Prevalence of Synthetic Cannabinoids in the Workplace David J. - PDF document

6/11/2014 Prevalence of Synthetic Cannabinoids in the Workplace David J. Kuntz, PhD, DABFT Executive Director of Analytical Toxicology Clinical Reference Laboratory Lenexa, KS 66215 email | kuntzd@crlcorp.com 1

6/11/2014 Webinar Objectives 1. Brief history of the emergence synthetic cannabinoids 2. Effects of synthetic cannabinoids on the body 3. Testing for synthetic cannabinoids at CRL 4. Results of testing 90,000 workplace samples 5. Governmental steps to control their distribution 2

6/11/2014 Spice History The synthetic cannabinoids were created by Dr. John W. • Huffman in 1995 who was synthesizing chemicals to imitate THC on CB1 (brain) & CB2 (immune system) receptors to develop new medicines. • Other pharmaceutical companies and scientists have also been involved in research and has led to some of the other unique alpha-numeric naming conventions. One compound was the 18 th compound created and • became JWH-018. The list of compounds numbered to 450. • JWH-018 and JWH-073 became the most popular as they had high potency but have been largely replaced with different compounds. 3

6/11/2014 Cannabinoid Receptor Effects • Reported as useful in the treatment of pain, vomiting, epilepsy, multiple sclerosis, Parkinson’s, anxiety, and other claims – CB1 receptors when stimulated in the CNS results in the mood changes, memory, time perception, auditory and visual changes with increasing dose – CB2 receptors are mainly located in immune-cells and are responsible in reducing inflammation • Toxic effects with increasing dose to include seizures, psychosis, tachycardia, hyperactivity and suicidal thoughts 4

6/11/2014 Spice Effects Reported in Humans Psychological Physiological • Slurred speech Mild euphoria • Poor coordination Hyperventilation • Light-headedness Hyperactivity D • Red eyes Anxiety O • Pupil dilation Paranoia S • Elevated Pulse/BP Hallucinations E • Flank pain (kidney injury) Vomiting • Chest pain Seizures Suicidal 5

6/11/2014 Packaging of Spice • The synthetic cannabinoids are either liquids or crystalline which are dissolved in a solvent sprayed onto or mixed with potpourri of different fragrances and is often reflected in the name of the product. • The packaging is typically plastic bags or small packet with very unique pictures and names. The internet is filled with purchase sites along with purchase prices by the gram or kilogram. • All are labeled “Not for Human Consumption” as an attempt to eliminate the FDA/DEA from investigating the product. 6

6/11/2014 Synthetic Cannabinoid Products 7

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6/11/2014 Spice Testing at CRL • The synthetic cannabinoids quickly became a popular alternative to plant marijuana due to its similar psychological and physiological effects. • The use appeared to be widespread in the Midwest of the United States with a major supplier only 30 miles from Kansas City • Clients of Clinical Reference Laboratory (CRL) were requesting that a workplace drug testing panel be developed to detect the use of these compounds by their employees • In July 2011, the first panel of JWH-018 and JWH-073 was developed to detect use. The panel was expanded several times to now include twelve compounds. • Screening is performed by LC/MS/MS with a separate LC/MS/MS analysis for confirmation using a different type of analytical column. • Panel expansion/updates are based on the reported prevalence of new compounds and availability of the reference standards. • 9

6/11/2014 Synthetic Cannabinoids Generic terms to the herbal mixtures (incense, potpourri) which are sprayed with synthetic cannabinoids dissolved in acetone and smoked to get a “legal high” similar to marijuana. Typically packaged in foil-type packets and sold as “Not for Human Consumption”. Sold in convenience stores, gas stations, or head shops. CRL is currently testing for metabolites of the following 21-compounds: JWH-018 JWH-019 BB-22 JWH-073 JWH-081 PB-22 JWH-122 JWH-210 5-F-PB-22 JWH-250 AM-2201 AB-PINACA UR-144 MAM-2201 ADB-PINACA XLR-11 RCS-4 5-F-AB-PINACA AKB-48 5-F-AKB-48 ADBICA 10

6/11/2014 Compound Similarities • Many compounds have minor modifications that can enhance their pharmacologic effects by adding a Fluorine to the molecule • Examples of modifications: � AM-2201 is 5-fluoro-JWH-018 ( 10-fold stronger than JWH-018 ) � XLR-11 is 5-F-UR-144 � AB-PINACA vs. 5-F-AB-PINACA 11

6/11/2014 Synthetic Cannabinoid Products • • K2 Armageddon • K2 Blond • Astral Blast • K2 Blue • Black Mamba • K2 Blueberry • Blue Fire • K2 Cherry • Bonzai • K2 Citron • Cloud 10 • K2 Cloud 9 • Coma • K2 Melon • Demon Ritual Botanical • K2 Pink • Fake Weed • K2 Rasta • Funky Green Stuff • K2 Sex • Genie • K2 Summit • Head Trip • K2 Ultra • Herbal Incense • K2 Watermelon • Smoke • K3 • Super Kush • K3 Ultimate • Texas Kush • Lava Red • Voodoo Spice • Mr. Happy • Zombie Twilight 12

6/11/2014 Year One Data Summary (July 2011-September 2012) Total Number of Samples – 15,995 Total Number of Positives – 1,116 Overall Positive Rate - 7.0% 13

6/11/2014 Year Two Data Summary (October 2012- September 2013) Total Number of Samples – 40,857 Total Number of Positives – 886 Overall Positive Rate – 2.2% 14

6/11/2014 Cumulative Data Summary (July 2011 – April 2014) Total Number of Samples – 89,051 Total Number of Positives – 2630 Overall Positive Rate – 2.9% 15

6/11/2014 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb May2 Apr 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 2014 2014 014 2014 Total Positive Samples 19 5 156 207 136 97 62 60 42 93 83 38 72 84 79 169 JWH-018 11 5 35 19 22 5 6 7 4 10 17 0 7 5 6 6 JWH-073 10 0 13 1 10 2 2 6 1 5 10 0 2 1 5 2 JWH-081 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 JWH-210 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 JWH-250 1 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 RCS-4 0 0 0 3 1 0 0 0 0 0 0 0 0 0 0 0 JWH-122 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 AM2201 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 JWH-019 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 MAM2201 0 0 2 0 0 0 0 1 0 0 0 0 2 0 2 1 UR-144 0 0 131 193 135 95 60 55 39 87 72 38 58 74 74 145 XLR11 0 0 21 30 1 2 1 1 0 2 0 1 0 2 1 5 AKB48 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1 0 2 1 5-F-AKB48 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 0 0 0 BB-22 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 0 0 0 PB-22 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 13 10 6 34 5-F-PB n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 8 14 7 14 AB-PINACA n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 24 ADB-PINACA n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 5-F-AB-PINACA n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 5 ADBICA n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 16

6/11/2014 Percent Positive by Reason for Testing 9.0% 8.0% 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% Follow Up Not Specified Other Post Accident Preemployment Random Reasonable Cause Return to Duty July 2012 thru June 2013 July 2013 thru April 2014 17

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6/11/2014 K2 Positives K2 vs. Multi-drug Positive Jan 2013 - Apr 2014 AMP/MAMP THC K2 86.9% THC 5.6% AMP/MAMP 2.4% Methadone <1% HC/HM <1% COCAINE <1% BENZO <1% OC/OM <1% Morphine <1% Tramadol <1% BUTALBITAL <1% ETG <1% Bath Salts <1% 6-AM <1% Fentanyl <1% 19

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6/11/2014 Requirements to Schedule New Chemicals The Comprehensive Crime Control Act of 1984 gives the Attorney General authority to emergency schedule a drug or drug class but must satisfy three of eight factors: 1. History and current pattern of use 2. Scope of abuse 3. Duration 4. Significance of abuse 5. Risk to public health 6. Actual abuse 7. Diversion from legitimate channels 8. Clandestine importation, manufacture or distribution 21

6/11/2014 Synthetic Drug Control Act of 2012 • Signed by President Obama in July 2012 • Expanded wording to include cannabimimetic Agents – Any substance that is a cannabinoid receptor Type I (CB1 receptor agonist as demonstrated by binding studies and function assays) – Amends Schedule I of the Controlled Substances Act to include many additional “Bath Salt” compounds • Expands time for temporary scheduling to avoid imminent hazards to Public Safety – Extends from 1 to 2 years for emergency temporary scheduling – Extends 6 month period to 12 months for additional information before a final ruling on status 22