Toxicology

STANFORD, CALIF. – Dr. Leslie Gee walked into a local smoke shop near Stanford in May 2012 and bought a packet of synthetic cannabinoids 7 months after California banned similar versions.

That’s just one of many designer drugs that adolescents are using and abusing, with effects that may mimic illicit substances but also can cause unpredictable and sometimes serious adverse effects.

Courtesy Dr. Leslie Gee

If you don’t ask about it, teenagers probably won’t tell.

Ask adolescent patients, "Are you using anything to get high?" Dr. Gee said at a pediatric update sponsored by Stanford (Calif.) University. Send acutely intoxicated teens to the emergency room or pediatric intensive care unit if needed, or provide supportive care and monitor them.

Call the American Association of Poison Control Centers help line at 800-222-1222 if you’re confused about what’s happening, and give the phone number to parents and families before they might need it, added Dr. Gee, a pediatrician at the university whose clinical focus is adolescent medicine.

A July 2012 federal law placed many synthetic cannabinoid ingredients into schedule I of the Controlled Substances Act, but manufacturers keep changing the ingredients, so they still can be bought legally.

Synthetic cannabinoids are available in shops and on the Internet, and adolescents are using them. In 2011, 11% of 12th graders reported using synthetic cannabinoids and 36% reported using marijuana, according to an annual survey of 50,000 teenagers by researchers at the University of Michigan.

The survey found that 7% of eighth graders and 3% of 12th graders abused inhalants in 2011. Prescription medications were abused by 15% percent of 12th graders. A total of 6% of 10th graders and 5% of 12th graders tried to get high from dextromethorphan, an ingredient in many over-the-counter cold medications that’s also sold as a powder online. About 6% of 12th graders tried chewing or smoking salvia, an herb in the mint family sold in smoke shops and on the Internet. There are no data yet on abuse of some of the newer designer drugs, such as so-called "bath salts," said Dr. Gee, who also is a postdoctoral research fellow in psychiatry and behavioral science.

Some of these substances can’t be detected by urine drug screens. But a laboratory screen for substance abuse generally is fairly useless in adolescents anyway, whether you’re concerned about legal or illegal drugs, Dr. Seth D. Ammerman said in a separate presentation at the meeting.

"Kids are a step ahead," said Dr. Ammerman, an adolescent medicine expert and medical director of the Teen Health Van at the university. "You can get a lot more out of a history than a drug screen."

Mnemonics such as HEADSSS, SBIRT, and CRAFT can help remind physicians about questions to ask when screening for substance abuse, but make sure any particular tool has been tested in teenagers before adopting it, he advised.

Most important, make substance abuse screening part of your routine, he urged. Screen for tobacco use at all adolescent encounters. Screen all adolescents for substance use at visits for preventive services. And screen for substance use in higher-risk patients, including teens brought in by parents because of behavioral issues or school problems, adolescents with acute medical problems such as GI disturbances or trauma, teens seen in emergency departments for any reason but especially for trauma, and residents of group homes, juvenile hall, foster homes, or shelters.

"We still have a ways to go to figure out the best way to screen adolescents for substance use. There’s much active research and some useful tools, but none include every question" that you may want to ask, Dr. Ammerman said.

A common way to start is the HEADSSS assessment, with questions about home; education or work; activities; drugs, alcohol and tobacco; sexuality; sadness; depression or suicidal ideation; and safety.

The SBIRT – Screening, Brief Intervention, and Referral for Treatment – doesn’t address tobacco use, but if you routinely screen for tobacco as a vital sign, you’ll have that covered, Dr. Ammerman said. Under SBIRT, ask if the patient has drunk alcohol, smoked marijuana, or used any other substance to get high including illicit drugs, over-the-counter preparations, prescription medications, inhalants, herbs, or plants.

If the patient says, "No" to all three questions, praise the patient and continue to encourage abstinence, he said. If there’s a "Yes" response, perform the CRAFFT screen for alcohol and drug use, Dr. Ammerman suggested. The acronym stands for Car, Relax, Alone, Forget, Friends/family, and Trouble. Have you driven or ridden in a Car in which anyone was high? Have you used substances to Relax or feel better about yourself? Have you used substances Alone? Ever done anything under the influence of substances that you Forgot? Have Friends or family commented on your use? Have you had any Trouble with parents, school, police, etc., related to substance use?

Adolescents who give at least two positive responses are increased risk of addiction and deserve further attention.

Many physicians received a screening tool in the mail last year from the National Institute on Alcohol Abuse and Alcoholism with specific questions for different age groups entitled "Alcohol Screening and Brief Intervention for Youth: A Practitioner’ Guide," but "I personally prefer the SBIRT," Dr. Ammerman said. "It’s validated and easy to use."

Dr. Gee described some of the common "legal highs" and designer drugs, and what to do besides taking a good history if you suspect adolescents are using them.

• Inhalants. The average U.S. household contains 30-50 products that can be used for inhalant abuse through sniffing, "bagging" (spraying or placing in a bag and then inhaling from the bag), or "huffing" (placing a rag soaked in chemicals on one’s face). Some contain hydrocarbons that depress the central nervous system. Others contain nitrite that cause vasodilation.

Inhalant abuse can cause asphyxia, suffocation, or "sudden sniffing death" from sensitization of the myocardium to catecholamines (especially Freon) and a catecholamine rush after exercise or masturbation, resulting in cardiovascular collapse, she said.

Clues to inhalant abuse include a "glue sniffer’s rash" on the face, cheeks, and nose. The family may notice empty containers around the house or a chemical smell on the teen’s breath, skin, or clothes.

Most inhalants won’t be detected by standard urine drug screens. Evaluate using pulse oximetry, an ECG, and cardiac monitoring for arrhythmias, complete blood count, complete metabolic panel, and urinalysis, she suggested. Depending on the substance being abused, consider checking methemoglobin and lead levels. Treat with supportive care.

• Prescription drugs. Prescribed narcotics, benzodiazepines, or medications for attention-deficit/hyperactivity disorder are found in many households. They may cause respiratory depression or organ failure. Evaluate with urine drug screening and manage with supportive care appropriate to the ingested substance.

• Dextromethorphan. It goes by at least 10 aliases: Robo; Skittles; Dex; and more. A typical dose for cold therapy is 15-30 mg four times a day. Higher doses produce side effects at different dose plateaus: mild inebriation or stimulation from 100-200 mg, and euphoria, mild hallucinations, slurred speech, and short-term memory loss after 200-400 mg. A dose of 300-600 mg can alter consciousness and impair vision and motor control. At 500-1,500 mg, the mind and body dissociate.

Abuse can produce life-threatening effects including serotonin syndrome, high fever, rhabdomyolysis, arrhythmias, loss of consciousness, and brain damage.

Treatment is supportive care. When you suspect dextromethorphan abuse, also screen and treat for coingestion of other substances, especially acetaminophen and selective serotonin reuptake inhibitors.

• Salvia. A perennial herb native to Mexico, salvia is not a controlled substance, but California prohibits its sale to minors. Effects kick in within 5-10 minutes of chewing or within 30 seconds of smoking 200-500 mcg, and include hallucinations, bright lights, vivid colors and shapes, body or object distortions, uncontrolled laughter, or a sense of body loss. Provide supportive care.

• Synthetic cannabinoids. Added to blends of herbs and sold legally in the United States as alternatives to marijuana from 2009 until the recent regulations, synthetic cannabinoids produce psychoactive and sedative effects similar to marijuana, although possibly less potent. They also may produce more adverse effects, including withdrawal symptoms, cardiac problems, or psychoses. "I’ve seen reports of acute MIs and arrhythmias" from these products, Dr. Gee said.

Standard urine drug screens won’t detect them, but newer screening tests are in development. Consider coingestion of other substances and contaminants and provide supportive care.

• Bath salts. These synthetic cathinones entered the United States from Europe around 2010. They contain methylenedioxypyrovalerone, methylone, 4-methylmethcathinone – all three of which became schedule I substances in 2011 – or an ever-new roster of similar drugs. "They’re just marketed as bath salts or plant food as a way to get around regulations," Dr. Gee said. "They’re not something you’d want to put in your bath or plants."

Snorting or consuming orally induce empathy, stimulation, alertness, and euphoria within 3-4 hours that last 6-8 hours – similar to the effects of cocaine, cathinone (khat), amphetamines, or 3,4-methylenedioxymethamphetamine (MDMA, or Ecstasy). But they also can cause intense, prolonged panic attacks, violent behavior, and psychosis. Some "dramatic, scary" news reports have linked bath salts with violent behavior, she said.

Standard drug screens won’t detect synthetic cathinones, but tests are being developed. Consider coingestion of other substances and contaminants if you suspect bath salts use, and provide supportive care for agitation and psychoses.

Some possible references to help with substance abuse screening follow:

• The U.S. Drug Enforcement Administration offers handouts, links, and information on legal issues surrounding drugs and chemicals of concern.

• The Partnership at drugfree.org produced a toolkit for parents about synthetic drugs.

• The U.S. Office of National Drug Control Policy soon will release a Synthetic Drug Prevention Toolkit, Dr. Gee said.

• A sort of wiki for drug use, the website Erowid.org posts accounts of personal experiences – what happened when someone tried a drug, how much they tried, etc. It’s a window for clinicians looking to understand more about drug use and abuse, she added.

• One physician in the audience recommended Millennium Laboratories of San Diego to test patient samples for any synthetic drug, with a 24-hour turnaround.

Dr. Gee and Dr. Ammerman reported having no relevant financial disclosures.

STANFORD, CALIF. – Dr. Leslie Gee walked into a local smoke shop near Stanford in May 2012 and bought a packet of synthetic cannabinoids 7 months after California banned similar versions.

That’s just one of many designer drugs that adolescents are using and abusing, with effects that may mimic illicit substances but also can cause unpredictable and sometimes serious adverse effects.

Courtesy Dr. Leslie Gee

If you don’t ask about it, teenagers probably won’t tell.

Ask adolescent patients, "Are you using anything to get high?" Dr. Gee said at a pediatric update sponsored by Stanford (Calif.) University. Send acutely intoxicated teens to the emergency room or pediatric intensive care unit if needed, or provide supportive care and monitor them.

Call the American Association of Poison Control Centers help line at 800-222-1222 if you’re confused about what’s happening, and give the phone number to parents and families before they might need it, added Dr. Gee, a pediatrician at the university whose clinical focus is adolescent medicine.

A July 2012 federal law placed many synthetic cannabinoid ingredients into schedule I of the Controlled Substances Act, but manufacturers keep changing the ingredients, so they still can be bought legally.

Synthetic cannabinoids are available in shops and on the Internet, and adolescents are using them. In 2011, 11% of 12th graders reported using synthetic cannabinoids and 36% reported using marijuana, according to an annual survey of 50,000 teenagers by researchers at the University of Michigan.

The survey found that 7% of eighth graders and 3% of 12th graders abused inhalants in 2011. Prescription medications were abused by 15% percent of 12th graders. A total of 6% of 10th graders and 5% of 12th graders tried to get high from dextromethorphan, an ingredient in many over-the-counter cold medications that’s also sold as a powder online. About 6% of 12th graders tried chewing or smoking salvia, an herb in the mint family sold in smoke shops and on the Internet. There are no data yet on abuse of some of the newer designer drugs, such as so-called "bath salts," said Dr. Gee, who also is a postdoctoral research fellow in psychiatry and behavioral science.

Some of these substances can’t be detected by urine drug screens. But a laboratory screen for substance abuse generally is fairly useless in adolescents anyway, whether you’re concerned about legal or illegal drugs, Dr. Seth D. Ammerman said in a separate presentation at the meeting.

"Kids are a step ahead," said Dr. Ammerman, an adolescent medicine expert and medical director of the Teen Health Van at the university. "You can get a lot more out of a history than a drug screen."

Mnemonics such as HEADSSS, SBIRT, and CRAFT can help remind physicians about questions to ask when screening for substance abuse, but make sure any particular tool has been tested in teenagers before adopting it, he advised.

Most important, make substance abuse screening part of your routine, he urged. Screen for tobacco use at all adolescent encounters. Screen all adolescents for substance use at visits for preventive services. And screen for substance use in higher-risk patients, including teens brought in by parents because of behavioral issues or school problems, adolescents with acute medical problems such as GI disturbances or trauma, teens seen in emergency departments for any reason but especially for trauma, and residents of group homes, juvenile hall, foster homes, or shelters.

"We still have a ways to go to figure out the best way to screen adolescents for substance use. There’s much active research and some useful tools, but none include every question" that you may want to ask, Dr. Ammerman said.

A common way to start is the HEADSSS assessment, with questions about home; education or work; activities; drugs, alcohol and tobacco; sexuality; sadness; depression or suicidal ideation; and safety.

The SBIRT – Screening, Brief Intervention, and Referral for Treatment – doesn’t address tobacco use, but if you routinely screen for tobacco as a vital sign, you’ll have that covered, Dr. Ammerman said. Under SBIRT, ask if the patient has drunk alcohol, smoked marijuana, or used any other substance to get high including illicit drugs, over-the-counter preparations, prescription medications, inhalants, herbs, or plants.

If the patient says, "No" to all three questions, praise the patient and continue to encourage abstinence, he said. If there’s a "Yes" response, perform the CRAFFT screen for alcohol and drug use, Dr. Ammerman suggested. The acronym stands for Car, Relax, Alone, Forget, Friends/family, and Trouble. Have you driven or ridden in a Car in which anyone was high? Have you used substances to Relax or feel better about yourself? Have you used substances Alone? Ever done anything under the influence of substances that you Forgot? Have Friends or family commented on your use? Have you had any Trouble with parents, school, police, etc., related to substance use?

Adolescents who give at least two positive responses are increased risk of addiction and deserve further attention.

Many physicians received a screening tool in the mail last year from the National Institute on Alcohol Abuse and Alcoholism with specific questions for different age groups entitled "Alcohol Screening and Brief Intervention for Youth: A Practitioner’ Guide," but "I personally prefer the SBIRT," Dr. Ammerman said. "It’s validated and easy to use."

Dr. Gee described some of the common "legal highs" and designer drugs, and what to do besides taking a good history if you suspect adolescents are using them.

• Inhalants. The average U.S. household contains 30-50 products that can be used for inhalant abuse through sniffing, "bagging" (spraying or placing in a bag and then inhaling from the bag), or "huffing" (placing a rag soaked in chemicals on one’s face). Some contain hydrocarbons that depress the central nervous system. Others contain nitrite that cause vasodilation.

Inhalant abuse can cause asphyxia, suffocation, or "sudden sniffing death" from sensitization of the myocardium to catecholamines (especially Freon) and a catecholamine rush after exercise or masturbation, resulting in cardiovascular collapse, she said.

Clues to inhalant abuse include a "glue sniffer’s rash" on the face, cheeks, and nose. The family may notice empty containers around the house or a chemical smell on the teen’s breath, skin, or clothes.

Most inhalants won’t be detected by standard urine drug screens. Evaluate using pulse oximetry, an ECG, and cardiac monitoring for arrhythmias, complete blood count, complete metabolic panel, and urinalysis, she suggested. Depending on the substance being abused, consider checking methemoglobin and lead levels. Treat with supportive care.

• Prescription drugs. Prescribed narcotics, benzodiazepines, or medications for attention-deficit/hyperactivity disorder are found in many households. They may cause respiratory depression or organ failure. Evaluate with urine drug screening and manage with supportive care appropriate to the ingested substance.

• Dextromethorphan. It goes by at least 10 aliases: Robo; Skittles; Dex; and more. A typical dose for cold therapy is 15-30 mg four times a day. Higher doses produce side effects at different dose plateaus: mild inebriation or stimulation from 100-200 mg, and euphoria, mild hallucinations, slurred speech, and short-term memory loss after 200-400 mg. A dose of 300-600 mg can alter consciousness and impair vision and motor control. At 500-1,500 mg, the mind and body dissociate.

Abuse can produce life-threatening effects including serotonin syndrome, high fever, rhabdomyolysis, arrhythmias, loss of consciousness, and brain damage.

Treatment is supportive care. When you suspect dextromethorphan abuse, also screen and treat for coingestion of other substances, especially acetaminophen and selective serotonin reuptake inhibitors.

• Salvia. A perennial herb native to Mexico, salvia is not a controlled substance, but California prohibits its sale to minors. Effects kick in within 5-10 minutes of chewing or within 30 seconds of smoking 200-500 mcg, and include hallucinations, bright lights, vivid colors and shapes, body or object distortions, uncontrolled laughter, or a sense of body loss. Provide supportive care.

• Synthetic cannabinoids. Added to blends of herbs and sold legally in the United States as alternatives to marijuana from 2009 until the recent regulations, synthetic cannabinoids produce psychoactive and sedative effects similar to marijuana, although possibly less potent. They also may produce more adverse effects, including withdrawal symptoms, cardiac problems, or psychoses. "I’ve seen reports of acute MIs and arrhythmias" from these products, Dr. Gee said.

Standard urine drug screens won’t detect them, but newer screening tests are in development. Consider coingestion of other substances and contaminants and provide supportive care.

• Bath salts. These synthetic cathinones entered the United States from Europe around 2010. They contain methylenedioxypyrovalerone, methylone, 4-methylmethcathinone – all three of which became schedule I substances in 2011 – or an ever-new roster of similar drugs. "They’re just marketed as bath salts or plant food as a way to get around regulations," Dr. Gee said. "They’re not something you’d want to put in your bath or plants."

Snorting or consuming orally induce empathy, stimulation, alertness, and euphoria within 3-4 hours that last 6-8 hours – similar to the effects of cocaine, cathinone (khat), amphetamines, or 3,4-methylenedioxymethamphetamine (MDMA, or Ecstasy). But they also can cause intense, prolonged panic attacks, violent behavior, and psychosis. Some "dramatic, scary" news reports have linked bath salts with violent behavior, she said.

Standard drug screens won’t detect synthetic cathinones, but tests are being developed. Consider coingestion of other substances and contaminants if you suspect bath salts use, and provide supportive care for agitation and psychoses.

Some possible references to help with substance abuse screening follow:

• The U.S. Drug Enforcement Administration offers handouts, links, and information on legal issues surrounding drugs and chemicals of concern.

• The Partnership at drugfree.org produced a toolkit for parents about synthetic drugs.

• The U.S. Office of National Drug Control Policy soon will release a Synthetic Drug Prevention Toolkit, Dr. Gee said.

• A sort of wiki for drug use, the website Erowid.org posts accounts of personal experiences – what happened when someone tried a drug, how much they tried, etc. It’s a window for clinicians looking to understand more about drug use and abuse, she added.

• One physician in the audience recommended Millennium Laboratories of San Diego to test patient samples for any synthetic drug, with a 24-hour turnaround.

Dr. Gee and Dr. Ammerman reported having no relevant financial disclosures.

STANFORD, CALIF. – Dr. Leslie Gee walked into a local smoke shop near Stanford in May 2012 and bought a packet of synthetic cannabinoids 7 months after California banned similar versions.

That’s just one of many designer drugs that adolescents are using and abusing, with effects that may mimic illicit substances but also can cause unpredictable and sometimes serious adverse effects.

Courtesy Dr. Leslie Gee

If you don’t ask about it, teenagers probably won’t tell.

Ask adolescent patients, "Are you using anything to get high?" Dr. Gee said at a pediatric update sponsored by Stanford (Calif.) University. Send acutely intoxicated teens to the emergency room or pediatric intensive care unit if needed, or provide supportive care and monitor them.

Call the American Association of Poison Control Centers help line at 800-222-1222 if you’re confused about what’s happening, and give the phone number to parents and families before they might need it, added Dr. Gee, a pediatrician at the university whose clinical focus is adolescent medicine.

A July 2012 federal law placed many synthetic cannabinoid ingredients into schedule I of the Controlled Substances Act, but manufacturers keep changing the ingredients, so they still can be bought legally.

Synthetic cannabinoids are available in shops and on the Internet, and adolescents are using them. In 2011, 11% of 12th graders reported using synthetic cannabinoids and 36% reported using marijuana, according to an annual survey of 50,000 teenagers by researchers at the University of Michigan.

The survey found that 7% of eighth graders and 3% of 12th graders abused inhalants in 2011. Prescription medications were abused by 15% percent of 12th graders. A total of 6% of 10th graders and 5% of 12th graders tried to get high from dextromethorphan, an ingredient in many over-the-counter cold medications that’s also sold as a powder online. About 6% of 12th graders tried chewing or smoking salvia, an herb in the mint family sold in smoke shops and on the Internet. There are no data yet on abuse of some of the newer designer drugs, such as so-called "bath salts," said Dr. Gee, who also is a postdoctoral research fellow in psychiatry and behavioral science.

Some of these substances can’t be detected by urine drug screens. But a laboratory screen for substance abuse generally is fairly useless in adolescents anyway, whether you’re concerned about legal or illegal drugs, Dr. Seth D. Ammerman said in a separate presentation at the meeting.

"Kids are a step ahead," said Dr. Ammerman, an adolescent medicine expert and medical director of the Teen Health Van at the university. "You can get a lot more out of a history than a drug screen."

Mnemonics such as HEADSSS, SBIRT, and CRAFT can help remind physicians about questions to ask when screening for substance abuse, but make sure any particular tool has been tested in teenagers before adopting it, he advised.

Most important, make substance abuse screening part of your routine, he urged. Screen for tobacco use at all adolescent encounters. Screen all adolescents for substance use at visits for preventive services. And screen for substance use in higher-risk patients, including teens brought in by parents because of behavioral issues or school problems, adolescents with acute medical problems such as GI disturbances or trauma, teens seen in emergency departments for any reason but especially for trauma, and residents of group homes, juvenile hall, foster homes, or shelters.

"We still have a ways to go to figure out the best way to screen adolescents for substance use. There’s much active research and some useful tools, but none include every question" that you may want to ask, Dr. Ammerman said.

A common way to start is the HEADSSS assessment, with questions about home; education or work; activities; drugs, alcohol and tobacco; sexuality; sadness; depression or suicidal ideation; and safety.

The SBIRT – Screening, Brief Intervention, and Referral for Treatment – doesn’t address tobacco use, but if you routinely screen for tobacco as a vital sign, you’ll have that covered, Dr. Ammerman said. Under SBIRT, ask if the patient has drunk alcohol, smoked marijuana, or used any other substance to get high including illicit drugs, over-the-counter preparations, prescription medications, inhalants, herbs, or plants.

If the patient says, "No" to all three questions, praise the patient and continue to encourage abstinence, he said. If there’s a "Yes" response, perform the CRAFFT screen for alcohol and drug use, Dr. Ammerman suggested. The acronym stands for Car, Relax, Alone, Forget, Friends/family, and Trouble. Have you driven or ridden in a Car in which anyone was high? Have you used substances to Relax or feel better about yourself? Have you used substances Alone? Ever done anything under the influence of substances that you Forgot? Have Friends or family commented on your use? Have you had any Trouble with parents, school, police, etc., related to substance use?

Adolescents who give at least two positive responses are increased risk of addiction and deserve further attention.

Many physicians received a screening tool in the mail last year from the National Institute on Alcohol Abuse and Alcoholism with specific questions for different age groups entitled "Alcohol Screening and Brief Intervention for Youth: A Practitioner’ Guide," but "I personally prefer the SBIRT," Dr. Ammerman said. "It’s validated and easy to use."

Dr. Gee described some of the common "legal highs" and designer drugs, and what to do besides taking a good history if you suspect adolescents are using them.

• Inhalants. The average U.S. household contains 30-50 products that can be used for inhalant abuse through sniffing, "bagging" (spraying or placing in a bag and then inhaling from the bag), or "huffing" (placing a rag soaked in chemicals on one’s face). Some contain hydrocarbons that depress the central nervous system. Others contain nitrite that cause vasodilation.

Inhalant abuse can cause asphyxia, suffocation, or "sudden sniffing death" from sensitization of the myocardium to catecholamines (especially Freon) and a catecholamine rush after exercise or masturbation, resulting in cardiovascular collapse, she said.

Clues to inhalant abuse include a "glue sniffer’s rash" on the face, cheeks, and nose. The family may notice empty containers around the house or a chemical smell on the teen’s breath, skin, or clothes.

Most inhalants won’t be detected by standard urine drug screens. Evaluate using pulse oximetry, an ECG, and cardiac monitoring for arrhythmias, complete blood count, complete metabolic panel, and urinalysis, she suggested. Depending on the substance being abused, consider checking methemoglobin and lead levels. Treat with supportive care.

• Prescription drugs. Prescribed narcotics, benzodiazepines, or medications for attention-deficit/hyperactivity disorder are found in many households. They may cause respiratory depression or organ failure. Evaluate with urine drug screening and manage with supportive care appropriate to the ingested substance.

• Dextromethorphan. It goes by at least 10 aliases: Robo; Skittles; Dex; and more. A typical dose for cold therapy is 15-30 mg four times a day. Higher doses produce side effects at different dose plateaus: mild inebriation or stimulation from 100-200 mg, and euphoria, mild hallucinations, slurred speech, and short-term memory loss after 200-400 mg. A dose of 300-600 mg can alter consciousness and impair vision and motor control. At 500-1,500 mg, the mind and body dissociate.

Abuse can produce life-threatening effects including serotonin syndrome, high fever, rhabdomyolysis, arrhythmias, loss of consciousness, and brain damage.

Treatment is supportive care. When you suspect dextromethorphan abuse, also screen and treat for coingestion of other substances, especially acetaminophen and selective serotonin reuptake inhibitors.

• Salvia. A perennial herb native to Mexico, salvia is not a controlled substance, but California prohibits its sale to minors. Effects kick in within 5-10 minutes of chewing or within 30 seconds of smoking 200-500 mcg, and include hallucinations, bright lights, vivid colors and shapes, body or object distortions, uncontrolled laughter, or a sense of body loss. Provide supportive care.

• Synthetic cannabinoids. Added to blends of herbs and sold legally in the United States as alternatives to marijuana from 2009 until the recent regulations, synthetic cannabinoids produce psychoactive and sedative effects similar to marijuana, although possibly less potent. They also may produce more adverse effects, including withdrawal symptoms, cardiac problems, or psychoses. "I’ve seen reports of acute MIs and arrhythmias" from these products, Dr. Gee said.

Standard urine drug screens won’t detect them, but newer screening tests are in development. Consider coingestion of other substances and contaminants and provide supportive care.

• Bath salts. These synthetic cathinones entered the United States from Europe around 2010. They contain methylenedioxypyrovalerone, methylone, 4-methylmethcathinone – all three of which became schedule I substances in 2011 – or an ever-new roster of similar drugs. "They’re just marketed as bath salts or plant food as a way to get around regulations," Dr. Gee said. "They’re not something you’d want to put in your bath or plants."

Snorting or consuming orally induce empathy, stimulation, alertness, and euphoria within 3-4 hours that last 6-8 hours – similar to the effects of cocaine, cathinone (khat), amphetamines, or 3,4-methylenedioxymethamphetamine (MDMA, or Ecstasy). But they also can cause intense, prolonged panic attacks, violent behavior, and psychosis. Some "dramatic, scary" news reports have linked bath salts with violent behavior, she said.

Standard drug screens won’t detect synthetic cathinones, but tests are being developed. Consider coingestion of other substances and contaminants if you suspect bath salts use, and provide supportive care for agitation and psychoses.

Some possible references to help with substance abuse screening follow:

• The U.S. Drug Enforcement Administration offers handouts, links, and information on legal issues surrounding drugs and chemicals of concern.

• The Partnership at drugfree.org produced a toolkit for parents about synthetic drugs.

• The U.S. Office of National Drug Control Policy soon will release a Synthetic Drug Prevention Toolkit, Dr. Gee said.

• A sort of wiki for drug use, the website Erowid.org posts accounts of personal experiences – what happened when someone tried a drug, how much they tried, etc. It’s a window for clinicians looking to understand more about drug use and abuse, she added.

• One physician in the audience recommended Millennium Laboratories of San Diego to test patient samples for any synthetic drug, with a 24-hour turnaround.

Dr. Gee and Dr. Ammerman reported having no relevant financial disclosures.

The first-ever nationwide strike on the designer drug industry resulted in 90 arrests and the seizing of 5 million drug packets and more than $36 million in cash, according to the U.S. Drug Enforcement Administration.

"Although tremendous progress has been made in legislating and scheduling these dangerous substances, this enforcement action has disrupted the entire illegal industry, from manufacturers to retailers," said DEA Administrator Michele M. Leonhart of the strike, which is called Operation Log Jam.

Synthetic cathinones (with street names like "bath salts" or "plant food") and synthetic cannabinoids (better known as "Spice" and "K2") have become increasingly popular in recent years, especially among young adults.

Many of the drugs come with the disclaimer "Not for human consumption," and they’re marketed at retail stores, head shops, and online.

Some are sold in hookah bars as "hookah cleaner," said Mark Ryan, director of Louisiana Poison Center and a national authority in the field.

"But in fact, they’re incredibly dangerous, with users having unpredictable – and sometimes deadly – reactions to these substances," Ms. Leonhart said in a news conference.

Earlier in July, President Barack Obama signed into law the Food and Drug Administration Safety and Innovation Act, permanently placing 26 of the substances used in designer drugs into schedule I of the Controlled Substances Act.

Yet, the manufacturers continually change the formula to avoid the law.

The sophistication of the designer drug industry has grown over the past 2 years, and such drugs are "an emerging problem," said Ms. Leonhart, "I put them up there with prescription drugs."

In just 1 year, calls to poison centers regarding synthetic cannabinoids has more than doubled, and calls regarding synthetic cathinones has increased 24-fold, she said.

In 2010, poison control centers responded to roughly 3,200 calls related to designer drugs, according to the DEA. In 2011, that number jumped to more than 13,000 calls. Some 60% of the cases involved patients aged 25 years and younger, according to the DEA.

Mr. Ryan of the Louisiana Poison Center said that for the past 3 years, he has spent 2-3 hours every day handling problems related to synthetic drugs. Many of the calls have been from emergency physicians bewildered by their patients’ symptoms.

The drugs have unpredictable effects, and can cause hallucinations, paranoia, coma, and sometimes death. And because of their varying formulations, the drugs have no known antidotes, and their long-term effects are not known.

All physicians can do is "treat the patient, not the poison," said Mr. Ryan.

Meanwhile, there’s no quick, easy test to identify the drugs, said Dr. Cathleen Clancy, an emergency physician and associate medical director of the National Capital Poison Center in Washington, D.C.

"What we get is an agitated patient who says that they have ingested something, and sometimes they don’t even tell you that," she said in an interview.

In one of the few published case studies, Dr. Joanna Cohen and colleagues presented three cases involving teenagers aged 16-18 years who had used synthetic cannabinoids (synthetic marijuana). The investigators cautioned that "given the sensitivity of the developing brain and association between early cannabis use and psychosis, adolescent use of these new synthetic cannabinoids is particularly concerning" (Pediatrics 2012;129:e1064-7).

So what should physicians tell their patients?

"Explain to them that when they take these drugs, they’re being guinea pigs. These are adaptations, and we don’t know how they’ll affect the [users]. I think if people understood that, they’d be less willing to try those drugs," said Dr. Clancy.

Operation Log Jam was conducted by the DEA and U.S. Immigration and Customs Enforcement, with assistance from Internal Revenue Service Criminal Investigations, the U.S. Postal Inspection Service, U.S. Customs and Border Protection, the Federal Bureau of Investigation, the Food and Drug Administration’s Office of Criminal Investigation, and local and state law enforcement officials in more than 109 U.S. cities.

Synthetic Drugs Fact Sheet

The first-ever nationwide strike on the designer drug industry resulted in 90 arrests and the seizing of 5 million drug packets and more than $36 million in cash, according to the U.S. Drug Enforcement Administration.

"Although tremendous progress has been made in legislating and scheduling these dangerous substances, this enforcement action has disrupted the entire illegal industry, from manufacturers to retailers," said DEA Administrator Michele M. Leonhart of the strike, which is called Operation Log Jam.

Synthetic cathinones (with street names like "bath salts" or "plant food") and synthetic cannabinoids (better known as "Spice" and "K2") have become increasingly popular in recent years, especially among young adults.

Many of the drugs come with the disclaimer "Not for human consumption," and they’re marketed at retail stores, head shops, and online.

Some are sold in hookah bars as "hookah cleaner," said Mark Ryan, director of Louisiana Poison Center and a national authority in the field.

"But in fact, they’re incredibly dangerous, with users having unpredictable – and sometimes deadly – reactions to these substances," Ms. Leonhart said in a news conference.

Earlier in July, President Barack Obama signed into law the Food and Drug Administration Safety and Innovation Act, permanently placing 26 of the substances used in designer drugs into schedule I of the Controlled Substances Act.

Yet, the manufacturers continually change the formula to avoid the law.

The sophistication of the designer drug industry has grown over the past 2 years, and such drugs are "an emerging problem," said Ms. Leonhart, "I put them up there with prescription drugs."

In just 1 year, calls to poison centers regarding synthetic cannabinoids has more than doubled, and calls regarding synthetic cathinones has increased 24-fold, she said.

In 2010, poison control centers responded to roughly 3,200 calls related to designer drugs, according to the DEA. In 2011, that number jumped to more than 13,000 calls. Some 60% of the cases involved patients aged 25 years and younger, according to the DEA.

Mr. Ryan of the Louisiana Poison Center said that for the past 3 years, he has spent 2-3 hours every day handling problems related to synthetic drugs. Many of the calls have been from emergency physicians bewildered by their patients’ symptoms.

The drugs have unpredictable effects, and can cause hallucinations, paranoia, coma, and sometimes death. And because of their varying formulations, the drugs have no known antidotes, and their long-term effects are not known.

All physicians can do is "treat the patient, not the poison," said Mr. Ryan.

Meanwhile, there’s no quick, easy test to identify the drugs, said Dr. Cathleen Clancy, an emergency physician and associate medical director of the National Capital Poison Center in Washington, D.C.

"What we get is an agitated patient who says that they have ingested something, and sometimes they don’t even tell you that," she said in an interview.

In one of the few published case studies, Dr. Joanna Cohen and colleagues presented three cases involving teenagers aged 16-18 years who had used synthetic cannabinoids (synthetic marijuana). The investigators cautioned that "given the sensitivity of the developing brain and association between early cannabis use and psychosis, adolescent use of these new synthetic cannabinoids is particularly concerning" (Pediatrics 2012;129:e1064-7).

So what should physicians tell their patients?

"Explain to them that when they take these drugs, they’re being guinea pigs. These are adaptations, and we don’t know how they’ll affect the [users]. I think if people understood that, they’d be less willing to try those drugs," said Dr. Clancy.

Operation Log Jam was conducted by the DEA and U.S. Immigration and Customs Enforcement, with assistance from Internal Revenue Service Criminal Investigations, the U.S. Postal Inspection Service, U.S. Customs and Border Protection, the Federal Bureau of Investigation, the Food and Drug Administration’s Office of Criminal Investigation, and local and state law enforcement officials in more than 109 U.S. cities.

Synthetic Drugs Fact Sheet

The first-ever nationwide strike on the designer drug industry resulted in 90 arrests and the seizing of 5 million drug packets and more than $36 million in cash, according to the U.S. Drug Enforcement Administration.

"Although tremendous progress has been made in legislating and scheduling these dangerous substances, this enforcement action has disrupted the entire illegal industry, from manufacturers to retailers," said DEA Administrator Michele M. Leonhart of the strike, which is called Operation Log Jam.

Synthetic cathinones (with street names like "bath salts" or "plant food") and synthetic cannabinoids (better known as "Spice" and "K2") have become increasingly popular in recent years, especially among young adults.

Many of the drugs come with the disclaimer "Not for human consumption," and they’re marketed at retail stores, head shops, and online.

Some are sold in hookah bars as "hookah cleaner," said Mark Ryan, director of Louisiana Poison Center and a national authority in the field.

"But in fact, they’re incredibly dangerous, with users having unpredictable – and sometimes deadly – reactions to these substances," Ms. Leonhart said in a news conference.

Earlier in July, President Barack Obama signed into law the Food and Drug Administration Safety and Innovation Act, permanently placing 26 of the substances used in designer drugs into schedule I of the Controlled Substances Act.

Yet, the manufacturers continually change the formula to avoid the law.

The sophistication of the designer drug industry has grown over the past 2 years, and such drugs are "an emerging problem," said Ms. Leonhart, "I put them up there with prescription drugs."

In just 1 year, calls to poison centers regarding synthetic cannabinoids has more than doubled, and calls regarding synthetic cathinones has increased 24-fold, she said.

In 2010, poison control centers responded to roughly 3,200 calls related to designer drugs, according to the DEA. In 2011, that number jumped to more than 13,000 calls. Some 60% of the cases involved patients aged 25 years and younger, according to the DEA.

Mr. Ryan of the Louisiana Poison Center said that for the past 3 years, he has spent 2-3 hours every day handling problems related to synthetic drugs. Many of the calls have been from emergency physicians bewildered by their patients’ symptoms.

The drugs have unpredictable effects, and can cause hallucinations, paranoia, coma, and sometimes death. And because of their varying formulations, the drugs have no known antidotes, and their long-term effects are not known.

All physicians can do is "treat the patient, not the poison," said Mr. Ryan.

Meanwhile, there’s no quick, easy test to identify the drugs, said Dr. Cathleen Clancy, an emergency physician and associate medical director of the National Capital Poison Center in Washington, D.C.

"What we get is an agitated patient who says that they have ingested something, and sometimes they don’t even tell you that," she said in an interview.

In one of the few published case studies, Dr. Joanna Cohen and colleagues presented three cases involving teenagers aged 16-18 years who had used synthetic cannabinoids (synthetic marijuana). The investigators cautioned that "given the sensitivity of the developing brain and association between early cannabis use and psychosis, adolescent use of these new synthetic cannabinoids is particularly concerning" (Pediatrics 2012;129:e1064-7).

So what should physicians tell their patients?

"Explain to them that when they take these drugs, they’re being guinea pigs. These are adaptations, and we don’t know how they’ll affect the [users]. I think if people understood that, they’d be less willing to try those drugs," said Dr. Clancy.

Operation Log Jam was conducted by the DEA and U.S. Immigration and Customs Enforcement, with assistance from Internal Revenue Service Criminal Investigations, the U.S. Postal Inspection Service, U.S. Customs and Border Protection, the Federal Bureau of Investigation, the Food and Drug Administration’s Office of Criminal Investigation, and local and state law enforcement officials in more than 109 U.S. cities.

Synthetic Drugs Fact Sheet

School’s out and the living is easy for teens come summertime, but a new government study suggests it’s also dangerous, as the rates of first-time substance use among 12- to 17-year-olds peak in June and July.

On an average day in these two summer months, approximately 11,000 adolescents use alcohol for the first time, 5,000 try their first cigarette, and 4,500 begin using marijuana, according to a report released June 3 by the Substance Abuse and Mental Health Services Administration (SAMHSA). The report is based on interviews with 231,500 adolescents in the National Survey on Drug Use and Health (NSDUH) during 2002-2010.

Copyright Stockphoto4U/iStockphoto.com

The daily average rates for first-time alcohol, cigarette, and marijuana use during the rest of the year are 5,000-8,000 for first-time alcohol use and 3,000-4,000 each for first-time cigarette and marijuana use, according to the report, titled "Monthly Variation in Substance Use Initiation among Adolescents."

First-time hallucinogen use also peaked in June and July, with a daily average rate of 1,500 new users per day, compared with 1,100-1,400 in other months. Inhalant initiation peaked in July specifically, with a daily average rate of 1,800 new users in that month, compared with 1,100-1,700 during the rest of the year, according to the report. No similar summer-month increases were observed in the use of cocaine or nonmedical prescription drugs.

The summer peaks of first-time use of many of the substances are likely associated with the increased idle time and decreased responsibilities and adult supervision during breaks from school, "although initiation of substance use can occur at any time," the authors wrote, noting that multiple implications can be drawn from the findings. For example, intensifying public service announcements and media campaigns targeting adolescents during the summer months may amplify their impact. "Messages focusing on preventing initiation may be particularly important during these months," they wrote.

Additionally, "the findings may point toward critical opportunities during the summer to implement activities and events that are attractive alternatives to drug use initiation or continued use," particularly in communities with limited prevention resources, according to the authors. From a law-enforcement perspective, targeted efforts toward preventing tobacco and alcohol sales to minors may be more effective during the peak initiation months.

The NSDUH is an annual nationwide survey involving interviews with approximately 70,000 randomly selected individuals aged 12 years and older. Respondents who report using various substances are asked to indicate the year and month of first use of each substance. The current report focused specifically on individuals who reported initiation in the use of substances within the year prior to the survey and who were 12-17 years old at the time of initiation, according to the authors.

The annual first-time substance use averages among adolescents surveyed from 2002 to 2010 were 2.9 million for alcohol (7,800 new users per day); 1.4 million for cigarettes (3,800 new users per day); 1.3 million for cigars (3,600 new users per day); 600,000 for smokeless tobacco (1,700 new users per day); 1.4 million for marijuana (3,700 new users per day); 900,000 for nonmedical prescription-type drugs (2,500 new pain reliever users per day, 900 new tranquilizer users per day, 800 new stimulant users per day, 200 new sedative users per day); 600,000 for inhalants (1,500 new users per day); 500,000 for hallucinogens (1,400 new users per day); and 300,000 for cocaine (800 new users per day).

No conflicts of interest were disclosed.

School’s out and the living is easy for teens come summertime, but a new government study suggests it’s also dangerous, as the rates of first-time substance use among 12- to 17-year-olds peak in June and July.

On an average day in these two summer months, approximately 11,000 adolescents use alcohol for the first time, 5,000 try their first cigarette, and 4,500 begin using marijuana, according to a report released June 3 by the Substance Abuse and Mental Health Services Administration (SAMHSA). The report is based on interviews with 231,500 adolescents in the National Survey on Drug Use and Health (NSDUH) during 2002-2010.

Copyright Stockphoto4U/iStockphoto.com

The daily average rates for first-time alcohol, cigarette, and marijuana use during the rest of the year are 5,000-8,000 for first-time alcohol use and 3,000-4,000 each for first-time cigarette and marijuana use, according to the report, titled "Monthly Variation in Substance Use Initiation among Adolescents."

First-time hallucinogen use also peaked in June and July, with a daily average rate of 1,500 new users per day, compared with 1,100-1,400 in other months. Inhalant initiation peaked in July specifically, with a daily average rate of 1,800 new users in that month, compared with 1,100-1,700 during the rest of the year, according to the report. No similar summer-month increases were observed in the use of cocaine or nonmedical prescription drugs.

The summer peaks of first-time use of many of the substances are likely associated with the increased idle time and decreased responsibilities and adult supervision during breaks from school, "although initiation of substance use can occur at any time," the authors wrote, noting that multiple implications can be drawn from the findings. For example, intensifying public service announcements and media campaigns targeting adolescents during the summer months may amplify their impact. "Messages focusing on preventing initiation may be particularly important during these months," they wrote.

Additionally, "the findings may point toward critical opportunities during the summer to implement activities and events that are attractive alternatives to drug use initiation or continued use," particularly in communities with limited prevention resources, according to the authors. From a law-enforcement perspective, targeted efforts toward preventing tobacco and alcohol sales to minors may be more effective during the peak initiation months.

The NSDUH is an annual nationwide survey involving interviews with approximately 70,000 randomly selected individuals aged 12 years and older. Respondents who report using various substances are asked to indicate the year and month of first use of each substance. The current report focused specifically on individuals who reported initiation in the use of substances within the year prior to the survey and who were 12-17 years old at the time of initiation, according to the authors.

The annual first-time substance use averages among adolescents surveyed from 2002 to 2010 were 2.9 million for alcohol (7,800 new users per day); 1.4 million for cigarettes (3,800 new users per day); 1.3 million for cigars (3,600 new users per day); 600,000 for smokeless tobacco (1,700 new users per day); 1.4 million for marijuana (3,700 new users per day); 900,000 for nonmedical prescription-type drugs (2,500 new pain reliever users per day, 900 new tranquilizer users per day, 800 new stimulant users per day, 200 new sedative users per day); 600,000 for inhalants (1,500 new users per day); 500,000 for hallucinogens (1,400 new users per day); and 300,000 for cocaine (800 new users per day).

No conflicts of interest were disclosed.

School’s out and the living is easy for teens come summertime, but a new government study suggests it’s also dangerous, as the rates of first-time substance use among 12- to 17-year-olds peak in June and July.

On an average day in these two summer months, approximately 11,000 adolescents use alcohol for the first time, 5,000 try their first cigarette, and 4,500 begin using marijuana, according to a report released June 3 by the Substance Abuse and Mental Health Services Administration (SAMHSA). The report is based on interviews with 231,500 adolescents in the National Survey on Drug Use and Health (NSDUH) during 2002-2010.

Copyright Stockphoto4U/iStockphoto.com

The daily average rates for first-time alcohol, cigarette, and marijuana use during the rest of the year are 5,000-8,000 for first-time alcohol use and 3,000-4,000 each for first-time cigarette and marijuana use, according to the report, titled "Monthly Variation in Substance Use Initiation among Adolescents."

First-time hallucinogen use also peaked in June and July, with a daily average rate of 1,500 new users per day, compared with 1,100-1,400 in other months. Inhalant initiation peaked in July specifically, with a daily average rate of 1,800 new users in that month, compared with 1,100-1,700 during the rest of the year, according to the report. No similar summer-month increases were observed in the use of cocaine or nonmedical prescription drugs.

The summer peaks of first-time use of many of the substances are likely associated with the increased idle time and decreased responsibilities and adult supervision during breaks from school, "although initiation of substance use can occur at any time," the authors wrote, noting that multiple implications can be drawn from the findings. For example, intensifying public service announcements and media campaigns targeting adolescents during the summer months may amplify their impact. "Messages focusing on preventing initiation may be particularly important during these months," they wrote.

Additionally, "the findings may point toward critical opportunities during the summer to implement activities and events that are attractive alternatives to drug use initiation or continued use," particularly in communities with limited prevention resources, according to the authors. From a law-enforcement perspective, targeted efforts toward preventing tobacco and alcohol sales to minors may be more effective during the peak initiation months.

The NSDUH is an annual nationwide survey involving interviews with approximately 70,000 randomly selected individuals aged 12 years and older. Respondents who report using various substances are asked to indicate the year and month of first use of each substance. The current report focused specifically on individuals who reported initiation in the use of substances within the year prior to the survey and who were 12-17 years old at the time of initiation, according to the authors.

The annual first-time substance use averages among adolescents surveyed from 2002 to 2010 were 2.9 million for alcohol (7,800 new users per day); 1.4 million for cigarettes (3,800 new users per day); 1.3 million for cigars (3,600 new users per day); 600,000 for smokeless tobacco (1,700 new users per day); 1.4 million for marijuana (3,700 new users per day); 900,000 for nonmedical prescription-type drugs (2,500 new pain reliever users per day, 900 new tranquilizer users per day, 800 new stimulant users per day, 200 new sedative users per day); 600,000 for inhalants (1,500 new users per day); 500,000 for hallucinogens (1,400 new users per day); and 300,000 for cocaine (800 new users per day).

No conflicts of interest were disclosed.

SAN DIEGO – Antibiotics are the greatest contributor to allergic contact dermatitis among topical medications, according to a retrospective study of 100 patients.

"Neomycin and bacitracin are the worst offenders," said Dr. Shanna Spring, who presented the study at the annual meeting of the American Contact Dermatitis Society.

The most common positive patch test was for bacitracin (44 tests), followed by neomycin (29) and tixocortol-21-pivalate (19). Notably, 14% of individuals tested positive for both neomycin and bacitracin.

The researchers conducted a retrospective file review from the Ottawa Patch Test Clinic between January 2000 and September 2010. They randomly selected 100 patient files from the “interesting case database” compiled by the clinic staff.

Patients were eligible for the study if they had at least one positive patch test result to a topical medication; those whose patch test read as an irritant, macular erythema, or equivocal were excluded. Three-quarter of patients (74%) were older than 40 years, 68% were female and 34% were atopic, said Dr. Spring of the University of Ottawa.

The researchers were able to identify present relevant sensitizers in 80 patients. The most common sensitizers were antibiotics (59 patients), followed by steroids (31), anesthetics (6) and antifungals (6).

Most patients (64) had only one positive patch test; 20 had two positive tests. Eight patients had five positive patch tests.

In terms of co-reactions, 14 patients had more than one positive patch test for antibiotics. “This is not unexpected, as we know that aminoglycosides cross react,” said Dr. Spring. Eight patients had co-reactions of antibiotics and anesthetics; five patients had co-reactions to steroids only.

Dr. Spring reported that she has no relevant disclosures.

SAN DIEGO – Antibiotics are the greatest contributor to allergic contact dermatitis among topical medications, according to a retrospective study of 100 patients.

"Neomycin and bacitracin are the worst offenders," said Dr. Shanna Spring, who presented the study at the annual meeting of the American Contact Dermatitis Society.

The most common positive patch test was for bacitracin (44 tests), followed by neomycin (29) and tixocortol-21-pivalate (19). Notably, 14% of individuals tested positive for both neomycin and bacitracin.

The researchers conducted a retrospective file review from the Ottawa Patch Test Clinic between January 2000 and September 2010. They randomly selected 100 patient files from the “interesting case database” compiled by the clinic staff.

Patients were eligible for the study if they had at least one positive patch test result to a topical medication; those whose patch test read as an irritant, macular erythema, or equivocal were excluded. Three-quarter of patients (74%) were older than 40 years, 68% were female and 34% were atopic, said Dr. Spring of the University of Ottawa.

The researchers were able to identify present relevant sensitizers in 80 patients. The most common sensitizers were antibiotics (59 patients), followed by steroids (31), anesthetics (6) and antifungals (6).

Most patients (64) had only one positive patch test; 20 had two positive tests. Eight patients had five positive patch tests.

In terms of co-reactions, 14 patients had more than one positive patch test for antibiotics. “This is not unexpected, as we know that aminoglycosides cross react,” said Dr. Spring. Eight patients had co-reactions of antibiotics and anesthetics; five patients had co-reactions to steroids only.

Dr. Spring reported that she has no relevant disclosures.

SAN DIEGO – Antibiotics are the greatest contributor to allergic contact dermatitis among topical medications, according to a retrospective study of 100 patients.

"Neomycin and bacitracin are the worst offenders," said Dr. Shanna Spring, who presented the study at the annual meeting of the American Contact Dermatitis Society.

The most common positive patch test was for bacitracin (44 tests), followed by neomycin (29) and tixocortol-21-pivalate (19). Notably, 14% of individuals tested positive for both neomycin and bacitracin.

The researchers conducted a retrospective file review from the Ottawa Patch Test Clinic between January 2000 and September 2010. They randomly selected 100 patient files from the “interesting case database” compiled by the clinic staff.

Patients were eligible for the study if they had at least one positive patch test result to a topical medication; those whose patch test read as an irritant, macular erythema, or equivocal were excluded. Three-quarter of patients (74%) were older than 40 years, 68% were female and 34% were atopic, said Dr. Spring of the University of Ottawa.

The researchers were able to identify present relevant sensitizers in 80 patients. The most common sensitizers were antibiotics (59 patients), followed by steroids (31), anesthetics (6) and antifungals (6).

Most patients (64) had only one positive patch test; 20 had two positive tests. Eight patients had five positive patch tests.

In terms of co-reactions, 14 patients had more than one positive patch test for antibiotics. “This is not unexpected, as we know that aminoglycosides cross react,” said Dr. Spring. Eight patients had co-reactions of antibiotics and anesthetics; five patients had co-reactions to steroids only.

Dr. Spring reported that she has no relevant disclosures.

SAN DIEGO – The ubiquitous acrylates take home the Contact Allergen of the Year title for 2012.

"We chose them because acrylates are everywhere in the environment," said Dr. Donald V. Belsito, who announced this year’s winner at the annual meeting of the American Contact Dermatitis Society.

© Andrey Popov/iStockphoto.com

Acrylates are plastic materials that are formed by the polymerization of monomers derived from acrylic or methacrylic acid. First used in Plexiglas, these compounds have a wide range of applications, including: paints, adhesives, dental composite resins, printing inks, and artificial nails. Acrylates also are used in a number of medical devices, including contact lenses, hearing aids, and bone cement for orthopedic endoprostheses.

While monomers are very strong irritants and allergens, fully polymerized acrylates are relatively inert. "Patch testing is tricky, and I think that’s something that we’re just finding out about the acrylates," said Dr. Belsito, a professor of clinical dermatology at Columbia University in New York. "They’re very volatile. The stability of the [patch test] allergens is a major issue, and they should be frozen or refrigerated."

In addition, the concentration necessary to reveal allergic sensitization is close to the irritancy threshold. These molecules also can induce active sensitization.

The North American Standard Series (Chemotechnique screening series) has been found to identify many cases of acrylate allergy caused by the inclusion of methyl methacrylate and ethyl acrylate in the series. However, clinicians should not rule out acrylate allergy even if the initial screening is negative. (Dermatitis 2011;22:98-101).

When patch tested, acrylate-allergic patients often display multiple positive tests. Previously, this was thought to be caused by cross-reaction. However, more recent analyses have shown that most acrylate-based industrial products contain many other acrylates as impurities – and thus are not included on the material safety data sheets.

"Many of the so-called cross reactions could in fact be concomitant reactions," noted Dr. Denis Sasseville in his article on acrylates, published in the January/February issue of Dermatitis (2012;23:6-16 [doi:10.1097/DER.obo13e31823d1b81]).

Methacrylates are tested at 2%, acrylates at 0.1%, and cyanoacrylates at 10%, according to Dr. Sasseville, who is a researcher in the division of dermatology at McGill University, Montreal. It is believed that patch testing with methyl methacrylate, 2-hydrorxymethyl methacrylate, ethyl acrylate, ethylene dimethacrylate, triethylene glycol diacrylate, and ethyl cyanoacrylate will identify most acrylate allergies.

The occupational exposure for dentists in particular is quite high; classic dental acrylics (including methyl acrylate) will cross through latex and vinyl gloves within minutes. Double gloving is suggested.

In one Finnish study of dental personnel, dentists and other dental personnel were most commonly exposed to 2-hydroxyethyl methacrylate, triethylene glycol dimethacrylate, and 3,3-bis[4-(2-hydroxy-3-methacryoxypropoxy) phenyl] propane (Contact Dermatitis 2007;57:324-30).

Both Dr. Belsito and Dr. Sasseville reported that they have no relevant disclosures.

SAN DIEGO – The ubiquitous acrylates take home the Contact Allergen of the Year title for 2012.

"We chose them because acrylates are everywhere in the environment," said Dr. Donald V. Belsito, who announced this year’s winner at the annual meeting of the American Contact Dermatitis Society.

© Andrey Popov/iStockphoto.com

Acrylates are plastic materials that are formed by the polymerization of monomers derived from acrylic or methacrylic acid. First used in Plexiglas, these compounds have a wide range of applications, including: paints, adhesives, dental composite resins, printing inks, and artificial nails. Acrylates also are used in a number of medical devices, including contact lenses, hearing aids, and bone cement for orthopedic endoprostheses.

While monomers are very strong irritants and allergens, fully polymerized acrylates are relatively inert. "Patch testing is tricky, and I think that’s something that we’re just finding out about the acrylates," said Dr. Belsito, a professor of clinical dermatology at Columbia University in New York. "They’re very volatile. The stability of the [patch test] allergens is a major issue, and they should be frozen or refrigerated."

In addition, the concentration necessary to reveal allergic sensitization is close to the irritancy threshold. These molecules also can induce active sensitization.

The North American Standard Series (Chemotechnique screening series) has been found to identify many cases of acrylate allergy caused by the inclusion of methyl methacrylate and ethyl acrylate in the series. However, clinicians should not rule out acrylate allergy even if the initial screening is negative. (Dermatitis 2011;22:98-101).

When patch tested, acrylate-allergic patients often display multiple positive tests. Previously, this was thought to be caused by cross-reaction. However, more recent analyses have shown that most acrylate-based industrial products contain many other acrylates as impurities – and thus are not included on the material safety data sheets.

"Many of the so-called cross reactions could in fact be concomitant reactions," noted Dr. Denis Sasseville in his article on acrylates, published in the January/February issue of Dermatitis (2012;23:6-16 [doi:10.1097/DER.obo13e31823d1b81]).

Methacrylates are tested at 2%, acrylates at 0.1%, and cyanoacrylates at 10%, according to Dr. Sasseville, who is a researcher in the division of dermatology at McGill University, Montreal. It is believed that patch testing with methyl methacrylate, 2-hydrorxymethyl methacrylate, ethyl acrylate, ethylene dimethacrylate, triethylene glycol diacrylate, and ethyl cyanoacrylate will identify most acrylate allergies.

The occupational exposure for dentists in particular is quite high; classic dental acrylics (including methyl acrylate) will cross through latex and vinyl gloves within minutes. Double gloving is suggested.

In one Finnish study of dental personnel, dentists and other dental personnel were most commonly exposed to 2-hydroxyethyl methacrylate, triethylene glycol dimethacrylate, and 3,3-bis[4-(2-hydroxy-3-methacryoxypropoxy) phenyl] propane (Contact Dermatitis 2007;57:324-30).

Both Dr. Belsito and Dr. Sasseville reported that they have no relevant disclosures.

SAN DIEGO – The ubiquitous acrylates take home the Contact Allergen of the Year title for 2012.

"We chose them because acrylates are everywhere in the environment," said Dr. Donald V. Belsito, who announced this year’s winner at the annual meeting of the American Contact Dermatitis Society.

© Andrey Popov/iStockphoto.com

Acrylates are plastic materials that are formed by the polymerization of monomers derived from acrylic or methacrylic acid. First used in Plexiglas, these compounds have a wide range of applications, including: paints, adhesives, dental composite resins, printing inks, and artificial nails. Acrylates also are used in a number of medical devices, including contact lenses, hearing aids, and bone cement for orthopedic endoprostheses.

While monomers are very strong irritants and allergens, fully polymerized acrylates are relatively inert. "Patch testing is tricky, and I think that’s something that we’re just finding out about the acrylates," said Dr. Belsito, a professor of clinical dermatology at Columbia University in New York. "They’re very volatile. The stability of the [patch test] allergens is a major issue, and they should be frozen or refrigerated."

In addition, the concentration necessary to reveal allergic sensitization is close to the irritancy threshold. These molecules also can induce active sensitization.

The North American Standard Series (Chemotechnique screening series) has been found to identify many cases of acrylate allergy caused by the inclusion of methyl methacrylate and ethyl acrylate in the series. However, clinicians should not rule out acrylate allergy even if the initial screening is negative. (Dermatitis 2011;22:98-101).

When patch tested, acrylate-allergic patients often display multiple positive tests. Previously, this was thought to be caused by cross-reaction. However, more recent analyses have shown that most acrylate-based industrial products contain many other acrylates as impurities – and thus are not included on the material safety data sheets.

"Many of the so-called cross reactions could in fact be concomitant reactions," noted Dr. Denis Sasseville in his article on acrylates, published in the January/February issue of Dermatitis (2012;23:6-16 [doi:10.1097/DER.obo13e31823d1b81]).

Methacrylates are tested at 2%, acrylates at 0.1%, and cyanoacrylates at 10%, according to Dr. Sasseville, who is a researcher in the division of dermatology at McGill University, Montreal. It is believed that patch testing with methyl methacrylate, 2-hydrorxymethyl methacrylate, ethyl acrylate, ethylene dimethacrylate, triethylene glycol diacrylate, and ethyl cyanoacrylate will identify most acrylate allergies.

The occupational exposure for dentists in particular is quite high; classic dental acrylics (including methyl acrylate) will cross through latex and vinyl gloves within minutes. Double gloving is suggested.

In one Finnish study of dental personnel, dentists and other dental personnel were most commonly exposed to 2-hydroxyethyl methacrylate, triethylene glycol dimethacrylate, and 3,3-bis[4-(2-hydroxy-3-methacryoxypropoxy) phenyl] propane (Contact Dermatitis 2007;57:324-30).

Both Dr. Belsito and Dr. Sasseville reported that they have no relevant disclosures.

WASHINGTON – The nation is at the front-end of a potential epidemic, as synthetic marijuana and synthetic hallucinogens known as "bath salts" gain popularity, especially among youth, officials warned Feb. 16.

"There has been a shocking increase in the number of people having adverse events to these synthetic drugs," said R. Gil Kerlikowske, director of the Office of National Drug Control Policy. "We simply cannot afford to wait when it comes to safety of young people."

Synthetic drugs first gained the attention of U.S. officials and health care providers in 2010. When ingested or smoked, they can cause a variety of severe and sometimes long-last effects, including hallucinations, paranoia, and seizures.

So far there have been at least 30 deaths nationwide – including suicides – related to these drugs, estimated Mark Ryan, director of the Louisiana Poison Center. Users reportedly also have attacked paramedics and emergency department staff.

"The calls we get have been among the worst. People are desperate for help," said Deborah Anne Carr, executive director of the American Association of Poison Control Centers.

Mr. Ryan said that at his center, 90% of calls regarding synthetic drugs are placed by health care providers. In contrast, only about 20% of calls regarding other poisoning situations are placed by health care providers.

Unlike other drugs, synthetic drugs usually have an immediate and severe effect, Mr. Ryan pointed out. "So the physicians call and ask ‘What is "bath salt" and what do I do?’ "

Another complication: Synthetic drugs come in a wide range of formulations. "There are literally hundreds of these compounds," said Mr. Ryan. "[Manufacturers] may use same name and get a different compound. There’s no consistency."

According to the Monitoring the Future survey – an annual, nationally representative sample of 8th, 10th, and 12th graders conducted by the University of Michigan, Ann Arbor, and supported by the National Institute on Drug Abuse – approximately one in nine 12th graders reported that they had used "spice" or "K2" (street names for synthetic marijuana) in 2011, making synthetic marijuana the second most frequently used illicit drug after marijuana.

Poison control centers have reported sharp increases in the number of calls related to synthetic drugs. Last year, there were 6,959 calls related to synthetic marijuana and 6,138 calls related to "bath salts," compared with 2,906 and 304 calls respectively in 2010, according to the American Association of Poison Control Centers.

Synthetic marijuana and bath salts often are sold legally in retail outlets such as smoke shops, gas stations, and convenience stores, and are often labeled as herbal incense or plant food. They are frequently labeled "not for human consumption" in order mask their intended purpose and avoid regulation, according to ONDCP.

Meanwhile, lawmakers are beginning to address this new phenomenon on the federal and state level.

The Synthetic Drug Control Act (H.R. 1254), a bill to add a wide variety of synthetic cannabinoid and hallucinogenic drugs to the Controlled Substances Act, was passed by the U.S. House of Representatives at the end of last year and sent to the Senate. Mr. Kerlikowske said that he hoped that the Senate would act on the measure soon.

According to U.S. Customs and Border Protection, many of these products appear to originate overseas.

Synthetic marijuana and bath salts were first detected in the United States in 2008 by the Drug Enforcement Administration, which obtained a temporary Schedule I designation for some of the chemicals used to make bath salts last October. At least 38 states have taken action to control one or more of the chemicals.

Abuse of the substances is an issue in Europe as well, Mr. Ryan said.

"This is a serious ‘wake-up call’ for everyone about the extent of synthetic drug use among kids, and that’s why it’s so important for parents to educate themselves about changing drug trends so they’ll know what to look for," Steve Pasierb, president and CEO of the Partnership at Drugfree.org, a drug abuse information clearinghouse, said in a statement.

The Partnership at Drugfree.org introduced a kit, which includes a slide show about synthetic drugs, a corresponding podcast and video, and a printable guide that details what to look for and what the street names are.

WASHINGTON – The nation is at the front-end of a potential epidemic, as synthetic marijuana and synthetic hallucinogens known as "bath salts" gain popularity, especially among youth, officials warned Feb. 16.

"There has been a shocking increase in the number of people having adverse events to these synthetic drugs," said R. Gil Kerlikowske, director of the Office of National Drug Control Policy. "We simply cannot afford to wait when it comes to safety of young people."

Synthetic drugs first gained the attention of U.S. officials and health care providers in 2010. When ingested or smoked, they can cause a variety of severe and sometimes long-last effects, including hallucinations, paranoia, and seizures.

So far there have been at least 30 deaths nationwide – including suicides – related to these drugs, estimated Mark Ryan, director of the Louisiana Poison Center. Users reportedly also have attacked paramedics and emergency department staff.

"The calls we get have been among the worst. People are desperate for help," said Deborah Anne Carr, executive director of the American Association of Poison Control Centers.

Mr. Ryan said that at his center, 90% of calls regarding synthetic drugs are placed by health care providers. In contrast, only about 20% of calls regarding other poisoning situations are placed by health care providers.

Unlike other drugs, synthetic drugs usually have an immediate and severe effect, Mr. Ryan pointed out. "So the physicians call and ask ‘What is "bath salt" and what do I do?’ "

Another complication: Synthetic drugs come in a wide range of formulations. "There are literally hundreds of these compounds," said Mr. Ryan. "[Manufacturers] may use same name and get a different compound. There’s no consistency."

According to the Monitoring the Future survey – an annual, nationally representative sample of 8th, 10th, and 12th graders conducted by the University of Michigan, Ann Arbor, and supported by the National Institute on Drug Abuse – approximately one in nine 12th graders reported that they had used "spice" or "K2" (street names for synthetic marijuana) in 2011, making synthetic marijuana the second most frequently used illicit drug after marijuana.

Poison control centers have reported sharp increases in the number of calls related to synthetic drugs. Last year, there were 6,959 calls related to synthetic marijuana and 6,138 calls related to "bath salts," compared with 2,906 and 304 calls respectively in 2010, according to the American Association of Poison Control Centers.

Synthetic marijuana and bath salts often are sold legally in retail outlets such as smoke shops, gas stations, and convenience stores, and are often labeled as herbal incense or plant food. They are frequently labeled "not for human consumption" in order mask their intended purpose and avoid regulation, according to ONDCP.

Meanwhile, lawmakers are beginning to address this new phenomenon on the federal and state level.

The Synthetic Drug Control Act (H.R. 1254), a bill to add a wide variety of synthetic cannabinoid and hallucinogenic drugs to the Controlled Substances Act, was passed by the U.S. House of Representatives at the end of last year and sent to the Senate. Mr. Kerlikowske said that he hoped that the Senate would act on the measure soon.

According to U.S. Customs and Border Protection, many of these products appear to originate overseas.

Synthetic marijuana and bath salts were first detected in the United States in 2008 by the Drug Enforcement Administration, which obtained a temporary Schedule I designation for some of the chemicals used to make bath salts last October. At least 38 states have taken action to control one or more of the chemicals.

Abuse of the substances is an issue in Europe as well, Mr. Ryan said.

"This is a serious ‘wake-up call’ for everyone about the extent of synthetic drug use among kids, and that’s why it’s so important for parents to educate themselves about changing drug trends so they’ll know what to look for," Steve Pasierb, president and CEO of the Partnership at Drugfree.org, a drug abuse information clearinghouse, said in a statement.

The Partnership at Drugfree.org introduced a kit, which includes a slide show about synthetic drugs, a corresponding podcast and video, and a printable guide that details what to look for and what the street names are.

WASHINGTON – The nation is at the front-end of a potential epidemic, as synthetic marijuana and synthetic hallucinogens known as "bath salts" gain popularity, especially among youth, officials warned Feb. 16.

"There has been a shocking increase in the number of people having adverse events to these synthetic drugs," said R. Gil Kerlikowske, director of the Office of National Drug Control Policy. "We simply cannot afford to wait when it comes to safety of young people."

Synthetic drugs first gained the attention of U.S. officials and health care providers in 2010. When ingested or smoked, they can cause a variety of severe and sometimes long-last effects, including hallucinations, paranoia, and seizures.

So far there have been at least 30 deaths nationwide – including suicides – related to these drugs, estimated Mark Ryan, director of the Louisiana Poison Center. Users reportedly also have attacked paramedics and emergency department staff.

"The calls we get have been among the worst. People are desperate for help," said Deborah Anne Carr, executive director of the American Association of Poison Control Centers.

Mr. Ryan said that at his center, 90% of calls regarding synthetic drugs are placed by health care providers. In contrast, only about 20% of calls regarding other poisoning situations are placed by health care providers.

Unlike other drugs, synthetic drugs usually have an immediate and severe effect, Mr. Ryan pointed out. "So the physicians call and ask ‘What is "bath salt" and what do I do?’ "

Another complication: Synthetic drugs come in a wide range of formulations. "There are literally hundreds of these compounds," said Mr. Ryan. "[Manufacturers] may use same name and get a different compound. There’s no consistency."

According to the Monitoring the Future survey – an annual, nationally representative sample of 8th, 10th, and 12th graders conducted by the University of Michigan, Ann Arbor, and supported by the National Institute on Drug Abuse – approximately one in nine 12th graders reported that they had used "spice" or "K2" (street names for synthetic marijuana) in 2011, making synthetic marijuana the second most frequently used illicit drug after marijuana.

Poison control centers have reported sharp increases in the number of calls related to synthetic drugs. Last year, there were 6,959 calls related to synthetic marijuana and 6,138 calls related to "bath salts," compared with 2,906 and 304 calls respectively in 2010, according to the American Association of Poison Control Centers.

Synthetic marijuana and bath salts often are sold legally in retail outlets such as smoke shops, gas stations, and convenience stores, and are often labeled as herbal incense or plant food. They are frequently labeled "not for human consumption" in order mask their intended purpose and avoid regulation, according to ONDCP.

Meanwhile, lawmakers are beginning to address this new phenomenon on the federal and state level.

The Synthetic Drug Control Act (H.R. 1254), a bill to add a wide variety of synthetic cannabinoid and hallucinogenic drugs to the Controlled Substances Act, was passed by the U.S. House of Representatives at the end of last year and sent to the Senate. Mr. Kerlikowske said that he hoped that the Senate would act on the measure soon.

According to U.S. Customs and Border Protection, many of these products appear to originate overseas.

Synthetic marijuana and bath salts were first detected in the United States in 2008 by the Drug Enforcement Administration, which obtained a temporary Schedule I designation for some of the chemicals used to make bath salts last October. At least 38 states have taken action to control one or more of the chemicals.

Abuse of the substances is an issue in Europe as well, Mr. Ryan said.

"This is a serious ‘wake-up call’ for everyone about the extent of synthetic drug use among kids, and that’s why it’s so important for parents to educate themselves about changing drug trends so they’ll know what to look for," Steve Pasierb, president and CEO of the Partnership at Drugfree.org, a drug abuse information clearinghouse, said in a statement.

The Partnership at Drugfree.org introduced a kit, which includes a slide show about synthetic drugs, a corresponding podcast and video, and a printable guide that details what to look for and what the street names are.

Daily cigarette smoking and binge drinking among American teenagers declined over the past year, but the use of marijuana and the abuse of prescription drugs remain a problem, data from the 2011 Monitoring the Future survey have shown.

The National Institute on Drug Abuse (NIDA) announced the survey findings Dec. 14 at a press conference.

The survey found that daily cigarette use, which peaked in the mid- to late 1990s, continued to drop in the past year; 2.4% of 8th graders, 5.5% of 10th graders, and 10.3% of 12th graders reported daily smoking. However, the decline in smoking has slowed in recent years, the researchers said in a press release. "These levels remain too high given the significant morbidity and mortality associated with tobacco use," they said.

Alcohol use, particularly binge drinking, declined significantly among all three age groups over the last 5 years, to a 2011 prevalence of 6.4% of 8th graders, 14.7% of 10th graders, and 21.6% of 12th graders. Binge drinking was defined as five or more drinks in a row in the last 2 weeks.

The use of marijuana among teens climbed in 2011 for the fourth straight year, the survey found. In 2011, 12.5% of 8th graders, 28.8% of 10th graders, and 36.4% of 12th graders reported past-year use of marijuana. These numbers were not significantly different from the 2010 rates. However, the 5-year trends show increases in daily, current, and past-year marijuana use by 10th and 12th graders. The increases might be attributable, in part, to a decline in the perceived risk associated with marijuana use, the researchers suggested. For example, more high school seniors reported marijuana use than smoking cigarettes in the past 30 days (22.6% vs. 18.7%).

The use of marijuana among teens climbed in 2011 for the fourth straight year, the survey found.

In addition, the 2011 survey included first-time data on the use of synthetic marijuana, called K2 or "spice," among high school seniors. About 11.4% of high school seniors reported using spice during the past year. Earlier this year, the Drug Enforcement Administration declared many of the chemicals used in such products as schedule I drugs and deemed them unsafe for at least a year. In addition, at least 18 states have banned synthetic marijuana. "Next year’s results should tell us a lot more about how successful these new control efforts are," Lloyd D. Johnston, Ph.D., research scientist at the Institute for Social Research at the University of Michigan and lead investigator of the survey, said in a statement. "We know that the great majority of those who have used synthetic marijuana also used medical marijuana during the year, as well as a number of other drugs."

Prescription and over-the-counter (OTC) medications account for most of the drugs abused by 12th grade students in the past year. Nonmedical use of OxyContin remained stable across grades 8, 10, and 12, and amphetamine use increased among 12th graders, to 8.2% in 2011 from 6.6% in 2010. Nonmedical use of Vicodin remained stable among seniors, but declined among 10th graders, from 7.7% in 2010 to 5.9% in 2011.

In response to the persistent trends in prescription drug abuse, NIDA unveiled its PEERx campaign, a prevention effort that seeks to educate young people about the dangers of prescription drug use in an engaging way. The teen-friendly site features a "mixer" that shows teens what can happen if they combine prescription drugs with different activities. For example, the equation "Hot Date plus Adderall" equals a photo of a frustrated girl who comments: "He took some Adderall and got more into the video game than into me. Some date!" The site also explains the science behind drug abuse, and includes interactive videos that allow teens to make different choices about illicit use of prescription drugs in various situations (such as taking a stimulant the night before a big test) and view the possible outcomes.

The annual Monitoring the Future survey tracks annual drug abuse trends among U.S. teenagers via responses from 8th, 10th, and 12th grade students to questions about drug use, including attitudes and perceived risks. About 47,000 students participated in the 2011 survey. The lead investigators are all affiliated with the University of Michigan’s Institute for Social Research.

Daily cigarette smoking and binge drinking among American teenagers declined over the past year, but the use of marijuana and the abuse of prescription drugs remain a problem, data from the 2011 Monitoring the Future survey have shown.

The National Institute on Drug Abuse (NIDA) announced the survey findings Dec. 14 at a press conference.

The survey found that daily cigarette use, which peaked in the mid- to late 1990s, continued to drop in the past year; 2.4% of 8th graders, 5.5% of 10th graders, and 10.3% of 12th graders reported daily smoking. However, the decline in smoking has slowed in recent years, the researchers said in a press release. "These levels remain too high given the significant morbidity and mortality associated with tobacco use," they said.

Alcohol use, particularly binge drinking, declined significantly among all three age groups over the last 5 years, to a 2011 prevalence of 6.4% of 8th graders, 14.7% of 10th graders, and 21.6% of 12th graders. Binge drinking was defined as five or more drinks in a row in the last 2 weeks.

The use of marijuana among teens climbed in 2011 for the fourth straight year, the survey found. In 2011, 12.5% of 8th graders, 28.8% of 10th graders, and 36.4% of 12th graders reported past-year use of marijuana. These numbers were not significantly different from the 2010 rates. However, the 5-year trends show increases in daily, current, and past-year marijuana use by 10th and 12th graders. The increases might be attributable, in part, to a decline in the perceived risk associated with marijuana use, the researchers suggested. For example, more high school seniors reported marijuana use than smoking cigarettes in the past 30 days (22.6% vs. 18.7%).

The use of marijuana among teens climbed in 2011 for the fourth straight year, the survey found.

In addition, the 2011 survey included first-time data on the use of synthetic marijuana, called K2 or "spice," among high school seniors. About 11.4% of high school seniors reported using spice during the past year. Earlier this year, the Drug Enforcement Administration declared many of the chemicals used in such products as schedule I drugs and deemed them unsafe for at least a year. In addition, at least 18 states have banned synthetic marijuana. "Next year’s results should tell us a lot more about how successful these new control efforts are," Lloyd D. Johnston, Ph.D., research scientist at the Institute for Social Research at the University of Michigan and lead investigator of the survey, said in a statement. "We know that the great majority of those who have used synthetic marijuana also used medical marijuana during the year, as well as a number of other drugs."

Prescription and over-the-counter (OTC) medications account for most of the drugs abused by 12th grade students in the past year. Nonmedical use of OxyContin remained stable across grades 8, 10, and 12, and amphetamine use increased among 12th graders, to 8.2% in 2011 from 6.6% in 2010. Nonmedical use of Vicodin remained stable among seniors, but declined among 10th graders, from 7.7% in 2010 to 5.9% in 2011.

In response to the persistent trends in prescription drug abuse, NIDA unveiled its PEERx campaign, a prevention effort that seeks to educate young people about the dangers of prescription drug use in an engaging way. The teen-friendly site features a "mixer" that shows teens what can happen if they combine prescription drugs with different activities. For example, the equation "Hot Date plus Adderall" equals a photo of a frustrated girl who comments: "He took some Adderall and got more into the video game than into me. Some date!" The site also explains the science behind drug abuse, and includes interactive videos that allow teens to make different choices about illicit use of prescription drugs in various situations (such as taking a stimulant the night before a big test) and view the possible outcomes.

The annual Monitoring the Future survey tracks annual drug abuse trends among U.S. teenagers via responses from 8th, 10th, and 12th grade students to questions about drug use, including attitudes and perceived risks. About 47,000 students participated in the 2011 survey. The lead investigators are all affiliated with the University of Michigan’s Institute for Social Research.

Daily cigarette smoking and binge drinking among American teenagers declined over the past year, but the use of marijuana and the abuse of prescription drugs remain a problem, data from the 2011 Monitoring the Future survey have shown.

The National Institute on Drug Abuse (NIDA) announced the survey findings Dec. 14 at a press conference.

The survey found that daily cigarette use, which peaked in the mid- to late 1990s, continued to drop in the past year; 2.4% of 8th graders, 5.5% of 10th graders, and 10.3% of 12th graders reported daily smoking. However, the decline in smoking has slowed in recent years, the researchers said in a press release. "These levels remain too high given the significant morbidity and mortality associated with tobacco use," they said.

Alcohol use, particularly binge drinking, declined significantly among all three age groups over the last 5 years, to a 2011 prevalence of 6.4% of 8th graders, 14.7% of 10th graders, and 21.6% of 12th graders. Binge drinking was defined as five or more drinks in a row in the last 2 weeks.

The use of marijuana among teens climbed in 2011 for the fourth straight year, the survey found. In 2011, 12.5% of 8th graders, 28.8% of 10th graders, and 36.4% of 12th graders reported past-year use of marijuana. These numbers were not significantly different from the 2010 rates. However, the 5-year trends show increases in daily, current, and past-year marijuana use by 10th and 12th graders. The increases might be attributable, in part, to a decline in the perceived risk associated with marijuana use, the researchers suggested. For example, more high school seniors reported marijuana use than smoking cigarettes in the past 30 days (22.6% vs. 18.7%).

The use of marijuana among teens climbed in 2011 for the fourth straight year, the survey found.

In addition, the 2011 survey included first-time data on the use of synthetic marijuana, called K2 or "spice," among high school seniors. About 11.4% of high school seniors reported using spice during the past year. Earlier this year, the Drug Enforcement Administration declared many of the chemicals used in such products as schedule I drugs and deemed them unsafe for at least a year. In addition, at least 18 states have banned synthetic marijuana. "Next year’s results should tell us a lot more about how successful these new control efforts are," Lloyd D. Johnston, Ph.D., research scientist at the Institute for Social Research at the University of Michigan and lead investigator of the survey, said in a statement. "We know that the great majority of those who have used synthetic marijuana also used medical marijuana during the year, as well as a number of other drugs."

Prescription and over-the-counter (OTC) medications account for most of the drugs abused by 12th grade students in the past year. Nonmedical use of OxyContin remained stable across grades 8, 10, and 12, and amphetamine use increased among 12th graders, to 8.2% in 2011 from 6.6% in 2010. Nonmedical use of Vicodin remained stable among seniors, but declined among 10th graders, from 7.7% in 2010 to 5.9% in 2011.

In response to the persistent trends in prescription drug abuse, NIDA unveiled its PEERx campaign, a prevention effort that seeks to educate young people about the dangers of prescription drug use in an engaging way. The teen-friendly site features a "mixer" that shows teens what can happen if they combine prescription drugs with different activities. For example, the equation "Hot Date plus Adderall" equals a photo of a frustrated girl who comments: "He took some Adderall and got more into the video game than into me. Some date!" The site also explains the science behind drug abuse, and includes interactive videos that allow teens to make different choices about illicit use of prescription drugs in various situations (such as taking a stimulant the night before a big test) and view the possible outcomes.

The annual Monitoring the Future survey tracks annual drug abuse trends among U.S. teenagers via responses from 8th, 10th, and 12th grade students to questions about drug use, including attitudes and perceived risks. About 47,000 students participated in the 2011 survey. The lead investigators are all affiliated with the University of Michigan’s Institute for Social Research.