2 presentations (part one) table of contents Community Drug Early Warning System: Recent Findings for Washington, DC 3 Bath Salts and Spice: Facts and Strategies 36 A Forensic Perspective on Synthetic Drug Trends 64 The Real Deal on Synthetic 3 Drugs: Recent Findings for Washington, DC July 17, 2014 Presented by: Eric D. Wish, Ph.D. Erin Artigiani, MA Center for Substance Abuse Research University of Maryland College Park www.cesar.umd.edu [email protected] 4 CESAR is… • Founded in 1990 as an interdisciplinary research center at the University of Maryland, College Park • Conducts policy-relevant research in all areas related to substance abuse • Maintains a clearinghouse of substance abuse information • Publishes the weekly CESAR Fax • Specializes in applied epidemiology 5 6 Source: Center for Substance Abuse Research (CESAR), Community Drug Early Warning System (CDEWS), December 2013. 2014* 13.0 2013 2012 2011 2010 2009 2008 2007 2006 7 2005 2004 2003 2002 2001 2000 District Columbia. forthe of Agency 1999 1998 Services 1997 Pretrial Pretrial June 2014 June 1996 - 1995 1994 1993 1992 1984 1991 1990 1989 1988 1987 1986 1985 1984 SOURCE: Adapted by from the by CESAR from data SOURCE: Adapted 0 Percentage of Washington, DC, Adult DC, of Washington, Percentage 20 10 40 30 60 50 70 Arrestees Testing Positive for Cocaine: Cocaine: for Positive Testing Arrestees Arrestees Testing Positive for Marijuana: for Positive Testing Arrestees 10 20 30 40 50 60 70 Percentage of Washington, DC, Juvenile Juvenile DC, of Washington, Percentage 0 1987 SOURCE: Adapted by from the by CESAR from data SOURCE: Adapted 1988 1989 1990 1991 1992 8 1993 1994 1987 1995 1996 1997 1998 - June 2014 June Pretrial Pretrial 1999 2000 Services Services 2001 2002 Agency District Columbia. forthe of Agency 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 38.8 2014 National Arrestee Drug Monitoring9 Programs • NIJ sponsored the development of the Drug Use Forecasting Program (DUF) in 1986 and the subsequent Arrestee Drug Abuse Monitoring Program (ADAM) in 2000 to track drug trends in 35 sites; Funding was eliminated in 2004 • ADAM II was re-established in 2007 by ONDCP • ADAM II is county specific and not statewide (N=4,412 male arrestees tested in 2 qtrs per yr) • In 2011, ADAM II operated in 10 sites; projected to be cut to 5 sites Source: Center for Substance Abuse Research (CESAR), Community Drug Early Warning System (CDEWS), December 2013. 10 CDEWS Goals • Assess the feasibility of the CDEWS methodology in different types of CJS populations and sites • Assess the value of expanding the drug testing protocol to include synthetic cannabinoids • Assess emerging drugs at the community level • Generate hypotheses and questions for future research Source: Center for Substance Abuse Research (CESAR), Community Drug Early Warning System (CDEWS), December 2013. 11 CDEWS Methodology CDEWS rapidly collects small random samples of CJS specimens that tested positive and negative and are ready to be discarded, without regard to age, gender, or charge Source: Center for Substance Abuse Research (CESAR), Community Drug Early Warning System (CDEWS), December 2013. 12 Location of Participating Study Sites 1 population in 3 populations in Prince George’s Washington, DC County, Maryland 1 population in Chesterfield, Virginia Source: Center for Substance Abuse Research (CESAR), Community Drug Early Warning System (CDEWS), September 2013. 13 Specimens Selected and Tested, by Site and Population CJS Test Result Subset Tested Site and Population Positive Negative Total for SC Washington, DC – Pretrial Services Agency for the District of Columbia Parole & Probation 197 103 300 156 Pretrial Surveillance 200 100 300 164 Lockup 200 100 300 162 Virginia – Chesterfield Community Corrections Services Probation 37 67 104 58 Maryland - Prince George’s County Drug Court Drug Court 16 44 60 51 Total 650 414 1064 591 Source: Center for Substance Abuse Research (CESAR), Community Drug Early Warning System (CDEWS), September 2013. The FRIENDS Laboratory Expanded Drug Screening Panel14 Drugs Tested, by Method Detection Limit Enzyme Immunoassay (EIA) Amphetamines 500 ng/mL Barbiturates 200 ng/mL Benzodiazepines 300 ng/mL Buprenorphine 5 ng/mL Cocaine 150 ng/mL MDMA 500 ng/mL Methadone 300 ng/mL Methadone Metabolite 300 ng/mL Opiates 300 ng/mL Oxycodone 100 ng/mL PCP 25 ng/mL THC 50 ng/mL Thin-layer Chromatography (TLC) Ami/Nortriptyline Hydroxyzine Amphetamines Methadone Ativan/Dalmane Morphine Benzodiazepines Oxycodone Clonazepam Opiates Cocaine Phenmetrazine Codeine Phenothiazines Demerol Quinine Dilaudid Tramadol Doxepin Valium Hydrocodone Confirmations Liquid Chromatography/Mass Spectrometry LC/MS was conducted on all EIA positives for opiates, amphetamines and buprenorphine. LC/MS confirmation for opiates was also conducted on all EIA oxycodone positives with a negative EIA opiate screen. Gas Chromatography/Mass Spectrometry GC/MS was conducted on all EIA positives for PCP. Source: Center for Substance Abuse Research (CESAR), Community Drug Early Warning System (CDEWS), September 2013. 15 SC Testing Panel for CDEWS 2 Synthetic Cannabinoid Metabolites Tested for in CDEWS 1 To be added in CDEWS 2 AM-2201 AKB-48 JWH-018 BB-22 JWH-019 PB-22 JWH-073 5F-AKB-48 JWH-081 5F-PB-22 JWH-122 AB-PINACA JWH-210 5F-AB-PINACA JWH-250 ADB-PINACA MAM-2201 ADBICA RCS-4 UR-144 XLR-11 Source: Center for Substance Abuse Research (CESAR), Community Drug Early Warning System (CDEWS), July 2014. Metabolites Found in All Synthetic Cannabinoid16 Positive Specimens from Five CJS Populations in Three Sites, 2013 (N=118) UR-144 and XLR-11 31% UR-144 Only 60% XLR-11 Only 4% UR-144 and JWH-018 3% 3+ Metabolites 2% Source: Center for Substance Abuse Research (CESAR), Community Drug Early Warning System (CDEWS), September 2013. Percentage of Specimens from Young Males17 Testing Positive for Synthetic Cannabinoids, by CJS Population and CJS Screen Result, 2013 (N=272 Specimens from Males ≤ Age 30) 50% 45% 39% 40% 37% 36% 35% 30% 28% 24% 25% 21% 19% 20% 20% % Positive 15% 13% 10% 5% NA 0% Pos Neg Pos Neg Pos Neg Pos Neg Pos Neg (N=60) (N=36) (N=39) (N=36) (N=25) (N=25) (N=16) (N=20) (N=0) (N=15) DC Parole & Probation DC Pretrial Surveillance DC Lockup Chesterfield Probation Prince George's County Drug Court CJS Population CJS Screen Positive CJS Screen Negative Source: Center for Substance Abuse Research (CESAR), Community Drug Early Warning System (CDEWS), September 2013. Percentage of Specimens from Three DC CJS Male18 Populations Combined Testing Positive for Synthetic Cannabinoids, by PSA Drug Screen Result and Age, 2013 (N=341 specimens from Washington, DC Parole & Probation, Pretrial Surveillance and Lockup) 100% 90% 80% 70% Percentage 60% Testing Positive for Synthetic 50% Cannabinoids 38%39% 40% 33% 31% 26% 30% 25% 22% 21% 17% 20% 10% 10% 7% 0% 0% 20 and Younger 21 to 25 26 to 30 31 to 40 41 to 50 51 and Older (N=28) (N=18) (N=40) (N=51) (N=56 (N=28) (N=23) (N=27) (N=23) (N=20) (N=15) (N=12) PSA Screen Positive PSA Screen Negative Source: Center for Substance Abuse Research (CESAR), Community Drug Early Warning System (CDEWS), September 2013. 19 Mean Age of Persons Positive for Specific Drugs (N=900 specimens collected from DC Lockup, Pretrial Surveillance, and Parole & Probation) Percent Positive by CDEWS Average Age Lab for: x ̅ (SD) Synthetic Cannabinoids (n=107) 28.5 (8.5) Marijuana (200) 31.0 (11.0) PCP (158) 34.5 (10.4) Oxymorphone (32) 39.9 (13.6) Hydrocodone (11) 40.0 (13.1) Hydromorphone (18) 40.2 (15.0) Oxycodone (30) 41.3 (13.5) Buprenorphine (72) 43.2 (13.5) Benzodiazepines (23) 43.3 (11.5) Opiates (152) 43.4 (12.7) Morphine (141) 44.1 (12.5) Codeine (127) 44.4 (12.3) Cocaine (170) 46.4 (10.2) Methadone (46) 50.2 (7.9) Source: Center Substance for Research Abuse (CESAR), Community Drug Early WarningSystem (CDEWS), September 2013. Other Drugs Found in Specimens Testing Positive by CDEWS20 Laboratory for Marijuana, Synthetic Cannabinoids (SC) or Both (N=210 specimens from Washington, DC Parole & Probation, Pretrial Surveillance and Lockup Populations Tested for Synthetic Cannabinoids) Marijuana Only Marijuana and SC Percent also Positive SC Only Positive by Positive by Positive by by CDEWS Lab for: CDEWS Lab CDEWS Lab CDEWS Lab (N=85) (N=103) (N=22) PCP 22% 23% 27% Marijuana 0 NA NA Cocaine 4 7 14 Codeine 8 7 5 Morphine 8 7 9 Buprenorphine 7 6 0 Oxymorphone 0 6 5 Oxycodone 0 5 5 Hydromorphone 1 1 5 Methadone 2 1 0 Benzodiazepines 0 1 0 Hydrocodone 1 1 5 Dextromethorphan 0 0 5 Tramadol 1 2 0 Synthetic Cannabinoids NA 0 NA Source: Center for Substance Abuse Research (CESAR), Community Drug Early Warning System (CDEWS), September 2013. NIDA Community Epidemiology 21 Workgroup • Our June 2014 was just submitted to NIDA • Covers Synthetics and other drugs • http://www.drugabuse.gov/ab out-nida/organization/ workgroups-interest-groups- consortia/community- epidemiology-work-group- cewg/meeting-reports/area- reports-june-2014 • CESAR will continue working with CEWG reps through NDEWS 22 What are Synthetic Cannabinoids? • A blend of herbs and plant material sprayed with one or more synthesized chemical compounds or metabolites that are believed to bind to the same receptors as THC • Sold in small pouches or packets of 0.5-10 grams each as herbal incense or potpourri and often marked as “not for human consumption” • Typically smoked in joints or pipes or ingested in tea • Can be more potent than marijuana • Not detected by standard drug tests • At least 41 states and Puerto Rico have passed legislation making synthetic cannabinoids illegal Source: Center for Substance Abuse Research (CESAR), December 2013.