Phenibut and EMS Earlier this week, the Michigan Poison Center (MPP) received an inquiry from a UP emergency physician who had cared for two patients in two days who had been abusing a substance called Phenibut, a synthetically produced central nervous system depressant with similarities to the neurotransmitter known as GABA. Phenibut is not an FDA approved or regulated drug. It typically is marketed as a dietary substitute and is readily available in stores (especially “headshops”) and online. While officially considered a supplement, it is felt to have properties more similar to a prescription sedative. It is marketed outside of the US for depression, anxiety, and posttraumatic stress disorder. Recently Phenibut has been recognized as having the potential for physical dependence, withdrawal, and addiction.1,2 In response to the UP physician’s concern that these two cases might be part of an increase in Phenibut use, the MPC initiated a review, identifying 12 cases this year.3 They also notified MDHHS of the concern. The Division of EMS and Trauma, using Michigan EMS Information System data identified 8 cases in the first 11 months of 2019 compared to 5 cases in the last 6 months of 2018. One EMS case was also identified by MPC. Of the combined 19 cases from 2019, one third occurred in the Upper Peninsula, with 5 of the 8 cases (62.5%) in the last 6 months coming from the UP. Cases were reported in 10 Michigan counties. Documented coingestants were noted in 36.8% of the cases and included cannabinoids (2), kratom (3), ETOH, Flakka (bath salts), and other medications. Of the EMS cases, the median age was 36 years (range 24-64) and 70% were male. Half the cases demonstrated anxiety and the other half demonstrated a decreased level of consciousness. None of the EMS cases required lifesaving intervention. While EMS responses to incidents involving Phenibut appear to be infrequent, there is a disproportionately high percent of cases in the UP. Considerations for EMS: Phenibut is yet another drug that EMS personnel may see in the field. In caring for patients who may have taken Phenibut consider the following: • As with any patient, priority is always airway, breathing, and circulatory support. • Obtain (and document) a good history and specifically inquire about “supplements” • Coingestants are common • Patients may present anxious which may represent withdrawal from Phenibut, co-use of a stimulant, or another medical condition • Patients may present with a decreased level of consciousness which may represent overdose of Phenibut with or without other sedating medications and/or other conditions o Have a low threshold to suspect opioid overdose in any patient with a decreased level of consciousness. • Contact MPC (1-800-222-1222) when EMS encounters patients with unusual drug exposures. 1 Ahuja, T., Mgbako, O., Katzman, C., & Grossman, A. (2018). Phenibut (β-Phenyl-γ-aminobutyric Acid) Dependence and Management of Withdrawal: Emerging Nootropics of Abuse. Case reports in psychiatry, 2018, 9864285. doi:10.1155/2018/9864285 2 Jouney EA. Phenibut (β-Phenyl-γ-Aminobutyric Acid): an Easily Obtainable "Dietary Supplement" With Propensities for Physical Dependence and Addiction. Curr Psychiatry Rep. 2019 Mar 9;21(4):23. doi: 10.1007/s11920-019-1009-0. Review. PubMed PMID: 30852710. 3 C Aaron, personal communication, December 2, 2019. MI-EMSIS Incidents Involving Phenibut – July 2018 to November 2020 (N=13) .