DOCSLIB.ORG

Subacute Degeneration of the Spinal Cord Due to Nitrous Oxide Inhalation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Subacute Degeneration of the Spinal Cord Due to Nitrous Oxide Inhalation Journal of Neurology (2018) 265:1089–1095 https://doi.org/10.1007/s00415-018-8801-3 ORIGINAL COMMUNICATION No laughing matter: subacute degeneration of the spinal cord due to nitrous oxide inhalation Stephen Keddie1,2 · Ashok Adams1 · Andrew R. C. Kelso1,4 · Benjamin Turner1 · Klaus Schmierer1,4 · Sharmilee Gnanapavan1,4 · Andrea Malaspina1,4 · Gavin Giovannoni1,4 · Ian Basnett1 · Alastair J. Noyce1,3,4,5 Received: 28 January 2018 / Revised: 13 February 2018 / Accepted: 14 February 2018 / Published online: 3 March 2018 © The Author(s) 2018. This article is an open access publication Abstract Background Whilst the dangers of ‘legal highs’ have been widely publicised in the media, very few cases of the neurological syndrome associated with the inhalation of nitrous oxide (N­ 2O) have been reported. Here we set out to raise awareness of subacute degeneration of the spinal cord arising from recreational ­N2O use so that formal surveillance programs and public health interventions can be designed. Methods Case series documenting the clinical and investigational features of ten consecutive cases of subacute degeneration of the spinal cord presenting to a hospital with a tertiary neurosciences service in East London. Results Sensory disturbance in the lower (± upper) limbs was the commonest presenting feature, along with gait abnormali- ties and sensory ataxia. MRI imaging of the spine showed the characteristic features of dorsal column hyperintensity on ­T2 weighted sequences. Serum ­B12 levels may be normal because subacute degeneration of the spinal cord in this situation is triggered by functional rather than absolute ­B12 defciency. Discussion A high index of suspicion is required to prompt appropriate investigation, make the diagnosis and commence treatment early. This is the largest reported series of patients with subacute degeneration of the spinal cord induced by recrea- tional use of N­ 2O. However, the number of patients admitted to hospital likely represents the ‘tip of the iceberg’, with many less severe presentations remaining undetected. After raising awareness, attention should focus on measuring the extent of the problem, the groups afected, and devising ways to prevent potentially long-term neurological damage. Keywords Subacute degeneration of the spinal cord · Myelopathy · Hydroxocobalamin · Vitamin ­B12 Introduction * Alastair J. Noyce [email protected] Nitrous oxide ­(N2O or laughing gas) has been used in clini- cal practice as a dissociative anaesthetic for over 170 years, 1 The Royal London Hospital, Emergency Care and Acute but its recreational use has become widespread, facilitated Medicine Clinical Academic Group, Neuroscience, Barts by legal over-the-counter availability. N­ O abuse is rapidly Health NHS Trust, London, UK 2 rising throughout the USA and UK, and has become the 2 National Hospital for Neurology and Neurosurgery seventh most commonly used recreational drug according and Department of Molecular Neuroscience, MRC Centre for Neuromuscular Disease, UCL Institute of Neurology, to the Global Drug Survey 2016 [1]. Queen Square, London, UK Several case reports have documented the potential for 3 Department of Molecular Neuroscience, UCL Institute ­N2O to cause damage to the nervous system through interfer- of Neurology, Queen Square, London, UK ence with vitamin B­ 12 metabolism, leading to megaloblas- 4 Barts and The London School of Medicine, Neuroscience tic anaemia and subacute degeneration of the spinal cord and Trauma, Blizard Institute, Queen Mary University [2–5] which itself can be irreversible [6]. Here, we report of London, London, UK the largest series of patients with neurological complications 5 Barts and The London School of Medicine, Preventive from ­N2O abuse, in an efort to raise awareness and prompt Neurology Unit, Wolfson Institute of Preventive Medicine, appropriate surveillance, so that an adequate public health Queen Mary University of London, Charterhouse Square, response may be designed and implemented. London WC1N 1PJ, UK Vol.:(0123456789)1 3 1090 Journal of Neurology (2018) 265:1089–1095 Methods was well preserved in most patients. Additional clinical features were gait ataxia (n = 8), falls (n = 3), Romberg’s All adult patients presenting between 1st of November sign (n = 6), pseudoathetosis (n = 5), Lhermitte’s phenom- 2016 and 1st May 2017 to the Emergency Department of enon (n = 1), Uhtof’s phenomenon (n = 1), and segmental n the Royal London Hospital, with a history of N 2O use myoclonus ( = 1). and symptoms suggestive of subacute degeneration of the spinal cord were included. Two patients had a pre- Investigations existing diagnosis of subacute degeneration of the spinal cord and re-presented during this period (cases 8 and 10). Median haemoglobin level was 148 (range 117–170 g/L). Blood tests were performed to rule out alternative causes All patients had normal mean cell volume (median 92.4; of myelopathy in most patients, including virology, anti- range 89.8–94.8 fL). Four patients had low vitamin B12 lev- nuclear antibodies, anti-neutrophil cytoplasmic antibod- els (median 191; range 109–2000 ng/L). MMA was meas- ies, anti-cardiolipin antibodies, aquaporin 4 antibodies ured in eight patients (median 2.9; range 0.16–110 μmol/L) and paraneoplastic antibodies. Nutritional defciencies of and was not taken in patients whose B12 level was below copper and folate were also routinely tested. Cerebrospi- normal or elevated as a result of replacement. MMA was nal fuid examination was performed in four patients. All elevated in seven of the eight patients. Four of these could patients were seen and examined by an attending consult- be deemed clinically relevant/revealing, with an associated ant neurologist and imaging reported by a consultant neu- normal B12 level. Three were ‘complimentary’, with an asso- roradiologist. Where serum vitamin B 12 level was normal, ciated low B12 level. The MMA level was normal in one serum methylmalonic acid (MMA) was also measured. patient whose vitamin B 12 level was low (case 7), but it tran- Where possible, patients were followed up in the outpa- spired that they had been aware of the risks of myelopathy tient department. Due to difculties contacting patients and had been concurrently taking oral B12 1000 μg once a (change of address, GP or phone number), not all patients day as prophylaxis. Despite this they had nonetheless devel- were available to provide consent, and therefore all cases oped subacute degeneration of the spinal cord. have been fully anonymised. A CSF examination was performed in four patients. White cell counts were < 1 in all cases. Protein was raised in two patients at 0.5 and 0.7 g/L (normal ≤ 0.4 g/L). Glu- cose was within normal limits in all. Unmatched oligoclonal Results bands were demonstrated in one patient, the signifcance of which is unclear but would suggest a degree of intrathecal Demographics immunological response. MRI of the spinal cord was performed in nine patients There were approximately 150,000 attendances to the and showed T2 signal change afecting the dorsal columns Emergency Department over the 6-month study period. of the cervical spine, consistent with subacute degeneration Table 1 summarises the clinical features of the ten study of the spinal cord (see Fig. 1). In one patient, pathological cases included in this report. The median age of patients enhancement was detected initially. Follow-up MRI was per- was 22 years (range 17–26), three were women and seven formed in four patients after an average of 14 months (range were men. Seven patients were of Bangladeshi descent, 5–27 months) from presentation. In two patients the signal one Asian, one mixed White-Caribbean and one was change persisted and in the other two it had resolved. In the White. Eight were current smokers, six drank alcohol cases where MRI signal change had resolved (cases 7 and more than twice per week, and three used other drugs 10), both received treatment for a minimum of 4 months. recreationally (two used cocaine and one marijuana). On Case 7 had abstained from N20, had been taking oral B12 average, patients used N 2O around two-three times per prior to presenting, and was asymptomatic following treat- week, and the number of N2O canisters consumed ranged ment. Case 10 continued to use N20 once a fortnight and between 75 and 2000 per week. experienced persistent paraesthesia in the feet. The patient also had poor diabetic control, and nerve conduction stud- ies demonstrated mixed axonal and demyelinating features Clinical features consistent with diabetic neuropathy. Altered sensation in the limbs was the predominant pre- Management senting feature (seven had symptoms in the upper limbs and all ten had symptoms in the lower limbs). Strength All patients received hydroxocobalamin injections, 1 mg intramuscularly on alternate days, for a median of 2 weeks. 1 3 Journal of Neurology (2018)265:1089–1095 Journal ofNeurology Table 1 Clinical and investigational fndings in 10 patients with N2O-induced subacute degeneration of the spinal cord Case Number of UL sen- LL sensory UL distal LL distal UL refexes LL refexes Gait ataxia Bladder/ Other Vitamin MMA MRI at Follow-up reported sory motor motor bowel B12 level level presenta- MRI* N2O can- power power (ng/L) (μmol/L) tion isters per week 1 100 PP/JPS/LT Vib loss IV IV + +++ C Y Nil Myoclonic 138 0.7 C2–7 Persistent loss jerks, dorsal dorsal Uhtof’s column column hyperin- hyperin- tensity tensity, and enhance- enhance- ment ment resolved 2 1000 JPS/Vib Vib loss V V ++
Load more

Recommended publications
  • MDMA and Sexual Behavior
    Note: This is a pre-copy-editing, author-produced PDF of an article accepted for publication in Substance Use & Misuse following peer review. The definitive publisher-authenticated version [McElrath K (2005) MDMA and sexual behavior: ecstasy users’ perceptions about sexuality and sexual risk, Substance Use & Misuse, 40:9, 1461-1477] is available online at http://www.informaworld.com/smpp/title~db=all~content=g714012467 MDMA and Sexual Behavior: Ecstasy Users’ Perceptions About Sexuality and Sexual Risk KAREN MCELRATH School of Sociology and Social Policy, Belfast, Ireland Published in Substance Use & Misuse,(2005) 40:9,1461—1477 This study examines the relationship between MDMA (Ecstasy), sexual behavior, and sexual risk taking. The sample consisted of 98 current and former users of MDMA. Several strategies were utilized to recruit respondents and data were collected through in-depth interviews during 1997 and 1998. The majority of respondents had used MDMA during the 6-month period prior to the interview and a large percentage had consumed the drug on 100 occasions or more. Most respondents reported feelings of emotional closeness while consuming MDMA but without the desire for penetrative sex. Others, however, reported that MDMA increased sexual arousal and some respondents (in particular gay and bisexual females) had used MDMA specifically for sexual enhancement. Sexual risk taking (e.g., having multiple partners, engaging in sex without a condom) was prevalent among respondents who did engage in sexual activity during MDMA episodes. Explanations for the findings are offered and implications for prevention/intervention are discussed. Keywords MDMA; ecstasy; sexual behavior Introduction Although a patent for 3,4-methylenedioxymethamphetamine (MDMA) was issued in 1914 (Shulgin, 1986), “recreational”a use of the drug did not surface until the 1970s and 1980s, and for the most part was restricted to selected regions in the U.S.
    [Show full text]
  • MDMA ('Ecstasy'): a Review of Its Harms and Classification Under the Misuse of Drugs Act 1971
    MDMA (‘ecstasy’): A REVIEW OF ITS HARMS AND CLASSIFICATION UNDER THE MISUSE OF DRUGS ACT 1971 Advisory Council on the Misuse of Drugs ACMD Advisory Council on the Misuse of Drugs 3rd Floor (SW), Seacole Building 2 Marsham Street London SW1P 4DF February 2008 Rt Hon Jacqui Smith MP Home Office 2 Marsham Street London SW1P 4DF Dear Home Secretary, The Advisory Council on the Misuse of Drugs (ACMD) recently considered that a review of MDMA (‘ecstasy’) would be timely as there is a much greater body of evidence regarding the harms and misuse of MDMA since the Council last provided its advice to Ministers in 1996. I have pleasure in enclosing the Council’s report. The use of MDMA is undoubtedly harmful. I would therefore like to emphasise that the Council continues to be concerned about the widespread use of MDMA; particularly among young people. Due to its prevalence of use, MDMA is a significant public health issue and we believe that criminal justice measures will only have limited effect. You will wish to note that the Council strongly advises the promulgation of public health messages. It is of vital importance that issues of classification do not detract from messages concerning public health. Forensic evidence shows that MDMA is by far the most commonly seized of the ‘ecstasy-like’ drugs. MDMA is presently generically classified in Class A under the Misuse of Drugs Act with other ‘ecstasy-like’ drugs. The ACMD has not extended this review to other compounds within the generic classification since their use is considerably less than that of MDMA.
    [Show full text]
  • 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.
    [Show full text]
  • Motor Delays in MDMA (Ecstasy) Exposed Infants Persist to 2 Years
    Neurotoxicology and Teratology 54 (2016) 22–28 Contents lists available at ScienceDirect Neurotoxicology and Teratology journal homepage: www.elsevier.com/locate/neutera Motor delays in MDMA (ecstasy) exposed infants persist to 2 years Lynn T. Singer a,⁎, Derek G. Moore b,MeeyoungO.Mina, Julia Goodwin b, John J.D. Turner b, Sarah Fulton a,AndrewC.Parrottc a Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, United States b The University of East London, Docklands Campus, University Way, London E16 2RD, United Kingdom c Swansea University, Singleton Park, Swansea, Wales SA2 8PP, United Kingdom, article info abstract Article history: Background: Recreational use of 3,4 methylenedioxymethamphetamine (ecstasy, MDMA) is increasing world- Received 29 July 2015 wide. Its use by pregnant women causes concern due to potentially harmful effects on the developing fetus. Received in revised form 5 January 2016 MDMA, an indirect monoaminergic agonist and reuptake inhibitor, affects the serotonin and dopamine systems. Accepted 20 January 2016 Preclinical studies of fetal exposure demonstrate effects on learning, motor behavior, and memory. In the first Available online 21 January 2016 human studies, we found prenatal MDMA exposure related to poorer motor development in the first year of life. In the present study we assessed the effects of prenatal exposure to MDMA on the trajectory of child devel- Keywords: opment through 2 years of age. We hypothesized that exposure would be associated with poorer mental and Behavior Cocaine motor outcomes. Alcohol Materials and Methods: The DAISY (Drugs and Infancy Study, 2003–2008) employed a prospective longitudinal Teratology cohort design to assess recreational drug use during pregnancy and child outcomes in the United Kingdom.
    [Show full text]
  • Recreational Drug Use: What’S the Harm?
    Your Employee and Family Assistance Program is a support service that can help you take the first step toward change. Recreational drug use: what’s the harm? Recreational drug use can be defined as the use of drugs strictly for pleasure, and quite often in social situations. Recreational users are not necessarily physically or psychologically dependent on drugs, however these users do run the risk of developing a dependency. There is considerable controversy surrounding the use of drugs, and opinions vary widely from those who think all drugs should be illegal, to those who advocate for the legalization of certain drugs. Even though it is illegal to use drugs such as marijuana, cocaine, LSD, ecstasy, and amphetamines, those who choose to use these substances can find them quite readily. And many—both young and old—believe there is little or no harm to using these drugs recreationally. Why use? Recreational drug users find that using drugs, from marijuana to cocaine, can help them: improve their mood, increase excitement and enjoyment, reduce inhibitions, become more relaxed, and achieve social acceptance among their peers. These benefits are generally reported to be immediate and short-term. The negative consequences of recreational drug use, on the other hand, tend to be delayed and longer term. Escalation Any recreational drug user risks escalation of their drug use, which in turn may develop into a drug dependency. Drug use and the problems associated with it may start off as limited or small, but gradually escalate to causing bigger problems in more areas of the user's life.
    [Show full text]
  • Substance Misuse: Result of Stress (Physical Or Emotional) Or Fatigue, Are Fungi Containing the Chemical Psilocybin
    Clinical sweating, numbness, confusion and difficulty Magic mushrooms concentrating. Longer term, flashbacks may In addition to their most common title, magic occur, during which the user re-experiences the mushrooms go by a wide range of names Module 1982 trip days, months or even years later, perhaps including Shrooms, Mushies, Magics, Liberties, following subsequent drug use but also as a Philosopher’s Stones, Amani and Agarics. They Substance misuse: result of stress (physical or emotional) or fatigue, are fungi containing the chemical psilocybin. which can trigger severe anxiety or paranoia. This pro-drug is converted in the body to hallucinogenics Tolerance can develop rapidly, and psychological psilocin, which has psychoactive properties. – though not physical – dependence can occur.1 Although there are over 180 psilocybin- From this CPD module you will learn: containing mushrooms found across the world, Substances the most commonly used in the UK is Psilocybe • What a hallucinogenic drug is, how they exert their effects and the This learning module will focus on magic semilanceata, a small, light brown mushroom risks associated with their use mushrooms and lysergic acid diethylamide, more known as the liberty cap. There is also the more • Detailed information about the two most used hallucinogens, magic commonly known as LSD, as these are the two potent Amanita muscaria, also known as the mushrooms and LSD hallucinogenic drugs widely used recreationally. fly agaric, which resemble the red and white It is worth noting that psychedelic drug use toadstools of fairy tales, though this contains • Some of the less commonly used psychedelic drugs appeared to increase during the COVID-19 additional psychoactive chemicals such as • Some relevant harm reduction measures for hallucinogenics pandemic, while use of substances such as ibotenic acid and muscimol which can cause ecstasy and nitrous oxide fell, in all likelihood delirium, drooling, dizziness and vomiting as well because these are more associated with highly as convulsions.
    [Show full text]
  • Signs & Symptoms of Dextromethorphan Exposure From
    Signs & Symptoms of Dextromethorphan Exposure from YouTube Michael Chary1, Emily H. Park2, Andrew McKenzie1, Julia Sun1, Alex F. Manini3, Nicholas Genes4* 1 Ichan School of Medicine at Mount Sinai, New York, New York, United States of America, 2 Rutgers New Jersey Medical School, Newark, New Jersey, United States of America, 3 Division of Medical Toxicology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America, 4 Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America Abstract Detailed data on the recreational use of drugs are difficult to obtain through traditional means, especially for substances like Dextromethorphan (DXM) which are available over-the-counter for medicinal purposes. In this study, we show that information provided by commenters on YouTube is useful for uncovering the toxicologic effects of DXM. Using methods of computational linguistics, we were able to recreate many of the clinically described signs and symptoms of DXM ingestion at various doses, using information extracted from YouTube comments. Our study shows how social networks can enhance our understanding of recreational drug effects. Citation: Chary M, Park EH, McKenzie A, Sun J, Manini AF, et al. (2014) Signs & Symptoms of Dextromethorphan Exposure from YouTube. PLoS ONE 9(2): e82452. doi:10.1371/journal.pone.0082452 Editor: Renaud Lambiotte, University of Namur, Belgium Received May 28, 2013; Accepted October 23, 2013; Published February 12, 2014 Copyright: ß 2014 Chary et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
    [Show full text]
  • Mental Health Effects of Recreational Drugs and Alcohol Understanding
    Understanding the mental health effects of recreational drugs and alcohol understanding mental health effects of recreational drugs and alcohol 1 Understanding the mental health effects of recreational drugs and alcohol This booklet is for anyone who wants to know more about the mental health effects of recreational drugs and alcohol. It explains how drugs and alcohol affect mental health, and what might happen if you use recreational drugs and have a mental health problem. It also provides information on what support is available and guidance for friends and family. Contents What are recreational drugs and alcohol? 4 How can recreational drugs affect mental health? 5 What types of drugs are there? 8 What effect could different drugs have? 11 Can recreational drugs and medication affect each other? 32 What support is available? 36 What help is available if I have a dual diagnosis? 38 How can family and friends help? 42 Useful contacts 45 3 Understanding the mental health effects of recreational drugs and alcohol What are recreational drugs and alcohol? Drugs are substances people take: • to give themselves a pleasurable experience • to help them feel better if they are having a bad time • because their friends are using them • to see what it feels like. They include alcohol, tobacco (nicotine), substances such as cannabis, heroin, cocaine and ecstasy, and some prescribed medicines. All my experiences with recreational drug use started due to social influences, of wanting to 'fit in'. Recreational drugs may be: • legal – such as nicotine and alcohol • illegal – this means it is against the law to have them or supply them to other people; most recreational drugs are illegal • controlled – these are drugs used in medicine, such as benzodiazepines; it is legal to take controlled drugs if a doctor has given you a prescription for them but it is illegal to have them if not; it is also illegal to give or sell controlled drugs to anyone else.
    [Show full text]
  • Acute Toxic Effects of Club Drugs
    Club drugs p. 1 © Journal of Psychoactive Drugs Vol. 36 (1), September 2004, 303-313 Acute Toxic Effects of Club Drugs Robert S. Gable, J.D., Ph.D.* Abstract—This paper summarizes the short-term physiological toxicity and the adverse behavioral effects of four substances (GHB, ketamine, MDMA, Rohypnol®)) that have been used at late-night dance clubs. The two primary data sources were case studies of human fatalities and experimental studies with laboratory animals. A “safety ratio” was calculated for each substance based on its estimated lethal dose and its customary recreational dose. GHB (gamma-hydroxybutyrate) appears to be the most physiologically toxic; Rohypnol® (flunitrazepam) appears to be the least physiologically toxic. The single most risk-producing behavior of club drug users is combining psychoactive substances, usually involving alcohol. Hazardous drug-use sequelae such as accidents, aggressive behavior, and addiction were not factored into the safety ratio estimates. *Professor of Psychology, School of Behavioral and Organizational Sciences, Claremont Graduate University, Claremont, CA. Please address correspondence to Robert Gable, 2738 Fulton Street, Berkeley, CA 94705, or to [email protected]. Club drugs p. 2 In 1999, the National Institute on Drug Abuse launched its Club Drug Initiative in order to respond to dramatic increases in the use of GHB, ketamine, MDMA, and Rohypnol® (flunitrazepam). The initiative involved a media campaign and a 40% increase (to $54 million) for club drug research (Zickler, 2000). In February 2000, the Drug Enforcement Administration, in response to a Congressional mandate (Public Law 106-172), established a special Dangerous Drugs Unit to assess the abuse of and trafficking in designer and club drugs associated with sexual assault (DEA 2000).
    [Show full text]
  • Gastrointestinal, Hepatic and Biliary Sequelae of Frequent Ketamine Use: a Prospective Observational Study
    Gastrointestinal, hepatic and biliary sequelae of frequent ketamine use: a prospective observational study Reference number BDF 140031 Final Research Report Dr. Seto Wai Kay Walter Clinical Associate Professor Department of Medicine The University of Hong Kong 1 Background Recreational use1 of inhalational ketamine is emerging as a major global social and health issue [1, 2]. While ketamine, a N-methyl D-aspartate receptor antagonist, has medical uses in anesthesia and chronic pain control, its highly addictive nature has led to a massive increase in recreational consumption worldwide. Due to the ease of production and low cost, the non-medical use of ketamine is especially increasing in East and South East Asia, with its lifetime prevalence in the general population ranging from 0.3% to 2.0% [United Nations 3], comprising up to 39.7% of total recreational drug users in these regions [4]. The self-reported use of recreational ketamine in Western countries, including the United Kingdom, Australia and Canada, is also increasing [5, 6]. From 2008 to 2014, law enforcement seizures of ketamine worldwide has increased by more than threefold [3]. Long-term heavy use of ketamine is associated with different medical problems, including cognitive impairment and psychological issues [7]. Inhalation of ketamine could result in hallucinations, out-of-the-body experiences and psychological dissociation. One of the well-known side effects of ketamine is bladder dysfunction, which is seen in one- quarter of chronic ketamine users [8]. Damage to the urological system is also well- documented, with many ketamine users developing a large variety of urinary problems, ranging from lower urinary tract symptoms and bladder incontinence to hydronephrosis, renal impairment and papillary necrosis [8, 9].
    [Show full text]
  • An Update on Licit and Illicit Ketamine Use
    Substance Abuse and Rehabilitation Dovepress open access to scientific and medical research Open Access Full Text Article REVIEW To use or not to use: an update on licit and illicit ketamine use Jih-Heng Li1 Abstract: Ketamine, a derivative of phencyclidine that was developed in the 1960s, is an Balasingam Vicknasingam2 anesthetic and analgesic with hallucinogenic effects. In this paper, the pharmacological and Yuet-wah Cheung3 toxicological effects of ketamine are briefly reviewed. Ketamine possesses a wide safety margin Wang Zhou4 but such a therapeutic benefit is somewhat offset by its emergence phenomenon (mind-body Adhi Wibowo Nurhidayat5 dissociation and delirium) and hallucinogenic effects. The increasing abuse of ketamine, initially Don C Des Jarlais6 predominantly in recreational scenes to experience a “k-hole” and other hallucinatory effects but more recently also as a drug abused during the workday or at home, has further pushed Richard Schottenfeld7 governments to confine its usage in many countries. Recently, urinary tract dysfunction has 1 College of Pharmacy, Kaohsiung been associated with long-term ketamine use. In some long-term ketamine users, such damage Medical University, Kaohsiung, Taiwan; 2National Centre for Drug can be irreversible and could result in renal failure and dialysis. Although ketamine has not yet Research, Universiti Sains Malaysia, been scheduled in the United Nations Conventions, previous studies using different assessment 3 Malaysia; Department of Sociology, parameters to score the overall harms of drugs indicated that ketamine may cause more harm The Chinese University of Hong Kong, Hong Kong, China; 4Wuhan than some of the United Nations scheduled drugs. Some countries in Southeast and East Asia Center for Disease Control and have reported an escalating situation of ketamine abuse.
    [Show full text]
  • A Summary of the Health Harms of Drugs Health Harms of Drugs
    A summary of the health harms of drugs Health harms of drugs Reader information box Document purpose For information Gateway reference 16365 Title A summary of the health harms of drugs Author The Centre for Public Health, Faculty of Health & Applied Social Science, Liverpool John Moore's University, on behalf of the Department of Health and National Treatment Agency for Substance Misuse Publication date August 2011 Target audience Medical directors, directors of public health, allied health professionals, GPs, non-medical policy and communications teams across government, and drug treatment and recovery services, commissioners and service users Circulation list Government drug strategy partners, including colleagues at the FRANK drugs information and advice service, drug treatment and recovery services, clinicians, commissioners and service users Description A reference document summarising, for a non-medical audience, the latest scientific evidence about the health-related harms of emerging and established licit and illicit drugs commonly used in the UK Cross reference A summary of the health harms of drugs: technical document Superseded documents Dangerousness of drugs – a guide to the risks and harms associated with substance misuse Action required N/A Timing N/A Contact details Alex Fleming Policy information manager National Treatment Agency for Substance Misuse 6th Floor Skipton House 80 London Road London SE1 6LH [email protected] 2 Health harms of drugs A summary of the health harms of drugs August 2011 Prepared by Lisa
    [Show full text]