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UPDATED: Prescription drug found in synthetic cannabis
UPDATED: Prescription drug found in synthetic cannabis
products - experts respond
4
July
The Ministry of Health
announced on Thursday that a particular variety of the
'synthetic cannabis' smoking blends, Kronic - Pineapple
Express, is being recalled due to the presence of a
prescription drug.
On
Saturday a second brand, Juicy Puff Super Strength, was
recalled due to the presence of the same drug.
Herbal smoking blends treated with legal, psychoactive synthetic cannabinoids have been causing public debate over their effects and accessibility.
Testing conducted by ESR revealed that the Pineapple Express and Juicy Puff varieties of the legal smoking blends also contained the controlled benzodiazepine drug, phenazepam.
You can read the Ministry of Health press release here, and official recall notifications for Kronic and JuicyPuff.
The Science Media Centre contacted experts for more information on the detection of phenazepam in in legal smoking blends. We will update our site with further comments as they become available.
Feel free to use these quotes in your
stories. To follow up with these or other local experts,
please contact the Science Media Centre.
Dr Paul Quigley, Emergency Medicine Specialist,
Wellington Hospital, answered some questions:
Has this specific brand (Pineapple Express) been associated negative symptoms in users that could be attributed to phenazepam?
"Our experience with any of the available non-nicotine combustible recreational drugs is very limited. There have been small numbers of presentations over the last 2 years, with initial patients presenting after taking Dream or Spice brands. We could not say that anyone brand has presented more often than another.
"Our most common patient presentations are mainly because of symptoms of anxiety and agitation. These may be associated with short self-limiting episodes of hallucination. All presentations have been of the mild variety and have needed short-term observation and reassurance. These symptoms would not consistent with benzodiazepine use, but is consistent with cannabinoid effect.
"Around the country there have been reports of patients presenting with sedation and also dysphoria which would be more consistent."
What are the possible risks associated with smoking a drug like phenazepam? (as opposed to oral ingestion)
"Smoking any drug increases its potency and has a pharmacological effect similar to injecting the drug. This means the effects of the drug are more immediate and also stronger than taking the same drug orally. This has been shown to markedly increase the potential for addiction because the stimulation of the reward system of the brain is more immediate and with a stronger response. With a drug like phenazepam this would be of particular concern as all benzodiazepine drugs have the potential to cause addiction.
"We have very limited knowledge or experience of Phenazepam in New Zealand. However, Benzodiazepines all have the same clinical action, side effects and toxicology. Benzodiazepines are clinically used to stop epileptic seizures, induce sedation and reduce anxiety. They can be used to reduce the symptoms from drug and alcohol withdrawal. They are prescription only medications and in the past some have been removed from the pharmaceutical market such as flunitrazepam because the potential for harm was greater than the benefit.
"Ironically, benzodiazepines are addictive and cause a very dangerous withdrawal syndrome with anxiety, paranoia and epileptic seizures. This may be what some Emergency Departments are experiencing in patients presenting days after smoking these agents. It could be a form of withdrawal.
"Benzodiazepines have other side effects that are of concern when being used as a recreational drug. They cause both retro-grade (things in the past) and ante-grade (future events) amnesia. It is this effect that makes benzodiazepines a drug commonly used in drug-facilitated sexual assault. The victim cannot recall whether the events really happened or not, making history taking very difficult. It is concerning that people are smoking a benzodiazepine that can cause amnesia, they potentially not be able remember what they were doing or what they were going to do. They would be extremely vulnerable."
Are there known interactions between cannabinoids and phenazepam?
"The principal effect of Benzodiazepines is to cause sedation and reduce anxiety. This effect would be additive to any other substance that causes sedation. Of greatest importance would be the interaction between Alcohol and benzodiazepines. This causes potent sedation and loss of motor control, this can be to the level of coma. People have died from taking combinations of alcohol and benzodiazepines, this has been because of respiratory depression. As many recreational drug users also consume alcohol there is significant potential for excessive sedation to occur.
"There would be a similar increase in sedative effect to those of the cannabinoids but this would be very variable. Some cannabinoids actually cause anxiety and agitation; in this situation benzodiazepines would actually suppress symptoms and reduce anxiety. Many recreational drug users choose Benzodiazepines to enable sleep after taking stimulant drugs such as methamphetamines."
"In Summary: Smoking
a benzodiazepine like Phenazepam has the potential to be
very dangerous. The smoker would be at risk
of;
• Increased and unexpected sedation
• Loss of
current and future memory
• Risk of addiction and
dependency on benzodiazepines
o This could cause a
withdrawal / craving syndrome on cessation of
smoking.
Users smoking phenazepam-laced products would
potentially be at risk of harm from others while
intoxicated.
They would also be significantly unsafe to drive."
Dr Leo Schep, Toxicologist,
National Poisons Centre
"We know very little on the toxicology of these analogues [synthetic cannabinoids] in humans. Presently it is based on phone inquiries to the National Poisons Centre (NPC), cases in Dunedin hospital ED and the few papers describing presenting clinical signs and symptoms at hospitals. These include tachycardia, vomiting, drowsiness, disassociation/hallucinations, tight chest, psychosis and chest palpitations.
"The only predominant clinical effect that could be attributed to phenazepam is drowsiness, though this has also been reported overseas, where there is no evidence of this contaminant.
"Phenazepam is a benzodiazepine and like all benzos, there is a cumulative central nervous system depression (drowsiness, stumbling, coma and in extreme cases a risk of respiratory depression) when taken with alcohol. We have no idea of their interaction with the analogues but it may potentially influence their activity, possibly further contributing to CNS depression."
Further commentary from experts can be found here.
Note to
editors
The Science Media Centre (NZ) is an independent source of expert comment and information for journalists covering science and technology in New Zealand. Our aim is to promote accurate, evidence-based reporting on science and technology by helping the media work more closely with the scientific community. The SMC (NZ) is an independent centre established by the Royal Society of New Zealand with funding from the Ministry of Science + Innovation. The views expressed in this Science Alert are those of the individuals and organisations indicated and do not reflect the views of the SMC or its employees.
Science Media Centre NZ
Our aim is to promote accurate, evidence-based reporting on science and technology by helping the media work more closely with the scientific community.
The Science Media Centre is New Zealand's only trusted, independent source of information for the media on all issues related to science. Thousands of news stories providing context from and quoting New Zealand researchers have been published as a direct result of our work.
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