Veterinary Technician December 2005 TOXICOLOGY BRIEF 881

INGESTION OF CLUB DRUGS

Hayley Smith, BFA, CVT Users of club drugs may ASPCA Animal Poison Control Center give them to pets, not Urbana, Illinois realizing the consequences.

With news of club drug use among college and high school stu- Control Center has received numerous dents, it is not surprising that pets are being exposed to these drugs calls involving the ingestion of ecstasy; however, a total of 10 calls were made by accident and by human intent to “get the dog high.” Unfortu- regarding γ-hydroxybutyrate (GHB) and nately, when the pet is brought to the veterinary office, the content Rohypnol. Familiarizing the veterinary of the substance involved is not always known, and it can be very staff with the characteristics of various club drugs and the clinical signs that difficult to take an accurate history. Knowing what to ask the owner they may cause in animals can help in and what signs to look for can help in identifying the drug involved managing these potentially life-threat- and choosing the correct treatment. ening cases. ECSTASY Club drugs are often used to enhance signs to determine what the drug may Ecstasy is one of the most publicized the effects of alcohol and thus the have been and what the course of treat- club drugs. Its common nicknames user’s mood. In some unfortunate cir- ment should be. However, accurate include X, clarity, and Adam. Its chem- cumstances, these drugs are used to reports on animal exposures to club ical name is 3,4-methylenedioxymeth- intentionally overdose a person and drugs are rare. Therefore, information amphetamine, and as an amphetamine, make that person unaware of his or her on the effects of these drugs in animals it is classified as a schedule 1 con- surroundings. Sometimes, animals either is limited, and treatment usually trolled substance. Ecstasy is typically are intentionally given a club drug or involves managing clinical signs. In the available as a tablet and comes in a ingest it out of curiosity. When an ani- past 5 years, the ASPCA Animal Poison variety of colors with an image etched mal is brought to a veterinary office or the ASPCA Animal Poison Control Cen- Glossary ter is consulted for ingestion of a club drug, details on what the drug is or Dysphoria — An emotional state characterized by anxiety and restlessness how much of it was ingested may be Neurotransmitter — A chemical that transmits information from one brain cell vague. After all, there is no prescribing to another information for these drugs, and own- Paradoxical effect — A sign that is not normally expected in a given ers may not want to admit to buying circumstance them. Also, illegal drugs are commonly Serotonin syndrome — Condition that occurs when there is either excessive mixed with unknown chemicals. The release or inhibited uptake of serotonin veterinary team must assess the patient’s

Toxicology Brief is contributed by veterinary technicians at the American Society for the Prevention of Cruelty to Animals–Animal Poison Control Center, 1717 S. Philo Rd., Suite 36, Urbana, IL 61802; hotline: 888-4ANI-HELP (888-426-4435) or 900-443-0000 (a $50 consultation fee is charged to the caller’s telephone bill); email: [email protected] (for nonemergency information only); Web site: www.apcc.aspca.org. 882 TOXICOLOGY BRIEF Veterinary Technician December 2005

into or printed on it. Tablets are gener- activated charcoal can also be effective may also come as a white powder. Like ally available in 50- to 150-mg doses, in early decontamination. If signs are ecstasy, it is often adulterated with a but strengths may vary because of present, treatment should focus on sta- number of other toxic substances.3 adulteration with other amphetamines, bilizing the patient. Thermoregulation GHB is a natural derivative of the hallucinogens, or stimulants.1 is essential because body temperature neurotransmitter γ-aminobutyric acid Humans use ecstasy for its hallucino- may increase to more than 105˚F and affects sleep cycles, body tempera- genic effects and for its stimulant prop- (40.6˚C). Blood pressure and electrolytes ture, and memory. It was originally erties to suppress drowsiness and should be monitored and managed as researched for use as an anesthetic, but hunger; these same effects may occur in necessary. Electrocardiograms should resulting seizures ended studies.3 Today, companion animals. At low doses, be obtained and assessed. Fluid therapy users desire the CNS depressant effects ecstasy causes serotonin syndrome and should be initiated to help control tem- of the drug; however, overdoses in both increases the release of dopamine and perature, balance electrolytes, and pre- humans and companion animals result norepinephrine while inhibiting metabo- vent dehydration caused by hyperther- in bradycardia, hypotension, hypo- lism.1 Primary clinical signs include mia. Acepromazine, chlorpromazine, or thermia, vomiting, seizures, and possibly hyperactivity, tachycardia, hypertension, barbiturates can be used to control cen- death.1 Because the strength and compo- hyperthermia, and seizures. Any expo- tral nervous system (CNS) excitement, sition of illicit drugs vary, any animal sure to the drug can cause clinical signs while propranolol may be used to con- exposure to GHB should be taken seri- and should be considered potentially life trol cardiac arrhythmias. Cyprohepta- ously. With early intervention and close threatening, although early management dine may be helpful in managing sero- supervision, however, patients usually can help to minimize the severity of tonin syndrome. Diazepam should be fully recover after exposure to GHB.2 signs.2 Long-term effects may be a con- avoided because it may exacerbate dys- Emesis and gastric lavage are gener- cern; studies in rats and nonhuman pri- phoric effects.2 ally contraindicated for GHB exposures mates have shown that even one dose of because the patient may lose conscious- ecstasy can cause neurotoxicity resulting γ-HYDROXYBUTYRATE ness soon after exposure. Diazepam in long-term learning impairment, Although its nicknames “liquid may be used to control seizures; propo- although this is unlikely in acute expo- ecstasy” and “liquid X” may seem to fol or phenobarbital may be used if sures in companion animals. suggest that GHB is the liquid form of diazepam is ineffective. Naloxone can If the patient is asymptomatic, induc- ecstasy, it is a different chemical with be used in patients with bradypnea. ing emesis may decrease the risk of completely different effects. GHB is Fluid therapy may be necessary to con- signs developing; this should be done classified as a schedule 1 controlled trol hypotension, but care should be with care, however, because the onset substance. It is typically available as a taken to avoid hypothermia.2,3 of signs may be rapid. Gastric lavage or liquid in various concentrations but FLUNITRAZEPAM Slang Terms and Drug Classifications for Illicit Drugs5 Because the effects of flunitrazepam are similar to those of GHB, uneducated Chemical Name Classification Street Names users of the drugs can confuse them; each drug may be referred to ambigu- Club Drugs ously as “the date rape drug.” Fluni- 3,4-Methylenedioxymethamphetamine Schedule 1 MDMA, Adam, trazepam is more commonly known as ecstasy, XTC, X roofies, a nickname that is probably m o Flunitrazepam Schedule 4 Rohypnol, roofies, derived from its brand name outside the c United States, Rohypnol. Roche Labora- . R-2, date rape drug l tories currently manufactures 1- and 2- a Glc-Hydroxybutyric acid Schedule 1 GHB, liquid ecstasy/X, 2

n mg tablets (green, white, or purple ) in r scoop, Georgia Home Latin America and Europe for use as a u Boy, Grievous Bodily sedative and preanesthetic. When used o Harm, date rape drug J illicitly, however, this typically oblong- h shaped tablet may be crushed so that it c Other Illicit Substances e can be snorted or dissolved in a bever-

T Ketamine Schedule 3 Special K, cat Valium age.4 Like diazepam, flunitrazepam is a t e Lysergic acid diethylamide Schedule 1 LSD, acid schedule 4 benzodiazepine, but it is 10 V times more potent. (Some sources sug- . Marijuana Schedule 1 Pot, weed, grass,

w gest that flunitrazepam could be moved Mary Jane, Bud, dope w to a schedule 3 classification because of 1,5 w Methamphetamine Schedule 2 Crystal meth, speed its predatory use in date rape. ) Veterinary Technician December 2005 883

CONCLUSION Controlled Substance When an animal ingests an illicit Classifications5 substance, the situation must be dealt with tactfully. Pet owners do not Schedule 1 — High potential for always tell the entire story because abuse; no accepted medical use they fear being reported to the author- Schedule 2 — Potential for severe ities. It is important to reassure the physical dependence; must be client that an accurate history is nec- kept in locked cabinet and strictly essary for the clinic to best care for tracked the animal. To estimate the severity of Schedule 3 — Potential for signs and plan a proper treatment pro- moderate-low physical tocol, the client should be asked pre- dependence; may be stored with cisely what substances were ingested, other prescription drugs how much was ingested, and how long Schedule 4 — Low potential for ago the exposure took place. If the abuse; may be stored with other amount is uncertain, it is safer to prescription drugs assume that the pet ingested the entire amount of drug that was available. In Schedule 5 — Lower potential for these life-threatening situations, tech- abuse; may be stored with other nicians can help by obtaining a his- prescription drugs tory that is as accurate as possible and monitoring patients closely. They Illicit users desire flunitrazepam’s should also educate themselves about effects as a CNS depressant, including the local laws and the effects of com- amnesia and drowsiness.5 Signs of mon illicit drugs. exposure in animals are similar to those of diazepam overdose, including ACKNOWLEDGMENTS lethargy, hypothermia, hypotension, The author thanks Mindy Bough, CVT; Tina and tachycardia leading to apnea with Wismer, DVM, DABVT, DABT; and Sharon high doses.1,2 Paradoxical effects (e.g., Gwaltney-Brant, DVM, PhD, DABVT, DABT, hyperactivity, restlessness) may occur who are affiliated with the ASPCA Animal Poison Control Center in Urbana, Illinois. after large doses of flunitrazepam, which can lead to an incorrect diagno- sis in cases with a sketchy history.2,6 REFERENCES 1. Smith KM, Larive LL, Romanelli F: Club Possible exposures to flunitrazepam drugs: Methylenedioxymethampheta- should be considered life threatening mine, flunitrazepam, ketamine hydro- because of the high potency of the drug chloride, and gamma-hydroxybutyrate. and because, as with all illicit drugs, Am J Health Syst Pharm 59(11):1067– unknown substances could be involved. 1074, 2002. Emesis is recommended within 5 to 2. ASPCA Animal Poison Control Center Case Database: Unpublished data, 15 minutes after ingestion if the patient Urbana, IL, 2005. is asymptomatic; activated charcoal 3. Gahlinger PM: Club drugs: MDMA, may also prevent absorption. Gastric gamma-hydroxybutyrate (GHB), Rohyp- lavage can be used for decontamination nol, and ketamine. Am Fam Physician with proper stomach tubing if the 69(11):2619–2626, 2004. patient loses consciousness. Supportive 4. US Drug Enforcement Administration: treatment must include apnea preven- Rohypnol (Flunitrazepam). Accessed tion and thermoregulation. In cases November 2005 at http://www.dea.gov/ involving severe CNS or respiratory concern/flunitrazepam.html. depression, flumazenil may be given as 5. US Drug Enforcement Administration: an antidote. Fluids should be given to Drug Scheduling. Accessed November 2005 at http://www.dea.gov/pubs/ patients with hypotension and tachy- scheduling.html. 1,2 cardia. With early and proper man- 6. Klein M, Kramer F: Rave drugs: Pharma- agement of signs, patients can fully cological considerations. Am Assoc Nurs recover from flunitrazepam exposure. Anesth J 72(1):61–67, 2004. VT