Statement on Common Synthetic Drugs
Synthetic Drug Fact Sheet
Refers to a wide variety of herbal mixtures that produce experiences similar to marijuana (cannabis) and that are marketed as “safe,” legal alternatives to that drug. Sold under many names, including K2, fake weed, Yucatan Fire, Skunk, Moon Rocks, and others — and commonly labeled “not for human consumption” — these products contain dried, shredded plant material and chemical additives that are responsible for their psychoactive (mind-altering) effects.
Labels on Spice products often claim that they contain “natural” psycho-active material taken from a variety of plants. Spice products do contain dried plant material, but chemical analyses show that their active ingredients are synthetic (or designer) cannabinoid compounds.
For several years, Spice mixtures have been easy to purchase in head shops and gas stations and via the Internet. Because the chemicals used in Spice have a high potential for abuse and no medical benefit, the Drug Enforcement Administration (DEA) has designated the five active chemicals most frequently found in Spice as Schedule I controlled substances, making it illegal to sell, buy, or possess them. Manufacturers of Spice products attempt to evade these legal restrictions by substituting different chemicals in their mixtures.
Potential detrimental health effects: rapid heart rate, vomiting, agitation, confusion, and hallucinations. Spice can also raise blood pressure and cause reduced blood supply to the heart (myocardial ischemia), and in a few cases it has been associated with heart attacks. Regular users may experience withdrawal and addiction symptoms. Note that there may be harmful heavy metal residues in Spice mixtures, the effects of which are yet unknown.
MDMA is a synthetic, psychoactive drug that has similarities to both the stimulant amphetamine and the hallucinogen mescaline. It is taken orally, usually as a capsule or tablet. The popular term Molly (slang for “molecular”) refers to the pure crystalline powder form of MDMA, usually sold in capsules. The drug’s effects last approximately 3 to 6 hours, although it is not uncommon for users to take a second dose of the drug as the effects of the first dose begin to fade. It is commonly taken in combination with other drugs.
The surge of serotonin caused by taking MDMA depletes the brain of this important chemical, however, causing negative after effects – including confusion, depression, sleep problems, drug craving, and anxiety — that may occur soon after taking the drug or during the days or even weeks thereafter.
MDMA can have many of the same physical effects as other stimulants like cocaine and amphetamines. These include increases in heart rate and blood pressure, which are particularly risky for people with circulatory problems or heart disease. MDMA users may experience other symptoms such as muscle tension, involuntary teeth clenching, nausea, blurred vision, faintness, and chills or sweating.
In high doses, MDMA can interfere with the body’s ability to regulate temperature. On rare but unpredictable occasions, this can lead to a sharp increase in body temperature (hyperthermia), which can result in liver, kidney, or cardiovascular system failure or even death. MDMA can interfere with its own metabolism (breakdown within the body), causing potentially harmful levels to build up in the body if it is taken repeatedly within short periods of time.
Compounding the risks is the fact that ecstasy tablets and even capsules of supposedly pure “Molly” sometimes actually contain other drugs instead or in addition. Those may include ephedrine (a stimulant), dextromethorphan (a cough suppressant), ketamine, caffeine, cocaine, methamphetamine, or even, most recently, synthetic cathinones (the psychoactive ingredients in “bath salts”). These substances are harmful alone and may be particularly dangerous mixed with MDMA. Users who intentionally or unknowingly combine such a mixture with additional substances such as marijuana and alcohol may be putting themselves at even higher risk for adverse health effects.
Additionally, the closeness-promoting effects of MDMA and its use in sexually charged contexts (and especially in combination with sildenafil) may encourage unsafe sex, which is a risk factor for contracting or spreading HIV and hepatitis.
The term “bath salts” refers to an emerging family of drugs containing one or more synthetic chemicals related to cathinone, an amphetamine-like stimulant found naturally in the Khat plant. Bath salts are typically taken orally, inhaled, or injected, with the worst outcomes being associated with snorting or needle injection.
Typically, bath salts look like a white or brown crystalline powder and are sold in small plastic or foil packages labeled “not for human consumption.” Sometimes also marketed as “plant food”—or, more recently, as “jewelry cleaner” or “phone screen cleaner”—they are sold online and in drug paraphernalia stores under a variety of brand names, such as “Ivory Wave,” “Bloom,” “Cloud Nine,” “Lunar Wave,” “Vanilla Sky,” “White Lightning,” and “Scarface.”
Reports of severe intoxication and dangerous health effects associated with use of bath salts have made these drugs a serious and growing public health and safety issue. The synthetic cathinones in bath salts can produce euphoria and increased sociability and sex drive, but some users experience paranoia, agitation, and hallucinatory delirium; some even display psychotic and violent behavior, and deaths have been reported in several instances.
Bath salts have been linked to an alarming surge in visits to emergency departments and poison control centers across the country. Common reactions reported for people who have needed medical attention after using bath salts include cardiac symptoms (such as racing heart, high blood pressure, and chest pains) and psychiatric symptoms including paranoia, hallucinations, and panic attacks.
Patients with the syndrome known as “excited delirium” from taking bath salts also may have dehydration, breakdown of skeletal muscle tissue, and kidney failure. Intoxication from several synthetic cathinones including MDPV, mephedrone, methedrone, and butylone has proved fatal in several instances.
Early indications are that synthetic cathinones have a high abuse and addiction potential. In a study of the rewarding and reinforcing effects of MDPV, rats showed self-administration patterns and escalation of drug intake nearly identical to methamphetamine. Bath salts users have reported that the drugs trigger intense cravings (or a compulsive urge to use the drug again) and that they are highly addictive. Frequent consumption may induce tolerance, dependence, and strong withdrawal symptoms when not taking the drug.
The presence of krokodil within the continental United States has only been confirmed twice within the past year, but the drug’s side effects and highly addictive qualities have made it a hot topic on popular media outlets.
Krokodil, or desomorphine, is an opiate that first emerged in Russia as a less expensive homemade substitute to heroin. The drug can be purchased for one tenth of the cost of heroin, has a faster onset of its effects, and is often cooked at home using codeine (an over-the-counter drug in Russia), paint thinner, and match heads.
Easy access to the drug contributed to its popularity, but it also contributes to grotesque and severe side effects. The cooking process does not remove all the toxins and impurities from the drug before injection, which results in scaly, green patches, gangrene, hemorrhaging of arteries, and widespread necrosis of tissue – often resulting in such extensive rotting of the flesh that bare bone is exposed. Krokodil produces a high that lasts about two hours, and withdrawal symptoms from the drug are often so severe that sedation and an extended hospital stay would be necessary to detox.
The drug is now considered an epidemic in Russia, with the average life expectancy of addicts estimated at two years, maximum.
Heroin is manufactured from opium poppies cultivated in four primary source areas: South America, Southeast and Southwest Asia, and Mexico. Although Afghanistan produces the majority of the world’s heroin, South American heroin has become the most prevalent type available in the U.S., particularly in the Northeast, South and Midwest. The particular form known as “black tar” from Mexico, a less pure form of heroin, is more commonly found in the western and southwestern United States. This heroin may be sticky like roofing tar or hard like coal, with its color varying from dark brown to black.
Street heroin is rarely pure and may range from a white to dark brown powder of varying consistency. Such differences typically reflect the impurities remaining from the manufacturing process and/or the presence of additional substances. These “cuts” are often sugar, starch, powdered milk and occasionally other drugs, which are added to provide filler.
Heroin can be sniffed, smoked or injected. Like other opiates, heroin is a sedative drug that slows body functioning. People who use it describe a feeling of warmth, relaxation and detachment, with a lessening sense of anxiety. These effects appear quickly and can last for several hours, depending on the amount of heroin taken and the route of administration. Initial use can result in nausea and vomiting, but these reactions fade with regular use.
People who use heroin regularly are likely to develop a physical dependence. Withdrawal symptoms (“cold turkey”) may begin within 6 to 24 hours of discontinuation of the drug; however, this time frame can fluctuate with the degree of tolerance as well as the amount of the last consumed dose. Symptoms may include sweating, anxiety, depression, chills, severe muscle aches, nausea, diarrhea, cramps and fever.
Injection poses the greatest risk of lethal overdose by enabling large amounts of heroin (and additional contaminants if any) into the bloodstream at once. Symptoms of a heroin overdose include slow and shallow breathing, convulsions, coma and possibly death.
The use of “dirty” or shared needles when injecting heroin can spread deadly infectious diseases such as HIV and Hepatitis B and C. Injecting drugs and/or sharing needles can contribute to other diseases and conditions that may be serious or even life threatening, including endocarditis, embolism or blood clot, botulism, tetanus, and flesh-eating bacteria. Finally, injecting may cause abscesses (a painful skin inflammation) that, in turn, may result in blood poisoning.
Cocaine and Crack
Cocaine comes from the leaves of the coca plant that grows in the Andes Mountains in South America. For thousands of years, many indigenous tribes in this region have chewed coca leaves to produce a mild, stimulating feeling, and continue to do so to this day. Cocaine is a fine white powder, bitter to the taste. When inhaled or injected, it causes a numbing effect.
“Crack” cocaine is a smokeable form of cocaine made into small “rocks” by processing cocaine with sodium bicarbonate (baking soda) and water. Criminal penalties for possession and sale of powder and crack cocaine are severe. Possession of 28 grams of crack cocaine yields a five-year mandatory minimum sentence for a first offense; it takes 500 grams of powder cocaine to prompt the same sentence.
The duration of cocaine’s effects depends on the route of administration. The high from snorting or sniffing powder cocaine may last 15-30 minutes. Smoking crack delivers large quantities of the drug to the lungs, producing effects comparable to intravenous injection. These effects are felt almost immediately after smoking, are very intense, and last 5-10 minutes.
Cocaine’s effects are short lived, and once the drug leaves the brain, the user experiences a “coke crash” that includes depression, irritability, and fatigue. Although there are numerous possibilities on the horizon, there is currently no FDA-approved treatment method for cocaine addiction. High doses and/or prolonged use of cocaine can trigger aggravated paranoia. When addicted individuals stop using cocaine, they often become depressed. Prolonged cocaine snorting can result in ulceration of the mucous membrane of the nose.