K2 Spice Bath Salts

In the past 5-10 years or so a number of new drugs of abuse have come into the American culture.  Just about all of these are synthetic, which makes them much more difficult to deal with. Learn about the drugs below; then see Dr. Imbrogno's comments after that.

Synthetic Marijuana - K2, Spice, Spice Gold

Synthetic cannabinoids are a structurally diverse class of mostly synthetic substances that bind to cannabinoid receptors in our body, and when ingested create a similar type of high that naturally occurring cannabinoids (marijuana) produce. Hundreds of different synthetic cannabinoids have been created (initially most of them were created in laboratories for research purposes).

The first synthetic marijuana became available in 2004 under the brand name of "Spice". Since then, 100s of other brands (some with the same chemical structure and others with different chemical structures) have come into the market. These drugs are usually laced on herbal-plant material and then smoked, and hence referred to by many as "herbal incense".

Brand Names: Some of the brand names have included: K2, Spice, Chronic Spice, Spice Gold, Spice Silver, Stinger, Yucatan Fire, Skunk, Pulse, Black Mamba, Mystery, Red X Dawn, Zohai, Mr. Nice Guy, Spicylicious, K3, K3 Legal, Earthquake, or Genie. But there are many others and many new brand names are popping up all the time.
Although there are quite a few chemicals on the market that fit the class of "synthetic marijuana", the majority of the market consisted of 5 major drugs: JWH-018, JWH-073, JWH-200, CP-47,497, and cannabicyclohexanol.

Legal Status: On March 1, 2011, under emergency order, the DEA placed the above 5 substances into Schedule I of the Controlled Substance Act, meaning that the manufacture, distribution, dispensation, possession, importation; or exportation of these 5 substances it is illegal in the United States unless under specific order of the DEA for research purposes. At this time there is no medically approved use for these substances.

Currently, these 5 substances are illegal in the United States, but there are many other synthetic cannabinoids which are not. It is anticipated that the manufacture, distribution and consumption of these currently unregulated synthetic compounds will soon began to increase very dramatically.

Toxicity: Obviously, there is no human research data available; but, the laboratory research indicates that the potency of these herbal incense compounds varies from anywhere from 10 to over 100 times that of natural marijuana. This brings into question the potential seriousness of toxicity, and some speculation that this leads to a stronger psychological addiction. Anecdotal reports seem to indicate an increased occurrence of hallucinations, agitation, abnormal heart rates and elevated blood pressure over what one would expect to see from routine marijuana use. This finding is most likely explained by the increased potency of these drugs. 

bath salts:   MDPV & Mephedrone:  Synthetic  Stimulants

Two very potent stimulants that are currently being used include MDPV (Bath Salts) and Mephedrone.

MDPV-  3, 4-Methylenedioxypyrovalerone is the active ingredient in MDPV, "Bath Salts". It is also known as Cloud 9, Ivory Wave, Ocean, Charge Plus, White Lightning, Scarface, Hurricane Charlie, Red Dove, and White Dove.

Mephedrone-  4-methylmethcathinone(4-MMC), [or 4-methylephedrone] is the active ingredient in Mephedrone which is reportedly manufactured in China.  It is also known as meph, drone, MCAT and meow meow

Legal Status: MDPV and Mephedrone are not approved for use, or consumption in the US, but they are not illegal in the US. They can frequently be purchased on the Internet. Some states have made these substances illegal, but, as of this date, Ohio has not.

Toxicity: MDPV & Mephedrone both affect the human body in a manner similar to amphetamines and cocaine (as stimulants); yet they are man-made with very different chemical structures. These 2 substances appear to be quite potent stimulants; and, early data suggests that they have a much higher incidence of toxic events compared to the other stimulants, especially with respect to cardiac events.

Testing

A number of laboratories are now developing testing protocols for the synthetic marijuana compounds and bath salts. Here are some of the issues. There are no national standards for cut-off and confirmation levels which have been set for the testing of the substances. Each laboratory has its own internal validation protocols; so, you can pretty much be assured that if the laboratory finds the substance in the specimen, that it's there. And, these laboratories will usually stand behind their results. However, questions arise as to what those results mean. Not all of the substances are illegal. What about appropriate cut-off levels for secondhand smoke or passive inhalation? Although the laboratories will stand behind their results, one laboratory director advised me that at this time a declaration of "passive inhalation" by a donor could not be refuted based upon the current status of the medical science behind the testing protocols at this time. Currently, the cut-off and confirmation levels have been set for routine marijuana testing in the urine based upon extensive research; so that a claim of passive inhalation cannot be substantiated, and is not considered by the MRO. That research is not available for the synthetic marijuanas; so passive inhalation can not be ruled out.

The testing procedure for "Bath Salts" usually confirms the 2 main substances involved: MDPV and Mephedrone.
Testing for the synthetic cannabinoids (spice, K2, etc.) is much more problematic, since the testing protocols for these drugs is evolving. Most laboratories will test for the 2 most common and most frequently encountered synthetic cannabinoids: JWH-018, JWH-073 (usually found in Spice & K2). Some laboratories are adding 1 or 2 of the other synthetic marijuana compounds which have also been determined to be illegal to their panels. The window of detection for the synthetic cannabinoids is estimated to be the same as that of marijuana, approximately 72 hours.

Dr. Imbrogno's Comments

These 2 new classes of drugs, bath salts (stimulants) and the synthetic marijuana substances (herbal incense) are very potent and dangerous drugs which are circumventing the current legal and laboratory detection systems.

The "high" from these drugs is similar but not the same as the originals; this may keep some drug users from switching to them. For those people who use drugs, the word going around is that the herbal incense (synthetic marijuanas) and bath salts are legal and will beat a drug test. From the information above, they are partially right. In and of itself, this may cause an uptick in the use of these substances and be cause for consideration of including them in an employer's drug panel of tests. But, there are several other significant issues you should look at before including these tests in your standardized drug testing panel.

Since bath salts, the stimulants MDPV and Mephedrone, are not illegal; testing for them can present certain challenges unless you carefully craft your corporate policy on drug testing to include the substances.

Of the 100s of synthetic marijuana compounds only 5 are illegal. Fortunately, these 5 are the substances most frequently used in "herbal incense" to get high; and laboratories can now test for the 2 most common and most frequently used synthetic marijuanas.  As testing for these 5 substances becomes more common, it is almost certain that many more new chemical structures will hit the market that have not yet been determined "illegal". But at this time, no commercial laboratory detection procedures have been developed for them. With all the possible chemical structures for the synthetic compounds, will we just be chasing our tail?

Also of importance, it appears at this time that a claim of "secondhand smoke" or "passive inhalation" by the donor cannot be refuted based upon current testing procedures. Where does this put your testing program if you can’t really rely on a positive result?

There still exists serious concern whether the testing protocols for these substances will withstand legal challenges. Although each laboratory has its own internal quality and validation standards, the testing protocols have not been set and standardized throughout the US.

My final recommendation is for employers to wait until most of these issues have settled out before adding these drugs to one of your standard drug testing panels. There are too many unresolved issues at this time. However, if you believe that you currently have a problem with one or several of these drugs in your workplace, you must be very cautious to develop (and probably re-write) your drug testing policy to address the aforementioned issues. Our laboratory has these tests available, and we can assist in heading you in the right direction.

Please feel free to contact me or Julie Reedy should you have further questions.

Dean Imbrogno, M.D., M.P.H.
Medical Director,
MedWork Occupational Health Care