American Association of Poison Con-

trol Centers, National Poison Data

System report, exposure calls as a

result of gabapentin increased from

5,889 in 2012, to 20,064 in 2016.

The DEA reports that, in a cohort of

503 adults reporting nonmedical use

of pharmaceuticals (and not enrolled

in treatment facilities for such illicit

use) in Appalachian Kentucky, 15% of

respondents reported using

gabapentin specifically to “get high”.

This number represented a 165%

increase compared to one year prior

and a 2,950% increase from 2008

respondents within the same cohort,

and IMS Health reports that from

2011 to 2017, total prescriptions for

gabapentin steadily increased over

two-fold from 2,965,784 to

6,722,145.

(Continued on Page 4)

By Travis Herbert, DECP Unit

P hone rings: “Hey- what’s

up?”

Caller: “Hey, have you heard

about gabapentin?”

Me: “Yeah, it’s an anti-seizure medi-

cation. It’s not supposed to be a

drug people really seek when they

want to get high.”

Caller: “I keep doing evaluations on

people who use it. Why would they

use if it doesn’t get them high?”

Me: “That’s a good question. Let me

dig around and see what I can find”.

That was me… not too long ago. My,

have times changed. A simple

search of gabapentin in just about

any search engine will yield you

some interesting results. Use is on

the rise. Across all boards, gabapen-

tin is being used with increased

frequency. According to GoodRX, in

May 2018, gabapentin was the 5th

most prescribed drug in the nation.

It was the #1 drug dispensed in Ohio

as of December 2016, and according

to the RADARS research group within

the Denver Health and Hospital Au-

thority, the abuse rate has increased

nearly 400% between 2006 and

2015. According to the 2016 the

I t’s becoming increasingly com-

mon to come across impaired

drivers abusing prescription

medications. Many of these medica-

tions are CNS depressants and there

are dozens of drugs in this category.

When we evaluate these people in

the field, impairment is usually sig-

nificant and easy to determine. CNS

depressant medications, when

abused, produce very similar “drunk

like” effects such as slurred speech,

bloodshot eyes, poor coordination,

LOC, HGN, and VGN. Unfortunately,

many of these drugs, unless they are

in the subcategory benzodiazepine,

are not detected in blood or urine

samples submitted to our crime labs.

One such drug in particular is Cari-

soprodol, widely known by its brand

name Soma.

Soma is a potent sedative and a centrally acting muscle relaxant. It is very commonly prescribed for skele-tal muscle injuries. Like other CNS depressants, Soma is a schedule IV controlled substance and has been shown to have potential for abuse. Soma abuse has been on the rise for years. According to the 2012 Nation-al Survey on Drug Use and Health, 3.69 million people, aged 12 and older, used Soma for non- medical reasons in their lifetime. (Continued on page 3)

Neurontin® capsule. Gabapentin

use in on the rise.

Going Goofy For Gabbys: Gabapentin Is

Not Just Your Mother’s Pain Medication

I N S I D E

T H I S I S S U E :

Goofy For

Gabbys

1

Soma Abuse 1

California

and Cannabis

2

Word of the

Day

2

Molly History

Lesson

3

Convergence

Word Solved

4

Indications of Soma Abuse and Intoxication

by Matt Iturriria – CHP Bakersfield Area

C A L I F O R N I A

H I G H W A Y P A T R O L

Impaired Driving

Newsletter F O U R T H Q U A R T E R , 2 0 1 8 V O L U M E 1 , I S S U E 4

D R U G

S P E C T A C U L A R !

• Why are we seeing

an increase in

gabapentin use?

• What does a an

evaluation look like

on someone who is

under the influence

of carisoprodol?

• MDMA history

lesson

P A G E 2

“California was the

first state in the

country to “legalize”

the use and

cultivation of medical

marijuana when we

passed Proposition

215.”

Word Of The Day:

California and the Federal Government; The Cannabis Conflict

Captain Tyler Eccles, California Highway Patrol , DRE #10897

O f the many questions asked of me over the last 15 years both within and

outside the DRE program relating to cannabis, the greatest confu-sion surrounds to the relationship between the State and Feds. The following are a sample of patrol level inquiries:

Hasn’t California adopted cannabis laws that are in clear violation of Federal statutes?

Isn’t cannabis still a felony at the Federal level and can’t I enforce the Federal law?

Has the Federal government legal-ized medical cannabis in Califor-nia?

Will I be breaking the law if I take enforcement action or don’t take action against someone who claims a medical exemption?

The answers to most questions associated with cannabis laws are clear. The answer simply put is often, “Yes and no.” Ambiguity is the best friend of our State canna-bis laws. To understand and an-swer the questions above and many more associated with Feder-al laws, it is important to under-stand the direction provided by the United States Department of Justice (US DOJ). Guidance and directives provided by US Attorney General are the foundation to understanding how the Feds oper-ate in California and other similar States.

California was the first state in the country to “legalize” the use and cultivation of medical marijuana when we passed Proposition 215, also known as the Compassionate

Use Act of 1996 (CUA). Several States also adopted similar mariju-ana statutes over the decade that followed. Many individuals found themselves on the wrong end of Federal cannabis enforcement claiming State protection due to the “legalized” nature of medical marijuana during this period of medical marijuana expansion. In October of 2009, Deputy Attorney General David W. Ogden released a memorandum which addressed limited prosecutorial resources of the US DOJ and provided guidance to Federal prosecutors in states that enacted laws authorizing medical use of marijuana. This memorandum (known as the Ogden Memo) states in part, “As a general matter, pursuit of these priorities should not focus federal resources in your States on indi-viduals whose actions are in clear and unambiguous compliance with existing State laws providing for the medical use of marijuana.” The challenge with this prosecuto-rial directive for California is that the CUA was everything but clear and unambiguous. Following this memorandum many States in-quired with the Federal govern-ment regarding the status of com-mercial cultivation and distribution of marijuana at the State level.

As a result of these inquiries, the Federal government provided clarification in a memorandum from Deputy Attorney General James M. Cole on June 29, 2011. This memorandum states in part, “The Department’s view of the efficient use of limited federal resources as articulated in the Ogden Memorandum has not changed… Persons who are in the

business of cultivating, selling or distributing marijuana, and those who knowingly facilitate such activities, are in violation of the Controlled Substances Act, regard-less of state law.” For several years following the release of these memos many law enforce-ment personnel in States with medical marijuana statutes (to include us in California) claim to have experienced a reduction in Federal marijuana enforcement and an increase in commercial medical marijuana activity. On January 4, 2018, Attorney General Jeff Sessions established prosecu-torial directives under the new administration with a memoran-dum of his own. This memo states in part, “Given the Department’s well-established general princi-ples, previous nationwide guid-ance specific to marijuana en-forcement is unnecessary and is rescinded, effective immediately.”

The current standing of the US DOJ is that cannabis is illegal and they reserve the right to enforce the law as it is written. A long term and sustained increase in Federal enforcement of cannabis violations here in California is yet to be seen. It is imperative for each of us to be very familiar with our agency policies relating to cannabis enforcement. While your enforcement action of all things cannabis may comply with State and Federal law, you may violate internal policies which are meant to address the liability of such actions. My one piece of advice… KNOW YOUR POLICIES!

Gar·ru·li·ty

/ɡəˈroo͞lədē/

noun:

excessive talkativeness, especially on trivial matters.

"During the evaluation, the suspect resorted to garrulity in attempt to show they

were unimpaired.”

Soma, From Page 1

P A G E 3 V O L U M E 1 , I S S U E 4

ly from then until the 1970’s, when Dr. Alexander “Sasha” Shulgin introduced it

to psychotherapists. Its side effects outweighed its benefits and it became known as a club drug and was featured

in Dr. Shulgin’s PIKAL, where he includ-ed its recipe. After MDMA became popular in the rave scene, Dr. Shulgin

lamented that it had been “sidetracked into the Yahoo generation.” Today, it’s still popular in music and in the club or rave culture. Songs like “Mask Off”, by

Future glamorize the drug. Evaluations of people suspected to be under the

By Travis Herbert, DECP

3,4 Methylenedioxymethamphetamine, or MDMA, or was first developed in

1912 by the Merck Pharmaceutical Company in Germany. It was originally known as Methylsafrylaminc, and was intended to be used as a parent com-

pound to control bleeding. It is often claimed that MDMA was used to con-trol appetite, but that is not the case.

Merck did not show much interest in the drug, and its use pops up periodical-

influence of MDMA would present much like a CNS

Stimulant, despite that MDMA falls in the hallucinogen catego-

ry.

What Is the History of MDMA?

MDMA, often called “Molly” on the

streets and in popular music.

“Perhaps the

most

significant

indicator I

have

experienced is

profoundly

dilated

pupils.”

Ideas for submission?

Email us at

DRE@chp.ca.gov

Abuse statistics of Soma show that people who use the drug for 3 months or longer have a higher risk of develop-ing an addiction to Soma. If you have been a DRE trained officer

for any amount of time, you have prob-

ably evaluated a subject abusing Soma.

What’s interesting about Soma is that it

has some particular indicators that

other CNS depressants may not. For

Instance, I’ve noticed in my experiences

with Soma intoxication that subjects

usually display slurred speech and tend

to stutter as well. Agitation is also very

common and specific to Soma intoxica-

tion.

Perhaps the most significant indicator I

have experienced is profoundly dilated

pupils. In fact, 9.0 mm pupils are very

commonly seen in my experiences with

Soma intoxication. Keep in mind that

dilated pupils for Soma is one of the ex-

ceptions on our DRE matrix for CNS de-

pressants. This is where the inexperienced

DRE may get confused.

To make things even more complicated is

the fact that Soma is commonly pre-

scribed by doctors with Vicodin (narcotic

analgesic). In cases where the subject is

abusing both drugs, of course we would

see significant impairment. The antagonis-

tic effect in regard to pupil size, the over-

lapping effect with HGN and additive

effect with heart rate/ blood pressure

could also be evident.

I’ve also found in my experiences that

tolerant users of Soma will also mix the

drug with alcohol. In fact I just arrested a

subject a few days ago that appeared to

be severely impaired by alcohol. He had

the strong odor, unsteady gait, bloodshot

eyes, slurred speech, etc. After obtaining

a BAC that did not correlate with the

severity of his HGN (.07%), I performed a

drug influence evaluation. His pupils were

8.5 mm in near total darkness with

a really slow reaction to light. The

subject later admitted he has been

prescribed Soma for a back injury

he sustained over a year ago.

Just keep in mind that Soma is a

very commonly prescribed and

abused drug. The eyes will general-

ly tell you the story.

prescribe gabapentin for, and there are no

guidelines for things such as amounts, or

the number of refills one can get. Wait,

what? You mean a doctor can prescribe it

for something it was never intended to be

used for? Yes! According to the Journal

of Managed Care Pharmacy, gabapentin

has been prescribed off-label for treating

depression to lack of sleep, and a multi-

To understand its increased usage, we

need to understand what it is. Gabapen-

tin (Neurontin®) is a prescription medica-

tion approved by the FDA for treatment of

neuropathic pain and epileptic disorders.

According to its FDA- approved label,

gabapentin is used clinically in the man-

agement of postherpetic neuralgia in

adults and as an adjunctive therapy in the

treatment of partial onset seizures and

with and without secondary generaliza-

tion in adults and pediatric patients 3

years and older with epilepsy.

So, it’s for nerve pain and seizures. Well

there you go! That’s why we are seeing

an increase, right? Hold on a second.

Let’s dive a little deeper. Turns out,

gabapentin is NOT scheduled according to

the Controlled Substances Act of 1970.

What does that mean? It means that

according to the DEA, doctors don’t really

have any limitations on what they can

tude of other ailments, including drug

addiction. Since it’s not regulated, a doc-

tor has no real limitations in the amount

of gabapentin he or she can prescribe.

Interestingly, people found gabapentin in

and of itself does not produce much eu-

phoric effect, if any. It does, however,

potentiate the effects of numerous drugs,

including opiates and other depressants.

This is why we are seeing an increase in

the number of people abusing gabapen-

tin; it makes the other drugs’ effects

stronger, it’s cheap and very easy to get,

and there is no regulation.

During your evaluations, ask your subject

about gabapentin use. Be sure to include

gabapentin on your toxicological screen

requests, as it is not a part of a typical

toxicology screen.

Email: therbert@chp.ca.gov

Impaired Driving Section

601 N. 7th Street

Sacramento, CA 95811

Phone: 916.843.4360

Fax: 916.322.3169

E-mail: DRE@chp.ca.gov

California Highway Patrol

Gabapentin, From Page 1

“Systematic Standardized Evaluation”

Gabapentin in various generic

forms.

Impaired Driving Newsletter 4

Answers From Last Issue