Meth source is from Mexico

It may be that the United States is a victim of its own success. Following a decade long fight to reduce domestic methamphetamine manufacture, the United States' efforts may have inadvertently spurred Mexican cartels to switch formulas to a classical chemistry method that is capable of producing very pure forms of the drug. For nearly 20 years, domestic American methamphetamine cookers have relied on a relatively simple process of reducing chemicals from over-the-counter cold tablets into the powerful, dreaded central nervous system stimulant. In a bid to control this behavior, laws and regulations were put into effect to restrict the public's access to susceptible cold pills that contained pseudoephedrine. In the end, methamphetamine makers could acquire small amounts of these pills one way or another, enough to make small batches of methamphetamine. Small "gram" labs and bathtub labs proliferated in those areas of the country where methamphetamine reigned as a primary drug of abuse. Methamphetamine production became so rudimentary in America that addicts in some cities could be seen walking down a street with a two-liter plastic soda bottle mixing the ingredients needed for a quick "meth" fix. Methamphetamine abuse has dragged on in America for quite some time now. And although the contemporary designer drug phenomenon has caught our nation's attention for the moment, there are some frightening developments occurring on the methamphetamine front.

For many years now, Mexican drug cartels have operated a network of mega or super "meth" labs just south of the U.S. border. Using mostly the same manufacturing technique as domestic labs, labs in Mexico have historically produced moderate to moderately high-quality methamphetamine from the extraction and reduction of cold tablets. In some cases, labs in Mexico were able to entirely eliminate the need for cold pills; they were able to directly convert large quantities of pure ephedrine into methamphetamine. Ephedrine is not very difficult to find on the black market. But in the final analysis, the cartels faced the fact that worldwide access to necessary precursors was dwindling. Like their "meth" making confederates across the border in the U.S., cartel access to cold tablets was dwindling.

Fast forward to 2012. DEA agents in large American cities have encountered large quantities of smuggled methamphetamine from Mexico. The loads seem to be getting bigger and bigger. More alarming however is the fact that these new batches of methamphetamine seem to be much cleaner and more pure. And there's a reason for that. Because of shortages in the cold pill supply chain, cartel "cookers" have taken up with a classic recipe for methamphetamine production. In fact, the cartels have taken a page out of the outlaw motorcycle gang cookbook of the 60s. Called the P-2-P method, Mexican chemists are using a synthesis method of manufacture that has the capacity to produce nearly pure methamphetamine. Combined with methylamine, Mexican chemists have a relatively easy time of it because necessary precursors for this process are widely available in the country. In particular, phenylacetone, a chemical prerequisite for P-2-P is widely available. It's also cheap.

The P-2-P method is not an easy one to undertake for the "cook" however. It requires some sophistication, and a chemistry background at the very least. The process also requires unique glassware and hardware that can't be found at a local hardware store. Nevertheless, the technique is tried and true. And it produces a very fine, glass-like final product. And more and more, this drug has been found on American streets. In the third quarter of 2011, the DEA reported that nearly 85% of lab samples from methamphetamine seizures in America were products of the P-2-P process. And during that time the DEA noted that the average price for a gram of methamphetamine has plummeted to under $100; in some major cities high-quality methamphetamine can be purchased for $75 per gram. One gram of methamphetamine can be cut up to create four individual doses. One dose of methamphetamine is capable of triggering a stimulant high that may persist for 8 to 12 hours.

The Mexican P-2-P method methamphetamine or "crank" has a distinctive odor to it. Users call it a "cat pee" or "baby pee" smell. For the experienced user, that smell is directly tied to the drug's perceived purity. The more it smells, the stronger it probably is in the estimation of a user. The smell is a consequence of the use of methylamine in the synthesis of the drug. Methylamine has ammonia-like odor to it; this odor persists through the final cleaning process that dresses the drug for sale on the street. The final refined product can appear as crushed glass or crystals or as a clumpy, slightly damp powder with a blue or yellow hue.

While American cocaine is getting more expensive and less pure, methamphetamine is tracking in an opposite direction. With these developments in methamphetamine manufacture occurring south of the border, we are likely in for another spate of trouble. There's no more flammable a recipe for trouble than for there to be widespread availability of a pure, powerful drug for sale at cheap market prices. At some point, the designer drug craze in America will fizzle out. And when that happens, it will be time again for America to focus on of its most intractable drug problems, methamphetamine abuse. Let's hope that somehow, somewhere, the chemical precursors for the P-2-P method are reduced or cut off in Mexico. But until then, cartel methamphetamine cookers seem to have tilted the market in their favor.

Following the action of Congress earlier this year, manufacturers of synthetic cannabinoids, specifically spice, have adjusted their operations to produce a whole new batch of dangerous drugs that have now made it to the streets. The cat and mouse game played between law enforcement and manufacturers has resulted in a chaotic situation for healthcare and rehabilitation professionals who are stuck treating those rushed to emergency rooms suffering from extreme cannabinoid poisoning. Someone choosing to smoke contemporary spice products could very well be inhaling 20 or more different cannabinoid compounds, all having been laced onto the small amount of plant material that has been packaged for smoking. And none of these clandestinely manufactured cannabinoids have ever been studied for their effects on people. The only human investigation of these drugs occurs out on the streets and other places where users smoke spice. A recent advisory from the publishers of the New England Journal of Medicine warned physicians that the national poison control system had been inundated with calls in 2010 and 2011 from hospitals and other facilities seeking information about the effects of spice on humans[1]. Alarmingly, poison control centers knew very little about what spice was; the ever changing formulas of the myriad different spice products made it very difficult for researchers to fully characterize the drugs. New spice drugs such as AM-2201, MAM-2201, UR-144, and RCS-4 have now shown up in forensic blood and urine samples of spice users.  These new compounds are indicative of the efforts that manufacturers have taken in an attempt to distance themselves and their spice products from the original slate of banned substances that then included JWH-073, JWH-018, and JWH-200. These new compounds occupy a gray area between legality and illegality as they relate to federal statutes. A number of states have moved to ban these new spice intoxicants in state legislatures. And as you can imagine, when this happens, game on again. Back to the lab they go to work on the next generation of cannabinoid compounds that skirt the boundaries of current drug laws.

Researchers have now summarized 1,353 official, separate cases of exposure to spice and have documented a particular set of signs and symptoms associated with the drug's use. Clinical effects consisted of a rapid heartbeat, agitation, vomiting, confusion, and hallucinations (or delusions). These symptoms of spice use stand in stark contrast to the physical signs that police and medical experts are accustomed to seeing aboard those who smoke organic marijuana, the stuff that contains THC, the traditional intoxicant of "weed." Marijuana and spice share one very important characteristic; they both contain drugs that have a unique affinity for binding to cannabinoid receptors in the brain. But it has become rather obvious that the spice-bound cannabinoids seem to have an even greater affinity for those receptors than does organic marijuana (THC). This situation results in a spice high that is uncomfortable, a "turn off" for many old-time marijuana users who have experimented with spice. In fact, many chronic marijuana users are dismissive of spice. They criticize the drug as being too much like amphetamine, not enough like their beloved weed.

Police drug influence experts have been evaluating spice users for several years now. And although there is no official set of signs and symptoms that have been agreed to and admitted as direct evidence in the courtroom, there is a growing consensus amongst DAR- and DRE-trained personnel on how a "typical" spice intoxicated user presents in the field. Symptoms of the intoxicated spice user include, but are not limited to, the following signs:

• Dilated pupils that react slowly to light
• Smooth pursuit; no nystagmus
• Non-convergence of the eyes
• Dry mouth; green tongue
• Cracked lips
• Rapid-fire speech
• Repetitive speech patterns
• Vacillating emotional state (happy then sad, then happy)
• Hyperactive, unable to sit or stand still for long
• Rapid heartbeat, in excess of 100 beats per minute possible
• Increase in blood pressure (in particular systolic pressure may exceed 170 mmHG)
• Piloerection-gooseflesh; dry skin
• Hyperflexia-exaggerated movements and motions
• Agitation; loss of patience

These signs and symptoms aren't seen in every case where spice use is suspected. These effects are dose dependent. They are also subject to the effects of tolerance. It appears that users of spice react differently to these products. Whereas some users claim to feel more mellow and reflective, others complain of frightening agitation and hallucinations and dark emotional experiences.

As time goes by, the spice experience continues to grow. With dozens of products on the market today and with federal and state law lagging behind the machinations of chemists in spice labs, it doesn't look like our spice problems are going away anytime soon.

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Opana Tablets

For nearly 15 years, public safety and rehabilitation communities have focused their enforcement and prevention efforts on stemming the impact of Oxycontin diversion on drug use in their communities and neighborhoods. Things have now changed. Oxycontin is now manufactured in a formula that makes it very difficult to transform it into an injectable drug. This development has spawned interest in the abuse of a sister pain management drug called Opana ER (ER for "extended release"). This drug is a sustained release variant of oxymorphone, a powerful morphine derivative. Like Oxycontin in its early iterations, Opana ER has been susceptible to manipulation by substance abusers seeking to alter it for the purposes of I.V. injection. Opana ER can be crushed and injected; it can also be altered to be smoked like crack cocaine. The incidence of Opana ER diversion and alteration has prompted the manufacturer to undertake formula changes to minimize the potential for its diversion and abuse. It is hoped that the new version of Opana ER will significantly reduce the incidence of its diversion as an injected or smoked drug. When ingested by these methods, Opana ER is an extremely addictive drug.

Aggravating the serious consequences of Opana ER abuse is a recently published advisory from the FDA that warns of a serious blood disorder for people who inject it. Thrombotic thrombocytopenic purpura (TTP) is a disorder that results in severe kidney disease, a condition that necessitates dialysis. In at least one case, TTP has resulted in the death of an Opana ER abuser.

TTP causes small blood clots that accumulate in blood vessels scattered throughout the body. These clots can then become congested in organs, such as the kidneys, brain, and heart. The condition can lead to bleeding under the skin and the development of purple spots called "purpura." Stroke, blood clots in the lungs, and internal hemorrhaging are serious consequences that may occur following I.V. injection of abused Opana ER. In its conventional role in pain management, Opana ER is a drug that is taken by mouth. As such, the drug has a solid record as a reliable therapy for the treatment of serious, chronic pain. TTP occurs only in those cases where substance abusers divert the drug and inject it. Pain patients aren't known to do this; only those seeking an illicit opiate high undertake the process of converting Opana ER into an injectable form.

Pain management is a medical discipline that has been hijacked by legions of substance abusers and others intent on making money from the diversion of powerful opioids. Caught in the vise between fraudulent patients and the law enforcement officials who seek to root them out are the legitimate chronic pain patients who need access to expert medical care and the physicians who have been trained to treat them. But the craziness spurred by widespread prescription drug diversion has brought suspicion down upon the legitimate patients who need this vital medical care. But for the foreseeable future, this situation appears to be bleak. New sustained release opiates are scheduled for release to the market and, as such, they represent new targets for the groups and crime mobs that have developed sophisticated methods for diverting them. Prescription drug diversion and abuse is a long ways from coming under control in America.

The Journal of Drug Abuse Recognition (DAR) has closely monitored the development of the "bath salt" designer drug movement over the course of the past 24 months. Over the course of this period, there have been several dozen different substances and compounds that have emerged as notable and ominous public safety threats. Recently the Journal has learned of the reemergence of an early designer drug that had seemed to have retired from the street drug scene. Known in the drug marketplace as "smiles," this substance is more precisely identified as 2C-I a phenethylamine drug, a representative of a larger class of hallucinogenic drugs with known empathogenic effects. Regarded by many as an Ecstasy-like (MDMA) drug, 2C-I has developed a notorious reputation for its ability to put users into hospital emergency rooms or otherwise in harms way. In recent months, trips to the ER by users of this drug have spiked.

"Smiles" is one of a slew of drugs that research chemist and drug aficionado Alexander Shulgin made famous in his 1960's book, PiHKAL: A Chemical Love Story. Shulgin has openly advocated the use of phenethylamine drugs as a way to open one's brain and heart to the real emotions and experiences of life. This proposition poses great appeal to teenagers and young adults. And it's almost always someone of the younger crowd who presents in an emergency room in extreme distress. And although 2C-I was placed into Schedule I of the Controlled Substances Act in July of this year, the drug has persistently been available through the Internet (online) and at select boutiques and "head shops." And as has been the tendency with designer drug development, a new alternative to "smiles" has emerged as an option item on the bath salt menu. It's called 25B-NBOMe, better known as just 25B. This drug is a very close chemical relation to another banned phenethylamine, 2C-B. The new 25B drug has also been tagged and referred to on the street as "smiles," and that has sown some confusion as to which drug is which. Word of mouth and social media outlets have fueled a demand for 25B. Already, there are recorded cases of young people who have overdosed on the drug in much the same fashion to those who've abused 2C-I.

All of the drugs referenced here are reliable triggers for powerful hallucinogenic effects. But it's quite easy to overdose as the products are mostly sold in a white powder form; users must individually weigh and measure out how much is to be taken and snorted (intranasal). In this fashion, it's very easy to spoon out too much of the powder and unwittingly send one's self into an overdose. The direct effects of these drugs are profoundly obvious, particularly when compared to more traditional hallucinogens such as LSD, peyote buttons (mescaline) and magic mushrooms (psilocybin). For police and emergency room personnel, the symptoms of intoxication are discernable and can be discriminated from the effects caused by other drugs of abuse.

Phenethylamine class drugs are powerful agonists or activators of receptors that regulate the activity of the neurotransmitter, serotonin (5HT), 5HT is the chemical octane for the engine that drives a hallucinogenic experience. As a result, users of "smiles" and other drugs of the class will exhibit classic symptoms that are typically caused by other hallucinogenic drugs. The experiences can range from rather modest euphoria similar to what is felt with the use of Ecstasy (MDMA) to a powerful antagonism and central nervous system activation like that caused by methamphetamine. In some instances, users can experience both types of effects and will do so at very high levels of stimulation. The stimulation can be disabling to the extent that users are sort of frozen in place and are incapable of moving; most users though experience a sort of over-energization (some users describe it as being "over-amped") and a sense that they can't sit still. Paradoxically, in some cases, users have been incapacitated and immobilized to such an extent where the only way they can communicate to others is through grunts, snorts and other visceral noises.

But nearly all users cite "smiles" and its sibling drugs as being uniquely powerful hallucinogenic substances. For many users, the hallucinogenic aspect of the "trip" is downright frightening. And because of the drugs' rather long half-life, the high associated with these drugs can be a roller coaster ride, one that's impossible to stop or slow down. An eight to ten hour high is not unusual for those who use these drugs. "Smiles" can trigger some rather predictable signs and symptoms that seem to appear in nearly all users who are considered to be "under the influence." Some of these indicators consist of but are not limited to the following signs:

• Dilated pupils that are slow to react to direct light
• Flushed complexion
• Sweating
• Dry mouth
• Rapid, possibly nonsensical speech patterns
• Rapid and frequent mood swings
• Inability to sit still; hyperactive
• Rapid heart rate (above 100 bpm)
• Elevated blood pressure (above 140/90 mmHg)
• Piloerection (hair standing on end)
• Nasal passage irritation (from snorting of the drug)

These are just some of the signs exhibited by users of "smiles" and the other drugs of the class. But readers should remember that hallucinogenic drugs are unique in that any given experience will be dictated by the mood and affect of the user himself or herself. These drugs are known to make sullen or depressed users feel worse for the wear. Unlike Ecstasy, they are not known to be mood elevators. It makes one wonder then, how in the world did the street name "smiles" stick with this stuff in the first place?

Follow the Journal of Drug Abuse Recognition for continuing coverage of the designer drug phenomenon. Watch for news of emerging drugs and for strategies in drug detection and substance abuse prevention.

Many of our readers work with clients and patients who are dealing with the sometimes-crushing events in life. These experiences are exacerbated by substance abuse and confrontations with the criminal justice system. Many of these individuals face a host of economic problems, many of which emanate from their employment status. Throughout the world, a great deal of social turmoil has ensued in response to the global-wide recession. In a recently published study, researchers examined the relationship between unemployment and the incidence of completed suicide. The study published in the British Medical Journal focused on suicide rates in the United Kingdom during the recession. [1] 

Prior to the recession in the years 2000-2007, there had been a substantial trend that demonstrated a declining rate of suicide in the U.K. Starting in 2008 and running through 2010, the rates for male and female suicide diverged from the trend lines that had been set for the prerecession period. The numbers were significantly different for men, not so noticeable for women. In fact, with each 10% increase in the number of unemployed workers, a 1.4% increase in suicide in men was seen. Changes in employment status in women did not appear to be associated with a change in rates of suicide. The analyses suggested that there were 846 more suicides between 2008 and 2010 than had the rates adhered to prerecession trend lines. Analyses suggested that 40% of the "excess" suicides were, in fact, associated with unemployment status.

Prior studies have linked unemployment to suicide. The burden of unemployment may portend psychological impacts that are more severe in men. Perhaps the traditional social expectation for men to provide for themselves and their families is the force that drives this trend. We live in times where economic conditions in this country are very strained. Reductions in the rates of unemployed and underemployed should be a vital national objective. For some people, a lower unemployment rate is a matter of life and death.

The DARS Journal mystery drug for November 2012 is indeed curious. It is one of the more difficult challenges that this column has posited to its readers. The drug was originally brought to market in 1957. At that time it had obtained federal approval as a therapy to treat insomnia and morning sickness in affected women. The drug had additional therapeutic value as an anxiolytic, a medicine designed to treat anxiety and stress.

This month's drug shares an etiology of many drugs from its generation; a German chemist, a former member of the Nazi Party, developed it. Heinrich Mückter was a physician, a scientist responsible for viral research and development of pharmaceutical products to treat typhus. After the war, Dr. Mückter fell into the hands of the free world and began to develop this month's drug for the West. Mückter was initially believed to have discovered a wonder drug, a medicine with broad capabilities. In addition to its well-established value in treating nausea in morning sickness, the drug was also found effective in reducing cough and in the relief of pain related to cluster headache. It was an analgesic on top of everything else it appeared to do. This month's drug quickly became a panacea for various conditions that were responsible for a great deal of human misery. From pain management specialists who saw the drug as a non-opiate alternative to obstetricians struggling to control disabling morning sickness in soon-to-be mothers, this drug was a rising star.

But knowledge of human physiology and microbiology were still in relatively nascent stages back in 1957. Things that we know now as basic biologic and chemistry know-how we're not known then. One of those physiological situations of some mystery still was how drugs did or didn't pass a mother's placental barrier. It was at this microscopic level that this month's drug made its name. Not a good name unfortunately. It became notorious for its association with birth defects, those that are known scientifically as teratogenic effects.

Ironically, political and regulatory issues slowed the approval process for this month's drug in places such as the United States and Germany. The adverse impact the drug had on patients and on infants was far less in the United States and Germany than it was in other western societies because governmental approval needed to dispense this drug was never granted. Still, in the United States the drug was broadly distributed to physicians in their offices for use in a widespread clinical testing program. Because of the wide reach of the clinical testing program, it was impossible to determine how many pregnant women may have been provided this drug to treat morning sickness. Because this drug was never officially approved for sale in the United States, its tendency to trigger birth defects was restrained. Nonetheless, those cases that did emerge in the United States were horrendous. Medical annals of the 1960s and 1970s are riddled with incidence of severe birth defects that were attributed to the use of this drug.

In an even more interesting twist is that this month's drug has now demonstrated some contemporary potential in healing several debilitating diseases. For starters, the drug has evidenced great potency in containing leprosy. Called erythema nodosum leprosum (ENL), this disease is significantly arrested with patients who now take this drug. Even more interesting is the impact that this drug has on a virulent type of cancer, multiple myeloma. A type of bone cancer, multiple myeloma is a disease that extends for years, often times in latent or "smoldering" stages. This month's drug seems to be uniquely effective in preventing the advance of this disease. The pharmacological actions of the drug are not exactly understood. But the proof is pretty compelling; the drug is a powerful agent that can arrest the forward progress of serious disease.

A one-off drug for discussion here, this month's drug is certainly unusual. Indeed, this is a drug that has been the subject of intense litigation and medical debate. Nevertheless, it is a drug of significant potency and has demonstrated a capacity to treat a variety of heinous conditions. The drug is currently approved by the FDA for use in very restricted situations and is mostly prescribed in combination with other well-studied drugs. Pregnant women cannot take it. However, the drug appears to be attracting significant attention from physicians who seek to ease the misery of their patients who suffer from intractable disease.

Ready to render a guess?

Click Here for this month's mystery drug.

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