Heroin in Malaysia and Singapore.

Clandestine heroin laboratories have been a feature of the Malaysian illicit drug scene since soon after the abuse of heroin emerged in 1972. The first few clandestine heroin laboratories which synthesised heroin via the acetylation of imported morphine were uncovered in 1973 and 1977. By the mid-1980s, this type of laboratory was replaced by heroin-cutting laboratories whereby imported high-grade heroin was cut to street heroin. This was to meet the rising demand for the drug owing to the rapid escalation of the number of drug users. Over the years, the most significant change in the composition of the street heroin is the decrease in its purity from 30%-50% to 3%-5%. Caffeine has remained the major adulterant and chloroquine is detected in virtually all recent seizures.

Age, period, and cohort effects in synthetic cannabinoid use among US adolescents, 2011-2015.

BACKGROUND: Synthetic cannabinoids use has been a public health concern given association with hospitalization and death among users. While national reports estimate that reported use is declining among adolescents, differences by birth cohort may indicate subgroups who remain at higher risk, both in the overall adolescent population and among demographic subgroups. METHODS: We estimated age, period, and cohort models of self-reported past-year synthetic cannabinoid use (queried as "synthetic marijuana" ["K2," "Spice"]) among 54,865 adolescents aged 13-19 attending high school from 2011 to 2015. RESULTS: Past-year use decreased from 11.86% in 2011 to 4.75% in 2015. This decrease was best represented as a linear downward trend. When stratified by key covariates, however, results indicated evidence of a positive cohort effect for students of higher socioeconomic status (SES). For those students, use did not decrease at the same rate as the overall population; younger cohorts of high SES students remain at higher risk for synthetic cannabinoid use than older cohorts as well as lower SES peers. A similar and stronger association was found for frequent marijuana users (≥20 occasions of past-year use). Multi-level models indicated that groups at highest risk included older adolescents, Hispanics and other/mixed race students, cigarette users, and frequent marijuana users. CONCLUSION: Synthetic cannabinoid use is associated with morbidity as well as mortality; continued attention to reducing synthetic cannabinoid use remains an important public health priority to maximizing student health.

Do police arrestees substitute legal highs for other drugs?

BACKGROUND: Some commentators have suggested legal highs (LH) might reduce existing illegal drug use and contribute to lower drug-related harm. However, no studies have specifically investigated substitution between LH and other drugs. AIMS: To explore the extent to which police detainees substitute LH for illegal drugs. METHOD: A total of 848 detainees at four central police stations were interviewed about their drug and LH use. Detainees were asked what impact their LH use had on their other drug use (i.e., 'no change', 'more', 'less' or 'stopped'). The detainees were placed into four groups: (i) no LH use; (ii) LH use and 'no change' in drug use; (iii) LH use and 'more' drug use; (iv) LH use and 'less' or 'stopped' drug use. Demographics and levels of drug use in the past month were compared between groups. RESULTS: Ninety-six percent of the LH using detainees had used synthetic cannabinoids (SC), and, of those who reported substituting a drug, 94% had substituted (natural) cannabis. Overall, 54% of the detainee sample had not used SC, 34% had used SC but not changed their cannabis use, 9% had used SC and used 'less' or 'stopped' cannabis use, and 3% had used SC and used 'more' cannabis. The SC users were more likely to have recently been in drug treatment. All those who used SC had higher cannabis consumption regardless of substitution behaviour. The SC users who used 'more' cannabis also used more methamphetamine and ecstasy. CONCLUSION: Twenty percent of those who used SC and cannabis reported reducing or stopping their cannabis use while 6% increased their cannabis use, suggesting a modest overall reduction in cannabis use. Further research is required to quantify the magnitude of substitution changes, the impact on drug-related harm, and extent to which substitution occurs for other LH and other populations.

1-Adamantylamine a simple urine marker for screening for third generation adamantyl-type synthetic cannabinoids by ultra-performance liquid chromatography tandem mass spectrometry.

Background Synthetic cannabinoids (NOIDS) are novel psychotropic drugs (NPS) currently freely sold in the United Kingdom as 'research chemicals'. Detection of NOIDS use is not available in current routine methods. Here we describe a marker which helps determine which patients have used these substances. Methods In a test case, ultra-performance liquid chromatography mass spectrometry (UPLC-Tof) was used to screen the legal high Herbal Haze II, the contents of hand-rolled cigarettes and five patient samples for NOIDS and their metabolites. Results Analysis of legal high Herbal Haze II and cigarettes identified the third generation adamantyl-type NOIDS N-(1-adamantyl)-1-pentyl-1H-indazole-3-carboxamide (AKB-48), 5F-AKB-48 and N-adamantyl-1-fluoropentylindole-3-carboxamide (STS-135). Out of 18 potential metabolites, 1-adamantylamine (C10H17N) was detected in all five urine samples. This adamantyl-type NOID marker was incorporated into our routine LC-MS/MS urine screen. Out of 14,436 random urine samples screened over eight months, 296 (2.05%) tested positive for the adamantyl-type NOID marker. Conclusion We have discovered a urine marker for identifying patients smoking legal high products containing the third generation adamantyl-type NOIDS such as AKB-48 and its fluoropentyl analogue 5F-AKB-48, which are among the most popular NOIDS currently available in legal high products sold in UK. This marker can be incorporated into routine LC-MS/MS drug screening alongside classic drugs of abuse. Positive detection rates for this new legal high marker are greater than for established classic drugs that are routinely screened such as amphetamine. This work highlights the need for a flexible toxicology screening service capable of adapting to changes in drug use such as the growing popularity of legal highs/NPS.

A New Differential Diagnosis: Synthetic Cannabinoids-Associated Acute Renal Failure.

Synthetic cannabinoids (SCs) are herbal blends that use plant material with varying concentrations of synthetic analogues of cannabinoids. These products are sold as incense or potpourri and are labeled "Not for human use." Even so, rates of abuse are rapidly increasing worldwide, especially in the young adult population. An extensive network of users exists, and the products can easily be ordered on the Internet under various brand names, including the most popular ones, "K2" and "Spice." Not much is known about their spectrum of toxicity and no specific antidote is available at present. Renal failure is a rare complication associated with SC abuse. We describe a case of acute kidney injury associated with use of SCs and present a review of the current literature, including the history and some key pharmacologic and epidemiologic findings related to synthetic cannabinoid compounds.

Synthetic cannabinoid use in a nationally representative sample of US high school seniors.

BACKGROUND: Synthetic cannabinoids are marketed as "legal highs" and have similar effects to cannabis (marijuana). Although prevalence of synthetic cannabinoid use is now declining in the US, use has been associated with tens of thousands of poisonings and hospitalizations, particularly among teens. It is important to examine which teens are at highest risk for use of these new, potentially deleterious drugs as they are understudied and continue to emerge. METHODS: Data were analyzed from a nationally representative sample of high school seniors in the Monitoring the Future study (2011-2013; Weighted N = 11,863; modal age: 18). Bivariable and multivariable models were used to delineate correlates of recent (12-month) synthetic cannabinoid use. RESULTS: Ten percent reported any recent use and 3% reported more frequent use (used ≥ 6 times). Females were at low odds for use and going out 4-7 evenings per week for fun consistently increased odds of use. Black and religious students were at low odds of use until controlling for other drug use, and higher income increased odds of use until controlling for other drug use. Lifetime use of alcohol, cigarettes and other illicit drugs all robustly increased odds of use, but frequency of lifetime marijuana use was the strongest correlate with more frequent use further increasing odds of synthetic cannabinoid use. Only 0.5% of non-marijuana users reported use of synthetic cannabinoids. CONCLUSIONS: This is among the first national studies to delineate correlates of synthetic cannabinoid use. Results can inform national and local efforts to prevent use and adverse consequences resulting from use.

Headspace-gas chromatographic-mass spectrometric analysis of South American commercial solvents and their use in the illicit conversion of cocaine base to cocaine hydrochloride.

This study presents data that establish the makeup of solvents utilized in illicit cocaine hydrochloride production, as determined via the identification of the occluded solvents in the crystal matrix of the final product. The occluded solvent ratios can differ dramatically from the ratios of the original processing solvents. Additionally, the presented data suggest the diversion of commercial solvents to illicit cocaine hydrochloride laboratories. Thirty-five commercial solvents were obtained from five chemical manufacturing companies in South America. Each solvent was qualitatively and quantitatively analyzed using static headspace-gas chromatography-mass spectrometry (HS-GC-MS). After obtaining the chemical profile for each commercial solvent, solvents and/or solvent mixtures were prepared to be comparable in composition to several of the commercial products. Over 90 individual batches of cocaine hydrochloride were prepared from cocaine base using these solvents or solvent mixtures, which match those most commonly employed in clandestine laboratories. Additionally, a number of unique manufacturing by-products produced from processing solvents were identified, and their significance is discussed.

"Spiceophrenia": a systematic overview of "spice"-related psychopathological issues and a case report.

OBJECTIVES: The use of synthetic cannabimimetics (SC; "spice" drugs) is increasing, especially among teenagers and young adults. In parallel with this, the number of studies describing intoxication episodes associated with psychotic symptoms in SC users is growing. We present both a systematic review of the related literature and a case report, which seems to highlight the existence of a possible association between SC use and psychosis. METHODS: Some 223 relevant studies were here identified and reviewed. Out of these, 120 full text articles were assessed for eligibility, and 41 were finally included in the systematic review. RESULTS: According to the available data from the studies here identified, SC's average age of users was 22.97 years, and the male/female ratio was 3.16:1. SC compounds most often reported in studies using biological specimen analysis were JWH-018, JWH-073, JWH-122, CP-47,497, and JWH-250. Mounting evidence seemed to suggest that psychotic symptoms such as hallucinations and delusions may occur in acute/chronic SC users. CONCLUSIONS: Although a clear causal link may not be here identified, the available evidence suggests that SC can trigger the onset of acute psychosis in vulnerable individuals and/or the exacerbation of psychotic episodes in those with a previous psychiatric history.

Acute mental disturbance caused by synthetic cannabinoid: a potential emerging substance of abuse in Hong Kong.

Synthetic cannabinoids are hybrid herbal/chemical products which mimic the effects of cannabis. They are usually marketed as incense or 'herbal smoking blend', and best known by the brand names 'K2' and 'Spice'. Their popularity among recreational drug abusers has grown rapidly due to their easy availability, relatively low cost, non-detection by conventional drug tests, and ease of concealing their use from family and authorities. They took Europe and later North America by storm in the late 2000s, yet limited medical literature exists detailing their adverse effects. They began to emerge in the Hong Kong drug scene in 2009. We report on a man who developed acute mental disturbance after 4 weeks of daily K2 abuse. This is the first case report of mental disorder caused by synthetic cannabinoid abuse in a Chinese.

Chiral gas chromatography as a tool for investigations into illicitly manufactured methylamphetamine.

The aim of this study was to develop a chiral gas chromatographic method for the separation of compounds likely to be found in the EMDE synthesis of methylamphetamine, a heavily abused stimulant drug. Here we describe the separation of the enantiomers of ephedrine, pseudoephedrine, chlorinated intermediates and methylamphetamine using fluorinated acid anhydrides as chemical derivatization reagents prior to gas chromatographic analysis on a 2,3-di-O-methyl-6-t-butyl silyl-ß-cyclodextrin stationary phase (CHIRALDEX™ B-DM). Separation of the enantiomers of pseudoephedrine, methylamphetamine and chloro-intermediates was achieved using PFPA derivatization, and enantiomers of ephedrine using TFAA derivatization, in run times of less than 40 minutes. The use of HFBA as a derivatization reagent for this set of analytes is also discussed.

Widespread pulmonary granulomatosis following long time intravenous drug abuse--a case report.

Foreign body granulomas in the lungs following acute singular or long time intravenous drug abuse are frequent findings during microscopic investigation of the lungs. Most cases present single granulomas. Cases with multiple foreign body granulomas, already palpable during autopsy and leading to pulmonary granulomatosis with multiple granulomas are less frequent. We report the case of a 32-year old man, dying suddenly and unexpectedly after a well-known history of drug abuse for more than a decade. The granulomas are caused by foreign particle embolization immediately after intravenous injection of not only the drug itself but also of adulterants, e.g. cotton fibers, potato starch or microcrystalline cellulose. At the end, a reduction in the size of the pulmonary bed had occurred followed by pulmonary hypertension. For the first time, lung dust in such a case was characterised by energy dispersive X-ray (EDX).

Synthesis and identification of hydroxylated metabolites of the anti-estrogenic agent cyclofenil.

The detection of metabolites of the anti-estrogenic substance cyclofenil, listed on the World Anti-Doping Agency (WADA) Prohibited List since 2004 is described. Target substances are hydroxylated metabolites, bearing an aliphatic hydroxyl group either in the 2-, 3- or 4-position of the aliphatic ring, in addition to the phenolic functions on the aromatic rings. Structural identification used NMR as well as high-resolution mass spectrometry after nano-electrospray ionisation (ESI). Unambiguous detection of all three synthesised cyclofenil metabolites M1-M3 was done using gas chromatography for separation and electron ionisation mass spectrometry for detection of the per-silylated compounds in comparison with a reference urine deriving from an excretion study within the WADA 2007 Educational Programme.

Residual solvents in methylenedioxymethamphetamine tablets as a source of strategic information and as a tool for comparative analysis: the development and application of a static headspace gas chromatography/mass spectrometry method.

Various solvents can be used in the synthesis of the illicit synthetic drug methylenedioxymethamphetamine (MDMA, commonly known as Ecstasy). In the crystallization process, traces of those solvents can be trapped inside crystals; during the following tabletting process, the solvent traces remain present in the tablets. The forensic investigation of tablets for solvents may increase knowledge of production methods and contribute to a possible choice of monitoring or regulating certain organic solvents. Further, the identification and quantification of solvents in MDMA tablets may contribute to the chemical characterization of illicit tablets for comparative examination. The methods of analysis of volatile components in illicit MDMA tablets described so far are often based on solid-phase micro extraction (SPME). To avoid several disadvantages of SPME, a quantitative static headspace method was developed using gas chromatography/mass spectrometry (GC/MS); for quantification, the standard addition method appeared to be advantageous. The residual solvents in 155 MDMA tablets were analysed and 150 of them were quantified.