A Public Health Response to ‘K2’
Disclaimer
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This project was supported by the Association of
Public Health Laboratories (APHL) through
Cooperative Agreement Number
#U60/CD303019 from Centers for Disease
Control and Prevention ("CDC"). Its contents are
solely the responsibility of the authors and does
not necessarily represent the official views of
CDC or APHL.
I have no conflict of interest of financial
interest.
What is K2?
The Ugly Beauty of K2
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Touted as one of the most
dangerous mountains; a
mountaineer's dream
Second highest in the
world (800 ft shorter than
Mount Everest)
Only 274 have made it to
the summit but only 254
have made it down (1 in 10
die)
Site of one of the worst
tragedies in mountaineering
history (August 1, 2008); 11
out of 30 international
climbers died
It’s beautiful, it’s a
challenge/achievement, it’s
facing down death.
The New Face of K2…Designer Drugs
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People are arriving at
emergency rooms with
symptoms that would not
normally be associated with
marijuana
Several suspected death
cases
Numerous reports of
impairment (job and driving)
2,800 Cases Nationwide in
2010, but 706 cases by the
end of Feb. for 2011
“Where does a parent go to get answers?” asked Mike Rozga, who said he learned
of K2 only after his son’s death. “We talk to our kids about sex. We talk to our kids
about drugs, and we talk to our kids about drinking and being responsible. But
how can you talk to your kids about something you don’t even know about?” – NY
Times 2010
Arkansas Public Health Response Model
Arkansas State Legislature
(K2 Regulation)
Arkansas State
Health Officer
Arkansas State
Epidemiologist
“I love it, when a plan
comes together”
(Equity and Disparity
Evaluations)
Arkansas Public
Health Laboratory
Descriptive
(Public Health
Analyses)
University of Arkansas
for Medical Sciences
(Basic Research)
Inferential
Translational
Cayman Chemical
Company
Arkansas Children's
Hospital
(Analytical Standard
Production)
(Clinical Evaluations)
Arkansas State
Crime Laboratory
(Forensic Product
Evaluations)
Specific Question
Addressed and Associated
Informational Gaps
What are the benefits of new technology?
1) Developing analytical methods for forensic analysis, toxicological assessments, and
biomonitoring.
2) Determining use and prevalence in Arkansas.
3) Assessing human metabolism.
4) Producing analytical standards for unique human metabolites that can be used as
biomarkers.
5) Assessing toxicological/pharmacological consequences of K2 use.
3 Primary Measureable
Objectives Addressing…
Whether or not the new technology can cost effectively provide
information necessary for answering key public health, forensic,
toxicological, medical, epidemiological, or legal questions?
1) Forensically characterizing products purchased in Arkansas and translating this
information for the working group…Establishment of a statewide surveillance system
2) Identification of potential phase I and II metabolites of JWH-018 and JWH073...Development and validation of clinical and biomonitoring methods
3) Evaluation of human urine collected from Arkansas Children Hospital.
4) Development of Statewide regulation.
PRODUCT MATERIAL
CASE HIGHLIGHTS
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Approximately 400 items/cases submitted to ASCL
in 2010
50% cases had at least 1 other controlled substance
present (marijuana, Salvinoran A, prescription
tablets).
Several smoking devices testing positive for K2
compounds and THC
A few cases contained hand-rolled cigarettes
16 lbs. seized by Marion PD containing 7 different
products.
Statewide Surveillance System
14
13
12
# Cases
12
10
8
6
4
2
1
1
JWH-073
JWH-018 &
JWH-250
0
JWH-018 &
JWH-073
JWH-018
K2 Compounds
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Other derivatives detected in 2011: JWH-122,
JWH-210, JWH-081, AM-2201, RCS-4
Developing Clinical/Toxicology
Testing Capabilities
Parent or
Active Drug
“Phase I”
(P450s)
Liver
“Phase II”
(UGTs)
Liver
Purpose: Increase Water
solubility of the compound
Patient Symptoms – Arkansas*
Pt
#
Agitation
HR
1
+
2
+
Confusio
n
Assay Results
Urinary Qualitative
Result
+
JWH-018 and 073
Trace Amount
+
JWH-018 and 073
Trace Amount
JWH-018 and 073
Trace Amount
JWH-018 and 073
Significant Level
Negative
ND
Negative
ND
3
+
+
4
+
+
5
+
8
+
N/V
+
+
Glc
+
K
+
+
+
6
7
Hallucinations
+
+
+
+
+
+
+
+
+
JWH-018 and 073
Significant Level
+
+
JWH-018 and 073
Significant Level
*Collected by Arkansas Poison Control Center
Population Based Study to
Determine Use and Prevalence
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Urine collected for adolescent drug screens
– About 1% Positive for K2 in Arkansas Adolescents
– Dressen et. al. 2010 >50% positive in at risk
populations
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Have partnered with poison control to assist in
collecting samples from patients suspected of
using K2.
Regulatory Process
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Kansas, Kentucky, Georgia, Missouri
and Alabama have banned these
substances by scheduling them.
Tennessee’s legislature passed an act
banning the substance; however, it is
not scheduled.
The US Armed forces have banned its
use and distribution.
Several counties and municipalities in
Arkansas banned it by local ordinance.
Arkansas became the first state to
ban it by rule on July 2, 2010.
Regulatory Process
Ark. Code Ann. § 20-7-109(a)(1)(E)
 Power is conferred on the State
Board of Health to make all
necessary and reasonable rules
and regulations of a general
nature for the proper control of
chemical exposures that may
result in adverse health effects
to the public.
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$100 to $500 fine and/or 30
days in the county jail.
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Permanent State Rule in
October
Regulatory Process
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DEA began federal regulatory process
for possession and sale on Nov. 24
2010. Formerly Scheduled March 1,
2011.
Recent Arkansas Acts: 751 and 587:
– Schedule VI code section to
include known “JWH” substances
that had been found in Arkansas,
and all similar substances that
induce similar pharmacological
effects or possess a similar
chemical structure.
– Allows for a more expedited
process to have these substances,
and others that might surface,
scheduled by emergency rule.
http://www.arkleg.state.ar.us/assembly/2011/2011R/Acts/Act751.pdf
http://www.arkleg.state.ar.us/assembly/2011/2011R/Acts/Act587.pdf
Summary: A Successful Cost Effective Public Health Response
HUMAN
TESTING
TRANSLATIONAL
SCIENCE
BASIC
RESEARCH
Educational and Community
Outreach
REGULATION
K2 PRODUCT
TESTING
Future Work:
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WSJ – In Quest of a
‘legal high’
David Llewellyn – 49 yr old
Scotsman that is a former
addict
Multi-million dollar rogue operation
Abuses science, i. e. David Nichols
a pharmacologist at Purdue
University
Bath Salts/Plant Food
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Cathinone:
Amphetamine
(‘Ecstasy on Crack’)
Very Dangerous
– Severe hallucinations
– Deaths
– Permanent neuronal
damage
Acknowledgements……………
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ADH –PHL
– Suzanne Owen, Vi-Huyen Le,
Kevin Stewart, John Blevins
ADH
– Robert Brech, Jerry Jones,
Nate Smith etc.
UAMS
– Anna Radominsk-Pandya,
Stacie Bratton Nicole Yiew
– Paul Prather, Lisa Cortez
– Bill Fantegrossi and Dave
Wessinger…AKA ‘The
Williams’
DEA
– Terry Boos
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Arkansas State Crime
Laboratory
– Cindy Moran, Felisia Lackey,
Amy Smedley
ACH
– Laura James
– Lisa Bates-Dubrow
Univ. of Helsinki
– Moshe Finel
Cayman Chemical Company
– Paul Kennedy
CDC
– Bob Kobelski
– Jerry Thomas
Acknowledgements…’The Silent
Partners’
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ADH
– Environmental
Chemistry
APHL – K2 Contract
Award
NIH - GM075893
UAMS - Center for
Translational
Neuroscience (RR020146)
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ASCL
CDC – 2007– N- 9272;
Bioterrorism Cooperative
Agreement
Questions…
Now or Come by the Poster
Jeffery H. Moran
Branch Chief, Environmental Chemistry
Arkansas Public Health Laboratory
Arkansas Department of Health
201 South Monroe Street
Little Rock, Arkansas 72205
(501) 661-2826 office
(501) 661-2972 fax