Letter to the Editor: The Drug Trend Conundrum

| April 1, 2016 | 0 Comments

01_ICNS_Mar-Apr_2016Dear Editor:

The frequent emergence of new illicit drugs and the ever-evolving trends in their use continue to cause difficulties for clinicians in regard to screening, detection, and treatment and to the different drug monitoring agencies in regard to determining appropriate regulations. Since the advent of synthetic cannabinoids and “bath salts” in recent years, there have been newer drugs on the scene that have equally deleterious effects on the physical and mental health of their users.

One such drug that has hit the scene in the last two years is alpha-pyrrolidinopentiophenone, similar in structure to other synthetic cathinones (e.g., “bath salts”). It is known on the streets by different names—the most popular being “Flakka” and “Gravel.”[1–3] Alpha-pyrrolidinopentiophenone can be ingested orally, smoked, snorted, used parenterally, and also vaporized in e-cigarette devices. This latter route of administration leads to rapid introduction into the blood stream, resulting in high risk of overdoses.[1] The drug has been reported to cause paranoia, hallucinations, aggressive behaviors, and self-injurious behaviors (including completed suicides). Access to Flakka/Gravel via the internet has made it easily accessible, and has been reported as being more affordable than other prevalent stimulants such as crystal methamphetamine.3 Its mechanisms of actions are mediated by inhibition of dopamine uptake at the dopamine transporter (DAT).[1,2]

Another increasingly popular drug in the last two years is butane hash oil, known on the streets as “Budder” and “Dabs,” among other names. The process of manufacturing this drug is very unstable, involving soaking leaves and stems of marijuana plants in the highly flammable gas, butane, to extract its constituents in a highly concentrated form, which produces significant euphoric effects in users. Butane hash oil has been reported to contain more than 90-percent tetrahydrocannabinol, making it much more potent and toxic to its users than typical marijuana, causing significant hallucinations, paranoia, anxiety, and cardiac problems.[4]

There have been reports of a significant increase in incidents of severe burns from butane gas explosions during the process of manufacturing of butane hash oil in California, leading to significant public health concerns.[4,5] Since the liberalization of their marijuana policy, Colorado has also reported an increase in burns related to the butane hash oil manufacturing.[4]

According to a 2015 article in Nature Chemical Biology, there has been significant progress in the creation of a genetically modified yeast strain that can convert simple sugars into opiates, including morphine and heroin.[6] The report implied that this research could result in cheaper, less addictive, safer, and more effective opioid analgesics. The authors also postulated, however, that it may lead to a significant increase in access to opiates and would likely lead to an alternative system for criminal networks.[6]

An innovative agency was recently created here in the United States—National Drug Early Warning System (NDEWS)—that is a collaborative effort between National Institutes of Health and the University of Maryland’s Center for Substance Abuse Research. The NDEWS was set up to report on emerging trends and patterns of drug use, and also to assist health experts in responding quickly to illicit drug outbreaks. The NDEWS scans social media and websites and utilizes national and local level data resources to identify and report new drug trends.[1,7] It would be prudent for all healthcare clinicians to stay up to date on current illicit drug trends— using services such as NDEWS—in order to provide optimum care for their patients. The information collected by the NDEWS can be accessed by visiting http://ndews.umd.edu/.

1. National Institute on Drug Abuse. Emerging Trends. http://www.drugabuse.gov/drugs-abuse/emerging-trends. Accessed on 09/06/2015.
2. Kolanos R, Sakloth F, Jain AD, et al. Structural modification of the designer stimulant alpha-pyrrolidinovalerophenone influences potency at dopamine transporters. ACS Chem Neurosci. 2015 Aug 11. [Epub ahead of print]
3. Dabroski K. New Drugs on the Street: Budder and Flakka. The Solution News. http://tsnnews.com/new-drugs-street-budder-flakka/. Accessed on 09/06/2015.
4. Bell C, Slim J, Flaten HK, et al. Butane hash oil burns associated with marijuana liberalization in Colorado. J Med Toxicol. 2015 Aug 20. [Epub ahead of print]
5. UC DAVIS Health System. Butane hash-oil burns on the rise. http://www.ucdmc.ucdavis.edu/welcome/features/2015-2016/07/20150729_hash-oil-burns.html. Accessed on 09/06/2015.
6. Oye KA, Lawson JC, Bubela T. Drugs: regulate ‘home-brew ‘ opiates. Nature. 2015;521(7552):281–283.
7. National Institute of Health. NIH system to monitor emerging drug trends. http://www.nih.gov/news/health/jul2014/nida-17.htm. Accessed on 09/10/2015.

With regards,
Adegboyega Oyemade, MD
FAPA Board Certified Addiction Psychiatrist, Maryland Treatment Centers, Inc, Baltimore, Maryland

Funding/financial disclosures
The author received no funding nor has any conflicts of interest relevant to the content of this letter.

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Category: Letters to the Editor, Past Articles, Psychiatry, Substance Use Disorders

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