Exploring six emerging drugs of abuse

Abuse of unregulated synthetic drugs — found on the shelves of some gas stations, convenience stores, and head shops and on the Internet — has been on the rise, particularly among teens and young adults.
“It’s a very experimental population and they’re interested in trying the latest or new thing,” said John Douglas MD, clinical director of Silver Hill Hospital’s Outpatient Opioid Addiction Programduring a meeting of the Wilton Task Force to Reduce Substance Abuse Among Youth on Thursday, March 19.
Dr. Douglas told the group of 16 attendees about the six most common emerging drugs — synthetic cathinones (“bath salts”), piperazine derivatives (“legal ecstasy”), kratom (“Ithang”), methoxetamine (“legal ketamine”), synthetic cannabinoids (“legal marijuana”), and Salvia divinorum (“Salvia”).
Dr. Douglas explained that people who develop drug addictions usually start using drugs in their teen years.
“People who develop addiction usually start in adolescence and it’s usually under social pressure,” he said, “so if you’re able to prevent someone from developing an addiction in adolescence, you can save them a lifetime of misery.”
Synthetic drugs are often derivatives of other drugs whose chemicals have been changed, said Dr. Douglas. Because of their novel chemical structures, they are often not detected in standard urine drug screenings, making them appealing to people who regularly undergo such tests.
One reason the use of synthetic drugs is surging, said Dr. Douglas, is because they are often unregulated by the United States Drug Enforcement Administration.
Dr. Douglas said the government started noticing there were many new drugs that weren’t being regulated and passed the Synthetic Drug Abuse Prevention Act of 2012.
“With a title like that, you’d think that would have solved the problem, but that’s not what happened,” said Dr. Douglas. “It made some illegal but it left some of them still unregulated.”
Because they are widely available, Dr. Douglas said, people tend to think synthetic drugs are safe.
“When people see things sold on the shelves of stores they go into, they think they must have passed some regulatory standard,” he said, “but really, they’re untested chemicals and we just don’t have the laws active to prevent people from selling them.”

Synthetic cathinones

Synthetic cathinones are commonly sold under the name “bath salts,” said Dr. Douglas, as a “marketing ploy” to hide the fact they are drugs of abuse.
Cathinone is the psychoactive chemical of the East African khat plant, and synthetic cathinones are considered cheaper alternatives to methamphetamines or cocaine.
According to Dr. Douglas, “desired” effects of the cathinones include intense joy, heightened alertness, elevated energy, and increased sexual arousal. “Undesired effects” include intense cravings, severe agitation, psychosis, self-mutilation, and suicide attempts.

The cravings produced by synthetic cathinones are similar to those experienced with methamphetamines.
“These cravings cause people to take repeated doses of the synthetic cathinones, which increases their chance of medical complication,” he said. “People have had heart attacks, arrhythmias and have died from using bath salts.”
Synthetic cathinones increase heart rate, blood pressure and body temperature; some of its street names are “Charge Plus,” “White Lightning” and “Meow.”

Piperazine derivatives

Piperazine derivatives, or “legal ecstasy,” are powdered substances that are crushed into pills.
Benzylpiperazine, or BZP, is a popular piperazine derivative, said Dr. Douglas, which has been designated a Schedule I substance in the United States.
“Piperazine is a dirty category of drug — you may get the drug cut with other drugs like meth or cocaine,” he said. “You never really know what you’re getting with this drug, and that’s what makes it dangerous.”

In low doses, piperazine derivatives produce a stimulant effect, while high doses produce a hallucinogen effect. It can bring on palpitations, anxiety, headache, nausea, and vomiting.
Physical signs of piperazine derivative consumption include increased heart rate and body temperature, as well as dilated pupils and seizures.
“Cosmic Jet,” “Party Pills” and “XXX Strong as Hell” are some street names of piperazine derivatives.


Kratom is the leaf of the Mitragyna plant — native to Southeast Asia — which contains a psychoactive chemical compound called “mitragynine.”
Dr. Douglas said kratom has been used for centuries to treat acute pain experienced during opiate withdrawal.
It is usually smoked or brewed into tea, but it’s also chewed or taken as pills.

“It works just like other opioids like heroin or morphine,” he said, “but it’s 13 times more potent than morphine.”
Kratom’s desired effects include intense joy and sedation, while its undesired effects include nausea, vomiting, dry mouth, constipation, and confusion.
“Ithang,” “kakuam,” “ketum,” “krypton,” and “thom” are just some of kratom’s street names, and its physical signs include pinpoint pupils and respiratory depression.
Currently, kratom is legal to buy and sell, said Dr. Douglas, and it’s commonly bought over the Internet.


Although it’s much more common in Europe, said Dr. Douglas, methoxetamine — also known as “legal ketamine” and “legal special K” — has started popping up in the United States.
Methoxetamine is a synthetic derivative of the veterinary anesthetic ketamine.
“It’s a white powder and it’s usually snorted or ingested,” said Dr. Douglas, “but very little is known about its toxicity.”

Other names for methoxetamine include “MXE,” “M-Ket, “Kmax,” and “Mexxy,” and its physical signs include increased heart rate and rotary nystagmus.
Desired side effects of methoxetamine include intense joy, disconnected feeling and hallucinations, while undesired side effects include nausea, vomiting, diarrhea, paranoia, and anxiety.
According to Dr. Douglas, methoxetamine can be bought online, where it’s listed as a research chemical and “not for human consumption.”

Synthetic cannabinoids

Dr. Douglas said synthetic cannabinoids — which are sprayed onto a wide variety of plant matter — are a “really interesting category” that he thinks “everyone should be aware of right now.”
“They stimulate the same receptors as marijuana but have a completely different chemical structure,” said Dr. Douglas.
Synthetic cannabinoids stimulate CB1 receptors in the central nervous system, and “many bind with stronger affinity than THC.”

“It’s a common substance that I particularly ran into when I worked in a psychiatric emergency setting,” said Dr. Douglas.
“Most patients bought it at convenience stores, but they’re also sold as incense or potpourri online.”
There are many street names for synthetic cannabinoids, said Dr. Douglas, including “K2,” “Spice,” “Legal Bud,” “Cloud 9,” and “Black Magic.”
Desired effects of synthetic cannabinoids include intense joy, relaxation and slowed time. Undesired effects include social withdrawal, impaired judgment, impaired short-term memory, anxiety, paranoia, and psychosis.
Physical signs include dry mouth, red eyes, increased heart rate, and impaired coordination.

Salvia divinorum

Salvia divinorum is a mint herb, native to Mexico, that causes vivid, brief hallucinations and minimal side effects.
Similar to piperazine, Dr. Douglas said, “you don’t always know if you’re getting the same thing from one package to the next.”
Salvia divinorum’s other names include “Diviners Sage,” “Magic Mint,” “Maria Pastora,” “Purple Sticky,” Sally D,” and “Salvia Zone.”