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Drevin G, Briet M, Ferec S, Demiselle J, Beloncle F, Abbara C. Acute Sodium Oxybate Intoxication: A Case Report and Review of the Literature. Ther Drug Monit 2023; 45:277-281. [PMID: 35914751 DOI: 10.1097/ftd.0000000000001011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/19/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Despite a better safety profile than illicit γ-hydroxybutyric acid (GHB) and other GHB analogs, sodium oxybate continues to raise serious concerns regarding clinical safety. In this study, the authors report the case of near-fatal intoxication involving sodium oxybate-alcohol combination in a 40-year-old woman. In addition, a review of the literature on published cases of intoxication involving this pharmaceutical form of GHB was conducted. A 40-year-old woman was admitted to the intensive care unit in a coma after voluntary ingestion of 18 g of sodium oxybate and alcohol. METHODS The GHB plasma concentration was quantified to be 146 mg/L using liquid chromatography coupled with tandem mass spectrometry. An English literature search was performed using PubMed without any limiting period to identify all available scientific publications involving cases of sodium oxybate intoxication. RESULTS Six cases were identified. Five involved fatal intoxication cases, with GHB postmortem blood concentrations ranging from 11.5 to 3500 mg/L. One involved a nonfatal intoxication case with a GHB serum concentration of 569 mg/L 7 hours postingestion. CONCLUSIONS In the present case, the estimated elimination half-life was 154 minutes. The risk of acute poisoning seems to be high considering the pharmacokinetic properties of sodium oxybate. Physicians and toxicologists must take such properties into account.
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Affiliation(s)
- Guillaume Drevin
- Service de Pharmacologie-Toxicologie Pharmacovigilance, CHU Angers, Angers, France
- Université d'Angers, Angers, France
| | - Marie Briet
- Service de Pharmacologie-Toxicologie Pharmacovigilance, CHU Angers, Angers, France
- Université d'Angers, Angers, France
- Laboratoire MitoVasc, UMR INSERM 1083 CNRS 6015, Angers, France; and
| | - Severine Ferec
- Service de Pharmacologie-Toxicologie Pharmacovigilance, CHU Angers, Angers, France
| | - Julien Demiselle
- Service de Médecine intensive-réanimation et médecine hyperbare, CHU Angers, Angers, France
| | - François Beloncle
- Service de Médecine intensive-réanimation et médecine hyperbare, CHU Angers, Angers, France
| | - Chadi Abbara
- Service de Pharmacologie-Toxicologie Pharmacovigilance, CHU Angers, Angers, France
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2
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Fischler PV, Soyka M, Seifritz E, Mutschler J. Off-label and investigational drugs in the treatment of alcohol use disorder: A critical review. Front Pharmacol 2022; 13:927703. [PMID: 36263121 PMCID: PMC9574013 DOI: 10.3389/fphar.2022.927703] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Compounds known to be successful in the treatment of alcohol use disorder include the aversive agent, Disulfiram, the glutamatergic NMDA receptor antagonist, Acamprosate, and the opioid receptor antagonists, Naltrexone and Nalmefene. Although all four are effective in maintaining abstinence or reduction of alcohol consumption, only a small percentage of patients receive pharmacological treatment. In addition, many other medications have been investigated for their therapeutic potential in the treatment of alcohol use disorder. In this review we summarize and compare Baclofen, Gabapentin, Topiramate, Ondansetron, Varenicline, Aripiprazole, Quetiapine, Clozapine, Antidepressants, Lithium, Neuropeptide Y, Neuropeptide S, Corticotropin-releasing factor antagonists, Oxytocin, PF-05190457, Memantine, Ifenprodil, Samidorphan, Ondelopran, ABT-436, SSR149415, Mifepristone, Ibudilast, Citicoline, Rimonabant, Surinabant, AM4113 and Gamma-hydroxybutyrate While some have shown promising results in the treatment of alcohol use disorder, others have disappointed and should be excluded from further investigation. Here we discuss the most promising results and highlight medications that deserve further preclinical or clinical study. Effective, patient-tailored treatment will require greater understanding provided by many more preclinical and clinical studies.
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Affiliation(s)
- Pascal Valentin Fischler
- Department for Gynecology and Obstetrics, Women’s Clinic Lucerne, Cantonal Hospital of Lucerne, Lucerne, Switzerland
- *Correspondence: Pascal Valentin Fischler,
| | - Michael Soyka
- Psychiatric Hospital University of Munich, Munich, Germany
| | - Erich Seifritz
- Director of the Clinic for Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Clinic Zürich, Zürich, Switzerland
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3
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Fateh ST, Salehi-Najafabadi A. Repurposing of substances with lactone moiety for the treatment of γ-Hydroxybutyric acid and γ-Butyrolactone intoxication through modulating paraoxonase and PPARγ. Front Pharmacol 2022; 13:909460. [PMID: 35935832 PMCID: PMC9354891 DOI: 10.3389/fphar.2022.909460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
GHB and GBL are highly accessible recreational drugs of abuse with a high risk of adverse effects and mortality while no specific antidotes exist. These components can also be found in the clinical setting, beverages, and cosmetic products, leading to unwanted exposures and further intoxications. As the structural analogue of GABA, GHB is suggested as the primary mediator of GHB/GBL effects. We further suggest that GBL might be as critical as GHB in this process, acting through PPARγ as its receptor. Moreover, PPARγ and PON (i.e., the GHB-GBL converting enzyme) can be targeted for GHB/GBL addiction and intoxication, leading to modulation of the GHB-GBL balance and blockage of their effects. We suggest that repurposing substances with lactone moiety such as bacterial lactones, sesquiterpene lactones, and statins might lead to potential therapeutic options as they occupy the active sites of PPARγ and PON and interfere with the GHB-GBL balance. In conclusion, this hypothesis improves the GHB/GBL mechanism of action, suggests potential therapeutic options, and highlights the necessity of classifying GBL as a controlled substance.
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Affiliation(s)
- Sepand Tehrani Fateh
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Salehi-Najafabadi
- Department of Microbiology, School of Biology, University College of Science, University of Tehran, Tehran, Iran
- *Correspondence: Amir Salehi-Najafabadi,
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4
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Freestone J, Prestage G, Bourne A, Ezard N, Race K, Nedanoski A, Murray J, Siefried KJ. Controlling for pleasure and risk: The experiences of sexuality and gender diverse people who use GHB. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 105:103747. [DOI: 10.1016/j.drugpo.2022.103747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/23/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
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5
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Lee HHC, McGinty GE, Pearl PL, Rotenberg A. Understanding the Molecular Mechanisms of Succinic Semialdehyde Dehydrogenase Deficiency (SSADHD): Towards the Development of SSADH-Targeted Medicine. Int J Mol Sci 2022; 23:2606. [PMID: 35269750 PMCID: PMC8910003 DOI: 10.3390/ijms23052606] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 11/21/2022] Open
Abstract
Succinic semialdehyde dehydrogenase deficiency (SSADHD) is a rare genetic disorder caused by inefficient metabolic breakdown of the major inhibitory neurotransmitter, γ-aminobutyric acid (GABA). Pathologic brain accumulation of GABA and γ-hydroxybutyrate (GHB), a neuroactive by-product of GABA catabolism, leads to a multitude of molecular abnormalities beginning in early life, culminating in multifaceted clinical presentations including delayed psychomotor development, intellectual disability, hypotonia, and ataxia. Paradoxically, over half of patients with SSADHD also develop epilepsy and face a significant risk of sudden unexpected death in epilepsy (SUDEP). Here, we review some of the relevant molecular mechanisms through which impaired synaptic inhibition, astrocytic malfunctions and myelin defects might contribute to the complex SSADHD phenotype. We also discuss the gaps in knowledge that need to be addressed for the implementation of successful gene and enzyme replacement SSADHD therapies. We conclude with a description of a novel SSADHD mouse model that enables 'on-demand' SSADH restoration, allowing proof-of-concept studies to fine-tune SSADH restoration in preparation for eventual human trials.
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Affiliation(s)
- Henry H. C. Lee
- F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Boston, MA 02115, USA; (G.E.M.); (A.R.)
- Rosamund Stone Zander Translational Neuroscience Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Gabrielle E. McGinty
- F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Boston, MA 02115, USA; (G.E.M.); (A.R.)
| | - Phillip L. Pearl
- Division of Epilepsy & Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA;
| | - Alexander Rotenberg
- F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Boston, MA 02115, USA; (G.E.M.); (A.R.)
- Division of Epilepsy & Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA;
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6
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Ricci G, Busardò F, Gibelli F, Sirignano A, Brunetti P. Evaluating the risk of toxicity and adverse drug interactions involving recreational GHB use and prescribed drugs. Expert Opin Drug Metab Toxicol 2022; 17:1445-1454. [DOI: 10.1080/17425255.2021.2029404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Giovanna Ricci
- Section of Legal Medicine, School of Law, University of Camerino, Via Andrea D’Accorso 16, 62032 Camerino, Italy
| | - Francesco Busardò
- Unit of Forensic Toxicology, Section of Legal Medicine, Department of Excellence of Biomedical Sciences and Public Health, Marche Polytechnic University of Ancona, Via Tronto 10, 60126 Ancona, Italy
| | - Filippo Gibelli
- Department of Diagnostics and Public Health, Section of Forensic Medicine, University of Verona, Verona, Italy
| | - Ascanio Sirignano
- Section of Legal Medicine, School of Law, University of Camerino, Via Andrea D’Accorso 16, 62032 Camerino, Italy
| | - Pietro Brunetti
- Unit of Forensic Toxicology, Section of Legal Medicine, Department of Excellence of Biomedical Sciences and Public Health, Marche Polytechnic University of Ancona, Via Tronto 10, 60126 Ancona, Italy
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7
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Giorgetti A, Busardò FP, Giorgetti R. Toxicological Characterization of GHB as a Performance-Enhancing Drug. Front Psychiatry 2022; 13:846983. [PMID: 35509886 PMCID: PMC9058118 DOI: 10.3389/fpsyt.2022.846983] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
Performance-enhancing drugs (PEDs) are represented by several compounds used to ameliorate the image, the appearance, or an athletic or non-athletic performance. Gamma-hydroxybutyrate (GHB) is an endogenous molecule first used as anesthetic and then marketed as a nutritional supplement with a wide diffusion in the bodybuilding community. The aim of the present work is to provide a toxicological characterization of the use of GHB as a PED, including the scientific basis for its use, the patterns of use/abuse, and the health risks arising from its consumption in this peculiar recreative setting. A literature search was performed on multiple databases including experimental studies on humans and animals as well as epidemiological reports and forensic case reports/series. Experimental studies demonstrated that the use of GHB as a PED is motivated by the release of growth hormone and the induction of sleep. However, the panel of desired performance-related effects was much wider in real cases and epidemiological studies. Even though the use of GHB among bodybuilders has decreased, its use to enhance some kind of performance, particularly sexual ones or social-communicative ones, as well as means to increase mood and perceived energy, is still common.
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Affiliation(s)
- Arianna Giorgetti
- Unit of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francesco Paolo Busardò
- Department of Excellence of Biomedical Sciences and Public Health, "Politecnica delle Marche" University of Ancona, Ancona, Italy
| | - Raffaele Giorgetti
- Department of Excellence of Biomedical Sciences and Public Health, "Politecnica delle Marche" University of Ancona, Ancona, Italy
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8
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Tête X, Masson Y, Donat N, Rager G, Leclerc T, Fontaine B. Mise au point sur l’utilisation du GammaOH en anesthésie–réanimation. ANESTHÉSIE & RÉANIMATION 2021. [PMCID: PMC8346353 DOI: 10.1016/j.anrea.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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9
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Azevedo K, Johnson M, Wassermann M, Evans-Wall J. Drugs of Abuse-Opioids, Sedatives, Hypnotics. Crit Care Clin 2021; 37:501-516. [PMID: 34053703 DOI: 10.1016/j.ccc.2021.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Over the last 2 decades, prescription and nonprescription substance use has significantly increased. In this article, 3 particular drug classes-opioids, sedatives, and hypnotics-are discussed. For each class, a brief history of the agent, a description of relevant pharmacology, the clinical presentation of overdose, the management of specific drug overdoses, and a summary of salient points are presented. The intent is to provide a clinically relevant and comprehensive approach to understanding these potential substance exposures in order to provide a framework for management of opioid, sedative, and hypnotic overdoses.
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Affiliation(s)
- Keith Azevedo
- Departments of Emergency and Internal Medicine, University of New Mexico Hospital, MSC11 6025, 1 University of New Mexico, Albuquerque, NM 87131, USA.
| | - Molly Johnson
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, MSC11 6025, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - Michael Wassermann
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, MSC11 6025, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - Jessica Evans-Wall
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, MSC11 6025, 1 University of New Mexico, Albuquerque, NM 87131, USA
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10
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Doyno CR, White CM. Sedative-Hypnotic Agents That Impact Gamma-Aminobutyric Acid Receptors: Focus on Flunitrazepam, Gamma-Hydroxybutyric Acid, Phenibut, and Selank. J Clin Pharmacol 2021; 61 Suppl 2:S114-S128. [PMID: 34396551 DOI: 10.1002/jcph.1922] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/03/2021] [Indexed: 12/29/2022]
Abstract
There are many nonopioid central nervous system depressant substances that share a gamma-aminobutyric acid (GABA) receptor-related mechanism of action. These sedatives-hypnotics can be indicated to treat anxiety, seizures, depression, and insomnia but are also used as substances of abuse and used to facilitate sexual assault. Barbiturates, methaqualone, and glutethimide were among the first type A GABA receptor-mediated sedative-hypnotics. Their clinical use was limited for most indications by serious adverse events and strong abuse potential but continue to be used illicitly around the world. The benzodiazepines supplanted barbiturates for most indications because they were less likely to cause severe adverse events in monotherapy. Flunitrazepam is a newer benzodiazepine that is preferentially used recreationally and to facilitate sexual assault. Flunitrazepam has greater potency and higher affinity for the type A GABA receptor than most benzodiazepines. Gamma-hydroxybutyric acid is sought illicitly for its hypnotic, euphoric and anabolic effects as well as to facilitate sexual assault. When any of these GABAergic drugs are used in high doses or with other sedative hypnotic agents, respiratory depression, coma, and death have occurred. Chronic use of these GABAergic drugs can lead to significant withdrawal syndromes. Phenibut and selank are poorly studied Russian drugs with GABAergic mechanisms that are inexplicably sold to US consumers as dietary supplements. Poison control center calls regarding phenibut have increased substantially over the past 5 years. Desired euphoriant effects account for the recreational and illicit use of many GABA-modulating agents. However, illicit use can lead to significant toxicities related to abuse, dependence, and subsequent withdrawal syndromes. Significant evaluation of developing agents with GABA properties should be conducted to determine abuse potential before public access ensues.
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Affiliation(s)
- Cassandra R Doyno
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut, USA.,John Dempsey Hospital, University of Connecticut, Farmington, Connecticut, USA
| | - C Michael White
- Department of Research Administration, Hartford Hospital, Hartford, Connecticut, USA
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11
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Rodriguez-Cruz V, Ren T, Morris ME. Drug-drug interaction between diclofenac and gamma-hydroxybutyric acid. Biopharm Drug Dispos 2021; 42:351-358. [PMID: 34191301 DOI: 10.1002/bdd.2296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 06/08/2021] [Accepted: 06/21/2021] [Indexed: 11/09/2022]
Abstract
Gamma hydroxybutyric acid (GHB) has been approved clinically to treat excessive daytime sleepiness and cataplexy in patients with narcolepsy, alcohol and opioid withdrawal, and as an anesthetic. The use of GHB clinically is limited due to its high abuse potential. The absorption, clearance and tissue uptake of GHB is mediated by proton-dependent and sodium-coupled monocarboxylate transporters (MCTs and SMCTs) and inhibition of these transporters may result in a change in GHB pharmacokinetics and pharmacodynamics. Previous studies have reported that non-steroidal anti-inflammatory drugs (NSAIDs) may inhibit these monocarboxylate transporters. Therefore, the purpose of this work was to analyze the interaction between GHB (at a dose of 600 mg/kg i. v.) and the NSAID, diclofenac, by examining the effects of this drug on the in vivo pharmacokinetics and pharmacodynamics in rat studies. The pharmacodynamic effect evaluated was respiratory depression, a measure of toxicity observed by GHB at this dose. There was an improvement in the respiratory rate with diclofenac administration suggesting an effect of diclofenac on GHB toxicity. In vitro studies with rat blood brain endothelial cells (RBE4) that express MCT1 indicated that diclofenac can inhibit GHB transport with an IC50 of 10.6 μM at pH 7.4. In vivo studies found a decrease in brain GHB concentrations and a decrease in the brain-to-plasma concentration ratio following diclofenac treatment. With this study we can conclude that diclofenac and potentially other NSAIDs can inhibit the transport of GHB into the brain, therefore decreasing GHB's pharmacodynamic effects and toxicity.
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Affiliation(s)
- Vivian Rodriguez-Cruz
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Tianjing Ren
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Marilyn E Morris
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
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12
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Chemsex/slamsex-related intoxications: A case report involving gamma-hydroxybutyrate (GHB) and 3-methylmethcathinone (3-MMC) and a review of the literature. Forensic Sci Int 2021; 321:110743. [DOI: 10.1016/j.forsciint.2021.110743] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 12/20/2022]
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13
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Bernstein A. Gamma-Hydroxybutyrate (GHB) Withdrawal in a Patient with Polysubstance Use. J Psychoactive Drugs 2020; 53:299-301. [PMID: 33357048 DOI: 10.1080/02791072.2020.1865591] [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: 10/22/2022]
Abstract
Gamma-hydroxybutyrate (GHB) and its various pro-drugs are GABA-B central nervous system depressants more commonly known as "G" and "liquid ecstasy" among those who consume. Due to the depressant quality of the substance and its convenience in online marketplaces, it has become a more commonly abused drug, characteristically among people involved in the "club scene" and among men who have sex with men. As the dose of GHB necessary to obtain feelings of euphoria is relatively low combined with the substance's rapid metabolism, GHB is nearly undetectable through traditional emergency department urinary drug testing. Consequentially, although the treatment of GHB intoxication and withdrawal is mainly supportive, it is difficult for providers to determine whether GHB is the cause of a patient's symptoms. Moreover, when GHB is combined with other substances, treatment becomes more complicated. The author presents a case of GHB intoxication and withdrawal in a patient with an extensive polysubstance use history demonstrating not only the difficulty of diagnosis but also a timeline outlining the interventions taken from arrival to discharge with a successful outcome faster than the conventional timeline of GHB withdrawal and recovery.
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Affiliation(s)
- Adam Bernstein
- Department of Psychiatry, Creedmoor Psychiatric Center, Queens Village, NY, USA
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14
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Violence against women and drug-facilitated sexual assault (DFSA): A review of the main drugs. J Forensic Leg Med 2020; 74:102020. [DOI: 10.1016/j.jflm.2020.102020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/18/2020] [Accepted: 07/03/2020] [Indexed: 12/16/2022]
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16
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Abstract
Psychoactive substances with chemical structures or pharmacological profiles that are similar to traditional drugs of abuse continue to emerge on the recreational drug market. Internet vendors may at least temporarily sell these so-called designer drugs without adhering to legal statutes or facing legal consequences. Overall, the mechanism of action and adverse effects of designer drugs are similar to traditional drugs of abuse. Stimulants, such as amphetamines and cathinones, primarily interact with monoamine transporters and mostly induce sympathomimetic adverse effects. Agonism at μ-opioid receptors and γ-aminobutyric acid-A (GABAA) or GABAB receptors mediates the pharmacological effects of sedatives, which may induce cardiorespiratory depression. Dissociative designer drugs primarily act as N-methyl-d-aspartate receptor antagonists and pose similar health risks as the medically approved dissociative anesthetic ketamine. The cannabinoid type 1 (CB1) receptor is thought to drive the psychoactive effects of synthetic cannabinoids, which are associated with a less desirable effect profile and more severe adverse effects compared with cannabis. Serotonergic 5-hydroxytryptamine-2A (5-HT2A) receptors mediate alterations of perception and cognition that are induced by serotonergic psychedelics. Because of their novelty, designer drugs may remain undetected by routine drug screening, thus hampering evaluations of adverse effects. Intoxication reports suggest that several designer drugs are used concurrently, posing a high risk for severe adverse effects and even death.
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17
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di Giannantonio M, Negri A, Schiavone S, Vannini C, Pettorruso M, De-Giorgio F, Verrastro V, Trabace L, Corbo M, Gottardo R, Camuto C, Mazzarino M, Barra A, De Berardis D, Lopez JI, Del Villar CM, Schifano F, Martinotti G. Prescription Drug Misuse in "Clubbers" and Disco Goers in Ibiza. Front Psychiatry 2020; 11:592594. [PMID: 33384628 PMCID: PMC7770108 DOI: 10.3389/fpsyt.2020.592594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/16/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Prescription drug misuse and its related risks are considered a worldwide public health issue. Current trends show that the extent of such phenomenon may not be limited to subjects with psychiatric disorders, as it also spreads to dance party and nightclub attendees, who often consume prescription drugs in combination with alcohol and psychoactive substances. This study aims to report the sociodemographic data and the psychiatric and clinical features of a sample of clubbers reporting prescription drugs use. Methods: Patients admitted to the psychiatry ward of the Can Misses Hospital in Ibiza were recruited for the study during a span of four consecutive years (2015-2018). The inclusion criteria were age 18-75 years old and the intake of psychoactive substances or more than five alcohol units during the previous 24 h. Substance use habits, psychopathological features, and use of unprescribed pharmaceuticals were investigated. Urine samples were collected and analyzed using gas chromatography/mass spectrometry. Results: A total of 110 subjects with psychoactive substance intoxication were recruited for the study. Among these, 37 (40%) disclosed the use of prescription drugs without medical supervision. The most common compounds were benzodiazepines (66%), antiepileptic drugs (8%), antidepressants (6%), opioids (6%), antipsychotics (6%), stimulants (6%), and non-steroidal anti-inflammatory drugs (NSAIDs, 2%). Prescription drug misuse was negatively associated with the use of psychodysleptics (two-tailed Fisher's exact test p = 0.018, ρ = -0.262). Conclusions: The use of prescription drugs is also common among clubbers, usually characterized by low propensity to be prescribed benzodiazepines, antipsychotics, or antidepressants. Prescription drugs may be an alternative to classic and novel psychoactive compounds or may be used to tamper and self-medicate the effects determined by the use of substances. Party goers should be adequately informed about possible risks of co-intake of psychoactive substances and prescription drugs to prevent serious medical and psychiatric consequences.
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Affiliation(s)
- Massimo di Giannantonio
- Department of Neuroscience, Imaging, Clinical Sciences, University G.d'Annunzio, Chieti-Pescara, Italy
| | - Attilio Negri
- Department of Clinical, Pharmaceutical and Biological Sciences, School of Life & Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom.,Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, Milan, Italy
| | - Stefania Schiavone
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Chiara Vannini
- Department of Neuroscience, Imaging, Clinical Sciences, University G.d'Annunzio, Chieti-Pescara, Italy
| | - Mauro Pettorruso
- Department of Neuroscience, Imaging, Clinical Sciences, University G.d'Annunzio, Chieti-Pescara, Italy
| | - Fabio De-Giorgio
- Department of Health Care Surveillance and Bioethics, Section of Legal Medicine, University Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valeria Verrastro
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Luigia Trabace
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Mariangela Corbo
- Department of Neuroscience, Imaging, Clinical Sciences, University G.d'Annunzio, Chieti-Pescara, Italy
| | - Rossella Gottardo
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Cristian Camuto
- Department of Health Care Surveillance and Bioethics, Section of Legal Medicine, University Cattolica del Sacro Cuore, Rome, Italy.,Laboratorio Antidoping FMSI, Rome, Italy
| | | | - Andrea Barra
- Azienda Sanitaria Locale Potenza, Potenza, Italy
| | - Domenico De Berardis
- NHS, Department of Mental Health, Psychiatric Service for Diagnosis and Treatment, Hospital "G. Mazzini," ASL 4, Teramo, Italy
| | | | | | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse & Novel Psychoactive Substances Research Unit, School of Life & Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging, Clinical Sciences, University G.d'Annunzio, Chieti-Pescara, Italy.,Psychopharmacology, Drug Misuse & Novel Psychoactive Substances Research Unit, School of Life & Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
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18
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Cheng B, Sang JM, Cui Z, Bacani N, Armstrong HL, Zhu J, Elefante J, Olarewaju G, Card KG, Blackwell E, Lachowsky NJ, Hogg RS, Roth EA, Moore DM. Factors Associated with Cessation or Reduction of Methamphetamine Use among Gay, Bisexual, and Other Men Who Have Sex with Men (gbMSM) in Vancouver Canada. Subst Use Misuse 2020; 55:1692-1701. [PMID: 32406780 PMCID: PMC7527035 DOI: 10.1080/10826084.2020.1756854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Methamphetamine (MA) use among gay, bisexual, and other men who have sex with men (gbMSM) is a pervasive issue, associated with detrimental health outcomes. We identified factors associated with discontinuation or reduction in MA among a subset of gbMSM reporting frequent (at least weekly) use, with a specific focus on symptoms of anxiety and depression. Methods: We recruited sexually-active gbMSM aged ≥16 years in Vancouver, Canada into a prospective-cohort study using respondent-driven sampling. Participants completed study visits once every six months. We used generalized linear mixed models to identify factors associated with reductions in MA use following a visit where participants previously reported using MA at least weekly. Results: Of 584 cohort participants with at least one follow-up visit, 67 (11.5%) reported frequent MA use at baseline or in follow-up visits. Of these, 46 (68.7%) had at least one subsequent study visit where they transitioned to less frequent (monthly or less) or no MA use. In multivariable models, reduced MA use was less likely for those who spent >50% of social time with other gbMSM (aRR = 0.49, 95%CI:0.28-0.85), gave or received drugs in exchange for sex (aRR = 0.34, 95%CI:0.13-0.87), injected drugs (aRR = 0.35, 95%CI:0.18-0.68), or used gamma-hydroxybutyrate (GHB) (aRR = 0.41, 95%CI:0.21-0.78). Symptoms of anxiety or depression were not associated with reductions in MA use. Conclusions: Social connection and drug-related factors surrounding MA use were associated with reductions, but anxiety and depressive symptomatology were not. Incorporating socialization and polysubstance-related components with MA reduction may help in developing efficacious interventions toward reducing MA use for gbMSM.
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Affiliation(s)
- Brooke Cheng
- Faculty of Science, University of British Columbia, Vancouver, BC, Canada
| | - Jordan M Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Nicanor Bacani
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | - Julia Zhu
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Julius Elefante
- St. Paul's Hospital, Vancouver, BC, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Gbolahan Olarewaju
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kiffer G Card
- University of Victoria, Victoria, BC, Canada.,Canadian Institute for Substance Use Research, Victoria, BC, Canada
| | | | - Nathan J Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,University of Victoria, Victoria, BC, Canada.,Canadian Institute for Substance Use Research, Victoria, BC, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Simon Fraser University, Burnaby, BC, Canada
| | - Eric A Roth
- University of Victoria, Victoria, BC, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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19
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van Mechelen JC, Dijkstra B, Vergouwen A. Severe illicit gamma-hydroxybutyric acid withdrawal in a pregnant woman: what to do? BMJ Case Rep 2019; 12:12/12/e230997. [PMID: 31796453 PMCID: PMC7001713 DOI: 10.1136/bcr-2019-230997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This case report presents the case of a 29 weeks pregnant woman in her late twenties who was seen at the emergency department of a hospital with a seizure of unknown cause. By anamnesis and hetero-anamnesis the use of illicit gamma-hydroxybutyric acid (GHB) was revealed. Examination showed dilated pupils, sweating, tremor, tachycardia and bradyphrenic thinking. Subsequently, the seizure was indicated as a severe illicit GHB withdrawal symptom. Thereafter, treatment had to be decided on in the absence of evidence-based and practiced-based guidelines and treatment options for this specific patient population. Initially diazepam was started, which was later on substituted by sodium oxybate. Despite the critical professional situation the patient gave birth to a healthy daughter after 37 weeks of pregnancy.
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Affiliation(s)
- J C van Mechelen
- Department of Psychiatry and Medical Psychology, OLVG Location West, Amsterdam, North Holland, the Netherlands
| | - Bag Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, Nijmegen, Gelderland, the Netherlands.,Research and development, Novadic-Kentron Addiction Care, Vught, Noord-Brabant, the Netherlands
| | - Acm Vergouwen
- Department of Psychiatry and Medical Psychology, OLVG Location West, Amsterdam, North Holland, the Netherlands
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20
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Zwitterionic HILIC stationary phase as a valuable alternative in separative techniques: Application to the analysis of gamma-hydroxybutyric acid and its metabolite in hair. J Chromatogr B Analyt Technol Biomed Life Sci 2019; 1134-1135:121876. [PMID: 31783252 DOI: 10.1016/j.jchromb.2019.121876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/30/2019] [Accepted: 11/03/2019] [Indexed: 12/17/2022]
Abstract
In this work, the physical and chemical properties of a novel zwitterionic LC stationary phase are applied to the development, validation and application of a new fast and reliable method devoted to the analysis of GHB (gamma-hydroxybutyric acid) and its relatively new discovered glucuronide metabolite in hair. The obtained sensitivity, expressed as limit of detection (LOD) and quantification (LOQ), were 0.033 and 0.10 ng/mg for GHB and 0.11 and 0.37 ng/mg, for GHB-glucuronide respectively. Linearity was assessed between LOQ and 50 ng/mg for both compounds. GHB and GHB-glucuronide extraction from hair matrix was maintained simple and consisted in an acidified-solvent incubation. No samples purification was required before LC-MS/MS analysis. The method was finally applied to 65 real hair sample, 60 adults and 5 children below 2 years old. The obtained results highlighted that GHB concentrations were in the range 0.11-0.96 ng/mg (average 0.38 ± 0.25 ng/mg) in 44 cases (68%) while in 21 samples GHB concentrations were in the range between LOD and LOQ (0.033-0.1 ng/mg). GHB-glucuronide was detected in few samples (n. 3) at levels below LOQ. The interest on these molecules relies on the fact that GHB is both a naturally occurring inhibitory neurotransmitter in the central nervous system and an illicit drug often experienced by victims of drug-facilitated sexual assault. GHB-glucuronide was firstly identified in urine by the group of Petersen in 2013 and, as per analogy to ethyl glucuronide, it was proposed as a longer biomarker for GHB intoxication.
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21
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Mor Z, Turner D, Livnat Y, Levy I. Recreational drug and excessive alcohol use among HIV-infected men who have sex with men in Central Israel. BMC Public Health 2019; 19:1360. [PMID: 31651293 PMCID: PMC6813972 DOI: 10.1186/s12889-019-7747-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 10/04/2019] [Indexed: 01/19/2023] Open
Abstract
Background HIV-infected men who have sex with men (MSM) who use recreational drugs (RD) or excessive alcohol (EA) may be involved in risky sexual behaviours, including unprotected anal intercourse (UAI). This study describes the prevalence RD/EA-use among HIV-infected MSM, and compares those who used RD/EA with those who did not. Methods This cross-sectional study included HIV-infected MSM who were recruited in a convenient sample from two AIDS-treatment centres and events for HIV-infected MSM in Israel in 2016. Participants completed anonymous questionnaires including RD/EA-use and their sexual behaviours. RD/EA-use was defined as consumption of any psychoactive stimulants or dissociative anaesthetics, or an uptake of alcohol until drunkenness before or during sex. Results Of all 276 HIV-infected MSM, 202 (73.2%) used RD/EA. Those who used RD/EA were younger, reported earlier sexual debut, had more sexual partners, were more likely to perform UAI with casual partners, more commonly involved in paid sex, used psychiatric medications and more likely to be unsatisfied with their health-status compared to those who did not use RD/EA. HIV-infected MSM who used RD/EA reported a lower CD4-count and higher viral-load than those who did not. In a multivariate analysis, being younger, reported earlier sexual debut and been prescribed psychiatric drugs were associated with RD/EA-use among HIV-infected MSM. Conclusions A large proportion of HIV-infected MSM used RD/EA and also engaged in risky sexual behaviours. A subset of HIV-infected MSM can benefit from mental support during their routine treatment at the AIDS treatment centres and should also receive harm reduction intervention by their providers in order to minimize potential risks pertaining to RD/EA-use.
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Affiliation(s)
- Zohar Mor
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel. .,School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel.
| | - Dan Turner
- AIDS Treatment Centre, Sourasky medical Centre, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Livnat
- Israeli AIDS Task Force, Tel Aviv, Israel.,Buchman Faculty of Law, Tel Aviv University, Tel Aviv, Israel
| | - Itzchak Levy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,AIDS and STD Unit, Sheba Medical Centre, Ramat Gan, Israel
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22
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Bulut H. A New Psychoactive Substance, Gamma Hydroxybutyrate (GHB): A Case Report. ACTA ACUST UNITED AC 2019; 56:229-231. [PMID: 31523153 DOI: 10.29399/npa.23198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/09/2018] [Indexed: 11/07/2022]
Abstract
Gamma Hydroxybutyrate (GHB) is a central nervous system depressant effecting GABA-B receptors. GHB is taken along with other psychoactive substances like alcohol, cocaine, ecstasy, and amphetamines especially during parties. Due to the fact that it has been linked to sexual assault, GHB has drawn attention in recent years. This substance is often taken by youngsters and results in euphoric states of mind, signs of relief, easiness in communication, increases in sexual appetite, and experiences of different states of mind. Dizziness, hypotension, bradycardia, nauseation, and vomiting are typical toxication symptoms of GHB. Also, epileptic seizures, respirotary depression, and deaths have been reported as a result of taking GHB. It is widely known that the use of GHB in our country has increased gradually. This case report is important as it summarizes the anamnesis, penetration, and clinical symptoms of GHB. In order to prevent the use of GHB, it would be appropriate to develop psycho-education methodologies, establish legislative regulations, and include GHB tests in substance screening analyses.
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Affiliation(s)
- Hüseyin Bulut
- SBÜ Kanuni Sultan Süleyman Training and Research Hospital, Department of Psychiatry, İstanbul, Turkey
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23
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Thibaut F, Chagraoui A, Buckley L, Gressier F, Labad J, Lamy S, Potenza MN, Rondon M, Riecher-Rössler A, Soyka M, Yonkers K, Yonkers K. WFSBP * and IAWMH ** Guidelines for the treatment of alcohol use disorders in pregnant women. World J Biol Psychiatry 2019; 20:17-50. [PMID: 30632868 DOI: 10.1080/15622975.2018.1510185] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES These practice guidelines for the treatment of alcohol use disorders during pregnancy were developed by members of the International Task Force of the World Federation of Societies of Biological Psychiatry and the International Association for Women's Mental Health. METHODS We performed a systematic review of all available publications and extracted data from national and international guidelines. The Task Force evaluated the data with respect to the strength of evidence for the efficacy and safety of each medication. RESULTS AND DISCUSSION There is no safe level of alcohol use during pregnancy. Abstinence is recommended. Ideally, women should stop alcohol use when pregnancy is planned and, in any case, as soon as pregnancy is known. Detecting patterns of alcohol maternal drinking should be systematically conducted at first antenatal visit and throughout pregnancy. Brief interventions are recommended in the case of low or moderate risk of alcohol use. Low doses of benzodiazepines, for the shortest duration, may be used to prevent alcohol withdrawal symptoms when high and chronic alcohol intake is stopped and hospitalisation is recommended. Due to the low level of evidence and/or to low benefit/risk ratio, pharmacological treatment for maintenance of abstinence should not be used during pregnancy. At birth, foetal alcohol spectrum disorders must be searched for, and alcohol metabolites should be measured in meconium of neonates in any doubt of foetal alcohol exposure.
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Affiliation(s)
- Florence Thibaut
- a University Hospital Cochin , Faculty of Medicine Paris Descartes, INSERM U 894, Centre Psychiatry and Neurosciences , Paris , France
| | - Abdeslam Chagraoui
- b Neuronal and Neuroendocrine Differentiation and Communication Laboratory , Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Normandie Univ , UNIROUEN, INSERM, U1239, CHU Rouen , Rouen , France ; Department of Medical Biochemistry , Rouen University Hospital , Rouen , France
| | - Leslie Buckley
- c Addiction Services , University Health Network, University of Toronto , Toronto , Canada
| | - Florence Gressier
- d Department of Psychiatry , INSERM UMR1178 CESP, Univ. Paris-Sud , Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre , Le Kremlin Bicêtre , France
| | - Javier Labad
- e Department of Mental Health , Parc Tauli Hospital Universitari, I3PT ; Department of Psychiatry and Legal Medicine , Universitat Autonoma de Barcelona, CIBERSAM, Sabadell , Barcelona , Spain
| | - Sandrine Lamy
- f Department of Addictology , Ramsay- General de Santé, SSR Petit Colmoulins , Harfleur , France
| | - Marc N Potenza
- g Neuroscience and Child Study , Yale University School of Medicine , New Haven , CT , USA
| | - Marta Rondon
- h Instituto Nacional Materno Perinatal , Lima , Peru
| | - Anita Riecher-Rössler
- i Center for Gender Research and Early Detection , University of Basel Psychiatric Hospital , Basel , Switzerland
| | - Michael Soyka
- j University of Munich , Munich, and Medicalpark Chiemseeblick, Bernau , Germany
| | - Kim Yonkers
- k Center for Wellbeing of Women and Mothers, Psychiatry, of Epidemiology (Chronic Diseases) and of Obstetrics, Gynecology, and Reproductive Sciences , Yale University , New Haven , CT , USA
| | - Kim Yonkers
- Center for Wellbeing of Women and Mothers, Psychiatry, of Epidemiology (Chronic Diseases) and of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT, USA
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24
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Going knock —Recurrent comatose GHB intoxication in the Netherlands & Flanders (Belgium). THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 58:137-148. [DOI: 10.1016/j.drugpo.2018.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 05/23/2018] [Accepted: 06/11/2018] [Indexed: 11/22/2022]
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25
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Eischens P, Atherton WL. Psychedelic therapy as a complementary treatment approach for alcohol use disorders. JOURNAL OF PSYCHEDELIC STUDIES 2018. [DOI: 10.1556/2054.2018.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Peter Eischens
- Department of Addictions & Rehabilitation Studies, East Carolina University, Health Sciences Building, Greenville, NC, USA
| | - William Leigh Atherton
- Department of Addictions & Rehabilitation Studies, East Carolina University, Health Sciences Building, Greenville, NC, USA
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26
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Madah-Amiri D, Myrmel L, Brattebø G. Intoxication with GHB/GBL: characteristics and trends from ambulance-attended overdoses. Scand J Trauma Resusc Emerg Med 2017; 25:98. [PMID: 28938889 PMCID: PMC5610436 DOI: 10.1186/s13049-017-0441-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/13/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Overdoses from so-called "club drugs" (GHB/GBL) have become a more frequent cause of overdoses attended by ambulance services. Given its availability, affordability, and lack of awareness of risks, there is a common misconception among users that the drug is relatively safe. METHODS This study reviewed ambulance records in Bergen, Norway between 2009 and 2015 for cases of acute poisonings, particularly from suspected GHB/GBL intoxication. RESULTS In total, 1112 cases of GHB and GBL poisoning were identified. GHB was suspected for 995 (89%) of the patients. Men made up the majority of the cases (n = 752, 67.6%) with a median age of 27 years old. Temporal trends for GHB/GBL overdoses displayed a late-night, weekend pattern. The most frequent initial symptoms reported were unconsciousness, or reduced consciousness. Most of the patients required further treatment and transport. During the period from 2009 to 2015, there was a nearly 50% decrease in GHB/GBL overdoses from 2013 to 2014. DISCUSSION The characteristics of GHB/GBL overdose victims shed light on this patient group. The decrease in incidence over the years may be partly due to a legal ban on GBL in Norway, declared in 2010. It may also be due to an increase in the use of MDMA/ecstasy. CONCLUSION The review of ambulance records on the prehospital treatment of overdoses can be beneficial in monitoring, preparing, and prevention efforts aimed to benefit this vulnerable group.
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Affiliation(s)
- Desiree Madah-Amiri
- The Norwegian Centre for Addiction Research, The University of Oslo, Oslo, Norway
| | - Lars Myrmel
- Bergen Emergency Medical Services, Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Guttorm Brattebø
- Bergen Emergency Medical Services, Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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27
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Chen LY, Renn TY, Liao WC, Mai FD, Ho YJ, Hsiao G, Lee AW, Chang HM. Melatonin successfully rescues hippocampal bioenergetics and improves cognitive function following drug intoxication by promoting Nrf2-ARE signaling activity. J Pineal Res 2017; 63. [PMID: 28480587 DOI: 10.1111/jpi.12417] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/02/2017] [Indexed: 12/25/2022]
Abstract
Prolonged exposure to gamma-hydroxybutyric acid (GHB) would cause drug intoxication in which impaired cognitive function results from enhanced hippocampal oxidative stress may serve as a major symptom in this deficiency. Considering melatonin possesses significant anti-oxidative efficacy, this study aimed to determine whether melatonin would successfully promote the nuclear factor erythroid 2-related factor 2 and antioxidant responsive element (Nrf2-ARE) signaling, depress oxidative stress, and rescue hippocampal bioenergetics and cognitive function following drug intoxication injury. Adolescent rats subjected to 10 days of GHB were received melatonin at doses of either 10 or 100 mg/kg. Time-of-flight secondary ion mass spectrometry, biochemical assay, quantitative histochemistry, [14 C]-2-deoxyglucose analysis, together with Morris water maze were employed to detect the molecular signaling, oxidative status, bioenergetic level, as well as the cognitive performances, respectively. Results indicated that in GHB-intoxicated rats, enhanced oxidative stress, increased cholesterol level, and decreased anti-oxidative enzymes activities were detected in hippocampal regions. Intense oxidative stress paralleled well with reduced bioenergetics and poor performance in behavioral testing. However, in rats treated with melatonin following GHB intoxication, all above parameters and cognitive function were gradually returned to nearly normal levels. Melatonin also remarkably promoted the translocation of Nrf2 from cytoplasm to nucleus in a dose-dependent manner, thereby increased the Nrf2-ARE signaling-related downstream anti-oxidative enzymes activities. As melatonin effectively rescues hippocampal bioenergetics through depressing the oxidative stress by promoting Nrf2-ARE molecular machinery, this study thus highlights for the first time that clinical use of melatonin may serve as a therapeutic strategy to improve the cognitive function in unsuspecting victims suffered from GHB intoxication injury.
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Affiliation(s)
- Li-You Chen
- Department of Anatomy, School of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Education, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ting-Yi Renn
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Chieh Liao
- Department of Anatomy, School of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Fu-Der Mai
- Department of Biochemistry and Molecular Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ying-Jui Ho
- School of Psychology, College of Medical Science and Technology, Chung Shan Medical University, Taichung, Taiwan
| | - George Hsiao
- Department of Pharmacology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ai-Wei Lee
- Department of Anatomy and Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hung-Ming Chang
- Department of Anatomy and Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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28
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Palomino-Schätzlein M, Wang Y, Brailsford AD, Parella T, Cowan DA, Legido-Quigley C, Pérez-Trujillo M. Direct Monitoring of Exogenous γ-Hydroxybutyric Acid in Body Fluids by NMR Spectroscopy. Anal Chem 2017; 89:8343-8350. [DOI: 10.1021/acs.analchem.7b01567] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Martina Palomino-Schätzlein
- NMR
Facility, Centro de Investigación Príncipe Felipe (CIPF), C. Eduardo Primo Yúfera 3, 46012 Valencia, Spain
| | - Yaoyao Wang
- Institute
of Pharmaceutical Science, Faculty of Life Science and Medicine, King’s College London, SE1 9NH London, United Kingdom
| | - Alan D. Brailsford
- Department
of Forensic Sciences and Drug Monitoring, Drug Control Centre, King’s College London, SE1 9NH London, United Kingdom
| | - Teodor Parella
- Servei
de Ressonància Magnètica Nuclear, Universitat Autònoma de Barcelona, E-08193 Cerdanyola del Vallès, Barcelona, Spain
| | - David A. Cowan
- Department
of Forensic Sciences and Drug Monitoring, Drug Control Centre, King’s College London, SE1 9NH London, United Kingdom
| | - Cristina Legido-Quigley
- Institute
of Pharmaceutical Science, Faculty of Life Science and Medicine, King’s College London, SE1 9NH London, United Kingdom
| | - Míriam Pérez-Trujillo
- Servei
de Ressonància Magnètica Nuclear, Universitat Autònoma de Barcelona, E-08193 Cerdanyola del Vallès, Barcelona, Spain
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29
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Intoxication by gamma hydroxybutyrate and related analogues: Clinical characteristics and comparison between pure intoxication and that combined with other substances of abuse. Toxicol Lett 2017; 277:84-91. [PMID: 28579487 DOI: 10.1016/j.toxlet.2017.05.030] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/28/2017] [Accepted: 05/29/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To study the profile of European gamma-hydroxybutyrate (GHB) and gammabutyrolactone (GBL) intoxication and analyse the differences in the clinical manifestations produced by intoxication by GHB/GBL alone and in combination with other substances of abuse. METHOD We prospectively collected data on all the patients attended in the Emergency Departments (ED) of the centres participating in the Euro-DEN network over 12 months (October 2013 to September 2014) with a primary presenting complaint of drug intoxication (excluding ethanol alone) and registered the epidemiological and clinical data and outcomes. RESULTS We included 710 cases (83% males, mean age 31 years), representing 12.6% of the total cases attended for drug intoxication. Of these, 73.5% arrived at the ED by ambulance, predominantly during weekend, and 71.7% consumed GHB/GBL in combination with other substances of abuse, the most frequent additional agents being ethanol (50%), amphetamine derivatives (36%), cocaine (12%) and cannabis (8%). Among 15 clinical features pre-defined in the project database, the 3 most frequently identified were altered behaviour (39%), reduced consciousness (34%) and anxiety (14%). The severity ranged from mild cases requiring no treatment (308 cases, 43.4%) to severe cases requiring admission to intensive care (103 cases, 14.6%) and mechanical ventilation (49 cases, 6.9%). No deaths were reported. In comparison with only GHB/GBL consumption, patients consuming GHB/GBL with co-intoxicants presented more vomiting (15% vs. 3%, p<0.001) and cardiovascular symptoms (5.3% vs. 1.5%, p<0.05), a greater need for treatment (59.8% vs. 48.3%, p<0.01) and a longer ED stay (11.3% vs. 3.6% patients with ED stay >12h, p<0.01). CONCLUSIONS The profile of the typical GHB/GBL-intoxicated European is a young male, requiring care for altered behaviour and reduced level of consciousness, mainly during the weekend. The clinical features are more severe when GHB is consumed in combination with other substances of abuse.
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30
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Hearne E, Alves EA, Van Hout MC, Grund JPC. Home Manufacture of Drugs: An Online Investigation and a Toxicological Reality Check of Online Discussions on Drug Chemistry. J Psychoactive Drugs 2017; 49:279-288. [PMID: 28535130 DOI: 10.1080/02791072.2017.1320735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Emerging trends in market dynamics and the use of new psychoactive substances are both a public health concern and a complex regulatory issue. One novel area of investigation is the availability of homemade opioids, amphetamines and dissociatives, and the potential fueling of interest in clandestine home manufacture of drugs via the Internet. We illustrate here how online communal folk pharmacology of homemade drugs on drug website forums may actually inform home manufacture practices or contribute to the reduction of harms associated with this practice. Discrepancies between online information around purification and making homemade drugs safer, and the synthesis of the same substances in a proper laboratory environment, exist. Moderation and shutdown of synthesis queries and discussions online are grounded in drug websites adhering to harm-reduction principles by facilitating discussions around purification of homemade drugs only. Drug discussion forums should consider reevaluating their policies on chemistry discussions in aiming to reach people who cannot or will not refrain from cooking their own drugs with credible information that may contribute to reductions in the harms associated with this practice.
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Affiliation(s)
- Evelyn Hearne
- a MSc Public Health (Addictions) Student, The Public Health Institute , Liverpool John Moore's University , Liverpool , UK
| | - Emanuele Amorim Alves
- b Ph.D. Student,Department of Legal Medicine and Forensic Sciences, Faculty of Medicine , University of Porto , Porto , Portugal.,c Ph.D. Student,UCIBIO-REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy , University of Porto , Porto , Portugal.,d Technician in Public Health, EPSJV-Polytechnical School of Health Joaquim Venâncio , Oswaldo Cruz Foundation , Rio de Janeiro , Brazil
| | - Marie Claire Van Hout
- e Professor of Public Health Policy, The Public Health Institute , Liverpool John Moore's University , Liverpool , UK
| | - Jean-Paul C Grund
- f Director of Research CVO , Addiction Research Centre , Utrecht , Netherlands.,g Senior Researcher, Department of Addictology, 1st Faculty of Medicine , Charles University, Prague, and General University Hospital , Prague , Czech Republic.,h Guest Researcher, Freudenthal Institute for Science and Mathematics Education , Utrecht University , Utrecht , Netherlands
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Kapitány-Fövény M, Zacher G, Posta J, Demetrovics Z. GHB-involved crimes among intoxicated patients. Forensic Sci Int 2017; 275:23-29. [PMID: 28288338 DOI: 10.1016/j.forsciint.2017.02.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 02/02/2017] [Accepted: 02/23/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In recent years, the involvement of GHB in drug facilitated sexual assaults has been one of the most frequently studied aspects of GHB in both clinical and non-clinical settings. GHB-involved acquisitory crimes, however, can be mentioned as understudied research topics, as well as the poisoning severity properties of GHB. MEASURES The medical reports of Péterfy Sándor Street Hospital Clinic and Casualty Centre's 408 GHB-intoxication cases (352 patients) were reviewed and registered. Analyzed data consisted of epicrisis, serum and urine concentration of various substances (including GHB), scores of Glasgow Coma Scale and Poisoning Severity Score. RESULTS Majority of the patients were males, in their twenties. GHB was detected in 34.1% and it was solely consumed in 27.7% of all the cases. Ethanol was found to be the most frequently co-ingested substance. A higher rate of severe poisonings was observed among males. We found significant difference in the frequency of enduring sexual assaults and acquisitory crimes between intentional and unintentional GHB intake cases. Among unintentional GHB intake cases, 6.5% endured GHB-involved sexual assaults, whereas 21.7% endured an acquisitory crime. Among recurrent GHB intoxication cases generated by the same patients, voluntary and sole GHB consumptions were more frequently observed, however, enduring any crime was less characteristic. DISCUSSION Our results regarding demographic and substance use characteristics and the frequency of GHB-facilitated sexual assaults are in line with former findings. Enduring acquisitory crimes due to unintentional GHB intake was found to be more inherent than enduring sexual assaults. Authors emphasise that the victims of these acquisitory crimes were typically males. CONCLUSION GHB's role in drug facilitated acquisitory crimes seems to be significant, although the decrease in GHB's popularity is observed among intoxicated patients as well. The need for further research on GHB's impact on cognitive impairment and on sexual correlates of intentional GHB use is addressed by the authors.
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Affiliation(s)
- Máté Kapitány-Fövény
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary; Faculty of Health Sciences, Semmelweis University, Budapest, Hungary; Nyírő Gyula Hospital National Institute of Psychiatry and Addictology, Drug Outpatient and Prevention Centre, Budapest, Hungary.
| | - Gábor Zacher
- Military Hospital State Health Centre, Emergency Ward, Budapest, Hungary
| | - János Posta
- Institute of Forensic Medicine, University of Debrecen, Hungary
| | - Zsolt Demetrovics
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
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Soyka M, Kranzler HR, Hesselbrock V, Kasper S, Mutschler J, Möller HJ. Guidelines for biological treatment of substance use and related disorders, part 1: Alcoholism, first revision. World J Biol Psychiatry 2017; 18:86-119. [PMID: 28006997 DOI: 10.1080/15622975.2016.1246752] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
These practice guidelines for the biological treatment of alcohol use disorders are an update of the first edition, published in 2008, which was developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). For this 2016 revision, we performed a systematic review (MEDLINE/PUBMED database, Cochrane Library) of all available publications pertaining to the biological treatment of alcoholism and extracted data from national guidelines. The Task Force evaluated the identified literature with respect to the strength of evidence for the efficacy of each medication and subsequently categorised it into six levels of evidence (A-F) and five levels of recommendation (1-5). Thus, the current guidelines provide a clinically and scientifically relevant, evidence-based update of our earlier recommendations. These guidelines are intended for use by clinicians and practitioners who evaluate and treat people with alcohol use disorders and are primarily concerned with the biological treatment of adults with such disorders.
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Affiliation(s)
- Michael Soyka
- a Psychiatric Hospital Meiringen , Meiringen , Switzerland.,b Department of Psychiatry , Ludwig-Maximilians-University , Munich , Germany.,c Medicalpark Chiemseeblick , Bernau , Germany
| | - Henry R Kranzler
- d Crescenz VAMC , University of Pennsylvania and VISN 4 MIRECC , Philadelphia , PA , USA
| | | | - Siegfried Kasper
- f Department of Psychiatric Medicine , University of Vienna, Vienna , Austria
| | - Jochen Mutschler
- a Psychiatric Hospital Meiringen , Meiringen , Switzerland.,g Psychiatric Hospital University of Zürich, Zürich , Switzerland
| | - Hans-Jürgen Möller
- b Department of Psychiatry , Ludwig-Maximilians-University , Munich , Germany
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Qurishi R, Markus W, Habra MM, Bressers B, De Jong CA. EMDR Therapy Reduces Intense Treatment-Resistant Cravings in a Case of Gamma-Hydroxybutyric Acid Addiction. JOURNAL OF EMDR PRACTICE AND RESEARCH 2017. [DOI: 10.1891/1933-3196.11.1.30] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article presents the first experiences of using eye movement desensitization and reprocessing (EMDR) therapy to aid in the treatment of gamma-hydroxybutyric acid (GHB) dependency. A case presented itself as a result of intense, treatment-resistant cravings despite pharmacological treatment. The patient received 7 weekly sessions using a subset of the palette of EMDR interventions in addiction (PEIA; Markus & Hornsveld, 2017) targeting both negative and positive valenced addiction-related memory representations from the past, present, and future. Patient-reported GHB craving showed a gradual and prolonged reduction. Urine samples showed that the patient remained abstinent during and at least 6 months after EMDR therapy. Further research regarding the effectiveness of EMDR therapy in this particularly challenging group of substance users is warranted.
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Brailsford AD, Bartlett C, Kicman AT, Cowan DA. Increases in Serum Growth Hormone Concentrations Associated with GHB Administration. J Anal Toxicol 2016; 41:54-59. [DOI: 10.1093/jat/bkw107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/13/2016] [Accepted: 07/24/2016] [Indexed: 11/13/2022] Open
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Microwave-assisted on-spot derivatization for gas chromatography–mass spectrometry based determination of polar low molecular weight compounds in dried blood spots. J Chromatogr A 2016; 1465:175-83. [DOI: 10.1016/j.chroma.2016.08.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 12/26/2022]
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The potential utility of some legal highs in CNS disorders. Prog Neuropsychopharmacol Biol Psychiatry 2016; 64:267-74. [PMID: 26232510 DOI: 10.1016/j.pnpbp.2015.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 07/24/2015] [Accepted: 07/26/2015] [Indexed: 12/21/2022]
Abstract
Over the last decade there has been an explosion of new drugs of abuse, so called legal highs or novel psychoactive substances (NPS). Many of these abused drugs have unknown pharmacology, but their biological effects can be anticipated from their molecular structure and possibly also from online user reports. When considered with the findings that some prescription medications are increasingly abused and that some abused drugs have been tested clinically one could argue that there has been a blurring of the line between drugs of abuse and clinically used drugs. In this review we examine these legal highs/NPS and consider whether, based on their known or predicted pharmacology, some might have the potential to be clinically useful in CNS disorders.
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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: 36] [Impact Index Per Article: 4.0] [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].
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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.
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Comprehensive Application of Time-of-flight Secondary Ion Mass Spectrometry (TOF-SIMS) for Ionic Imaging and Bio-energetic Analysis of Club Drug-induced Cognitive Deficiency. Sci Rep 2015; 5:18420. [PMID: 26674573 PMCID: PMC4682059 DOI: 10.1038/srep18420] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 11/17/2015] [Indexed: 12/15/2022] Open
Abstract
Excessive exposure to club drug (GHB) would cause cognitive dysfunction in which impaired hippocampal Ca2+-mediated neuroplasticity may correlate with this deficiency. However, the potential changes of in vivo Ca2+ together with molecular machinery engaged in GHB-induced cognitive dysfunction has never been reported. This study aims to determine these changes in bio-energetic level through ionic imaging, spectrometric, biochemical, morphological, as well as behavioral approaches. Adolescent rats subjected to GHB were processed for TOF-SIMS, immunohistochemistry, biochemical assay, together with Morris water maze to detect the ionic, molecular, neurochemical, and behavioral changes of GHB-induced cognitive dysfunction, respectively. Extent of oxidative stress and bio-energetics were assessed by levels of lipid peroxidation, Na+/K+ ATPase, cytochrome oxidase, and [14C]-2-deoxyglucose activity. Results indicated that in GHB intoxicated rats, decreased Ca2+ imaging and reduced NMDAR1, nNOS, and p-CREB reactivities were detected in hippocampus. Depressed Ca2+-mediated signaling corresponded well with intense oxidative stress, diminished Na+/K+ ATPase, reduced COX, and decreased 2-DG activity, which all contributes to the development of cognitive deficiency. As impaired Ca2+-mediated signaling and oxidative stress significantly contribute to GHB-induced cognitive dysfunction, delivering agent(s) that improves hippocampal bio-energetics may thus serve as a promising strategy to counteract the club drug-induced cognitive dysfunction emerging in our society nowadays.
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“Chemsex” and harm reduction need among gay men in South London. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1171-6. [DOI: 10.1016/j.drugpo.2015.07.013] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/06/2015] [Accepted: 07/15/2015] [Indexed: 11/17/2022]
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40
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Schifano F, Orsolini L, Duccio Papanti G, Corkery JM. Novel psychoactive substances of interest for psychiatry. World Psychiatry 2015; 14:15-26. [PMID: 25655145 PMCID: PMC4329884 DOI: 10.1002/wps.20174] [Citation(s) in RCA: 236] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Novel psychoactive substances include synthetic cannabinoids, cathinone derivatives, psychedelic phenethylamines, novel stimulants, synthetic opioids, tryptamine derivatives, phencyclidine-like dissociatives, piperazines, GABA-A/B receptor agonists, a range of prescribed medications, psychoactive plants/herbs, and a large series of performance and image enhancing drugs. Users are typically attracted by these substances due to their intense psychoactive effects and likely lack of detection in routine drug screenings. This paper aims at providing psychiatrists with updated knowledge of the clinical pharmacology and psychopathological consequences of the use of these substances. Indeed, these drugs act on a range of neurotransmitter pathways/receptors whose imbalance has been associated with psychopathological conditions, including dopamine, cannabinoid CB1, GABA-A/B, 5-HT2A, glutamate, and k opioid receptors. An overall approach in terms of clinical management is briefly discussed.
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Affiliation(s)
- Fabrizio Schifano
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Herts, UK
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Sadones N, Archer JRH, Ingels ASME, Dargan PI, Wood DM, Wood M, Neels H, Lambert WE, Stove CP. Do capillary dried blood spot concentrations of gamma-hydroxybutyric acid mirror those in venous blood? A comparative study. Drug Test Anal 2015; 7:336-40. [DOI: 10.1002/dta.1760] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 11/05/2014] [Accepted: 11/05/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Nele Sadones
- Laboratory of Toxicology; Ghent University; Ghent Belgium
| | - John R. H. Archer
- Guy's and St Thomas' NHS Foundation Trust; Clinical Toxicology; London UK
| | - Ann-Sofie M. E. Ingels
- Laboratory of Toxicology; Ghent University; Ghent Belgium
- Laboratory of Toxicology; National Institute for Criminalistics and Criminology; Brussels Belgium
| | - Paul I. Dargan
- Guy's and St Thomas' NHS Foundation Trust; Clinical Toxicology; London UK
- King's College London; London UK
| | - David M. Wood
- Guy's and St Thomas' NHS Foundation Trust; Clinical Toxicology; London UK
- King's College London; London UK
| | - Michelle Wood
- Waters Corporation; MS Technologies Centre; Manchester UK
| | - Hugo Neels
- Toxicological Centre; University of Antwerp; Wilrijk Belgium
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