DEA jams synthetic marijuana and “bath salts” industry
Jul28

DEA jams synthetic marijuana and “bath salts” industry

With all the discord in Washington these days, it’s rare to see several US governmental organizations working together to address a significant public health problem. This week, the US Drug Enforcement Agency (DEA) mobilized Operation Log Jam, an unusual and highly-coordinated action with six other federal agencies aimed to shut down the synthetic designer drug industry in 109 US cities. The products targeted were of two broad classes: 1) synthetic marijuana “incense” products comprised of naphthoylindole cannabimimetic compounds first synthesized by John W. Huffman’s lab at Clemson in the mid-1990s, and 2) “bath salts” or “plant food” products containing the stimulant/empathogen mephedrone (4-methylmethcathinone) or the stimulant MDPV (3,4-methylenedioxypyrovalerone). This compilation of posts on synthetic marijuana and, to a lesser extent, “bath salts” serves as a good primer on the subject. These products were sold widely on the internet, headshops, and convenience stores and were associated with 13,000 poison control calls last year, 60% of which were in individuals under 25. Disturbing acute and chronic side effects have been reported by users that include severe anxiety and paranoia, unnerving hallucinations, and even heart attacks. Several specific compounds were criminalized by an emergency DEA action and numerous state and local laws over the last two years. Still, products continued to be available containing compounds not explicitly criminalized, with marketers claiming legal status. Commenters here and elsewhere have argued that this industry would go away if marijuana would simply be decriminalized in the US. Earlier this week, TIME Healthland writer Maia Szalavitz made a good argument for this (or at least FDA regulation of recreational drugs) in the context of Operation Log Jam. Comprehensive action I find two aspects of this initiative quite unique since I began covering the synthetic formerly-legal highs phenomenon. First, Operation Log Jam aimed to address every level of the synthetic designer drug industry: manufacturers, wholesalers, and retailers. From the DEA press release: As of today [26 July], more than 4.8 million packets of synthetic cannabinoids (ex. K2, Spice) and the products to produce nearly 13.6 million more, as well as 167,000 packets of synthetic cathinones (ex. bath salts), and the products to produce an additional 392,000 were seized. In addition, $36 million was also seized in the raids. Among the federal agencies involved was the US Postal Service since the internet-marketed products are sometimes shipped via regular mail. US Customs and Border Protection acted to target the flow of compounds synthesized non-domestically into the country. And, of course, the IRS was involved to, “trace the path of illicit drug proceeds by identifying the financial linkages among the various co-conspirators,” as indicated by Richard Weber, Chief, IRS Criminal...

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K2 Synthetic Marijuana: Heart Attacks, Suicides, and Surveillance
Nov14

K2 Synthetic Marijuana: Heart Attacks, Suicides, and Surveillance

Sixteen-year-old boys having heart attacks. Blog reports of deaths and suicides. And a little known chemistry and public health resource mobilized to identify “legal highs.” The chemical and biological phenomenon that is “synthetic marijuana” continued to develop over the last week as we learn more about these products from the medical and public health communities. Most notably, pediatric cardiologists reported in the journal Pediatrics on three cases of Texas teenagers who experienced myocardial infarctions – heart attacks – after using a synthetic marijuana product (DOI: 10.1542/peds.2010-3823). (Many thanks to Dr. Ivan Oransky, Executive Editor at Reuters Health, for providing us with primary information after their own excellent report by Frederik Joelving). Brief background Sold under names like K2 or Spice as “incense” or “potpourri” and labeled as “not intended for human consumption,” these products are laced with one or more synthetic psychoactive compounds that were published in 1990s work studying structure-activity relationships on cannabinoid receptors. The vast majority of the synthetic work was done in the laboratory of Dr. John W. Huffman, now professor emeritus of the Department of Chemistry at Clemson University, with his compounds know by “JWH-” nomenclature. The US Drug Enforcement Agency secured emergency prohibition of five of these compounds late last year, spurring “legal highs” manufacturers to reformulate second-generation Spice products containing related compounds not explicitly designated as illegal. Although the DEA does have the authority to prosecute sale and possession of these analogs, such action is rare. To learn more, we’ve put together a compilation of our synthetic marijuana posts for the reader’s further reference. Adolescent heart attacks In this week’s advance Pediatrics publication, the three cases – all in 16-year-old boys – were seen at the UT-Southwestern Medical Center in Dallas within three months of one another. The common presentation was a 3- to 7-day history of chest pain with myocardial infarction confirmed by electrocardiographic and biochemical endpoints (ST elevation in the inferolateral leads and substantial increases in cardiac troponin-I released into the bloodstream). As you might predict, heart attacks are extremely rare in otherwise healthy 16-year-olds. But marijuana itself is known to cause cardiac effects, with rare cases of myocardial infarction. In the discussion of the Pediatrics report, Dr. Arshid Mir and colleagues describe literature extending back to 1979 (DOI: 10.3109/15563657909010604) on the increased risk of cardiac disturbances, including myocardial infarction, within the first hour of marijuana use. Increased heart rate is a well-recognized effect of marijuana that is mediated by increased sympathetic nervous system outflow to the heart. This 1976 paper in Circulation describes how the majority of this tachycardia can be prevented by premedication with the non-selective beta-blocker, propranolol. But what about...

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