1
|
Yeniocak S, Kalkan A, Yamanoğlu A, Öztürk S, Söğüt Ö, Metiner M. The effects of synthetic cannabinoids on the cardiovascular system: A case-control study. Turk J Emerg Med 2021; 21:198-204. [PMID: 34849432 PMCID: PMC8593429 DOI: 10.4103/2452-2473.329634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES: Limited clinical studies have investigated the effects of synthetic cannabinoids (SCs) on the cardiovascular system (CVS). The aim of this study was to evaluate the effects of SCs on the CVS. METHODS: The patient group of this single-center, prospective, case–control study consisted of adult patients presenting to the emergency department (ED) with symptoms of SC use. Vital signs and electrocardiogram (ECG) after use of SC of patients were followed. A control group with a similar number of patients and patient demographics were formed following the patient admission process. Pulse rate, arterial blood pressure (ABP), and ECG of patient and control groups were compared using Mann–Whitney U and Chi-squared tests. RESULTS: A total of 148 people were included in the study, 74 in the patient group and 74 in the control group. Systolic and diastolic ABPs of patient group were statistically significantly lower than those of the control group (P < 0.001). P-wave width and amplitude in the patient group were significantly higher compared to the control group (P: 0.027 and P: 0.004, respectively). QRS width on patient group ECGs was significantly higher than in the control group, while T-wave amplitude was significantly lower (P: 0.045 and P < 0.001, respectively). ST elevation was seen in 12 (16.2%) subjects in the patient group, while no ST elevation was seen in the control group (P < 0.001). CONCLUSION: SCs can reduce systemic tension and SCs may cause changes in ECG, especially P wave, ST segment, T wave, and QRS. Further large-scale studies are needed to show whether these changes are associated with fatal arrhythmias or myocardial infarction.
Collapse
Affiliation(s)
- Selman Yeniocak
- Department of Emergency Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Asım Kalkan
- Department of Emergency Medicine, Okmeydanı Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Adnan Yamanoğlu
- Department of Emergency Medicine, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Semi Öztürk
- Department of Cardiology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Özgür Söğüt
- Department of Emergency Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Merve Metiner
- Department of Emergency Medicine, Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
2
|
Abstract
There is growing recognition that substance use is associated with the emergence of psychosis.Elements of post-modernity dominate contemporary social contexts and operate as existential background factors that contribute to the emergence of substance-related psychotic phenomena, particularly use of potent and highly rewarding novel psychoactive substances (NPS). About 25% of first-episode psychoses are substance-induced (SIP). DSM-5 SIP diagnosis is based on the assumption that symptoms are transient and disappear after sustained abstinence. This narrowed definition does not consider the issue of persistent SIP. There is a clear need for a new diagnostic framework that provides reliable, unambiguous clinical criteria to differentiate between comorbid conditions (i.e., schizophrenia patients with a substance use disorder) and substance-related psychoses. In the present contribution, we aim to outline a novel and separate clinical entity: substancerelated exogenous psychosis (SREP). Within this diagnostic category, we refer to both transientand persistent psychoses associated with substance use. SREP is conceived as a distinct psychoticdisorder with psychopathological specificities that clearly differentiate it from schizophrenia. We address differences in terms of clinical presentation, epidemiology, etiological models and treatment response. SREP is characterized by altered states of consciousness, persecutory delusions, visual and cenesthetic hallucinations, impulsivity and psychomotor agitation, affectiveand negative symptoms, a pervasive feeling of unreality and intact insight. Delusions are typically secondary to abnormal perception resulting from a characteristic "sensorialization" of the world. Longitudinal studies are warranted to substantiate our hypothesis of a novel diagnostic categoryand support the clinical validity of SREP. This may have important implications in terms of early differential diagnosis and staging (i.e., between comorbid conditions, persistent and transientsubstance-related psychotic states) as well as choice of treatment interventions.
Collapse
|
3
|
Madhu S, Komala M, Pandian P. Formulation Development and Characterization of Withaferin-A Loaded Polymeric Nanoparticles for Alzheimer’s Disease. BIONANOSCIENCE 2021. [DOI: 10.1007/s12668-020-00819-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
4
|
Schifano F, Napoletano F, Chiappini S, Guirguis A, Corkery JM, Bonaccorso S, Ricciardi A, Scherbaum N, Vento A. New/emerging psychoactive substances and associated psychopathological consequences. Psychol Med 2021; 51:30-42. [PMID: 31327332 DOI: 10.1017/s0033291719001727] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The present paper provides an updated review of both the large number of new/novel/emerging psychoactive substances (NPS) and their associated psychopathological consequences. Focus was here given on identification of those NPS being commented in specialised online sources and the related short-/long-term psychopathological and medical ill-health effects. METHODS NPS have been identified through an innovative crawling/navigating software, called the 'NPS.Finder®', created in order to facilitate the process of early recognition of NPS online. A range of information regarding NPS, including chemical and street names; chemical formula; three-dimensional image and anecdotally reported clinical/psychoactive effects, were here made available. RESULTS Using the 'NPS.Finder®' approach, a few thousand NPS were here preliminarily identified, a number which is about 4-fold higher than those figures suggested by European and international drug agencies. NPS most commonly associated with the onset of psychopathological consequences included here synthetic cannabinoids/cannabimimetics; new synthetic opioids; ketamine-like dissociatives; novel stimulants; novel psychedelics and several prescription and over-the-counter medicines. CONCLUSIONS The ever-increasing changes in terms of recreational psychotropics' availability represent a relatively new challenge for psychiatry, as the pharmacodynamics and pharmacokinetics of many NPS have not been thoroughly understood. Health/mental health professionals should be informed about the range of NPS; their intake modalities; their psychoactive sought-after effects; the idiosyncratic psychotropics' combinations and finally, their medical and psychopathological risks.
Collapse
Affiliation(s)
- F Schifano
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | | | - S Chiappini
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - A Guirguis
- Swansea University Medical School, Institute of Life Sciences 2, Swansea University, Singleton Park, Swansea, Wales
| | - J M Corkery
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - S Bonaccorso
- Camden and Islington NHS Mental Health Foundation Trust, London, UK
| | - A Ricciardi
- Camden and Islington NHS Mental Health Foundation Trust, London, UK
- Department of Mental Health, ASL Roma 1, Rome, Italy
| | - N Scherbaum
- LVR-Klinikum Essen, Klinik für Psychiatrie und Psychotherapie, University of Duisburg-Essen, Essen, Germany
| | - A Vento
- Addictions' Observatory (ODDPSS), Rome, Italy
- 'Guglielmo Marconi' University, Rome, Italy
- Department of Mental Health, ASL Roma 2, Rome, Italy
| |
Collapse
|
5
|
Wood DM, Dargan PI. Regional, national and international datasets: How they improve our understanding of the acute harms associated with prescription medicine misuse. Br J Clin Pharmacol 2020; 87:1654-1659. [PMID: 33118204 DOI: 10.1111/bcp.14592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 12/13/2022] Open
Abstract
Prescription medicine misuse is a significant problem in many areas of the world. Understanding the acute and chronic harms related to misuse of prescription medicines allows healthcare professionals, drug addiction treatment services and legislative authorities to determine what interventions may be beneficial to reduce these harms and protect individuals and society. However, it is difficult to obtain systematic data on the harms associated with prescription medicine misuse because of how patient visits to clinics and hospitals are recorded and coded in regional or national databases. In this review, we discuss how regional, national and international sources of information can help develop a greater understanding of the prevalence and pattern of acute harms related to prescription medicine misuse using data from ambulance attendances, emergency department presentations and poisons information services.
Collapse
Affiliation(s)
- David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.,Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Paul I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.,Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| |
Collapse
|
6
|
Fletcher EH, Tasker SM, Easton P, Denvir L. Improving the help and support provided to people who take new psychoactive substances ('legal highs'). J Public Health (Oxf) 2018; 38:e489-e495. [PMID: 28158593 DOI: 10.1093/pubmed/fdv191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E H Fletcher
- Public Health Directorate, NHS Tayside, Kings Cross Hospital, Dundee DD3 8EA, UK
| | - S M Tasker
- Public Health Directorate, NHS Tayside, Kings Cross Hospital, Dundee DD3 8EA, UK
| | - P Easton
- Public Health Directorate, NHS Tayside, Kings Cross Hospital, Dundee DD3 8EA, UK
| | - L Denvir
- Public Health Directorate, NHS Tayside, Kings Cross Hospital, Dundee DD3 8EA, UK
| |
Collapse
|
7
|
Presentations to the emergency department with non-medical use of benzodiazepines and Z-drugs: profiling and relation to sales data. Eur J Clin Pharmacol 2018; 75:77-85. [DOI: 10.1007/s00228-018-2550-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/29/2018] [Indexed: 10/28/2022]
|
8
|
Bonsai intoxication at emergency service: A review of 61 cases. JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.422416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
9
|
White CM. Mephedrone and 3,4-Methylenedioxypyrovalerone (MDPV): Synthetic Cathinones With Serious Health Implications. J Clin Pharmacol 2017; 56:1319-1325. [PMID: 27029951 DOI: 10.1002/jcph.742] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 03/24/2016] [Indexed: 11/10/2022]
Abstract
This article presents information on the predominant synthetic cathinones used in the Western world, mephedrone and methylenedioxypyrovalerone (MDPV). Synthetic cathinones are commonly used drugs of abuse in the United States and Europe, with numerous cases of patient harm and death. Patients exhibit many neurological, cardiovascular, and muscular adverse events and frequently require therapy to control psychotic or agitated states and acute kidney injury resulting from myopathy or rhabdomyolysis. There are potential genetic polymorphisms and drug interactions that might accentuate risk, but there are no studies evaluating to what extent this occurs or if it is clinically relevant. Clinicians should be aware of the known pharmacology, pharmacokinetics, and reports of effects to detect potential issues and treat patients presenting with these adverse effects.
Collapse
Affiliation(s)
- C Michael White
- University of Connecticut School of Pharmacy & Hartford Hospital Department of Pharmacy, Storrs, CT, USA.
| |
Collapse
|
10
|
Williams M, Martin J, Galettis P. A Validated Method for the Detection of 32 Bath Salts in Oral Fluid. J Anal Toxicol 2017; 41:659-669. [DOI: 10.1093/jat/bkx055] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 06/26/2017] [Indexed: 11/13/2022] Open
|
11
|
Budzynska B, Michalak A, Frankowska M, Kaszubska K, Biała G. Acute behavioral effects of co-administration of mephedrone and MDMA in mice. Pharmacol Rep 2017; 69:199-205. [DOI: 10.1016/j.pharep.2016.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/07/2016] [Accepted: 10/07/2016] [Indexed: 12/11/2022]
|
12
|
Dogan S, Kalafat UM, Gurmen ES, Akman C, Ozturk ZS, Bildik B, Ocak T. An unknown side effect of Bonsai vesiculobullous skin reaction in emergency department. Am J Emerg Med 2017; 35:1033.e1-1033.e2. [PMID: 28162870 DOI: 10.1016/j.ajem.2017.01.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 01/27/2017] [Indexed: 10/20/2022] Open
Affiliation(s)
- Serkan Dogan
- Istanbul Kanuni Sultan Süleyman Education and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Utku Murat Kalafat
- Istanbul Kanuni Sultan Süleyman Education and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey.
| | - Ekim Saglam Gurmen
- Istanbul Kanuni Sultan Süleyman Education and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Canan Akman
- Istanbul Kanuni Sultan Süleyman Education and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Zeynep Saral Ozturk
- Istanbul Kanuni Sultan Süleyman Education and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Busra Bildik
- Istanbul Kanuni Sultan Süleyman Education and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Tarik Ocak
- Istanbul Kanuni Sultan Süleyman Education and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| |
Collapse
|
13
|
Guirguis A, Girotto S, Berti B, Stair JL. Identification of new psychoactive substances (NPS) using handheld Raman spectroscopy employing both 785 and 1064nm laser sources. Forensic Sci Int 2017; 273:113-123. [PMID: 28260646 DOI: 10.1016/j.forsciint.2017.01.027] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/19/2017] [Accepted: 01/29/2017] [Indexed: 11/26/2022]
Abstract
The chemical identification of new psychoactive substances (NPS) in the field is challenging due not only to the plethora of substances available, but also as a result of the chemical complexity of products and the chemical similarity of NPS analogues. In this study, handheld Raman spectroscopy and the use of two excitation wavelengths, 785 and 1064nm, were evaluated for the identification of 60 NPS products. The products contained a range of NPS from classes including the aminoindanes, arylalkylamines, benzodiazepines, and piperidines & pyrrolidines. Identification was initially assessed using the instruments' in built algorithm (i.e., % HQI) and then further by visual inspection of the Raman spectra. Confirmatory analysis was preformed using gas chromatography mass spectrometry. For the 60 diverse products, an NPS was successfully identified via the algorithm in 11 products (18%) using the 785nm source and 29 products (48%) using the 1064nm source. Evaluation of the Raman spectra showed that increasing the excitation wavelength from 785 to 1064nm improved this 'first pass' identification primarily due to a significant reduction in fluorescence, which increased S/N of the characteristic peaks of the substance identified. True positive correlations between internet products and NPS signatures ranged from 57.0 to 91.3% HQI with typical RSDs<10%. Tablet formulations and branded products were particularly challenging as a result of low NPS concentration and high chemical complexity, respectively. This study demonstrates the advantage of using a 1064nm source with handheld Raman spectroscopy for improved 'first pass' NPS identification when minimal spectral processing is required, such as when working in field. Future investigations will focus on the use of mixture algorithms, effect of NPS concentration, and further improvement of spectral libraries.
Collapse
Affiliation(s)
- Amira Guirguis
- School of Life and Medical Sciences, Department of Pharmacy, Pharmacology and Postgraduate Medicine, University of Hertfordshire, Hatfield, UK.
| | - Sarah Girotto
- School of Life and Medical Sciences, Department of Pharmacy, Pharmacology and Postgraduate Medicine, University of Hertfordshire, Hatfield, UK.
| | - Benedetta Berti
- School of Life and Medical Sciences, Department of Pharmacy, Pharmacology and Postgraduate Medicine, University of Hertfordshire, Hatfield, UK.
| | - Jacqueline L Stair
- School of Life and Medical Sciences, Department of Pharmacy, Pharmacology and Postgraduate Medicine, University of Hertfordshire, Hatfield, UK.
| |
Collapse
|
14
|
Schifano F, Orsolini L, Papanti D, Corkery J. NPS: Medical Consequences Associated with Their Intake. Curr Top Behav Neurosci 2017; 32:351-380. [PMID: 27272067 DOI: 10.1007/7854_2016_15] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Over the last decade, the 'traditional' drug scene has been supplemented - but not replaced - by the emergence of a range of novel psychoactive substances (NPS), which are either newly created or existing drugs, including medications, now being used in novel ways. By the end of 2014, in excess of 500 NPS had been reported by a large number of countries in the world. Most recent data show, however, that synthetic cathinones, synthetic cannabinoids, and psychedelics/phenethylamines account for the largest number of NPS.The present chapter aims at providing an overview of the clinical and pharmacological issues relating to these most popular NPS categories. Given the vast range of medical and psychopathological issues associated with the molecules here described, it is crucial for health professionals to be aware of the effects and toxicity of NPS. A general overview of the acute management of NPS adverse events is provided as well, although further studies are required to identify a range of evidence-based, index molecule-focused, treatment strategies. The rapid pace of change in the NPS online market constitutes a major challenge to the provision of current and reliable scientific knowledge on these substances.
Collapse
Affiliation(s)
- Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, Herts, AL10 9AB, UK.
| | - Laura Orsolini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, Herts, AL10 9AB, UK
| | - Duccio Papanti
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, Herts, AL10 9AB, UK
| | - John Corkery
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, Herts, AL10 9AB, UK
| |
Collapse
|
15
|
Fitzpatrick D, O'Meara P, Cunningham A. Pre-hospital identification and post-recovery challenges of intoxication with synthetic cannabinoid containing legal high products such as 'Exodus Damnation'. Scott Med J 2016; 61:192-194. [PMID: 27688259 DOI: 10.1177/0036933016659177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This short report describes the case of a young adult male who had smoked a synthetic cannabinoid legal high product called 'Exodus Damnation'. The patient's presentation was atypical from that described in the literature, with hypotension and hypoxaemia. Of note was the rapid recovery after pre-hospital intervention with high-flow oxygen therapy and intravenous fluids. The patient refused on-going care, despite repeated advice to attend the Emergency Department. The distinct lack of specialist support and referral to drug treatment for this patient population, with whom ambulance services are coming into contact with increasing frequency, is reported. For those patients with the capacity to refuse on-going care, ambulance services may be in an opportune position to actively promote referral to support services for these vulnerable individuals.
Collapse
Affiliation(s)
- David Fitzpatrick
- Paramedic Clinical Research Specialist, Scottish Ambulance Service, NMAHP Research Unit, University of Stirling, UK
| | - Patrick O'Meara
- National Head of Ambulance Control Services, Scottish Ambulance Service, UK
| | - Andrew Cunningham
- Scientific Analyst, European Monitoring Centre for Drugs and Drug Addiction, Portugal
| |
Collapse
|
16
|
Wood DM, Ceronie B, Dargan PI. Healthcare professionals are less confident in managing acute toxicity related to the use of new psychoactive substances (NPS) compared with classical recreational drugs. QJM 2016; 109:527-9. [PMID: 26574500 PMCID: PMC4986425 DOI: 10.1093/qjmed/hcv208] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The features of acute classical recreational drugs or new psychoactive substances (NPS) toxicity fall into three broad groups: (i) stimulant; (ii) hallucinogenic and (iii) depressant. Currently, there is no information available on healthcare professionals knowledge/confidence in managing the acute toxicity related to NPS use. AIM We have compared knowledge and confidence of managing acute toxicity related to use of NPS with that seen with the use of to classical recreational drugs. DESIGN AND METHODS Physicians/nurses completed a questionnaire survey to self-assess on a 5-point scale their knowledge (1-little knowledge; 5-very knowledgeable) and confidence (1-little confidence; 5-very confident) of managing acute toxicity related to the use of classical recreational drugs or NPS. Differences between knowledge and confidence for classical recreational drugs and NPS were assessed using paired Student's t-test; comparison between doctors, nurses and the frequency of managing acute classical recreational drug/NPS toxicity was assessed using unpaired Student's t-test. RESULTS One hundred and eighty-eight (82 physicians, 106 nurses) completed the survey. Classical drug compared with NPS knowledge: nurses 2.9 ± 1.0 vs. 2.1 ± 1.0, P < 0.001; physicians 3.1 ± 0.8 vs. 2.1 ± 1.0, P < 0.001. There was no difference between nurses and physicians in classical drug (P = 0.11) or NPS (P = 0.89) knowledge. Confidence in managing classical drug toxicity compared with NPS confidence: nurses 3.0 ± 1.1 vs. 2.3 ± 1.1, P < 0.001; physicians 3.0 ± 0.9 vs. 2.1 ± 1.0, P < 0.001. There was no difference between nurses and physicians in classical drugs (P = 0.85) or NPS (P = 0.33) confidence. CONCLUSIONS Physicians/nurses are less confident in managing acute NPS toxicity. Management of toxicity is not dependent on knowing the drug/NPS, but should be on the basis of these clinical signs/symptoms. Training/education should focus on the concept of managing the pattern of toxicity that an individual presents with rather than the actual drug(s).
Collapse
Affiliation(s)
- D M Wood
- From the Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - B Ceronie
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - P I Dargan
- From the Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners Faculty of Life Sciences and Medicine, King's College London, London, UK
| |
Collapse
|
17
|
Owen DR, Wood DM, Archer JRH, Dargan PI. Phenibut (4-amino-3-phenyl-butyric acid): Availability, prevalence of use, desired effects and acute toxicity. Drug Alcohol Rev 2015; 35:591-6. [PMID: 26693960 DOI: 10.1111/dar.12356] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 09/19/2015] [Accepted: 09/22/2015] [Indexed: 02/03/2023]
Abstract
INTRODUCTION AND AIMS There has been a global increase in the availability and use of novel psychoactive substances (NPS) over the last decade. Phenibut (β-phenyl-γ-aminobutyric acid) is a GABAB agonist that is used as an NPS. Here, we bring together published scientific and grey information sources to further understand the prevalence of use, desired effects and acute toxicity of phenibut. DESIGN AND METHODS Using European Monitoring Centre for Drugs and Drug Addiction Internet snapshot methodology, we undertook an English language Internet snapshot survey in May 2015 to gather information on the availability and price of phenibut from Internet NPS retailers. To gather information on prevalence of use, desired effects and/or adverse effects, we searched grey literature (online drug discussion forums) and medical literature (PubMed and abstracts from selected International Toxicology conferences). RESULTS We found 48 unrelated Internet suppliers selling phenibut in amounts ranging from 5 g (US$1.60, £1.01/g) to 1000 kg (US$0.23, £0.14/g). Capsules containing 200-500 mg of phenibut were available in packs of between 6 (US$4.45, £2.80/g) and 360 (US$0.43, £0.27/g). According to the grey literature, phenibut is taken for its anxiolytic and euphoric properties, with tolerance and withdrawal syndromes commonly reported adverse effects. Phenibut is taken orally at an average dose of 2.4 g. Case reports in the medical literature feature users who present to emergency departments heavily sedated or experiencing withdrawal. There have been no reported deaths relating to phenibut use. DISCUSSION AND CONCLUSIONS Phenibut is readily available in the UK from Internet sites selling NPS. Its desired and adverse effects appear similar to other gamma-aminobutyric acid receptor agonists. [Owen DR, Wood DM, Archer JRH, Dargan PI. Phenibut (4-amino-3-phenyl-butyric acid): Availability, prevalence of use, desired effects and acute toxicity. Drug Alcohol Rev 2016;35:591-596].
Collapse
Affiliation(s)
- David R Owen
- Division of Brain Sciences, Imperial College London, London, UK
| | - David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - John R H Archer
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - Paul I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK. .,Faculty of Life Sciences and Medicine, King's College London, London, UK.
| |
Collapse
|
18
|
Nizar H, Dargan PI, Wood DM. Using internet snapshot surveys to enhance our understanding of the availability of the novel psychoactive substance 4-methylaminorex and 4,4'-dimethylaminorex. J Med Toxicol 2015; 11:80-4. [PMID: 25167967 DOI: 10.1007/s13181-014-0425-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
4,4'-Dimethylaminorex is a stimulant novel psychoactive substance (NPS) first detected in Europe in November 2012. It is a derivative of 4-methylaminorex, a substance controlled under Schedule 1 of the 1971 United Nations Convention on Psychotropic Substances. There is currently no information on the availability or cost of these substances from Internet suppliers. An Internet snapshot study was undertaken in English using established European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) methodology to determine the availability of 4-methylaminorex and 4,4'-dimethylaminorex in April 2014. Twenty Internet sites selling 4-methylaminorex were identified, 18 selling in US dollars and two in GB Pound Sterling. Fourteen (70 %) Internet sites had a minimum purchase amount of ≥10 g (compared to user doses of 10-25 mg). For the 18 suppliers selling in US$, 9 quoted a fixed price per gram irrespective of the amount ordered and 11 had a reducing price per gram with increasing purchase quantity (US$30.8 ± 34.2/g for 1 g purchase to US$15.2 ± 20.3/g for 1 kg purchase). Only one Internet site selling 4,4'-dimethylaminorex was identified, selling in Euros. The minimum purchase quantity was 500 mg. The price per gram reduced from <euro>36.08/g for a 500 mg purchase to <euro>2.20/g for a 100 g purchase. This Internet snapshot demonstrated that there was a greater availability from Internet suppliers of products advertised as 4-methylaminorex than 4,4'-dimethylaminorex, despite the 4-methylaminorex being an internationally controlled substance. Whilst this may reflect misunderstanding by suppliers, it has the potential to put those purchasing at risk of contravening border control and/or local law enforcement legislation. The use of methodology such as Internet snapshot surveys is of increasing interest to clinical/medical toxicologists in their understanding of the supply, availability and cost of novel psychoactive substances.
Collapse
Affiliation(s)
- Hisham Nizar
- Clinical Pharmacology, Charing Cross Hospital, London, UK
| | | | | |
Collapse
|
19
|
Mounsey SJ, Dargan PI, Stewart M, Brown A, Newton N, Wood DM. Perceived risk of using novel psychoactive substances in school students: lower in users compared to non-users. JOURNAL OF SUBSTANCE USE 2015. [DOI: 10.3109/14659891.2015.1021870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
20
|
Lee HMD, Wood DM, Hudson S, Archer JRH, Dargan PI. Acute toxicity associated with analytically confirmed recreational use of methiopropamine (1-(thiophen-2-yl)-2-methylaminopropane). J Med Toxicol 2015; 10:299-302. [PMID: 24706157 DOI: 10.1007/s13181-014-0399-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Methiopropamine use in Europe has been detected since January 2011, but there is limited information on its acute toxicity. Here, we describe a case of analytically confirmed methiopropamine acute toxicity. CASE REPORT A 27-year-old woman with no previous medical history was brought to the emergency department with palpitations, chest tightness, anxiety, nausea, vomiting and visual hallucinations following the use of a 'Quicksilver'. Toxicological analysis of her urine collected at presentation to the ED detected methiopropamine at a concentration of 400 ng/mL. Other drugs were also detected but at a much lower concentration. CONCLUSION This is the first ever case report of analytically confirmed acute toxicity related to methiopropamine use. It confirms the potential for significant acute toxicity with cardiovascular, gastrointestinal and psychotic symptoms thus providing further information to help with managing these patients and allow legislative authorities to consider the need for its control.
Collapse
Affiliation(s)
- Hwee Min D Lee
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK,
| | | | | | | | | |
Collapse
|
21
|
Bonnici KS, Dargan PI, Wood DM. Novel psychoactive substances or ‘legal highs'. Br J Hosp Med (Lond) 2015; 76:C130-4. [DOI: 10.12968/hmed.2015.76.9.c130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kathleen S Bonnici
- is Acute Medicine ST6 in the Department of Acute Medicine, Chelsea & Westminster Hospitals NHS Foundation Trust, London SW10 9NH
| | | | - David M Wood
- is Consultant Physician and Clinical Toxicologist in the Clinical Toxicology Department, St Thomas' Hospital, London
| |
Collapse
|
22
|
|
23
|
Glanville J, Dargan PI, Wood DM. 4-methyl-5-(4-methylphenyl)-4,5-dihydrooxazol-2-amine (4,4'-DMAR, 4,4'-dimethylaminorex): availability, prevalence of use, desired effects and acute toxicity. Hum Psychopharmacol 2015; 30:193-8. [PMID: 25784180 DOI: 10.1002/hup.2472] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 01/30/2015] [Accepted: 02/12/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE 4-Methyl-5-(4-methylphenyl)-4,5-dihydrooxazol-2-amine (4,4'-dimethylaminorex (4,4'-DMAR)) is a derivative of the controlled substances aminorex and 4-methylaminorex marketed as a potential novel psychoactive substance. This paper brings together the published scientific and 'grey' literature to understand 4,4'-DMAR as a novel psychoactive substance. METHODS Searches of the published scientific and 'grey' literature, using the keywords '4-methyl-euphoria', '4-methyl-U4Euh', '4-M-4-MAR', '4,4-dimethylaminorex', '4,4'-DMAR', 'para-methyl-4-aminorex' and 'Serotoni', were undertaken to identify information on the availability, prevalence of use and desired/unwanted effects of 4,4'-DMAR. RESULTS No studies have reported the prevalence of use of 4,4'-DMAR. Internet snapshot studies in April and May 2014 showed availability of 4,4'-DMAR from one and two Internet suppliers respectively. Price decreased with increasing purchase amounts from €12/g for a 1-g purchase to €2.20/g for a 100-g purchase in April 2014. Internet discussion fora suggest that the desired and unwanted effects of 4,4'-DMAR are similar to those seen with other sympathomimetic drugs such as 3,4-methylenedioxy-methamphetamine and mephedrone, although the duration of unwanted effects and 'comedown' appear to be longer. Unwanted effects were reported at doses of 5-200 mg, which overlaps with the reported doses (10-200 mg) associated with desired effects. 4,4'-DMAR has been detected, along with other drugs, in 27 deaths in Europe; the contribution of the 4,4'-DMAR in these deaths has not been established. CONCLUSIONS Currently, there appears to limited availability of 4,4'-DMAR; therefore, use is likely to be low. Its desired and unwanted effects appear similar to other sympathomimetic recreational drugs such as methylenedioxy-methamphetamine or mephedrone.
Collapse
Affiliation(s)
- James Glanville
- General Medicine, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK; Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | | | | |
Collapse
|
24
|
Budzynska B, Boguszewska-Czubara A, Kruk-Slomka M, Kurzepa J, Biala G. Mephedrone and nicotine: oxidative stress and behavioral interactions in animal models. Neurochem Res 2015; 40:1083-93. [PMID: 25862193 PMCID: PMC4422847 DOI: 10.1007/s11064-015-1566-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/12/2015] [Accepted: 03/30/2015] [Indexed: 12/13/2022]
Abstract
The purpose of our experiment was to examine the influence of co-administration of nicotine and mephedrone on anxiety-like behaviors, cognitive processes and the nicotine-induced behavioral sensitization as well as processes connected with induction of oxidative stress in the brain of male Swiss mice. The results revealed that co-administration of subthreshold doses of mephedrone and nicotine (0.05 mg/kg each) exerted marked anxiogenic profile in the elevated plus maze and displayed pro-cognitive action in the passive avoidance paradigm (nicotine 0.05 mg/kg and mephedrone 2.5 mg/kg). Furthermore, one of the main findings of the present study was that mephedrone, administered alone at the dose not affecting locomotor activity of mice (1 mg/kg), enhanced the expression of nicotine-induced locomotor sensitization. Moreover, mephedrone administered with nicotine decreased general antioxidant status and catalase activity as well as antioxidant enzymes activity in the hippocampus and prefrontal cortex and increased concentration of malondialdehyde, an indicator of lipid peroxidation processes. Considering the likelihood that mephedrone is taken as a part of polydrug combination with nicotine, the effects of this combination on mammalian organisms have been confirmed in our study. Understanding the consequences of co-administration of psychoactive substances on the central nervous system and oxidative processes in the brain provide the important toxicological significance, and may be useful in polydrug intoxication treatment.
Collapse
Affiliation(s)
- Barbara Budzynska
- Department of Pharmacology and Pharmacodynamics, Medical University of Lublin, 4A Chodzki Street, 20-093, Lublin, Poland,
| | | | | | | | | |
Collapse
|
25
|
Siddiqi S, Verney C, Dargan P, Wood DM. Understanding the availability, prevalence of use, desired effects, acute toxicity and dependence potential of the novel opioid MT-45. Clin Toxicol (Phila) 2014; 53:54-9. [DOI: 10.3109/15563650.2014.983239] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
26
|
Heyerdahl F, Hovda KE, Giraudon I, Yates C, Dines AM, Sedefov R, Wood DM, Dargan PI. Current European data collection on emergency department presentations with acute recreational drug toxicity: Gaps and national variations. Clin Toxicol (Phila) 2014; 52:1005-12. [DOI: 10.3109/15563650.2014.976792] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
27
|
Acute combined poisoning with the new designer drug 4-methyl-N-ethyl-cathinone (4-MEC) and gammabutyrolactone (GBL): A case report with different analytical approaches for identification of some metabolites. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2014. [DOI: 10.1016/j.toxac.2014.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
28
|
Helfer AG, Turcant A, Boels D, Ferec S, Lelièvre B, Welter J, Meyer MR, Maurer HH. Elucidation of the metabolites of the novel psychoactive substance 4-methyl-N-ethyl-cathinone (4-MEC) in human urine and pooled liver microsomes by GC-MS and LC-HR-MS/MS techniques and of its detectability by GC-MS or LC-MSnstandard screening approaches. Drug Test Anal 2014; 7:368-75. [DOI: 10.1002/dta.1682] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Andreas G. Helfer
- Department of Experimental and Clinical Toxicology; Institute of Experimental and Clinical Pharmacology and Toxicology, Saarland University; D-66421 Homburg (Saar) Germany
| | - Alain Turcant
- Laboratoire de Pharmacologie-Toxicologie; Centre Hospitalier Universitaire; Angers France
| | - David Boels
- Centre Anti-Poison; Centre Hospitalier Universitaire; Angers France
| | - Séverine Ferec
- Laboratoire de Pharmacologie-Toxicologie; Centre Hospitalier Universitaire; Angers France
| | - Bénédicte Lelièvre
- Laboratoire de Pharmacologie-Toxicologie; Centre Hospitalier Universitaire; Angers France
| | - Jessica Welter
- Department of Experimental and Clinical Toxicology; Institute of Experimental and Clinical Pharmacology and Toxicology, Saarland University; D-66421 Homburg (Saar) Germany
| | - Markus R. Meyer
- Department of Experimental and Clinical Toxicology; Institute of Experimental and Clinical Pharmacology and Toxicology, Saarland University; D-66421 Homburg (Saar) Germany
| | - Hans H. Maurer
- Department of Experimental and Clinical Toxicology; Institute of Experimental and Clinical Pharmacology and Toxicology, Saarland University; D-66421 Homburg (Saar) Germany
| |
Collapse
|
29
|
Wood DM, Hill SL, Thomas SHL, Dargan PI. Using poisons information service data to assess the acute harms associated with novel psychoactive substances. Drug Test Anal 2014; 6:850-60. [DOI: 10.1002/dta.1671] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 03/29/2014] [Accepted: 04/03/2014] [Indexed: 11/11/2022]
Affiliation(s)
- D. M. Wood
- Clinical Toxicology; Guy's and St Thomas’ NHS Foundation Trust and Kings Health Partners; London UK
- King's College London; London UK
| | - S. L. Hill
- Medical Toxicology Centre; Newcastle University; Newcastle UK
- Clinical Pharmacology and Therapeutics, Royal Victoria Infirmary; Newcastle Upon Tyne Hospitals NHS Foundation Trust; Newcastle UK
| | - S. H. L. Thomas
- Medical Toxicology Centre; Newcastle University; Newcastle UK
- Clinical Pharmacology and Therapeutics, Royal Victoria Infirmary; Newcastle Upon Tyne Hospitals NHS Foundation Trust; Newcastle UK
| | - P. I. Dargan
- Clinical Toxicology; Guy's and St Thomas’ NHS Foundation Trust and Kings Health Partners; London UK
- King's College London; London UK
| |
Collapse
|
30
|
XXXIV International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) 27–30 May 2014, Brussels, Belgium. Clin Toxicol (Phila) 2014. [DOI: 10.3109/15563650.2014.906213] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
31
|
Wood DM, Heyerdahl F, Yates CB, Dines AM, Giraudon I, Hovda KE, Dargan PI. The European Drug Emergencies Network (Euro-DEN). Clin Toxicol (Phila) 2014; 52:239-41. [DOI: 10.3109/15563650.2014.898771] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
32
|
Corazza O, Assi S, Schifano F. From "Special K" to "Special M": the evolution of the recreational use of ketamine and methoxetamine. CNS Neurosci Ther 2013; 19:454-60. [PMID: 23421859 DOI: 10.1111/cns.12063] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 12/27/2012] [Accepted: 01/07/2013] [Indexed: 01/18/2023] Open
Abstract
This article reviews the recreational use of ketamine ("Special K"; KET) and explores the recent diffusion of its new derivative methoxetamine ("Special M"; MXE). The literature search on the nonclinical/recreational use of KET and MXE was carried out in a range of medical databases. Considering the limitations of peer-reviewed information, data were integrated with a qualitative assessment of a range of websites, drug fora, and other online resources including e-newsgroups, chat rooms, mailing lists, e-newsletters, and bulletin boards. The recreational use of KET has started since its discovery in 1962. This was due to its rapid onset, short duration of action, and peculiar psychotropic effects ("K-hole"). The latter effect ranges from confusion to dissociation and depersonalization (near-death experience). However, KET abuse is often associated with physical and psychological side effects, of which the worst is urological/bladder toxicity. Recently, MXE has emerged as a legal and "bladder-friendly" KET alternative. MXE presents with the same dissociative effect of KET, but with slower onset and longer duration of action. However, MXE seems to be associated with worse side effects than KET, ranging from mood disturbances/suicidal attempts to acute cerebellar toxicity. After 50 years of its discovery, KET has led to the emergence of MXE. However, this latter derivative does not appear to be a safer alternative to KET itself.
Collapse
Affiliation(s)
- Ornella Corazza
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.
| | | | | |
Collapse
|
33
|
Abe E, Ricard F, Darrouzain F, Alvarez JC. An automated method for measurement of methoxetamine in human plasma by use of turbulent flow on-line extraction coupled with liquid chromatography and mass spectrometric detection. Anal Bioanal Chem 2012; 405:239-45. [DOI: 10.1007/s00216-012-6470-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 09/26/2012] [Accepted: 09/28/2012] [Indexed: 11/24/2022]
|
34
|
First European case of convulsions related to analytically confirmed use of the synthetic cannabinoid receptor agonist AM-2201. Eur J Clin Pharmacol 2012; 69:373-6. [PMID: 22936123 DOI: 10.1007/s00228-012-1379-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 07/25/2012] [Indexed: 01/12/2023]
Abstract
PURPOSE There is increasing reported use of synthetic cannabinoid receptor agonists (SCRA) across Europe. To date, there is limited information on the acute toxicity (harm) related to the use of these products. We describe here a case in which an individual developed convulsions related to the use of the SCRA AM-2201. CASE REPORT A 20 year old male smoked a "Spice" (SCRA-containing) product called "Black Mamba," and rapidly after smoking, he had a generalised self-terminating tonic-clonic convulsion. After a 2 h observation period in the Emergency Department (ED), he self-discharged against medical advice. Subsequent analysis of urine collected at the time of presentation to the ED detected metabolites of AM-2201; no other drugs were detected on extensive analytic screening. DISCUSSION This is the first case of convulsions related to the use of SCRA described in Europe, and the first case of convulsions related to the use the SCRA AM-2201 confirmed by analysis of biological samples. It is important for emergency physicians, clinical toxicologists and clinical pharmacologists managing those presenting with acute toxicity related to the use of SCRA to analytically confirm the exact compound(s) involved, to enable accurate description of the acute toxicity associated with individual SCRA.
Collapse
|
35
|
Wood DM, Dargan PI. Use and acute toxicity associated with the novel psychoactive substances diphenylprolinol (D2PM) and desoxypipradrol (2-DPMP). Clin Toxicol (Phila) 2012; 50:727-32. [DOI: 10.3109/15563650.2012.716158] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|