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Smith JL, Greene S, McCutcheon D, Weber C, Kotkis E, Soderstrom J, Douglas B, Lenton S, Grigg J, Dessauer P, Ezard N, Fatovich DM. A multicentre case series of analytically confirmed gamma-hydroxybutyrate intoxications in Western Australian emergency departments: Pre-hospital circumstances, co-detections and clinical outcomes. Drug Alcohol Rev 2024. [PMID: 38426636 DOI: 10.1111/dar.13830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/26/2023] [Accepted: 02/17/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Gamma-hydroxybutyrate (GHB) use is associated with high risk of accidental overdose. This study examined the pre-hospital circumstances, demographic characteristics and clinical outcomes of analytically confirmed GHB emergency department (ED) presentations in Western Australia (WA). METHODS This case series was conducted across three WA EDs involved in the Emerging Drugs Network of Australia, from April 2020 to July 2022. Patient demographics, pre-hospital drug exposure circumstances and ED presentation and outcome characteristics were collected from ambulance and hospital medical records of GHB-confirmed cases. RESULTS GHB was detected in 45 ED presentations. The median age was 34 years and 53.3% (n = 24) were female. Most patients arrived at the ED by ambulance (n = 37, 85.7%) and required immediate emergency care (Australasian Triage Score 1 or 2 = 97.8%). One-third of patients were admitted to intensive care (n = 14, 31.1%). Methylamphetamine was co-detected in 37 (82.2%) GHB-confirmed cases. Reduced conscious state was indicated by first recorded Glasgow Coma Scale of ≤8 (n = 29, 64.4%) and observations of patients becoming, or being found, 'unresponsive' and 'unconscious' in various pre-hospital settings (n = 28, 62.2%). 'Agitated' and/or 'erratic' mental state and behavioural observations were recorded in 20 (44.4%) cases. DISCUSSION AND CONCLUSIONS Analytically verified data from ED presentations with acute toxicity provides an objective information source on drug use trends and emerging public health threats. In our study, patients presenting to WA EDs with GHB intoxication were acutely unwell, often requiring intensive care treatment. The unexpectedly high proportion of female GHB intoxications and methylamphetamine co-ingestion warrants further exploration.
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Affiliation(s)
- Jennifer L Smith
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australia
- East Metropolitan Health Service, Perth, Australia
| | - Shaun Greene
- Emergency Department, Austin Hospital, Melbourne, Australia
- Victorian Poisons Information Centre, Melbourne, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Australia
| | - David McCutcheon
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australia
- School of Medicine, The University of Western Australia, Perth, Australia
- Emergency Department, Royal Perth Hospital, Perth, Australia
- Royal Perth Hospital Research Foundation, Perth, Australia
| | - Courtney Weber
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australia
- East Metropolitan Health Service, Perth, Australia
| | - Ellie Kotkis
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australia
- East Metropolitan Health Service, Perth, Australia
| | - Jessamine Soderstrom
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australia
- East Metropolitan Health Service, Perth, Australia
- School of Medicine, The University of Western Australia, Perth, Australia
- Emergency Department, Royal Perth Hospital, Perth, Australia
| | | | - Simon Lenton
- National Drug Research Institute and enAble Institute, Curtin University, Perth, Australia
| | - Jodie Grigg
- National Drug Research Institute and enAble Institute, Curtin University, Perth, Australia
| | | | - Nadine Ezard
- The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia
- The National Centre for Clinical Research on Emerging Drugs, UNSW Sydney, Sydney, Australia
- New South Wales Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Daniel M Fatovich
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australia
- East Metropolitan Health Service, Perth, Australia
- School of Medicine, The University of Western Australia, Perth, Australia
- Emergency Department, Royal Perth Hospital, Perth, Australia
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Schwegler E, Bachmann M, Kube F, Eriksson U. Gender-specific differences in comorbidities, in-hospital complications and outcomes in emergency patients with ethanol intoxication with and without multisubstance use. Swiss Med Wkly 2023; 153:40061. [PMID: 37155832 DOI: 10.57187/smw.2023.40061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
AIMS OF THE STUDY To analyse gender-specific differences in comorbidities, multisubstance abuse, in-hospital complications, intensive care unit transfers and referrals to psychiatric wards of emergency department patients with ethanol intoxication. Several lines of evidence suggest an influence of gender differences on diagnostic and therapeutic approaches to various diseases. METHODS Over a period of 7 years, all patients with signs or symptoms of ethanol intoxication and a positive blood ethanol test admitted for the first time to the emergency department of a Swiss regional tertiary referral hospital were prospectively enrolled. Patients were categorised into two subgroups: patients without additional drug use were considered ethanol-only cases, whereas patients who had also ingested other substances (as determined from bystanders, physicians and urine drug screening) were considered multisubstance cases. A retrospective analysis of this database evaluated gender-specific differences in comorbidities, multisubstance abuse, in-hospital complications, intensive care unit transfers and referrals to psychiatric wards within these two subgroups. Statistical analysis included Fisher's exact test for categorical data and Wilcoxon rank sum test for continuous data. RESULTS Of 409 enrolled patients, 236 cases were ethanol-only and 173 were multisubstance cases. The three most common comorbidities in multisubstance patients showed significant gender differences: psychiatric disorders (43% males vs 61% females; p = 0.022), chronic ethanol abuse (55% males vs 32% females; p = 0.002) and drug addiction (44% males vs 17% females; p = 0.001). Gender differences were also found for the most frequently co-ingested substances: benzodiazepines (35% males vs 43% females; p = 0.014), cannabis (45% males vs 24% females; p = 0.006) and cocaine (24% males vs 6% females; p = 0.001). Male and female ethanol-only patients were transferred to the intensive care unit in 8% of cases. In multisubstance cases, 32% of male and 43% of female patients were transferred to the intensive care unit (no significant gender difference). The psychiatric ward referral rate in male (30%) and female (48%) patients with multisubstance abuse was significantly different (p = 0.028). No significant gender difference in psychiatric ward referral rates was observed for ethanol-only patients (12% males, 17% females). CONCLUSION Among emergency department patients admitted with ethanol intoxication, gender differences in comorbidities, substance use and psychiatric ward referrals were highly significant among patients who presented with multisubstance abuse. Rates of intensive care unit transfer for patients with ethanol intoxication are substantial for both genders, reflecting relevant disease burden and resource demand, as well as the need for further preventive efforts.
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Affiliation(s)
- Eric Schwegler
- Department of Medicine, GZO Regional Health Center, Wetzikon, Switzerland
| | - Marta Bachmann
- Department of Medicine, GZO Regional Health Center, Wetzikon, Switzerland
| | - Frank Kube
- Emergency Department, GZO Regional Health Center, Wetzikon, Switzerland
| | - Urs Eriksson
- Department of Medicine, GZO Regional Health Center, Wetzikon, Switzerland
- University of Zurich, Zürich, Switzerland
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Stockham P, Partridge E, Alfred S, Boyle L, Camilleri A, Green H, Haustead D, Humphries M, Kostakis C, Mallon J. Characteristics of analytically confirmed gamma-hydroxybutyrate (GHB) positive patients in the emergency department: presentation, poly-drug use, disposition and impact on intensive care resource utilisation. Clin Toxicol (Phila) 2023; 61:241-247. [PMID: 37129222 DOI: 10.1080/15563650.2023.2178933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Gamma-hydroxybutyrate is a potent central nervous system depressant with a narrow recreational dose window and analytical detection time. We describe data relating to intoxicated patients presenting to emergency departments across metropolitan Adelaide who tested positive for gamma-hydroxybutyrate. This work was part of the Emergency Department Admission Blood Psychoactive Testing study. METHODS Over a 15-month period, patients presenting to four metropolitan emergency departments with symptoms of drug intoxication were enrolled in the study. The methodology involved the collection of demographic and clinical data and a de-identified blood sample which underwent comprehensive toxicological analysis. Gamma-hydroxybutyrate was determined using an acid-catalysed cyclisation followed by liquid-liquid extraction and gas chromatography-mass spectrometry. Data relating to samples positive for gamma-hydroxybutyrate were examined. RESULTS AND DISCUSSION A total of 1120 patients were enrolled between March 2019 and May 2020, 309 of whom were positive for gamma-hydroxybutyrate (27.6%). Of these, 256 (83%) were also positive for metamfetamine (methamphetamine). The most common clinical observation in gamma-hydroxybutyrate-positive patients was central nervous system depression (89%). There was a significant relationship between gamma-hydroxybutyrate status and sex; although males outnumbered females in absolute terms, a higher proportion of females (32%) tested positive for gamma-hydroxybutyrate than males (25%, P = 0.0155). Blood gamma-hydroxybutyrate concentrations ranged from 10 to 651 mg/L (0.096-6.2 mmol/L) and increasing gamma-hydroxybutyrate concentration correlated with severe toxicity. The presence of gamma-hydroxybutyrate had a significant impact on the patient discharge destination: the majority (69.2%) of gamma-hydroxybutyrate-positive patients were managed and discharged from the emergency department or their attached short stay wards. A significantly higher proportion of gamma-hydroxybutyrate-positive patients were admitted to the intensive care unit (28.2%) compared with gamma-hydroxybutyrate-negative patients (12.7%, chi-squared = 36.85, P <0 .001). Gamma-hydroxybutyrate positive cases accounted for 45.8% of all study-related intensive care unit admissions. CONCLUSIONS Gamma-hydroxybutyrate is commonly detected in illicit drug-related emergency department presentations and is detected disproportionately in the patient cohort who require intensive care unit level care.
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Affiliation(s)
- Peter Stockham
- Forensic Science SA (Toxicology), Adelaide, Australia
- College of Science and Engineering, Flinders University, Bedford Park, Australia
| | - Emma Partridge
- Forensic Science SA (Toxicology), Adelaide, Australia
- College of Science and Engineering, Flinders University, Bedford Park, Australia
| | - Sam Alfred
- Emergency Department, Royal Adelaide Hospital, Adelaide, Australia
| | - Laura Boyle
- Mathematical Sciences Research Centre, Queen's University Belfast, Belfast, UK
- School of Mathematical Sciences, The University of Adelaide, Adelaide, Australia
| | | | - Hannah Green
- Emergency Department, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Daniel Haustead
- Emergency Department, Royal Adelaide Hospital, Adelaide, Australia
- Emergency Department, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Melissa Humphries
- School of Mathematical Sciences, The University of Adelaide, Adelaide, Australia
| | | | - Jake Mallon
- Emergency Department, Flinders Medical Centre, Bedford Park, Australia
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Abid M, Kietzerow J, Iwersen-Bergmann S, Schnitgerhans T, Andresen-Streichert H. Characteristics and dose-effect relationship of clinical gamma-hydroxybutyrate intoxication: A case series. J Forensic Sci 2021; 67:416-427. [PMID: 34523720 DOI: 10.1111/1556-4029.14880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/20/2021] [Accepted: 08/17/2021] [Indexed: 11/27/2022]
Abstract
Gamma-Hydroxybutyrate (GHB) overdoses cause respiratory depression, coma, or even death. Symptoms and severity of poisoning depend on blood-concentrations and individual factors such as tolerance. A retrospective case study was conducted, evaluating GHB intoxication cases. GHB-concentrations in blood and urine were determined by gas chromatography-mass spectrometry (GC-MS) along with, in part, via enzymatic assay. GHB-concentrations, demographic data, and additional drug use, as well as specific clinical information, were evaluated. The correlation between GHB-levels in blood and associated symptoms were examined. In total, 75 cases originating from the Emergency Departments (EDs) of Hamburg and surrounding hospitals were included. Fifty-four of the patients (72%) were male. The mean GHB-concentration in blood was 248 mg/L (range 21.5-1418 mg/L). Out of the group with detailed clinical information (n = 18), the comatose group (n = 10/18) showed a mean of 244 mg/L (range 136-403 mg/L), which was higher than that of the somnolent and awake patients. Of the comatose collective, 70% (n = 7) showed co-use of one or more substances, with the additional use of cocaine being the most frequently detected (n = 5). In conclusion, a moderate dose-effect relationship was observed, although, there was some overlap in dosage concentration levels of GHB in awake and comatose patients. In GHB-intoxication cases, co-use was common as were clinical effects such as acidosis, hypotension, and impact on the heart rate. Timely analytical determination of the GHB-concentration in blood could support correct diagnosis of the cause of unconsciousness.
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Affiliation(s)
- Madelaine Abid
- Department of Toxicology, Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jana Kietzerow
- Department of Toxicology, Institute of Legal Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Stefanie Iwersen-Bergmann
- Department of Toxicology, Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tino Schnitgerhans
- Department of Internal Medicine, Asklepios-Klinik Nord - Heidberg, Hamburg, Germany
| | - Hilke Andresen-Streichert
- Department of Toxicology, Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Toxicology, Institute of Legal Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
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Rodriguez-Cruz V, Morris ME. γ-Hydroxybutyric Acid-Ethanol Drug-Drug Interaction: Reversal of Toxicity with Monocarboxylate Transporter 1 Inhibitors. J Pharmacol Exp Ther 2021; 378:42-50. [PMID: 33963018 DOI: 10.1124/jpet.121.000566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/04/2021] [Indexed: 11/22/2022] Open
Abstract
The drug of abuse, γ-hydroxybutyric acid (GHB), is commonly co-ingested with ethanol, resulting in a high incidence of toxicity and death. Our laboratory has previously reported that GHB is a substrate for the monocarboxylate transporters (MCTs), necessary for its absorption, renal clearance, and tissue distribution, including across the blood-brain barrier. Our goal was to investigate the drug-drug interaction (DDI) between GHB and ethanol and to evaluate MCT1 inhibition as a strategy to reverse toxicity. The toxicokinetics of this DDI were investigated, including brain-to-plasma concentration ratios, in the presence and absence of ethanol. The toxicodynamic parameters examined were respiratory depression (breathing frequency, tidal volume) and sedation (time of return-of-righting reflex). Ethanol was administered (2 g/kg i.v.) 5 minutes before the intravenous or oral administration of GHB, and MCT1 inhibitors AZD-3965 and AR-C155858 (5 mg/kg i.v.) were administered 60 minutes after GHB administration. Ethanol administration did not alter the toxicokinetics or respiratory depression caused by GHB after intravenous or oral administration; however, it significantly increased the sedation effect, measured by return-to-righting time. AZD-3965 or AR-C155858 significantly decreased the effects of the co-administration of GHB and ethanol on respiratory depression and sedation of this DDI and decreased brain concentrations and the brain-to-plasma concentration ratio of GHB. The results indicate that ethanol co-administered with GHB increases toxicity and that MCT1 inhibition is effective in reversing toxicity by inhibiting GHB brain uptake when given after GHB-ethanol administration. SIGNIFICANCE STATEMENT: These studies investigated the enhanced toxicity observed clinically when γ-hydroxybutyric acid (GHB) is co-ingested with alcohol and evaluated strategies to reverse this toxicity. The effects of the novel monocarboxylate transporter 1 (MCT1) inhibitors AR-C155858 and AZD-3965 on this drug-drug interaction have not been studied before, and these preclinical studies indicate that MCT1 inhibitors can decrease brain concentrations of GHB by inhibiting brain uptake, even when administered at times after GHB-ethanol. AZD-3965 represents a potential treatment strategy for GHB-ethanol overdoses.
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Affiliation(s)
- Vivian Rodriguez-Cruz
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Marilyn E Morris
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, New York
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Dijkstra BAG, Beurmanjer H, Goudriaan AE, Schellekens AFA, Joosten EAG. Unity in diversity: A systematic review on the GHB using population. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 94:103230. [PMID: 33892279 DOI: 10.1016/j.drugpo.2021.103230] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Over the past decades gamma-hydroxybutyrate (GHB) has emerged as a popular drug with high potential of (ab)use due to its euphoric and relaxing effects. An overview of different populations using GHB is urgently needed, since this would enable development of adequate prevention and treatment policies to diminish the risks associated with GHB use. We systematically reviewed literature on different GHB using populations, comparing demographic characteristics, GHB use patterns, psychosocial aspects and psychiatric comorbidity. METHODS We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using Rayyan software. Original studies published from January 1997 up to October 2019 on GHB use were included. Out of 80 full-text articles, 60 articles of 51 unique studies were included. Most studies included people using GHB 1) presenting at emergency departments (n = 22), 2) recruited from the general population (n = 11), or 3) presenting at addiction care (n = 8). RESULTS Three main sub-populations of people using GHB are described in the literature: people using GHB recreationally without adverse effects; people using GHB recreationally with adverse effects, and people with dependence on GHB. These groups show considerable overlap in gender, age range, and comorbid substance use, as well as amount of GHB use per occasion. Differences are related to frequency and function of GHB use, the number of comas experienced, as well as work status, and psychiatric comorbidity. CONCLUSION Policy interventions should aim at preventing the transition from recreational substance use to GHB use, as most users are experienced recreational substance users prior to starting GHB use. When people use GHB regularly, interventions should aim at reducing the level of GHB use and preventing GHB use-related harm. Longitudinal studies and population-based probability sampling are required for more insight in the dynamics of GHB use in different sub-populations, and the transition from one group to the other, ultimately leading to dependence on GHB.
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Affiliation(s)
- B A G Dijkstra
- Nijmegen Institute for Scientist-Practitioner in Addiction (NISPA), Radboud University, Nijmegen, the Netherlands; Radboudumc, Department of Psychiatry, Nijmegen, the Netherlands; Novadic-Kentron Addiction Treatment Center, Vught, the Netherlands.
| | - H Beurmanjer
- Nijmegen Institute for Scientist-Practitioner in Addiction (NISPA), Radboud University, Nijmegen, the Netherlands; Novadic-Kentron Addiction Treatment Center, Vught, the Netherlands
| | - A E Goudriaan
- Jellinek and Arkin, Amsterdam, the Netherlands; Amsterdam University Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands
| | - A F A Schellekens
- Nijmegen Institute for Scientist-Practitioner in Addiction (NISPA), Radboud University, Nijmegen, the Netherlands; Radboudumc, Department of Psychiatry, Nijmegen, the Netherlands
| | - E A G Joosten
- Nijmegen Institute for Scientist-Practitioner in Addiction (NISPA), Radboud University, Nijmegen, the Netherlands; Radboudumc, Department of Psychiatry, Nijmegen, the Netherlands
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Felmlee MA, Morse BL, Morris ME. γ-Hydroxybutyric Acid: Pharmacokinetics, Pharmacodynamics, and Toxicology. AAPS J 2021; 23:22. [PMID: 33417072 PMCID: PMC8098080 DOI: 10.1208/s12248-020-00543-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/23/2020] [Indexed: 12/23/2022] Open
Abstract
Gamma-hydroxybutyrate (GHB) is a short-chain fatty acid present endogenously in the brain and used therapeutically for the treatment of narcolepsy, as sodium oxybate, and for alcohol abuse/withdrawal. GHB is better known however as a drug of abuse and is commonly referred to as the "date-rape drug"; current use in popular culture includes recreational "chemsex," due to its properties of euphoria, loss of inhibition, amnesia, and drowsiness. Due to the steep concentration-effect curve for GHB, overdoses occur commonly and symptoms include sedation, respiratory depression, coma, and death. GHB binds to both GHB and GABAB receptors in the brain, with pharmacological/toxicological effects mainly due to GABAB agonist effects. The pharmacokinetics of GHB are complex and include nonlinear absorption, metabolism, tissue uptake, and renal elimination processes. GHB is a substrate for monocarboxylate transporters, including both sodium-dependent transporters (SMCT1, 2; SLC5A8; SLC5A12) and proton-dependent transporters (MCT1-4; SLC16A1, 7, 8, and 3), which represent significant determinants of absorption, renal reabsorption, and brain and tissue uptake. This review will provide current information of the pharmacology, therapeutic effects, and pharmacokinetics/pharmacodynamics of GHB, as well as therapeutic strategies for the treatment of overdoses. Graphical abstract.
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Affiliation(s)
- Melanie A Felmlee
- Department of Pharmaceutics and Medicinal Chemistry Thomas J Long School of Pharmacy, University of the Pacific, Stockton, California, USA
| | - Bridget L Morse
- Drug Disposition, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, 46285, USA
| | - Marilyn E Morris
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, State University of New York, 304 Pharmacy Building, Buffalo, New York, 14214, USA.
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Raposo Pereira F, McMaster MTB, Schellekens A, Polderman N, de Vries YDAT, van den Brink W, van Wingen GA. Effects of Recreational GHB Use and Multiple GHB-Induced Comas on Brain Structure and Impulsivity. Front Psychiatry 2020; 11:166. [PMID: 32300311 PMCID: PMC7142256 DOI: 10.3389/fpsyt.2020.00166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/21/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND AIMS The regular use of gamma-hydroxybutyrate acid (GHB) can induce GHB-induced comas. Other substance use disorders are associated with alterations in brain structure and impulsivity. Here we aim to investigate if these are also modulated by either regular GHB use or GHB-induced comas. METHODS In a sample of human males, structural and diffusion neuroimaging data were collected for 27 GHB users with ≥4 GHB-induced comas (GHB-Coma), 27 GHB users without GHB-induced comas (GHB-NoComa), and 27 polydrug users who never used GHB (No-GHB). The structural brain parameters were analyzed macroscopically using voxel-based morphometry and microscopically using tract-based spatial statistics (TBSS) and tractography. Impulsivity was assessed with the Barrat Impulsivity Scale. RESULTS In comparison to the other two groups, the GHB-Coma group showed a higher fractional anisotropy in the body of the corpus callosum and a lower mean diffusivity in the forceps minor (i.e., whole-brain TBSS analysis). No macrostructural differences nor microstructural differences, as assessed with tractography, were observed. The GHB-Coma group also reported higher impulsivity, which was more strongly associated with white matter volume and fractional anisotropy in tracts involved in impulse control (post-hoc analysis). GHB use per se was associated neither with differences in brain structure nor with impulsivity. CONCLUSIONS The results suggest that multiple GHB-induced comas, but not GHB use per se, are associated with microstructural alterations in white matter and with higher self-reported impulsivity, which in turn was associated with white matter tracts involved in impulse control.
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Affiliation(s)
- Filipa Raposo Pereira
- Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
| | - Minni T. B. McMaster
- Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
| | - Arnt Schellekens
- Department of Psychiatry, Radboud University Medical Centre (Radboudumc), Nijmegen, Netherlands
- Nijmegen Institute for Scientist Practitioners in Addiction (NISPA), Nijmegen, Netherlands
| | - Nikki Polderman
- Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Yvon D. A. T. de Vries
- Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
| | - Guido A. van Wingen
- Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
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Luethi D, Liechti ME. Designer drugs: mechanism of action and adverse effects. Arch Toxicol 2020; 94:1085-1133. [PMID: 32249347 PMCID: PMC7225206 DOI: 10.1007/s00204-020-02693-7] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/25/2020] [Indexed: 12/18/2022]
Abstract
Psychoactive substances with chemical structures or pharmacological profiles that are similar to traditional drugs of abuse continue to emerge on the recreational drug market. Internet vendors may at least temporarily sell these so-called designer drugs without adhering to legal statutes or facing legal consequences. Overall, the mechanism of action and adverse effects of designer drugs are similar to traditional drugs of abuse. Stimulants, such as amphetamines and cathinones, primarily interact with monoamine transporters and mostly induce sympathomimetic adverse effects. Agonism at μ-opioid receptors and γ-aminobutyric acid-A (GABAA) or GABAB receptors mediates the pharmacological effects of sedatives, which may induce cardiorespiratory depression. Dissociative designer drugs primarily act as N-methyl-D-aspartate receptor antagonists and pose similar health risks as the medically approved dissociative anesthetic ketamine. The cannabinoid type 1 (CB1) receptor is thought to drive the psychoactive effects of synthetic cannabinoids, which are associated with a less desirable effect profile and more severe adverse effects compared with cannabis. Serotonergic 5-hydroxytryptamine-2A (5-HT2A) receptors mediate alterations of perception and cognition that are induced by serotonergic psychedelics. Because of their novelty, designer drugs may remain undetected by routine drug screening, thus hampering evaluations of adverse effects. Intoxication reports suggest that several designer drugs are used concurrently, posing a high risk for severe adverse effects and even death.
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Affiliation(s)
- Dino Luethi
- Center for Physiology and Pharmacology, Institute of Pharmacology, Medical University of Vienna, Währinger Strasse 13a, 1090, Vienna, Austria.
- Institute of Applied Physics, Vienna University of Technology, Getreidemarkt 9, 1060, Vienna, Austria.
- Division of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland.
| | - Matthias E Liechti
- Division of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland.
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Raposo Pereira F, McMaster MTB, de Vries YAT, van den Brink W, van Wingen GA. Demographic and Clinical Characteristics of Regular GHB-Users with and without GHB-Induced Comas. Subst Use Misuse 2020; 55:2148-2155. [PMID: 32772606 DOI: 10.1080/10826084.2020.1793368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Gamma hydroxybutyric acid (GHB) has been used recreationally for nearly three decades and its chronic use is frequently associated with serious adverse events including GHB-intoxication with GHB-induced comas. Moreover, despite its low prevalence, the number of individuals with GHB-use disorders is steadily increasing. However, the risk-factors associated with chronic GHB-use or the development of a GHB-use disorders remain poorly understood. Purpose: This study aims to profile two types of GHB-users, those with and those without GHB-induced comas. Methods: We included 27 GHB users with ≥4 GHB-induced comas (GHB-Coma), 27 GHB users without a coma (GHB-NoComa), and 27 polydrug users who never used GHB (No-GHB). Participants completed self-reported questionnaires in order to assess their demographic and clinical features, and their use profile of GHB and other drugs. Results: The typical GHB user in our sample was young, single, living alone, well-educated, and a student. The GHB-Coma group had lower self-control and reported higher negative affect than the GHB-NoComa group. GHB-Coma participants were heavier GHB users and mostly used GHB alone at home, whereas the GHB-NoComa group mostly used GHB with friends and in nightclubs. Remarkably, the majority of participants were not concerned about potential neurocognitive impairments induced by GHB-intoxication and/or GHB-induced comas. Conclusion: In this assessment, different profiles for recreational users with and without GHB-induced comas were well expressed. Their description contributes to a better understanding of the risk factors associated with recreational GHB-use, GHB-induced coma, and the development of GHB-use disorders.
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Affiliation(s)
- Filipa Raposo Pereira
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, The Netherlands
| | - Minni T B McMaster
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, The Netherlands
| | - YvonD A T de Vries
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Wim van den Brink
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, The Netherlands
| | - Guido A van Wingen
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, The Netherlands
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11
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Bühler T, Schmid Y, Liechti ME. [Knockout Drugs: Diagnostics in the Emergency Unit and Clinical Practice]. PRAXIS 2019; 108:869-876. [PMID: 31571536 DOI: 10.1024/1661-8157/a003306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Knockout Drugs: Diagnostics in the Emergency Unit and Clinical Practice Abstract. Every now and then, physicians are challenged with date rape drugs. If there is a suspicion of substance administration, the question of involving forensic medicine is commonly raised. In obscure situations or questionable offences, however, patients may wish for an initial diagnosis in the emergency department or the private practice. The physicians are often greatly challenged by the variety of substances, the limited analytical methods and difficulties with the interpretion of results. The major goal of this article is to present diagnostic options including their limitations. An overview of frequently involved substances is provided. Particular focus will be placed on practical aspects, including questions regarding pre-analytics and health insurance coverage.
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Affiliation(s)
- Tim Bühler
- Abteilung für Klinische Pharmakologie & Toxikologie, Universitätsspital Basel
| | - Yasmin Schmid
- Abteilung für Klinische Pharmakologie & Toxikologie, Universitätsspital Basel
| | - Matthias E Liechti
- Abteilung für Klinische Pharmakologie & Toxikologie, Universitätsspital Basel
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12
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Raposo Pereira F, Zhutovsky P, Mcmaster MT, Polderman N, de Vries YD, van den Brink W, van Wingen GA. Recreational use of GHB is associated with alterations of resting state functional connectivity of the central executive and default mode networks. Hum Brain Mapp 2019; 40:2413-2421. [PMID: 30720906 PMCID: PMC6590661 DOI: 10.1002/hbm.24532] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/11/2018] [Accepted: 01/16/2019] [Indexed: 12/18/2022] Open
Abstract
Gamma-hydroxybutyrate acid (GHB) is a recreational drug with a high addictive potential. Severe side effects such as GHB-induced coma are common and linked to increased emergency room attendances. Task-based functional-imaging studies have revealed an association between the regular use of GHB and multiple GHB-induced comas, and altered neurocognitive function. However the effects of multiple GHB-induced comas and regular GHB-use on intrinsic brain connectivity during rest remain unknown. The study population consisted of 23 GHB-users with ≥4 GHB-induced comas (GHB-Coma), 22 GHB-users who never experienced a GHB-induced coma (GHB-NoComa) and 24 polydrug users who never used GHB (No-GHB). Resting-state scans were collected to assess resting-state functional-connectivity within and between the default mode network (DMN), the bilateral central executive network (CEN) and the salience network (SN). The GHB-NoComa group showed decreased rsFC of the right CEN with a region in the anterior cingulate cortex (pFWE = 0.048) and decreased rsFC between the right CEN and the DMN (pFWE = 0.048) when compared with the No-GHB group. These results suggest that regular GHB-use is associated with decreased rsFC within the right CEN and between the right CEN and the DMN. The presence of multiple GHB-induced comas is not associated with (additional) alterations in rsFC.
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Affiliation(s)
- Filipa Raposo Pereira
- Department of Psychiatry, Amsterdam NeuroscienceAmsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
- Amsterdam Brain and CognitionUniversity of AmsterdamAmsterdamthe Netherlands
| | - Paul Zhutovsky
- Department of Psychiatry, Amsterdam NeuroscienceAmsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
- Amsterdam Brain and CognitionUniversity of AmsterdamAmsterdamthe Netherlands
| | - Minni T.B. Mcmaster
- Department of Psychiatry, Amsterdam NeuroscienceAmsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
- Amsterdam Brain and CognitionUniversity of AmsterdamAmsterdamthe Netherlands
| | - Nikki Polderman
- Department of Psychiatry, Amsterdam NeuroscienceAmsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Yvon D.A.T. de Vries
- Department of Psychiatry, Amsterdam NeuroscienceAmsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam NeuroscienceAmsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
- Amsterdam Brain and CognitionUniversity of AmsterdamAmsterdamthe Netherlands
| | - Guido A. van Wingen
- Department of Psychiatry, Amsterdam NeuroscienceAmsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
- Amsterdam Brain and CognitionUniversity of AmsterdamAmsterdamthe Netherlands
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13
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Liakoni E, Gugelmann H, Dempsey DA, Wiegand TJ, Havel C, Jacob P, Benowitz NL. Butanediol Conversion to Gamma-Hydroxybutyrate Markedly Reduced by the Alcohol Dehydrogenase Blocker Fomepizole. Clin Pharmacol Ther 2019; 105:1196-1203. [PMID: 30450642 DOI: 10.1002/cpt.1306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/01/2018] [Indexed: 11/07/2022]
Abstract
1,4-Butanediol (BDO)-used as solvent and abused for its euphoric effects-is converted to gamma-hydroxybutyrate (GHB) by the enzyme alcohol dehydrogenase. This double-blind, placebo-controlled crossover study with six healthy volunteers is the first to date investigating the role of the ADH inhibitor fomepizole (4-methylpyrazole (4MP)) in moderating this conversion in humans. Participants received on two different days either intravenous placebo or 15 mg/kg 4MP followed by oral administration of 25 mg/kg BDO. Pretreatment with 4MP resulted in significantly higher BDO maximal plasma concentration (P = 0.001) and area under the concentration-time curve (AUC; P = 0.028), confirming that ADH is the primary pathway for the conversion of BDO to GHB in humans. With 4MP, the mean arterial pressure was significantly lower at 105 minutes compared to baseline (P = 0.003), indicating that blood pressure lowering, observed not with a temporal relationship to 4MP administration but after the maximum BDO concentration was reached, may be an intrinsic effect of BDO.
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Affiliation(s)
- Evangelia Liakoni
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, California, USA
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hallam Gugelmann
- California Poison Control Center, University of California, San Francisco, California, USA
| | - Delia A Dempsey
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, California, USA
| | | | - Christopher Havel
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, California, USA
| | - Peyton Jacob
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, California, USA
| | - Neal L Benowitz
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California, San Francisco, California, USA
- California Poison Control Center, University of California, San Francisco, California, USA
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, California, USA
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14
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Liakoni E, Dempsey DA, Meyers M, Murphy NG, Fiorentino D, Havel C, Haller C, Benowitz NL. Effect of γ-hydroxybutyrate (GHB) on driving as measured by a driving simulator. Psychopharmacology (Berl) 2018; 235:3223-3232. [PMID: 30232528 PMCID: PMC6457903 DOI: 10.1007/s00213-018-5025-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
RATIONALE Gamma-hydroxybutyrate acid (GHB), a GABAB receptor agonist approved for treatment of narcolepsy, impairs driving ability, but little is known about doses and plasma concentrations associated with impairment and time course of recovery. OBJECTIVE To assess effects of oral GHB (Xyrem®) upon driving as measured by a driving simulator, and to determine plasma concentrations associated with impairment and the time course of recovery. METHODS Randomized, double-blind, two-arm crossover study, during which 16 participants received GHB 50 mg/kg orally or placebo. GHB blood samples were collected prior to and at 1, 3, and 6 h post dosing. Driving simulator sessions occurred immediately after blood sampling. RESULTS Plasma GHB was not detectable at baseline or 6 h post dosing. Median GHB concentrations at 1 and 3 h were 83.1 mg/L (range 54-110) and 24.4 mg/L (range 7.2-49.7), respectively. Compared to placebo, at 1 h post GHB dosing, significant differences were seen for the life-threatening outcome collisions (p < 0.001) and off-road accidents (p = 0.018). Although driving was not faster, there was significantly more weaving and erratic driving with GHB as measured by speed deviation (p = 0.002) and lane position deviation (p = 0.004). No significant impairment regarding driving outcomes was found in the GHB group at 3 and 6 h post dose. CONCLUSION GHB in doses used to treat narcolepsy resulted in severe driving impairment at 1 h post dosing. After 3 to 6 h, there was full recovery indicating that safe driving is expected the next morning after bedtime therapeutic GHB use in the absence of other substances.
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Affiliation(s)
- Evangelia Liakoni
- Departments of Medicine and Bioengineering & Therapeutic Sciences: The University of California San Francisco, San Francisco CA
| | - Delia A Dempsey
- Departments of Medicine and Bioengineering & Therapeutic Sciences: The University of California San Francisco, San Francisco CA
| | - Matthew Meyers
- Department of Pediatrics, Division of Adolescent Medicine: The University of California San Francisco, San Francisco, CA
| | - Nancy G Murphy
- Department of Emergency Medicine: Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Christopher Havel
- Departments of Medicine and Bioengineering & Therapeutic Sciences: The University of California San Francisco, San Francisco CA
| | | | - Neal L Benowitz
- Departments of Medicine and Bioengineering & Therapeutic Sciences, The University of California San Francisco, San Francisco, CA, USA.
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15
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Klobučar I, Potočnjak I, Dumančić J, Stemberger K, Čupić M, Kokotović T, Kucijan Z, Degoricija V. Acute poisonings in Croatia: differences in epidemiology, associated comorbidities and final outcomes - a single-centre 15-year follow-up. Clin Toxicol (Phila) 2018; 57:181-188. [PMID: 30318932 DOI: 10.1080/15563650.2018.1506129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To determine the demographic and social characteristics of acutely intoxicated patients in the emergency department (ED), intention of drug/chemical intake, main toxic agents, outcomes and time trends for all variables. METHODS This prospective, observational study included acutely intoxicated patients treated in the ED of the University Hospital Centre Sisters of Charity, Zagreb, Croatia, during the years 2001, 2010 and 2015. The diagnosis was derived from patient's self-report, clinical observations and laboratory test results (quantitative test for serum ethanol levels and qualitative tests for drugs in urine). RESULTS A total of 1593 patients were enrolled in the study (331 in 2001, 618 in 2010, 644 in 2015), with a predominance of men (55.9%, 65.2%, 70.7%, respectively). The median age was 28 [18-89], 39 [18-92] and 40 years [18-95], respectively. There was a decline in the number of suicide attempts during the study (46.2%, 22.2%, 17.1% of patients, respectively) with a predominance of women (64.1-68.2%), and an escalation in the number of unintentional overdoses by substances of abuse (50.2%, 72.3%, 81.7% of patients, respectively) with a predominance of men (74.1-79.1%). Ethanol was the main toxic agent (40.2%, 69.4%, 75.8% of patients, respectively), used primarily as a substance of unintentional overdose. Anxiolytics were the most frequently implicated pharmaceuticals among all patients (46.5%, 32.0%, 18.5% of patients, respectively) and the main substance used in suicide attempts. The number of patients hospitalized in the Intensive Care Unit (ICU) decreased during the study from 20.2% of all patients in 2001 to 7.9% in 2010 and 6.8% in 2015. They accounted for 7.2%, 5.8% and 5.6% of all ICU-treated patients, respectively. In-hospital mortality (ED and ICU) caused by acute intoxications was low (0.9%, 0.8%, 0.8%, respectively). CONCLUSIONS The escalation of overdoses by ethanol was a major medical and public concern in Zagreb. Anxiolytics were the main substance used in suicide attempts, with a low death rate due to their good safety profile.
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Affiliation(s)
- Iva Klobučar
- a Department of Cardiology , University Hospital Centre Sisters of Charity , Zagreb , Croatia
| | - Ines Potočnjak
- b Department of Medicine , University Hospital Centre Sisters of Charity , Zagreb , Croatia
| | - Jelena Dumančić
- b Department of Medicine , University Hospital Centre Sisters of Charity , Zagreb , Croatia.,c Neuropsychiatric Hospital "Dr. Ivan Barbot" , Popovača , Croatia
| | | | - Miriam Čupić
- b Department of Medicine , University Hospital Centre Sisters of Charity , Zagreb , Croatia.,c Neuropsychiatric Hospital "Dr. Ivan Barbot" , Popovača , Croatia
| | - Tomislav Kokotović
- e Institute of Emergency Medicine of the Istrian County , Pula , Croatia
| | - Zdravka Kucijan
- e Institute of Emergency Medicine of the Istrian County , Pula , Croatia
| | - Vesna Degoricija
- b Department of Medicine , University Hospital Centre Sisters of Charity , Zagreb , Croatia.,d University of Zagreb School of Medicine , Zagreb , Croatia
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16
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Raposo Pereira F, McMaster MTB, Polderman N, de Vries YDAT, van den Brink W, van Wingen GA. Adverse effects of GHB-induced coma on long-term memory and related brain function. Drug Alcohol Depend 2018; 190:29-36. [PMID: 29966850 DOI: 10.1016/j.drugalcdep.2018.05.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/03/2018] [Accepted: 05/21/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Gamma-Hydroxybutyric acid (GHB) is a drug of abuse associated with increasing numbers of GHB-dependent patients and emergency attendances often related to GHB-induced coma. Animal studies suggest that GHB induces oxidative stress in the hippocampus, resulting in memory impairments. However, the consequences of chronic GHB use and GHB-induced coma on human brain function and cognition are unknown. METHODS We recruited 27 GHB users with ≥4 GHB-induced comas (GHB-Coma), 27 GHB users without a coma (GHB-NoComa), and 27 polydrug users who never used GHB (No-GHB). Participants completed verbal and spatial memory tests and an associative memory encoding task during functional magnetic resonance imaging (fMRI) to probe hippocampus functioning. RESULTS The GHB-Coma group showed a lower premorbid IQ (p = 0.006) and performed worse on the verbal memory test (p = 0.017) compared to the GHB-NoComa group, despite exhibiting similar levels of education. Compared with the other two groups, the GHB-Coma group showed lower left hippocampus (pSVC = 0.044) and left lingual gyrus (pFWE = 0.017) activity, and a trend for lower hippocampal functional connectivity with the left superior temporal cortex during performance of the associative memory encoding task (pFWE = 0.063). No significant differences were observed between the GHB-NoComa group and the No-GHB group. CONCLUSIONS These results suggest that multiple GHB-induced comas, but not the use of GHB per se, are associated with alterations of memory performance and memory-related brain, although no causal link can be inferred from this cross-sectional study. The results highlight the need for public awareness to minimize the negative health consequences of recreational GHB use, in particular when related with GHB-induced comas.
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Affiliation(s)
- Filipa Raposo Pereira
- Department of Psychiatry, Academic Medical Center, The University of Amsterdam, AMC (PA.3-220), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands; Amsterdam Neuroscience, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, The University of Amsterdam, P.O. Box 19268, 1000 GG, Amsterdam, The Netherlands.
| | - Minni T B McMaster
- Department of Psychiatry, Academic Medical Center, The University of Amsterdam, AMC (PA.3-220), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands; Amsterdam Neuroscience, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, The University of Amsterdam, P.O. Box 19268, 1000 GG, Amsterdam, The Netherlands
| | - Nikki Polderman
- Department of Psychiatry, Academic Medical Center, The University of Amsterdam, AMC (PA.3-220), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Yvon D A T de Vries
- Department of Psychiatry, Academic Medical Center, The University of Amsterdam, AMC (PA.3-220), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center, The University of Amsterdam, AMC (PA.3-220), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands; Amsterdam Neuroscience, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, The University of Amsterdam, P.O. Box 19268, 1000 GG, Amsterdam, The Netherlands
| | - Guido A van Wingen
- Department of Psychiatry, Academic Medical Center, The University of Amsterdam, AMC (PA.3-220), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands; Amsterdam Neuroscience, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, The University of Amsterdam, P.O. Box 19268, 1000 GG, Amsterdam, The Netherlands
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17
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Hegazi A, Morton S, Pakianathan M, Cosgrove C, Aroney R, Dore E, Hempling M. A novel sexual health referral pathway for patients presenting to the emergency department with gamma-hydroxybutyrate or gamma-butyrolactone overdose. Int J STD AIDS 2017; 28:1466-1467. [PMID: 29113574 DOI: 10.1177/0956462417736637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A Hegazi
- 1 The Courtyard Clinic, Wandsworth Integrated Sexual Health, St. George's University Hospital Foundation Trust, London, UK
| | - S Morton
- 2 Emergency Medicine Department, St. George's University Hospital Foundation Trust, London, UK
| | - M Pakianathan
- 1 The Courtyard Clinic, Wandsworth Integrated Sexual Health, St. George's University Hospital Foundation Trust, London, UK
| | - C Cosgrove
- 3 Clinical Infection Unit, St. George's University Hospital Foundation Trust, London, UK
| | - R Aroney
- 1 The Courtyard Clinic, Wandsworth Integrated Sexual Health, St. George's University Hospital Foundation Trust, London, UK
| | - E Dore
- 1 The Courtyard Clinic, Wandsworth Integrated Sexual Health, St. George's University Hospital Foundation Trust, London, UK
| | - M Hempling
- 2 Emergency Medicine Department, St. George's University Hospital Foundation Trust, London, UK
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