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Veterans’ Use of Designer Cathinones and Cannabinoids

Although not a new phenomenon, the use of designer drugs by veterans is rising, and health care providers need to understand their impact and how to diagnose their use.
Federal Practitioner. 2014 November;31(11):22-27
November 17, 2014|Federal Practitioner
Gerald Scott Winder, MD;Bradley Stilger, MD;Avinash Hosanagar, MD
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Gerald Scott Winder, MD; Bradley Stilger, MD; Colleen Ehrnstrom, PhD; and Avinash Hosanagar, MD

Dr. Winder is a psychosomatic medicine fellow, and Dr. Stilger is a psychiatry resident, and Dr. Hosanagar is on the faculty and a psychiatrist all at the University of Michigan Department of Psychiatry in Ann Arbor, Michigan. Dr. Hosanagar is a psychiatrist and Dr. Ehrnstrom was a clinical psychologist at the VA Ann Arbor Health Care System and at the University of Michigan Department of Psychiatry and now is a clinical psychologist at the Eastern Colorado Health Care System in Aurora, Colorado.

Many synthetic cannabinoid herbal mixes also contain a detectable compound called tocopherol, seemingly added as an antioxidant.69,70 Synthetic cannabinoids are an evolving drug class, and reliable detection will require that laboratories stay up-to-date in their detection methods. As stated earlier, a commercial laboratory in the region accepted the civilian and veteran patient samples for these case studies. The synthetic cannabinoid panels offered evaluation of the drug itself (GC-MS), an oral fluid screen (LC-MS), and isolation of metabolites in urine (enzyme-linked immunosorbent assay).

Conclusion

Designer drugs will remain a challenge for providers caring for veterans for several key reasons: (1) Veterans are a vulnerable population who abuse substances at higher rates than do their civilian counterparts; (2) Chemists are able to manufacture variations of known habit-forming substances; (3) Modern technology facilitates the purchase and wide distribution of addictive substances; (4) Many designer drugs are deceptively packaged and marketed; (5) The effects of the drugs are often severe; (6) No standardized treatment guidelines exist; and (7) Detection of the drugs is difficult, and new versions of the molecules may evade even cutting-edge techniques.

Due to the high cost of detecting synthetic cathinones and synthetic cannabinoids in body fluids, screening should be considered only in settings where severe symptoms are accompanied by reasonable clinical suspicion of use and an otherwise negative toxicologic workup. As more designer drugs inevitably emerge, research will be needed on their pharmacology, toxidromes, and detection. Military and civilian practitioners must remain abreast of the dynamic trends in designer drugs to ensure that their patients receive the highest level of medical care.

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.  

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.

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