Impaired Operation by Substances Other Than

By: Jonathan D. Greenstein There exist standardized protocols to detect operators who may be impaired by alcohol or drugs and most officers are quite familiar with some of the most common indicators of possible impairment; bloodshot eyes, slurred speech, delayed movements and an unsteady balance. However, with the recent surge in the use of analogue substances 1, the ability for some officers to recognize and articulate influence is complicated. The purpose of this article is to provide a primer on the subject and look at both detection and possible enforcement strategies. It will focus primarily on Bath Salts based on recent trend analysis. Bath Salts Bath Salts are indirectly marketed as legal alternatives to cocaine, amphetamine, and Ecstasy (MDMA or 3,4-Methylenedioxymethamphetamine). They are likely to contain MDPV (3,4Methylenedioxypyrovalerone) as the primary chemical stimulant, however as they are not regulated in the context of legitimate food or drug products, they can contain any number of substances. MDPV reportedly produces a combination of amphetamine-like central nervous system stimulation and euphoria, and Ecstasy-like hallucinogenic effects. Excessive use appears to result in intense cravings to binge/re-dose similar to methamphetamine. Adverse physical effects may include a rapid increase in heart rate, chest pains, nosebleeds, sweating, nausea, and vomiting; and adverse psychological effects may include agitation, irritability, dizziness, insomnia, depression, delusions, paranoia, and suicidal thoughts. Higher doses of MDPV have also reportedly produced intense and prolonged panic attacks and psychotic episodes that have resulted in violent behavior. Identifying Substances Presently most bath salts closely resemble cocaine; a white to off-white crystalline powder. While visual identification is helpful, there is no universally accepted presumptive or field testing protocol. Depending on your location though, the use of Scotts Reagent and/or Marquis Reagent kits may be an acceptable practice. Consult with your agency or laboratory for guidance. Bath Salts are marketed under an ever growing list of trade-names and brands. The most frequently encountered include: Charge, Ivory, Ivory Wave, Meow Meow, MCAT, 4MMC, Drone, Bubbles, Bubble Love, Bounce, Plant Food, Meph, Shake n Vac, Mad Cow and Eight Ball. The can be packaged in individual or multi-gram packages and small vials. Given the propensity for users to binge on bath salts, it may not be unusual to find multiple packages. ________________
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Analogues are substances that look, feel and often times affect the user in the same manner as its controlled/illegal counterpart.

Symptoms Users of Bath Salts have been described as being paranoid, aggressive, agoraphobic; experiencing anxiety and potentially panic attacks, suffering from insomnia, and having suicidal ideations. Users report that they experience hallucinations and may hear voices in their heads weeks after consumption. You may observe indicators of increased respiration, perspiration and manifestations of anxiety. Because the symptoms tend to parallel those seen in users of cocaine and methamphetamines, and hallucinogens, officers will want to review the signs and symptoms seen in users of those drugs. As noted, there is no consistency in production of bath salts and two users who have consumed the same brand may display different symptoms. The same can be said of individual users, which is further explained in the following sections. Physiological and Long-Term Effects Reporting indicates users may present acute and long-lasting paranoid psychosis requiring heavy sedation before treatment. It is also known to raise the heart rate and blood pressure to dangerous levels and cause kidney failure, seizures, severe weight loss, muscle damage, loss of bowel control, and coma. Both long and short-term users may experience nose bleeds if the product is snorted through the nose. If injection is over a long course, users will likely display classic IV drug abuse indicators. Enforcement Field contacts leading to the taking of a subject into custody can come through a variety of circumstances; therefore officers should remain alert for the signs and symptoms of possible influence. While it is dependent upon the local laws that address public intoxication and impaired operation as to what enforcement action is taken, recognizing the potential dangers a user of bath salts may pose to themselves, the public and responding officers and being able to articulate such may be the basis for taking a person into protective custody in order to mitigate these dangers. As with any other substance that causes disassociation, paranoia and skews users perceptions; responding officers must remain alert for unpredictable behavior and potentially non-compliance. Even if the substance being used is believed to be bath salts, you must recognize that as noted previously, there are no consistent manufacturing standards and these substances, like any drug; can affect users differently. Even a regular user can have a different reaction depending on quantity and route of consumption. For subjects found operating a motor vehicle, currently, it is recommended that they be taken into custody. If for no other reason than to evaluate them medically and if impaired, charge or release them to a responsible party in accordance with your policies. Again, this is entirely dependent on local laws and the circumstances surrounding your contact.

Regardless of final disposition; make note of any statements made by the operator, observations of behavior, and the presence of packages or containers that contain or contained suspected substances. Ensure you document the contact and disposition completely. Field Assessments As with other cases of suspected impaired operation, one of the most critical aspects is observation. It is through observation that potential indicators may be observed. Because there are presently no standardized tests of subjects who may be under the influence of analogues, there exists a need to identify if Driving Under the Influence of Drugs (DUID) examinations will become the standard. For the purpose of this article, we will focus on DUID examinations that are used to identify impairment by Central Nervous System (CNS) Depressants, CNS Stimulants and Hallucinogens as they parallel the reported effects of Bath Salts. Noted is that this is subject to change and should not be taken as an endorsement of DUID testing for examination of subject who may be using bath salts. This information is provided for awareness purposes only. Central Nervous System Depressants or CNS Depressants slow down the operations of the brain and the body. Examples of CNS Depressants include alcohol, barbiturates, anti-anxiety tranquilizers, GHB, Rohypnol and many other anti-depressants. Central Nervous System Stimulants or CNS Stimulants are known to accelerate the heart rate and elevate the blood pressure and potentially over-stimulate the body. Examples of CNS Stimulants include Cocaine, "Crack", Amphetamines and Methamphetamines. Hallucinogens can cause the user to perceive things differently than they actually are. Examples include LSD, Peyote, Psilocybin and MDMA. As noted, this discussion of DUID examinations is for informational purposes, and until a standardized protocol is established, you should consult with your agency and prosecutor before using these measures in the development of probable cause. Another valuable tool that may be of use during field contacts and examinations are Standardized Field Sobriety Tests (SFST) that is specific to alcohol. The Standardized Field Sobriety Test (SFST) is a battery of three tests administered and evaluated in a standardized manner to obtain validated indicators of impairment and establish probable cause for arrest. These tests were developed as a result of research sponsored by the National Highway Traffic Safety Administration (NHTSA) and which have become the most widely accepted methods for identifying probable impairment. The three tests of the SFST are: Horizontal Gaze Nystagmus (HGN), Walk-andTurn (WAT), and One-Leg Stand (OLS).

HGN Testing: Horizontal Gaze Nystagmus is an involuntary jerking of the eye that occurs naturally as the eyes gaze to the side. Under normal circumstances, nystagmus occurs when the eyes are rotated at high peripheral angles. However, when a person is impaired by alcohol, nystagmus is exaggerated and may occur at lesser angles. An alcohol-impaired person will also often have difficulty smoothly tracking a moving object. In the HGN test, the officer observes the eyes of a suspect as the suspect follows a slowly moving object such as a pen or small flashlight, horizontally with his or her eyes. The examiner looks for three indicators of impairment in each eye: if the eye cannot follow a moving objects smoothly, if jerking is distinct when the eye is at maximum deviation, and if the angle of onset of jerking is within 45 degrees of center. If, between the two eyes, four or more clues appear, the suspect likely has a BAC of 0.08 or greater. NHTSA research found that this test allows proper classification of approximately 88 percent of suspects (Stuster and Burns, 1998). HGN may also indicate consumption of seizure medications, phencyclidine, a variety of inhalants, barbiturates, and other depressants. Walk and Turn: The Walk-and-Turn test and One-Leg Stand test are "divided attention" tests that are easily performed by most unimpaired people. They require a suspect to listen to and follow instructions while performing simple physical movements. Impaired persons have difficulty with tasks requiring their attention to be divided between simple mental and physical exercises. In the Walk-and-Turn test, the subject is directed to take nine steps, heel-to-toe, along a straight line. After taking the steps, the suspect must turn on one foot and return in the same manner in the opposite direction. The examiner looks for eight indicators of impairment: if the suspect cannot keep balance while listening to the instructions, begins before the instructions are finished, stops while walking to regain balance, does not touch heel-to-toe, steps off the line, uses arms to balance, makes an improper turn, or takes an incorrect number of steps. NHTSA research indicates that 79 percent of individuals who exhibit two or more indicators in the performance of the test will have a BAC of 0.08 or greater (Stuster and Burns, 1998). One Leg Stand: In the One-Leg Stand test, the suspect is instructed to stand with one foot approximately six inches off the ground and count aloud by thousands (One thousand-one, one thousand-two, etc.) until told to put the foot down. The officer times the subject for 30 seconds. The officer looks for four indicators of impairment, including swaying while balancing, using arms to balance, hopping to maintain balance, and putting the foot down. NHTSA research indicates that 83 percent of individuals who exhibit two or more such indicators in the performance of the test will have a BAC of 0.08 of greater (Stuster and Burns, 1998). Combined Measures: When the component tests of the SFST battery are combined, officers are accurate in 91 percent of cases, overall, and in 94 percent of cases if explanations for some of the false positives are accepted (Stuster and Burns, 1998).

Officer and Public Safety As cited, users of bath salts are known to behave violently, experience intense paranoia and may resist with vigor. It is important to recognize that they may be experiencing complete disassociation and a complete disconnect from the world. Recent cases have demonstrated that pain compliance, use of a Taser 2, impact weapons and chemical agents may not have the typical result. It is recommended that the protocols used for response to non-compliant users of hallucinogens be applied in cases of bath salt users, with the caveat that no two cases are the same and officers on the scene must make risk informed decisions based on their experience and training, the tools at their disposal and the risk posed by the resistant subject. Officers should review the effects of stimulants, depressants, hallucinogens and alcohol, and how the use of these substances effects a persons perceptions, ability to comprehend commands and response to traditional hands-on techniques. The time to learn the signs, symptoms and difficulties that may be experienced in a field contact situation is before hand, not as you have to deal with a dynamic situation. Further study is in order. The study of the long term effects of bath salts, the span of users compliance and resistance and what new techniques for effecting apprehensions may be required to overcome the disconnect from pain compliance and reality.

Conclusion As with any new drug, further study is needed. Until data from arrests and encounter is compiled and analyzed, the best course of action will likely be the recommendation that officers treat each encounter as an unknown. In furtherance of data analysis, the need to collect consistent information from encounters, arrests and medical intervention is critical. While bath salts quickly found themselves on the prohibited substance lists through emergency legislation, they are likely not the end of analogue substances.

________________ 2-Tasers utilize Electro-Muscular Disruption (EMD) technology. The effect of a Taser when used in the EMD mode versus direct contact on users of bath salts has not provided adequate research.

The following are presumptive results for Bath Salts. Always confirm with analytical laboratory. Sodium Nitroprusside Reagent: MDPV, Mephedrone, Methylone, 4-fluro (Flephedrone), 3-fluro (3-FMC) and 3-methoxymethcathinone) will turn blue-purple with Sodium Nitroprusside. Marquis Reagent: MDPV will turn bright yellow when tested with Marquis Reagent. Scotts Reagent: MDPV will turn blue with cobalt thiocyanate.

References and Further Reading Identifying Types of Drug Intoxication: Laboratory Evaluation of a Subject-Examination Procedure: http://www.decp.org/pdfs/Johns_Hopkins_Study_May_1985.pdf DRE Protocol and Examinations: http://www.decp.org/experts/12steps.htm NHTSA SFST: http://www.nhtsa.gov/people/injury/alcohol/sfst/appendix_a.htm These protocols should be used in the course of traffic enforcement operations Synthetic drugs drive more DUI arrests. Published: Friday, June 17, 2011, 12:00 AM: http://www.pennlive.com/midstate/index.ssf/2011/06/synthetic_drugs_drive_more_dui.html Man high on bath salts kills neighbor's goat, police say. Published May 2, 2011: http://wvgazette.com/News/201105020871

Notice: This article was written as part of a professional development exercise. The observations, findings and conclusions are the authors own and do not represent the policy or procedures of his employer. Before readers take any action based on the contents of this article, they should review their respective policies and procedures. Any reference to copyrighted, trademarked or other information is for illustrative purposes and should not be taken as an endorsement. About the Author Jonathan Greenstein has served in a variety of positions in law enforcement, from patrol to criminal investigations. As an experienced investigator he has conducted long term investigations of complex frauds and swindles, narcotics violations, abductions and deaths. He is a graduate of advanced training in criminal investigations and has lectured on the modalities of criminal operations. He has published numerous articles and manuals related to crime prevention, awareness and guidelines for investigators conducing inquiries into a wide range of criminal offenses. He may be contacted with questions or comments: jonathan.greenstein@leo.gov