6.Dustin Smith — Direct/Cross/Redirect

DUSTIN SMITH: My name is Lieutenant Dustin Smith.

DUSTIN SMITH: Sure. My name is Lieutenant Dustin Smith, S-M-I-T-H.

DUSTIN SMITH: I am the current Forensic Toxicology Supervisor and Chief Toxicologist at the South Carolina Law Enforcement Division, commonly known as SLED.

DUSTIN SMITH: Sure. I have a Bachelor's of Science in Biology with a Minor in Chemistry from the College of Charleston. Since that point I've undergone extensive internal and external training both within the forensic toxicology laboratory at the South Carolina Law Enforcement Division and at multiple courses and classes outside of the laboratory. I am also a member of the Technology Working Group through the National Institute of Justice. I sit on the most recent forum to determine the best practices forensic, for forensic DUI casework sponsored by the National Safety Council. And I am certified as a Fellow of the American Board of Forensic Toxicology.

DUSTIN SMITH: Sorry.

DUSTIN SMITH: Yes, ma'am. That's correct.

DUSTIN SMITH: So I oversee the toxicology department. I receive the day-to-day operations from budget and personnel. I also am responsible for the training of new technicians and toxicologists. I'm responsible for method development and validation in the laboratory, and I'm responsible for reviewing all casework that involves any drug work before those finalized reports are released back to the submitting agencies.

DUSTIN SMITH: Like I said before, I have undergone extensive training inside and outside. So inside the South Carolina Law Enforcement Division toxicology department, I have been certified as a Forensic Toxicologist. Externally I routinely attend the Society of Forensic Toxicologist meetings where there are courses that keep me current with the field of forensic toxicology. I have attended both the Borkenstein alcohol and driving and drugs and driving courses, and course work.

DUSTIN SMITH: Yes, I have.

DUSTIN SMITH: Approximately 100 times.

DUSTIN SMITH: Okay. So just to kind of go over briefly what synthetic cannabis, or synthetic cannabinoids are. It's the same thing as spice, or K2. Those are kind of colloquial terms for it. Synthetic cannabinoids were first produced in order to predate a legal alternative to marijuana. The first compounds that were produced very closely mirrored the effects of marijuana. Very similar psychoactive effects. They were -- they interacted with the same receptors and to the same extent as marijuana does. As those compounds began becoming scheduled, or becoming illegal, the clandestine drug manufacturers would move on to another suite of compounds. And the next suite of compounds had effects that were also similar but not quite the same, and then the next set would get a little bit further from the true marijuana effects, and then so on and so on. At this point we're to the tenth or eleventh or twelfth iteration of those compounds. It's a revolving door. As soon as one suite of compounds becomes established, the governments will make the determinations that those are dangerous, they will make those illegal, and then the clandestine labs will create new drugs after that.

DUSTIN SMITH: Yes, it was.

DUSTIN SMITH: It is -- it is federally illegal.

DUSTIN SMITH: It became a controlled substance through the federal government on January 1st, 2015.

DUSTIN SMITH: We certainly did see it in our casework, yes.

DUSTIN SMITH: There have been. The studies are limited, but there have been studies. Like I said before, the problem with synthetic cannabinoids and the study of synthetic cannabinoids is that they don't hang around for long. So by the time that the studies get completed it's not pertinent any longer because they've moved on to the next suit of compounds. But yes, there have been some studies that have been done on various suits of synthetic cannabinoids including AB Pinaca.

DUSTIN SMITH: Yes, they are.

DUSTIN SMITH: Yes.

DUSTIN SMITH: I am.

DUSTIN SMITH: So by the time AB Pinaca, the iteration of synthetic cannabinoids that included AB Pinaca came onto the market, we're pretty far away now from traditional marijuana. The effects aren't terribly similar any longer. Obviously you take one of these drugs, or any illicit drug for the euphoric effects of the drugs. You want to take a drug because you want to feel good. So one of the primary effects of the drug is that -- still is euphoria. Sort of the side-effects of the drug, which are interesting because they differ so much from the traditional marijuana, include agitation, can include --

DUSTIN SMITH: Okay.

DUSTIN SMITH: Confusion, anxiety. They can include paranoia, and they can include hallucinations. And one of the -- one of the interesting things that really is specific to some of the later iterations of synthetic cannabinoids, which AB Pinaca is a member of, are psychosis or altered mental state. So both of those two things would be big things that would be associated with it.

DUSTIN SMITH: That's correct.

DUSTIN SMITH: They have. They are consistent with the use of AB Pinaca.

DUSTIN SMITH: Sure. So the synthetic cannabinoids are interesting in that they don't -- typical drugs will usually go one way or the other. They're either going to be a central nervous depressant, like alcohol or opioids, or they'll be a central nervous system stimulant like cocaine or methamphetamine. Synthetic cannabinoids kind of share some from each. So some of the central nervous system depressant like effects that you expect to see include things like lethargy, which means you move very slowly, drowsiness, slurred speech, some -- those are the primary ones that would be associated with the central nervous system depressant side. As far as the central nervous system stimulant side goes, you can experience increased heart rate, although there are instances where you can also experience decreased heart rate. A lot of these symptoms are dose specific also. Sometimes you may exhibit one suite of symptoms at a lower dose of the drug and then you may exhibit a different suite of symptoms at a higher dose of the drug.

DUSTIN SMITH: Well, typically the low dose of this drug you see symptoms that are more consistent with a central nervous system depressant. You see decreased heart rate. You see decreased body temperature. You see decreased --

DUSTIN SMITH: I'm sorry. A You see decreased heart rate, decreased blood pressure, decreased body temperature. But at higher levels it does act much more like a stimulant where you may see increased heart rate, increased blood pressure and increased body temperature. Some of the things that you would expect to see with these, you know, may include agitation, confusion, potentially sweating. There also is something called excited delirium that you may experience at these higher levels, which means you might make excited gestures or comments that might be nonsensical.

DUSTIN SMITH: Absolutely, yes.

DUSTIN SMITH: That's correct, yes.

DUSTIN SMITH: Like I said before, unfortunately the literature on AB Pinaca is relatively limited. But the literature does state that there is an indication that this is a drug of considerable abuse potential, meaning that people could become addicted to this drug quite easily, and that the withdrawal from this drug can also be significant.

DUSTIN SMITH: Sure. So like I said before, when you take a drug, an illicit drug particularly, the expectation is that you're going to feel good. That's the reason why you take that drug. You want to escape realty. You want to feel better than what you're currently, you want to get away from whatever pain you might be in or what have you. If you take that drug consistently over a long period of time you develop a dependence to it. After you develop a dependence to the drug your body wants to go back to what's called homeostasis. It wants to go back to what's normal. And so, that your body actually starts to make conformational changes to the receptors in the body. So what that means is it starts to change the structure of the receptor a little bit. It makes it so the drug might not fit into the receptor quite as well anymore, so you don't get the same affect from it as you did before. So you have to take it more often and you have to take it -- take more of it, get the same affect that you were getting before. Well, unfortunately when you stop taking that drug, at that point your body is used to having that drug there to fill that receptor, and once that drug is not there anymore you may develop -- or you typically develop withdrawal systems. Where you were taking the drug before to feel good, when you don't have that drug anymore you feel bad. So you go into what's called a dysphoric state where you just, you know, feel bad all the time. And that, that dysphoric state can just be, can include depression. It can include actual physical pain. And so, those are kind of some of the things that you would expect to see from a withdrawal.

DUSTIN SMITH: So the longer you use the drug and the more drug that you have to have in order to accomplish the affect that you want, the more significant the withdrawal could be when you remove that drug from the, from the body.

DUSTIN SMITH: That's correct.

DUSTIN SMITH: That's correct, yeah. It was only around for a couple of months. It was, you know, it was very common during that time period. You know, it became scheduled, or became illegal, and then they moved on to another drug. So there wasn't a lot of time there for them to do a lot of studies on it.

DUSTIN SMITH: Unfortunately they are not.

DUSTIN SMITH: Okay.

DUSTIN SMITH: Yes, I have.

DUSTIN SMITH: It is one of many components. Potential components, yes.

DUSTIN SMITH: Yes.

DUSTIN SMITH: It took the form of very many synthetic cannabinoids named very many names. Scooby Snax is one of them.

DUSTIN SMITH: That's my understanding, yes.

DUSTIN SMITH: So smoking is the most common. The vast majority of the time when you ingest a synthetic cannabinoid it will be smoked in some way or another.

DUSTIN SMITH: Good, thank you.

DUSTIN SMITH: That's correct. January 2015.

DUSTIN SMITH: That's correct.

DUSTIN SMITH: That's correct, yes.

DUSTIN SMITH: Not anymore. No, it's not.

DUSTIN SMITH: There are. There have been over time. They're not 160 varieties on the market at one time. There are typically somewhere between six and fifteen different drugs that constitute what is known as synthetic cannabinoids at any given time.

DUSTIN SMITH: That's correct. We're very far removed from the initial synthetic cannabinoids at this point.

DUSTIN SMITH: I'm sorry. I don't understand.

DUSTIN SMITH: Sure. So the initial synthetic cannabinoids were created for a very useful -- well, were synthesized for a potentially a very useful thing. Marijuana interacts with two different receptors primarily. What's called a CB1 and a CB2. The CB1 is the receptor that typically gives you the euphoric effects and the CB2 has some of the peripheral effects, one of which is the increased appetite. So a lot of these drugs were being created as appetite stimulants -- or being created as potential appetite stimulants for people who had cancer or had other reasons why they weren't able to eat very well.

DUSTIN SMITH: Yes, I believe so.

DUSTIN SMITH: That's correct. Dr. Hoffman at Clemson was the first person who published.

DUSTIN SMITH: That is correct, yes.

DUSTIN SMITH: That's --

DUSTIN SMITH: That's sort of the idea, yeah. If you put it, the key goes in. It still fits. But it just doesn't, it doesn't initiate the full response of the receptor.

DUSTIN SMITH: AB Pinaca has been shown to have a far greater receptor affinity than marijuana does. Now, whether it's a true full agonist or not I don't know. But it has -- has somewhere, there are differing reports. But somewhere between two and twenty times more affinity for the receptor than marijuana does.

DUSTIN SMITH: That's correct, yeah. Sure, yes.

DUSTIN SMITH: Well, people with mental illness who use synthetic cannabinoids, synthetic cannabinoids can exacerbate the effects of mental illness.

DUSTIN SMITH: That is correct, yes.

DUSTIN SMITH: I -- unfortunately there's not -- again, there's not a lot of information on the pharmacology of the drug. So there is, there have been some studies on half-life. A half-life is the amount of time it takes for half of the drug to be eliminated from the body. And it typically takes about seven or so half-lives for the drug to be eliminated entirely from the body. The only studies that have thus far been done on AB Pinaca. And I don't know that future studies will be done at this point because the drug is not that much of a concern today. But the only drugs that, I mean, the only studies that have been done have been done in-vitro. And what in-vitro means is that they took liver enzyme cells and they put them into a tube, and then they put the drug in and then they studied the elimination of the drug outside of the body. There have not been any studies done to the best of my knowledge, to the best of my literature search, on how the actual human body interacts with the drug.

DUSTIN SMITH: Approximately 20 minutes in-vitro. Now, again, that means that that's in a controlled environment. What we see in half-lives, regardless of the drug in the human body, it's fairly variable. And so, we don't know whether that half-life would be consistent with what's in the human body or not. But that is the only information that we have available to us at the time.

DUSTIN SMITH: Well, it takes about seven half-lives to remove it from the body entirely. Typically it takes about five half-lives to remove it from the body so that it's lower than what most forensic laboratories can detect.

DUSTIN SMITH: That's correct, based on in-vitro studies.

DUSTIN SMITH: Are you asking in regards to traditional marijuana or are you asking in regards to synthetic cannabinoids?

DUSTIN SMITH: So in regards to traditional marijuana, the tetrahydrocannabinol, which is the active component of marijuana, metabolizes into a product metabolite known as hydroxytetrahydrocannabinol --

DUSTIN SMITH: Sorry.

DUSTIN SMITH: Well, I think -- I think that is what you're getting, because I think that's what you're expecting to get. When you go into a store and you buy synthetic cannabinoids, or you buy Spice, you're expecting to get a synthetic cannabinoid. You don't know which one. You have no idea which one. But you are expecting to get a synthetic cannabinoid of some variety, and that's what he got. I mean, that's what, that's what was identified in this case.

DUSTIN SMITH: It's very different than marijuana, that's correct.

DUSTIN SMITH: So there have been studies in regards to synthetic cannabinoids and their, their effects on those who already have underlying conditions such as anxiety, depression and mental illness. And what those studies show is that synthetic cannabinoids specifically exacerbate those effects when you're already prone to those conditions.

DUSTIN SMITH: That is correct, yes.

DUSTIN SMITH: So again, a half-life is the amount of time that it takes for half of the drug to be eliminated. So if a half-life of this particular drug in-vitro is approximately 20 minutes. That means if you take 10 milligrams of drug, after 20 minutes there would only be five milligrams left, and after 20 minutes more there would be two and half, and so on and so on. It traditionally takes about seven and a half lives for that drug to be eliminated from the body almost entirely, or to a level where it's insignificant after seven and a half lives. And then after about five and a half lives you wouldn't expect to see it in a detectable level of the body. Again, in-vitro just means that it's done outside of the body. They take liver enzyme cells, they placed them into a tube with the drug, the drub binds with those cells -- or the drug is effected by those cells, and then the metabolism that you would expect to happen within the body happens in that tube instead. Unfortunately there are a lot of things that go on in the human body that can't be replicated in that tube. Again, half-lives in the human body are quite variable, even for drugs that are very, very well studied. So you may see half-lives where the average is three to six hours. But you may see something, you know, where it's not unusual to see it from two to twelve hours. So while this study does indicate 20 minutes, the one study that was done indicates 20 minutes in vitro, that could be, that could be exactly right or it could be quite a ways away from what the true estimated value would be in the human body.

DUSTIN SMITH: Not in an AB Pinaca half-life, no.

DUSTIN SMITH: Yes, it is my opinion that --

DUSTIN SMITH: So, yes, someone who's a chronic user of a synthetic cannabinoid such as AB Pinaca after some amount of time will build up some tolerance to that drug. That tolerance, once the drug is then removed from the body, from the equation, would almost certainly cause some level of withdrawal.

DUSTIN SMITH: Thank you. (Whereupon, the witness stepped down from the witness stand.)