DOCSLIB.ORG

Drug-Induced Psychosis and Neurological Effects Following Nitrous Oxide Misuse: a Case Report

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Drug-Induced Psychosis and Neurological Effects Following Nitrous Oxide Misuse: a Case Report CLINICAL Matthew Mo Kin Kwok, MD, CCFP(EM), FCFP, Jane de Lemos, PharmD, MSc Epid, Mazen Sharaf, BSc Pharm, ACPR Drug-induced psychosis and neurological effects following nitrous oxide misuse: A case report The case of a 20-year-old female who experienced auditory and visual hallucinations after inhaling nitrous oxide she obtained legally in “whippits”—canisters used in whipped cream dispensers—highlights the need to report such adverse events to appropriate authorities so that data can be collected about the dangers associated with commercially available products and the number of misuse cases in Canada. ABSTRACT: Nitrous oxide (N O) is an increasingly of N O as a consumer good contributes to misuse, 2 2 An increasing number of publications and popular recreational drug globally. Users com- as seen in the case of a 20-year-old female who the Global Drug Survey (GDS), a self-report monly inhale the gas from punctured canisters presented to the emergency department com- survey of recreational drug use, suggest N2O is known as “whippits” that are designed for use in plaining of visual and auditory hallucinations. The being misused by those seeking the dissociative whipped cream dispensers. A surge in N O use patient had no history of psychiatric or medical 2 state produced by puncturing whippits and in- has been reported in the UK, with a self-report illness before experiencing symptoms, and results haling the gas or “nanging.” The GDS found recreational drug survey finding an increase in from laboratory investigations and physical exami- that when nicotine, alcohol, and caffeine were use from 20% in 2014 to 31% in 2017. The survey nations revealed no abnormalities. The patient excluded, N2O was the seventh most common found that when nicotine, alcohol, and caffeine reported inhaling nitrous oxide on a daily basis, drug used by 130 000 respondents.3 were excluded, N O was the seventh most com- however, and had recently increased her use of 2 Whippits are readily available through mon drug used by respondents. The accessibility legally obtained whippits. A psychiatrist, a neu- storefront and online suppliers with no re- rologist, and an addictions medicine specialist striction on age of purchaser, medical history, assessed the patient in consultation and agreed quantity desired, or intended use. As long as that her psychosis was the result of N O misuse. Dr Kwok is an emergency physician 2 the purchaser can pay for the product there is This case illustrates the need to increase awareness at Richmond Hospital and a clinical no barrier to obtaining whippits. regarding the possible sequalae of nitrous oxide assistant professor in the Department Each whippit contains 8 g of 100% N2O, on misuse and address current reporting limitations of Emergency Medicine at the University average. The duration of action is short-lived and the ease of access consumers have to nitrous 4 of BC. Dr de Lemos is a clinical (1 to 2 minutes) after the canister is punctured oxide products. pharmacist at Richmond Hospital and and the gas is released into an inflatable or an 1 a clinical professor in the Department enclosed object for inhalation. of Pharmaceutical Sciences at UBC. At itrous oxide (N2O), commonly known N2O that is chemically identical to the N2O 1 the time of writing, Mr Sharaf was a as “laughing gas,” has historically in whippits is also sold with a drug identifica- pharmacy practice resident at Lower been used for medicinal purposes tion number (DIN) for medicinal purposes. such as anesthesia, analgesia, and sedation.2 It is Mainland Pharmacy Services. Currently, N When used as an inhalational anesthetic, N2O he is a clinical pharmacist at Children’s also available as a consumer product in canisters has analgesic and sedative effects. In accor- and Women’s Health Centre of BC. known as “whippits” that are used in whipped dance with federal legislation, N2O is classified cream dispensers. by Health Canada as an “ethical” product that This article has been peer reviewed. BC MEDICAL JOURNAL VOL. 61 NO. 10 | DECEMBER 2019 385 CLINICAL Drug-induced psychosis and neurological effects following nitrous oxide misuse “does not require a prescription, but that is gen- Discussion determine which authority should receive the 5 erally prescribed by a medical practitioner. Ethi- This case illustrates the need to consider the report. When N2O with a DIN is used for a cal products are unscheduled non-prescription possible sequalae of nitrous oxide misuse medicinal purpose, the appropriate authority is professional use products.”5 (whether acute or chronic), the current report- the Canada Vigilance Program, which operates ing limitations, and N2O accessibility issues. the adverse reaction online database. When Case data the N2O comes from a product marketed for A 20-year-old female presented to the emer- Possible sequalae making whipped cream, the appropriate author- gency department with visual and auditory hal- Beyond symptoms of psychosis, N2O misuse ity is Health Canada Consumer Products and lucinations, agitation, and gait disturbance. She has been associated with myeloneuropathy and Cosmetics. A member of our health care team voiced concerns about a “transmitting” device neurological effects, which are mentioned in submitted a report to both authorities to ensure in her throat. She believed that this device was a growing number of reports.1,2,6-8 These ad- appropriate actions could be taken. making her legs weak and affecting her walking. verse effects can result from both acute and In response to our report, a Health Canada She also heard voices from the device telling chronic exposure. A systematic review from representative explained that Consumer Prod- her to kill herself. She had come to the emer- 2016 that focused exclusively on N2O misuse ucts and Cosmetics would document the misuse gency department because she was worried for revealed that the users in 72 of 91 cases experi- but only take further action if the N2O canister her safety. enced some sort of neurological adverse effect, had faults or hazards regarding its intended use, The patient had no history of psychiatric or which is making whipped cream. medical illness. She reported inhaling nitrous To our surprise, no cases of N2O misuse oxide on a daily basis. She had increased her Nitrous oxide can be have been reported to Health Canada Consum- use recently and was inhaling gas from approxi- readily obtained as a er Products and Cosmetics, and only one case mately 100 whippits per day. The patient stated of substance abuse of N O had been reported commercial product 2 that she bought the canisters legally with a shop- to the Canada Vigilance Program. ping app and showed the physician the website without any restrictions. We also contacted the BC Drug and Poi- she used to make her purchases. She reported son Information Centre (DPIC) and learned no other recreational or prescription drug use. that the provincial toxicology call centre re- The patient was a slim and slightly built predominantly myelopathy, myeloneuropathy, ceived 14 calls regarding N2O toxicity from Asian female. She appeared anxious but not and subacute combined degeneration.2 Less misuse of whippits or similar commercial distressed. She was cooperative and her vital common presentations included psychiatric products between 2015 and 2019. Since our signs at triage were stable. On examination symptoms as seen in our case. Additionally, investigation determined that Health Canada she showed no sign of head trauma. Her pupils 29 cases of nitrous-oxide-related death were received only one report of N2O misuse in were equal and reactive to light. Her speech and reported.2 Although the systematic review was this period, many incidents appear to have her gait were normal. Her neck was supple and unable to establish a dose-related toxicity be- gone unreported. her thyroid examination revealed no abnor- cause of unreliable data, the majority of cases The number of 2N O cases described in the malities. Respiratory, cardiac, and abdominal involved the daily use of whippits. literature, the calls made to BC DPIC, and findings were unremarkable. Her neurologi- The mechanism of these adverse effects is news stories of misuse9 all suggest that current cal examination results were normal with no not well understood. N2O is thought to be as- reporting does not reflect the magnitude of the lateralizing sign, and her mental status exam sociated with low vitamin B12 levels. N2O- toxicity problem. revealed normal affect. induced oxidation converts vitamin B12 from Laboratory investigations included an ECG a reduced to an oxidized form, which inhibits N2O accessibility issues that revealed normal sinus rhythm and a QTC the activity of methionine synthase, leading to Nitrous oxide can be readily obtained as a of 399. CBC, electrolyte, blood urea nitrogen, impairment of methylation reactions and DNA commercial product without any restrictions. and creatinine levels were all within normal synthesis. This in turn leads to the accumula- In the case described here, the patient pur- limits. ASA, acetaminophen, and ethanol lev- tion of homocysteine.2,6 Clinical syndromes chased canisters from a reputable online shop- els were normal. Her vitamin B12 level was have been reported with both acute and chronic ping website and had them shipped directly also normal. nitrous oxide use. to her. A psychiatrist, a neurologist, and an addic- Whippits come in different sizes and can tion medicine physician assessed the patient in Reporting limitations be purchased in bulk. At the time of writing, consultation and agreed that she was psychotic Health care providers play an important role a package of 100 canisters could be purchased as a result of N2O misuse. The patient was kept in reporting adverse events from nitrous oxide online for less than $100.00 ($1.00 per can- in hospital until her symptoms resolved and she misuse to the appropriate authorities.
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]
  • 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.
    [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]