The Scourge of Synthetic Drugs
We have heard a lot about K2 (Spice, Black Mamba and other quaint names), the synthetic "marijuana" that has been ravaging people and cities. And about Ecstasy and other illegal stimulants that are club drugs as well as students' and "mothers' little helpers" (expression thanks to The Rolling Stones). The use and abuse of synthetic, illicit drugs has become a public health crisis that is not going away, and in fact it may become more serious.
New York City, in 2015, saw thousands of emergency visits for toxic reactions to synthetic marijuana alone (The Not-So-Nice Spice). These visits, as well as emergency calls to poison control centers, finally diminished after a major police and public health mobilization with raids on key distribution sites enabled by governmental executive orders, which shut down the major manufacturer and local suppliers.
The next generation of illegally synthesized and distributed drugs with powerful effects on the human mind (and body) is in the pipeline. New production of synthetics has ratcheted up to replace last year's drugs, in response to public health bans and criminal consequences.
Researchers recently reported in the Journal of Drug and Alcohol Dependence (1) an abundance of what they termed "novel psychoactive substances" (NPS); "novel" seems a euphemism for these newly synthesized and highly toxic drugs en route to sales and consumption, in this country and abroad. The researchers identified over 400 compounds, with 255 of them newly synthesized; their data was from the 2012-2014 European Union (EU) Early Warning System (EWS).
With perhaps tragic irony many of these novel drugs are labelled "Not For Human Consumption." They are promoted as "herbal highs" and "plant food," and sold online, in head shops, bodegas, truck stops, and from drug dealers. Another recent survey reported that near to 3 million youth in the EU, about 5 percent of those ages 15-24 had consumed NPS (2). The novel psychoactive substances span many classes of drugs but the great predominance are compounds meant to mimic marijuana and stimulants. We will focus on those two groups here.
In fact, two thirds of the novel psychoactives are "synthetic cannabimimetics" -- literally "mimics" of cannabis, or marijuana. The manufacture of these drugs, most recently K2 and the like, dates back about 10 years when sold as alternatives to marijuana. The actual NPS are chemicals cooked up in fly by night labs, sprayed onto herbs, dried and packaged for sale. A good deal of their production is going on in China and Russia. Unlike marijuana, they are far more potent and last longer in the body, cheaper, promoted as "natural," and "legal" (until they are illegal, at which time they are replaced by yet another mimetic). Especially vulnerable to sale and use are people living in poverty, those with mental and addictive disorders, and youth -- all of whom seek cheap, accessible and potent products. The NPS marketing, including trendy names, colorful packages, and ostensible low risk of criminal prosecution, make them truly dangerous to the public health.
The synthetic cannabimimetics already available have shown a host of serious adverse effects, as NYC and many other cities have seen. These include acute toxic symptoms such as high blood pressure and rapid pulse, nausea and vomiting, profound somnolence to the point of being unresponsive, panicky feelings, aggressive actions, disorientation, psychosis and seizures. Kidney damage has been seen, which can lead to long term renal disease. Fatalities have also been reported. These types of reactions are apt to be more severe with the new drugs because of their greater potency and duration of action, as well as their potential to interact with prescribed and non-prescribed other drugs a person may take.
The illegally synthesized cathinones are a great variety of amphetamine-like drugs. Some of their early versions, also dating back almost 10 years, were sold as alternatives to pharmaceutical psychostimulants (like Ritalin, Dexedrine and Adderall). MDMA (Ecstasy or Molly) and Bath Salts add to the list of synthetic cathinones - as have other drugs more recently with street names such as Ocean Breath, Fire Ball, Sextasy, which are sold to replace or pretend to be Ecstasy.
These compounds act primarily on the noradrenaline and dopamine brain receptors (with some effect as well on serotonin). This mode of action explains their euphoric and excitatory effects, as well as their capacity to raise blood pressure and heart rate (including palpitations), sweating, insomnia, muscle twitching, dizziness, grinding of teeth, and nausea and vomiting. Paranoia, hallucinations, and agitation have been reported, and can result in emergency room visits and hospital stays. Cathinones are known to be toxic to the liver as well.
Drugs are big business
The EU reports on the plentitude of NPS, and the financial windfalls they represent in Europe and the US, can only predict more illegal activity ahead. That means, as well, grave medical and social consequences from the glut of new drugs we may soon see.
Most countries, including the United States, have employed a variety of legal actions to forestall the production and distribution of synthetic drugs of abuse. Raids on labs and points of sale can make a difference but only in a limited way and transiently so, since many of the labs are abroad and the points of sale can change on a moment's notice. Moreover, the drug manufacturers stay a step ahead of the law by introducing a minor modification in the drug's chemical structure, adding a fluoride ion for example, and thus becoming "legal" again, until authorities declare the latest product illegal.
Demand-side efforts, aimed at reducing consumer demand have generally emphasized public service announcements and education in schools aimed to make drugs appear aversive. We know, from anti-tobacco campaigns, that the most effective ads are those that are the most gory and distasteful (e.g., those showing dying people or those who cannot breathe or have a tracheostomy). Getting people to watch those, particularly youth, is a challenge. Peer influences in schools are generally more effective than adults or didactic exhortations.
Perhaps the strongest evidence to date for the effectiveness of demand-side approaches is in treatment. Estimates are that for every $1 spent in treatment that $10 is saved in societal costs. Treatment, however, must be comprehensive and continuous, not just a reliance on one approach or a short-sighted view that addiction is a temporary condition.
There seems to be a growing interest in fighting drug trafficking by destroying the profits of the manufacturers and distributers. The UK Editor for The Economist, Tom Wainwright, who spent years as a correspondent covering the cartels in Mexico and Latin America, describes how this might be done in his new book, Narco-Nomics, which I reviewed. In the US, four states and The District of Columbia already have made recreational marijuana legal and many more have introduced medical marijuana. We need to see, over the next few years, if legalization cuts deeply into the pocketbooks of illicit drug manufacturers, especially those selling marijuana and synthetic cannabimimetics.
The conventional "war on drugs" has failed repeatedly, cost a fortune and has unjustly targeted the poor and people of color. To better face a future with more illegal drug importation and distribution we need new ideas, new approaches to protect the public health. Perhaps at least one approach should derive from the admonition, "it's the economy, stupid."
(1) Zawilska, JB, Andrzejczak, D: Next generation of novel psychoactive substances on the horizon - A complex problem to face, Drug and Alcohol Dependence, 157 (2015) 1-17
(2) Corazza, O, et al: "Spice, Kryptonite, Black Mamba: an overview of brand names and marketing strategies of novel psychoactive substances on the web, J. Psychoactive Drugs 2014, 46, 287-294.
The opinions expressed herein are solely my own as a psychiatrist and public health advocate. I receive no support from any pharmaceutical or device company.
My book for families who have a member with a mental illness is The Family Guide to Mental Health Care (Foreword by Glenn Close) -- is now available in paperback.
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