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Don't call it 'synthetic marijuana': the drug behind a mass New York overdose

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New York: When emergency medical technicians were called to a mass casualty event in Brooklyn in July, dispatchers used a word more associated with Hollywood movies than medical emergencies: "zombies".

Emergency workers reported multiple people at the scene, near a subway station on Myrtle Avenue and Broadway, "all of whom had a degree of altered mental status that was described by bystanders as 'zombielike'," according to a study published on Wednesday in The New England Journal of Medicine.

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Teen dies from synthetic drug use

Police are warning of the dangers of synthetic drugs after the death of a NSW teenager who was found by a ditch, hours after smoking a synthetic form on cannabis.

In fact, they had overdosed on a designer drug - one that would raise alarms both in the medical community and drug enforcement circles and could, possibly, be a precursor of more potent and dangerous drugs still to come.

The report, based on blood and urine samples drawn from eight of the 18 men taken to hospitals in the area that day, offers the first detailed look at a powerful drug that has caused dozens of people to overdose. It identifies the drug as a synthetic cannabinoid called AMB-FUBINACA which was originally developed by the pharmaceutical company Pfizer.

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The report, by a team of authors, offers a window into the ever-evolving world of synthetic drugs, which are growing increasingly powerful even as the makers of the illicit substances continue to create new chemical compounds to evade detection.

The drugs are usually described by the generic shorthand "synthetic marijuana", but Roy Gerona, a clinical chemist at the University of California, San Francisco, who helped write the report, said the term was dangerously misleading.

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"There is this false idea out there that these drugs are safe, because no one overdoses on marijuana," he said.

But the drug used in Brooklyn - which went by the street name AK-47 24 Karat Gold - was 85 times as potent as the main agent in plant-grown marijuana, THC, or tetrahydrocannabinol, according to lab tests.

In fact, synthetic cannabinoids have a completely different chemical structure from plant-based THC, according to the study - one of the major attractions for both makers and consumers of designer drugs.

These chemical compounds, often created in labs in China based on research conducted at Western universities and pharmaceutical companies, are not regulated when they appear on the market and are hard to detect.

"And if you are someone who is regularly drug tested, it will not show up,"  Gerona said.

He traced the history of synthetic drugs to Clemson University and a researcher, John Huffman, who was looking for ways to create a drug in the lab that could enhance the medicinal aspects of THC while eliminating the psychotropic effects.

In the course of his work, Huffman synthesised more than 300 compounds and his work was published in academic literature.

Not long after, in about 2008, a synthetic compound began appearing on the street, called K2 in America and Spice in Europe. The main chemical agent, known as JWH-18, was named after the Clemson researcher.

Soon JWH-18 was showing up around the country and was eventually scheduled as a Class 1 narcotic.

The drugmakers would have to evolve to stay one step ahead of law enforcement.

In the case of the drug in the Brooklyn outbreak, Pfizer established a patent for a synthetic cannabinoid it called AB-FUBINACA in 2009. The drug seems to have been abandoned by the company and was never tested on humans.

But the patent is public, and Gerona said that drug labs in China and other foreign nations scour patents for information that can be useful in creating the next class of drugs.

These drugs move straight from the lab to the street, so the first trials of their effects are conducted on buyers.

AMB-FUBINACA was 50 times more powerful than that first generation of designer drugs like K2, according to the study.

As the drugs become more potent, the way they are mixed by middlemen becomes more crucial - with a slight miscalculation having possibly devastating effects.

In Brooklyn, Gerona said, it seemed someone had gotten the dosing wrong.

The result: users falling into a trance-like state, groaning and moaning, their eyes lifeless and their movements slow and seemingly mechanical.

For the first time, the researchers break down how much money can be made from a product like AMB-FUBINACA.

The way the market works is simple. Overseas labs create a new compound and often use the unregulated internet - also referred to as the dark web - to market and sell the product.

Online, according to the researchers, AMB-FUBINACA could be found in powder form, selling for  $US1950 to $US3800 ($2600 to $5070) a kilogram. It is then mixed in with cheap herbal products, allowing users to smoke the drug.

A sample of the drug recovered in Brooklyn contained 16 milligrams of AMB-FUBINACA per gram of smokable mixture.

So 1 kilogram of AMB-FUBINACA could be portioned out over 15,625 doses, with a typical street price of $US35. That means the dealer stands to make close to $US500,000.

As soon as the drug shows up on the radar of authorities, the makers move on to the next compound.

"There is this cat-and-mouse chase, with clandestine labs synthesising new drug, waiting until it becomes scheduled [made illegal] and then moving to a new compound," Gerona said.

And if the dangers of synthetic cannabinoids have researchers concerned, the risks of designer opioids are perhaps even greater.

Just last month, the federal Drug Enforcement Administration issued an alert for a new designer drug called Pink, which had been responsible for 46 confirmed deaths, including 31 in New York and 10 in North Carolina.

"Pink belongs to a family of deadly synthetic opioids far more potent than morphine," according to the agency. "It is usually imported to the United States, mainly from illicit labs in China."

Gerona said that while it is not in the interest of dealers to kill their clients, as these synthetic compounds become increasingly potent, the risks will continue to grow.

"No compound that has been made yet has the potential to kill thousands of people," he said. "But that is a scenario that is becoming more and more close to reality."

New York Times

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