DOCSLIB.ORG

Intoxication with New Psychoactive Substances in Patients Diagnosed At

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

Pomeranian J Life Sci 2020;66(2):13-17 doi: 10.21164/pomjlifesci.642 Intoxication with new psychoactive substances in patients diagnosed at the Department of Clinical and Forensic Toxicology, Pomeranian Medical University in Szczecin in 2015–2018 Barbara Potocka-Banaś1, A , Urszula Semeniuk1, B, Sławomir Majdanik2, C, Krzysztof Borowiak1, D, Tomasz Janus1, E 1 Pomeranian Medical University in Szczecin, Department of Clinical and Forensic Toxicology, Powstańców Wlkp. 72, 70-110 Szczecin, Poland 2 Pomeranian Medical University in Szczecin, Department of Forensic Medicine, Powstańców Wlkp. 72, 70-110 Szczecin, Poland A ORCID: 0000-0003-0259-2006; B ORCID: 0000-0003-0247-4202; C ORCID: 0000-0003-0472-1924; D ORCID: 0000-0002-2526-2686; E ORCID: 0000-0002-2363-2196 [email protected] ABSTRACT Results: Our research was based on Introduction: Intoxication with new psychoactive substances poisoning with volatile and non-volatile organic compounds car- (NPSs), colloquially known as designer drugs, has become a sig- 5,916 diagnostic tests for- The aim of the study was to conduct a statistical analysis of ried out in 2015–2018 at Pomeranian Medical University in Szc retrospectivenificant problem data in fromthe last test several records years. for the presence of NPSs zecin. Psychoactive substances used for non-medical purposes weresubstances, detected the in poisonings 1,465 patients. caused In bythe the period intentional under analysisuse NPS 1,328 of these patients were poisoned with classic psychoactive inMaterials patients andhospitalized methods in 2015–2018 in the West Pomeranian Conclusions: A retrospective analysis of the above-mentioned undertakenprovince. at the Department of Clinical and Forensic Toxi- were recorded in 137. gradual increase in the : We analyzed 5,916 results of tests incidence of poisoning with psychoactive substances used for samples had been analyzed by liquid chromatography coupled data for the period 2015–2018 revealed a withcology mass at Pomeranian spectrometry Medical (LC/MS) University and Headspace in Szczecin. gas chroma Blood- Keywords: intoxication; new psychoactive substances; designer non-medical purposes. tography (GC/Headspace). drugs; data analysis; diagnostic tests. INTRODUCTION The most popular and largest group are psychostimulants, which act on the central nervous system (CNS) and often pro- Intoxication with new psychoactive substances (NPSs) has duce effects comparable to those elicited by cocaine, ampheta- become a common and serious clinical, social and forensic - ally known as designer drugs, are compounds that have been Psychostimulantsmine and MDMA (3,4-methylenedioxymethamphetamine), cause a i.e. problemchemically in thealtered last severalfrom controlled years. These substances substances, and colloquiare usu- Theseincreased include psychomotor cardiovascular activity, symptoms euphoria, suchanorexia, as sinus insomnia. tachy- ally sold online cardia, palpitations, chestbroad pain, spectrumhypertension, of adverse myocarditis, effects. labels that do not precisely describe their contents, and their cardiac arrest; haematological problems such as dissemi- [1, the2]. Theycharacters are distributed of pop culture in packages (Pink Panther), with nated intravascular coagulation, thrombocytopaenia, anae- collectors’ items (driver’s charm), or items of everyday use names refer, e.g. to impairment, reduced mental performance; emotional prob- suggests that these compounds produce only psychoactive lemsmia; cognitivesuch as irritability, dysfunction, aggression, e.g. confusion, panic chronic attacks, cognitive anhedo- (moistureeffects, while absorber). in fact only The someterm “newof them psychoactive do substances” nia, depression, suicidal thoughts; neurological symptoms, chemical structure and mechanisms of action, NPSs are clas- so. Considering the paraesthesia, bruxism, dyskinesia, headache and dizziness; • e.g. insomnia, hyperthermia, mydriasis, visual disturbances, sified into 4 major groups [3]: hallucinations psychostimulants (β-cathinone derivatives, piperazine perception disorders – paranoid delusions, auditory and visual • derivatives,synthetic cannabinoids 2,5-dimethoxyphenethylamine (indole derivatives, derivatives,cyclohexyl- [4]. phenolcalled 2Cs), derivatives, classic cannabinoids), oftenSynthetic entirely cannabinoidsdifferent from thatare agonistsof natural of cannabinoids, the CB1 and theyCB2 • hallucinogens (derivatives of tryptamine, phenylethyl- receptors.can produce Despite effects the up toaltered chemical structure, which is- amine and arylcyclohexylamine), • 500 times more potent in the mech anism stimulating the CB1 receptor pathway (central), and synthetic opioids. the CB2 receptor pathway (peripheral), and elicit narcotic, 13 Barbara Potocka-Banaś, Urszula Semeniuk, Sławomir Majdanik, Krzysztof Borowiak, Tomasz Janus empathogenic, intoxicating/psychotropic effects similar MATERIALS AND METHODS to the pharmacological properties The study presents a retrospective analysis of data from toxi- andthose toxicity of Δ-9-THC of synthetic found cannabinomimeticsin cannabis products is i.e., very marijuana limited, butand clinicalhashish. data Information imply a broad on spectrum of toxic effects from cology tests carried out analyzed at DoCaFT results PMU inand Szczecin medical in data 2015–2018 from effects include disorders of the cardiovascular system, such as and commissioned by 18 hospitals from the West Pomeranian- hypertension,cannabinol analogues. tachycardia, The mostarrhythmia, frequently chest reported pain, shortness adverse province.tive for the Overall, presence we of psychoactive substances used for non- referrals for 5,916 cases, from which 1,465 patients tested posi are equally frequent: seizures, including tonic-clonic seizures, chromatography coupled with mass spectrometry (LC/MS) and of breath, and myocardial infarction. Neurological symptoms- medicinal purposes. Blood samples were analyzed by liquid stances also leads to psychiatric disorders: panic and anxi- of NPSs detected in the tests was compared to the number of etysleep attacks, disorders, hallucinations, headaches and delusional dizziness. psychosis, Abuse of aggressive these sub Headspace gas chromatography (GC/Headspace). The number been reported, including disorientation and disorders of short- all psychoactive substances detected in poisoned patients. behaviour,term memory and depression. Cognitive impairment has also RESULTS receptor, [5]. - Most hallucinogens activate the serotonin 5-HT2 sic and designer drugs used for non-medical purposes, were psychedelicmainly the 5-HT effects2� ofsubtype. hallucinogens Hallucinogens largely depend cause changes on the per in- In the period 2015–2018, psychoactive substances, both clas consciousness,sonality traits andperceptual emotional anomalies, state of andthe hallucinations.user, as well as Thethe (classic substances) included: ethyl alcohol, amphetamine, methamphetamine,detected in blood samples cocaine, from tetrahydrocannabinol, 1,465 patients. The 1st MDMA, group after the use of hallucinogens include increased heart rate, increasedexpectations blood and pressure, the circumstances. risk of serotonin Toxic syndrome,effects observed clonic seizures, insomnia, delirium, and rhabdomyolysis Ecstasy, and lysergic acid diethylamide (LSD). The 2nd group New designer opioids act on becauseincluded of NPSs, intoxication also known with as classic designer psychoactive drugs. substances, [6]. - In the analysed period 1,328 patients were hospitalized vation of central opioid receptorsthe produces µ, ð, and anĸ opioid analgesic receptors, effect, The study was based on blood samples collected from relievesmainly in anxiety the CNS and and panic less attacks, in the peripheral causes mood tissues. changes, The actiand patientsand 137 patients tested wereat DoCaFT diagnosed PMU with in Szczecin poisoning for caused the presence by NPSs. - - tion, dizziness, reduced blood pressure, seizures, liver damage, lowersand respiratory the seizure depression threshold. leading Toxic toeffects death include constipa of psychoactive substances. The tests for the presence of psy The aim of the study was to conduct a statistical analysis choactive substances were positive in 314 patients (21.4%) in of retrospective data from tests for the presence[7]. of NPSs in 2015, for 371 patients (25.3%) in 2016, for 382 patients (26.1%) in 2017, and for 398 patients (27.2%) in 2018 (Fig. 1). The tests for the presence of NPSs were positive in 8 patients patientsthe Department hospitalized of Clinical in 2015–2018 and Forensic in the Toxicology, West Pomeranian Pomera- (0.54%) in 2015, 19 patients (1.29%) in 2016, 46 patients (3.13%)- province. We analyzed 5,916 results of tests undertaken at in 2017, and 64 patients (4.36%) in 2018 (Fig. 2). Analysis of the data for 2015 showed that synthetic cannabi nian Medical University in Szczecin (DoCaFT PMU in Szczecin). noid (1-pentyl-1H-indol-3-yl) (2,2,3,3-tetramethylcyclopropyl) 30 25 20 15 10 psychoactive substances(%) 5 Rates of test positive for non-medical 0 2015 2016 2017 2018 Years FIGURE 1. Share of positive tests for psychoactive substances used for non-medical purposes annually across the period 2015–2018 in the total sample of positive tests (n = 1465) 14 ojs.pum.edu.pl/pomjlifesci Intoxication with new psychoactive substances in patients diagnosed at the Department of Clinical and Forensic Toxicology, PMU in Szczecin in 2015–2018 5 4.5 4 3.5 3 2.5 2 Ratest of NPS Ratest of 1.5 1 0.5 0 2015 2016 2017 2018 Years
Recommended publications
  • Medical Review Officer Manual

    Medical Review Officer Manual

    Department of Health and Human Services Substance Abuse and Mental Health Services Administration Center for Substance Abuse Prevention Medical Review Officer Manual for Federal Agency Workplace Drug Testing Programs EFFECTIVE OCTOBER 1, 2010 Note: This manual applies to Federal agency drug testing programs that come under Executive Order 12564 dated September 15, 1986, section 503 of Public Law 100-71, 5 U.S.C. section 7301 note dated July 11, 1987, and the Department of Health and Human Services Mandatory Guidelines for Federal Workplace Drug Testing Programs (73 FR 71858) dated November 25, 2008 (effective October 1, 2010). This manual does not apply to specimens submitted for testing under U.S. Department of Transportation (DOT) Procedures for Transportation Workplace Drug and Alcohol Testing Programs (49 CFR Part 40). The current version of this manual and other information including MRO Case Studies are available on the Drug Testing page under Medical Review Officer (MRO) Resources on the SAMHSA website: http://www.workplace.samhsa.gov Previous Versions of this Manual are Obsolete 3 Table of Contents Chapter 1. The Medical Review Officer (MRO)........................................................................... 6 Chapter 2. The Federal Drug Testing Custody and Control Form ................................................ 7 Chapter 3. Urine Drug Testing ...................................................................................................... 9 A. Federal Workplace Drug Testing Overview..................................................................
  • Phencyclidine: an Update

    Phencyclidine: an Update

    Phencyclidine: An Update U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES • Public Health Service • Alcohol, Drug Abuse and Mental Health Administration Phencyclidine: An Update Editor: Doris H. Clouet, Ph.D. Division of Preclinical Research National Institute on Drug Abuse and New York State Division of Substance Abuse Services NIDA Research Monograph 64 1986 DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Alcohol, Drug Abuse, and Mental Health Administratlon National Institute on Drug Abuse 5600 Fishers Lane Rockville, Maryland 20657 For sale by the Superintendent of Documents, U.S. Government Printing Office Washington, DC 20402 NIDA Research Monographs are prepared by the research divisions of the National lnstitute on Drug Abuse and published by its Office of Science The primary objective of the series is to provide critical reviews of research problem areas and techniques, the content of state-of-the-art conferences, and integrative research reviews. its dual publication emphasis is rapid and targeted dissemination to the scientific and professional community. Editorial Advisors MARTIN W. ADLER, Ph.D. SIDNEY COHEN, M.D. Temple University School of Medicine Los Angeles, California Philadelphia, Pennsylvania SYDNEY ARCHER, Ph.D. MARY L. JACOBSON Rensselaer Polytechnic lnstitute National Federation of Parents for Troy, New York Drug Free Youth RICHARD E. BELLEVILLE, Ph.D. Omaha, Nebraska NB Associates, Health Sciences Rockville, Maryland REESE T. JONES, M.D. KARST J. BESTEMAN Langley Porter Neuropsychiatric lnstitute Alcohol and Drug Problems Association San Francisco, California of North America Washington, D.C. DENISE KANDEL, Ph.D GILBERT J. BOTV N, Ph.D. College of Physicians and Surgeons of Cornell University Medical College Columbia University New York, New York New York, New York JOSEPH V.
  • Advisory Council on the Misuse of Drugs Chair: Professor Les Iversen Secretary: Rachel Fowler 3Rd Floor Seacole Building 2

    Advisory Council on the Misuse of Drugs Chair: Professor Les Iversen Secretary: Rachel Fowler 3Rd Floor Seacole Building 2

    ACMD Advisory Council on the Misuse of Drugs Chair: Professor Les Iversen Secretary: Rachel Fowler 3rd Floor Seacole Building 2. Marsham Street London SW1P 4DF 020 7035 0454 Email: [email protected] Rt Hon. Theresa May MP Home Office 2 Marsham Street London SW1P 4DF 18th October 2012 Dear Home Secretary, In March 2012 the ACMD advised that methoxetamine be subject to a temporary class drug order. Methoxetamine was marketed as a legal alternative to ketamine until a temporary class drug order was implemented in April 2012. As is now required, the ACMD has followed its initial assessment with a consideration of methoxetamine in the context of the Misuse of Drugs Act 1971; I enclose the report with this letter. The chemical structure of methoxetamine bears a close resemblance to that of both ketamine and phencyclidine (PCP, „Angel Dust‟, a class A drug), which both produce well- documented and serious adverse effects following both acute and chronic usage. Users report that the effects of methoxetamine are similar to those of ketamine, however, some users report that the effects are of longer duration.The harmful effects reported include severe dissociation, cardiovascular symptoms, paranoid thoughts and unpleasant hallucinations. The first analytically confirmed series reported by Guy‟s and St Thomas‟ NHS Foundation Trust, London in 2011, was of three individuals who presented having self-reported use of methoxetamine. All three presented with a ketamine-like dissociative state, but also had significant stimulant effects with agitation and cardiovascular effects including tachycardia and hypertension. Toxicological screening of serum samples confirmed methoxetamine use in two of the cases.
  • Guidance on the Clinical Management of Acute and Chronic Harms of Club Drugs and Novel Psychoactive Substances NEPTUNE

    Guidance on the Clinical Management of Acute and Chronic Harms of Club Drugs and Novel Psychoactive Substances NEPTUNE

    Novel Psychoactive Treatment UK Network NEPTUNE Guidance on the Clinical Management of Acute and Chronic Harms of Club Drugs and Novel Psychoactive Substances NEPTUNE This publication of the Novel Psychoactive Treatment UK Network (NEPTUNE) is protected by copyright. The reproduction of NEPTUNE guidance is authorised, provided the source is acknowledged. © 2015 NEPTUNE (Novel Psychoactive Treatment UK Network) 2015 Club Drug Clinic/CAPS Central and North West London NHS Foundation Trust (CNWL) 69 Warwick Road Earls Court SW5 9HB http://www.Neptune-clinical-guidance.com http://www.Neptune-clinical-guidance.co.uk The guidance is based on a combination of literature review and expert clinical con sensus and is based on information available up to March 2015. We accept no responsi bility or liability for any consequences arising from the use of the information contained in this document. The recommended citation of this document is: Abdulrahim D & Bowden-Jones O, on behalf of the NEPTUNE Expert Group. Guidance on the Management of Acute and Chronic Harms of Club Drugs and Novel Psychoactive Substances. Novel Psychoactive Treatment UK Network (NEPTUNE). London, 2015. NEPTUNE is funded by the Health Foundation, an independent charity working to improve the quality of health care in the UK. Editorial production and page design by Ralph Footring Ltd, http://www.footring.co.uk NEPTUNE NEPTUNE (Novel Psychoactive Treatment UK Network): Expert Group members NEPTUNE Expert Group Dr Owen Bowden-Jones Neptune Chair Clinical and programme lead Consultant
  • Ketamine: Peril and Promise

    Ketamine: Peril and Promise

    m a p s • v o l u m e x v i i n u m b e r 1 • s p r i n g ~ s u m m e r 2 o o 7 23 Ketamine: Peril and Promise Those following science news will have noticed some recent buzz about ketamine. What’s going on? Carlos Zarate Jr., MD, of the National Institute of Mental Health (NIMH) recently injected 18 patients who had treatment- resistant depression with ketamine and found that their depres- sion significantly improved within hours - an improvement that 1 R. Andrew Sewell, MD lasted for up to a week after a single dose. This is in striking [email protected] contrast to conventional antidepressants, which have to be taken every day and need weeks to months to have any therapeutic effect. The importance of these findings was articulated by the NIMH director, Thomas Insel, MD: “To my knowledge, this is the first report of any medication or other treatment that results in such a pronounced, rapid, prolonged response with a single dose.” This study corroborates earlier findings by researchers in 2000 who gave ketamine to seven depressed patients and noted a Veterans began to return remarkable and lasting remission of depression in all of them.2 to the United States By coincidence, Zarate was an attend- 1). It was invented in 1962 by the phar- with unusual stories ing physician at the medical center where macist Calvin Stevens and patented in I did my training, and I remember well 1966 by Parke-Davis for use as an anaes- about psychedelic the dismay everyone expressed when he thetic in humans and animals.
  • Phencyclidine Intoxication and Adverse Effects: a Clinical and Pharmacological Review of an Illicit Drug

    Phencyclidine Intoxication and Adverse Effects: a Clinical and Pharmacological Review of an Illicit Drug

    The California Journal of Emergency Medicine VIII: February 2007 Page 9 Clinical Review Phencyclidine Intoxication and Adverse Effects: A Clinical and Pharmacological Review of an Illicit Drug Tareg Bey, MD and Anar Patel, MD Department of Emergency Medicine, University of California, Irvine, Medical Center Orange, California. Correspondence: Tareg Bey, MD, FACEP, FAAEM Department of Emergency Medicine University of California, Irvine Medical Center 101 The City Drive, Rte 128 Orange, CA 92868 Tel: (714) 456.5239 Fax: (714) 456.5390 E-mail: [email protected] INTRODUCTION varied forms, it can be snorted, smoked, ingested or injected intravenously or subcutaneously.1, 7, 8 Phencyclidine (PCP, “angel dust”) is an infamous A typical PCP-laced marijuana cigarette contains to 0mg hallucinogenic sought for its ability to induce the illusion of of the drug. The average tablet varies in weight from to 6 mg.3, euphoria, omnipotence, superhuman strength, and social and 9 Only 0.25 mg of IV solution is required to produce sedation, sexual prowess. The acronym PCP stems from its organic compared to 0mg required via ingestion or inhalation.0 name -(-phenylcyclohexyl) piperidine, which alludes to its Inhalation accounts for 70% of usage, however, because relatively simple production from the arylcyclohexylamine onset of action occurs in 2-5 minutes, without the complications , 2 piperidine. of injection. Effects may take 5 to 60 minutes when ingested More than 60 designer analogs more toxic than PCP, but orally.3, 6, 11, 2 Phencyclidine is a weak base that is lipid, water, able to escape clinical detection, were common before the sale and alcohol soluble, giving it an extraordinary volume of of piperidine and its derivatives became illegal in the United distribution of 6.2 L/kg.2 Thus, the relationship between dose, States in 1978.
  • Medications Used for Conscious Sedation / Analgesia for Diagnostic

    Medications Used for Conscious Sedation / Analgesia for Diagnostic

    UNIVERSITY OF VIRGINIA HEALTH SYSTEM ADULT AND GERIATRIC SEDATION/ANALGESIA FOR DIAGNOSTIC AND THERAPEUTIC PROCEDURES CLASS & ONSET, PEAK EFFECT, DRUG DOSING GUIDELINES ADVERSE DRUG MECHANISM OF AND DURATION OF COMMENTS REVERSAL (IV ADMINISTRATION) REACTIONS ACTION ACTION Midazolam Benzodiazepine Adults 18 - 64 years of age: Onset: 1- 3 min Respiratory and Advantages include quick onset Flumazenil (Versed) 0.05 mg/kg repeated every 2 - 3 minutes to adequate cardiovascular depression and short duration of action. Due (0.2mg over 15 (Binds to GABA receptor sedation up to a max dose of 0.2mg/kg. Peak Effect: 5 -7 min may occur. to quick onset and rapid clearance, seconds, may resulting in CNS (Small incremental doses of 1 - 3mg every 2-3 May also cause ataxia, is often the most satisfactory repeat at 1 min depression) minutes up to an average total dose of 5mg) Duration of Action: dizziness, hypotension, benzodiazepine for peri-procedure as needed) 20 - 30 min bradycardia, blurred vision, sedation. Combine with an opioid Elderly (> 65) and those with COPD, congestive heart and paradoxical agitation. for painful procedures but reduce failure, or chronic debilitation: dose by 25 -50%. 0.02mg/kg repeated every 2 - 3 minutes to adequate Cautions: (1,3) sedation up to a max dose of 0.2mg/kg (Small incremental doses of 0.5 - 1mg every 2-3 min) Lorazepam Benzodiazepine Adults 18 - 64 years of age: Onset: 3 - 7 min Respiratory and Compared to midazolam, has Flumazenil (Ativan) 0.02 - 0.05 mg/kg repeated every 3-4 minutes up to a cardiovascular depression slower onset and longer duration of (0.2mg over 15 (Binds to GABA receptor max dose of 4mg.
  • Ketamine (C13h16clno)

    Ketamine (C13h16clno)

    Ketamine (C13H16ClNO) Ketamine General Facts Molecular formular: C13H16ClNO Systematic name: 2-(2-chlorophenyl)-2-(methylamino)cyclohexan-1-one (IUPAC name) Alternatenames: a. In medical jargon: Ketaject, Ketanest, dl-Ketamine, Ketalar, CI 581 base, CLSTA 20, Ketolar b. In drug jargon: special K, green, jet, K, and super C Molar mass: 237.092042 g/mol Appearance: white powder, colorless liquid History and Discovery Initial genesis: finding a substitude for Morphin as a anaesthetic initially: Heroin, however too addicting temporary substitute: phencyclidine (PCP) Phencyclidine strong analgesic properties, hallucinogenic effects leading to an introduction in drug world as „angel dust“ 1962: Ketamine as drug with milder side-effects but similar structure 1964: experiments on paid prisoners, first suspicion on effects on psyche 1966: patent by Clarke-Davis 1970: officially in use proven as safe and very effective anaesthetic and painkiller for humans and animals effects strike quickly and does not cause depression or collapse of airways Used for casualties of traffic accidents or battlefield victims Historical usage: Vietnam war as anaesthetic however, still with psychic side effects Synthesis (following the mechanism developed by Calvin L. Stevens) Initial reagent: cyclopentyl Grignard Step 0: Producing cyclopentyl Grignard Reacting cyclopentyl bromide with magnesium in solvent (ether or THF) Best results: distill solvent from Grignard under vacuum and replace with hydrocarbon solvent (e.g. benzene) Step 1: processing to (o-chlorophenyl)-cyclopentyl
  • Methoxetamine (MXE) Critical Review Report Agenda Item 5.9

    Methoxetamine (MXE) Critical Review Report Agenda Item 5.9

    Methoxetamine (MXE) Critical Review Report Agenda item 5.9 Expert Committee on Drug Dependence Thirty-seventh Meeting Geneva, 16-20 November 2015 37th ECDD (2015) Agenda item 5.9 MXE Page 2 of 22 37th ECDD (2015) Agenda item 5.9 MXE Contents Acknowledgements .......................................................................................................................... 5 Summary ........................................................................................................................................... 6 1. Substance identification ................................................................................................................. 7 A. International Nonproprietary Name (INN) ..................................................................................... 7 B. Chemical Abstract Service (CAS) Registry Number ....................................................................... 7 C. Other Names .................................................................................................................................... 7 D. Trade Names ................................................................................................................................... 7 E. Street Names .................................................................................................................................... 7 F. Physical properties .......................................................................................................................... 7 G. WHO Review History .....................................................................................................................
  • Assessing Illicit Drugs in Wastewater

    Assessing Illicit Drugs in Wastewater

    Assessing illicit drugs in wastewater Advances in wastewater-based drug epidemiology Editor Sara Castiglioni Mario Negri Institute, Milan, Italy EMCDDA project group Liesbeth Vandam and Paul Griffiths 22 Legal notice This publication of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is protected by copyright. The EMCDDA accepts no responsibility or liability for any consequences arising from the use of the data contained in this document. The contents of this publication do not necessarily reflect the official opinions of the EMCDDA’s partners, any EU Member State or any agency or institution of the European Union. Europe Direct is a service to help you find answers to your questions about the European Union Freephone number (*): 00 800 6 7 8 9 10 11 (*) The information given is free, as are most calls (though some operators, phone boxes or hotels may charge you). More information on the European Union is available on the Internet (http://europa.eu). Luxembourg: Publications Office of the European Union, 2016 ISBN 978-92-9168-856-2 doi:10.2810/017397 © European Monitoring Centre for Drugs and Drug Addiction, 2016 Reproduction is authorised provided the source is acknowledged. Recommended citations: Book: European Monitoring Centre for Drugs and Drug Addiction (2016), Assessing illicit drugs in wastewater: advances in wastewater-based drug epidemiology, Insights 22, Publications Office of the European Union, Luxembourg. Chapter: e.g. Castiglioni, S. (2016), ‘A global overview of wastewater-based epidemiology’, pp. 31–55 in Assessing illicit drugs in wastewater: advances in wastewater-based drug epidemiology, EMCDDA Insights 22, Publications Office of the European Union, Luxembourg.
  • Sigma, PCP, and NMDA Receptors

    Sigma, PCP, and NMDA Receptors

    National Institute on Drug Abuse RESEARCH MONOGRAPH SERIES Sigma, PCP, and NMDA Receptors 133 U.S. Department of Health and Human Services • Public Health Service • National Institutes of Health Sigma, PCP, and NMDA Receptors Editors: Errol B. De Souza, Ph.D. Addiction Research Center National Institute on Drug Abuse Doris Clouet, Ph.D. Division of Basic Research National Institute on Drug Abuse Edythe D. London, Ph.D. Addiction Research Center National Institute on Drug Abuse Research Monograph 133 1993 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Substance Abuse and Mental Health Services Administration National Institute on Drug Abuse 5600 Fishers Lane Rockville, MD 20857 ACKNOWLEDGMENT This monograph is based on the papers and discussions from a technical review on “Sigma, PCP, and NMDA Receptors Systems” held on September 27-28, 1989, in Baltimore, MD. The review meeting was sponsored by the National Institute on Drug Abuse. COPYRIGHT STATUS The National Institute on Drug Abuse has obtained permission from the copyright holders to reproduce certain previously published material as noted in the text. Further reproduction of this copyrighted material is permitted only as part of a reprinting of the entire publication or chapter. For any other use, the copyright holder’s permission is required. All other material in this volume except quoted passages from copyrighted sources is in the public domain and may be used or reproduced without permission from the Institute or the authors. Citation of the source is appreciated. Opinions expressed in this volume are those of the authors and do not necessarily reflect the opinions or official policy of the National Institute on Drug Abuse or any other part of the Department of Health and Human Services.
  • April 2013 Volume 8 Issue 4

    April 2013 Volume 8 Issue 4

    April 2013 Volume 8 Issue 4 Inside In This Issue 2 Moral Injury: An Emerging Concept in Combat Trauma George Loeffler, M.D. 4 Methoxetamine: The Rise of a Ketamine Analogue “Legal High” Cassandra Craig, B.Sc. George Loeffler, M.D. 6 Depression, Suicide, and Ketamine John Burger, M.D. George Loeffler, M.D. 9 Use of “Bath Salts” Among Members of the United States Military: A Case Report With Discussion Daniel G. Allen, M.D. Wander S. Segura, M.D. Rebecca R. Burson, D.O. 11 Deployment Stress, Dextro­ This issue of the Residents’ Journal focuses on the theme of military psychiatry. The methorphan, Ketamine, and issue begins with an article by the Guest Section Editor, George Loeffler, M.D., on the Pharmacologic Interactions: emerging concept of moral injury. In a case report, Daniel G. Allen, M.D., Wander S. A Multifactorial Presentation Segura M.D., and Rebecca R. Burson, D.O., describe the effects of methylenedioxypy- of Mania rovalerone use in an active-duty service member, as well as the unique challenges use Philip Y.T. Liu, M.D. of this substance presents to both service members and military health care providers. Rebecca R. Burson, D.O. Philip Y.T. Liu, M.D., and Dr. Burson present a case report of first-episode sub- stance-induced mania with psychotic features in a decorated soldier evacuated from a 13 Virtual Reality Exposure combat-stressed environment. Ryan Richmond, B.S., discusses virtual reality exposure Therapy for the Treatment of therapy for treatment of combat posttraumatic stress disorder. Last, Nicole Garber, Combat Posttraumatic Stress M.D., presents data on the effects of military deployment on children.