1. No category

Continuing Education
Course
Bath Salts and
Synthetic Marijuana:
An Emerging Threat
BY Rommie L. Duckworth
TRAINING THE FIRE SERVICE FOR 135 YEARS
To earn continuing education credits, you must successfully complete the course examination.
The cost for this CE exam is $25.00. For group rates, call (973) 251-5055.
Bath Salts and
Synthetic Marijuana:
An Emerging Threat
Educational Objectives
On completion of this course, students will
1) Define the term “Designer Drug”.
3) Determine what constitutes Bath Salts, and their effects.
2) Learn how regulation is not inhibiting the production of
designer drugs.
4) Determine what constitutes Synthetic Marijuana, and its
effects
BY ROMMIE L. DUCKWORTH
April 5, 2011. Spanaway, Washington: Medic and Army Sergeant Dave Stewart, high on bath salts bought at a local pipe
shop, killed himself and his wife during a police pursuit. Their
five-year-old son was also found dead in the car.
August 21, 2011. Bowling Green, Kentucky: Teenager Ashley
Stillwell became paralyzed while smoking 7H, a form of synthetic marijuana, with her friends. She lay on the floor, helpless,
as her friends discussed what to do, including how to dispose
of her body.
June 5, 2012. Austin, Texas: Eighteen-year-old Giovanni Leask
was arrested for attacking and kicking a paramedic in the throat
while he was being treated for injuries resulting from his jumping off a bridge. Leask was high on bath salts at the time.
A
round the country and across the news,
stories like these are playing out with alarming
frequency. Emergency services are confronted by
horrific events caused by a surge in the use of new types of
designer drugs. This article discusses the upsurge in bath salts
and synthetic marijuana: what they are, where they have been
coming from, and what form they may take in the future; what
regulators and law enforcement are doing to stop them; and
what field providers can do to manage the fallout from this
new wave of designer drugs.
Designer Drugs
Although abuse of prescription painkillers like oxycontin
remains the largest drug problem in the United States (overdoses kill more than 15,000 people per year),1 designer drugs
present an evolving problem for law enforcement, regulators,
www.FireEngineeringUniversity.com
emergency responders, and healthcare providers. Designer
drugs are chemical compounds that are newly created, modified, or repurposed to provide abusers with effects similar to
currently illegal recreational drugs. They are often relatively
easy to make and, because of their ever-changing ingredient
list, are also extremely difficult to regulate.
The term “designer drugs” originated in the 1980s, but
the idea of marketing legal chemical combinations related
to regulated or banned drugs dates back to the 1920s. Such
compounds, similar in structure or the effects produced by another chemical, are called “analogs.” When morphine, heroin,
and other opiates were regulated by the International Opium
Convention of 1925, dealers began to sell acetylpropionylmorphine—a similar but as yet unregulated drug.2
Most recently, emergency responders are confronting synthetic marijuana and bath salts across North America and Europe.
According to the American Association of Poison Control Centers, calls regarding synthetic marijuana almost doubled from
2010 to 2011,3 and calls related to bath salts went up from 304
in 2010 to more than 6,000 in 2011.4 Not only are these drugs
cheap and easy to obtain, but many users believe they are legal
or, at least, that they are unlikely to get arrested for using or
possessing them.
REGULATION
In the United States in 1986, the Controlled Substance
Analog Enforcement Act was passed to control unregulated
substances that mimic controlled substances. The loophole
through which many designer drugs slip is the fact that, unless specifically banned, chemical substances labeled as “not
for human consumption” are not considered drugs at all. As a
emerging threats ●
result, as soon as one “active ingredient” for a designer drug
is banned, another analog or variant is substituted, continuing the game of catch-up for regulators, law enforcement, and
other emergency responders.
One explanation for the popularity of these substances is
the relative difficulty in testing for them in suspected abusers; synthetic marijuana is not detectable in standard urine
drug screens. Still, determining what drugs were taken is less
important for field providers than managing the signs and
symptoms resulting from the abuse.
On a federal level on March 1, 2011, a ban on five of the
main synthetic cannabinoids (JWH-018, JWH-073, JWH-200,
CP 47,497, and CP 47,497 C8) was enacted, making all of them
Schedule 1 Controlled Substances.5 On September 7, 2011, the
United States Drug Enforcement Agency invoked “emergency
scheduling” on the three primary active ingredients in bath salts
to restrict sales from October 7, 2011, to October 7, 2012.6
Although federal bans help control large distributors and
cross-state trafficking, state and local authorities must also
act to affect individual users and local distributors. As of this
writing, most states have banned at least some of the active
ingredients in these designer drugs, but the degree to which
these drugs are manufactured, distributed, sold, possessed, or
used still varies widely.
BATH SALTS
What are they? Never intended for use as actual bath salts,
these chemicals have virtually nothing in common with the
Epsom salts you might use to relax in your tub after a long
shift. These recreational drugs are marketed as products “not for
human consumption” to avoid state and federal regulation as
drugs or food substances. They are instead sold as plant fertilizers; insect repellants; pond cleaners; vacuum fresheners; and,
of course, most popularly as bath salts, from which the slang for
this category of drug is derived.
Where did they come from? Bath salts arrived in the
United States around 2008, but both demand and availability of the product exploded in 2010. Typically supplied as a
white, brown, or gray powder (depending on the manufacturing method), bath salts are packaged in small foil or plastic
bags. The active ingredients in these formulations are analogs
of cathinone, a derivative of the khat plant used as a stimulant for hundreds of years throughout the Middle East and
Africa.7 Although cathinone itself is a federal Class I Controlled Substance (high potential for abuse, no medical uses),
the cathinone analogs mephedrone (4-MMC), methylone, and
methylenedioxypyrovalerone (MDPV) are the primary active
ingredients in most bath salt concoctions and are not yet
permanently federally controlled. (5) Not only can a variety of
these active ingredients be found in bath salt mixtures separately or in combinations, but they can also be mixed with a
variety of “filler” components.
Common brand names of bath salts include “Vanilla Sky,” “Cloud
Nine,” “Ivory Wave,” “Aura,” “Blizzard,” “Scarface,” and “White Lightning.” The speed at which new products can be produced means
that this list may be outdated by the time you finish reading this
sentence. Despite ongoing regulatory efforts at the state and federal
levels, bath salts can still be purchased through many convenience
stores, gas stations, head shops, tattoo parlors, and the Internet.
Routes. Bath salts are typically snorted, but abusers may also
ingest, inject, or smoke them; insert them rectally directly; or mix
them with water and use them as eye drops.
Mechanism of action. The active ingredients in bath salts
impact monamine neurotransmitters acting as dopamine-norepinephrine reuptake inhibitors (NDRI).8 This, in turn, leads to
an increase in serotonin and, to a lesser extent, dopamine.9
Intended effects. The sensations abusers seek may either
be those similar to MDMA (Ecstasy) such as increased arousal,
sociability, and euphoria or those similar to cocaine and methamphetamine such as increased mental focus, stimulation, and
physical energy. Bath salts are often used in combination with
other recreational substances such as alcohol, marijuana, amphetamines, LSD, opiates, benzodiazepines, and other designer
drugs for a combination of effects.
Unintended effects. The results can vary widely depending
on product strength, active ingredients and fillers, dosing, route
of administration, and individual physiology. Because of this,
bath salts frequently produce undesired cardiac side effects including tachycardia, hypertension, hyperthermia, and peripheral
vasoconstriction and neurological side effects including insomnia,
depression, hallucinations, anxiety, psychosis, paranoia, confusion, and excited delirium.10 In addition, bath salts have been
reported to produce a high craving for immediate re-dosing,
leading to increases in the frequency and intensity of these undesired side effects.
Duration. The duration of effects varies greatly in the same way
that the effects themselves can. Onset of action (the “come up”
phase) is typically from 30 minutes to two hours, with the “peak”
at approximately 90 minutes and the “come down” phase some
time from two to four hours.
Why you might see them. Some patients, thinking that
bath salts are legal products, may readily admit to their use
and call for assistance if they begin to experience unpleasant
side effects. You might also suspect bath salt abuse in patients
found to be suddenly hyperactive, paranoid, aggressive, “fiendish” (compulsory drug seeking or re-dosing), suicidal, self-mutilating, or in excited delirium without other explanation.
SYNTHETIC MARIJUANA
What is it? In an effort to circumvent regulation, synthetic
marijuana, like bath salts, is labeled “not for human consumption.” Most commonly marketed under the names of “Spice”
and “K2” and labeled as incense, synthetic marijuana is typically sold as loose-leaf herbs in small prepackaged bags or
prerolled cigarettes.11 Other common names for synthetic
marijuana include “Genie,” “Yucatan Fire,” “Sence,” “Smoke,”
“Skunk,” and “Zohai.” Like bath salts, new slang terms and
brand names for synthetic marijuana continue to develop. Also
like bath salts, various forms of synthetic marijuana can be
obtained through local shops and the Internet.
Where did it come from? Trafficking of synthetic cannabinoids was first reported in the United States in December
2008, when a shipment was seized by U.S. Customs in Dayton,
Ohio.12
www.FireEngineeringUniversity.com
● emerging threats
These herbal concoctions list ingredients including plants
thought to produce cannabis-like effects including Scutellaria
nana, Nelumbo nucifera, Leonotis leonurus, Nymphaea caerulea,
Canavalia maritima, Pedicularis densiflora, Zornia latifolia, and
Leonurus sibiricus, but it is now understood that the herbal ingredients themselves serve primarily as filler. The active ingredients in
these products are typically powdered synthetic cannabinoids that
contain no actual marijuana and are simply mixed or sprayed onto
the herbs.13 Synthetic cannabinoids are a class of man-made substances that act as cannabinoid receptor agonists. This means that
they are chemicals that bind with receptors (CB1 in the brain and
CB2 in the spleen), producing a high similar to that of naturally
occurring cannabinoids (marijuana, THC).14
A number of active ingredients have been found in these
mixtures, all variations and derivatives of pharmaceutical
research going back 50 years. This research has long been in
an effort to isolate the undesired psychoactive effects of cannabinoids from the therapeutically valuable ones, particularly
for the treatment of nausea and loss of appetite from cancer
chemotherapies.15
Cannabinoid agonists fall into four major groups:
• Analogs of THC developed in the 1960s including HU-120
(HU stands for Hebrew University, where the chemical was
synthesized).
• Nonclassical cannabinoids such as the cyclohexylphenol
(CP) series developed by Pfizer in the 1970s.
• Aminoalkylindoles or JWH compounds, developed in the
1990s and named after their inventor, J. W. Huffman.
• Miscellaneous compounds including fatty acid amides such
as oleamide.
These chemicals are all fairly volatile (vaporize readily) and,
therefore, “smokeable,” and examples from all four groups
have been reported to be in synthetic marijuana.
Although you probably will not know the specific underlying
active ingredient affecting your patient, it is important that you
recognize that, like bath salts, synthetic marijuana refers to not
one single product but rather to a wide variety of products with
varying active ingredients in varying combinations and with
different fillers, which may produce drastic and sudden changes
in patient condition.16
The primary synthetic cannabinoid currently in use is JWH018. (14) Although JWH-018 is currently banned, more than
100 other synthetic cannabinoids that may lead to emergency
services dealing with ever-changing forms of “legal highs”
exist.
Routes. Synthetic marijuana is typically smoked or eaten in
the same manner as natural marijuana.
Mechanism of action. Natural cannabinoids (such as
THC) and synthetic cannabinoids (of which more than 100
compounds already exist) act by binding to CB1 and CB2
receptors. These receptors are linked to proteins that regulate
neurotransmitters. Although, as with bath salts, the variety of
active ingredients, fillers, doses, and dosing methods will impact the effect or “high” of synthetic marijuana, synthetic cannabinoids tend to bind better and longer to the CB receptors
than natural THC, generally producing stronger effects.17
www.FireEngineeringUniversity.com
Little scientific research has been done on the long-term
effects of these drugs in humans, but it seems that tolerance
may develop relatively quickly, leading to a great potential
for dependence.18 Not only are the active ingredients in these
products much stronger than most users expect, but it appears
that unknown interactions are producing effects that are the
opposite of what users and healthcare providers would expect
to see with natural marijuana.19
Intended effects. The effects that users typically seek to
obtain through synthetic marijuana products are the same as
those with natural marijuana including euphoria, relaxation,
and sociability.
Unintended effects. As with bath salts, the effects of synthetic
marijuana can vary widely depending on product strength, active ingredients and fillers, dosing, route of administration, and
individual physiology. Undesired cardiac side effects of synthetic
marijuana include tachycardia, hypertension, and chest pain or
myocardial infarction. Neurological side effects including parasthesias, anxiety, psychosis, paranoia, confusion, tremors, seizures,
hallucinations, and excited delirium. As a result of the psychological effects of synthetic marijuana, some users present with
suicidal ideation, self-mutilation, and highly aggressive behavior.
20-23
Some users report such little effect from “normal” dosing that
they may use larger quantities in subsequent doses, enhancing the undesired effects. Discussion of synthetic marijuana use
on Internet discussion forums and comment threads illustrate
the variety and unpredictability of the effects of these drugs.
Comments range from “I tried the ‘legal’ K2 last night and was
not impressed” to “I smoke weed and have for many years! My
heartbeat started to get my attention. It started to beat harder
and faster. I thought I was going to die or at the very least was
having a heart attack. The pain was really bad, but the fear of
dying was worse. This is just a warning. I am not trying to scare
you.” (17)
Duration. As with bath salts, the duration of the effects of
synthetic marijuana can vary greatly. Onset of action (the “come
up” phase) is typically from 15 to 30 minutes, with the “peak” at
approximately 90 minutes and the “come down” phase extremely
variable, from one to six hours.
Why you might see them. Like users of bath salts, many
users of synthetic marijuana believe that they are using legal
products, may admit to their use, and call 911 when they or
someone else begins experiencing side effects. You may suspect synthetic marijuana abuse in patients found to be experiencing uncontrollable tremors, seizures, difficulty breathing,
chest pain, or suddenly becoming anxious, paranoid, aggressive, suicidal, self-mutilating, or in excited delirium without
other explanation.
MANAGEMENT OF
EMERGENCIES
Although there is no “antidote” for either bath salt or synthetic
marijuana intoxication, basic life support (BLS) and advanced life
support (ALS) emergency responders can apply a number of very
good general guidelines to manage suspected emergencies.
emerging threats ●
PREPARATION
Police, firefighters, emergency medical service (EMS), and in-hospital healthcare providers must work in close coordination to provide care for these patients, and this coordination must begin well
before the call to 911. Law enforcement, EMS, and firefighters called
to the scene must all have the same expectations as to what is going
to happen as well as who will play what roles. Likewise in-hospital
and prehospital healthcare providers must have an understanding of
each other’s protocols and capabilities.
MANAGE THE SCENE
• As always, first ensure safety for yourself, your fellow providers, and bystanders. Remember, patients abusing bath salt
and synthetic marijuana are particularly prone to sudden
and violent behavioral changes.
• The 911 calls for these patients may not include any information about drug use. Clues and cues to bath salt and synthetic
marijuana use include drug paraphernalia or litter on scene,
sudden onset tremors, seizures, difficulty breathing, chest pain,
anxiety, paranoid, and aggressive or suicidal behavior without
other explanation. Keep in mind that drugs might not be the
patient’s only issue.
• Cofactors to bath salt and synthetic marijuana-related emergencies include police use of chemical (pepper spray) or
electrical (TASER®) restraint prior to your arrival. Additionally, a patient history of mental illness, multiple types of drugs
onboard, and patient comorbid factors such as diabetes or
history of respiratory or cardiac problems may be obtainable
only through evidence and bystanders on scene.
MANAGE THE PATIENT
• Attempt to establish a patient rapport, but always be prepared for sudden changes in patient behavior.
• Coordinate with other emergency responders to physically
restrain the patient. You can use a variety of methods, but
be sure to control all four extremities as well as the patient’s
head. Do not use chemical pepper spray, and do not place
the patient in a prone or hog-tied position. Keep in mind
that physical restraint may be particularly difficult in these
patients because of increased strength, decreased pain sensitivity, and loss of rational thought.
• (ALS) If possible, pharmaceutical restraints should quickly follow or occur simultaneously with physical restraint. Administer
benzodiazepines such as midazolam (Versed®) or lorazepam
(Ativan®) per protocol preferably IN or IM.
MANAGE THE CARE
• As soon as possible, perform a full physical exam, triaging and
treating signs and symptoms. As always, focus on the ABCs.
• Consider other causes of altered mental states including
those listed in the AEIOU tips mnemonic:
—Alcohol
—Endocrine/Electrolytes/Encephalopathy
—Insulin (hypoglycemia)
—Oxygen (hypoxia)
—Uremia
—Toxins/Trauma (CHI)
—Infection
—Psychiatric
—Shock/Stroke/Seizure
• (ALS) Establish an IV, and protect it from removal. If you
suspect excited delirium, you may consider a fluid bolus and
administration of sodium bicarbonate for shock and rhabdomyolysis according to local protocol.
• The patient will often be hyperthermic. This may be because
of prior agitation, the protesting of physical restraint, or
metabolic factors related to the drugs. If this is the case,
consider external cooling as you would any other hyperthermic patient. Keep in mind that hyperthermia is another key
indicator of excited delirium.
• (ALS) Closely monitor the patient’s mental state, level of
sedation, ECG, pulse oximetry, and other vital signs.
• Continually reassess your patient, as sudden and drastic
behavioral and physiological changes are the hallmarks of
designer drug-related emergencies.
PITFALLS AND PRECAUTIONS
• Preparation for these calls begins with responder education
and collaboration.
• Always keep safety in mind, as conditions can change rapidly
on these calls.
• Coordinate physical restraint, and be prepared for a prolonged struggle.
• If at all possible, do not attempt physical restraint without
chemical restraint.
• Do not attempt chemical restraint without physical restraint.
• Consider bath salts/synthetic marijuana/other designer drugs
as an underlying cause of sudden patient changes, such as
those listed above, without other explanation.
• Consider other causes of altered mental status (AEIOUTIPS).
THE FUTURE
Bath Salts
More recently termed “research chemicals,” designer drugs
continue to be created, modified, marketed, and abused at an
alarming rate. Now that the primary active ingredients in bath
salts, 4-MMC and MDPV, have been regulated, manufacturers
are substituting analogs including a-PPP, MPPP, MDPPP, and
other chemical cousins that produce similar intoxicating and
toxic effects. And the ingredients aren’t the only thing evolving. In addition to marketing as bath salts, plant fertilizers, and
insect repellants, bath salts are most recently being marketed
under the description of electronic screen cleaners and jewelry
cleaners with names like “M-Shine,” “Freebase,” and “Blast.” 24
Synthetic Marijuana
Likewise, synthetic marijuana is being updated and marketed
on Web sites claiming, “There is a new generation of K2 products
that are completely legal everywhere” or “Not covered by any
ban, restriction, or regulation!” Despite state and federal bans,
these new concoctions are likely to continue to progress through
the more than 100 synthetic cannabinoids differentiated only by
www.FireEngineeringUniversity.com
● emerging threats
new names like “K2 Sky,” “K2 Solid Sex,” “K2 Orisha,” “K2 Amazonian Shelter,” and “K2 Thai Dream.” 25
Despite ongoing efforts to control the distribution and use
of these designer drugs, emergency responders must be prepared to deal with this problem as it evolves. Bath salts and
synthetic marijuana aren’t going away any time soon, and the
optimal way to prepare yourself is to know and understand
what these substances are, how they work, and how best to
manage patients who are users:
•M
anage the scene.
•M
anage the patient.
•M
anage the care.
You may encounter abusers of bath salts or synthetic marijuana
under a variety of circumstances. You may not know what they
took, how much of it they took, or even what was in it. You may
not know if your call is going to be fatal or just frightful. But you
can know how to manage the scene, the patient, and the prehospital care that you will need to provide for the best possible patient
outcome. ●
References
1. Barker, P, Chapter, JB, Chapter, JG, Chapter, BH, Hedden, SL, Chapter,
AH, Chapter, MJPO, et al. (2011). Results from the 2010 National Survey on
Drug Use and Health: (No. 11-4658). oas.samhsa.gov, Summary of National
Findings. Rockville, MD: Substance Abuse and Mental Health Services
Administration.
2. Streatfeild, D. (2002). Cocaine. An Unauthorized Biography (p. 532).
Random House.
3. AAPCC. (2012a, May 23). American Association of Poison Control Centers Synthetic Marijuana Data. aapcc.org, Updated May 23, 2012. Retrieved
June 13, 2012, from http://www.aapcc.org/dnn/Portals/0/Synthetic%20
Marijuana%20Data%20for%20Website%205.23.2012.pdf.
4. AAPCC. (2012b, May 23). American Association of Poison Control Centers Bath Salts Data. aapcc.org, Updated May 23, 2012. Retrieved June 13,
2012, from http://www.aapcc.org/dnn/Portals/0/Bath%20Salts%20Data%20
for%20Website%205.23.2012.pdf.
5. DEA. (2011a, April 1). Microgram Bulletin. (D. E. Administration, Ed.)justice.gov, REQUEST FOR INFORMATION ON SYNTHETIC CATHINONES.
Retrieved June 13, 2012, from http://www.justice.gov/dea/programs/forensicsci/microgram/mg2011/mg0411.pdf.
6. DEA. (2011b, September 7). News from DEA, News Releases, 09/07/11.
justice.gov. Springfield, VA. Retrieved June 14, 2012, from http://www.
justice.gov/dea/pubs/pressrel/pr090711.html.
7. Nutt, D., King, L., & Saulsbury, W. (2007). Development of a rational scale
to assess the harm of drugs of potential misuse. The Lancet.
12. DEA Diversion Control - Controlled Substance Schedules. deadiversion.
usdoj.gov. Springfield, VA: DEA; http://www.gpo.gov/fdsys/pkg/FR-201203-01/html/2012-4982.htm.
13. emcdda.europa.eu. (n.d.). emcdda.europa.eu, European Monitoring
Centre for Drugs and Drug Addiction. Paper PDF can be accessed at
http://www.emcdda.europa.eu/publications/thematic-papers/spice.
14. Huffman, JWJ, Mabon, RR, Wu, MJM, et al. (1999). Current Medicinal
Chemistry. (Atta-ur-Rahman, ed.) Cannabimimetic Indoles, Pyrroles and
Indenes (Vol 6, pp705-720). Boca Raton, FL.
15. Huffman, J. W., Dai, D., Martin, B. R., & Compton, D. R. (1994). Design,
Synthesis and Pharmacology of Cannabimimetic Indoles. Bioorganic &
Medicinal Chemistry L.etters, 4(4), 563–566.
16. Auwärter, V., Dresen, S., & Weinmann, W. (2009). “Spice”and other
herbal blends: harmless incense or cannabinoid designer drugs? … Mass
Spectrometry.
17. Bergen, K. (2010, February 17). Kansas lab looked at synthetic marijuana’s effect on brain - Columbia Missourian. Missourian, Potent Combinations. Retrieved June 14, 2012, from http://www.columbiamissourian.com/
stories/2010/02/17/legal-substance-mimic-marijuana-has-harmful-effects/.
18. Zimmermann, U. S., Winkelmann, P. R., Pilhatsch, M., Nees, J. A.,
Spanagel, R., & Schulz, K. (2009). Withdrawal phenomena and dependence
syndrome after the consumption of “spice gold”. Deutsches Ärzteblatt
international, 106(27), 464–467.
19. AAPCC. (2010, March 24). American Association of Poison Control
Centers Warn About Dangers of Synthetic Marijuana Product. American
Association of Poison Control Centers. ndria, VA. Retrieved June 14, 2012,
from http://www.prnewswire.com/news-releases/american-associationof-poison-control-centers-warn-about-dangers-of-synthetic-marijuanaproducts-89004037.html.
20. Castellanos, D., Singh, S., Thornton, G., & Avila, M. (2011). Synthetic
Cannabinoid Use: A Case Series of Adolescents. Journal of Adolescent
Health.
21. DEA DEA Diversion Control - Controlled Substance Schedules, deadiversion.usdoj.gov. Springfield, VA: DEA. 4/2012, http://www.deadiversion.
usdoj.gov/schedules/orangebook/orangebook.pdf.
22. Hoyte, C. O., Jacob, J., Monte, A. A., Al-Jumaan, M., Bronstein, A. C., &
Heard, K. J. (2012). A Characterization of Synthetic Cannabinoid Exposures
Reported to the National Poison Data System in 2010. Annals of Emergency Medicine, –. doi:10.1016/j.annemergmed.2012.03.007.
23. Mir, A., Obafemi, A., & Young, A. (2011). Myocardial Infarction Associated With Use of the Synthetic Cannabinoid K2. Pediatrics.
24. Allen, R., & Owens, W. (2012, May 31). FDNY Fireguard Update: Bath
Salts. FDNY Center for Terrorism and Disaster Preparedness (CTDP), Legal,
Synthetic Amphetamines. New York, NY. Retrieved June 14, 2012, from
http://www.nysvara.org/news/2012/june/120603.pdf.
25. Mazzoni, O., Diurno, M. V., di Bosco, A. M., Novellino, E., Grieco, P.,
Esposito, G., Bertamino, A., et al. (2009). Synthesis and Pharmacological
Evaluation of Analogs of Indole-Based Cannabimimetic Agents. Chemical
Biology & Drug Design, –. doi:10.1111/j.1747-0285.2009.00910.x.
8. Springer, D. D., Fritschi, G. G., & Maurer, H. H. H. (2003). Metabolism
of the new designer drug alpha-pyrrolidinopropiophenone (PPP) and
the toxicological detection of PPP and 4’-methyl-alpha-pyrrolidinopropiophenone (MPPP) studied in rat urine using gas chromatography-mass
spectrometry. Journal of Chromatography B, 796(2), 253–266. doi:10.1016/j.
jchromb.2003.07.008.
9. Karila, L. (2011). GHB and synthetic cathinones: clinical effects and potential consequences - Karila - 2010 - Drug Testing and Analysis - Wiley Online
Library. Drug testing and analysis.
10. Wood, D., Davies, S., & Puchnarewicz, M. (2009). 153. Recreational Use
of 4-Methylmethcathinone (4-MMC) Presenting with Sympathomimetic
Toxicity and Confirmed by Toxicological Screening. Clinical Toxicology
47:7331.
11. Deluca, P., Schifano, F., Davey, Z., Corozza, O., di Furia, L., Farre, M.,
Flesland, L., et al. (2010). Psychonaut WebMapping Research Group. psychonautproject.eu, Spice Report. London, UK: Psychonaut WebMapping
Research Group.
www.FireEngineeringUniversity.com
● ROMMIE L. DUCKWORTH is a career fire lieutenant and
EMS coordinator for the Ridgefield (CT) Fire Department.
He has more than 20 years of experience working in career
and volunteer fire agencies, public and private emergency
services, and hospital-based healthcare systems. He is a
frequent speaker at national conferences and a regular contributor to research programs, magazines, textbooks, and
new media on fire and emergency service topics.
Continuing Education
Bath Salts and Synthetic Marijuana: An Emerging Threat
COURSE EXAMINATION INFORMATION
To receive credit and your certificate of completion for participation in this educational activity, you must complete the program post examination and receive a score of 70% or better. You have the following options for completion.
Option One: Online Completion
Use this page to review the questions and mark your answers. Return to www.FireEngineeringUniversity.com and sign in. If you have not
previously purchased the program, select it from the “Online Courses” listing and complete the online purchase process. Once purchased,
the program will be added to your User History page where a Take Exam link will be provided. Click on the “Take Exam” link, complete all
the program questions, and submit your answers. An immediate grade report will be provided; on receiving a passing grade, your “Certificate of Completion” will be provided immediately for viewing and/or printing. Certificates may be viewed and/or printed anytime in the
future by returning to the site and signing in.
Option Two: Traditional Completion
You may fax or mail your answers with payment to PennWell (see Traditional Completion Information on following page). All information
requested must be provided to process the program for certification and credit. Be sure to complete ALL “Payment,” “Personal Certification
Information,” “Answers,” and “Evaluation” forms. Your exam will be graded within 72 hours of receipt. On successful completion of the posttest
(70% or higher), a “Certificate of Completion” will be mailed to the address provided.
COURSE EXAMINATION
1)Which prescription painkiller remains the largest cause of
overdose deaths in the United States?
a.Vicodin
b.Oxycontin
c.Tylenol
d.Morphine
2)Designer Drugs are _____________ that are newly created,
modified, or repurposed to provide abusers with effects similar to
currently illegal recreational drugs.
a.Chemical Compounds
b.Store-bought drugs
c.Combined drugs
d.Single chemical drugs
3)Designer Drugs are harder to make than their real counterparts.
a.True
b.False
4)When did Designer Drugs make an appearance in the United
States?
a.1960s
b.1970s
c.1980s
d.1990s
5)Chemical compounds used in Designer Drugs are similar in
structure, or their effects produced by another chemical are
called, “analogs”.
a.True
b.False
6) According to the American Association of Poison Control Centers,
Calls regarding synthetic marijuana almost _______________ from
2010 to 2011.
a.Doubled
b.Tripled
c.Quadrupled
d.Quintupled
7)Many users of Designer Drugs believe they are legal, and that
they are unlikely to get arrested for using or possessing them.
a.True
b.False
8)What act was passed in 1986 to control unregulated substances
that mimic controlled substances?
a.Controlled Substance Enforcement Act
b.Designer Drug Analog Enforcement Act
c. Synthetic Drug and Substance Control Act
d.Controlled Substance Analog Enforcement Act
9)The loophole through which many Designer Drugs slip is the fact
that, unless specifically banned, chemical substances labeled as
“not for human consumption” are not considered drugs at all.
a.True
b.False
10) Which drug is usually sold as plant fertilizers, insect repellents,
pond cleaners, vacuum fresheners?
a. Bath Salts
b.Designer Oxycontin
c. Synthetic Marijuana
d.None of the above
11) How are Bath Salts packaged?
a. In
b.In
c. In
d.In
large bricks
large pails for wholesale
small foil or plastic bags
small landscape bags for long-term storage
12) Bath Salts are typically ___________ when used as Designer Drugs.
a.Snorted
b.Smoked
c.Injected
d.Eaten
13) The mechanism of action for Bath Salts is ____________ .
a.Decrease in Norepinephrine
b.Increase in Serotonin
c.Decrease in Serotonin
d.Increase in Adrenaline
14) What Designer Drug is commonly marketed under such names
as “Spice” and “K2?”
a. Bath Salts
b.Oxycontin derivatives
c. Synthetic Marijuana
d.Synthetic Oxycontin
www.FireEngineeringUniversity.com
Continuing Education
Bath Salts and Synthetic Marijuana: An Emerging Threat
15) How is Synthetic Marijuana used as a Designer Drug?
18) Due to the state of euphoria that most Designer Drug users
seek, they are less prone to be sudden and violent behavioral
changes.
a. Smoked or injected
b.Smoked or eaten
c. Eaten or ingested
d.Only Smoked
a.True
b.False
16) S
ynthetic Marijuana can produce a stronger “high” than natural
marijuana.
a.True
b.False
a.True
b.False
17) What are some signs and symptoms of Synthetic Marijuana use?
a.Tremors
b.Seizures
c.Paranoia
d.All of the above
19) Also termed “research chemicals,” Designer Drugs are continuing
to be created, modified, marketed and abused at an alarming
rate.
20) The optimal way to prepare yourself against abusers of Designer
Drugs is to:
a. Manage the scene
b.Manage the patient
c. Manage the care
d.All of the above
Notes
www.FireEngineeringUniversity.com
Continuing Education
Bath Salts and Synthetic Marijuana: An Emerging Threat
PROGRAM COMPLETION INFORMATION
If you wish to purchase and complete this activity traditionally (mail or fax) rather than Online, you must provide the information requested
below. Please be sure to select your answers carefully and complete the evaluation information. To receive credit, you must receive a score of
70% or better.
Complete online at: www.FireEngineeringUniversity.com
PERSONAL CERTIFICATION INFORMATION:
Answer Form
Please check the correct box for each question below.
Last Name (PLEASE PRINT CLEARLY OR TYPE)
First Name
Profession/Credentials License Number
Street Address
Suite or Apartment Number
City/State Zip Code
1. ❑ A ❑ B ❑ C ❑ D
11. ❑ A ❑ B ❑ C ❑ D
2. ❑ A ❑ B ❑ C ❑ D
12. ❑ A ❑ B ❑ C ❑ D
3. ❑ A ❑ B ❑ C ❑ D
13. ❑ A ❑ B ❑ C ❑ D
4. ❑ A ❑ B ❑ C ❑ D
14. ❑ A ❑ B ❑ C ❑ D
5. ❑ A ❑ B ❑ C ❑ D
15. ❑ A ❑ B ❑ C ❑ D
6. ❑ A ❑ B ❑ C ❑ D
16. ❑ A ❑ B ❑ C ❑ D
7. ❑ A ❑ B ❑ C ❑ D
17. ❑ A ❑ B ❑ C ❑ D
8. ❑ A ❑ B ❑ C ❑ D
18. ❑ A ❑ B ❑ C ❑ D
9. ❑ A ❑ B ❑ C ❑ D
19. ❑ A ❑ B ❑ C ❑ D
10. ❑ A ❑ B ❑ C ❑ D
20. ❑ A ❑ B ❑ C ❑ D
Daytime Telephone Number with Area Code
Course Evaluation
Fax Number with Area Code
Please evaluate this course by responding to the following statements, using a scale of Excellent = 5 to Poor = 1.
E-mail Address
1. To what extent were the course objectives accomplished overall?
5
4
3
2
1
traditional compleTION INFORMATION:
2. Please rate your personal mastery of the course objectives.
5
4
3
2
1
Mail or fax completed answer sheet to
Fire Engineering University, Attn: Carroll Hull,
1421 S. Sheridan Road, Tulsa OK 74112
Fax: (918) 831-9804
3. How would you rate the objectives and educational methods?
5
4
3
2
1
4. How do you rate the author’s grasp of the topic?
5
4
3
2
1
PAYMENT & CREDIT INFORMATION
5. Please rate the instructor’s effectiveness.
5
4
3
2
1
Examination Fee: $25.00
6. Was the overall administration of the course effective?
5
4
3
2
1
Credit Hours: 4
Should you have additional questions, please contact Pete
Prochilo (973) 251-5053 (Mon-Fri 9:00 am-5:00 pm EST).
7. Do you feel that the references were adequate?
Yes
No
❑ I have enclosed a check or money order.
8. Would you participate in a similar program on a different topic?
Yes
No
❑ I am using a credit card.
9. If any of the continuing education questions were unclear or ambiguous, please list them.
My Credit Card information is provided below.
❑ American Express ❑ Visa ❑ MC ______________________________________________________________
❑ Discover
Please provide the following (please print clearly):
10. Was there any subject matter you found confusing? Please describe.
_______________________________________________________________
_______________________________________________________________
Exact Name on Credit Card
11. What additional continuing education topics would you like to see?
Credit Card # Expiration Date
_______________________________________________________________
_______________________________________________________________
Signature
PLEASE PHOTOCOPY ANSWER SHEET FOR ADDITIONAL PARTICIPANTS.
AUTHOR DISCLAIMER
The author(s) of this course has/have no commercial ties with the sponsors or the providers of the unrestricted educational
grant for this course.
INSTRUCTIONS
All questions should have only one answer. Grading of this examination is done manually. Participants will receive
confirmation of passing by receipt of a verification form.
COURSE CREDITS/COST
All participants scoring at least 70% on the examination will receive a verification form verifying 4 CE credits.
Participants are urged to contact their state or local authority for continuing education requirements.
SPONSOR/PROVIDER
No manufacturer or third party has had any input into the development of course content. All content has been derived
from references listed, and or the opinions of the instructors. Please direct all questions pertaining to PennWell or the
administration of this course to Pete Prochilo, [email protected].
EDUCATIONAL DISCLAIMER
The opinions of efficacy or perceived value of any products or companies mentioned in this course and expressed
herein are those of the author(s) of the course and do not necessarily reflect those of PennWell.
RECORD KEEPING
PennWell maintains records of your successful completion of any exam. Please go to www.FireEngineeringUniversity.com to
see your continuing education credits report.
Completing a single continuing education course does not provide enough information to give the participant the
feeling that s/he is an expert in the field related to the course topic. It is a combination of many educational courses and
clinical experience that allows the participant to develop skills and expertise.
© 2009 by Fire Engineering University, a division of PennWell.
COURSE EVALUATION and PARTICIPANT FEEDBACK
We encourage participant feedback pertaining to all courses. Please be sure to complete the survey included with the course.
Please e-mail all questions to: Pete Prochilo, [email protected].
www.FireEngineeringUniversity.com