Gas Station, Smoke Shop, and Corner Store Drugs: The New World of Kratom, Cannabinoids, Psychedelics, and Other Substances in Your Neighborhood

A portion of the North American drug landscape has fundamentally transformed, shifting from illicitly street-sourced substances to brightly lit convenience store shelves. This session will address the rise of “gas station drugs” that have become easily accessible and largely unregulated among retail products across the United States. Under the allure of “safe” and “legal”, numerous new drug substances are now available for purchase over-the-counter, and this new paradigm requires specialized knowledge from law enforcement, clinicians, scientists, and public health officials. Several policy changes have helped fuel this new landscape. The Agriculture Improvement Act of 2018 (“Farm Bill”) opened the door to new semi-synthetic cannabinoids (e.g., delta-8 THC, delta-10 THC) produced from hemp CBD extract, in addition to more potent cannabinoids (e.g., THCP). The DEA’s 2016 decision not to schedule mitragynine and 7-hydroxy mitragynine has led to a surge in high-potency kratom extracts and the sale of enriched semi-synthetic mitragynine alkaloids. Moreover, there has been a surge in availability of psilocin and its chemical derivatives (e.g., 4-AcO-DMT) sold in mushroom-marketed products, and repurposed therapeutic drugs, like tianeptine ("gas station heroin") and phenibut are now consumed in macro-doses to elicit altered psychoactive effects. The unpredictable nature of these “legal” drug products paired with unknown clinical effects has increased risks and adverse events. Confirmed drug analysis of substances purchased from smoke shops will be described. Strategies for recognizing signs of acute toxicity, addressing limitations of routine urine drug screening, and navigating complex legal status will be discussed, and countermeasure strategies will be explored.