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Drug Recognition Experts Bangor Police Department Bath Salts in the Bangor Area Slide 2 Slide 3 Bath Salts What are they? What effects do they have on people? What are they called on the street? Where does it come from? How do they take it? How long will the intoxication last? What are we seeing on the streets of Bangor? Slide 4 Items marketed as bath salts research chemicals or plant food are actually Synthetic Cathinones They have no value as marketed These synthetic cathinones that have hit the streets suddenly The popularity of these products has surpassed that of many typical street stimulants Bangor seems to have more than its share of these substances Slide 5 MDPV aka 3,4-methylenedioxypyrovalerone Mephedrone aka 4-methylmethcathinone, 4-MMC Methylone aka 3,4-methylenedioxymethcathinone, MDMC Naphyrone aka napthylpyrovalerone, NGR-1 4-Fluoromethcathinone aka 4-FMC, flepherdone Methedrone aka 4-methoxymethcathinone, bk-PMMA, PMMC Butylone aka bk-MBDB, beto-keto-N-Methylbenzodioxolylpropylamin Chemical compounds Slide 6 Khat Khat is typically chewed like tobacco. The fresh leaves, twigs, and shoots of the Khat shrub are chewed, and then retained in the cheek and chewed intermittently to release the active drug. Dried plant material can be made into tea or a chewable paste. Khat can also be smoked and even sprinkled on food. Slide 7 As of June 8, 2011, 30 states have legislatively banned synthetic cannabinoids (Spice, K-2 and JWH-018) Only 12 states have done so for synthetic cathinones. Slide 8 Effects Very similar signs and symptoms as CNS stimulants such as cocaine, MDMA and amphetamines. Many stimulant users prefer these substances because they are cheaper and the effects last much longer. Slide 9 Street names Ivory Wave Vanilla Sky Energy 1 Explosion Meow Plant food Bubbles Purple Rain Cloud 9 Monkey Dust Anything Monkey Slide 10 Sources These substances are NOT currently illegal Purchased in the head shops and, in some areas, gas/convenience stores The internet is currently a big source Slide 11 Slide 12 Slide 13 Mephedrone (4- MMC) 100g $430 500g $1400 1000g $2400 Methylone (bk- MDMA) 50g $340 100g $590 500g $1600 1000g $3130 MDAI 100g $800 500g $2500 Bulytone (bk- MBDB) 50g $430 100g $800 500g $2325 1000g $3985 MDPV 25g $355 50g $640 100g $1270 500g $4535 JWH-250 10g $350 25g $800 JWH-018 25g $350 50g $625 100g $1100 500g $2870 TFMPP 100g $250 500g $750 1000g $1200 Slide 14 The problem The American Association of Poison Control reported poison centers took 302 calls in 2010 about synthetic cathinones. As of May 12, 2011 the US poison control centers had received 2,237 calls. Northern NE Poison Center Slide 15 Ingestion Swallowed Snorting (most common) Injection Slide 16 Smoking with a crack pipe Smoking soaked cigarette Smoking Off foil Ingestion Slide 17 Onset and Duration Effects begin 5 15 minutes after use Euphoric effect can last over three hours Impairment remains long after the euphoria is gone Slide 18 Effects Increased heart rate Agitation Diminished requirement for sleep Lack of appetite Increased alertness and awareness Anxiety Fits and delusions Nosebleeds Slide 19 More serious effects Muscle spasms Increased BP Hallucinations Aggression Severe paranoia Panic attacks Sharp increase in body temps Kidney failure or risk of renal failure Muscle damage Loss of bowel control Potential for self harm Confusion Strong drive to use the substance despite the harmful effects Slide 20 Bangor Incidents The following are examples of some of the encounters the Bangor Police have had with subjects under the influence of synthetic cathinones. Slide 21 LE assists EMS with a complaint of a heart attack He showed severe anxiety He said he took Cloud 9 about 4 hours prior Self described as extreme paranoia, heart racing with pain and burning all over his body The officer noted Eugene folded over at times and could not be still Subject was transported to EMMC. He stayed for three days Eugene 35 years of age 03/04/11 Slide 22 Follow up interview with Eugene days later Superman baggie costs $30.00 The day he went to EMMC he took 12 bags He said most people snort it He said it was like cocaine but without the withdrawals He said the cravings are stronger than cocaine When he shoots it up it is closer to a crystal methamphetamine high Slide 23 Traffic stop with a complete DRE evaluation and noted psychophysical condition. Urinalysis later confirmed Cannabis Buprenorphine (a narcotic analgesic) & MDPV (methylenedioxypyrovaleron) 03/17/11 Jamie 31 year old female Slide 24 The Traffic stop -A store clerk called BPD with a suspected drunk driver at the gas pumps. -Smelled of alcohol -Having balance problems -Det. Tall arrives as it is leaving the lot and observes enough impaired driving to stop the car. Slide 25 Personal Contact Female driver making frantic and odd movements in the vehicle Det. Tall describes it as Jumping around in the front seat of the vehicle placing her head down by the floor and reaching her arms around her head. She put her license into her mouth and started to chew and grind her teeth on it. Twice She completely turned around in the drivers seat to face the officer. Slide 26 After she exited the m/v she continued with the jerky movements and jumping back and forth She constantly wrapped her arms around her head, leaned to the side to pull her pant legs up Claimed to have ADHD and off her medications. She said her related movements were due to that deficiency. Personal Contact Slide 27 Field Sobriety Tests HGN Unable to check because she could not watch the stimulus or focus on the finger. She kept looking away Walk & Turn Balance during instructions Stepped off the line Used arms for balance One Leg Stand Used arms for balance and counted 21,22,21. Slide 28 Admissions Suspect made comments about using bath salts. When asked about drug use she denied it but later admitted to smoking marijuana Paraphernalia Marijuana pipe seized Aluminum foil pieces several rolled up Several foils burned with a hole through them Slide 29 DRE Evaluation Preliminary exam Thirsty & complained of dehydration BAC = 0.00% - no alcohol in her system Denied taking meds/drugs but had a Vicodin two days prior Constant exaggerated movement Talkative vulgar language Bloodshot eyes Ptosis (droopy eyelids) Slide 30 Unable to determine pulse BP 156/96 Pupil size 3.5-3.5 mm 3.5-4.0 mm 3.0-3.5 mm No HGN or VGN Items of note 120-140/70-90 mmHg 2.5 5.0mm 5.0 8.5mm 2.0 4.5mm Normal Slide 31 Complained of a rash Emotional swings - crying then laughing Major muscles were contracting with head/neck contortions She was unable to sit still for more than 5 seconds at a time Complained of being hot and overheating Mild paranoia Slide 32 My Video observations As if her mind is cognizant but muscles not getting the messages comprehends process Short waves of motion then emotion then agitation Agitation increases with involuntary movements Slide 33 Amy 26 years old 3 calls to MSP 911 center First call 1.Open line no one talking to dispatch Satellite to track to residence She denied calling Cleared with a warning Slide 34 Amy 26 years old 3 calls to MSP 911 center Second Call 2. Screaming about people trying to get into her apartment Police respond but call is baseless. Warned for misuse of 911 services Slide 35 Amy 26 years old 3 calls to MSP 911 center Third call 3. Open line but dispatch hears Please dont hurt me Baseless Convinces to go to EMMC for med/psych evaluation Slide 36 Officers notes Upon arrival we found no one around. Amy was very paranoid and agitated, pacing, looking out the window, very jumpy and irrational. Thinking people want to kill her. Amys boyfriend states that she ingested bath salts earlier Amy 26 years old Slide 37 Amy was very sweaty, wet clammy skin, sweat dripping off her face. Checked her pulse and noted an extremely rapid heart rate. Complained of being very thirsty Taken to EMMC for eval of psych issue or rule out overdose Amy 26 years old Slide 38 Nick 28 years old Voluntarily in the station because he wanted to work for MDEA against a residence. He displayed typical signs of cathinone user I interviewed for training purpose only He was addicted to methamphetamines then cocaine but his drug of choice is opiates. He has track marks on both arms and admits to being a junky. Slide 39 Between rants and deliriums he told me the following: There are current 3 types of bath salts in the Bangor area. He described one as white, one as brown and the third he could only tell me was short lived. He said the cutting agents determined the color of the final product. He injects his drugs but most will smoke it with a crack pipe. It leaves a crusty residue in the pipe. He said some called it something like Skatle Slide 40 The quality of the product determines the quality of the high just like cocaine He said the bath salts give him energy but do not make him paranoid He believes he can and currently was functioning fine while using the bath salts. WRONG!! Right now there is a lot of cocaine available on the street because the salts are the preferred stimulant. Slide 41 Jerimy Male 33 Neighbors called for yelling and breaking glass Officers find Jerimy at ground floor bathroom window, paranoid and yelling. Jerimy had broken the toilet and sink and smashed the window to get help Mild cuts taken to EMMC for evaluation Slide 42 Follow up interview at EMMC Paranoid hallucinations of MDEA listening Confused rambling convinced his earlier hallucinations about people trying to kill him were real and that we are confused Restless and agitated Mood swings morose to agitated Slide 43 Follow up interview at EMMC Pulse rate 111-126 BPM by heart monitor Pupils 4.5 5.0 mm in room light Complained of pain with Novocain injections Thirsty with dry mouth Admitted to taking bath salts last night. Slide 44 Currently the State of Maine is not planning to make the synthetic cathinones illegal. They are relying on the federal government to so. The federal government is investigating and collecting data but has not passed a law or an emergency measure. Synthetic cathinones will remain available Slide 45 Your call A person acting strange Neighbor hears yelling from an apartment 911 hang ups Your response? Slide 46 What is going on behind that door? Slide 47 Hallucinations To the drug user the hallucinations ARE REAL!!! Their paranoia can be directed at you, intentionally or mistakenly Their agitation will build if you contradict them These are NOT automatic blue papers Slide 48 These people are paranoid and may be hallucinating, often about people trying to harm them They may exhibit classic fight or flight posturing. Stay alert They will converse and understand and reason with you have patience. Slide 49 Avoid confrontation Talk in a calm voice & identify yourself Avoid arguing/debating about the delusions If they are sure of something agree Minimize the stress - If they are paranoid, looking out the window then move them to another room where they feel safe Your actions my increase stresses. Slide 50 Theyre typically alert, responsive & listening Offer to get them to a safe place If the hospital sounds like a safe place to them then bring them If you have actual, specific PC for a blue paper consider that option. He/she may not agree. Find a responsible babysitter if possible If they are committing a crime consider arrest Emotions may cycle. If theyre agitated then wait a few seconds and ask a different line of questions. Slide 51 Officer Safety Slide 52 tom.reagan@bangormaine.gov 947-7384 ext 5706