Abuse of drugs "for kicks": a review of 252 admissions

DARK Classics in Chemical Neuroscience: Methaqualone

Commonly known as "Quaaludes," methaqualone (1) is a sedative-hypnotic medication, with effects resembling barbiturates and other downers, that exerts its effects through modulation of γ-aminobutyric acid type A receptors (GABA_AR). Following the discovery of the sedative and euphoric effects of methaqualone (1), it was quickly adopted by pharmaceutical companies and promoted by clinicians around the world as a "safe" sleeping pill option, and for a period it was available over the counter. The popularity of methaqualone (1) soared worldwide, and many people began to use it recreationally for its sedative-hypnotic-like psychoactive effects. Not long after its introduction, many individuals began to misuse the drug leading to overdoses and drug dependence which brought to light methaqualone's (1) addictive nature. In this review, the background, synthesis, pharmacology, metabolism, and pharmacokinetics of methaqualone (1) will be covered along with its discovery, history, and the derivatives that are currently available around the world through manufacture in clandestine laboratories.

Classification of overdose/self-poisoning presentations to an accident and emergency department

A simple classification system of overdoses presenting to a hospital emergency department is described. Five major overdose categories were developed (accidental, suicidal behavior, recreational/experimentation, compulsive use, and an indeterminate category), which were divided into 10 subcategories. A prospective survey at an inner-city hospital in Sydney classified 199 consecutive self-poisoning presentations as being due to compulsive drug use in 38% of cases; suicidal gesture as a reaction to stress, 17%; adverse reactions to recreational or experimental use, 15%; suicidal gesture to influence others, 7%; genuine accident or noncompliance with medication, 6%; genuine suicide attempt, 3%; and pseudo-overdose, 3%. The reason for the overdose was uncertain in the remainder of the cases. Additional data are also presented, including the types of drugs involved in each overdose category. Categories of overdose may be useful in psychosocial assessment for follow-up interventions, assist in research, and help reduce negative attitudes toward overdoses.

Tuinal as a drug of abuse

Six case reports are presented to illustrate the problems of abuse of Tuinal (equal parts of sodium quinalbarbitone and sodium amylobarbitone). Over a four-year period in South Australia, Tuinal has risen from causing no deaths to be second only to pentobarbitone as a cause of death. While deaths from pentobarbitone overdosage are largely suicidal, Tuinal deaths are largely accidental, the result of a lack of tolerance in combination with alcohol potentiation.

Psychological effects caused by drugs in overdose

Drug overdose is a common occurrence which accounts for up to 25% of medical inpatient admissions. Intentional overdose or attempted suicide is the most common cause of overdose, but there are other types of overdose which are often unrecognised as are the effects caused by these overdoses. Iatrogenic overdose occurs frequently and is often unavoidable. Many patients will make mistakes with their treatment and unwittingly suffer from the toxic effects of the drugs they are taking. About 7% of intentional overdose patients who are admitted to hospital have taken the drug for some psychological effect they have been seeking and have taken too much. This group is described as those who take 'drugs for kicks'. As many of the drugs taken cross the blood-brain barrier and exert some toxic effect on the cerebral cortex, secondary psychological disturbances frequently occur in all of these groups of patients, and can sometimes be the only sign of dangerous toxicity. It is important to recognise the patient's gross disturbances of behaviour, thinking and perception as a manifestation of drug toxicity which can be life threatening and often requires intense medical treatment. The range of the psychological response is somewhat limited and there is not a specific psychological disturbance characteristic of the toxicity of each group of drugs. However, there are some reactions which, coupled with the physical symptoms shown by the patient, can help to identify the patient as suffering from the toxic effects of drugs and even give some indication as to the type of drugs taken. This article describes the various psychiatric syndromes caused by drugs in overdose and attempts to identify these with most of the commonly encountered groups of drugs.

Methaqualone misuse: foreign experience and United States drug control policy

In 1972 methaqualone emerged as a major drug of nonmedical use in the United States--a subject of widespread publicity and public concern. In late 1973, government officials responded by taking the unprecedented measure of imposing the strictest controls available under United States law on a drug which had previously been subject only to a simple prescription requirement. Methaqualone had a similar history in other countries, particularly in Germany, Japan, and Great Britain. However, this history was ignored by United States officials until nonmedical methaqualone use had become a substantial problem in the United States.