Neuroscience that deals with addiction and drug dependency seems to move at a frustratingly slow pace. But there is some encouraging news relating to nicotine addiction that is very exciting. The news applies to those people who have yet to smoke who might become nicotine dependent as a result of chronic smoking. The news also applies to smokers who have already become dependent and who experience withdrawals any time they make an attempt to cease their smoking.

Investigators from the Weill Cornell Medical College in New York City (HickMJ et al. Sci TranslMed. 2012; 4[140]:140ra87) reported the results of an antibody transmitted by a virus that prevents nicotine from entering the human brain. So for someone who is a smoker, an anti-nicotine antibody with very specific and accurate targeting of nicotine can prevent smoke-carried nicotine from navigating the bloodstream and binding to nicotinic receptors in the brain. Further, vaccination with this virus gene also generated a store of antibody that persisted for weeks following its introduction. This means that anti-nicotine antibodies stay stored in the system for many weeks following their introduction to the bloodstream. The protective value of the treatment seems to extend for some time into the future.

This treatment did not block all nicotine from reaching its receptor site destination, but it rerouted most of it. The treatment also resulted in a decrease in some of the untoward effects of nicotine. Blood pressure and heart rate were particularly resistant to nicotine's stimulating central effects with the use of this vaccine.

Nicotine addiction is a frequent co-dependency in many people who use and abuse drugs. Development of a vaccine that inhibits the actions of nicotine may go a long way towards mitigating its effects. But this situation is complicated. For some people in recovery, activation of nicotine receptors is important towards calming the antagonizing effects of drug craving. In the minds of these folks, smoking and nicotine absorption is a means of maintaining sobriety. For smokers who do not have an occurring addictive disorder, the news of a nicotine vaccine may be greater news. In any event, the breakthrough towards immune system managed nicotine protection represents great hope.  

Dimethyltryptamine (DMT)

As a consequence of the contemporary designer drug phenomenon, some 1960s-era hallucinogens have come back into vogue. One drug in particular has seen resurgence in use that is probably related to the overall popularity of hallucinogenic drugs with younger users. The name of this drug: Dimethyltryptamine, or DMT for short. For readers on the west coast, this advisory is of particular importance. DMT is a drug that has a definite west coast history and root system; Northern California in particular has been a cauldron of DMT activity in the past years.

DMT is a curious drug. It is very similar in nearly all respects to bufotenine, a slimy neurotoxin that is released by the cane toad when it is under threat by an attacker. "Toad licking" is an expression tied to the act of aficionados who attempt to agitate the cane toad to express the milky fluid so that it can be collected and ultimately smoked. As outrageous as that sounds, there are some hallucinogen devotees who will go to that length to get what they need to get high. And by the way, it is a crime to agitate the poor old cane toad. So toad licking is a risky behavior and not just for the toad.

In any event, DMT is a naturally occurring hallucinogen that can be found in a long list of plants and trees. Perhaps the acacia tree is best known as a natural source of DMT. But this substance is also synthesized in underground labs as well. The processes involved are not easy to undertake, but it only takes a little production of DMT in order to make significant quantities of single dose allocations. DMT is a powerful hallucinogenic drug. In fact, LSD users often graduate to DMT use following their mastering of the LSD experience. A drug that was under the control of some west coast outlaw motorcycle gangs in the 1960s, the biker move to amphetamine manufacture and distribution opened up the DMT market to just about anyone who had the wherewithal to make it. Fueling the DMT binge was the following prompted by the works of Dr. Timothy Leary. Later, Dr. Sasha Shulgin's "research" into the tryptamine class of hallucinogenic drugs propelled DMT to headliner status at "sit-ins" and other hippie gatherings in California. Ultimately, DMT use spread east. It popped up in a number of major college towns, not an unexpected development. It was a drug that had no small roll to play at Woodstock.

DMT use today has resurged. Perhaps the bath salt phenomenon has in part prompted a return to drugs with hallucinogenic roots. Bath salts impart a partial hallucinogenic experience; they are psychedelic to some degree. DMT however is an entirely psychedelic experience. Once the drug enters the bloodstream it exhibits significant affinity for several centrally located serotonin receptors, a trait that it shares with other hallucinogens such as LSD and mescaline. In addition to, and in quite a novel fashion, the drug appears to also interact with the D1 dopamine receptor. These functional aspects of DMT make it powerfully hallucinogenic, but also quit a stimulative provocative. Reading and listening to the clinical reports of people who use DMT, one is struck by the complexity of the drug high and the significant emotional toll that it takes on the user. DMT is not a drug for the novitiate. DMT is a drug that can be unwieldy and frightening. And like all hallucinogens, a DMT high is an experience that potentiates foundational psychological baselines. For instance, someone who is down, morose or given to fits of depression, DMT will likely drive that "high" further down. Conversely, if a user has a more positive outlook on life and of those around him/her, the "trip" will likely be a tangent of that mood and disposition. In user "speak," don't take this drug if you're in a "downer mood."

DMT is a drug that is best absorbed by smoking. Although there are some devotees who believe snorting of the powder is better, safer and smoother, the real veterans subscribe to the "free base" smoking of the drug. Using cocaine or methamphetamine pipes, users will smoke up to 50 mg in a single dose. The drug is smoked just like someone who is smoking crack cocaine. The user holds his or her breath for as long as possible before inhaling another lung full. The powder gives off a pungent odor that users describe as burning tires or smoldering plastic. In any event, the taste of the smoke is not pleasant. DMT smokers can be picked out of a crowd based on the rancid bad breath that they exhibit.

Within 5-10 minutes of smoking, symptoms become obvious to the user. Almost immediately there are powerful distortions of color and sound. Sensory inputs are wildly distorted and potentiated. Once this has happened the user typically begins the "trip." Alien beings, time transportation, and unusual music pervade the experience. The user has a sense that he/she has been taken somewhere else. And oftentimes that trip somewhere else allows the user to meet other beings that happen to live in the outer limits of one's mind.

For very veteran users, DMT is a precursor drug to later use of LSD. In that sense, DMT is a light cocktail before the main course is served. But for most DMT users, the excitement of that experience is enough. The symptoms exhibited by a user will be classically hallucinogen. A DRE or DAR trained person will discover very dilated pupils that react well to light. There will be no nystagmus, nor will there be any lack of convergence. The internal clock will likely be tilted to the fast side, perhaps very fast. Pulse will be elevated, perhaps very elevated. Systolic blood pressure will be elevated; diastolic pressure will be near normal. Piloerection, flushed skin and ruddy facial appearance may also be evident. A user will have a difficult time responding to questions; there may be 30-60 second delays in answering basic inquiries such as "What is your home address?" or "What is your telephone number?" The high will subside by the fourth hour; by the eighth hour the user will be back close to baseline. The drug is not known to cause or trigger flashbacks.

DMT is purchased as an off-white powdery substance. It's bundled in wax paper or small glass ampoules. In some cities, DMT is nearly impossible to find. In other cities, it may be as ubiquitous as marijuana. West coast communities are more versed with DMT. College towns, especially in times where students are returning to campus, DMT may be around.

The past few months have created a great deal of uncertainty for public safety and healthcare professionals who must respond to the recreational use of synthetic cannabinoid drugs. Called K2 and Spice when they first hit the market, these drugs have morphed into a wide array of crushed leafy vegetable substances designed to be prepared and smoked like marijuana. Alleged to be potpourri and/or room odorizers, these products are almost always treated with solutions that contain synthetic cannabinoids, substances that were created to exert marijuana-like effects on the human central nervous system. In an effort to emulate marijuana, chemists took to "cooking up" new age cannabinoids that at the time were immune to the restrictions of state and federal law. Many of these synthetic cannabinoids were research chemicals intended to probe the role of human cannabinoid receptors with processes that stimulate and block appetite. Generations of Americans using marijuana have provided a great deal of anecdotal evidence to suggest that THC (the active ingredient of organic marijuana) is a potent means of stimulating appetite. The converse of that central effect suggests that if the human THC receptor could be blocked or somehow deactivated, a net effect of appetite suppression could be achieved. The resulting pharmaceutical possibilities were endless. The financial potential of such drugs would be exponential.

The speculative synthetic cannabinoids that were developed became the fertile hunting ground for modern day marijuana explorers. Barnyard and basement chemists took to recreating the formulas for experimental cannabinoids, many of which had not been heard from since the mid- to late 80s when they were last evaluated in research labs. Created in a laboratory environment, these synthetic cannabinoids were nearly all well outside the restrictions of American drug laws. In other words, manufacture and possession of these "drugs" was not a violation of the law. The race was on. Starting in late 2009, the first of the synthetic cannabinoid products hit the streets. But the impact on the marijuana user market was negligible; at least it was in the beginning. Organic marijuana users are very loyal to their brand. Getting old "joint smoking" marijuana users to switch brands to a somewhat whacky designer form of THC was a bridge too far. Except for fringe marijuana smokers, K2 and Spice struggled for market share. But with the European market having subsidized the burgeoning American synthetic cannabinoid market, Spice and K2 found the time it needed to plant a seed and develop a following.

In 2010, the market changed. Organic marijuana prices rose nationwide. High-quality California "bud" had risen in price in some places nearly 25%. Even low-grade Mexican marijuana had spiked in price. So a bit of a crack opened in the door to the domestic marijuana marketplace. The initial Spice products were coy; it was quite a mystery as to what they consisted of and how it was that they were supposed to be used. But intrepid marijuana smokers figured it out. The products, as it turned out, contained a mish-mash of unremarkable vegetation that had been sprayed with liquid synthetic cannabinoids, stuff with cryptic names like JWH-018, JWH-073 and HU-210. These chemicals were the same chemicals that had been experimented with back in the 1980s, the same formulas that had been evaluated for their potential use as pharmaceutical appetite stimulants. More important though was the fact that these drugs almost always triggered a cascade of organic marijuana effects in addition to whatever it was they did to stimulate or blunt appetite. It was obvious what was going on here. K2 and Spice makers were now delivering potent cannabinoids to marijuana users and doing so by skirting loopholes in drug laws. Smoking "dope" was now tantamount to being legal.

But all "good things" must come to an end. The marketplace exploded in size and scope. Like breeding rabbits, synthetic cannabinoid makers flooded the market with hundreds of products, all of which were potent agonists of the two species of human cannabinoid receptors. The synthetics sprayed onto garden spices and smoked by adults and kids turned out to be very potent. Potent enough to prompt many users to seek help from hospital emergency rooms and local poison control centers. It seemed that these drugs were in many ways too powerful; so powerful that many users described the drug as marijuana on steroids. A good number of users were turned off by the drugs. Between cost and potency, the allure was little. Many returned to use of reliable organic marijuana. But many others were hooked. K2 and Spice were powerful, mood-altering substances, and as a result, they culled out a population of loyal and devoted followers.

State and federal law enforcement authorities took quick notice of what was going on. To that end, emergency regulatory action and congressional action quickly followed. Congress and a variety of state legislatures took to passing laws that banned the majority of compounds that made up the menu of the first wave of the synthetic cannabinoid drugs. The President, along with a number of state governors, signed the legislation. Overnight, the first wave of synthetic cannabinoids had been cut off at the knees. It was now illegal to possess drugs that bore chemical similarity and pharmacological effects to the synthetic cannabinoids. Federal legislation even went so far as to try to prevent all synthetic analog drugs from production and exploitation in the future. The language in the federal legislation was quite broad and far-reaching.

But before the ink was even dry on President Obama's signature, synthetic cannabinoid makers had already pivoted and had moved on to production of new substances that were not encumbered by the recent legislation. These new K2 and Spice products contain compounds that are similar in their biochemical makeup, but are different enough from the banned drugs to keep them free of law enforcement entanglements. People who smoke materials treated with these drugs will experience the same highs triggered by the first generation of K2/Spice products, but perhaps will not have to contend with the "edgy" feelings that many users of first generation Spice products complained about. These second wave cannabinoids are different; they are more subtle in their direct effects. They are also different enough to escape detection from the drug assays that most forensic laboratories use to detect those products regularly found in the first wave. Those assays used to screen for the JWH and HU series of compounds will be ineffective when it comes to screening for these second wave of synthetic cannabinoids.

Welcome XLR-11, UR-144 and AB-001. These are some of the synthetic cannabinoids that seem to have escaped the dragnet that was put down by recent congressional legislation and have now emerged as constituents in second wave drugs. Although some of these compounds were found periodically in first wave potions, they turned out to be minor players. In response to recently enacted legislation, these drugs have vaulted to the top of the list of utilized cannabinoids. Many popular potions now contain blends of these various substances.

At MEDTOX Laboratories, investigative scientists have examined some of the compounds that are currently being sold as second wave synthetic cannabinoids. XLR-11 has been explicitly identified. XLR-11 (5-flouro-UR-144) is a synthetic cannabinoid that is a potent agonist of cannabinoid receptors. More potent at the CB2 receptor than it is at CB1, the drug is still capable of triggering profound marijuana-like effects for anyone who would smoke this drug. Classic marijuana under-the-influence symptoms would be expected with anyone who takes up with the smoking of these products. UR-144 is a closely related drug to XLR-11 and would likely render similar cannabinoid-like effects. AB-001 is similar in many respects to these drugs as well, but it is believed to be quite a bit less powerful. AB-001 was a drug that made rounds in European K2 blends back in 2011. But it appears to be back on the circuit here in the United States following the ban enacted by Congress earlier this summer.

Clearly the K2/Spice market has shifted in response to the federal legislation that was enacted to blunt it. But as with all modern drug-regulating statutes, there are loopholes that allow for certain dangerous drugs to skirt restrictions and stay in play on the commercial market. In the case of contemporary Spice/K2 products, such a situation is in play today. Facing law enforcement and rehabilitation professionals is the fact that there are several potent synthetic cannabinoids that are still apparently legal to manufacture and possess. And short of another round of DEA emergency legislation and a permanent ban by Congress, these drugs will continue to hector our streets, schools, and workplaces as substances of abuse capable of causing significant intoxification, dysfunction, and impairment.

MEDTOX is currently developing protocols for forensic screening and examination of urine samples that may contain these drugs and/or their metabolites. Please contact a MEDTOX sales representative for guidance in establishing testing systems for these substances. Stay tuned for DARSYS webinars and podcasts containing vital information related to changes in drug trends associated with designer drug and synthetic cannabinoid use.   

Now that the "second wave" of designer drugs has made it to American streets, police and public health officials are working very hard to identify what they are and what they do. Only once these drugs are affirmatively identified and classified can enforcement and prevention programs have any probative effect in slowing their distribution. Of concern for many experts is the emergence of a drug called methoxetamine.

Called "MXE" or "3-Meow" by users, methoxetamine is a drug that possesses many similarities to ketamine (Special K or "K"), a drug of the dissociative anesthetic class. To that association, ketamine and methoxetamine are close chemical cousins to the reviled dissociative anesthetic drug, P.C.P. (Angel dust). Making methoxetamine a unique drug within the larger context of dissociative anesthetics is the drug was conjured up as a means of exploiting loopholes in controlled substances laws. It was from the get go, a drug designed for sale in the gray market. Its chemical structure is arranged in such a way to skirt drug laws and allow for its legal sale to recreational drug users. And so far, it seems to be a rather popular attraction.

Methoxetamine seems to trigger many of the depressant effects that its cousin drug, ketamine, does. Ketamine is a regulated drug and is illegal to possess. Methoxetamine does not have that restriction to impede its distribution. It becomes another designer drug of concern for police, parents, employers, healthcare professionals, and drug rehabilitation professionals. As a dissociative anesthetic, the drug essentially disables the nervous system messaging system that delivers stimuli from peripheral parts of the body to the brain. Operating as NMDA receptor antagonists, ketamine and methoxetamine target the conscious part of the brain and cuts it off from all but essential parts that regulate autonomic functions such as respirations and heart rate. This inhibition can lead to hallucinations, distortions in sound and color, and an experience of a significant euphoria. To the unfamiliar recreational drug user, the experience may sound fun, worthy of experimentation. That's a reckless, dangerous decision.

Methoxetamine will be a powerful attractant to recreational drug users who enjoy getting high from the over-the-counter drug dextromethorphan (DXM), as well as those who gravitate to cough syrup concoctions such as "Lean" and "Purple Drank". Found in cough suppressants, DXM is an unpredictable drug that is capable of causing a wide range of symptoms that run from hallucinogenic to dissociative anesthetic. Methoxetamine is a more powerful iteration of DXM, a drug that can trigger a significant state of catatonia and catalepsy. Many DXM users are known to have suddenly fallen to the ground while under the influence. Many a traumatic injury has occurred as a result of a DXM user going suddenly limp and then striking their heads or faces on sharp objects.

Methoxetamine is widely available over the Internet. In July 2011, there were nearly 60  websites that specialized in the distribution of methoxetamine. That number has swelled further in 2012. Methoxetamine seems to affect drug users a bit differently than ketamine or DXM. Users of all three drugs claim that methoxetamine is a little harsher than the others. The untoward effects of ketamine are more pronounced with methoxetamine. In fact, users comment that they experience more hallucinations with methoxetamine. The drug seems to be an "edgier" version of ketamine. Nevertheless, this drug is legal and accessible to just about anyone who wants to purchase it.

The symptoms of someone using MXE (methoxetamine) are quite noticeable and distinct from other contemporary designer drugs. The drug is sold as a white powder; it is customarily snorted or smoked. The effects of the drug can be unpredictable with some users claiming short, fast moving highs while others claim of extended effects that lasted 12 or more hours. A fair number of patients have reported to hospitals with symptoms of overdose that persisted for several days following ingestion. But for the bulk of those people who use MXE, symptoms will resemble the following found in Drug Abuse Recognition (DAR) examinations:

• Blank stare: eyes open, slow blinking
• Nystagmus: horizontal and vertical bouncing of the eyes as they follow a stimulus
• Lack of convergence: inabilities of the eyes to cross while following a stimulus
• Pulse: near normal to slow
• Internal clock: distorted (fast or slow)
• Pupil size: Near normal
• Reaction to light: Normal to slow
• Movements: slow, deliberate, inaccurate
• Speech: slow, slurred and delayed
• Skin color: slight pallor, piloerection (hair on arms stand up)

Methoxetamine is a complex drug; it warrants concern and in-depth analysis. In addition to the NMDA antagonist aspect of its pharmacology, the drug also appears to influence dopamine and opioid receptor systems. Ketamine, its close chemical cousin, has demonstrated significant potential as an analgesic and antidepressant. It may very well be that methoxetamine possesses similar potentials, but only time will tell. It is early in the game for this new designer drug. Readers responsible for drug testing and drug rehabilitation programs should keep this drug in mind when considering what it is that a recreational drug user may be using when symptoms described above are clearly observable. Methoxetamine is legal and it is accessible, it is a clear and present concern.

Readers should check with their affiliated lab for instructions in how to test for the presence of methoxetamine. Interested readers can contact their MEDTOX sales representative for information about MEDTOX testing methods for this drug, as well as other drugs in the dissociative anesthetic class (PCP, ketamine, and dextromethorphan).

(Questions about methoxetamine abuse, symptomology, and methods for treatment can be directed to the DARS Program at info@darstraining.com)

Well, as a hot summer comes to a close in America. The time for poolside barbecues, children splashing in the water, and adults lounging in bathing suits and bikinis. And it is here, hidden in the frivolity of summertime fun and frolicking children that this month's drug exerts its influence. And while it is certainly a drug for all seasons, it typically experiences expanded use (and abuse) in the summertime months. This month's drug is a prescription medication, a drug available only in a brand form. There is no approved generic variant of it. This drug possesses a moderate potential for abuse and has been assigned to Schedule III by the DEA. The assignation to Schedule III has triggered controversy. See, this month's drug is a chemical cousin to a family of rather sinister relatives. The shifty relatives are all assigned up in Schedule II, a designation that necessarily attracts greater law enforcement, as well as regulatory scrutiny. The fact that this mystery drug got off with a "light sentence" with its assignment to Schedule III is a point of contention for some.  

Because of its status in Schedule III, this month's drug is a brisk seller the Internet. It is frequently packaged in slick marketing designs and slogans. It is a drug that can prepare a conscientious fitness devotee for the rigors of summertime fun. It all starts deep in the lateral hypothalamus, a place where the drug exerts its most prominent effects. There, the drug is believed to stimulate the release of norepinehprine and dopamine from storage sites in select nerve cells. The drug then triggers a process of binding to and then inhibiting of the presynaptic vesicular monoamine transporter 2 (VMAT2). Its ultimate effect is to create a sense of increased energy, reduced appetite, and heightened confidence.  

This month's drug is not an amphetamine; it's not methamphetamine. And despite less stringent focus of regulation and monitoring, the drug does pose significant potential for diversion and black market recreational use. The IUPAC name for this mystery drug is a definite giveaway as to its ultimate identity: benzyl-N-methyl-1-phenylpropan-2-amine (Hint: phenylpropanolamine). Especially for folks who have experience with medications of the anorectic class of drugs, this drug's identity should be emerging. This month's drug is an anorectic. It possesses great power in trimming not so svelte bodies into torsos that will fit into vacation bathing suits and bikinis.  

For someone desirous for a recreational high of stimulation and excitement, this months' drug would easily suffice. Whether bought over the Internet or scammed from a patient who possesses a prescription for it, this month's drug can provide a user with a moderately powerful stimulant ride. Although not quite like cocaine or methamphetamine, this month's drug provides an extended, modest high. There is no "rush" with the use of it. On occasion there are reports from the street of use by smoking or snorting of its crushed tablets. When ingested in one of these forms, the drug does deliver a more powerful first effect. Some users even claim that the drug is better than methamphetamine.

As a weight-loss drug, the month's drug suppresses appetite and increases metabolism. Suppression of appetite leads to less food intake. By altering the mechanisms that manage the monoamines serotonin and norepinephrine, the drug tricks the brain into thinking that it has eaten, when it really hasn't. The parent drug is quickly metabolized and broken down into its active metabolites. The stimulative power of this drug comes about as a result of the actions of its amphetamine metabolites. This relationship also leads to a lengthy half-life and a net effect as an extended release drug, a perfect fit for an appetite suppressant.  

Someone taking this drug may test positive for amphetamine and/or methamphetamine. It is one of the very few prescription drug alibis for someone who tests positive for drugs of the amphetamine class. An expert review officer may be needed to sort out the possible interactions here.  

Obesity and weight loss are topics that dominate public health discussions these days. Drugs that can trick the central nervous system into satiety are potentially blockbluster products for the one-third of all Americans who are obese, especially when such drugs can do so safely and reliably.  

Called Didrex, this month's drug has been combined with other appetite suppressants to create compounds of enhanced potency. The combined use of stimulant appetite suppressants has led to the development of some serious medical complications. Didrex is a drug that requires careful consideration and medical management by a prescribing physician. Patients who purchase this drug over the Internet are taking a great risk. Didrex should only be prescribed to patients who have undergone a comprehensive physical examination and a psychological evaluation.

Click Here for this month's mystery drug.

For those who are unable to open the link, email info@darstraining.com for the answer.

Thank you subscribers. We appreciate your dedicated readership. At DARSYS we are committed to providing clients with the service and solutions you need to run successful drug testing programs. Our Journal is just one way that we show that commitment. We always encourage feedback from our Journal readers. Please send your thoughts to info@darstraining.com.