Psychoactive Substance Profile (All Drugs)
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Methylphenidate Hydrochloride
Application for Inclusion to the 22nd Expert Committee on the Selection and Use of Essential Medicines: METHYLPHENIDATE HYDROCHLORIDE December 7, 2018 Submitted by: Patricia Moscibrodzki, M.P.H., and Craig L. Katz, M.D. The Icahn School of Medicine at Mount Sinai Graduate Program in Public Health New York NY, United States Contact: [email protected] TABLE OF CONTENTS Page 3 Summary Statement Page 4 Focal Point Person in WHO Page 5 Name of Organizations Consulted Page 6 International Nonproprietary Name Page 7 Formulations Proposed for Inclusion Page 8 International Availability Page 10 Listing Requested Page 11 Public Health Relevance Page 13 Treatment Details Page 19 Comparative Effectiveness Page 29 Comparative Safety Page 41 Comparative Cost and Cost-Effectiveness Page 45 Regulatory Status Page 48 Pharmacoepial Standards Page 49 Text for the WHO Model Formulary Page 52 References Page 61 Appendix – Letters of Support 2 1. Summary Statement of the Proposal for Inclusion of Methylphenidate Methylphenidate (MPH), a central nervous system (CNS) stimulant, of the phenethylamine class, is proposed for inclusion in the WHO Model List of Essential Medications (EML) & the Model List of Essential Medications for Children (EMLc) for treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) under ICD-11, 6C9Z mental, behavioral or neurodevelopmental disorder, disruptive behavior or dissocial disorders. To date, the list of essential medications does not include stimulants, which play a critical role in the treatment of psychotic disorders. Methylphenidate is proposed for inclusion on the complimentary list for both children and adults. This application provides a systematic review of the use, efficacy, safety, availability, and cost-effectiveness of methylphenidate compared with other stimulant (first-line) and non-stimulant (second-line) medications. -
Hallucinogens - LSD, Peyote, Psilocybin, and PCP
Hallucinogens - LSD, Peyote, Psilocybin, and PCP Hallucinogenic compounds found in some • Psilocybin (4-phosphoryloxy-N,N- plants and mushrooms (or their extracts) dimethyltryptamine) is obtained from have been used—mostly during religious certain types of mushrooms that are rituals—for centuries. Almost all indigenous to tropical and subtropical hallucinogens contain nitrogen and are regions of South America, Mexico, and classified as alkaloids. Many hallucinogens the United States. These mushrooms have chemical structures similar to those of typically contain less than 0.5 percent natural neurotransmitters (e.g., psilocybin plus trace amounts of acetylcholine-, serotonin-, or catecholamine- psilocin, another hallucinogenic like). While the exact mechanisms by which substance. hallucinogens exert their effects remain • PCP (phencyclidine) was developed in unclear, research suggests that these drugs the 1950s as an intravenous anesthetic. work, at least partially, by temporarily Its use has since been discontinued due interfering with neurotransmitter action or to serious adverse effects. by binding to their receptor sites. This DrugFacts will discuss four common types of How Are Hallucinogens Abused? hallucinogens: The very same characteristics that led to • LSD (d-lysergic acid diethylamide) is the incorporation of hallucinogens into one of the most potent mood-changing ritualistic or spiritual traditions have also chemicals. It was discovered in 1938 led to their propagation as drugs of abuse. and is manufactured from lysergic acid, Importantly, and unlike most other drugs, which is found in ergot, a fungus that the effects of hallucinogens are highly grows on rye and other grains. variable and unreliable, producing different • Peyote is a small, spineless cactus in effects in different people at different times. -
Hallucinogens - LSD, Peyote, Psilocybin, and PCP
Information for Behavioral Health Providers in Primary Care Hallucinogens - LSD, Peyote, Psilocybin, and PCP What are Hallucinogens? Hallucinogenic compounds found in some plants and mushrooms (or their extracts) have been used— mostly during religious rituals—for centuries. Almost all hallucinogens contain nitrogen and are classified as alkaloids. Many hallucinogens have chemical structures similar to those of natural neurotransmitters (e.g., acetylcholine-, serotonin-, or catecholamine-like). While the exact mechanisms by which hallucinogens exert their effects remain unclear, research suggests that these drugs work, at least partially, by temporarily interfering with neurotransmitter action or by binding to their receptor sites. This InfoFacts will discuss four common types of hallucinogens: LSD (d-lysergic acid diethylamide) is one of the most potent mood-changing chemicals. It was discovered in 1938 and is manufactured from lysergic acid, which is found in ergot, a fungus that grows on rye and other grains. Peyote is a small, spineless cactus in which the principal active ingredient is mescaline. This plant has been used by natives in northern Mexico and the southwestern United States as a part of religious ceremonies. Mescaline can also be produced through chemical synthesis. Psilocybin (4-phosphoryloxy-N, N-dimethyltryptamine) is obtained from certain types of mushrooms that are indigenous to tropical and subtropical regions of South America, Mexico, and the United States. These mushrooms typically contain less than 0.5 percent psilocybin plus trace amounts of psilocin, another hallucinogenic substance. PCP (phencyclidine) was developed in the 1950s as an intravenous anesthetic. Its use has since been discontinued due to serious adverse effects. How Are Hallucinogens Abused? The very same characteristics that led to the incorporation of hallucinogens into ritualistic or spiritual traditions have also led to their propagation as drugs of abuse. -
Methadone Information Your Safety and the Safety of Everyone
Methadone Information Your Safety and the Safety of Everyone Methadone, when taken as prescribed is safe. Methadone taken by any individual it is NOT prescribed to, can be deadly; and when mixed with other drugs, can be deadly; and in the hands of a child, is most certainly deadly. Why? Because it is often difficult to know what other drugs including prescription medications others are being prescribed including herbal/ natural medications; and because unless you are a pharmacist or an experienced physician who is knowledgeable about METHADONE you truly don’t know what will happen when medications are mixed. Treatment Rules and Regulations clearly state: “It is extremely important that medication (this means METHADONE!) be stored in a VERY secure place away from children once the patient takes it to their home. It is not advisable to store the medication in the refrigerator unless it is in a locked, childproof container.” “Patients are not to give away… (Take) home medications (methadone).”It is clearly stated in Rules and Regulations that “Children cannot be held while dosing.” “…The mixing of chemicals may be harmful or fatal.” This is why Locked boxes must meet stringent criteria; to protect you, and those around you. Methadone is a Central Nervous System (CNS) Depressant. This means that Methadone slows down all your central nervous systems including breathing, heart rate, Some medications should NEVER be taken with methadone because they too are CNS depressants. These include alcohol, Benzodiazepines, Naltrexone, Soma, other Opiates and Barbiturates. These drugs taken together potentiate or add to each other: 1+1 no longer = 2; it equals 5 or more If you are a child or anyone the drug is NOT prescribed for you may not know you are in danger as your heart slows, and your breathing becomes shallower and then you die. -
Substance Abuse: the Pharmacy Educator’S Role in Prevention and Recovery
Substance Abuse: The Pharmacy Educator’s Role in Prevention and Recovery Curricular Guidelines for Pharmacy: Substance Abuse and Addictive Disease i Curricular Guidelines for Pharmacy: Substance Abuse and Addictive Disease1,2 BACKGROUND OF THE CURRICULUM DEVELOPMENT PROJECT In 1988, the AACP Special Interest Group (SIG) on Pharmacy Student and Faculty Impairment (renamed Substance Abuse Education and Assistance) undertook the development of curricular guidelines for colleges/schools of pharmacy to facilitate the growth of educational opportunities for student pharmacists. These Curricular Guidelines for Pharmacy Education: Substance Abuse and Addictive Disease were published in 1991 (AJPE. 55:311-16. Winter 1991.) One of the charges of the Special Committee on Substance Abuse and Pharmacy Education was to review and revise the 1991 curricular guidelines. Overall, the didactic and experiential components in the suggested curriculum should prepare the student pharmacist to competently problem-solve issues concerning alcohol and other drug abuse and addictive diseases affecting patients, families, colleagues, themselves, and society. The guidelines provide ten educational goals, while describing four major content areas including: psychosocial aspects of alcohol and other drug use; pharmacology and toxicology of abused substances; identification, intervention, and treatment of people with addictive diseases; and legal/ethical issues. The required curriculum suggested by these guidelines addresses the 1 These guidelines were revised by the AACP Special Committee on Substance Abuse and Pharmacy Education. Members drafting the revised guidelines were Edward M. DeSimone (Creighton University), Julie C. Kissack (Harding University), David M. Scott (North Dakota State University), and Brandon J. Patterson (University of Iowa). Other Committee members were Paul W. Jungnickel, Chair (Auburn University), Lisa A. -
Substance Abuse and Dependence
9 Substance Abuse and Dependence CHAPTER CHAPTER OUTLINE CLASSIFICATION OF SUBSTANCE-RELATED THEORETICAL PERSPECTIVES 310–316 Residential Approaches DISORDERS 291–296 Biological Perspectives Psychodynamic Approaches Substance Abuse and Dependence Learning Perspectives Behavioral Approaches Addiction and Other Forms of Compulsive Cognitive Perspectives Relapse-Prevention Training Behavior Psychodynamic Perspectives SUMMING UP 325–326 Racial and Ethnic Differences in Substance Sociocultural Perspectives Use Disorders TREATMENT OF SUBSTANCE ABUSE Pathways to Drug Dependence AND DEPENDENCE 316–325 DRUGS OF ABUSE 296–310 Biological Approaches Depressants Culturally Sensitive Treatment Stimulants of Alcoholism Hallucinogens Nonprofessional Support Groups TRUTH or FICTION T❑ F❑ Heroin accounts for more deaths “Nothing and Nobody Comes Before than any other drug. (p. 291) T❑ F❑ You cannot be psychologically My Coke” dependent on a drug without also being She had just caught me with cocaine again after I had managed to convince her that physically dependent on it. (p. 295) I hadn’t used in over a month. Of course I had been tooting (snorting) almost every T❑ F❑ More teenagers and young adults die day, but I had managed to cover my tracks a little better than usual. So she said to from alcohol-related motor vehicle accidents me that I was going to have to make a choice—either cocaine or her. Before she than from any other cause. (p. 297) finished the sentence, I knew what was coming, so I told her to think carefully about what she was going to say. It was clear to me that there wasn’t a choice. I love my T❑ F❑ It is safe to let someone who has wife, but I’m not going to choose anything over cocaine. -
Comparison of the Inhibitory and Excitatory Effects of ADHD Medications Methylphenidate and Atomoxetine on Motor Cortex
Neuropsychopharmacology (2006) 31, 442–449 & 2006 Nature Publishing Group All rights reserved 0893-133X/06 $30.00 www.neuropsychopharmacology.org Comparison of the Inhibitory and Excitatory Effects of ADHD Medications Methylphenidate and Atomoxetine on Motor Cortex ,1 2 3 1 1 4 Donald L Gilbert* , Keith R Ridel , Floyd R Sallee , Jie Zhang , Tara D Lipps and Eric M Wassermann 1 2 Division of Neurology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA; University of Cincinnati 3 4 School of Medicine, Cincinnati, OH, USA; Division of Psychiatry, University of Cincinnati, Cincinnati, OH, USA; Brain Stimulation Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA Stimulant and norepinephrine (NE) reuptake inhibitor medications have different effects at the neuronal level, but both reduce symptoms of attention deficit hyperactivity disorder (ADHD). To understand their common physiologic effects and thereby gain insight into the neurobiology of ADHD treatment, we compared the effects of the stimulant methylphenidate (MPH) and NE uptake inhibitor atomoxetine (ATX) on inhibitory and excitatory processes in human cortex. Nine healthy, right-handed adults were given a single, oral dose of 30 mg MPH and 60 mg ATX at visits separated by 1 week in a randomized, double-blind crossover trial. We used paired and single transcranial magnetic stimulation (TMS) of motor cortex to measure conditioned and unconditioned motor-evoked potential amplitudes at inhibitory (3 ms) and facilitatory (10 ms) interstimulus intervals (ISI) before and after drug administration. Data were analyzed with repeated measures, mixed model regression. We also analyzed our findings and the published literature with meta-analysis software to estimate treatment effects of stimulants and NE reuptake inhibitors on these TMS measures. -
Hallucinogens and Dissociative Drugs
Long-Term Effects of Hallucinogens See page 5. from the director: Research Report Series Hallucinogens and dissociative drugs — which have street names like acid, angel dust, and vitamin K — distort the way a user perceives time, motion, colors, sounds, and self. These drugs can disrupt a person’s ability to think and communicate rationally, or even to recognize reality, sometimes resulting in bizarre or dangerous behavior. Hallucinogens such as LSD, psilocybin, peyote, DMT, and ayahuasca cause HALLUCINOGENS AND emotions to swing wildly and real-world sensations to appear unreal, sometimes frightening. Dissociative drugs like PCP, DISSOCIATIVE DRUGS ketamine, dextromethorphan, and Salvia divinorum may make a user feel out of Including LSD, Psilocybin, Peyote, DMT, Ayahuasca, control and disconnected from their body PCP, Ketamine, Dextromethorphan, and Salvia and environment. In addition to their short-term effects What Are on perception and mood, hallucinogenic Hallucinogens and drugs are associated with psychotic- like episodes that can occur long after Dissociative Drugs? a person has taken the drug, and dissociative drugs can cause respiratory allucinogens are a class of drugs that cause hallucinations—profound distortions depression, heart rate abnormalities, and in a person’s perceptions of reality. Hallucinogens can be found in some plants and a withdrawal syndrome. The good news is mushrooms (or their extracts) or can be man-made, and they are commonly divided that use of hallucinogenic and dissociative Hinto two broad categories: classic hallucinogens (such as LSD) and dissociative drugs (such drugs among U.S. high school students, as PCP). When under the influence of either type of drug, people often report rapid, intense in general, has remained relatively low in emotional swings and seeing images, hearing sounds, and feeling sensations that seem real recent years. -
Hallucinogens
Hallucinogens What Are Hallucinogens? Hallucinogens are a diverse group of drugs that alter a person’s awareness of their surroundings as well as their thoughts and feelings. They are commonly split into two categories: classic hallucinogens (such as LSD) and dissociative drugs (such as PCP). Both types of hallucinogens can cause hallucinations, or sensations and images that seem real though they are not. Additionally, dissociative drugs can cause users to feel out of control or disconnected from their body and environment. Some hallucinogens are extracted from plants or mushrooms, and others are synthetic (human-made). Historically, people have used hallucinogens for religious or healing rituals. More recently, people report using these drugs for social or recreational purposes. Hallucinogens are a Types of Hallucinogens diverse group of drugs Classic Hallucinogens that alter perception, LSD (D-lysergic acid diethylamide) is one of the most powerful mind- thoughts, and feelings. altering chemicals. It is a clear or white odorless material made from lysergic acid, which is found in a fungus that grows on rye and other Hallucinogens are split grains. into two categories: Psilocybin (4-phosphoryloxy-N,N-dimethyltryptamine) comes from certain classic hallucinogens and types of mushrooms found in tropical and subtropical regions of South dissociative drugs. America, Mexico, and the United States. Peyote (mescaline) is a small, spineless cactus with mescaline as its main People use hallucinogens ingredient. Peyote can also be synthetic. in a wide variety of ways DMT (N,N-dimethyltryptamine) is a powerful chemical found naturally in some Amazonian plants. People can also make DMT in a lab. -
Synthetic Cathinones ("Bath Salts")
Synthetic Cathinones ("Bath Salts") What are synthetic cathinones? Synthetic cathinones, more commonly known as "bath salts," are synthetic (human- made) drugs chemically related to cathinone, a stimulant found in the khat plant. Khat is a shrub grown in East Africa and southern Arabia, and people sometimes chew its leaves for their mild stimulant effects. Synthetic variants of cathinone can be much stronger than the natural product and, in some cases, very dangerous (Baumann, 2014). In Name Only Synthetic cathinone products Synthetic cathinones are marketed as cheap marketed as "bath salts" should substitutes for other stimulants such as not be confused with products methamphetamine and cocaine, and products such as Epsom salts that people sold as Molly (MDMA) often contain synthetic use during bathing. These cathinones instead (s ee "Synthetic Cathinones bathing products have no mind- and Molly" on page 3). altering ingredients. Synthetic cathinones usually take the form of a white or brown crystal-like powder and are sold in small plastic or foil packages labeled "not for human consumption." Also sometimes labeled as "plant food," "jewelry cleaner," or "phone screen cleaner," people can buy them online and in drug paraphernalia stores under a variety of brand names, which include: Flakka Bloom Cloud Nine Lunar Wave Vanilla Sky White Lightning Scarface Image courtesy of www.dea.gov/pr/multimedia- library/image-gallery/bath-salts/bath-salts04.jpg Synthetic Cathinones • January 2016 • Page 1 How do people use synthetic cathinones? People typically swallow, snort, smoke, or inject synthetic cathinones. How do synthetic cathinones affect the brain? Much is still unknown about how synthetic cathinones affect the human brain. -
Programme & Abstracts
The 57th Annual Meeting of the International Association of Forensic Toxicologists. 2nd - 6th September 2019 BIRMINGHAM, UK The ICC Birmingham Broad Street, Birmingham B1 2EA Programme & Abstracts 1 Thank You to our Sponsors PlatinUm Gold Silver Bronze 2 3 Contents Welcome message 5 Committees 6 General information 7 iCC maps 8 exhibitors list 10 Exhibition Hall 11 Social Programme 14 opening Ceremony 15 Schedule 16 Oral Programme MONDAY 2 September 19 TUESDAY 3 September 21 THURSDAY 5 September 28 FRIDAY 6 September 35 vendor Seminars 42 Posters 46 oral abstracts 82 Poster abstracts 178 4 Welcome Message It is our great pleasure to welcome you to TIAFT Gala Dinner at the ICC on Friday evening. On the accompanying pages you will see a strong the UK for the 57th Annual Meeting of scientific agenda relevant to modern toxicology and we The International Association of Forensic thank all those who submitted an abstract and the Toxicologists Scientific Committees for making the scientific programme (TIAFT) between 2nd and 6th a success. Starting with a large Young Scientists September 2019. Symposium and Dr Yoo Memorial plenary lecture by Prof Tony Moffat on Monday, there are oral session topics in It has been decades since the Annual Meeting has taken Clinical & Post-Mortem Toxicology on Tuesday, place in the country where TIAFT was founded over 50 years Human Behaviour Toxicology & Drug-Facilitated Crime on ago. The meeting is supported by LTG (London Toxicology Thursday and Toxicology in Sport, New Innovations and Group) and the UKIAFT (UK & Ireland Association of Novel Research & Employment/Occupational Toxicology Forensic Toxicologists) and we thank all our exhibitors and on Friday. -
MDMA Get 24/7 Help Now!
MDMA Illicit substances can be categorized into one of three major drug types: depressants, stimulants, and hallucinogens. Depressants consist of substances that slow or “depress” the body’s normal functions. In contrast, stimulants do the opposite: they jump-start the central nervous system, increasing the user’s heart rate, blood pressure, respiration and body temperature. Hallucinogens are unlike either of the other illicit drug groups; as the name suggests, these are drugs that cause hallucinations, whether visual or auditory. Sometimes, illicit drugs can fall into two of these three categories. Methylenedioxy-methamphetamine, more commonly called MDMA, is one such example. It falls into two categories: stimulant and hallucinogen. MDMA drug addiction is one type of addiction treatment available through the Wellness Retreat Recovery program. Get 24/7 help now! All calls are free and confidential! 888-821-0238 MDMA About MDMA Like any other stimulant, MDMA increases the user’s energy, blood pressure, heart rate, and respiration. Still, MDMA stands apart from other stimulant drugs because it triggers a number of effects that are more common among hallucinogens. In fact, MDMA is most well-known for being the active ingredient in Ecstasy, a “club drug” that distorts the user’s senses and evokes uninhibited feelings of sensuality. Other effects include: increased sensory reception (i.e. fabric seems softer, drinks taste stronger, etc.) increased sensitivity to light emotional exacerbation sexual arousal Overall, MDMA has been known to intensity users’ emotional and physical experiences. However, this does not make MDMA a “safe” drug as many users might argue. The Effects of MDMA on the Brain Just like with any other illicit substance, continued use of MDMA can lead to addiction.