Designer drugs have exploded onto the scene in the past decade. These psychoactive substances are often manufactured overseas and sold in the U.S. over the internet. Others are sold in gas stations, smoke shops, or convenience stores. Marketed as natural, consumers think they are less dangerous. Side effects differ, but when taken in high doses, synthetics can cause aggressive and violent behavior. In 2016, synthetic opioids (primarily illegal fentanyl) passed prescription opioids as the most common drugs involved in overdose deaths in the United States.

Synthetic stimulants

Synthetic stimulants, aka bath salts, are substitutes for illicit stimulants like methamphetamine and cocaine. Bath salts are sold in small plastic or foil packages, and can be swallowed, snorted, smoked, or injected. Street names include Flakka, Bliss, Cloud Nine, White Lightning and Vanilla Sky, among others. The use of bath salts contributed to nearly 23,000 emergency room visits in 2011.

Users of synthetic stimulants may experience symptoms of:

• Increased alertness
• Euphoria
• Agitations
• Hallucinations
• Increased heart rate
• Seizures/Tremors

Synthetic Cannabinoids

Synthetic cannabinoids, commonly known as Spice or K2, have similar effects to marijuana. They can also show symptoms of stimulants or hallucinogens. Synthetic cannabinoids are human-made mind-altering chemicals that are either sprayed on dried, shredded plant material so they can be smoked or sold as liquids to be vaporized and inhaled in e-cigarettes and other devices. Effects may be similar to marijuana, or can act like a stimulant or hallucinogenic.

Users of synthetic cannabinoids may show symptoms including:

• Agitation
• Seizures
• Hypertension
• Violent behavior
• High blood pressure
• Dilated pupils
• Rapid heart rate
• Kidney failure

Synthetic opioids

Synthetic versions of fentanyl and ketamine are widely available. They’re usually injected, but ketamine can also be smoked or sniffed. These drugs have unpredictable and more severe side effects than the opioids they’re derived from. Ketamine's street name is Vitamin K.

Kratom comes from a tropical tree native to Southeast Asia. sold as a green powder in packets labeled "not for human consumption." People take kratom as a pill, capsule, gum or extract. Kratom can cause effects similar to both opioids and stimulants.

Desomorphine, aka Krokodil, is a derivative of the opioid pain medication codeine. It’s similar to heroin in both use and effects. It is highly addictive and can be made at home by mixing codeine with paint thinner, gasoline, hydrochloric acid, and iodine. Krokodil is sometimes called the zombie drug because it has become notorious for producing severe tissue damage including injury to the veins (phlebitis) and gangrene.

Why synthetics are popular

Misleading advertising may cause high-risk users to swap synthetic substances for the real thing. As the criminal justice system continues to reevaluate their response to substance use disorders, it's important for court, probation, and criminal justice professionals to understand that designer drugs are complex and ever-changing.

• Stay up-to-date with the latest trends in your market
• Use treatment court contracts or probation agreements to ban all forms of synthetic substances
• Make sure your drug testing program offers up-to-date tests for the latest synthetics
• Maintain best practices for drug testing protocol
• Give clients the opportunity to self-report
• Identify participants in court who are having positive results and showing improvement

Testing for synthetics

Synthetics are difficult for laboratories to detect because of the large number of differing substances and the constantly changing structures of these drugs. Urine drug testing is the most effective way to detect synthetics. The method for analyzing is liquid chromatography-tandem mass spectrometry (LC-MS/MS). LC-MS/MS is more costly than screening methods but allows you to have the broadest synthetic panel. To ensure testing for synthetics doesn’t become cost-prohibitive:

• Consider screening a subset of participants to successfully detect the use of designer drugs
• Randomly incorporate popular synthetics in your drug testing panel
• Confirm that your lab tests for a broad spectrum of compounds

If you are unsure of how to identify synthetic opioids or how to determine if someone you know is using?  with averhealth's lab director Michele Glinn, PhD.  You'll also learn how dealers are lacing drugs with Fentanyl and how we combat it.