The last months in DC have seen a huge spike in emergency room cases due to overdoses from so-called synthetic drugs. Fire and EMS departments reported 21 cases in August of 2012 and 50 in May 2014. In June of this year that number had risen to 439. This problem is not unique to DC – in the last decade, the DEA has tracked more than 300 types of synthetic drugs, the effects of which aren’t predictable or well understood. Through national emergency-room visits, the accepted metric for drug trends, a record 49 novel compounds were found in 2011.
Based on their chemical make-up these drugs are commonly divided into two categories:
Cannabinoids: chemically formulated versions of synthetic marijuana that consist of lab-manufactured THC.
Cathinones: also known as “bath salts”, they contain chemical compounds that mimic the effects of cocaine or crystal meth.
Apart from these two distinctions, no one currently really knows what is in the new synthetic drugs that are leading to this increase in hospitalizations. But that is not a problem unique to these substances; it is an intrinsic problem with all illegal drugs. A side effect of prohibition has always been adulteration and intoxication. When driving a drug underground, its production and sale falls into the hands of dodgy enterprises with no quality control standards.
Any classic psychoactive drug, such as cocaine or heroin, started as a renowned classical therapeutic agent, tested in laboratory conditions and produced by competent chemists. Abuse of these agents could kill, but their use within a controlled environment rarely would. However, contemporary producers have manufacturing bases in domestic kitchens where a slight mistake can produce poisonous substances, and whose products reach users after many steps though violent criminal networks of unknown origin.
We have seen the dangers of unregulated and adulterated products throughout the last century: moonshine created by mafia bootleggers in the Prohibition era, which led to multiple cases of blindness and death; crack cocaine in the 80s, a cheaper way to create a similar substance by mixing it with baking soda; and more recently the creation of meth labs, one of the most hazardous substances for health. Synthetic drugs appear to be the latest on this list.
The problem lies not in these particular substances, but in the model of drug prohibition that we keep trying to reproduce. Some of the dangers of new synthetic drugs come from the criminalization model, where there is no room for a regulated market. So while the federal and state governments rush out to prohibit every new substance that appears, they are avoiding tackling the intrinsic problems of the illegal market. We’ve yet to analyze the deeply rooted causes of drug use and addiction; public health aspects are being relegated as are investment in prevention or treatment. The legal landscape of synthetics
Both federal and state governments have tried to outlaw synthetic drugs. The Controlled Substances Analogue Enforcement Act of 1986 categorizes synthetic drugs with a proven chemical or pharmacological similarity to a Schedule I or Schedule II drugs as controlled substances. In 2012, President Obama signed into law the Synthetic Drug Abuse Prevention Act. The Act permanently categorized 26 types of synthetic cannabinoids and cathinones as Schedule I drugs. The DEA is also continuously using its emergency scheduling authority to add new versions of synthetic drugs into Schedule I. Since 2011, all 50 states have also banned synthetic cannabinoids and cathinones.
Drug makers are easily sidestepping these regulations, however. Manufacturers adapt simply by replacing the chemical compound of a banned synthetic substance with a newer formulation that is not yet known to the authorities. Additionally, in an effort to avoid FDA regulations, these drugs are often labeled “not for human consumption”, even though the products design, labeling and marketing allude to the products being smoked and/or inhaled as drug. Because of these loopholes, these drugs fall into a legal gray area.
These new drugs are not only replacing conventional illegal drugs by producing physical and psychological effects similar to traditional, mind-altering substances like cannabis, cocaine and heroin, but they are also in many cases attempting to do it out in the open, as legal products. These drugs are being sold in stores, marketed as potpourri, incense, pet food, and other legal products. They’re also easy to come by on the Internet. One website boasts “the most advanced scientific product available” – offering, for instance, 20 grams of something called Scooby Snax for $34. In the DC Metro area, local gas stations and convenience stores often sell the drugs in smaller packets for $5. There is no way to tell how one packet differs from another with the same label nor what substances they actually contain.
When one substance is discovered and prohibited, slight changes in their chemical compositions can be made so that existing law no longer covers the new drug. DC Police officials say it’s nearly impossible to charge a person for possession of a substance that takes so long to test and often isn’t detectable. Users are also saying that they use the synthetic substances instead of illegal drugs precisely so that they can pass drug tests and get jobs. What users often don’t know is that they are being used as human guinea pigs to new drugs whose make-up and effects cannot be known. What we know about these new drugs
While these drugs are changing day to day there have been two game-changers: synthetic pot and flakka. Synthetic pot, also known as Spice, K-2, or fake weed, is not even close to being same drug as pot. Its name, which is utterly misleading, is where the similarity ends. Synthetic cannabis, unlike pot, can cause a huge variety of symptoms, which can be severe: agitation, vomiting, hallucination, paranoia, tremor, seizure, tachycardia, hypokalemia, chest pain, cardiac problems, stroke, kidney damage, acute psychosis, brain damage, and death. Another issue with synthetic cannabis is its potency, which can be up to one hundred or more times greater than THC. Not only this, but it’s much more efficient at binding to cannabinoid receptors in the brain. Adding this to the fact that quality control is non-existent and that the drugs are always evolving gives a recipe for disaster.
Because of these differences, synthetic pot—which has only been researched very recently—can cause great public health harms. In 2014, for example, New Hampshire declared a state of emergency, when emergency room visits for overdoses from synthetic marijuana rose significantly. The substance was the cause of some teen deaths who had slipped into comas, reportedly from using the drug.
The second most recognized synthetic drug is known as flakka, a type of synthetic cathinone. Flakka is the street name for alphapyrrolidinopentiophenone (alpha-PVP), according to the National Institute on Drug Abuse, and is mainly produced in China (where many other synthetic drugs are also coming from) and distributed by dealers on the ground in the US for around $3 to $5 a dose. Unlike synthetic marijuana, flakka takes the form of crystals that can be snorted, injected, vaporized, or eaten. The epicenter of flakka use is Broward County, Florida, which had 477 reported cases of flakka use in 2014. And the drug has begun to spread to other rural communities and small towns. According to the DEA, Georgia, West Virginia, Pennsylvania, Illinois, and Ohio all had high rates of flakka use in 2013.
A recent VICE article explores the surge of flakka in Broward County. In this article, Paul Faulk, the director of Broward County’s Addiction Recovery Center, describes the explosion of the drug first hand: “We started seeing the emergence of flakka back in September, 2014, and didn’t know what it was but saw something different with the clients that were coming in… they behave in a way we have never seen with drug or alcohol intake: much more aggressive, paranoid, very anxious, and that makes it very very difficult to treat them.” Faulk said that the case load of flakka patients coming into the clinic has grown from one during September, 2014, to 40 to 50 a month in June. In May, he joined local law enforcement officers and community outreach groups who held an emergency press conference warning drug users to stay away from flakka. Flakka, like synthetic marijuana, is cheap and is frequently targeted at teenagers.
While less is known about other synthetic drugs, the dangers are similar. Recent cases in DC follow similar patterns to these two drugs. Police describe individuals with erratic or overly aggressive behavior. They are not quite sure how to treat them, as violent synthetic-drug users might not respond to sedatives the way other drug users would. Overdoses have also been almost impossible to prevent.
What users aren’t realizing is that when a person takes a new and unstudied drug, they are taking a big risk. The drug may be perfectly safe. It may even be beneficial. On the other hand, it could also be deadly on the first try. For example, Bromo-DragonFLY, a drug pilfered from the Purdue University lab of pharmacologist David Nichols for commercial release and considered to be the strongest serotonin agonist in the world, caused some people to lose their arms after taking high doses: “It clamped down so much on the blood vessels that the limbs die—you’re literally strangled from the inside,” says Jeff Lapoint, a medical toxicologist and emergency physician at Kaiser Permanente. A new approach is needed
Currently, many state and federal agents are looking to create broad bans to make sure all psychoactive synthetic drugs can be covered. Then again, prohibition is partly to blame for the dangers of these new substances and will likely not be the answer to the problem now. By the time a drug is made illegal, dozens of other variations of the synthetic have already been formulated and positioned for release into the market. Rather than launching a new front in the War on Drugs, policymakers should focus on a harm reduction strategy. To do this we need to move away from a rule-based system to a standards-based system. If these substances are kept in a legal and regulated market, consumers can gain insight into what they are consuming and what the adverse health consequences of use and abuse may be. Consumers need to know that they are playing a dangerous game when buying these seemingly harmless substances at their corner convenience store or on their web browser.
Recently, progress has been made in this country’s drug policy. Legalizing marijuana has allowed users safer access to regulated products, keeping them away from the dangers of the black market and providing them with the necessary health warnings. Just recently, Obama announced a new program aimed at curbing heroin use and trafficking. For the first time, half of the money will go to a program that emphasizes treatment over prosecution of drug addicts. These new actions address drugs as both public health and public safety issues. We need to make sure synthetic drugs follow this route instead of falling back into the Prohibition era.
The views reflected in this expert column are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.