Rat poison likely to blame for deadly side effects of synthetic pot in Illinois

Photo Illustration of K2. (Christopher Smith / Chicago Tribune)

By Elvia Malagon – Chicago Tribune

April 6th, 2018

Synthetic pot for years was sold under the guise of a cheaper alternative that allows users to dodge drug screenings.

And while there have been rashes of hospitalizations nationwide involving those who’ve ingested fake weed, experts say they’ve never seen the severe side effects — internal bleeding in particular — that have killed at least two and sickened dozens in the Chicago area and central Illinois in the past month. Investigators say that while users have been smoking different brands of the synthetic marijuana, the common ingredient that may be leaving people ill is rat poison.

The problems are the result of a cat-and-mouse game playing out among government entities passing laws to ban synthetic pot and manufacturers tweaking their recipes to keep the drug on the market — and money in their pockets, experts say.

The rat poison likely is to blame for the horrible side effects: internal bleeding, severe bloody noses and bleeding gums, according to the Illinois Department of Public Health. Officials and experts say this underscores the dangers of using synthetic cannabinoid products: Often the man-made drugs are manufactured and packaged under clandestine operations without being tested or otherwise scrutinized like legal medications that go through years of testing on animals and then people.

Typically, synthetic pot is created by spraying chemicals onto plant matter to make it look like real marijuana leaves. It is then packaged by manufacturers and, although bans are in place in Illinois and Chicago, it still makes its way to gas station and convenience store shelves. Officials say those sickened in Illinois were using different brands; still investigators are trying to trace whether it’s possible that the drug is from a single source.

The Centers for Disease Control and Prevention was sending a team to help the Illinois Department of Public Health in its medical investigation into the outbreak. Ninety-five people, two of whom died, have been hospitalized since early March as officials continued to seek answers in the outbreak, according to the state department. Most of the sick patients are 25 to 34 years old.

Synthetic cannabinoid is a man-made mixture of hundreds of chemicals that affect the same brain cell receptors as the active ingredient in marijuana — commonly known as tetrahydrocannabinol or THC — that causes people to get a euphoric high. Often sold and branded as “K2” and “Spice,” synthetic marijuana is typically sprayed on a plant material to be smoked, or it can be sold in a liquid form to be used in e-cigarettes or vaping devices, according to officials.

Many states, including Illinois, have passed laws to keep the substance off the shelves, but experts say manufacturers are constantly tweaking the formula to skirt laws that prohibit certain chemicals. In fewer than 10 years, the types of synthetic cannabinoid formulas jumped from two in 2009 to more than 80 in 2015, according to a report from the U.S. Department of Justice.

But once a law is created, manufacturers work to come up with a different formula in hopes of producing a drug that is legal in some cities and states, said Michael Baumann, a researcher who studies drug affects on the body for the National Institute on Drug Abuse. And manufacturers of the chemicals, often made without oversight overseas, consult scientific articles to see which compounds affect the same brain cell receptors as marijuana, he said.

“It’s hard to know exactly what substances are on the street at any given time,” Baumann said.

In Chicago, a city ordinance banning synthetic marijuana has been in place since 2011. The ordinance lists specific substances and then bans any other “non-prescription substance that has a chemical structure and/or pharmacological effect substantially similar to the active ingredient of marijuana, or tetrahydrocannabinol (THC).” There are also federal laws addressing synthetic drugs.

The Illinois Poison Center has continued to log cases of people becoming sick because of a synthetic cannabinoid product. There were 131 cases in 2015, 84 cases in 2016 and 51 in 2017, according to the agency. Since January, the agency has logged 101 cases statewide.

Chicago Ald. Edward Burke said he thinks the ordinance has been effective. In the wake of the outbreak, the city has made checks across the city at local retailers. But like any other illegal activity, Burke said there is a possibility of transactions happening from person to person.

“They’d be foolish to publicly advertise the products,” Burke said.

Chemists have been studying and developing synthetic cannabinoids as part of scientific research into how it could be used for medical purposes, said Paul Prather, a professor at the University of Arkansas for Medical Sciences. Prather, who has been studying the therapeutic use of synthetic cannabinoid, said the formulas haven’t been tested to determine side effects.

If you use “K2” or “Spice,” “You are the guinea pig ingesting it into your body to see what happens,” Prather said.

Prather said people use synthetic pot because it’s relatively cheap and isn’t detected on drug screenings, such as th

ose sometimes required by employers.

In the recent outbreak, multiple brands of synthetic marijuana products have so far been linked to those who became sick, the state department of health said. It’s possible that the tainted synthetic cannabinoids ended up in different packaging under various brand names, according to the agency.

The Illinois outbreak is the first time Baumann and Prather have heard of severe bleeding as a side effect. Baumann said the outbreak is a sign of the lack of oversight in the manufacture and packaging of the substances.

Of the dozens who fell ill in Illinois after using synthetic pot, at least nine tested positive for brodifacoum, more commonly known as rat poison, according to state officials.

Exposure to rat poison causes the body to block its natural use of vitamin K, which helps in the process of blood clotting, said Dr. Patrick Lank, a medical toxicologist who works at Northwestern Memorial Hospital. A person who has been exposed to this type of poison would have to take vitamin K for weeks to months to help manage their symptoms.

In Chicago, hospitalized users have tested positive for brodifacoum, said Dr. Allison Arwady, chief medical officer for the city’s department of public health.

Most of the Chicago patients have had blood in their urine and stool. Others have complained of abdominal pain, a possible sign of internal bleeding, Arwady said. Patients started seeing symptoms within days of using synthetic marijuana, but city officials are logging information about their use of synthetic marijuana for the past three months as they seek answers to the outbreak.

Most of the patients across Chicago smoked the fake pot, while others vaped the drug or drank it in tea, she said. Some bought the substance at a convenience store, some got it from a friend while others bought it from someone who sells other drugs.

Health officials and law enforcement officials have been talking to the patients as they try to piece together the network distributing the products.

Authorities have already charged in federal court the owner and two workers of the King Mini Mart at 1303 S. Kedzie Ave. in Lawndale after an undercover officer bought synthetic marijuana sold under names like “Blue Giant,” “Crazy Monkey” and “Matrix,” according to a federal complaint. Fouad Masoud, the owner of the mart, and employees Jamil Abdelrahman Jad Allah and Adil Khan Mohammed each face a federal charge of conspiracy to distribute a controlled substance. The store sold $10 packets containing 4 to 5 grams of synthetic pot, according to court records.

Investigators began looking into the Lawndale convenience store after someone who had purchased synthetic pot there got sick. Two of the seized products were sent to a laboratory operated by the U.S. Drug Enforcement Administration, which detected brodifacoum among the other chemicals, according to court records.

As the number of hospitalizations continued to increase, Arwady urged synthetic marijuana users to seek medical attention at the first signs of bleeding. Even minor bleeding can turn into something serious, she said.

“One person might get a very large dose, one person may get the small dose,” Arwady said. “And all of that would affect the time that it would take to notice the symptoms. We know that the folks coming into care might be only a small percentage of people who have been exposed to it.”

emalagon@chicagotribune.com

Twitter @ElviaMalagon

DOT 5 Panel Notice

DOT Drug Testing: After January 1, 2018 – Still a 5-Panel

The DOT testing at HHS-certified laboratories is a 5-panel drug test regimen.  As of January 1, 2018, the ‘Opiates’ category was renamed ‘Opioids’:

  • Marijuana (THC)
  • Cocaine
  • Amphetamines
  • Opioids
  • Phencyclidine (PCP)

Under ‘Opioids’, previously ‘Opiates’, DOT testing will continue to include confirmatory testing, when appropriate, for Codeine, Morphine, and 6-AM (heroin).  We added initial and confirmatory testing for the semi-synthetic opioids Hydrocodone, Hydromorphone, Oxycodone, and Oxymorphone to this Opioids group.  Some brand names for the semi-synthetic opioids include OxyContin®, Percodan®, Percocet®, Vicodin®, Lortab®, Norco®, Dilaudid®, Exalgo®.

Under Amphetamines, DOT testing includes confirmatory testing, when appropriate, for Amphetamine, Methamphetamine, MDMA, and MDA.  To this Amphetamines group, we added initial testing for MDA and removed testing for MDEA.

Since January 1st, we have required confirmation testing for 14 drugs under a 5‑panel test.  Broken out, here is what DOT drug testing looks like:

DOT 5 Panel Profile

Marijuana (THC)
Cocaine
Amphetamines
~Amphetamine
~Methamphetamine
~MDMA
~MDA
Opioids
~Codeine
~Morphine
~6-AM (Heroin)
~Hydrocodone
~Hydromorphone
~Oxycodone
~Oxymorphone
Phencyclidine (PCP)

For DOT testing, what does this mean for collectors, laboratories, MROs, and employers after January 1st ,2018?

  • Collectors will continue to check the 5-panel box in Step 1 of the CCF: That is, the box specified for “THC, COC, PCP, OPI, AMP.”
  • Laboratories will:
  • continue to report to MROs the specific drugs / drug metabolites they confirm as positive, and laboratories will add hydrocodone, hydromorphone, oxycodone, and oxymorphone confirmed positives, as appropriate.
  • on their semi-annual reports to DOT and their semi-annual reports to employers add: hydrocodone; hydromorphone; oxycodone; and oxymorphone confirmed positive totals, as appropriate, under Opioids.
  • MROs will continue to report to employers the specific drugs / drug metabolite they verify as positive; and MROs will add hydrocodone, hydromorphone, oxycodone, and oxymorphone verified positives, as appropriate.
  • Employers will continue to provide – on their annual MIS reports – the number of verified positive drug test results in each testing category (i.e., Marijuana, Cocaine, Amphetamines, Opioids, and PCP).
Updated: Tuesday, March 6, 2018

FAA, PMHSA, FRA & Coast Guard Announce 2018 Random Testing Rates

In December 2017, the Federal Railroad Administration (FRA), Federal Aviation Administration (FAA), and the Pipeline and Hazardous Materials Safety Administration (PMHSA) all announced their random testing rates for 2018. The U.S. Coast Guard (CG) announced its rates in January 2018. No announcements have been made regarding random testing rates by the Federal Motor Carriers Safety Administration (FMCSA) or the Federal Transit Administration (FTA). DATIA will notify members when those rates are announced.

Summary:

– FRA 25% Drug, 10% Alcohol – ** (MOW) Rates – 50% Drug, 25% Alcohol

– PMHSA 50% Drug, N/A Alcohol

– FAA 25% Drug, 10% Alcohol

– USCG 25% Drug, N/A Alcohol

– FMCSA – Not Yet Announced

– FTA – Not Yet Announced

Accelerating progress to reduce alcohol-impaired driving fatalities

New report calls for lowering blood alcohol concentration levels for driving, increasing federal and state alcohol taxes, increasing enforcement, among other recommendations

Date: January 17th, 2018

Source: National Academies of Sciences, Engineering, and Medicine

Despite progress in recent decades, more than 10,000 alcohol-impaired driving fatalities occur each year in the U.S. To address this persistent problem, stakeholders — from transportation systems to alcohol retailers to law enforcement — should work together to implement policies and systems to eliminate these preventable deaths, says a new report from the National Academies of Sciences, Engineering, and Medicine. The committee that conducted the study and wrote the report recommended a number of actions, such as lowering state laws criminalizing alcohol-impaired driving from 0.08 to 0.05 percent blood alcohol concentration (BAC), increasing alcohol taxes significantly, strengthening policies to prevent illegal alcohol sales to people under 21 and to already-intoxicated adults, enacting all-offender ignition interlock laws, and providing effective treatment for offenders when needed.

“While getting to zero alcohol-impaired driving deaths sounds like an overly ambitious goal, it builds on the momentum of Vision Zero, an approach that recognizes that traffic-related fatalities are not just ‘accidents,’ but rather are embedded in a network of events and circumstances with causal links that can be averted,” said committee chair Steven Teutsch, adjunct professor at UCLA Fielding School of Public Health, senior fellow at the Public Health Institute, and senior fellow at the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California. “The plateauing fatality rates indicate that what has been done to decrease deaths from alcohol-impaired driving has been working but is no longer sufficient to reverse this growing public health problem. Our report offers a comprehensive blueprint to reinvigorate commitment and calls for systematic implementation of policies, programs, and systems changes to renew progress and save lives.”

On average since 1982, one-third of all traffic fatalities are due to alcohol-impaired driving, and nearly 40 percent of alcohol-impaired driving fatalities are victims other than the drinking driver, the report says. In 2010, the total economic cost of these crashes was $121.5 billion, including medical costs, earnings losses, productivity losses, legal costs, and vehicle damage. Rural areas are disproportionally affected by alcohol-impaired driving crashes and fatalities.

It can be difficult for individuals to understand how many alcoholic beverages it will take for them to be impaired. Individuals differ in their degree of impairment due to several factors such as weight, age, gender, race, and ability to metabolize alcohol, the report says. In addition, inconsistent serving sizes and the combination of alcohol with caffeine and energy drinks, among other factors, undermine individuals’ ability to estimate their level of impairment.

Most strategies to reduce alcohol-impaired driving have focused on decreasing the likelihood that someone will drive after they are already impaired by alcohol through traditional enforcement and criminal justice approaches; however, broadening the focus to also encompass reducing drinking to the point of impairment is critically important, the report says.

Blood Alcohol Concentration Laws

In all 50 states, drivers age 21 or older are prohibited from driving with a BAC at or above 0.08 percent. However, the committee found that an individual’s ability to operate a motor vehicle (including a motorcycle) begins to deteriorate at low levels of BAC, increasing a driver’s risk of being in a crash. In addition, studies from countries that have decreased their BAC laws to 0.05 percent, such as Austria, Denmark, and Japan, demonstrate that this is an effective policy. Therefore, state governments should enact laws criminalizing alcohol-impaired driving at 0.05 percent BAC, the federal government should incentivize this change, and enacting the new BAC limit should be accompanied by media campaigns and robust and visible enforcement efforts.

Alcohol Taxes

Federal and state governments should increase alcohol taxes significantly, the report says. Strong evidence shows that higher alcohol taxes reduce binge drinking and alcohol-related motor vehicle crash fatalities, yet alcohol taxes have declined in inflation-adjusted terms at both federal and state levels, and taxes do not cover the costs attributable to alcohol-related harms. The report notes that in December 2017, Congress passed a tax bill that would decrease federal alcohol excise taxes by about 16 percent.

Sale and Availability of Alcohol

State and local governments should take appropriate steps to limit or reduce alcohol availability, including restrictions on the number of on- and off-premise outlets and the days and hours of alcohol sales, the report says. Off-premise outlets are establishments where alcohol can be sold but not consumed, such as supermarkets, and on-premise outlets are establishments where alcohol can be sold and consumed, such as bars and restaurants. In addition, federal, state, and local governments should adopt or strengthen laws and dedicate enforcement resources to stop illegal alcohol sales to already-intoxicated adults and people under 21. This includes strong penalties for licensed retailers or purveyors who engage in illegal alcohol sales to already-intoxicated adults, high-quality, mandatory training in responsible beverage service for managers, and compliance checks using underage decoys.

Alcohol Advertising and Marketing

Federal, state, and local governments should use their existing regulatory powers to strengthen and implement standards for permissible alcohol marketing content and placement across all media, establish consequences for violations, and promote and fund counter-marketing campaigns, the report says. Young people are at higher risk of alcohol-impaired driving and are influenced by alcohol marketing. In addition, the alcohol industry’s self-regulation of its marketing is ineffective and insufficient because the voluntary standards are permissive and vague, not consistently followed, and without penalties for violations.

Sobriety Checkpoints

Sobriety checkpoints aim to identify and arrest alcohol-impaired drivers as well as increase the perceived risk of arrest to deter driving while impaired. Given strong evidence of the effectiveness of highly publicized sobriety checkpoint programs to reduce alcohol-impaired driving fatalities in urban and rural areas, the report says, states and localities should conduct frequent sobriety checkpoints in conjunction with widespread publicity of these initiatives.

Ignition Interlocks

There were more than 1 million arrests for driving under the influence in 2015, and while about 20 percent to 28 percent of first-time DWI offenders will repeat the offense, reoffenders are 62 percent more likely to be involved in a fatal crash. Strong evidence from the U.S. and other countries, such as Canada, shows that individuals convicted of alcohol-impaired driving who have ignition interlocks installed on their vehicles are less likely than others to be rearrested for alcohol-related driving or to crash while the device is installed. Therefore, all states should enact laws to require ignition interlocks — breath alcohol analyzers connected to the ignition system of a vehicle — for all offenders with a BAC above the limit set by state law, the report says. Evidence shows that a minimum monitoring period of two years for interlock devices is effective for a first offense, and four years is effective for a second offense.

DWI Courts and Treatment

Every state should implement DWI courts — specialized courts aimed at changing DWI offenders’ behavior through comprehensive monitoring and substance abuse treatment — guided by the evidence-based standards set by the National Center for DWI Courts. In addition, an arrest for DWI or admission to the hospital for an alcohol-impaired driving injury presents the opportunity to screen and treat individuals who engage in hazardous drinking. Therefore, all health care systems and health insurers should cover and facilitate effective evaluation, prevention, and treatment strategies for binge drinking and alcohol use disorders including screening, brief intervention, and referral to treatment (SBIRT), cognitive behavioral therapy, and medication-assisted therapy.

Alternative Transportation

Municipalities should support policies and programs that increase the availability, convenience, affordability, and safety of transportation alternatives for drinkers who might otherwise drive, the report says. This includes permitting smartphone-enabled ride sharing, enhancing public transportation options (especially during nighttime and weekend hours), and boosting or incentivizing transportation alternatives in rural areas.

In-Vehicle Technologies

The Driver Alcohol Detection System for Safety (DADSS) program is a cooperative research partnership between the National Highway Traffic Safety Administration (NHTSA) and the Automotive Coalition for Traffic Safety to develop noninvasive, in-vehicle technology that prevents drivers from operating vehicles when their BAC exceeds the limit set by state law. Given strong public support and endorsement from various sectors, once DADSS is accurate and available for public use, auto insurers should provide policy discounts to stimulate its adoption. Once the cost is on par with other existing automobile safety features and is demonstrated to be accurate and effective, NHTSA should make DADSS mandatory in all new vehicles.

In order to ensure coordination across federal agencies, NHTSA should create a federal interagency coordinating committee to develop and oversee an integrated strategy, assure collaboration, maintain accountability, and share information among organizations committed to reducing alcohol-impaired driving, the report says.

Data collection and reporting of high-risk intersections, outlets, drinking behaviors before driving, risk factors, place of last drink data, and demographic trends are needed to measure, evaluate, and accelerate progress in reducing risk of fatalities. To fill data gaps and better integrate datasets, NHTSA also should ensure that timely standardized data on alcohol-impaired driving, crashes, serious injuries, and fatalities are collected and accessible for evaluation, research, and strategic public dissemination.

The study was sponsored by the National Highway Traffic Safety Administration. The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine.