drugs,” are new chemical compounds created to mimic the effects of specific illegal substances. New varieties are created constantly, reaching over 250 chemicals available today. They are deceptively marketed as “safe” and “legal” replacements or alternatives to illegal drugs, such as marijuana, ecstasy, PCP, or LSD. Some of these drugs have received sensationalist media coverage – the so-called “bath salts” have been associated with stories of zombie cannibalism, hallucinations, and self-inflicted wounds or suicides.
There are many categories of “designer” psychoactive substances, all created in chemical laboratories, with names like: tryptamines (hallucinogenic), piperazines (BZP or TFMPP, known as “legal” ecstasy), new varieties of opiates (MPP), phenethylamines (“bath salts” and 2C-X drugs), and syntehtic cannabinoids that functionally imitate the effects of THC and marijuana. They can be divided into two main groups: a) stimulants that make users euphoric, more active and more “aware” and b) psychedelic that alter their mental states and cause hallucinations. Both types of chemicals are harmful and highly toxic – much more so than the drugs they purport to replace.
On Sugar and Spice
While introducing the presenters and panelists of the Special Lecture, the Director of Los Angeles County Department of Public Health’s Substance Abuse Prevention and Control, John Viernes reminded the listeners that they may take for granted some commonly used chemicals, like sugar, and pointed out the deceptive marketing of “spice” – sold in smoke shops and other specialty retailers as “incense” that is “not for human consumption.”
What is spice? Despite its appearance as dried leaves and twigs of a plant, this is a chemical product. It consists of dried shredded plant material laced with chemical additives that cause its psychoactive effects. As Beth Rutkowski explained, the specific content of the chemical coctail keeps changing: when certain ingredients are banned by DEA or the federal government, new chemicals are introduced to take their place. This drug mixture is also known as K2, fake weed, and several brand names, presented as fruit-flavored “incense” and sold in smoke shops and other small specialty retail stores. Initially, spice was based on five drugs, mostly a synthetic cannabinoid JWH-18 (created in 1995 and banned in 2010). The predominant type of chemical used now is called AM-2201. What is more important here than the alphabet soup, is the changeability of these drugs: there were 19 different types of these chemicals in 2010 and 55 types in 2012. The complexity of issues keeps growing.
Why do people use them? These drugs imitate the “high” of smoking marijuana and are marketed as a “safe, legal” alternative to weed. What is not commonly known, though, is that these drugs also have highly dangerous side effects: hyperthermia, elevated blood preasure, irregular heart beat, seizures, vomiting, heart attacks, and kidney damage. They may also cause severe paranoia, delusions, and hallucinations. Spice is readily available in retail stores and online in attractive packages and affordable dosages. Its use is not detected in standard drug tests. This, as the panelists stated, appears to be the main motivation for use by teenagers and young adult males. They switch to spice from marijuana while being on probation, or needing to pass a clean drug test.
Not Really Bath Salts
The second most popular type of synthetic drug is marketed as “Bath Salts” and consists of white powder that looks a bit like cocaine. The deceptive labelling “not for human consumption” is exposed by the price difference between these so-called synthetic cathiones (about 30 dollars per package) and real bath salts (just a couple of dollars). They are sold in smoke shops, botanicas, etc. The specific chemicals may include MDPV, and other synthetic cathinones, which are analogs of amphetamine that imitate its stimulating effects (also resembling the effects of PCP). Unfortunately, bath salts are highly toxic and even deadly. Serious effect include hypertension, hyperthermia, nausea, convlusions, hallucinations and psychosis. Nothetless, as Ms. Rutkowski pointed out, the “zombie” stories associated with highly publicized violent incidents seem to have scared off potential users and this drug appears to be going out of favor.
People admitted to emergency departments who have used bath salts suffer from agitation, violent behavior, hallucinations, paranoia, high blood pressure, and heart problems, which may end up with heart attacks. The number of varieties of these drugs increased from 8 to 37 in the past three years. Their specific impact on the human body and brain is not clear and may change from one package to bath salts to another. Herein lies its danger – these drugs are life-threatening and unpredictable.
What to Do in Clinical Practice?
There are many other types of synthetic drugs, only briefly mentioned during the Lecture; what is important is their impact on clinical practice. The seriousness of potential lethal effects of the individual use of these chemicals require clinical staff to be well-trained and attentive, so that they recognize the presence of these dangerous drugs through particular symptoms. The three providers participating in the panel (CRI-Help, LA CADA, and Phoenix House) have all had incidents associated with spice and bath salts in their residential programs. In many cases, clients turned to spice to replace marijuana and avoid detection by drug tests. The use of bath salts was infrequent.
One best practice procedure is vigilance about symptoms and using spice-specific drug tests in suspicious cases. Prevention and education are the best antidotes: providing accurate, up-to-date drug education to clients about the harmfulness of these drugs is one of the optimal ways to decrease their usage. Another short-term way of countering their spread is to conduct searches of rooms and items brought by visitors and from home visits, to reduce contraband.
In terms of long-term treatment, however, as Dr. Whitfield said, all addictions should be treated in the same way, by providing psychiatric treatment of the issues that cause people to turn to drugs for comfort or stimulation. As he stated, after detoxification and stabilization of the patient, “it does not matter if it is spice, marijuana, or prescription drugs we are dealing with – the best and most effective response consists of psychiatric treatment of underlying issues such as depression, anxiety, trauma, or psychosis.”
Synthetic Drugs at Phoenix House
Dr. Trochimczyk presented statistics about the prevalence of particular “drugs of choice” among Phoenix House clients in Los Angeles. Synthetic drugs were very low on this list, affecting below 1% of clients. For adults at Phoenix House Venice, the first place was taken by cocaine (though its prevalence decreased in recent years to 26%), followed by heroin/morphine (about 22%), alcohol (21%), and cannabis (17%). The largest increase was in prescription drugs abuse, that grew from 3% to 7% in two years. For teenagers, the main drug of choice was marijuana (about 79%), followed by stimulants (27%), alcohol (13.6%), heroin/opiates (3.3%), cocaine (1.9%), hallucinogens (1.9%), and other drugs.
The use of spice as “legal and safe” alternative to marijuana, smuggled onto the campus to be smoked, has resulted in the increased need for spice-specific drug tests, targeting suspicious behaviors and administered in addition to the regular drug testing routine. At any given time, there are only one or two clients affected by spice within the residential program and no clients with a history of using bath salts. Internal statistics confirm that new synthetic drugs are the domain of young males (16-25 years old), who like to experiment with new chemically-induced experiences and want to avoid “dirty” drug tests.
For more information about substance abuse and mental health treatment programs at Phoenix House, or to refer someone in need for admission to our residential or outpatient services for teens with co-occurring disorders at the Phoenix House Academy of Los Angeles in Lake View Terrace, please call our Call Center at 1 888 671 9392. We are here to help you find the information and services you need!
The UCLA/PSATTC/SAPC Special Lecture on Synthetic Drugs was presented jointly by UCLA’s Integrated Substance Abuse Programs, Pacific Southwest Addiction Technology Transfer Center and County of Los Angeles, Department of Public Health’s Substance Abuse Prevention and Control.
The PowerPoint Presentation by UCLA’s Beth Rutkowski may be found on the ATTC website: “Will Synthetic Drugs Turn You into a Zombie?”