New Drugs Of Abuse
Published on Nov 18, 2015
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PRESENTATION OUTLINE
Faculty: Ian Mitchell
- Tilray - research stipend, speaking fees
- MD Briefcase - honorarium
- Realeaf - consultant
Tilray - I am the Qualified Investigator for a trial on the effects of cannabis on PTSD. I will receive a stipend for this work. I have also received a speaking fee for an educational session.
MD Briefcase - I have received an honorarium for serving as an expert reviewer for an online cannabis certification course.
Realeaf Wellness Center - I am a consultant for Realeaf patients, though I do not have any interest in the company.
MD Briefcase - I have received an honorarium for serving as an expert reviewer for an online cannabis certification course.
Realeaf Wellness Center - I am a consultant for Realeaf patients, though I do not have any interest in the company.
Photo by Gekko93
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Photo by digital-dreams
Field Study of Recreational Pharmacology
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The ecology of drugs is changing, moving from bulky, minimally processed organic products to highly purified synthetic chemicals that can be shipped through the mail
Old drugs - cocaine, heroin, cannabis
Old drugs - cocaine, heroin, cannabis
Photo by ResoluteSupportMedia
Drug Panics - is zombification necessary?
We begin the process of zombification
Despite the panic, krokodil has not been seen in North America, and is unlikely to appear, given the easy availability of heroin.
Despite the panic, krokodil has not been seen in North America, and is unlikely to appear, given the easy availability of heroin.
Fentanyl
145 deaths in Alberta in the first six months of 2015
Two thirds of overdoses are happening is suburban homes.
http://globalnews.ca/news/2218471/alberta-health-services-says-fentanyl-ant...
Moving from abuse of diverted medical products to pure industrial product used on its own or as an adulterant.
Two thirds of overdoses are happening is suburban homes.
http://globalnews.ca/news/2218471/alberta-health-services-says-fentanyl-ant...
Moving from abuse of diverted medical products to pure industrial product used on its own or as an adulterant.
Photo by Nottingham Vet School
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Spurred on by the increase in opiate deaths, take home naloxone projects are hoping to help decrease the deaths.
Photo by e_monk
Be a Naloxone Ninja
Ventilate
to reduce acidosis
Ventilation is more important than the provision of naloxone.
Naloxone Dilution
0.04 - 0.08 mg iv q60s
The focus should be on the reversal of respiratory effects rather than
Photo by AmaruDaiKyoko
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Used as an alternate to alcohol, far fewer calories.
Fine line between "therapeutic" and "coma-inducing" dosages, especially if combined with alcohol
Do not always require intubation, although coingestions common.
Rapid fluctuating levels of consciousness
Some use it for sleep - withdrawal problematic
Fine line between "therapeutic" and "coma-inducing" dosages, especially if combined with alcohol
Do not always require intubation, although coingestions common.
Rapid fluctuating levels of consciousness
Some use it for sleep - withdrawal problematic
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Phenibut
Similar to baclofen
Available online without a prescription
Invented in USSR, given to cosmonauts
Withdrawal can occur, similar to alcohol, GHB, other GABA agents.
Available online without a prescription
Invented in USSR, given to cosmonauts
Withdrawal can occur, similar to alcohol, GHB, other GABA agents.
Photo by ** RCB **
Khat
Khat is a plant that is chewed for its stimulant properties, mostly in Yemen, Somalia and Ethiopia. It has recently been banned in the UK and in Canada, possession of this plant could get you up to 3 years in jail, though prosecutions appear infrequent.
Its use is generally of no particular medical concern though the environmental and financial impact of this drug is substantial.
The connection to this talk arises in the “Khat” to “cathinones” to “meow-meow” (the internet loves their cat puns).
Khat contains cathinone.
Mephedrone (also known as 4-methylmethcathinone, or MCAT or “meow-meow”)
Its use is generally of no particular medical concern though the environmental and financial impact of this drug is substantial.
The connection to this talk arises in the “Khat” to “cathinones” to “meow-meow” (the internet loves their cat puns).
Khat contains cathinone.
Mephedrone (also known as 4-methylmethcathinone, or MCAT or “meow-meow”)
Photo by CharlesFred
Bath Salts
Photo by 666isMONEY ☮ ♥ & ☠
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Zombie Panic
Photo by duane.schoon
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Like LSD, flakka induces insanity in those who have not taken it.
The latest drug to give its users superhuman strength and drive them insane. Is this the one that finally is true?
Alpha pyrrolidinopentiophenone
Can be vaped as liquid
The latest drug to give its users superhuman strength and drive them insane. Is this the one that finally is true?
Alpha pyrrolidinopentiophenone
Can be vaped as liquid
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Best testing option is ecstasydata.org, run by erowid.org, with subsidies from the DEA. Pills can be sent to them with a $40 fee ($100 for powder, which is less often adulterated).
Home tests available
SSRIs block effects, especially citalopram.
Differences in womens toxicity - water retention
Generally safe, if pure MDMA
Home tests available
SSRIs block effects, especially citalopram.
Differences in womens toxicity - water retention
Generally safe, if pure MDMA
Photo by cruithne
Paramethoxymethamphetamine
Paramethoxymethamphetamine killed 27 Western Canadians in 2011-2012 when it got into the MDMA supply.
More potent, but delayed onset.
Should law enforcement agencies publish the results of drug testing on seized drugs or when there is a threat of death"
More potent, but delayed onset.
Should law enforcement agencies publish the results of drug testing on seized drugs or when there is a threat of death"
Photo by Imagens Evangélicas
BZP/TFMPP
BZP and TFMPP are piperazine stimulants and anti-helminthics that have an effect similar to MDMA when combined.
They were very popular in New Zealand
They were very popular in New Zealand
Drug Regulation
The New Zealand Experiment
Drug regulationin New Zealand was a brave experiment that failed, partly due to PETA
Photo by richard_munden
The Dark Web
Photo by gigmum2008
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The first online transaction was for cannabis
Synthetic Cannabinoids
Risk of CVA and renal failure with synthetic cannabinoids.
Antagonist theoretically available - rimonabant story
Photo by szapucki
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Cannabinoid hyperemesis syndrome can be treated with topical capsaicin 0.075%
Synthetic cannabinoids have been associated with hyperemesis syndrome.
http://drugmonkey.scientopia.org/2014/03/07/hyperemesis-associated-with-syn...
Synthetic cannabinoids have been associated with hyperemesis syndrome.
http://drugmonkey.scientopia.org/2014/03/07/hyperemesis-associated-with-syn...
Photo by Jenn and Tony Bot
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NBOME compounds
Very potent hallucinogens. Often sold as LSD.
More likely to cause death than LSD. Kidney failure, seizures and rhabdomyolysis are the main complications.
Very potent hallucinogens. Often sold as LSD.
More likely to cause death than LSD. Kidney failure, seizures and rhabdomyolysis are the main complications.
Photo by Sterneck
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NBOME compounds
Very potent hallucinogens. Often sold as LSD.
More likely to cause death than LSD. Kidney failure, seizures and rhabdomyolysis are the main complications.
Very potent hallucinogens. Often sold as LSD.
More likely to cause death than LSD. Kidney failure, seizures and rhabdomyolysis are the main complications.
Photo by Sterneck
Ketamine
Used as a less intense, shorter MDMA experience in small doses
Has moved from medical/veterinary diversion to large scale factory production.
Has moved from medical/veterinary diversion to large scale factory production.
Photo by gareth1953 Cataract Creating Chaos
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Long term use of high dose ketamine can lead to interstitial cystitis occasionally requiring urinary diversion
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Methoxetamine
A ketamine analog that was supposed to be less bladder toxic, but this is questionable.
Cerebellar toxicity and loss of bowel control
A ketamine analog that was supposed to be less bladder toxic, but this is questionable.
Cerebellar toxicity and loss of bowel control
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Very potent hallucinogen that comes from a brew combining a DMT rich shrub with an MAOI inhibiting
Vine has harmine alkaloids which are MAOI, plus you know, harmine, a beta carboline
Vine has harmine alkaloids which are MAOI, plus you know, harmine, a beta carboline
Photo by Eli Horne
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Photo by periodismo_itinerante
Ibogaine
Image Credit: http://www.film-documentaire.fr/film.php?id=11354
Used by the Bwiti tribe in Central Africa
"Dirty" drug. Acts at multiple sites.
Used by the Bwiti tribe in Central Africa
"Dirty" drug. Acts at multiple sites.
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Complications include arrthythmia, bradycardia
Mortality rate of 1/300, although probably related to risk factors that could be corrected or risk stratified. (Methadone prolongs QT and has long half life)
Cardiovascular complications appear to be often related to hypokalemia and hypomagnesemia.
Prolongation of QT interval can lead to VT or VF. Risk can be up to several days after the trip.
Mortality rate of 1/300, although probably related to risk factors that could be corrected or risk stratified. (Methadone prolongs QT and has long half life)
Cardiovascular complications appear to be often related to hypokalemia and hypomagnesemia.
Prolongation of QT interval can lead to VT or VF. Risk can be up to several days after the trip.
Photo by Nottingham Vet School
Getting High by Prescription
Photo by frankieleon
Tramadol
Photo by KeizerStreetArt
Wellbutrin
Poor man's cocaine - crushing tablets and injecting leads to skin ulcers
Snorting bypasses first pass metabolism
Abuse can lead to seizures.
A prison favorite.
Snorting bypasses first pass metabolism
Abuse can lead to seizures.
A prison favorite.
Photo by smkybear
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Gabapentin recreational dose is 900-5000 mg.
Favored in prison, often on top of methadone.
Favored in prison, often on top of methadone.
