From Meth to Marijuana: Q&A with Featured Researcher Dr. Jane Maxwell

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Dr. Jane Maxwell of the Addiction Research Institute at the University of Texas at Austin gives an overview of drug use trends, including heroin use, prescription painkillers, synthetics, and marijuana. See the Q&A below.

Watch a video of this iTraining webinar on the ATTC Vimeo site.

1. Are you aware of a new drug being smoked by teenagers that resembles marijuana in a liquid form?
No, but we know by blowing butane through a mesh screen the THC will liquefy but turn into a wax when it hits the water. You can put that wax (Shatter, Budder) in an electronic cigarette and smoke it. Also, for many years users of marijuana have dipped the joint or blunt in a solution of embalming fluid and PCP, so that could be happening. Or are they just using a water pipe?

 

2. Does P2P show up as meth or amphetamine in drug tests?
Phenyl-2-proponone is methamphetamine, just like the meth they made from pseudoephedrine.

 

3. Does P2P test positive for methamphetamine in lab tests? We are having an increase in amphetamine positive tests, but not methamphetamine. Are there any other drugs out there we are missing?
Adderall is amphetamine and it and similar drugs to treat attention deficit will show up in the laboratory tests. With the use of amphetamine as “smart pills” to increase attention and enable one to study longer, we need to be aware Adderall, etc. can be a drug of abuse and you may be seeing that if you are testing a population in college.

 

4. Have you factored in the great numbers of pain patients who have turned to heroin after their primary care physician has stopped prescribing opioids?
This is a great question but no easy answer. The National Household Survey on Drug Use and Health reported there were 252,300 people dependent on heroin or pain pills and another 156,000 who had begun heroin use in that year, as well as another 1,880,000 who had begun pain pill abuse in 2012. That would equal over 4.5 million people who are already dependent on pain medication and heroin or had started abusing it. In looking at available data, there are 1.5 million people who are in treatment with methadone or naltrexone, so there are four times as many in need of treatment for opioids than are receiving it.

 

5. How does Naltrexone interrupt overdose?
The slide was incorrect. It should have said “naloxone.” Apologies for the error and confusion.

 

6. How is the fentanyl combined w/heroin? Seems like it would take a bazillion expensive pills to mix with the heroin to distribute the micrograms of fentanyl effectively.
When the last heroin/fentanyl epidemic occurred, they found the fentanyl had been manufactured by rogue chemists and it was in the powder form, not pills. The fentanyl/heroin combination is more common in the East and I am expecting we will see another batch of rogue chemists in Mexico being busted. In the western US, I see a lot about the fentanyl patches, where people squeeze the gel out of them (or suck on the patches), but because the heroin is dark brown, it would not mix in well. In the west, users look at the color of the heroin—the darker brown it is, the stronger it is. It if is a light brown, it’s been cut with sleeping pills or Benadryl and Coffee Mate, so they know it’s weaker.

 

7. I work with the adolescent population and we hear a lot of our clients using kush and lean. Do you have any information on the side effects of these drugs?
Kush is a name for very potent marijuana. “Lean” is a term for drinking codeine cough syrup (re: Lil’ Wayne and The Beb). One manufacturer has since pulled it from the market but I assume other manufacturers still make it. The best study I have seen on Lean was done some years ago and it is still accurate, Leaning on syrup: The misuse of opioid cough syrup in Houston.

 

8. If someone did drink liquid meth, would they experience a high?
No, they’d be dead. The purpose of dissolving meth in liquid is to get it across the border and they are going to put as much meth as possible into it until it gets to the point it can no longer dissolve in the water. So the concentration is very, very high. There was a news article some time ago about a guy walking a water bottle (with dissolved meth in it) and border patrol questioned him and he offered to drink it and died. This may well be a rumor, but they aren’t putting meth in the water to get people to drink it. The cartels have facilities on the US side to separate the water and the meth and bring it back into its crystalline form.

 

9. Is K2 synthetic marijuana?
Yes. Be aware that the foil pouches with all the designs and names are created and bought off the internet and then filled with the substance by head shops or by dealers who import large bags of industrial chemicals from China and mix them up and fill and seal the packets here in the US (maybe in the back room of a head shop?)

 

 

10. Is “sherm” the same as “fry”?
Yes. For an excellent description of the phenomenon, read Fry: A Study of Adolescents Use of Embalming Fluid with Marijuana and Tobacco

 

11. I've heard there has been no increase in marijuana use rates in Colorado since legalization for all use. Is this true?
According to the National Household Survey on Drug Use and Health prevalence of use among youths 12-17 has not increased but it has for older individuals. However, those 12-17 now see less great risk from smoking marijuana once a month. The data on prevalence of use and perceptions of risk need to be monitored carefully to see if ultimately prevalence increases for youths. It shows that for those older than 17, with decriminalization/legalization, adult use is up.

 

12. How has the rise of DarkNet markets (e.g., Silk Road, Agora, Evolution, Cannabis Road) affected the availability of more exotic drugs?
I am trying to learn more about the Dark Net. There is the surface web with search engines we use on a daily basis, such as Google and Yahoo. It functions off an index system, locates domains that follows hyperlinks from other domains and data in-capabilities that do not allow the index to search into the deep web.
The Deep web is harder to access. Technical obstacles include timed-entry, password access, requires deliberate search into a website, and it is not always bad.
The Dark web is a small portion of the web that is intentionally hidden and inaccessible through standard web browsers. Other aspects allegedly include illegal services such as copyrighted media, hit-men/contract killings, human trafficking, child pornography, illegal firearms, and illegal drug trade as on Silk Road. Other alleged services include identity theft, new passports, IDs, social security numbers, stolen credit card numbers, Bit-coin, which is on-line encrypted currency, no banks involved, completely anonymous, and delivery through FedEx, UPS, DHL, etc.
A new book on cryptomarkets has recently been published by James Martin: Drugs on the Dark Net: How Cryptomarkets are Transforming the Global Trade in Illegal Drugs.

 

13. We have noticed that synthetic marijuana is preferred possibly due to the ineffectiveness of testing materials. People think that they can get loaded and not test positive for drugs at work sites or in treatment.
You need to make sure the test kits you are using are testing for the latest variations of synthetic cannabinoids. Look at the slide titled “Cannabinoids by Year” to see how quickly they change and compare the substances on the test kit against the latest chemicals on the slide. Unless the kit specifically says it tests for those combinations, you won’t find positive tests for the current types of synthetic marijuana that are being used.

 

14. What about the correlation of marijuana use and alcohol use, is that projected to rise?
Use of marijuana by adults is up but the prevalence of alcohol use was stable in 2012 and 2013 according to National Household Survey on Drug Use and Health.

 

15. What from a federal standpoint, does the government suggest how to address the heroin overdose epidemic?
Since I’m not a federal employee, the best way to see what the government is doing is to look at the federal websites to see what they are advocating.

 

16. What information do you have on buprenorphine diversion?
I've noticed a trend of news stories quoting law enforcement as saying buprenorphine abuse is becoming a problem, but from all the information I've found from SAMHSA and other sources, while buprenorphine diversion increased, with the number of prescriptions it still doesn't seem to be anything near an epidemic as some of these stories have claimed.
Most of the diversion I have seen is because people have become addicted to heroin or pain pills and cannot get into buprenorphine treatment because of the limitation on the number of patients a doctor can have or unable to get it because of cost. So is the “epidemic” really a reflection of the need for treatment?

 

17. What are the best ways of keeping children away from marijuana-based food?
See question 18 in terms of what Colorado is now doing. Also one recent study tested the advertised potency on the marijuana food and found of the 75 products (47 different brands) purchased, 17 percent were accurately labeled, 23 percent had lower purity, and 60 percent over-stated their THC content (Vandrey et al., 2015).

 

18. Do you have any data on marijuana overdoses?

We are being told by many that overdose doesn’t happen and no one has evidence of overdose death from marijuana.

I have never seen a death due to overdose of marijuana. However, a traumatic death in Colorado following ingestion of an edible marijuana product found a blood level of 7.2 ng/mL without evidence of polysubstance abuse (whole blood limit of delta-9 THC for driving a vehicle in Colorado is 5.0 ng/mL). (The user took one bite of a marijuana=infused brownie and got no effect so then ate the entire brownie and ended up jumping off a balcony).

On the basis of initial surveillance data and cases of accidental overconsumption, on February 1, 2015, Colorado instituted new packaging and labeling rules, requiring that recreational edible marijuana products contain no more than 10 mg of THC, or have clear demarcation of each 10-mg serving. In addition, before distribution, cannabinoid potency testing is now performed on batches of recreational edible marijuana products by state-certified laboratories.

 

19. We need to look at why the company selling Vivitrol gives the first dose free. Yes, just like drug dealers. The extremely high cost of Vivitrol makes it impossible for most clients.
Dr. Robert Foreman, who is with Alkermes, the company that sells Vivitrol, provided this answer:
  • For publicly funded federal programs such as Medicaid, 340B, the VA, IHS and others, the price is steeply discounted (about 40-50% per federally established policy); there are also discounts to states for individuals who do not qualify for Medicaid, but are indigent, which is less than the federal rebate/discount but still substantial.
  • For people with commercial insurance coverage, Alkermes provides up to $500/month co-pay assistance, so that the vast majority of people with commercial coverage can have $0 out of pocket costs.
  • Regarding Alkermes ongoing provision of samples to individuals leaving prison, this public health initiative is born of our company’s view that addiction is a disease and not a crime; our support and advocacy for prison re-entry programs are one of the many ways we advance the de-stigmatization and help to reform the just treatment of addicted individuals.