International GHB & Chemical Drug Conference
March 23-25, 2007
Wyndham Arlington Hotel, Arlington, Texas
Organized by Project GHB
www.projectghb.org
Project GHB is a nonprofit dedicated to education, research, awareness and treatment related to abuse of the drug gamma hydroxy butyrate, GHB, in terms of drug rape, abuse, overdose, death and addiction. Project GHB and this conference also focus on a variety of current and emerging drug trends such as meth, ketamine, MDMA (Ecstasy), absinthe, DNP, prescription drug abuse and over-the-counter product abuse such as the cough suppressant DXM. Presentations will cover the effects of these drugs, abuse patterns from self abuse to drug rape to murder and addiction, testing issues and treatment needs. Attendees are not required to stay within their chosen track, but may attend any classes of their choice. The featured presentation is about meth; it should be noted that GHB is being found increasingly frequently at meth lab scenes & many GHB users report co-abuse of meth.
March 23, Friday 0800-0900 REGISTRATION
March 23, Friday 0900-1000 Opening session
Trinka Porrata, Project GHB
Jeffrey B. Stamm, DEA Asst. SAC, Dallas
Lt. Rodney Thompson, Arlington Police Department
March 23, Friday, 1000-1200 (JOINT SESSION for all three tracks)
CRYSTAL METH (ICE): THE VIOLENT REALITY
By Gary Shimabukuro, President, Laulima Hawaii
Drug Education & Awareness for Workplace & Community
Crystal Methamphetamine (Ice) first got the attention of Hawaii law enforcement in the early 1980’s. By 1989 the use of ice had reached epidemic proportions. Murder, rape, assault, hostage situations, and domestic violence escalated. Burglary, theft, auto theft, and bank robberies also increased. Hawaii was ranked number one in the nation for larceny thefts and second for property crimes. Over forty percent of males and over fifty percent of females arrested tested positive for methamphetamine. Hawaii is known to have the highest per capita use of the drug called Ice.
· International, national, and local Ice trends
- Source countries for methamphetamine and precursor chemicals
- International and national drug trafficking organizations
· Signs and symptoms of use—physical and mental
· Identification of Ice and related paraphernalia
- Recognition of the various forms of methamphetamine
- Recognition of meth related paraphernalia
· Short and long term effects on body and brain
· Drug pharmacology--Chemical structure of methamphetamine
· Effects on families and the community
· Safety issues when interacting meth users & meth labs
Objectives:
· Provide an overview of the meth problem throughout global community.
· Participants will be able to recognize the physical and mental signs of meth use.
· Participants will be able to recognize methamphetamine in its various forms.
· Participants will be able to recognize meth related paraphernalia & “hide” techniques
· Participants will understand the dangers and be able to employ safety techniques when dealing with meth users.
Gary Shimabukuro has been providing drug education for businesses, schools, labor organizations, management groups, law enforcement agencies, military personnel and other organizations since 1978. He was a clinical supervisor for a substance abuse treatment program and a former certified trainer and "Trainer of Trainers" for the National Institute of Drug Abuse (NIDA). Since 1988, he has focused on creating a Drug Free Workplace. Approximately 200,000 people have attended training programs throughout Hawaii, Alaska, California, and the Pacific Basin, including Guam, Saipan, Palau, and New Zealand. Gary has volunteered his efforts in drug prevention and education in thousands of sessions for public and private schools ‑ for teachers, students, and parents; churches; youth athletic groups; rotary clubs; social groups; non‑profit organizations; and various other community groups.
TRACK I
MEDICAL TRACK
TRACK I—Day 1
March 23, Friday, 1300-1400
GHB Abuse: Motivations, medical CONSEQUENCES & Risks
Jo Ellen Dyer PharmD--Primary Investigator NIDA RO1 DA 14935
Clinical Professor of Pharmacy, U-C San Francisco
Clinical Toxicologist, California Poison Control System - San Francisco
The FORGE study Findings of GHB in human subjects: The FORGE study is a NIDA funded, multidisciplinary investigation of GHB use in humans, which focuses on the motivations, medical consequences and risk of GHB use.
1) A 5-year study of trends in GHB use in California
California trends as compared to national trend data: poison control center and DAWN
2) Interviews with subjects self reporting GHB use and subjects hospitalized for GHB use
Behaviors associated with increased risk of GHB-related hospitalization
Co-ingestion with ethanol or ketamine
DUI, driving under the influence, of GHB
GHB use to manage withdrawal symptoms
3) Qualitative focus-group findings of risk perception
4) Pharmacology studies of GHB, BD in human volunteers
GHB and ethanol effects and interactions
GHB urine concentrations after a single dose
1,4-Butanediol pharmacology after oral administration
Learning Objectives:
1) Explain the trends in GHB use and concern for future escalation
2) Describe the risk perception and consequences of driving under the influence of GHB
3) Diagram the pharmacokinetics of 1,4-butanediol
4) Identify the cognitive and mood effects of GHB and ethanol
Dr. Jo Ellen Dyer is a Clinical Professor of Pharmacy with the University of California at San Francisco and a Clinical Pharmacist and Toxicology Specialist with the San Francisco division of the California Poison Control System. California’s PCC System provides poisoning assessment/management advice to the public, health care practitioners and emergency medical systems throughout California. In 1990, Dr. Dyer published the first case reports of poisoning with GHB, then sold over the counter as a dietary supplement. Now, GHB is a commonly mentioned club drug in national surveys of emergency department admissions for drug abuse. She continues to track/report the new trends in drug abuse in the state of California, including the use of club drugs for assault or acquaintance rape. Predators utilize GHB and a variety of other sedating drugs to facilitate assault. Dr. Dyer is active in training health care practitioners and emergency medical responders, law enforcement, district attorneys, rape treatment counselors, and government agencies including the Food and Drug Administration and Drug Enforcement Administration in recognizing and managing the effects of recreational drugs. She has also provided expert testimony to the California assembly and the U.S. House of Representatives regarding GHB and drug facilitated assault. Her research is continuing with support from the National Institute of Drug Abuse, NIDA, to evaluate the motivations, medical consequences and risks of GHB use.
TRACK I – DAY 1
March 23, Friday, 1400-1500
DRUGS OF ABUSE – NOT THE USUAL FLAVORS
Dr. Kurt Kleinschmidt
Toxicology Fellowship Program Director, UT SW Medical Center
Director of the North Poison Control Center N. Texas
This is an overview of some of the "less commonly" used drugs of abuse. The focus will be on the typical complaints and medical problems that are experienced by users of agents including GHB, Ecstacy, Dextromethorphan, Ketamine, DNP, and "Cheese." This presentation does not address commonly used agents such as cocaine, methamphetamine, and heroin.
OBJECTIVES
1. Describe the usual presentation of a person who has used too much GHB.
2. Discuss the most life threatening medical problems that can affect Ecstasy users.
3. Compare the medical effects of Dextromethorphan and Ketamine.
4. Describe what cheese consists of and its dangers to users.
5. State which population uses DNP.
Kurt C. Kleinschmidt, MD, FACEP is an Associate Professor of Surgery in the Division of Emergency Medicine at the University of Texas Southwestern Medical Center in Dallas, Texas. He is the Director of the Toxicology Fellowship Program and is the Associate Medical Director of the Emergency Department at Parkland Memorial Hospital. His areas of interest include venous and arterial thrombotic diseases, toxicology, and graduate medical education issues. He graduated from the University of South Florida College of Medicine in 1986, completed his Emergency Medicine residency at Madigan Army Medical Center in 1990, and finished a clinical fellowship in Toxicology at the University of Texas Southwestern Medical Center in 1999. He is board certified in both Emergency Medicine and Toxicology.
TRACK I – DAY 1
March 23, Friday, 1500-1600
GHB-associated Fatalities: 226 Deaths
Deborah Zvosec, Ph.D.
Minnesota Medical Research Foundation
Outline:
I. Background:
a. GHB development and popular use of “dietary supplements” and “solvents”
II. Clinical effects
a. Intoxication, rapid and abrupt onset, variable effects, associated trauma
b. Lethality: mechanisms of death
III. Case series
a. Objectives and methodology
b. Results
i. 207 GHB-caused deaths
1. Deaths with and without co-intoxicants
2. GHB levels
3. Use contexts and products (“supplements,” solvents and Xyrem®)
ii. 13 GHB-related deaths – 6 Indeterminate
iii. Medical interventions:
1. Decedents left to “sleep it off” despite observed adverse events and known acute GHB ingestion
c. Discussion: Key findings
i. Lethality even without co-intoxicants
ii. Postmortem GHB levels may be low
1. Overlap with endogenous, therapeutic, and non-fatal toxicity levels
2. Delayed death with progressive metabolism of GHB
iii. There is no “lethal level”
1. Overlap of ante- and postmortem levels with non-fatal toxicity cases
iv. Factors increasing risk
1. Unpredictable effects
2. Use in liquid form, highly concentrated, variable
3. Recreational use contexts: difficult dose titration, frequent co-intoxicants, accidental ingestions, surreptitious dosing
4. Misinformation and misperceptions about GHB
a. Promotion as a “supplement” for purported health benefits
b. Promoted as non-toxic when used without other drugs
c. Risks minimized and advice to avoid 911 activation
v. Many of the deaths may well have been preventable
1. 18 toxicity series, over 640 patients, with no deaths, no complications
2. All decedents in series arrested prehospital
d. Why are GHB-associated deaths under-reported?
e. Study limitations & future directions
Learning objectives:
TRACK I – DAY 1 (Law Enforcement Related Class but in Track I schedule)
March 23, Friday, 1600-1700
EMERGING DRUGS
Tom DiBerardino, DEA
The workings of the Drug & Chemical Evaluation Section within the Office of Diversion Control and encounters with drug substances, mostly tryptamines and phenethylamines.
Tom DiBerardino, Ph.D., is with the Drug Enforcement Administration’s Drug & Chemical Evaluation, Office of Diversion Control.
TRACK I - DAY 2
March 24, Saturday, 0800-0900
ADDICTION ISSUES RE GHB & OTHER DRUGS
Karen Miotto, M.D., Associate Clinical Professor, UCLA Department
of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of
Medicine, and Medical Director of Substance Abuse Program,
Los Angeles Ambulatory Care Center, V.A.
What’s New in Addiction Science and Treatment
Goals:
1. To review the neurobiology and pharmacology of opiates, alcohol and various club drugs
2. To review clinical aspects of tolerance, dependence and withdrawal
3. To review updated information about medical treatments for addiction
Objectives:
At the conclusion of this presentation participants will understand trends in club drug use, the relevant aspects of tolerance, dependence and withdrawal and know the latest strategies to medically treat addiction.
v Trends in club drug use
Ø Marijuana as a club drug
Ø New information on Ketamine
v Relevant aspects of tolerance, dependence and withdrawal
Ø Psychological dependence
Ø Physical dependence
v New medication developments for treatment of alcohol and opiate addiction
Ø Opiates
§ Buprenorphine
Ø Alcohol
§ Acampersate
§ Vivitrol
v Updates on the reward pathway of various drugs of abuse
Ø Recent findings
v Negative reinforcing effects of withdrawal
Dr. Karen Miotto is an Associate Clinical Professor in the Department of Psychiatry and Biobehavioral Sciences at the UCLA David Geffen School of Medicine and is the former Director of the UCLA Alcoholism and Addiction Medicine Service. She is currently the Medical Director of the VA Los Angeles Ambulatory Care Center's Substance Abuse Program. She is frequently an invited speaker at national addiction meetings. In addition, she has published many professional papers and book chapters on substance abuse and pain management for addictive diseases. Her current research is on treatments for Club Drug Addiction. She is the recipient of a career development award from the National Institute on Drug Abuse to study treatment for GHB withdrawal.
TRACK I – DAY 2
March 24, Saturday, 0900-1200
Segment Title: GHB, GBL, 1, 4-BD and Research Update
Organizers: Timothy Maher and Syed Ali
Introduction/Overview…………………..Timothy Maher/Syed Ali
Single and multiple injections of GBH produce neurobehavioral and neurochemical changes in a rodent model
Syed Ali
Neurochemistry Laboratory, Division of Neurotoxicology, National Center for Toxicological Research/FDA, Jefferson, AR, USA.
GHB affects learning and memory
Ratna Sircar
Neurobehavioral Laboratory, Department of Psychiatry,
The Zucker Hillside Hospital, Glen Oaks, NY, USA.
New Discovery and GHB Receptor Pharmacology
Maharaj Ticku, Department of Pharmacology,
University of Texas Health Science Center, San Antonio, TX
GHB and 1, 4-BD can produced audiogenic withdrawal seizures
in Sardinian alcohol-preferring (SP) rats
Timothy Maher
Rainbow Babies & Children’s Hospital, Cleveland, OH, USA.
GHB: Do we really know how it works:
Neurotoxic or Neuroprotective?
Timothy Maher
Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA.
Project GHB: A communication link to users
of gamma hydroxybutyrate
Joseph Banken
Department of OBGYN, University of Arkansas for Medical Sciences, Little Rock, AR
TRACK I – DAY 2
March 24, Saturday, 1300-1400
Drugs on the Internet
Ashraf Mozayani, Pharm D., Ph.D., D-ABFT
Harris County Medical Examiner Office, Houston Texas
Access to drugs in the United States is controlled by the Drug Enforcement Administration (DEA). Researchers, physicians and other legitimate users of controlled drugs must obtain these substances from legitimate suppliers or manufacturers who comply with DEA rules. Traditionally, individuals who wish to obtain controlled substances without DEA approval were forced to buy from street dealers. Since the advent of global manufacturing and Internet commerce, it has become relatively easy for non-legitimate users to obtain controlled, restricted and even experimental drugs.
Legitimate drugs are now manufactured all over the world. Many drugs that are banned in the United States are available by prescription or even over-the-counter in other countries. Finding an Internet physician who will prescribe these drugs is a relatively simple task. Anabolic steroids are readily available from hundreds of websites. Spore kits that allow one to grow hallucinogenic mushrooms at home are readily available, as are seeds for many different cultivars of marijuana. Pharmaceutical manufacturers readily supply samples of experimental drugs to legitimate researchers, and it is sometimes not difficult to convince a manufacturer in Asia or Africa of the legitimacy of research credentials.
The primary purpose of this talk is to illustrate the variety of drugs available to the Internet consumer and also to show that sophisticated knowledge is not always necessary to obtain prescription or research drugs via the Internet.
Ashraf Mozayani, Pharm D., Ph.D., D-ABFT, Laboratory Director/Chief Toxicologist, Harris County Medical Examiner Office, Joseph A Jachimczyk Forensic Center, Houston, Texas.
TRACK I – DAY 2
March 24, Saturday, 1400-1500 (2 segments during hour)
Segment 1
Behavioral Pharmacology & Physical Dependence
Potential Of GHB & Its Pro-Drugs In Baboons
By Amy K. Goodwin, Ph.D.
John Hopkins University School of Medicine
Behavioral Biology Research Center, Baltimore, MD
The acute behavioral effects of GHB on food-maintained behavior, fine-motor coordination, and structured behavioral observation sessions in baboons will be discussed and compared to those of the GHB pro-drugs GBL and 1,4-BD. In addition, the effects of chronically administered GHB on food-maintained behavior, fine-motor coordination, and structured behavioral observations will be discussed and compared to those of GBL. The physical dependence potential of GHB will be compared to GBL during both precipitated and spontaneous withdrawal tests.
I. Introduction to GHB
a. Medical use & illicit use
b. Adverse effects & Emergence of GHB pro-drugs
II. Behavioral effects of acute administration of GHB, GBL, and 1,4-BD
a. Previous reports
b. Methods used in baboons & results
III. Behavioral effects of chronic administration of GHB and GBL
a. Previous reports
b. Methods used in baboons & results
IV. What does this mean?
a. Pre-clinical vs. clinical evaluations
b. Future directions
Learning Objectives:
Attendees will learn how GHB is used, both medically and recreationally, and about the emergence and use of the GHB pro-drugs GBL and 1,4-BD.
Attendees will learn what has already been reported about the acute and chronic effects of GHB in both human and non-human populations.
Attendees will learn about the tests used to evaluate acute behavioral effects of psychoactive drugs in baboons and what we found with respect to GHB, GBL, and 1,4-BD.
Attendees will also learn about the tests used to evaluate the physical dependence potential and withdrawal effects of chronically administered psychoactive drugs and what we found with respect to GHB and GBL.
Attendees will become aware of how pre-clinical research work informs clinical evaluations.
Amy Goodwin is presently an Instructor, Division of Behavioral Biology, Johns Hopkins University, since 2006. She received a BA from Northern Arizona University, MA from Western Michigan University, PhD from Western Michigan University and Post-Doctoral Fellowship at Johns Hopkins University, School of Medication. She had been involved in a number of research activities, published in peer-reviewed scientific journals and has received a number of research-related awards. 30 minutes
TRACK I – DAY 2
Segment 2
THE ECSTASY EXPERIENCE: RISKY BUSINESS??
Marcy Bubar Jordan, Ph.D., Research Development Coordinator
University of Texas Medical Branch, Galveston
NIDA funded study (grant 5R01DA013595-05) to study the effects of the drug “Ecstasy,” 3,4 methyldioxymethamphetamine or MDMA) on rats. The resulting data lends understanding to the actions of the abused drug MDMA and approaches to pharmacotherapy for MDMA dependence and understanding of risk factors with its use.
Marcy Bubar Jordan is current the Research Development Coordinator for the Center for Addiction Research, Department of Pharmacology & Toxicology, University of Texas Medical Branch, Galveston, Texas, where she received her Ph.D. in 2005. She has been involved in research regarding cocaine and MDMA and has been published in a variety of journals about that research.
TRACK I – DAY 2
March 24, Saturday, 1500-1530
PHARMACOLOGY OF GHB IN HUMANS
Sergio Abanades, MD, Clinical Pharmacologist, Staff Researcher,
Pharmacology Unit, Institut Municipal d’Investigacio Medica
Associate Professor of Pharmacology, Universitat Autnoma de Barcelona, Spain
This presentation will be a summary of Barcelona-based randomized and controlled clinical studies of GHB regarding pharmacodynamics, abuse liability and pharmacokinetics in humans. Data includes GHB intoxication in emergency settings.
Learning Objectives
Become aware of the clinical trials on pharmacodynamics, abuse liability and pharmacokinetics of GHB in humans.
Be brought up to date on GHB intoxication in emergency settings in terms of presentation and treatment.
Dr. Abanades specializes in Clinical Pharmacology and has expertise in the clinical evaluation of the effects of psychoactive drugs under controlled experimental designs. He is a staff researcher at the Human Pharmacology and Clinical Neurosciences Research Group of the Institut Municipal d'Investigació Mèdica (IMIM), located at the Barcelona Biomedical Research Park. He is also an associate professor of Pharmacology at the Autonomous University of Barcelona (Spain)
TRACK I – DAY 2
March 24, Saturday, 1530-1600
EFFECT OF GBL ON LOCOMOTOR ACTIVITY &
BRAIN DOPAMINE METABOLISM IN RODENTS
Teodoro Bottiglieri, Ph.D.
Baylor Institute of Metabolic Disease, Dallas, &
Dept of Biomedical Studies, Baylor University, Waco, Texas
Gamma hydroxybutyrate (GHB) is an endogenous metabolite of GABA and putative neurotransmitter. GHB and its prodrugs 1,4-butanediol (1,4-BD) and gamma butyrolactone (GBL) have become drugs of abuse in the United States and around the world. The effects of GHB and its precursors include ataxia, drowsiness, sedation, loss of locomotor activity, cardiorespiratory depression, coma, and possibly death.
The abuse of GHB and its pro-drugs, such as GBL, is a rising health care concern in the U.S. Between 1990 and January 2004 there were more than 7100 overdose reports or law enforcements encounters, 65 deaths, and 30 assaults due to GHB (Shannon and Quang 2000). The number of GHB overdoses reported in emergency rooms has continued to increase despite being regulated by the DEA with a schedule I classification (Lloyd 2002). GHB is a popular “club drug” due to its euphoric properties at low doses. Abuse of GHB in this capacity often results in overdosing requiring immediate medical attention. Among emergency department cases involving club drugs, GHB or GBL has been cited more often than ecstasy each year since 2000 (Leinwand 2001). In addition to overdoses of GHB, patients affected by SSADH deficiency, an inborn error of GABA metabolism, suffer from chronically high levels of GABA and GHB in various tissues. There are currently no know antidotes or drugs that can counteract the effect of GHB or it’s precursors such as GBL.
Research Objectives: To investigate the effect of GBL on locomotor activity in mice; to investigate the effect of GBL on brain dopamine metabolism; and develop potential antidote treatments for GHB/GBL toxicity, and treatment strategies for patients with SSADH deficiency
Conclusions:
GBL causes a loss of locomotor activity that is dose dependent similar to the effect seen in humans after GHB or GBL overdosing. The loss of locomotor activity induced by GBL is related to decreased concentration of 3-methoxytyramine in brain tissue, a sensitive marker of dopamine release. Several pharmacological agents that act to increase dopamine levels in the brain were tested for the effect of preventing or rescuing GBL toxicity. Two compounds Pergolide a D1/D2 receptor agonist, and nomifensine a DA reuptake inhibitor were found to be effective in antagonizing the effect of GBL. Other drugs including a GHB receptor agonist (NCS-382), COMT inhibitor (tolcapone), MAO inhibitor (pargyline), GABAa agonist (bicuculline), were ineffective. Both pergolide and nomifensine are FDA approved for use in humans. Our experimental data provide the rationale for conducting clinical trials to test the efficacy of these drugs in rescuing subjects from GHB or GBL overdosing, and for the treatment of ataxia that is common in patients with SSADH deficiency.
TRACK I – DAY 2
March 24, Saturday, 1600-1700
Drug-Facilitated Sexual Assault and Sexual Abuse:
A Medical Perspective
By Diana Faugno, RN, MSN, CPN, FAAFS, SANE-A
& Sharon Walker, MPH, PhD, RN, CFN
I. The Old News re DFSA--Most sexual assaults involve alcohol
a. Effects of alcohol may be similar to many of the new drugs used
b. Effects of alcohol used in combo w/second drug are extremely dangerous
c. Remember to find out--What they drank; how much they drank; size of drinks
II. Challenges Surrounding DFSA Investigations/Overcoming Challenges
a. Drug used
b. Collection of Evidence
c. Laboratory Methodologies
d. Challenges Associated with the Victim’s Lack of Resistance
e. Challenges of Inconsistent or Untrue Statements & Delayed Reporting
III. Learn the symptoms of various drugs used to facilitate sexual assault
a. Recognize The Indicators of A Drug-Facilitated Sexual Assault
b. Red flags that indicate a drug rape
IV. The Advantages and Disadvantages of a full-drug screen
a. The reality of hospital based drug testing
b. Who gets the first specimen of urine ?
c. No single analytical test will detect all potential drugs used in DFSA
d. Immunoassays/Detection Limits
V. Evidence Collection
a. The victim
b. The suspect
c. The witness
d. The crime scene
VI. Toxicology Labs
a. Protocol for testing--96 hours
b. Know where to send or take your evidence for testing
c. Rape drugs are more likely to be detected in urine than in blood.
VII. Recommendations for Medical Professionals
a. Get Urine if reported within 96 hours of ingestion
b. Get Blood if reported within 24 hours of ingestion (10 ml in grey top tube)
c. Immediate refrigerate specimens
d. Document when ingested, # of urinations, drugs/medication victim used
Drug Facilitated Sexual Abuse
VIII. The Drug Endangered Child
a. Exposure of child to methamphetamine in their home
b. Grooming child to desire meth with the intent to prostitute the child
c. Investigators routinely find sexual toys in meth environments
d. Child becomes target for sexual activity & prostituted in exchange for meth
IX. Intervention, Prevention & Treatment
a. Early intervention starts w/concerned person in contact with the child
. b. Educate professionals on early identification of abused child
c. Treatment of childhood sexual abuse
d. Prevention--Education for boys & girls
e. OK to tell
f. Assertion vs aggression
Objectives:
Participants will leave this session able to:
Diana Faugno, RN, MSN, CPN FAAFS, SANE-A, is a Forensic Nurse Consultant and a Board Director for End Violence Against Women International.
Sharon Walker, MPH, PhD, RN, CFN, is a certified forensic nurse and Vice President and COO of Generations Center in Dallas, Texas.
TRACK I – DAY 3
March 25, Sunday, 0800-0930
Don Mac Neil, Criminal Justice Consultant, Medtox
This seminar is specially designed to educate and aid frontline practitioners who are working in fields of drug rehabilitation, community corrections and education. Students will be introduced to emerging concepts in drug pharmacology associated with methamphetamine abuse and addiction. Students will also be introduced to lifestyle issues and behavioral habits of methamphetamine abusers, the manners of methamphetamine ingestion and manufacture. Current strategies in treating methamphetamine and abuse and addiction will be discussed. New pharmacological and behavioral therapies will be explained and discussed as well. Strategies for controlling methamphetamine relapse will also be put forth and analyzed. Critical concepts associated with methamphetamine abuse such as “methamphetamine mouth” and methamphetamine psychosis will also be discussed.
I. Introduction to methamphetamine abuse
II. The history and cultural issues associated with the amphetamines
III. Pharmacology of methamphetamine addiction
IV. Manners of use and abuse of methamphetamine
V. Signs and symptoms of methamphetamine abuse and addiction
VI. Explaining the phenomenon’s of “Meth Mouth” and “Meth Psychosis”
VII. Medical treatment of the methamphetamine abuser/addict
VIII. Managing the methamphetamine addict in recovery
Donald Mac Neil is a retired police commander and drug enforcement veteran with 20 years of experience from Southern California. A former California and Los Angeles County Narcotic Officer of the Year, Mr. Mac Neil is currently employed by MEDTOX Laboratories, Inc. as their chief criminal justice consultant. Mr. Mac Neil posses an undergraduate degree in biochemistry and a masters degree in biology. Mr. Mac Neil also works as faculty in criminal justice and homeland security departments at California State University, Long Beach and Tiffin University (OH). Mr. Mac Neil is a frequent lecturer and courtroom expert witness on matters of methamphetamine abuse, addiction and psychosis. Mr. Mac Neil is a frequent writer for professional criminal justice and corrections journals; many of his recent publications deal with methamphetamine abuse and addiction.
TRACK I – DAY 3
March 25, Sunday, 0930-1100
Pharmacology of Addiction
Don Mac Neil, MedTox Laboratories, Inc.
This seminar will address the current understanding of how drugs of abuse work in the brain. Students will learn of the various methods of drug ingestion and how these methods contribute to the development of physical dependency and addiction. Recent advances in the understanding of drug of abuse pharmacology will be discussed. Students will learn of the connections between drugs and the vital Central Nervous System transmitters that carry critical messages from one nerve cell to another. The neuroadaptive processes triggered by chronic drug abuse will also be discussed. Treatment strategies and their impact on the brain and its various structures will be evaluated.
Anatomy and features of the central nervous system (CNS)
Methods of ingestion; recognition of street drugs
Drugs and brain transmitters
Case Study: pharmacology of cocaine abuse
Addiction treatment strategies
Donald Mac Neil is a retired police commander and drug enforcement veteran with 20 years of experience from Southern California. A former California and Los Angeles County Narcotic Officer of the Year, Mr. Mac Neil is currently employed by MEDTOX Laboratories, Inc. as their chief criminal justice consultant. Mr. Mac Neil posses an undergraduate degree in biochemistry and a masters degree in biology. Mr. Mac Neil also works as faculty in criminal justice and homeland security departments at California State University, Long Beach and Tiffin University (OH). Mr. Mac Neil is a frequent lecturer and courtroom expert witness on matters of methamphetamine abuse, addiction and psychosis. Mr. Mac Neil is a frequent writer for professional criminal justice and corrections journals; many of his recent publications deal with methamphetamine abuse and addiction.
TRACK 1 - DAY 3
March 25, Sunday 1100-1200
GHB Addiction Project: Update and GHB Withdrawal
in the Emergency Department
&
The Emily Dowdy case
Deborah Zvosec, Ph.D.
Minnesota Medical Research Foundation
Outline:
I. General background
a. Popular use, promotion of “dietary supplements”
b. Who is/was at risk for GHB addiction?
c. Chronic use, tolerance, and GHB dependence
II. GHB withdrawal
a. Variable and unpredictable
b. Early or mild withdrawal
c. Severe withdrawal
III. GHB Addiction Project
a. Methodology
b. Findings
i. Basic demographics of participants
ii. Purpose of initial use, products used
iii. Addictive use, dose size and frequency, tolerance
iv. Acute complications
1. Overdoses
2. Trauma
3. GHB withdrawal regarding medical treatment
IV. GHB withdrawal in the Emergency Department (ED)
a. Basic demographics
b. Duration of use, dose frequency, last dose prior to presentation
c. ED course
i. Presenting signs and symptoms
ii. Vital signs
iii. ED stays
d. Key findings
i. Absence of autonomic instability does not predict mild course
ii. Patients discharged with continuing symptoms re-presented for further treatment or relapsed
V. References
a. Publications on the GHB Addiction Project
b. General: GHB addiction and withdrawal
VI. The Emily Dowdy Case—DUI Fatality Case
Learning objectives:
TRACK I – DAY 3
March 25, Sunday, 1300-1430
Prescription Drug Abuse
Marc Gonzalez,
TRACK II
LAW ENFORCEMENT TRACK
TRACK II – DAY 1
March 23, Friday, 1300-1430
CASE STUDY OF USA VS. WAYNE
AUSA Paul O’Brien & DEA S/A James Holland
A summary of the judicial aspects regarding the use, possession and distribution of analogs of GHB to include GBL/ gamma butyrolactone and 1, 4 butanediol. The aforementioned substances/chemicals were sold and distributed as a sleep aid and ingested by bodybuilders to aid in recovery from workouts. The case study will address how addiction and overdoses of GBL were investigated in Detroit and led to the identification of a major distribution center in Murfreesboro, TN.
AUSA Paul O'Brien has been an Assistant United States Attorney for 13 years. He is currently serving as the criminal chief for the Middle District of Tennessee.
S/A James Holland served seven years as a U.S. Marine infantry officer prior to being employed by the Drug Enforcement Administration. S/A Holland has been in general enforcement for 17 years, having been assigned to the New Orleans Field Division, the Oxford, Mississippi Resident Office and is currently assigned to the Nashville District Office in Tennessee.
TRACK II – DAY 1
March 23, Friday, 1430-1600 (2 segments)
THE CHANGING FACE OF DRUGS & DRIVING:
ZERO TOLERANCE VS. DRUG IMPAIRMENT
Judge Roderick Kennedy, New Mexico Appeals Court
The legal face of drugged driving is changing. Proving a
legally relevant degree of impairment by drugs in court is dependent on too many
unpredictable factors, given individual variations between subjects in the way
drugs affect the body. Legislative bodies in the US and throughout the world
are recognizing that zero-tolerance laws are the most effective ways of
injecting a greater degree of certainty in enforcement when combating drugged
driving. Despite the fact that zero tolerance laws cast a net that would
include drug users who are not necessarily dangerous because of drug-induced
impairment, courts have resolved these issues in favor of predictable and
consistent standards for criminal behavior.
JUDICIAL PERSPECTIVES ON PROVING THE PRESENCE
& EFFECT OF
DRUGS AT TRIAL
Judge Roderick Kennedy, New Mexico Appeals Court
Proving the presence of a drug or a particular symptom
caused by a drug does not necessarily predict a relevant effect of drug
ingestion. Cases in which impairment by a drug must be proven (whether
impairment of an offender or victim) must consist of two major elements:
identification of the relevant drug in a quantitative amount in the subject's
system at a relevant time; and associating the amount of drug in the subject's
system with a likely effect that satisfies legal requirements for admissible
evidence. Chemical analysts who identify the presence and amount of a drug are
not always competent witnesses to testify about the effect of one or multiple
drugs in the human system. Evidentiary standards, relevant case law and various
approaches to overcoming pitfalls at trial will be discussed.
Judge Roderick Kennedy has been with the New Mexico Court of Appeals since 1999, except for time spent in 2001 as Judge Pro Tem, Jicarilla Apache Nation, in Dulce, New Mexico. He has been an Assistant District Attorney in Albuquerque, NM; in private practice in criminal defense; and was a metropolitan court judge in Bernalillo County. He was a member of the County’s DWI Planning Council; assisted in rewriting DWI chemical testing regulations; drafted jail holding policy for intoxicated offenders; and instituted intensive pretrial services for repeat DWI offenders. He has published extensively on DWI related topics.
TRACK II – DAY 1
March 23, Friday, 1600-1700
The Charging Decision In Motor Vehicle Fatality Cases
Warren Diepraam, Prosecutor
Harris County District Attorney’s Office, Houston
The speech will focus on legal issues facing prosecutors and police officers in cases involving motor vehicle fatalities. There are a variety of options available to law enforcement that will fit the facts of the case. The speech will disclose the benefits and risks with each charging decision. The benefits and risks will be explained, both as to the initial portions of the prosecution/investigation and the latter portions post indictment and trial. The charging options will generally focus on Texas laws, but will also cover similar laws in other states and some creative prosecutions in other states such as the recent "Depraved Indifference Murder" prosecution in New York City. General charge issues discussed are:
The Charging Decision
Intoxication Manslaughter
Intoxication Assault
Felony DWI
Felony Murder
Depraved Indifference Murder
Manslaughter
Vehicular Homicide
Vehicular Manslaughter
Negligent Homicide
Injury to a Child / Elderly / Disabled Individual
FSRA / Hit and Run
Unavoidable Accident
Consider Your Options
DWI #3 (Texas or Habitual DWI Violator in other states) with deadly weapon paragraph is third degree aggravated offense
Felony Murder is an aggravated first degree felony
DWI #3 is a felony with no causation requirements
Consider if causation is an issue
Consider if 20 years does not seem appropriate
Chapter 19 Offenses
Add deadly weapon pleading
Can use on lower test scores
State can get lesser instruction
FSRA
Probably can't add deadly weapon
Warren Diepraam, Harris County District Attorney’s Office, Houston, Texas, is employed as an Assistant District Attorney with the Harris County District Attorney’s Office handling felony and misdemeanor cases in the Police Integrity Division. Chief Prosecutor in the District Attorney’s “Vehicular Assault Traffic Safety Team.” Has personally handled over 100 jury trial cases including capital murder, murder, aggravated robbery, intoxication manslaughter, driving while intoxicated, and sexual assault. Used novel legal theories in prosecuting habitually impaired drivers that are now employed by other prosecutors around the state. First prosecutor in the state to prosecute a habitually impaired driver that took the life of another person for felony murder. First prosecutor in the nation to charge and convict a habitual drug impaired driver for felony murder. First recipient of the National Traffic Safety Award recognizing prosecutors for significant contributions to traffic safety.
TRACK II – DAY 2
March 24, Saturday, 0800-0930
CLUB DRUGS IN FORENSIC TOXICOLOGY CASEWORK: RECENT EXPERIENCE WITH GHB, DXM & XTC
Barry Logan, PhD, DABFT, Toxicologist
Director, Forensic Laboratory Services Bureau, Washington State Patrol
This presentation will cover a recent GHB fatal overdose, examination of cause and manner of death in MDMA (XTC) cases, and a series of impaired driving cases and two homicides involving DXM.
Dr. Barry K. Logan is Director of the Forensic Laboratory Services Bureau of the Washington State Patrol, and State Toxicologist for the State of Washington. He has over seventy publications in the field of forensic toxicology and drug analysis, and has made over two hundred presentations to professional groups. He is Board Certified by the American Board of Forensic Toxicology, and serves on their Board of Directors. He also serves on the Boards of the National Safety Council's Committee on Alcohol and Other Drugs, the International Council on Alcohol, Drugs, and Traffic Safety (ICADTS), and the editorial boards of the Journal of Forensic Sciences, and the Journal of Analytical Toxicology. He is a Fellow of the American Academy of Forensic Sciences and an active member of the Society of Forensic Toxicologists, and the International Association of Forensic Toxicologists (TIAFT). In 2002 he was named Executive Director of the Center for Studies of Law in Action at Indiana University, and oversees the Borkenstein alcohol and drug courses offered through the University on the Bloomington campus. He continues to conduct and publish research in areas including drug use and driving impairment, and postmortem toxicology.
TRACK 2 – DAY 2
March 24, Saturday, 0930-1100
Endogenous levels of GHB in Urine
Samples
Marc LeBeau, PhD, Chief, Chemistry Unit
FBI Laboratory, Quantico, VA
Endogenous (naturally occurring) levels of GHB in urine samples, compared to exogenous (ingested) levels. Since GHB does occur naturally in limited quantities in the human body, this information is crucial in determining whether GHB found in rape, poisoning or death cases involved ingested GHB.
Learning Objectives
Attendees will become knowledgeable of the naturally occurring levels of GHB in human urine samples
Attendees will become aware of the limitations and challenges related to testing for GHB and interpreting results in rape, poisoning and death cases
Marc LeBeau is the head of the Chemistry Unit of the Federal Bureau of Investigation Laboratory and is an expert on the drugs used to facilitate sexual assault and especially GHB.
TRACK II – DAY 2
March 24, Saturday, 1100-1200
GHB Analogue Trials
Dr. James DeFrancesco, DEA, Chicago Lab
Trials throughout the country in numerous federal districts/circuits from 2001 to the present involving analogue prosecutions of BD and GBL including prosecution strategies and experts, defense strategies and experts, and court decisions will be reviewed.
James V. DeFrancesco, Ph.D. is a Senior Forensic Chemist with the Drug Enforcement Administration’s North Central Laboratory in Chicago. His diverse background in chemistry ranges from work in private industry for such companies as Mobil Oil (now Exxon Mobil), and Fujisawa Pharmaceuticals to teaching at DePaul University and Northwestern University. He earned his BS in chemistry from Elmhurst College in 1983. In 1992, he earned his Ph.D. from Michigan State University under Professor Peter J. Wagner, whose group is world-renowned for research in the area of organic photochemistry. He has been awarded for his outstanding work with an undergraduate scholarship, graduate fellowship from the NSF, merit level teaching appointments and commendation, a technology award from Mobil Oil for achievements in product development, and numerous service awards from the DEA and US Attorney’s Office.
He has published and presented his work in numerous research areas throughout his career. In his nine years with the DEA, he has become a leading expert in the forensic chemical analysis of GHB, BD, and GBL and has conducted significant research into the chemistry of GHB and GBL (jointly with researchers at the FDA). Additionally, he has been at the forefront of forensic science by providing technical assistance to law enforcement in major GHB/BD investigations (e.g. Operation Webslinger in 2002) and has provided key court testimony in numerous conspiracy prosecutions resulting in the establishment of legal precedence in this emerging area. Recently, he has been involved in the international investigation of clandestinely-produced fentanyl, its use as a replacement for heroin, and the subsequent overdose deaths in 2005 and 2006 in the US.
TRACK II – DAY 2
March 24, Saturday, 1300-1430
STEROIDS IN THE “WORKPLACE” & BEYOND
John Hoberman, Professor & Chair, Department of Germanic Languages, University of Texas, Austin
1. Origins of synthetic testosterone and anabolic steroids
2. History of clinical applications of testosterone and anabolic steroids
3. Elite athletes' use of androgenic drugs for performance-enhancement
4. "Workplace doping" with androgenic drugs:
a. Professional athletes
b. Police officers
c. Other action-oriented professions
5. Use of anabolic steroids by bodybuilders and male adolescents
6. Use of androgenic drug by aging people under the rubric of
"anti-aging" therapy
LEARNING OBJECTIVES:
1. How the medical profession has used and assessed the benefits and
hazards of androgenic drugs for clinical purposes
2. The prevalence of and motives for anabolic steroid use by male and
female adolescents in the United States
3. Evidence and arguments regarding the medical hazards of illicit
androgenic drug use
4. Identifying the commercially-driven promotion of androgenic drug
use for aging men and women
John M. Hoberman, Professor & Chair, Department of Germanic Languages, University of Texas, Austin, has published extensively on drug doping in sports worldwide, from issues of teen steroid abuse to Olympic competition. He has also published regarding steroid use in action professions, such as law enforcement and firefighting.
TRACK II – DAY 2
March 24, Saturday, 1430 – 1600
OPERATION WEBSLINGER—PROSECUTION OF AN INTERNET-BASED
1,4 BUTANEDIOL CONSPIRACY
John Davis, Assistant US Attorney
Eastern District of Missouri
A general explanation of 1,4 butanediol as a chemical analog of GHB. An overview of a mother-son team who set up and operated an international Internet 1,4 butanediol distribution ring from the Eastern District of Missouri. The investigation involved wiretaps of both the target's telephones and e-mail accounts. Prosecution ended with arrests in several states and guilty pleas from all indictees.
John T Davis is an Assistant US Attorney with Eastern District of Missouri since 1997. Initially assigned to the HIDTA (High Intensity Drug trafficking Area) Unit exclusively prosecuting methamphetamine related crime. Currently assigned to the OCDETF (Organized Crime Drug Enforcement Task Force) prosecuting large-scale drug conspiracies and organized crime. Former Assistant Prosecuting Attorney for St. Charles County, Missouri. Former Associate Circuit Judge for the Missouri's 11th Judicial Circuit. Current adjunct professor at: Saint Louis University School of Law - for the past 4 years; Lindenwood University - for the past 12 years; St. Charles County Community College - for the past 17 years
TRACK II – DAY 2
March 24, Saturday, 1600-1700
What do I look for? Basic overview of GHB Overdose,
withdrawal, deaths, and expert testimony
Deborah Zvosec, Ph.D.
Minnesota Medical Research Foundation
Outline:
I. Background
A. Development of GHB
B. Popular use: “Supplements,” solvents, and current sources
II. Medical overview
A. GHB overdose
a. Clinical effects
b. Associated injuries
c. How to recognize GHB overdose
d. Videos of GHB overdose
B. GHB addiction and withdrawal
a. General background: who gets addicted, how, and why?
b. Withdrawal symptoms and course
C. Deaths
a. Overdose deaths due to respiratory arrest, fatal accidents, restraint-associated cardiac arrest
i. Misinformation on products and websites for users to “sleep it off”
ii. Endogenous vs. Exogenous levels
iii. Why deaths are under-reported
b. GHB withdrawal deaths in the hospital, in custody, and at home
D. GHB-facilitated sexual assault:
a. What to look for
b. A negative GHB test does NOT mean that it was n