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Czarny J, Musiał J, Powierska-Czarny J, Raczkowski M, Galant N, Buszewski B, Gadzała-Kopciuch R. Determination of 465 psychoactive substances, drugs and their metabolites in urine by LC-MS/MS. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2024; 16:5426-5432. [PMID: 39037182 DOI: 10.1039/d4ay00777h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
Due to the emergence of novel psychoactive substances on the drug market, there is a growing demand for analytical methods allowing identification and determination of as many psychoactive substances as possible in the shortest possible time, which can be easily expanded to include additional analytes appearing in street trade. Immunochemical methods are not sufficient to meet constantly growing requirements. Therefore, the aim of the study was to develop an analytical method enabling quick analysis of urine samples for psychoactive substances, drugs and their metabolites. Liquid-liquid extraction (LLE) and liquid chromatography coupled with mass spectrometry (LC-MS/MS) were used for this purpose. Using available analytical standards, the operating parameters of the mass spectrometer were selected for each of the 477 analytes, and MRM (multiple reaction monitoring) acquisition was selected for each of them. The use of analytical standards allowed for the identification of analytes separated on the chromatography column. The exceptions are methylmethcathinone isomers (3-MMC and 4-MMC), which we were unable to separate using the gradient elution method used. Extraction using acetonitrile with the addition of ammonium formate and formic acid allowed us to obtain high recoveries without the use of β-glucuronidase. Recovery values ranged from 18.43 to 119.94%. The matrix effect was eliminated by obtaining a calibration curve in the matrix. The developed analytical method was validated in accordance with SWGTOX guidelines. Only 12 substances did not meet the validation criteria (CV: ±20% and bias: ±20%). Thus the validated method makes it possible to determine 465 psychoactive substances in just 30 minutes. In the validation process, values such as the limit of detection (LOD) and the limit of quantification (LOQ) were also determined. The LODs are in the range of 3-30 ng mL-1, and the LOQs are in the range of 10-100 ng mL-1. The method was successfully applied to toxicological analyses of urine samples, which was an opportunity to develop it further to meet the needs of toxicology.
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Affiliation(s)
- Jakub Czarny
- Institute of Forensic Genetics, Al. Mickiewicza 3/4, 85-071 Bydgoszcz, Poland
| | - Jadwiga Musiał
- Institute of Forensic Genetics, Al. Mickiewicza 3/4, 85-071 Bydgoszcz, Poland
- Department of Environmental Chemistry and Bioanalytics, Faculty of Chemistry, Nicolaus Copernicus University in Toruń, 7 Gagarin St., 87-100 Toruń, Poland.
| | | | - Michał Raczkowski
- Institute of Forensic Genetics, Al. Mickiewicza 3/4, 85-071 Bydgoszcz, Poland
| | - Natalia Galant
- Institute of Forensic Genetics, Al. Mickiewicza 3/4, 85-071 Bydgoszcz, Poland
| | - Bogusław Buszewski
- Department of Environmental Chemistry and Bioanalytics, Faculty of Chemistry, Nicolaus Copernicus University in Toruń, 7 Gagarin St., 87-100 Toruń, Poland.
- prof. Jan Czochralski Kuyavian-Pomeranian Research & Development Centre, Krasińskiego str. 4, Pl-87 100 Toruń, Poland
| | - Renata Gadzała-Kopciuch
- Department of Environmental Chemistry and Bioanalytics, Faculty of Chemistry, Nicolaus Copernicus University in Toruń, 7 Gagarin St., 87-100 Toruń, Poland.
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Comparison of Psychiatric and Clinical Profiles Between People Who Use Synthetic Cathinones and Methamphetamine: A Matched Case-Control Study. J Clin Psychopharmacol 2023; 43:122-130. [PMID: 36706307 PMCID: PMC9988231 DOI: 10.1097/jcp.0000000000001649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Synthetic cathinones are the most used novel psychoactive substances in Taiwan because they exhibit psychoactive effects similar to those of methamphetamine, inducing acute psychosis, violence, and self-harm. However, the differences in the clinical characteristics of patients with synthetic cathinone and methamphetamine intoxication admitted to psychiatric emergency departments (EDs) remain unclear. METHODS This study recruited patients with stimulant intoxication who were admitted to a psychiatric ED from April 2019 to May 2020. Sociodemographic, lifestyle, and psychopathological data were collected through face-to-face interviews and evaluated. Immunoassay tests and liquid chromatography-quadrupole time-of-flight mass spectrometry were performed to detect substances in urine specimens. The patients were matched by sex and age (in 5-year intervals). The associations between the 2 groups and physical complications were analyzed through logistic regression. RESULTS Twenty-four patients with synthetic cathinone intoxication were identified and matched with 48 patients with methamphetamine intoxication. The 2 groups exhibited similar clinical severity of psychotic symptoms and high risks of violence and self-harm. Both groups were predominated by unmarried patients, unemployed patients, and habitual smokers and drinkers. However, family histories of substance use and criminal records were less prevalent among the patients with synthetic cathinone intoxication, but they had a higher rate of physical complications (odds ratio, 8.55; 95% confidence interval, 2.15-34.03), compared with patients with methamphetamine intoxication. CONCLUSIONS Compared with patients intoxicated with methamphetamine, those intoxicated with synthetic cathinones may have similar tendencies toward psychosis, violence, and self-harm but higher risks of physical complications, which are prioritized in psychiatric EDs.
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Virmani I, Oteo A, Dunn M, Vidler D, Roper C, Officer J, Hardy G, Dargan PI, Eddleston M, Cooper JG, Hill SL, Macfarlane R, Keating L, Haden M, Hudson S, Thomas SHL. Accuracy of substance exposure history in patients attending emergency departments after substance misuse; a comparison with biological sample analysis. Clin Toxicol (Phila) 2023; 61:39-46. [PMID: 36322622 DOI: 10.1080/15563650.2022.2131566] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Acute toxicity caused by illicit substance use is a common reason for emergency department (ED) presentation. Knowledge of the substances involved is helpful for predicting and managing potential toxicity, but limited information is available about the accuracy of patient-reported substance exposure. This study assessed the accuracy of the history of exposure in those reporting use of a single substance by comparison with those identified by detailed toxicological analysis, focusing on synthetic cannabinoid receptor agonists (SCRA). METHODS Adults (≥16 years) presenting between March 2015 and July 2021 to participating UK hospitals with toxicity after reporting use of a single illicit substance were included. Exposure details were documented from medical records and blood and/or urine samples analysed using high-resolution accurate mass liquid chromatography-mass spectrometry (HRAM LCMS). Sensitivity, specificity, and positive and negative predictive values of the exposure history were calculated by comparison with biological sample analysis ("gold standard"). RESULTS Single substance exposure was reported for 474 (median age 33 years, IQR: 18 range 16-75, 80% males) patients. Analysis commonly identified multiple substances (Median 3, IQR 2-5). A history of exposure was documented for 121 of 151 patients where a SCRA or metabolite was detected on analysis (sensitivity 80.1%, 95% CI 72.9, 86.2%). Corresponding proportions were lower for 3,4-methylenedioxymethamphetamine (MDMA, 44/70, 62.9%., 95% CI 50.5%, 74.1%), heroin 41/108 (38.0% 95% CI 28.8-47.8%) and cocaine (22/56, 31.3%, 95% CI 20.9, 43.6%). CONCLUSIONS Multiple undeclared substances were detected analytically in most patients reporting single substance use. Clinicians should be alert to the potential presence and toxicity of unreported substances when managing patients presenting after substance misuse.
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Affiliation(s)
- Ishita Virmani
- Medical Toxicology Centre, Newcastle University, Newcastle, UK.,RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Alberto Oteo
- Addictions and Inclusion Directorate, Department of Health and Social Care, Office for Health Improvement & Disparities, London, UK
| | - Michael Dunn
- Medical Toxicology Centre, Newcastle University, Newcastle, UK
| | - Daniel Vidler
- Medical Toxicology Centre, Newcastle University, Newcastle, UK
| | - Clair Roper
- Medical Toxicology Centre, Newcastle University, Newcastle, UK
| | - Jane Officer
- Scottish Police Authority Forensic Services, Edinburgh, UK
| | - Gareth Hardy
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Paul I Dargan
- Clinical Toxicology, Guys & St Thomas' NHS Foundation Trust, London and Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Michael Eddleston
- Pharmacology, Toxicology & Therapeutics, University of Edinburgh, Edinburgh, UK
| | | | - Simon L Hill
- Medical Toxicology Centre, Newcastle University, Newcastle, UK.,Newcastle Hospitals NHS Foundation Trust and National Poisons Information Service, Newcastle, UK
| | | | - Liza Keating
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Mark Haden
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Simon Hudson
- LGC Sport and Specialised Analytical Services, Fordham, UK
| | - Simon H L Thomas
- Medical Toxicology Centre, Newcastle University, Newcastle, UK.,Newcastle Hospitals NHS Foundation Trust and National Poisons Information Service, Newcastle, UK
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Crulli B, Dines AM, Blanco G, Giraudon I, Eyer F, Liechti ME, Miró Ò, Hovda KE, Heyerdahl F, Yates C, Vallersnes OM, Wood DM, Dargan PI. Novel psychoactive substances-related presentations to the emergency departments of the European drug emergencies network plus (Euro-DEN plus) over the six-year period 2014-2019. Clin Toxicol (Phila) 2022; 60:1318-1327. [PMID: 36322684 DOI: 10.1080/15563650.2022.2137524] [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: 01/06/2023]
Abstract
INTRODUCTION Novel psychoactive substances (NPS) have been increasingly reported in the last 15-20 years. We aimed to describe presentations to the emergency department (ED) with acute recreational drug toxicity involving NPS. METHODS Data were extracted from the European Drug Emergencies Network (Euro-DEN) Plus database for all presentations to ED (36 EDs in 24 European countries) with acute toxicity between January 2014 and December 2019. Patient demographics, agents involved, and clinical outcomes were described and the subgroup of presentations involving NPS was compared with the rest of the cohort. RESULTS Out of 43,633 Euro-DEN Plus presentations, 3304 (7.6%) involved at least one NPS. Agents were identified mainly based on self-report or clinical presentation, with analytical confirmation being performed only in 17.9% of NPS presentations. The proportion of NPS presentations varied by centre (0-48.8%). For centres where data were available for all 6 years, NPS-related presentations peaked in 2015 (11.9%). In 2014, 78.4% of NPS agents reported were cathinones, while only 3.4% were synthetic cannabinoids (SCs); conversely, in 2019 only 11.6% of NPS agents reported were cathinones, while 72.2% were SCs. NPS-related presentations involved younger patients (median 30 (23-37) vs. 32 (25-40) years, p < 0.001) and more males (84.8 vs. 75.8%, p < 0.001) compared with the rest of the cohort. Patients presenting to ED after using NPS were more likely to self-discharge (22.8 vs. 15.1%), less likely to be admitted to critical care (3.6 vs. 6.1%) but had a longer length of stay in hospital (median 5.1 (2.7-18.7) vs. 4.7 (2.5-9.2) h, p < 0.001). Death occurred in 0.5% of all presentations involving NPS and in 0.4% of non-NPS presentations. CONCLUSIONS This large multicentre series of NPS presentations to European EDs showed marked geographical variation and changes over time in the proportion of presentations to ED involving NPS, as well as the proportion of NPS subgroups.
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Affiliation(s)
- Benjamin Crulli
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - Alison M Dines
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - Georgina Blanco
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - Isabelle Giraudon
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Florian Eyer
- Department of Clinical Toxicology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias E Liechti
- Division of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Knut E Hovda
- Department of Acute Medicine, The National CBRNE Centre of Medicine, Medical Division, Oslo University Hospital, Oslo, Norway
| | - Fridtjof Heyerdahl
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christopher Yates
- Emergency Department, Hospital Son Espases, Palma de Mallorca, Spain
| | - Odd Martin Vallersnes
- Department of General Practice, University of Oslo, Oslo, Norway.,Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway
| | - David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.,Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Paul I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.,Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Simão AY, Antunes M, Cabral E, Oliveira P, Rosendo LM, Brinca AT, Alves E, Marques H, Rosado T, Passarinha LA, Andraus M, Barroso M, Gallardo E. An Update on the Implications of New Psychoactive Substances in Public Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084869. [PMID: 35457736 PMCID: PMC9028227 DOI: 10.3390/ijerph19084869] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023]
Abstract
The emergence of new psychoactive substances has earned a great deal of attention, and several reports of acute poisoning and deaths have been issued involving, for instance, synthetic opiates. In recent years, there have been profound alterations in the legislation concerning consumption, marketing, and synthesis of these compounds; rapid alert systems have also been subject to changes, and new substances and new markets, mainly through the internet, have appeared. Their effects and how they originate in consumers are still mostly unknown, primarily in what concerns chronic toxicity. This review intends to provide a detailed description of these substances from the point of view of consumption, toxicokinetics, and health consequences, including case reports on intoxications in order to help researchers and public health agents working daily in this area.
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Affiliation(s)
- Ana Y. Simão
- Centro de Investigação em Ciências da Saúde (CICS-UBI), Universidade da Beira Interior, 6200-506 Covilha, Portugal; (A.Y.S.); (M.A.); (E.C.); (P.O.); (L.M.R.); (A.T.B.); (E.A.); (H.M.); (T.R.)
- Laboratório de Fármaco-Toxicologia, UBIMedical, Universidade da Beira Interior, 6200-284 Covilha, Portugal
| | - Mónica Antunes
- Centro de Investigação em Ciências da Saúde (CICS-UBI), Universidade da Beira Interior, 6200-506 Covilha, Portugal; (A.Y.S.); (M.A.); (E.C.); (P.O.); (L.M.R.); (A.T.B.); (E.A.); (H.M.); (T.R.)
- Serviço de Química e Toxicologia Forenses, Instituto Nacional de Medicina Legal e Ciências Forenses, Delegação do Sul, 1150-219 Lisboa, Portugal
| | - Emanuel Cabral
- Centro de Investigação em Ciências da Saúde (CICS-UBI), Universidade da Beira Interior, 6200-506 Covilha, Portugal; (A.Y.S.); (M.A.); (E.C.); (P.O.); (L.M.R.); (A.T.B.); (E.A.); (H.M.); (T.R.)
| | - Patrik Oliveira
- Centro de Investigação em Ciências da Saúde (CICS-UBI), Universidade da Beira Interior, 6200-506 Covilha, Portugal; (A.Y.S.); (M.A.); (E.C.); (P.O.); (L.M.R.); (A.T.B.); (E.A.); (H.M.); (T.R.)
| | - Luana M. Rosendo
- Centro de Investigação em Ciências da Saúde (CICS-UBI), Universidade da Beira Interior, 6200-506 Covilha, Portugal; (A.Y.S.); (M.A.); (E.C.); (P.O.); (L.M.R.); (A.T.B.); (E.A.); (H.M.); (T.R.)
| | - Ana Teresa Brinca
- Centro de Investigação em Ciências da Saúde (CICS-UBI), Universidade da Beira Interior, 6200-506 Covilha, Portugal; (A.Y.S.); (M.A.); (E.C.); (P.O.); (L.M.R.); (A.T.B.); (E.A.); (H.M.); (T.R.)
| | - Estefânia Alves
- Centro de Investigação em Ciências da Saúde (CICS-UBI), Universidade da Beira Interior, 6200-506 Covilha, Portugal; (A.Y.S.); (M.A.); (E.C.); (P.O.); (L.M.R.); (A.T.B.); (E.A.); (H.M.); (T.R.)
| | - Hernâni Marques
- Centro de Investigação em Ciências da Saúde (CICS-UBI), Universidade da Beira Interior, 6200-506 Covilha, Portugal; (A.Y.S.); (M.A.); (E.C.); (P.O.); (L.M.R.); (A.T.B.); (E.A.); (H.M.); (T.R.)
- Laboratório de Fármaco-Toxicologia, UBIMedical, Universidade da Beira Interior, 6200-284 Covilha, Portugal
| | - Tiago Rosado
- Centro de Investigação em Ciências da Saúde (CICS-UBI), Universidade da Beira Interior, 6200-506 Covilha, Portugal; (A.Y.S.); (M.A.); (E.C.); (P.O.); (L.M.R.); (A.T.B.); (E.A.); (H.M.); (T.R.)
- Laboratório de Fármaco-Toxicologia, UBIMedical, Universidade da Beira Interior, 6200-284 Covilha, Portugal
| | - Luís A. Passarinha
- Centro de Investigação em Ciências da Saúde (CICS-UBI), Universidade da Beira Interior, 6200-506 Covilha, Portugal; (A.Y.S.); (M.A.); (E.C.); (P.O.); (L.M.R.); (A.T.B.); (E.A.); (H.M.); (T.R.)
- UCIBIO—Applied Molecular Biosciences Unit, Departamento de Química, NOVA School of Science and Technology, Universidade NOVA, 2829-516 Caparica, Portugal
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, NOVA School of Science and Technology, Universidade NOVA, 2819-516 Caparica, Portugal
- Correspondence: (L.A.P.); (M.A.); (M.B.); (E.G.); Tel.: +351-275-329-001 (L.A.P. & E.G.); +55-800-042-0384 (M.A.); +351-21-881-1800 (M.B.)
| | - Maristela Andraus
- Chromatox/Dasa Laboratory Ltda. Sumaré, São Paulo 01259-000, Brazil
- Correspondence: (L.A.P.); (M.A.); (M.B.); (E.G.); Tel.: +351-275-329-001 (L.A.P. & E.G.); +55-800-042-0384 (M.A.); +351-21-881-1800 (M.B.)
| | - Mário Barroso
- Serviço de Química e Toxicologia Forenses, Instituto Nacional de Medicina Legal e Ciências Forenses, Delegação do Sul, 1150-219 Lisboa, Portugal
- Correspondence: (L.A.P.); (M.A.); (M.B.); (E.G.); Tel.: +351-275-329-001 (L.A.P. & E.G.); +55-800-042-0384 (M.A.); +351-21-881-1800 (M.B.)
| | - Eugenia Gallardo
- Centro de Investigação em Ciências da Saúde (CICS-UBI), Universidade da Beira Interior, 6200-506 Covilha, Portugal; (A.Y.S.); (M.A.); (E.C.); (P.O.); (L.M.R.); (A.T.B.); (E.A.); (H.M.); (T.R.)
- Laboratório de Fármaco-Toxicologia, UBIMedical, Universidade da Beira Interior, 6200-284 Covilha, Portugal
- Correspondence: (L.A.P.); (M.A.); (M.B.); (E.G.); Tel.: +351-275-329-001 (L.A.P. & E.G.); +55-800-042-0384 (M.A.); +351-21-881-1800 (M.B.)
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Garus-Pakowska A, Kolmaga A, Gaszyńska E, Ulrichs M. The Scale of Intoxications with New Psychoactive Substances over the Period 2014-2020-Characteristics of the Trends and Impacts of the COVID-19 Pandemic on the Example of Łódź Province, Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084427. [PMID: 35457295 PMCID: PMC9031094 DOI: 10.3390/ijerph19084427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 12/04/2022]
Abstract
Legal highs are new psychoactive substances (NPSs) which pose a high risk for human health, and the spread of the SARS-CoV-2 pandemic has changed peoples’ behaviours, including the demand for NPS. The aim of the study was to assess both the frequency of intoxication with NPS in Łódź province over the period 2014−2020, and the impact of the COVID-19 pandemic on developing this trend. An analysis was carried out of data on intoxications in Łódź province in the years 2014−2020 reported by hospitals. The medical interventions rate (MI) per 100,000 people in the population was calculated. The frequency of intoxications was compared taking sociodemographic variables into account, and the effect of seasonal influence on intoxications was calculated using the Holt−Winter multiplicative seasonal method. In the period considered, there were 7175 acute NPS poisonings in the Łódź province and 25,495 in Poland. The averaged MI rate between 2014−2020 was 9.45 for Poland and 38.53 for the Łódź province, and the lowest value was found during the COVID pandemic in the year 2020 (respectively, 2.1 vs. 16.94). NPS users were mainly young men of 19−24 years old from a big city. Most cases were registered at weekends and in summer months. The majority of intoxications were caused by unidentified psychoactive substances of legal highs (chi2 = 513.98, p < 0.05). The actual number of NPS-related poisonings in the Łódź province in 2020 was lower than the value extrapolated from trend analysis of data between 2014−2019. NPS use in Poland decreased during the pandemic. It should be noted that a decrease in the number of drug-related incidents can have more than one reason, e.g., preventive programs, increased awareness, or changes in the law. This paper advocates that, in addition to monitoring NPS-related intoxications, there is further investigation into the social, cultural, and behavioural determinants of NPS to facilitate targeted prevention programmes and the development of new medical treatments.
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Affiliation(s)
- Anna Garus-Pakowska
- Department of Nutrition and Epidemiology, Medical University of Lodz, 90-752 Lodz, Poland; (A.K.); (E.G.)
- Correspondence:
| | - Agnieszka Kolmaga
- Department of Nutrition and Epidemiology, Medical University of Lodz, 90-752 Lodz, Poland; (A.K.); (E.G.)
| | - Ewelina Gaszyńska
- Department of Nutrition and Epidemiology, Medical University of Lodz, 90-752 Lodz, Poland; (A.K.); (E.G.)
| | - Magdalena Ulrichs
- Department of Econometrics, Faculty of Economics and Sociology, University of Lodz, 90-255 Lodz, Poland;
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7
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Doyle MR, Gannon BM, Mesmin MP, Collins GT. Application of dose-addition analyses to characterize the abuse-related effects of drug mixtures. J Exp Anal Behav 2022; 117:442-456. [PMID: 35142382 PMCID: PMC9327442 DOI: 10.1002/jeab.741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 11/12/2022]
Abstract
Polysubstance use makes up a majority of drug use, yet relatively few studies investigate the abuse-related effects of drug mixtures. Dose-addition analyses provide a rigorous and quantitative method to determine the nature of the interaction (i.e., supraadditive, additive, or subadditive) between two or more drugs. As briefly reviewed here, studies in rhesus monkeys have applied dose-addition analyses to group level data to characterize the nature of the interaction between the reinforcing effects of stimulants and opioids (e.g., mixtures of cocaine + heroin). Building upon these foundational studies, more recent work has applied dose-addition analyses to better understand the nature of the interaction between caffeine and illicit stimulants such as MDPV and methamphetamine in rats. In addition to utilizing a variety of operant procedures, including drug discrimination, drug self-administration, and drug-primed reinstatement, these studies have incorporated potency and effectiveness ratios as a method for both statistical analysis and visualization of departures from additivity at both the group and individual subject level. As such, dose-addition analyses represent a powerful and underutilized approach to quantify the nature of drug-drug interactions that can be applied to a variety of abuse-related endpoints in order to better understand the behavioral pharmacology of polysubstance use.
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Affiliation(s)
- Michelle R Doyle
- Department of Pharmacology, University of Texas Health Science Center at San Antonio.,South Texas Veterans Health Care System, San Antonio
| | - Brenda M Gannon
- Department of Pharmacology, University of Texas Health Science Center at San Antonio
| | - Melson P Mesmin
- Department of Pharmacology, University of Texas Health Science Center at San Antonio
| | - Gregory T Collins
- Department of Pharmacology, University of Texas Health Science Center at San Antonio.,South Texas Veterans Health Care System, San Antonio
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8
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Hobbs JM, DeRienz RT, Baker DD, Shuttleworth MR, Pandey M. Case Report: Fatal Intoxication by the Novel Cathinone 4-fluoro-3-methyl-α-PVP. J Anal Toxicol 2022; 46:e101-e104. [PMID: 35020879 DOI: 10.1093/jat/bkac003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 12/13/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
A 30-year-old non-hispanic white male was found unresponsive at his workplace and admitted to the hospital in cardiac arrest. He was pronounced deceased shortly after arrival. At autopsy the pathologist noted a 176-pound, well-nourished, atraumatic, adult male with significant bilateral frothy pulmonary edema (right lung 930g and left lung 1130g), cardiomegaly (430g), dilated ventricles, and slight cerebral edema. Upon completion of the systematic toxicological analysis scope for the Franklin County Coroner's Office Toxicology Laboratory, no known drugs were found. Further review of the gas chromatography/mass spectrometry (GC/MS) full scan library summary reports showed an unknown peak in both the blood and urine solid phase extracts. An analogue of α-pyrrolidinovalerophenone (α-PVP) was identified, and a GC/MS selected ion monitoring (SIM) method was developed to identify and quantitate the presence of 4-fluoro-3-methyl-α-PVP. This method quantified the drug at 26ng/mL in gray top femoral blood, 30ng/mL in purple top heart blood, and 20ng/mL in red top vitreous humor. Qualitative presence was also observed in the urine but was not detected in liver. The decedent's cause of death was determined to be due to Fluoro-methyl-PVP toxicity and the manner was ruled to be accidental. Investigational follow-up interviews corroborated drug use by the deceased with a preference of research chemicals and synthetic cannabinoids via the internet. No published literature is available currently and to the author's knowledge this is the first incident of a fatal death solely attributed to this substituted cathinone.
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Affiliation(s)
- Jennifer M Hobbs
- Franklin County Coroner's Office, Franklin County Forensics Science Center, 2090 Frank Road, Columbus, Ohio 43223, USA
| | - Rebecca T DeRienz
- Franklin County Coroner's Office, Franklin County Forensics Science Center, 2090 Frank Road, Columbus, Ohio 43223, USA
| | - Daniel D Baker
- Franklin County Coroner's Office, Franklin County Forensics Science Center, 2090 Frank Road, Columbus, Ohio 43223, USA
| | - Morgan R Shuttleworth
- Franklin County Coroner's Office, Franklin County Forensics Science Center, 2090 Frank Road, Columbus, Ohio 43223, USA
| | - Maneesha Pandey
- Franklin County Coroner's Office, Franklin County Forensics Science Center, 2090 Frank Road, Columbus, Ohio 43223, USA
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9
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Soares J, Costa VM, Bastos MDL, Carvalho F, Capela JP. An updated review on synthetic cathinones. Arch Toxicol 2021; 95:2895-2940. [PMID: 34100120 DOI: 10.1007/s00204-021-03083-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023]
Abstract
Cathinone, the main psychoactive compound found in the plant Catha edulis Forsk. (khat), is a β-keto analogue of amphetamine, sharing not only the phenethylamine structure, but also the amphetamine-like stimulant effects. Synthetic cathinones are derivatives of the naturally occurring cathinone that largely entered the recreational drug market at the end of 2000s. The former "legal status", impressive marketing strategies and their commercial availability, either in the so-called "smartshops" or via the Internet, prompted their large spread, contributing to their increasing popularity in the following years. As their popularity increased, the risks posed for public health became clear, with several reports of intoxications and deaths involving these substances appearing both in the social media and scientific literature. The regulatory measures introduced thereafter to halt these trending drugs of abuse have proved to be of low impact, as a continuous emergence of new non-controlled derivatives keep appearing to replace those prohibited. Users resort to synthetic cathinones due to their psychostimulant properties but are often unaware of the dangers they may incur when using these substances. Therefore, studies aimed at unveiling the pharmacological and toxicological properties of these substances are imperative, as they will provide increased expertise to the clinicians that face this problem on a daily basis. The present work provides a comprehensive review on history and legal status, chemistry, pharmacokinetics, pharmacodynamics, adverse effects and lethality in humans, as well as on the current knowledge of the neurotoxic mechanisms of synthetic cathinones.
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Affiliation(s)
- Jorge Soares
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal.
| | - Vera Marisa Costa
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Maria de Lourdes Bastos
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Félix Carvalho
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - João Paulo Capela
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal.
- FP-ENAS (Fernando Pessoa Energy, Environment and Health Research Unit), CEBIMED (Biomedical Research Centre), Faculty of Health Sciences, University of Fernando Pessoa, Porto, Portugal.
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10
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de Moura FB, Sherwood A, Prisinzano TE, Paronis CA, Bergman J, Kohut SJ. Reinforcing effects of synthetic cathinones in rhesus monkeys: Dose-response and behavioral economic analyses. Pharmacol Biochem Behav 2021; 202:173112. [PMID: 33444603 DOI: 10.1016/j.pbb.2021.173112] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/31/2020] [Accepted: 12/31/2020] [Indexed: 12/12/2022]
Abstract
The abuse of synthetic cathinones ("bath salts") with psychomotor stimulant and/or entactogenic properties emerged as a public health concern when they were introduced as "legal" alternatives to drugs of abuse such as cocaine or MDMA. In this study, experiments were conducted in nonhuman primates to examine how differences in transporter selectivity might impact the reinforcing effects of synthetic cathinones. Rhesus monkeys (N = 5) were trained to respond for intravenous injections under a fixed-ratio (FR) 30, timeout 60-s schedule of reinforcement. The reinforcing effects of selected cathinones (e.g., MDPV, αPVP, MCAT, and methylone) with a range of pharmacological effects at dopamine and serotonin transporters were compared to cocaine and MDMA using dose-response analysis under a simple FR schedule and behavioral economic procedures that generated demand curves for two doses of each drug. Results show that one or more doses of all drugs were readily self-administered in each subject and, excepting MDMA (21 injections/session), peak levels of self-administration were similar across drugs (between 30 and 40 injections/session). Demand elasticity for the peak and the peak + 1/2-log dose of each drug did not significantly differ, and when data for the two doses were averaged for each drug, the following rank-order of reinforcing strength emerged: cocaine > MCAT = MDPV = methylone > αPVP = MDMA. These results indicate that the reinforcing strength of synthetic cathinones are not related to their selectivity in binding dopamine or serotonin transporter sites.
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Affiliation(s)
- Fernando B de Moura
- Behavioral Biology Program, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | | | - Thomas E Prisinzano
- College of Pharmacy, University of Kentucky, 789 S. Limestone Street, Lexington, KY 40536, USA
| | - Carol A Paronis
- Behavioral Biology Program, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Jack Bergman
- Behavioral Biology Program, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Stephen J Kohut
- Behavioral Biology Program, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
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11
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Stogner J, Miller BL. Exploring the Relationships between Sexual Orientation and Gender Identity and Youth Synthetic Cannabinoid Use. Subst Use Misuse 2021; 56:327-332. [PMID: 33353471 DOI: 10.1080/10826084.2020.1858105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Purpose: Existing studies have identified sexual minorities as being at enhanced risk for reporting synthetic cannabinoid (SC) use. It is unclear whether this association is the result of those that identify as a minority due to sexual orientation being more likely to use SCs, due to those that identify as transgender using SCs more, or both. Deconstructing this relationship will allow for targeted clinical advice and public health campaigns. Methods: Data from the 2015 and 2017 Youth Risk Behavior Study are utilized. In total, 31,279 youth were asked about their gender identity, sexual orientation, and SC use history. Bivariate analyses and logistic regression models were completed to explore relevant associations. Results: Identifying as lesbian, gay, bisexual, or questioning was linked to SC use and continuing SC use. Similarly, identifying as transgender was linked to SC use and continuing use. Regression analyses showed no significant interactive effect; identifying as both LGBQ and transgender does not have a compounding effect on use likelihood. Conclusions: Both sexual orientation and gender identity contribute to the relationship between sexual minority status and SC use noted in extant literature. This relationship is hypothesized to be tied to increased exposure to discrimination, victimization, and social isolation. Thus, efforts to directly counsel LGBTQ patients about the dangers associated with SC use are warranted as well as social policy reforms to better protect and support members of the LGBTQ community.
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Affiliation(s)
- John Stogner
- Criminal Justice and Criminology, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
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12
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Ciallella HL, Rutter LR, Nisbet LA, Scott KS. Extended Stability Evaluation of Selected Cathinones. Front Chem 2020; 8:597726. [PMID: 33304885 PMCID: PMC7692403 DOI: 10.3389/fchem.2020.597726] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/13/2020] [Indexed: 01/06/2023] Open
Abstract
Understanding the stability of drugs in a forensic toxicology setting is critical for the evaluation of drug concentrations. Synthetic cathinones are new psychoactive substances structurally derived from cathinone, the psychoactive component of Catha edulis ("khat"), a shrub that is indigenous to the Middle East and East Africa. Previous research has evaluated the stability of synthetic cathinones in biological matrices, including blood preserved with the combination of NaF and K2C2O4 used in gray-top tubes. However, it does not assess their stability in blood preserved with Na2EDTA, used for some clinical samples. Further, stability in unpreserved urine samples was only studied for two weeks. This research evaluates the stabilities of four Schedule I synthetic cathinones: mephedrone, MDPV (3,4-methylenedioxypyrovalerone), naphyrone, and α-PVP (alpha-pyrrolidinopentiophenone) at 20°C (room temperature), 4°C (refrigerator), and -20°C (freezer). Stability was assessed in methanolic and acetonitrile solutions, as well as in Na2EDTA-preserved blood and unpreserved urine. Solutions (1 mg/L) of each drug in each matrix stored in aliquots (100 μL, solvents; 1.2 mL, biological samples; n = 12) at each of the three temperatures for triplicate analysis on days 3, 7, 14, and 30. On day 0 of each study, three additional aliquots of each solution were analyzed. Biological samples underwent solid-phase extraction before analysis. All samples were analyzed in full-scan by gas chromatography-mass spectrometry (GC-MS). The results of this study show that under room temperature and refrigerator storage conditions, mephedrone, naphyrone, and MDPV will degrade in methanol. This degradation starts are early as day 3. Additionally, all four drugs will degrade in Na2EDTA-preserved human whole blood samples in at least one evaluated storage environment. However, when in acetonitrile-based working solutions and unpreserved urine samples, they proved to be more stable. Methanolic working solutions and samples of Na2EDTA-preserved blood containing these cathinones should be stored in the freezer and used or tested with urgency to ensure that quantitative sample analysis is as accurate as possible in forensic casework.
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Affiliation(s)
- Heather L. Ciallella
- Forensic Science, Department of Chemistry and Physics, Arcadia University, Glenside, PA, United States
| | - Lexus R. Rutter
- Forensic Science, Department of Chemistry and Physics, Arcadia University, Glenside, PA, United States
| | - Lorna A. Nisbet
- Forensic and Investigative Science, School of Life Science, Anglia Ruskin University, Cambridge, United Kingdom
| | - Karen S. Scott
- Forensic Science, Department of Chemistry and Physics, Arcadia University, Glenside, PA, United States
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13
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El Balkhi S, Monchaud C, Herault F, Géniaux H, Saint-Marcoux F. Designer benzodiazepines' pharmacological effects and potencies: How to find the information. J Psychopharmacol 2020; 34:1021-1029. [PMID: 31971477 DOI: 10.1177/0269881119901096] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Scientific data on the psychopharmacological effects of new psychoactive substances (NPSs) are scarce. Web fora contain a wealth of information posted by users as trip reports (TRs), but the reliability of the reports remains questionable because of the nature of the used molecule and the potential for dose inaccuracies. We focused on the TRs of designer benzodiazepine (DBZD) users since their psychopharmacological effects are similar to prescription benzodiazepines (BZDs). Moreover, the impact of functional groups on the BZD rings with regards to the potency has been fairly/quite studied, allowing structural analysis. METHODS DBZDs offering more than 15 TRs with at least two accounts on experienced effects were included. Data were analyzed with the empirical phenomenological psychological method. Reported effects were analyzed and the pharmacological potencies of DBZDs were compared by calculating a 'potency score'. RESULTS In total, 197 TRs for clonazolam, deschloroetizolam, diclazepam, etizolam, flubromazepam, flubromazolam, meclonazepam, metizolam, nifoxipam and pyrazolam were analyzed. Effects similar to prescription BZDs were reported for all the selected DBZDs. Pyrazolam was reported to be the most anxiolytic DBZD, flubromazolam the most hypnotic, etizolam the most euphoric and flubromazolam and clonazolam as the most amnesic DBZDs. Diclazepam and pyrazolam were not reported to induce euphoria. Flubromazepam, flubromazolam, clonazolam and meclonazepam were the most potent and deschloroetizolam, nifoxipam, metizolam and pyrazolam the least potent. The chemical structure of the different DBZDs and the functional groups on the BZD rings confirmed this ranking, except for nifoxipam. CONCLUSIONS When information on NPSs obtained from Internet fora are abundant, it could be considered as an appreciable data source.
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Affiliation(s)
- Souleiman El Balkhi
- Department of Pharmacology, Toxicology and Pharmacovigilance, Limoges University Hospital, Limoges, France.,INSERM, 1248 UMR, Limoges, France
| | - Caroline Monchaud
- Department of Pharmacology, Toxicology and Pharmacovigilance, Limoges University Hospital, Limoges, France.,INSERM, 1248 UMR, Limoges, France
| | | | - Hélène Géniaux
- Department of Pharmacology, Toxicology and Pharmacovigilance, Limoges University Hospital, Limoges, France
| | - Franck Saint-Marcoux
- Department of Pharmacology, Toxicology and Pharmacovigilance, Limoges University Hospital, Limoges, France.,INSERM, 1248 UMR, Limoges, France.,University of Limoges, Faculty of Pharmacy, Limoges, France
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14
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Archer JRH, Mendes F, Hudson S, Layne K, Dargan PI, Wood DM. Evaluation of long-term detection trends of new psychoactive substances in pooled urine from city street portable urinals (London, UK). Br J Clin Pharmacol 2020; 86:517-527. [PMID: 32050035 DOI: 10.1111/bcp.14239] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/03/2020] [Accepted: 01/12/2020] [Indexed: 11/28/2022] Open
Abstract
AIMS To evaluate the long-term trends of new psychoactive substance (NPS) detection in pooled urine samples collected across a city centre. METHODS Pooled urine samples from portable stand-alone urinals were collected on a monthly basis over 5.5 years (July 2013-December 2018) across a city centre. These were analysed using a high-performance liquid chromatography system, interfaced to a high-resolution accurate mass spectrometer. Data were processed against a database containing over 2000 drugs/metabolites including over 800 NPS. RESULTS In total, 44 NPS were detected with variation over time including cathinones (15, 34.1%), synthetic cannabinoids (8, 18.2%) and 21 (47.7%) other NPS. Since the introduction of the UK Psychoactive Substances Act (May 2016) cathinone detection has decreased with minimal detection over the last 4 months of the study. Synthetic cannabinoids were not detected on a regular basis until July 2016 with a subsequent variable detection frequency. There was a consistent, low level detection frequency of all other NPS throughout the study, but which appears to have increased alongside the decrease in cathinone detection. CONCLUSION Pooled urine analysis of samples taken from portable urinals in a city centre can be used as an effective monitoring tool to determine long-term trends in the use of NPS. The results of this study demonstrate the impact of the Psychoactive Substances Act and reflect the findings of population surveys and clinical studies. Triangulation of these data with other data sources will enable greater insight into the NPS phenomenon.
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Affiliation(s)
- John R H Archer
- Department of 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
| | - Fiona Mendes
- Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - Simon Hudson
- Laboratory and Managed Services, LGC, Fordham, UK
| | - Kerry Layne
- Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - Paul I Dargan
- Department of 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
| | - David M Wood
- Department of 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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15
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Armenta S, Gil C, Ventura M, Esteve-Turrillas FA. Unexpected identification and characterization of a cathinone precursor in the new psychoactive substance market: 3′,4′-methylenedioxy-2,2-dibromobutyrophenone. Forensic Sci Int 2020; 306:110043. [DOI: 10.1016/j.forsciint.2019.110043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
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16
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Peacock A, Bruno R, Gisev N, Degenhardt L, Hall W, Sedefov R, White J, Thomas KV, Farrell M, Griffiths P. New psychoactive substances: challenges for drug surveillance, control, and public health responses. Lancet 2019; 394:1668-1684. [PMID: 31668410 DOI: 10.1016/s0140-6736(19)32231-7] [Citation(s) in RCA: 150] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 06/05/2019] [Accepted: 08/08/2019] [Indexed: 12/30/2022]
Abstract
The rapid emergence since the mid-2000s of a large and diverse range of substances originally designed as legal alternatives to more established illicit drugs (pragmatically clustered and termed new psychoactive substances; [NPS]) has challenged traditional approaches to drug monitoring, surveillance, control, and public health responses. In this section of the Series, we describe the emergence of NPS and consider opportunities for strengthening the detection, identification, and responses to future substances of concern. First, we explore the definitional complexity of the term NPS. Second, we describe the origins and drivers surrounding NPS, including motivations for use. Third, we summarise evidence on NPS availability, use, and associated harms. Finally, we use NPS as a case example to explore challenges and opportunities for future drug monitoring, surveillance, control, and public health responses. We posit that the current means of responding to emerging substances might no longer be fit for purpose in a world in which different substances can be rapidly introduced, and where people who use drugs can change preferences on the basis of market availability.
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Affiliation(s)
- Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia; School of Psychology, University of Tasmania, Hobart, TAS, Australia.
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia; School of Psychology, University of Tasmania, Hobart, TAS, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Wayne Hall
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD, Australia; Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Roumen Sedefov
- European Monitoring Centre on Drugs and Drug Addiction, Lisbon, Portugal
| | - Jason White
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
| | - Kevin V Thomas
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Paul Griffiths
- European Monitoring Centre on Drugs and Drug Addiction, Lisbon, Portugal
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Abstract
The Swedish STRIDA project on new psychoactive substances (NPS) monitored the occurrence and health hazards of novel recreational drugs in Sweden through evaluation of analytically confirmed adverse events presenting in emergency departments and intensive care units. During a ~6-year period from 2010 to early 2016, about 2,600 cases of suspected NPS intoxications were included in the project. About 75% of patients were men and the total age range was 8-71 (median 24) years and 57% were 25 years or younger. A large number of NPS belonging to many different drug classes were identified in project samples of urine and blood (serum/plasma) submitted for free drug testing, including synthetic cannabinoid receptor agonists, stimulants, cathinones, hallucinogens, dissociative drugs, benzodiazepines, and opioids, and also in drug materials from the cases forwarded to the laboratory along with the biological samples. The STRIDA project has been shown to serve as an effective early warning system for NPS by collecting data on incidence, distribution, and adverse effects and has supported healthcare professionals in the knowledge and critical care of intoxications caused by a wide range of novel substances. The results of the STRIDA project have also illustrated how drug regulations can drive the NPS market.
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18
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Effects of cocaine on the discriminative stimulus and reinforcing effects of mephedrone in male rats. Psychopharmacology (Berl) 2019; 236:1043-1056. [PMID: 30448991 DOI: 10.1007/s00213-018-5110-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/05/2018] [Indexed: 12/21/2022]
Abstract
RATIONALE Abuse of cathinones has been a worldwide health concern for some time. Their chemical structures and wide variation in pharmacodynamic effects have led to clinical and preclinical effects that can be both similar to and different from other psychoactive substances such as methylenedioxymethamphetamine (MDMA), methamphetamine, and cocaine. OBJECTIVE The present study examined the discriminative stimulus and reinforcing effects of mephedrone to further characterize the behavioral and pharmacological profile of this first-generation substituted methcathinone. METHODS Rats were trained to discriminate mephedrone (3.2 mg/kg) from saline under a fixed-ratio 20 (FR-20) schedule of food presentation. After establishing dose-effect curves for increasing cumulative doses of mephedrone, substitution tests were conducted with bupropion (5.6-32 mg/kg), cocaine (1.8-18 mg/kg), morphine (0.56-10 mg/kg), and amitriptyline (3.2-32 mg/kg). In addition, cocaine (3.2-18 mg/kg) and the serotonin type-2 (5-HT2) receptor antagonist ritanserin (1, 3.2, and 10 mg/kg) were administered prior to the cumulative doses of mephedrone. Lastly, varying infusion doses of cocaine were substituted for mephedrone in subjects trained to self-administer mephedrone, and varying infusion doses of mephedrone were substituted for cocaine in subjects trained to self-administer cocaine to assess the importance of drug history on the reinforcing effects of mephedrone. RESULTS Of the drugs tested, cocaine had the highest level of mephedrone-lever responding when administered alone (73.5%). In combination with mephedrone, cocaine shifted the mephedrone dose-effect curve upwards in an infra-additive manner. Ritanserin had a small, but non-significant, effect on mephedrone's discriminative stimulus effects. An extensive history (baseline) of cocaine self-administration increased mephedrone self-administration compared to that obtained in mephedrone-trained subjects, whereas a baseline of mephedrone self-administration decreased cocaine self-administration compared to that obtained in cocaine-trained subjects. CONCLUSION The similarity between the discriminative stimulus effects of cocaine and mephedrone in male rats suggests an important overlap and the relative importance of the dopamine (DAT) and serotonin (SERT) transporters. The self-administration data suggest that mephedrone is less reinforcing than cocaine, but that a history of responding for cocaine can increase the reinforcing effects of mephedrone.
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Behavioral economic analysis of the reinforcing effects of "bath salts" mixtures: studies with MDPV, methylone, and caffeine in male Sprague-Dawley rats. Psychopharmacology (Berl) 2019; 236:1031-1041. [PMID: 30267131 PMCID: PMC6440875 DOI: 10.1007/s00213-018-5046-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/19/2018] [Indexed: 10/28/2022]
Abstract
RATIONALE "Bath salts" preparations often contain combinations of synthetic cathinones (e.g., 3,4-methylenedioxymethcathinone [methylone], 3,4-methylenedioxypyrovalerone [MDPV]), and caffeine, and evidence suggests that mixtures of synthetic cathinones and caffeine (e.g., MDPV + caffeine or methylone + caffeine) can be more potent and/or effective reinforcers than predicted for an additive interaction. OBJECTIVE To use demand curve analyses to compare the reinforcing effectiveness of MDPV and methylone to mixtures of MDPV + caffeine and methylone + caffeine. METHODS Male Sprague-Dawley rats acquired methylone self-administration (0.32 mg/kg/inf) under a fixed ratio (FR) 1 schedule of reinforcement and generated full dose-response curves for methylone (0.01-1 mg/kg/inf) under an FR5 schedule of reinforcement. Demand curves were then obtained for methylone, MDPV, caffeine, and methylone + caffeine and MDPV + caffeine mixtures by increasing the FR across sessions according to the following series: 3, 10, 18, 32, 56, 100, 178, etc. RESULTS: Self-administration of methylone was rapidly acquired by 87.5% of rats and was maintained across a range of doses, producing an inverted U-shaped dose-response curve. Rank order demand for the individual constituents was MDPV > methylone > caffeine. Demand for the 3:1 (but not 10:1) methylone + caffeine mixture was greater than that for methylone alone, and demand for MDPV alone was similar to both MDPV + caffeine mixtures evaluated. CONCLUSIONS These studies provide additional evidence that although methylone is an effective reinforcer, combining methylone with caffeine results in an enhanced reinforcing effectiveness compared to methylone alone. Thus, abused "bath salts" preparations containing synthetic cathinones and caffeine may have higher abuse liability than preparations containing only synthetic cathinones.
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20
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White JC, Wood DM, Hill SL, Eddleston M, Officer J, Dargan PI, Dunn M, Thomas SH. Acute toxicity following analytically confirmed use of the novel psychoactive substance (NPS) methiopropamine. A report from the Identification of Novel psychoActive substances (IONA) study. Clin Toxicol (Phila) 2019; 57:663-667. [DOI: 10.1080/15563650.2018.1538519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Joanna C. White
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - David M. Wood
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Simon L. Hill
- Clinical Toxicology, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | | | - Jane Officer
- Scottish Police Authority, SPA Forensic Services, Edinburgh, UK
| | - Paul I. Dargan
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Michael Dunn
- NIHR Health Protection Research Unit for Chemical Threats and Hazards, Newcastle University, Newcastle, UK
| | - Simon H.L. Thomas
- Clinical Toxicology, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
- NIHR Health Protection Research Unit for Chemical Threats and Hazards, Newcastle University, Newcastle, UK
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21
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Fletcher EH, Tasker SM, Easton P, Denvir L. Improving the help and support provided to people who take new psychoactive substances ('legal highs'). J Public Health (Oxf) 2018; 38:e489-e495. [PMID: 28158593 DOI: 10.1093/pubmed/fdv191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E H Fletcher
- Public Health Directorate, NHS Tayside, Kings Cross Hospital, Dundee DD3 8EA, UK
| | - S M Tasker
- Public Health Directorate, NHS Tayside, Kings Cross Hospital, Dundee DD3 8EA, UK
| | - P Easton
- Public Health Directorate, NHS Tayside, Kings Cross Hospital, Dundee DD3 8EA, UK
| | - L Denvir
- Public Health Directorate, NHS Tayside, Kings Cross Hospital, Dundee DD3 8EA, UK
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Hunter AH, Ayres T, Moreland N, Cox A. Phantom menace: novel psychoactive substances and the UK Armed Forces. J ROY ARMY MED CORPS 2018; 164:450-457. [DOI: 10.1136/jramc-2018-000927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 11/04/2022]
Abstract
Novel psychoactive substances (NPS) encompass a large group of synthesised compounds specifically designed to mimic traditional recreational drugs. Current UK Armed Forces compulsory drug testing does not screen for these substances, making them tempting to the small proportion of UK Armed Forces personnel who indulge in recreational drug use. The acute and chronic sequelae of NPS misuse are widely variable and associated with high morbidity. In this paper, we discuss NPS pharmacology and clinical presentation. We describe toxidromes and management of patients who have misused NPS.Finally, we reflect on the legal, ethical and military consequences of NPS misuse for both the service person misusing NPS and the Military Physician providing their care.
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23
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Gannon BM, Galindo KI, Mesmin MP, Rice KC, Collins GT. Reinforcing Effects of Binary Mixtures of Common Bath Salt Constituents: Studies with 3,4-Methylenedioxypyrovalerone (MDPV), 3,4-Methylenedioxymethcathinone (methylone), and Caffeine in Rats. Neuropsychopharmacology 2018; 43:761-769. [PMID: 28677665 PMCID: PMC5809783 DOI: 10.1038/npp.2017.141] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/26/2017] [Accepted: 06/29/2017] [Indexed: 01/19/2023]
Abstract
Bath salts use is associated with high rates of abuse, toxicity, and death. Bath salt preparations often contain mixtures of drugs including multiple synthetic cathinones (eg, 3,4-methylenedioxypyrovalerone (MDPV) or 3,4-methylenedioxymethcathinone (methylone)) or synthetic cathinones and caffeine; however, little is known about whether interactions among bath salt constituents contribute to the abuse-related effects of bath salts preparations. This study used male Sprague-Dawley rats responding under a progressive ratio schedule to quantify the reinforcing effectiveness of MDPV, methylone, and caffeine, administered alone and as binary mixtures (n=12 per mixture). Each mixture was evaluated at four ratios (10 : 1, 3 : 1, 1 : 1, and 1 : 3) relative to the mean ED50 for each drug alone. Dose-addition analyses were used to determine the predicted, additive effect for each dose pair within each drug mixture. MDPV, methylone, and caffeine maintained responding in a dose-dependent manner, with MDPV being the most potent and effective, and caffeine being the least potent and effective of the three bath salts constituents. High levels of responding were also maintained by each of the bath salts mixtures. Although the nature of the interactions tended toward additivity for most bath salts mixtures, supra-additive (3 : 1 MDPV : caffeine, and 3 : 1 and 1 : 1 methylone : caffeine) and sub-additive (3 : 1, 1 : 1, and 1 : 3 MDPV : methylone) interactions were also observed. Together, these findings demonstrate that the composition of bath salts preparations can have an impact on both their reinforcing potency and effectiveness, and suggest that such interactions among constituent drugs could contribute to the patterns of use and effects reported by human bath salts users.
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Affiliation(s)
- Brenda M Gannon
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Kayla I Galindo
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Melson P Mesmin
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Kenner C Rice
- Molecular Targets and Medications Discovery Branch, NIDA and NIAAA, Bethesda, MD, USA
| | - Gregory T Collins
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA,South Texas Veterans Health Care System, San Antonio, TX, USA,Department of Pharmacology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MC# 7764, San Antonio, TX 78229, USA, Tel: +1 210 567 4199, Fax: +1 210 567 1581, E-mail:
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24
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Corazza O, Valeriani G, Bersani FS, Corkery J, Martinotti G, Bersani G, Schifano F. "Spice," "kryptonite," "black mamba": an overview of brand names and marketing strategies of novel psychoactive substances on the web. J Psychoactive Drugs 2018; 46:287-94. [PMID: 25188698 DOI: 10.1080/02791072.2014.944291] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
UNLABELLED Abstract Introduction: Novel Psychoactive Substances (NPSs) are often sold online as "legal" and "safer" alternatives to International Controlled Drugs (ICDs) with captivating marketing strategies. Our aim was to review and summarize such strategies in terms of the appearance of the products, the brand names, and the latest trends in the illicit online marketplaces. METHODS Scientific data were searched in PsychInfo and Pubmed databases; results were integrated with an extensive monitoring of Internet (websites, online shops, chat rooms, fora, social networks) and media sources in nine languages (English, French, Farsi, Portuguese, Arabic, Russian, Spanish, and Chinese simplified/traditional) available from secure databases of the Global Public Health Intelligence Network. RESULTS Evolving strategies for the online diffusion and the retail of NPSs have been identified, including discounts and periodic offers on chosen products. Advertisements and new brand names have been designed to attract customers, especially young people. An increased number of retailers have been recorded as well as new Web platforms and privacy systems. DISCUSSION NPSs represent an unprecedented challenge in the field of public health with social, cultural, legal, and political implications. Web monitoring activities are essential for mapping the diffusion of NPSs and for supporting innovative Web-based prevention programmes.
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Affiliation(s)
- Ornella Corazza
- a Principal Lecturer and Academic Research Lead, School of Life and Medical Sciences , University of Hertfordshire , Hertfordshire, UK
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25
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Smith DA, Negus SS, Poklis JL, Blough BE, Banks ML. Cocaine-like discriminative stimulus effects of alpha-pyrrolidinovalerophenone, methcathinone and their 3,4-methylenedioxy or 4-methyl analogs in rhesus monkeys. Addict Biol 2017; 22:1169-1178. [PMID: 27060605 DOI: 10.1111/adb.12399] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/25/2016] [Accepted: 03/01/2016] [Indexed: 01/20/2023]
Abstract
Synthetic cathinones are beta-ketone amphetamine analogs that have emerged as a heterogeneous class of abused compounds that function as either monoamine transporter substrates or inhibitors. Pre-clinical drug discrimination procedures are useful for interrogating structure-activity relationships of abuse-related drug effects; however, in vivo structure-activity relationship comparisons between synthetic cathinones with different mechanisms of action are lacking. The aim of the present study was to determine whether the cocaine-like discriminative stimulus effects of the monoamine transporter inhibitor alpha-pyrrolidinovalerophenone (alpha-PVP) and the monoamine transporter substrate methcathinone were differentially sensitive to 3,4-methylenedioxy and 4-methyl substitutions. Male rhesus monkeys (n = 4) were trained to discriminate intramuscular cocaine (0.32 mg/kg) from saline in a two-key food-reinforced discrimination procedure. Potency and timecourse of cocaine-like discriminative stimulus effects were determined for (±)-alpha-PVP, (±)-methcathinone and their 3,4-methylenedioxy or 4-methyl analogs. Alpha-PVP and methcathinone produced dose- and time-dependent cocaine-like effects. A 3,4-methylenedioxy addition to either alpha-PVP or methcathinone (methylone) did not alter the potency or efficacy to produce cocaine-like effects, but did prolong the time course. A 4-methyl addition to alpha-PVP (pyrovalerone) did not alter the potency or efficacy to produce cocaine-like effects, but did prolong the time course. In contrast, addition of a 4-methyl moiety to methcathinone (4MMC; mephedrone) significantly attenuated efficacy to produce cocaine-like effects. Overall, these results suggest different structural requirements for cocaine-like discriminative stimulus effects of monoamine transporter inhibitor and substrate synthetic cathinone analogs. Given that 4MMC is more hydrophobic than MDMC, these results suggest that hydrophobicity may be an important determinant for limiting monoamine transporter substrate abuse-related behavioral effects.
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Affiliation(s)
- Douglas A. Smith
- Department of Pharmacology and Toxicology; Virginia Commonwealth University; Richmond VA USA 23298
| | - S. Stevens Negus
- Department of Pharmacology and Toxicology; Virginia Commonwealth University; Richmond VA USA 23298
- Institute for Drug and Alcohol Studies; Virginia Commonwealth University; Richmond VA USA 23298
| | - Justin L. Poklis
- Department of Pharmacology and Toxicology; Virginia Commonwealth University; Richmond VA USA 23298
| | - Bruce E. Blough
- Center for Drug Discovery; Research Triangle Institute; Research Triangle Park NC USA 27709
| | - Matthew L. Banks
- Department of Pharmacology and Toxicology; Virginia Commonwealth University; Richmond VA USA 23298
- Institute for Drug and Alcohol Studies; Virginia Commonwealth University; Richmond VA USA 23298
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26
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Lantz SM, Rosas-Hernandez H, Cuevas E, Robinson B, Rice KC, Fantegrossi WE, Imam SZ, Paule MG, Ali SF. Monoaminergic toxicity induced by cathinone phthalimide: An in vitro study. Neurosci Lett 2017; 655:76-81. [PMID: 28684237 DOI: 10.1016/j.neulet.2017.06.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/21/2017] [Accepted: 06/30/2017] [Indexed: 12/26/2022]
Abstract
Bath salts, or synthetic cathinones, have cocaine-like or amphetamine-like properties and induce psychoactive effects via their capacity to modulate serotonin (5-HT) and dopamine (DA). Structurally distinct synthetic cathinones are continuously being generated to skirt existing drug laws. One example of these modified compounds is cathinone phthalimide (CP), which has already appeared on the global market. The lack of toxicological studies on the effects of CP on monoaminergic systems led to the development of the present study in order to generate an acute toxicity profile for CP, and to clarify whether it primarily affects both dopamine and serotonin, like the synthetic cathinones mephedrone and methylone, or primarily affects dopamine, like 3, 4-methylenedioxypyrovalerone (MDPV). For the first time, the toxicity profile of CP (10μM-1000μM) is reported. In pheochromocytoma cells, exposure to CP induced cell death, and altered mitochondrial function, as well as intracellular DA and 5-HT levels; at the same time, reduced glutathione (GSH) levels remained unaffected. This seems to indicate that CP functions like mephedrone or methylone. The role of CP metabolites, the effect of CP induced hyperthermia on neurotoxicity, and its ability to traverse the blood-brain barrier warrant further consideration.
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Affiliation(s)
- Susan M Lantz
- Neurochemistry Laboratory, Division of Neurotoxicology, National Center for Toxicological Research/FDA, 3900 NCTR Rd, HFT-132, Jefferson, AR, 72079, United States.
| | - Hector Rosas-Hernandez
- Neurochemistry Laboratory, Division of Neurotoxicology, National Center for Toxicological Research/FDA, 3900 NCTR Rd, HFT-132, Jefferson, AR, 72079, United States.
| | - Elvis Cuevas
- Neurochemistry Laboratory, Division of Neurotoxicology, National Center for Toxicological Research/FDA, 3900 NCTR Rd, HFT-132, Jefferson, AR, 72079, United States.
| | - Bonnie Robinson
- Neurochemistry Laboratory, Division of Neurotoxicology, National Center for Toxicological Research/FDA, 3900 NCTR Rd, HFT-132, Jefferson, AR, 72079, United States.
| | - Kenner C Rice
- Drug Design and Synthesis Section, Molecular Targets and Medications Discovery Branch, NIDA/NIAAA 9800 Medical Center Drive Rm 228A, MSC-3373, Bethesda, MD, 20892, United States.
| | - William E Fantegrossi
- Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States.
| | - Syed Z Imam
- Neurochemistry Laboratory, Division of Neurotoxicology, National Center for Toxicological Research/FDA, 3900 NCTR Rd, HFT-132, Jefferson, AR, 72079, United States.
| | - Merle G Paule
- Neurochemistry Laboratory, Division of Neurotoxicology, National Center for Toxicological Research/FDA, 3900 NCTR Rd, HFT-132, Jefferson, AR, 72079, United States.
| | - Syed F Ali
- Neurochemistry Laboratory, Division of Neurotoxicology, National Center for Toxicological Research/FDA, 3900 NCTR Rd, HFT-132, Jefferson, AR, 72079, United States.
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Assi S, Gulyamova N, Ibrahim K, Kneller P, Osselton D. Profile, effects, and toxicity of novel psychoactive substances: A systematic review of quantitative studies. Hum Psychopharmacol 2017. [PMID: 28631432 DOI: 10.1002/hup.2607] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate the profile, effects, and toxicity of novel psychoactive substances (NPS). METHODS A systematic literature review was conducted between May 2015 and February 2016 and included 19 databases. Search terms included "novel psychoactive substance(s)," "effect(s)," and "toxicity" and their synonyms. Studies included were those from any country, in any language, and between January 2007 and April 2015. Studies published before 2007 and those regarding the synthesis of NPS were excluded. Data were extracted by evaluating the titles, abstract, and full text, respectively. Consequently, the extraction yielded 20 studies. RESULTS Forty-three NPS derivatives of 8 main pharmacological classes were identified. NPS were mostly used among young adults and adults within the age range of 16-64 years old. Cathinones and synthetic cannabinoids were the most prevalent among the aforementioned classes. The main desired effects of NPS use were empathy and increased ability to socialise. Reported toxicity associated with the use of NPS included cardiovascular, neurological, and psychoactive adverse reactions. CONCLUSIONS Despite the unique subjective effects associated with the use of NPS, harmful effects could be severe and/or lethal. Therefore, there is a need to develop research in the area of NPS and promote awareness among healthcare professionals.
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Affiliation(s)
- Sulaf Assi
- Department of Archaeology, Anthropology and Forensic Science, Bournemouth University, Poole, UK
| | - Nargilya Gulyamova
- Department of Archaeology, Anthropology and Forensic Science, Bournemouth University, Poole, UK
| | - Kinda Ibrahim
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Paul Kneller
- Department of Archaeology, Anthropology and Forensic Science, Bournemouth University, Poole, UK
| | - David Osselton
- Department of Archaeology, Anthropology and Forensic Science, Bournemouth University, Poole, UK
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28
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Orsolini L, Papanti D, Corkery J, Schifano F. An insight into the deep web; why it matters for addiction psychiatry? Hum Psychopharmacol 2017; 32. [PMID: 28657187 DOI: 10.1002/hup.2573] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/07/2017] [Accepted: 01/13/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Nowadays, the web is rapidly spreading, playing a significant role in the marketing or sale or distribution of "quasi" legal drugs, hence facilitating continuous changes in drug scenarios. The easily renewable and anarchic online drug-market is gradually transforming indeed the drug market itself, from a "street" to a "virtual" one, with customers being able to shop with a relative anonymity in a 24-hr marketplace. The hidden "deep web" is facilitating this phenomenon. The paper aims at providing an overview to mental health's and addiction's professionals on current knowledge about prodrug activities on the deep web. METHODS A nonparticipant netnographic qualitative study of a list of prodrug websites (blogs, fora, and drug marketplaces) located into the surface web was here carried out. A systematic Internet search was conducted on Duckduckgo® and Google® whilst including the following keywords: "drugs" or "legal highs" or "Novel Psychoactive Substances" or "NPS" combined with the word deep web. RESULTS Four themes (e.g., "How to access into the deepweb"; "Darknet and the online drug trading sites"; "Grams-search engine for the deep web"; and "Cryptocurrencies") and 14 categories were here generated and properly discussed. CONCLUSIONS This paper represents a complete or systematical guideline about the deep web, specifically focusing on practical information on online drug marketplaces, useful for addiction's professionals.
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Affiliation(s)
- Laura Orsolini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, College Lane Campus, University of Hertfordshire, Hatfield, Herts, UK.,Villa San Giuseppe Hospital, Hermanas Hospitalarias, Ascoli Piceno, Italy.,Polyedra Research, Teramo, Italy
| | - Duccio Papanti
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, College Lane Campus, University of Hertfordshire, Hatfield, Herts, UK
| | - John Corkery
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, College Lane Campus, University of Hertfordshire, Hatfield, Herts, UK
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, College Lane Campus, University of Hertfordshire, Hatfield, Herts, UK
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29
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Guirguis A, Corkery JM, Stair JL, Kirton SB, Zloh M, Schifano F. Intended and unintended use of cathinone mixtures. Hum Psychopharmacol 2017; 32. [PMID: 28657191 DOI: 10.1002/hup.2598] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Cathinones are one of the most popular categories of new psychoactive substances (NPS) consumed. Cathinones have different pharmacological activities and receptor selectivity for monoamine transporters based on their chemical structures. They are incorporated into NPS mixtures and used with other NPS or 'traditional' drugs. Cathinone use represents significant health risks to individuals and is a public health burden. METHODS Evidence of poly-NPS use with cathinones, seizure information, and literature analyses results on NPS mixtures was systematically gathered from online database sources, including Google Scholar, Scopus, Bluelight, and Drugs-Forum. RESULTS AND DISCUSSION Results highlight the prevalence of NPS with low purity, incorporation of cathinones into NPS mixtures since 2008, and multiple members of the cathinone family being present in individual UK-seized samples. Cathinones were identified as adulterants in NPS marketed as being pure NPS, drugs of abuse, branded products, herbal blends, and products labelled "not for human consumption." Toxicity resulting from cathinone mixtures is unpredictable because key attributes remain largely unknown. Symptoms of intoxication include neuro-psychological, psychiatric, and metabolic symptoms. Proposed treatment includes holistic approaches involving psychosocial, psychiatric and pharmacological interventions. CONCLUSION Raising awareness of NPS, education, and training of health care professionals are paramount in reducing harms related to cathinone use.
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Affiliation(s)
- Amira Guirguis
- School of Life and Medical Sciences, Department of Pharmacy, Pharmacology & Postgraduate Medicine, University of Hertfordshire, Hatfield, UK.,Psychopharmaology, Drug Misuse, & Novel Psychoactive Substances Research Unit, University of Hertfordshire, Hatfield, UK
| | - John Martin Corkery
- School of Life and Medical Sciences, Department of Pharmacy, Pharmacology & Postgraduate Medicine, University of Hertfordshire, Hatfield, UK.,Psychopharmaology, Drug Misuse, & Novel Psychoactive Substances Research Unit, University of Hertfordshire, Hatfield, UK
| | - Jacqueline Leslie Stair
- School of Life and Medical Sciences, Department of Pharmacy, Pharmacology & Postgraduate Medicine, University of Hertfordshire, Hatfield, UK.,Psychopharmaology, Drug Misuse, & Novel Psychoactive Substances Research Unit, University of Hertfordshire, Hatfield, UK
| | - Stewart Brian Kirton
- School of Life and Medical Sciences, Department of Pharmacy, Pharmacology & Postgraduate Medicine, University of Hertfordshire, Hatfield, UK.,Psychopharmaology, Drug Misuse, & Novel Psychoactive Substances Research Unit, University of Hertfordshire, Hatfield, UK
| | - Mire Zloh
- School of Life and Medical Sciences, Department of Pharmacy, Pharmacology & Postgraduate Medicine, University of Hertfordshire, Hatfield, UK.,Psychopharmaology, Drug Misuse, & Novel Psychoactive Substances Research Unit, University of Hertfordshire, Hatfield, UK
| | - Fabrizio Schifano
- School of Life and Medical Sciences, Department of Pharmacy, Pharmacology & Postgraduate Medicine, University of Hertfordshire, Hatfield, UK.,Psychopharmaology, Drug Misuse, & Novel Psychoactive Substances Research Unit, University of Hertfordshire, Hatfield, UK
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30
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Corkery JM, Orsolini L, Papanti D, Schifano F. From concept(ion) to life after death/the grave: The 'natural' history and life cycle(s) of novel psychoactive substances (NPS). Hum Psychopharmacol 2017; 32. [PMID: 28657188 DOI: 10.1002/hup.2566] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/03/2016] [Accepted: 11/03/2016] [Indexed: 11/09/2022]
Abstract
A range of information needs should be met in order to better understand and predict the longevity/existence of novel psychoactive substances (NPS). This conceptual paper argues that one way of assessing how long a molecule may be around is to document how the life cycles or natural histories of 'traditional' drugs and NPS evolve. The earliest indication of the possible appearance of a new substance might be evidenced on the DeepWeb. However, this means they are less visible, in line with the clandestine nature of drug use and supply. Therefore, monitoring discussion groups/fora needs the development of new methods compared to those used in the Surface Net. Issues needing consideration in establishing NPS life cycles are outlined here, together with the probable outcomes that could result. The approach advocated means that it should be easier to identify which NPS are likely to come up or are emerging in real time, and, therefore, pre-empt/prevent their supply.
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Affiliation(s)
- John Martin Corkery
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, University of Hertfordshire, Hatfield, UK
| | - Laura Orsolini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, University of Hertfordshire, Hatfield, UK
| | - Duccio Papanti
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, University of Hertfordshire, Hatfield, UK
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, University of Hertfordshire, Hatfield, UK
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31
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Helander A, Bäckberg M, Signell P, Beck O. Intoxications involving acrylfentanyl and other novel designer fentanyls – results from the Swedish STRIDA project. Clin Toxicol (Phila) 2017; 55:589-599. [DOI: 10.1080/15563650.2017.1303141] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Anders Helander
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Clinical Pharmacology, Karolinska University Laboratory, Stockholm, Sweden
| | | | - Patrick Signell
- Clinical Pharmacology, Karolinska University Laboratory, Stockholm, Sweden
| | - Olof Beck
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Clinical Pharmacology, Karolinska University Laboratory, Stockholm, Sweden
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32
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Abouchedid R, Hudson S, Thurtle N, Yamamoto T, Ho JH, Bailey G, Wood M, Sadones N, Stove CP, Dines A, Archer JRH, Wood DM, Dargan PI. Analytical confirmation of synthetic cannabinoids in a cohort of 179 presentations with acute recreational drug toxicity to an Emergency Department in London, UK in the first half of 2015. Clin Toxicol (Phila) 2017; 55:338-345. [PMID: 28421836 DOI: 10.1080/15563650.2017.1287373] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
CONTEXT Synthetic cannabinoid receptor agonists are the largest group of new psychoactive substances reported in the last decade; in this study we investigated how commonly these drugs are found in patients presenting to the Emergency Department with acute recreational drug toxicity. METHODS We conducted an observational cohort study enrolling consecutive adult patients presenting to an Emergency Department (ED) in London (UK) January-July 2015 (6 months) with acute recreational drug toxicity. Residual serum obtained from a serum sample taken as part of routine clinical care was analyzed using high-resolution accurate mass-spectrometry with liquid-chromatography (HRAM-LCMSMS). Minimum clinical data were obtained from ED medical records. RESULTS 18 (10%) of the 179 patient samples were positive for synthetic cannabinoid receptor agonists. The most common was 5F AKB-48 (13 samples, concentration 50-7600 pg/ml), followed by 5F PB-22 (7, 30-400 pg/mL), MDMB-CHMICA (7, 80-8000 pg/mL), AB-CHMINACA (3, 50-1800 pg/mL), Cumyl 5F-PINACA (1, 800 pg/mL) and BB-22 (1, 60 pg/mL). Only 9/18 (50%) in whom synthetic cannabinoid receptor agonists were detected self-reported synthetic cannabinoid receptor agonist use. The most common clinical features were seizures and agitation, both recorded in four (22%) individuals. Fourteen patients (78%) were discharged from the ED, one of the four admitted to hospital was admitted to critical care. CONCLUSIONS Synthetic cannabinoid receptor agonists were found in 10% of this cohort with acute recreational drug toxicity but self-reported in only half of these. This suggests that presentations to the ED with acute synthetic cannabinoid receptor agonist toxicity may be more common than reported.
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Affiliation(s)
- Rachelle Abouchedid
- a Clinical Toxicology , Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - Simon Hudson
- b Laboratory and Managed Services , LGC Ltd , Fordham , Cambridgeshire, UK
| | - Natalie Thurtle
- a Clinical Toxicology , Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - Takahiro Yamamoto
- a Clinical Toxicology , Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - James H Ho
- a Clinical Toxicology , Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - George Bailey
- a Clinical Toxicology , Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - Michelle Wood
- c Department of Health Sciences , Waters Corporation , Wilmslow , Cheshire, UK
| | - Nele Sadones
- d Laboratory of Toxicology , Ghent University , Ghent , Belgium
| | | | - Alison Dines
- a Clinical Toxicology , Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - John R H Archer
- a Clinical Toxicology , Guy's and St Thomas' NHS Foundation Trust , London , UK.,e Faculty of Life Sciences and Medicine , King's College London , London , UK
| | - David M Wood
- a Clinical Toxicology , Guy's and St Thomas' NHS Foundation Trust , London , UK.,e Faculty of Life Sciences and Medicine , King's College London , London , UK
| | - Paul I Dargan
- a Clinical Toxicology , Guy's and St Thomas' NHS Foundation Trust , London , UK.,e Faculty of Life Sciences and Medicine , King's College London , London , UK
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Batisse A, Marillier M, Chevallier C, Bourgogne E, Grégoire M, Laprévote O, Djezzar S. “NRG-3”: What's in this? TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2017. [DOI: 10.1016/j.toxac.2016.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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34
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"Being with a Buddha": A Case Report of Methoxetamine Use in a United States Veteran with PTSD. Case Rep Psychiatry 2017; 2017:2319094. [PMID: 28251011 PMCID: PMC5303589 DOI: 10.1155/2017/2319094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 01/11/2017] [Indexed: 12/31/2022] Open
Abstract
Methoxetamine (MXE) is a ketamine analogue with a high affinity for the N-methyl-D-aspartate (NMDA) receptor. MXE is a newly emerging designer drug of abuse and is widely available through on-line sources and is not detected by routine urine drug screens. In this report, we describe a United States (US) veteran with posttraumatic stress disorder (PTSD) and heavy polysubstance use, who injected high dose MXE for its calming effect. Given MXE's structural similarities to ketamine and recent work showing that ketamine reduces PTSD symptoms, we hypothesize that MXE alleviated this veteran's PTSD symptoms through action at the NMDA receptor and via influences on brain-derived neurotrophic factor (BDNF). To our knowledge, this is the first case report of self-reported use of MXE in the US veteran population. More awareness of designer drugs, such as MXE, is an important first step in engaging patients in the treatment of designer drug addiction in both military/veteran settings and civilian settings.
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Guerrieri D, Rapp E, Roman M, Druid H, Kronstrand R. Postmortem and Toxicological Findings in a Series of Furanylfentanyl-Related Deaths. J Anal Toxicol 2017; 41:242-249. [DOI: 10.1093/jat/bkw129] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 12/02/2016] [Indexed: 11/13/2022] Open
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Hassan Z, Bosch OG, Singh D, Narayanan S, Kasinather BV, Seifritz E, Kornhuber J, Quednow BB, Müller CP. Novel Psychoactive Substances-Recent Progress on Neuropharmacological Mechanisms of Action for Selected Drugs. Front Psychiatry 2017; 8:152. [PMID: 28868040 PMCID: PMC5563308 DOI: 10.3389/fpsyt.2017.00152] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/02/2017] [Indexed: 12/15/2022] Open
Abstract
A feature of human culture is that we can learn to consume chemical compounds, derived from natural plants or synthetic fabrication, for their psychoactive effects. These drugs change the mental state and/or the behavioral performance of an individual and can be instrumentalized for various purposes. After the emergence of a novel psychoactive substance (NPS) and a period of experimental consumption, personal and medical benefits and harm potential of the NPS can be estimated on evidence base. This may lead to a legal classification of the NPS, which may range from limited medical use, controlled availability up to a complete ban of the drug form publically accepted use. With these measures, however, a drug does not disappear, but frequently continues to be used, which eventually allows an even better estimate of the drug's properties. Thus, only in rare cases, there is a final verdict that is no more questioned. Instead, the view on a drug can change from tolerable to harmful but may also involve the new establishment of a desired medical application to a previously harmful drug. Here, we provide a summary review on a number of NPS for which the neuropharmacological evaluation has made important progress in recent years. They include mitragynine ("Kratom"), synthetic cannabinoids (e.g., "Spice"), dimethyltryptamine and novel serotonergic hallucinogens, the cathinones mephedrone and methylone, ketamine and novel dissociative drugs, γ-hydroxybutyrate, γ-butyrolactone, and 1,4-butanediol. This review shows not only emerging harm potentials but also some potential medical applications.
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Affiliation(s)
- Zurina Hassan
- Centre for Drug Research, Universiti Sains Malaysia, Minden, Malaysia
| | - Oliver G Bosch
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Darshan Singh
- Centre for Drug Research, Universiti Sains Malaysia, Minden, Malaysia
| | - Suresh Narayanan
- School of Social Sciences, Universiti Sains Malaysia, Minden, Malaysia
| | | | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Boris B Quednow
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Christian P Müller
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Abstract
Novel psychoactive drugs (NPDs), an emerging class of dangerous substances, generally mimic the actions of commonly abused substances such as marijuana, stimulants, hallucinogens, and opiates, but are formulated, marketed, and used either to sidestep legal restrictions or to avoid positive drug screens. Synthetic cannabinoids such as Spice and K2 along with synthetic stimulants often referred to as “bath salts” have recently entered U.S. markets. The current study explores the relationship between being arrested and using NPDs per self-report survey data obtained from 2,349 students at a large university in the Southeastern United States. Respondents indicated whether they had used synthetic psychoactive drugs, reported demographic characteristics, and whether they had been arrested for a number of offenses. Results from logistic regression and propensity score matching models indicate that those who have been arrested are also more likely to use NPDs.
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Helander A, Bradley M, Hasselblad A, Norlén L, Vassilaki I, Bäckberg M, Lapins J. Acute skin and hair symptoms followed by severe, delayed eye complications in subjects using the synthetic opioid MT-45. Br J Dermatol 2016; 176:1021-1027. [PMID: 27976363 DOI: 10.1111/bjd.15174] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND The introduction of unclassified new psychoactive substances (NPS) on the recreational drugs market through open online sale ('legal highs' or 'Internet drugs') continues unabated and represents a growing health hazard. The use of NPS has resulted in numerous, severe, adverse events and fatalities, due to unintended overdose or unknown toxic side-effects. OBJECTIVES To try to find a possible common underlying cause for the skin-hair-eye symptoms complex observed in three men. METHODS From late 2013 to mid-2014, three Swedish men aged 23-34 years with a history of recreational drug use independently presented with similar and very remarkable clinical signs, requiring extensive examination and prolonged treatment. RESULTS Common clinical signs included hair depigmentation, hair loss, widespread folliculitis and dermatitis, painful intertriginous dermatitis, dry eyes, and elevated liver enzymes. Two of them also showed transverse white Mees' lines (leukonychia striata) on the fingernails and toenails, suggesting a temporary, drug-induced, disorganized keratinization. The clinical signs gradually disappeared over time. However, later on, two developed severe bilateral secondary cataracts requiring surgery. Because drug tests within the Swedish STRIDA project had demonstrated intake of the NPS opioid MT-45 in all patients, this was suspected to be the common causative agent. CONCLUSIONS These cases highlight the importance for physicians and health professionals to consider the increasing number of novel, untested recreational drugs, as a potential cause of unusual and otherwise unrecognized clinical signs and symptoms.
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Affiliation(s)
- A Helander
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Departments of Clinical Chemistry and Clinical Pharmacology, Karolinska University Laboratory, Stockholm, Sweden
| | - M Bradley
- Dermatology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - A Hasselblad
- Dermatology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - L Norlén
- Dermatology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - I Vassilaki
- Dermatopathology Service, Dermipath AB, Stockholm, Sweden
| | - M Bäckberg
- Swedish Poisons Information Centre, Stockholm, Sweden
| | - J Lapins
- Dermatology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
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Collins GT, Abbott M, Galindo K, Rush EL, Rice KC, France CP. Discriminative Stimulus Effects of Binary Drug Mixtures: Studies with Cocaine, MDPV, and Caffeine. J Pharmacol Exp Ther 2016; 359:1-10. [PMID: 27493274 DOI: 10.1124/jpet.116.234252] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 08/01/2016] [Indexed: 11/22/2022] Open
Abstract
Illicit drug preparations often include more than one pharmacologically active compound. For example, cocaine and synthetic cathinones [e.g., 3,4-methylenedioxypyrovalerone (MDPV)] are often mixed with caffeine before sale. Caffeine is likely added to these preparations because it is inexpensive and legal; however, caffeine might also mimic or enhance some of the effects of cocaine or MDPV. In these studies, male Sprague-Dawley rats were trained to discriminate 10 mg/kg cocaine from saline, and the discriminative stimulus effects of cocaine, caffeine, and MDPV were evaluated alone and as binary mixtures (cocaine and caffeine, MDPV and caffeine, and cocaine and MDPV) at fixed-dose ratios of 3:1, 1:1, and 1:3 relative to the dose of each drug that produced 50% cocaine-appropriate responding. Dose-addition analyses were used to determine the nature of the drug-drug interactions for each mixture (e.g., additive, supra-additive, or subadditive). Although additive interactions were observed for most mixtures, supra-additive interactions were observed at the 50% effect level for the 1:1 mixture of cocaine and caffeine and at the 80% effect level for all three mixtures of cocaine and caffeine, as well as for the 3:1 and 1:3 mixtures of cocaine and MDPV. These results demonstrate that with respect to cocaine-like discriminative stimulus effects, caffeine can function as a substitute in drug preparations containing either cocaine or MDPV, with enhancements of cocaine-like effects possible under certain conditions. Further research is needed to determine whether similar interactions exist for other abuse-related or toxic effects of drug preparations, including cocaine, synthetic cathinones, and caffeine.
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Affiliation(s)
- Gregory T Collins
- Departments of Pharmacology (G.T.C., M.A., K.G., E.L.R., C.P.F.) and Psychiatry (C.P.F.), University of Texas Health Science Center at San Antonio, and South Texas Veterans Health Care System (G.T.C.), San Antonio, Texas; and Chemical Biology Research Branch, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland (K.C.R.)
| | - Megan Abbott
- Departments of Pharmacology (G.T.C., M.A., K.G., E.L.R., C.P.F.) and Psychiatry (C.P.F.), University of Texas Health Science Center at San Antonio, and South Texas Veterans Health Care System (G.T.C.), San Antonio, Texas; and Chemical Biology Research Branch, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland (K.C.R.)
| | - Kayla Galindo
- Departments of Pharmacology (G.T.C., M.A., K.G., E.L.R., C.P.F.) and Psychiatry (C.P.F.), University of Texas Health Science Center at San Antonio, and South Texas Veterans Health Care System (G.T.C.), San Antonio, Texas; and Chemical Biology Research Branch, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland (K.C.R.)
| | - Elise L Rush
- Departments of Pharmacology (G.T.C., M.A., K.G., E.L.R., C.P.F.) and Psychiatry (C.P.F.), University of Texas Health Science Center at San Antonio, and South Texas Veterans Health Care System (G.T.C.), San Antonio, Texas; and Chemical Biology Research Branch, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland (K.C.R.)
| | - Kenner C Rice
- Departments of Pharmacology (G.T.C., M.A., K.G., E.L.R., C.P.F.) and Psychiatry (C.P.F.), University of Texas Health Science Center at San Antonio, and South Texas Veterans Health Care System (G.T.C.), San Antonio, Texas; and Chemical Biology Research Branch, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland (K.C.R.)
| | - Charles P France
- Departments of Pharmacology (G.T.C., M.A., K.G., E.L.R., C.P.F.) and Psychiatry (C.P.F.), University of Texas Health Science Center at San Antonio, and South Texas Veterans Health Care System (G.T.C.), San Antonio, Texas; and Chemical Biology Research Branch, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland (K.C.R.)
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Daveluy A, Castaing N, Cherifi H, Richeval C, Humbert L, Faure I, Labadie M, Allorge D, Haramburu F, Molimard M, Titier K. Acute Methiopropamine Intoxication After "Synthacaine" Consumption. J Anal Toxicol 2016; 40:758-760. [PMID: 27474360 DOI: 10.1093/jat/bkw073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 04/26/2016] [Accepted: 05/08/2016] [Indexed: 11/13/2022] Open
Abstract
Use of methiopropamine (MPA), a synthetic metamfetamine analog, has been detected since 2011 in Europe, but there is limited information on its acute toxicity. A 30-year-old man was admitted to the emergency department in a confused state, with paranoid delusion, auditory and visual hallucinatory experiences, and incoherent speech following the use of "synthacaine" (a slang term derived from "synthetic" and "cocaine"). Toxicological screening for pharmaceuticals and drugs of abuse by liquid chromatography-diode-array detector, gas chromatography-mass spectrometry and liquid chromatography-tandem mass spectrometry (LC-MS-MS) detected MPA, which was subsequently quantified by a specific LC-MS-MS method. Of note, 13 h after presentation to the emergency department, the plasma concentration of MPA was 14 ng/mL. This case report confirms the toxicity of MPA and the need for toxicological analysis to confirm the substance actually ingested by users of new psychoactive substances.
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Affiliation(s)
- A Daveluy
- Service de pharmacologie médicale, centre d'addictovigilance, CHU Bordeaux
| | - N Castaing
- Service de pharmacologie médicale, laboratoire de pharmacologie-toxicologie, CHU Bordeaux
| | | | - C Richeval
- CHU Lille, Unité Fonctionnelle de Toxicologie, F-59000 Lille, France
| | - L Humbert
- CHU Lille, Unité Fonctionnelle de Toxicologie, F-59000 Lille, France
| | - I Faure
- Service des urgences, CHU Bordeaux
| | | | - D Allorge
- CHU Lille, Unité Fonctionnelle de Toxicologie, F-59000 Lille, France
| | - F Haramburu
- Service de pharmacologie médicale, centre d'addictovigilance, CHU Bordeaux
| | - M Molimard
- Service de pharmacologie médicale, laboratoire de pharmacologie-toxicologie, CHU Bordeaux
| | - K Titier
- Service de pharmacologie médicale, laboratoire de pharmacologie-toxicologie, CHU Bordeaux
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In vitro hepatotoxicity of 'Legal X': the combination of 1-benzylpiperazine (BZP) and 1-(m-trifluoromethylphenyl)piperazine (TFMPP) triggers oxidative stress, mitochondrial impairment and apoptosis. Arch Toxicol 2016; 91:1413-1430. [PMID: 27358233 DOI: 10.1007/s00204-016-1777-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 06/20/2016] [Indexed: 01/03/2023]
Abstract
N-Benzylpiperazine (BZP) and 1-(3-trifluoromethylphenyl)piperazine (TFMPP) are two synthetic phenylpiperazine analogues that have been frequently commercialized in combination as an alternative to ecstasy ('Legal X'). Despite reports of several clinical complications following the use of these drugs in association, few studies have been conducted so far to elucidate their combined toxicity. The present study was aimed at clarifying the cytotoxic effects of mixtures of BZP and TFMPP in vitro. Human-derived HepaRG cells and primary rat hepatocytes were exposed to the drugs, individually or combined at different mixture ratios, and cytotoxicity was assessed by the MTT assay. Mixture additivity expectations were calculated by the independent action and the concentration addition (CA) models and compared with the experimental outcomes. To delineate the mechanisms underlying the elicited effects, a range of stress endpoints was evaluated, including oxidative stress, energetic imbalance, and metabolic interactions. It was observed that primary rat hepatocytes are more sensitive than HepaRG cells to the toxicity of BZP (EC50 2.20 and 6.60 mM, respectively) and TFMPP (EC50 0.14 and 0.45 mM, respectively). For all BZP-TFMPP combinations tested, CA was the most appropriate model to predict the mixture effects. TFMPP proved to act additively with BZP to produce significant hepatotoxicity (p < 0.01). Remarkably, substantial mixture effects were observed even when each drug was present at concentrations that were harmless individually. In primary hepatocytes, a small deviation from additivity (antagonism) was observed toward the upper range of the concentration-response curve. GC/MS data suggest that a metabolic interaction may be at a play, as the mixture favors the metabolism of both substances, to a significant extent in the case of BZP (p < 0.05). Also, our results demonstrate the influence of oxidative stress and energetic imbalance on these effects (increase in RNS and ROS production, decrease in intracellular GSH/GSSG, ATP depletion and mitochondrial Δψm disruption). The present work clearly demonstrates that potentially harmful interactions among BZP and TFMPP are expected when these drugs are taken concomitantly.
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Umebachi R, Aoki H, Sugita M, Taira T, Wakai S, Saito T, Inokuchi S. Clinical characteristics of α-pyrrolidinovalerophenone (α-PVP) poisoning. Clin Toxicol (Phila) 2016; 54:563-7. [PMID: 27227375 DOI: 10.3109/15563650.2016.1166508] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT α-Pyrrolidinovalerophenone (α-PVP) is a synthetic cathinone that has been abused in recent years. The clinical presentation of acute α-PVP poisoning has not been well characterized. OBJECTIVE To elucidate the clinical features of acute α-PVP poisoning. MATERIALS AND METHODS This retrospective case series included eight subjects that visited our hospital emergency department (ED) between March 2012 and November 2014 and had analytically confirmed blood α-PVP levels. Data related to subject demographics, clinical history, laboratory findings, blood drug levels, and outcome were collected. RESULTS The median age of the eight study subjects was 27 (range; 21-63) years, and six were male. Drug preparations had been administered by rectal insertion (three subjects) or inhalation (five subjects). The time between drug exposure and presentation at the ED was 8.5 (1-24) h and blood α-PVP concentrations ranged from 1.0 to 52.5 ng/ml. Although psychiatric and neurological findings were reported before arrival at the ED in 5/8 and 7/8 subjects, respectively, these were only observed in 1/8 and 2/8 subjects, respectively, at the ED. Symptoms of high body temperature (3/8), tachycardia (5/8), hypertension (3/8), acid-base balance disorder (5/8), coagulopathy (4/6), blood creatinine phosphokinase >190 U/l (6/8), and a blood lactate level > 1.7 mmol/l (5/7) were observed. All subjects survived and were discharged. CONCLUSIONS This retrospective case series showed that after acute exposure to α-PVP, transient neuropsychiatric findings were accompanied by more persistent sympathomimetic physical findings, disorders of acid-base balance and blood coagulation, high blood creatinine phosphokinase, and hyperlactacidemia.
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Affiliation(s)
- Rimako Umebachi
- a Department of Emergency and Critical Care Medicine , Tokai University School of Medicine , Kanagawa , Japan
| | - Hiromichi Aoki
- a Department of Emergency and Critical Care Medicine , Tokai University School of Medicine , Kanagawa , Japan
| | - Mariko Sugita
- a Department of Emergency and Critical Care Medicine , Tokai University School of Medicine , Kanagawa , Japan
| | - Takayuki Taira
- a Department of Emergency and Critical Care Medicine , Tokai University School of Medicine , Kanagawa , Japan
| | - Shinjirou Wakai
- a Department of Emergency and Critical Care Medicine , Tokai University School of Medicine , Kanagawa , Japan
| | - Takeshi Saito
- a Department of Emergency and Critical Care Medicine , Tokai University School of Medicine , Kanagawa , Japan
| | - Sadaki Inokuchi
- a Department of Emergency and Critical Care Medicine , Tokai University School of Medicine , Kanagawa , Japan
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O'Connor AD, Padilla-Jones A, Gerkin RD, Levine M. Prevalence of Rhabdomyolysis in Sympathomimetic Toxicity: a Comparison of Stimulants. J Med Toxicol 2016; 11:195-200. [PMID: 25468315 DOI: 10.1007/s13181-014-0451-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Synthetic cathinones have emerged as popular drugs of abuse and produce sympathomimetic toxicity. It is unknown if rhabdomyolysis occurs more frequently following the use of synthetic cathinones compared to other stimulants. This retrospective study sought to determine the prevalence of rhabdomyolysis in patients with sympathomimetic toxicity and compare rates among patients using specific agents. Patients greater than 14 years of age with sympathomimetic toxicity and detection of a stimulant agent in urine via gas chromatography-mass spectroscopy (GC-MS) were included. Patients were excluded if clinical sympathomimetic toxicity was not present, a serum creatine kinase (CK) was not measured, or urine GC-MS was not performed. Rhabdomyolysis and severe rhabdomyolysis were defined as CK > 1000 and 10,000 IU/L, respectively. Prevalence of rhabdomyolysis and severe rhabdomyolysis were reported. Logistic regression was performed to determine the relative effect in single-agent exposures of a synthetic cathinone compared to other sympathomimetics on rhabdomyolysis. A secondary outcome, a composite endpoint defined as need for mechanical ventilation, renal replacement therapy, development of compartment syndrome, or death, was also analyzed. One hundred two subjects met inclusion criteria; median age (IQR) was 32 (25-42) years with a range of 14-65 years; 74 % were male. Rhabdomyolysis occurred in 42 % (43/102) of subjects. Patients whose sympathomimetic toxicity could be ascribed to a single agent were considered for further statistical analysis and placed into four groups: methamphetamine (n = 55), synthetic cathinone (n = 19), cocaine (n = 9), and other sympathomimetic (n = 6). In 89 subjects with single stimulant exposure, the prevalence of rhabdomyolysis was as follows: synthetic cathinone, 12/19 (63 %); methamphetamine, 22/55 (40 %); cocaine, 3/9 (33 %); and other single agent, 0/6 (0 %). The occurrence of severe rhabdomyolysis (CK > 10,000 IU/L) for each of the four groups was synthetic cathinone with 5/19 (26 %), methamphetamine with 2/55 (3.6 %), cocaine with 1/9 (11 %), and other with 0/6 (0 %). Median maximal CK (range) by groups was as follows: synthetic cathinone, 2638 (62-350,000+) IU/L; methamphetamine, 665 (61-50,233) IU/L; cocaine, 276 (87-25,614) IU/L; and other, 142 (51-816) IU/L. A statistically significant difference (p = 0.004) was found when comparing maximal CK among the four groups. Exposure to a synthetic cathinone compared with other sympathomimetics was associated with increased risk of developing rhabdomyolysis and severe rhabdomyolysis with odds ratios of 3.09 and 7.98, respectively. In this cohort of patients with sympathomimetic toxicity, 42 % developed rhabdomyolysis. Synthetic cathinones were associated with an increased risk of rhabdomyolysis and severe rhabdomyolysis compared with other stimulants.
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Affiliation(s)
- Ayrn D O'Connor
- Department of Medical Toxicology, Banner Good Samaritan Medical Center; Department of Internal Medicine, and Center for Toxicology and Pharmacology Education and Research, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA,
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Helander A, Bäckberg M, Beck O. Intoxications involving the fentanyl analogs acetylfentanyl, 4-methoxybutyrfentanyl and furanylfentanyl: results from the Swedish STRIDA project. Clin Toxicol (Phila) 2016; 54:324-32. [DOI: 10.3109/15563650.2016.1139715] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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45
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Watterson LR, Kufahl PR, Taylor SB, Nemirovsky NE, Olive MF. Sensitization to the motor stimulant effects of 3,4-methylenedioxypyrovalerone (MDPV) and cross-sensitization to methamphetamine in rats. ACTA ACUST UNITED AC 2016; 5. [PMID: 27284493 DOI: 10.4303/jdar/235967] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In recent years, there has been a dramatic increase in abuse of the synthetic cathinone 3,4-methylenedioxypyrovalerone (MDPV), often in combination with other illicit stimulants. PURPOSE We sought to determine if repeated exposure to MDPV would produce sensitization to the motor stimulant effects of the drug, and whether cross-sensitization would develop with the stimulant effects of methamphetamine (METH). STUDY DESIGN Male Sprague-Dawley rats were administered MDPV (1 or 5 mg/kg) or saline once daily for 5 days at 24 hour intervals, or were administered MDPV (1 mg/kg) or saline once daily for 5 days at 48 hour intervals. For cross-sensitization experiments, rats were administered METH (1 mg/kg) or MDPV (1 or 5 mg/kg) once daily for 5 days at 48 hour intervals, and following a 5 day incubation period, were given an acute challenge injection of either MDPV (0.5 mg/kg) or METH (0.5 mg/kg), respectively. RESULTS Rats repeatedly administered MDPV (1 mg/kg) every 48 hours, but not every 24 hours, demonstrated increased motor activity when given either a subsequent challenge of MDPV (0.5 mg/kg i.p.) or METH (0.5 mg/kg), indicating the development of behavioral sensitization and cross-sensitization, respectively. Moreover, rats repeatedly administered METH (1 mg/kg) every 48 hours did not exhibit cross-sensitization to the motor stimulating effects of a subsequent challenge with MDPV (0.5 mg/kg). CONCLUSION These results suggest that specific patterns of MDPV administration may lead to lasting changes in behavioral responses to subsequent METH exposure.
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Affiliation(s)
| | - Peter R Kufahl
- Arizona State University, Department of Psychology, Tempe, AZ, USA
| | - Sara B Taylor
- Arizona State University, Department of Psychology, Tempe, AZ, USA.,Hendrix College, Department of Psychology, Conway, AR, USA
| | | | - M Foster Olive
- Arizona State University, Department of Psychology, Tempe, AZ, USA.,Arizona State University, Interdisciplinary Graduate Program in Neuroscience, Tempe, AZ, USA
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Nizar H, Dargan PI, Wood DM. Using internet snapshot surveys to enhance our understanding of the availability of the novel psychoactive substance 4-methylaminorex and 4,4'-dimethylaminorex. J Med Toxicol 2015; 11:80-4. [PMID: 25167967 DOI: 10.1007/s13181-014-0425-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
4,4'-Dimethylaminorex is a stimulant novel psychoactive substance (NPS) first detected in Europe in November 2012. It is a derivative of 4-methylaminorex, a substance controlled under Schedule 1 of the 1971 United Nations Convention on Psychotropic Substances. There is currently no information on the availability or cost of these substances from Internet suppliers. An Internet snapshot study was undertaken in English using established European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) methodology to determine the availability of 4-methylaminorex and 4,4'-dimethylaminorex in April 2014. Twenty Internet sites selling 4-methylaminorex were identified, 18 selling in US dollars and two in GB Pound Sterling. Fourteen (70 %) Internet sites had a minimum purchase amount of ≥10 g (compared to user doses of 10-25 mg). For the 18 suppliers selling in US$, 9 quoted a fixed price per gram irrespective of the amount ordered and 11 had a reducing price per gram with increasing purchase quantity (US$30.8 ± 34.2/g for 1 g purchase to US$15.2 ± 20.3/g for 1 kg purchase). Only one Internet site selling 4,4'-dimethylaminorex was identified, selling in Euros. The minimum purchase quantity was 500 mg. The price per gram reduced from <euro>36.08/g for a 500 mg purchase to <euro>2.20/g for a 100 g purchase. This Internet snapshot demonstrated that there was a greater availability from Internet suppliers of products advertised as 4-methylaminorex than 4,4'-dimethylaminorex, despite the 4-methylaminorex being an internationally controlled substance. Whilst this may reflect misunderstanding by suppliers, it has the potential to put those purchasing at risk of contravening border control and/or local law enforcement legislation. The use of methodology such as Internet snapshot surveys is of increasing interest to clinical/medical toxicologists in their understanding of the supply, availability and cost of novel psychoactive substances.
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Affiliation(s)
- Hisham Nizar
- Clinical Pharmacology, Charing Cross Hospital, London, UK
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Archer JRH, Hudson S, Jackson O, Yamamoto T, Lovett C, Lee HM, Rao S, Hunter L, Dargan PI, Wood DM. Analysis of anonymized pooled urine in nine UK cities: variation in classical recreational drug, novel psychoactive substance and anabolic steroid use. QJM 2015; 108:929-33. [PMID: 25770158 DOI: 10.1093/qjmed/hcv058] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Analysis of anonymous pooled urine samples from street urinals has been used to demonstrate time-trends in the detection of classical recreational drugs and novel psychoactive substances (NPS). AIM This study aimed to expand this to undertake a geographical trend analysis of classical recreational drugs/NPS across UK. METHODS Samples of anonymous pooled urine were collected from street urinals that had been in place for one night in April 2014 in nine cities across the UK. Collected samples were then analysed for the presence of recreational drugs, NPS anabolic steroids using high-performance liquid chromatography coupled to high-resolution accurate mass full-scan mass spectrometry and gas chromatography coupled to electron impact ionization mass spectrometry operating in selected ion monitoring and full-scan modes. RESULTS Ten classical recreational drugs, nine NPS and four anabolic steroids were detected across the nine cities; the range of detection was from 1 in Leeds to 14 in London. The most common classical drugs were cocaine (9 cities) and 3,4-methylenedioxy-methamphetamine (8 cities); the most common NPS was 4-methylmethcathinone (5 cities). In addition there was variation in the detection of NPS, with methylhexaneamine detected only in Bristol and London, piperazines (3-trifluoromethylphenylpiperazine and 1-benzylpiperazine) and pentedrone only detected in Birmingham and the cathinone methylone only detected in London. CONCLUSIONS There is variability in the detection of classical recreational drugs, NPS and anabolic steroids across UK, likely reflecting variation in their use. This technique can be used to supplement drug use surveys to determine geographical and time trends in the use of these substances. This is important to ensure appropriate targeting of drug-related interventions.
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Affiliation(s)
- J R H Archer
- From the Clinical Toxicology Service Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - S Hudson
- Laboratory and Managed Services, LGC, Fordham, UK
| | - O Jackson
- Hull York Medical School, Hull, UK and
| | - T Yamamoto
- From the Clinical Toxicology Service Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - C Lovett
- From the Clinical Toxicology Service Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - H M Lee
- From the Clinical Toxicology Service Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - S Rao
- From the Clinical Toxicology Service Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - L Hunter
- From the Clinical Toxicology Service Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - P I Dargan
- From the Clinical Toxicology Service Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK, King's College London, London, UK
| | - D M Wood
- From the Clinical Toxicology Service Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK, King's College London, London, UK
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Müller HH, Kornhuber J, Sperling W. The behavioral profile of spice and synthetic cannabinoids in humans. Brain Res Bull 2015; 126:3-7. [PMID: 26548494 DOI: 10.1016/j.brainresbull.2015.10.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 10/27/2015] [Accepted: 10/30/2015] [Indexed: 02/06/2023]
Abstract
The use of synthetic cannabinoids (spice) is increasing. The number of descriptions of (new) clinical side effects is also increasing. We screened relevant publications for articles about spice with a focus on the clinical manifestations of the use of this drug. Spice creates diffuse psychiatric and somatic effects that are only partially similar to those of natural cannabinoids. Most of the observed effects are related to sympathomimetic-cardiac effects and neuropsychiatric manifestations. Clinical treatment is primarily based on intensive apparative and laboratory monitoring and supportive therapy. Because the exact active ingredients of spice are often difficult to determine with standard specific toxicology testing, the assessment and analysis of consumed substances by specialized laboratories is recommended.
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Affiliation(s)
- Helge H Müller
- Friedrich-Alexander University of Erlangen-Nuremberg, Department of Psychiatry and Psychotherapy, Erlangen, Germany; Medical Campus University of Oldenburg, School of Medicine and Health Sciences, University Hospital, Department of Psychiatry and Psychotherapy (Head of Department: Prof. Dr. Alexandra Philipsen), Karl-Jaspers-Klinik, Hermann-Ehlers-Straße 7, D-26160 Bad Zwischenahn, Germany.
| | - Johannes Kornhuber
- Friedrich-Alexander University of Erlangen-Nuremberg, Department of Psychiatry and Psychotherapy, Erlangen, Germany
| | - Wolfgang Sperling
- Friedrich-Alexander University of Erlangen-Nuremberg, Department of Psychiatry and Psychotherapy, Erlangen, Germany
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Lee HMD, Wood DM, Hudson S, Archer JRH, Dargan PI. Acute toxicity associated with analytically confirmed recreational use of methiopropamine (1-(thiophen-2-yl)-2-methylaminopropane). J Med Toxicol 2015; 10:299-302. [PMID: 24706157 DOI: 10.1007/s13181-014-0399-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Methiopropamine use in Europe has been detected since January 2011, but there is limited information on its acute toxicity. Here, we describe a case of analytically confirmed methiopropamine acute toxicity. CASE REPORT A 27-year-old woman with no previous medical history was brought to the emergency department with palpitations, chest tightness, anxiety, nausea, vomiting and visual hallucinations following the use of a 'Quicksilver'. Toxicological analysis of her urine collected at presentation to the ED detected methiopropamine at a concentration of 400 ng/mL. Other drugs were also detected but at a much lower concentration. CONCLUSION This is the first ever case report of analytically confirmed acute toxicity related to methiopropamine use. It confirms the potential for significant acute toxicity with cardiovascular, gastrointestinal and psychotic symptoms thus providing further information to help with managing these patients and allow legislative authorities to consider the need for its control.
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Affiliation(s)
- Hwee Min D Lee
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK,
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Odoardi S, Fisichella M, Romolo FS, Strano-Rossi S. High-throughput screening for new psychoactive substances (NPS) in whole blood by DLLME extraction and UHPLC–MS/MS analysis. J Chromatogr B Analyt Technol Biomed Life Sci 2015. [DOI: 10.1016/j.jchromb.2015.07.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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