Review: 23 patients with laboratory-confirmed MDPV exposure

Methylenedioxypyrovalerone (MDPV)

Methylenedioxypyrovalerone (MDPV)

3.5 out of 5 stars

Acute Methylenedioxypyrovalerone Toxicity. Fruberg BA et al. J Med Toxicol 2014 Dec 3 [Epub ahead of print]

Abstract

This is an impressive paper, but for reasons the authors thoroughly discuss in their limitations sections, there is somewhat less here than meets the eye.

The authors retrospectively reviewed patients seen over a 2-year period at 10 different hospitals who were entered into the ToxIC Registry and coded under a term consistent with “bath salt” exposure. Cases were eligible for the study if they had blood and/or urine laboratory confirmation positive for a synthetic cathinone (methylenedioxypyrovalerone (MDPV), mephedrone, methcathinone, methylone, or methedrone.)

The review identified 23 patients. All were positive for MDPV on confirmatory testing. One patient died. (For a paper reporting that fatal case, click here.)

The authors extracted a boatload of data from these cases (something that’s easy to do using a computerized registry database). Much of what they found is not surprising: most patients were young males, the most common findings were tachycardia and agitation, the patient who died presented with severe hyperthermia (> 104oF).

For the rest, very little is generalizable because factors such as referral bias, selection bias, co-ingestants, and the relatively small number of cases. Probably the most interesting finding is that, contrary to expectations, none of the patients had seizure activity.

Despite the flaws, this paper is worth looking at because all the patients had laboratory confirmation of exposure to synthetic cathinones.

Related posts:

Bath-salt constituent MDPV more like methamphetamine than ecstasy

MDPV can give a false positive test for phencyclidine (PCP)

Death from MDPV-associated excited delirium

 

Review: 23 patients with laboratory-confirmed MDPV exposure

Methylenedioxypyrovalerone (MDPV)

Methylenedioxypyrovalerone (MDPV)

3.5 out of 5 stars

Acute Methylenedioxypyrovalerone Toxicity. Fruberg BA et al. J Med Toxicol 2014 Dec 3 [Epub ahead of print]

Abstract

This is an impressive paper, but for reasons the authors thoroughly discuss in their limitations sections, there is somewhat less here than meets the eye.

The authors retrospectively reviewed patients seen over a 2-year period at 10 different hospitals who were entered into the ToxIC Registry and coded under a term consistent with “bath salt” exposure. Cases were eligible for the study if they had blood and/or urine laboratory confirmation positive for a synthetic cathinone (methylenedioxypyrovalerone (MDPV), mephedrone, methcathinone, methylone, or methedrone.)

The review identified 23 patients. All were positive for MDPV on confirmatory testing. One patient died. (For a paper reporting that fatal case, click here.)

The authors extracted a boatload of data from these cases (something that’s easy to do using a computerized registry database). Much of what they found is not surprising: most patients were young males, the most common findings were tachycardia and agitation, the patient who died presented with severe hyperthermia (> 104oF).

For the rest, very little is generalizable because factors such as referral bias, selection bias, co-ingestants, and the relatively small number of cases. Probably the most interesting finding is that, contrary to expectations, none of the patients had seizure activity.

Despite the flaws, this paper is worth looking at because all the patients had laboratory confirmation of exposure to synthetic cathinones.

Related posts:

Bath-salt constituent MDPV more like methamphetamine than ecstasy

MDPV can give a false positive test for phencyclidine (PCP)

Death from MDPV-associated excited delirium

 

Non-controlled and over-the-counter drugs of abuse

 

2.5 out of 5 stars

Abuse of Medications That Theoretically Are Without Abuse Potential. Reeves RR et al. South Med J 2015 Mar;108:151-157.

Abstract

This review of noncontrolled prescription and over-the-counter drugs that can be and have been abused for non-medical or recreational purposes is rather sketchy and anecdotal (as the authors admit,) but nevertheless contains some useful information.

Classes of drugs discussed include:

  • Cold & Cough products: pseudoephedrine, ephedrine, oxymetazoline, dextromethorphan
  • Anticholinergics: diphenhydramine, benztropine, trihexyphenidyl (Artane)
  • Antipsychotics: quetiapine, olanzapine
  • Antidepressants: tricyclics, bupropion, fluoxetine, venlafaxine
  • Anitconvulsants: pregabalin, gabapentin
  • Muscle relaxants: carisoprodol, cyclobenaprine (Flexeril,) baclofen

Among the more interesting take-home lessons from tis paper :

  • bupropion is sometimes abused by nasal insufflation (snorting), thus bypassing first-pass metabolism and enhancing its cocaine-like effect at high doses [as the clip above shows, bupropion is also abused by injection]
  • dextromethorphan in large doses has dissociative and  hallucinogenic effects similar to theses of phencyclidine (PCP) or ketamine
  • gabapentin and quetiapine have been reported to enhance the effects of Suboxone (buprenorphine/naloxone)

Tox Tunes #94: Cocaine Blues (David Bromberg)

Along comes Sally with her nose all tore
The doctor says she can’t sniff no more
He says that cocaine’s for horses, it’s not for men
He says it’s gonna kill me but he don’t say when

During the American folk music revival that started in the 1930s and continued into the 1960s and 70s, many musicians rediscovered the rich vein of drug themes that ran through the history of blues and country songs. I first heard Luke Jordan’s “Cocaine Blues” through David Bromberg’s excellent cover version.

Jordan (1882-1952) made several recordings for Victor Records in Charlotte NC and New York City. “Cocaine Blues” was recorded in 1927.

Related posts:

Tox Tunes #76: Cocaine Blues (Dave van Ronk)

Tox Tunes #20: Cocaine Habit Blues (Memphis Jug Band)

Tox Tunes #1: Cocaine Blues (Keith Richards)

Keef Kat, Boddahfinger, and other marijuana edibles — how should they be regulated

marijuana edibles

3 out of 5 stars

Half-Baked — The Retail Promotion of Marijuana Edibles. MacCoun RF, Mello MM. N Engl J Med 2015 Mar 12;372:989-991.

Full Text

This Perspective piece — from authors at the Stanford Schools of Law and Medicine — discusses problems raised by the increasing availability of marijuana edibles in some states. Often, these products are manufactured in forms that are enticing to children (such as cookies, candy bars, and gummy bears) and packaged to look like familiar consumer products. It have written about this problem previously in several columns for Emergency Medicine News — to read them, click here and here.

The authors point out an interesting paradox. Marijuana is still classified as a Schedule I drug by the federal government. This means that it is considered as being:

  •  a high risk for abuse
  •  without medical value, and
  • unsafe

As long as this is the case, the Food and Drug Administration can not regulate marijuana as a drug. In addition, as spell out in the Food, Drug and Cosmetic Act of 1938, food products can not contain ingredients not “generally recognized as safe.” This means that the FDA can not regulate the THC content or packaging of marijuana edibles by considering them as foods.

Recently, three U.S. senators — Rand Paul, Cory Booker, and Kristin Gillibrand — proposed legislation reclassifying marijuana as a Schedule II drug. This may actually have the effect of increasing regulation.

The authors proposed several requirements aimed at decreasing inadvertent overdose from marijuana edibles in children and adults:

  • child-resistant packaging (this is already required in many states)
  • clear labeling about doses, serving sizes, and risks
  • regulate degree to which marijuana edibles and look and taste like familiar products
  • standardized THC content

The authors don’t mention that last month many similar reforms went into effect in the state of Colorado.

And, by the way, I did not overlook the appropriateness of the second author’s last name.
 

[Photo of marijuana edibles from the U.S. Drug Enforcement Agency]

Keef Kat, Boddahfinger, and other marijuana edibles — how should they be regulated

marijuana edibles

3 out of 5 stars

Half-Baked — The Retail Promotion of Marijuana Edibles. MacCoun RF, Mello MM. N Engl J Med 2015 Mar 12;372:989-991.

Full Text

This Perspective piece — from authors at the Stanford Schools of Law and Medicine — discusses problems raised by the increasing availability of marijuana edibles in some states. Often, these products are manufactured in forms that are enticing to children (such as cookies, candy bars, and gummy bears) and packaged to look like familiar consumer products. It have written about this problem previously in several columns for Emergency Medicine News — to read them, click here and here.

The authors point out an interesting paradox. Marijuana is still classified as a Schedule I drug by the federal government. This means that it is considered as being:

  •  a high risk for abuse
  •  without medical value, and
  • unsafe

As long as this is the case, the Food and Drug Administration can not regulate marijuana as a drug. In addition, as spell out in the Food, Drug and Cosmetic Act of 1938, food products can not contain ingredients not “generally recognized as safe.” This means that the FDA can not regulate the THC content or packaging of marijuana edibles by considering them as foods.

Recently, three U.S. senators — Rand Paul, Cory Booker, and Kristin Gillibrand — proposed legislation reclassifying marijuana as a Schedule II drug. This may actually have the effect of increasing regulation.

The authors proposed several requirements aimed at decreasing inadvertent overdose from marijuana edibles in children and adults:

  • child-resistant packaging (this is already required in many states)
  • clear labeling about doses, serving sizes, and risks
  • regulate degree to which marijuana edibles and look and taste like familiar products
  • standardized THC content

The authors don’t mention that last month many similar reforms went into effect in the state of Colorado.

And, by the way, I did not overlook the appropriateness of the second author’s last name.
 

[Photo of marijuana edibles from the U.S. Drug Enforcement Agency]