Schizophrenia, dissociative anaesthesia and near-death experience; three events meeting at the NMDA receptor

"Trip-Sitting" in the Black Hole: A Netnographic Study of Dissociation and Indigenous Harm Reduction

An array of dissociative novel psychoactive substances, including "methoxetamine," "3-MeO-PCP," and "methoxphenidine," have emerged as substitutes for the illicit substance "ketamine." A netographic research methodology aimed to describe online, dissociative novel psychoactive substance users' perceptions of risk, informed knowledge around use, and indigenous harm-reduction practices as advocated within online drug fora, so as to provide credible information which can be used to inform public online health education and drug prevention. Systematic Internet searches were performed using the terms "synthetic dissociative," "methoxetamine," "methoxphenidine," "diphenidine," "3-MeO-PCP," "4-MeO-PCP," "2-MDP," and "dissociative research chemical" in combination with "forum." Following screening of 3,476 forum threads with removal of duplicates and exclusion criteria, 90 user trip reports and 115 fora threads from seven drug fora websites were analyzed by conducting content analysis. Five themes emerged with 43 categories. The findings illustrated how forum activity within the cyber drug user community disseminated and exchanged "communal folk pharmacology" relating to the use of dissociative novel psychoactive substances. Further research and consistent monitoring of Internet drug fora are advised to explore variations in harm-reduction tactics throughout dissociative NPS populations, and to consider how existing harm-reduction initiatives are influencing these hard-to-reach groups.

Epistemological implications of near-death experiences and other non-ordinary mental expressions: Moving beyond the concept of altered state of consciousness

During the last decades an increasing interest has developed in the so-called altered state of consciousness (ASCs); among these, near-death experiences (NDEs) are one of the most intriguing and debated examples. NDEs are deep and universal experiences with a clear phenomenology and incidence, while some of their features challenge the current views of human consciousness (focused on neural circuits and based on the concept of mind as a byproduct of brain circuitry) with relevant epistemological and historical implications. The origin of the ruling mechanist-reductionist paradigm can be traced back to Descartes' radical separation of res cogitans and res extensa and the conflict between the nascent science and the Inquisition; this led to removing the subjective properties of mind from the field of scientific interest, relegating them to philosophy and theology in order to enable the development of modern science. However, the physics of the 20th century has eventually moved beyond the classical paradigm, permitting a profound renewal of scientific interest in the mind. Modern research on NDEs has contributed to reopening the debate surrounding the Cartesian separation, the mind-brain relationship and the nature of consciousness. It is now time to reappraise the relevance, strengths, and weaknesses of the available scientific interpretations of NDEs, their relationship with other ASCs, as well as the very concept of ASC; the latter looks to be ill-founded, suggesting the need for: (a) a revision of the conventional approach to subjective phenomena, including both the third- and first-person perspective; and (b) a deep reflection on the possible links between different non-ordinary mental expression, as regards both their phenomenology and mechanisms from a non-pathological perspective.

Methoxetamine (MXE)--a phenomenological study of experiences induced by a "legal high" from the internet

Methoxetamine (MXE), a ketamine analogue, is one of the new "legal highs" sold on the Internet. The aim of this qualitative study was to provide an initial understanding of what characterizes the experiences induced by MXE. Anonymously written reports (33 persons) on the effects of MXE were collected from public Internet forums and analyzed using the Empirical Phenomenological Psychological Method. The analysis generated 10 themes: (1) preparation, motivation and anticipation; (2) initial effects; (3) malfunction of cognitive processes stabilizing normal state; (4) inner personal processes and learning; (5) emotional processes; (6) altered sensory perception; (7) dissolution and transition; (8) spiritual and transcendental experiences; (9) effects and processes after the experience; (10) re-dosing and addiction. MXE induced a heavily altered state of consciousness. The effects were similar to those induced by classic hallucinogens (such as LSD, psilocybin) and the dissociative ketamine. MXE seemed to have quite a high abuse potential. Beside the positive effects described, negative effects like fear and anxiety were also reported. Acceptance was considered the best coping strategy. Dissolution of identity and body often culminated in spiritual and transcendental experiences. More research is needed on safety issues, how to minimize harm, and the motivation for using legal highs.

Novel psychoactive substances as a novel challenge for health professionals: results from an Italian survey

INTRODUCTION

Novel psychoactive substances (NPS; a.k.a. 'legal highs' or 'smart drugs') are advertised online as 'safe' and 'legal' natural/synthetic analogues of controlled illicit drugs. However, only little research has been carried out in identifying the health professionals' knowledge and expertise relating to the intake of these compounds.

METHODS

Data presented here refer to the Italian component of the European Union-wide, European Commission-funded, ReDNet project survey. An ad-hoc questionnaire was administered to professionals from the departments of Addiction, Psychiatry, Paediatrics and Emergency Room Services in Italy.

RESULTS

The interviewees' sample included 243 professionals, mostly from the departments of Addiction (35%) and Psychiatry (28.4%). Overall, interviewees self-reported a poor technical knowledge relating to NPS; some 27% of respondents confirmed of not being aware if their patients presented with a previous history of NPS misuse.

DISCUSSION

Novel psychoactive substances prevalence of misuse was not considered to be an unusual phenomenon in Italy, and most health professionals appeared to have concerns relating to associated medical and psychopathological risks, especially in terms of aggression/psychomotor agitation. Overall, most respondents reported the need to have better access to NPS-related reliable sources of information.

From "Special K" to "Special M": the evolution of the recreational use of ketamine and methoxetamine

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.

Phenomenon of new drugs on the Internet: the case of ketamine derivative methoxetamine

On the basis of the material available both in the scientific literature and on the web, this paper aims to provide a pharmacological, chemical and behavioural overview of the novel compound methoxetamine. This is a dissociative drug related to ketamine, with a much longer duration of action and intensity of effects. A critical discussion of the availability of information on the web of methoxetamine as a new recreational trend is here provided. Those methodological limitations, which are intrinsically associated with the analysis of online, non-peer reviewed, material, are here discussed as well. It is concluded that the online availability of information on novel psychoactive drugs, such as methoxethanine, may constitute a pressing public health challenge. Better international collaboration levels and novel forms of intervention are necessary to tackle this fast-growing phenomenon.

Near-death states reported in a sample of 50 misusers

Increase in recreational ketamine use may be a cause for concern. We aimed here at assessing, in a sample of ketamine misusers, concordance between the typical near-death experience (NDE) features and the on-drug psychoactive effects the subjects experienced. In 2003-2005, a sample of previous ketamine misusers recollecting a ketamine-related NDE were recruited through snowballing and screened with the means of the Greyson NDE Scale; 125 participants made an initial contact with the researcher and 50 reported a minimum score of seven at the "Greyson NDE Scale". Interviewees were in the range 21-66 years old; 27 participants (54%) were educated at BA level, 18 (36%) had an MSc, and 5 (10%) a PhD. Eight (16%) interviewees had a definite religious background. An average lifetime ketamine intake of 140 occasions was reported by the interviewees, who typically presented with a polydrug, including cannabis and MDMA/ecstasy, misuse history. In 45 (90%) cases, the NDE occurred during the first few occasions of intake. Most frequent features of reported NDE states included: altered perception of time (90%), strong sense of detaching from own physical body (88%), and a sense of peace/joy (76% of subjects). Although results here described were elicited from a self-selected, nonrandomized, limited size sample of misusers, we suggest that recreational ketamine intake may be associated with occurrence of near-death related states.