Street drugs guide Fall 2022 (PHRM 48600)

Street drugs guide Fall 2022

Created by students enrolled in PHPR 48600 Beyond ecstasy Compiled by Cynthia Koh-Knox Sharp, PharmD, RPh Purdue University College of Pharmacy

First day ABCs

Last day ABCs

Table of contents Street drug topic (Author) Page Acetaminophen (Kristen Mouser).............................................................................................. 5 Alcohol (Arianna Dollinger) ........................................................................................................ 7 Alpha-methyltryptamine (Jasmine Ahn) .................................................................................... 9 Amanita (Austin Ignatovich) .................................................................................................... 11 Anabolic steroids (Anthony Jewett) ......................................................................................... 13 Anorectics (Ravani Sansoya) .................................................................................................... 15 Ayahuasca (Alexis Clarke) ........................................................................................................ 17 Benzodiazepines (Bill Tchachito) ............................................................................................. 19 Bromo-dragonfly (Cameron Cardinal) ..................................................................................... 21 Buprenorphine (Mackenzie Carr)............................................................................................. 23 Caffeine (Cameron Buschkoetter) ........................................................................................... 25 Cannabidiol/ cannabigerol (Hojun (John) Chang) .................................................................... 27 Cannabinol (Chloe Coryea) ...................................................................................................... 29 Cocaine (Jerry Connolly) .......................................................................................................... 31 Datura (Danielle Bellamy) ........................................................................................................ 33 Delta 8 & 9 (Sara Sans) ............................................................................................................. 35 Dextromethorphan (Tiana Duncan) ......................................................................................... 37 DHEA (dehydroepiandrosterone) (Brett Duncan) ................................................................... 39 DMT (dimethyltryptamine) (Hunter Duncan) .......................................................................... 41 Ergot (Elana Chuaprasert) ........................................................................................................ 43 Fentanyl (Luke Eckert).............................................................................................................. 45 Flakka Alpha-PVP (Pearl Feng) ................................................................................................. 47 Flumazenil (Abby Fisher) .......................................................................................................... 49 Gabapentin/pregabalin (Mikey Franks) ................................................................................... 51 Gamma hydroxybutyrate (GHB) (Jake Frederick) .................................................................... 53 Hashish (Sam Frey) ................................................................................................................... 55 Hawaiian Baby Woodrose (Allison Gerber) ............................................................................. 57 Heroin (Rachel Gerdt) .............................................................................................................. 59 Ibogaine (Abigail Gick) ............................................................................................................. 61 Isoflurane anesthetics (Justin Young) ...................................................................................... 63 K-2 Spice (Sarah Pensyl) ........................................................................................................... 65 Kava-kava (CC Gooden) ............................................................................................................ 67 Ketamine (Cassidy Hardin) ....................................................................................................... 69 Khat (Clark Hawkins) ................................................................................................................ 71 Kratom (Haylie Dickson) ........................................................................................................... 73 Krokodil (Katrina Hoang) .......................................................................................................... 75 3

Street drug topic (Author)

Page

Lysergic acid diethylamide (LSD) (Seoyeon (Yuna) Hong)........................................................ 77 MDMA (3,4-methylenedioxymethamphetamine) (Hunter Skelton) ....................................... 79 Mescaline (Ingrid Lund-Mikkelsen) .......................................................................................... 81 Methadone (Jilian Banzon) ...................................................................................................... 83 Methamphetamine (James Dycus) .......................................................................................... 85 Morning glory (Jailyn Jones)..................................................................................................... 87 Muscle relaxants (Claudia Chiang) ........................................................................................... 89 Naloxone (Katy Bedka) ............................................................................................................. 91 Nightshade (Kortlyn Kimbrough (Fernung))............................................................................. 93 Nitrous oxide (Kelly Gole) ........................................................................................................ 95 Nutmeg (Jeremy Seo Kim) ........................................................................................................ 97 Phencyclidine (PCP) (Jacob Lindsey) ........................................................................................ 99 Peyote (Grace Kwon).............................................................................................................. 101 Propofol (Lauren Martinez).................................................................................................... 103 Psilocybin (Kristen Lyons)....................................................................................................... 105 Pseudoephedrine (Austin Lowe) ............................................................................................ 107 Pyro(nitazine) (Mariah McKinney) ......................................................................................... 109 Pyrovalerone (Natalia Fijas) ................................................................................................... 111 Rohypnol (Madi Robertson) ................................................................................................... 113 Prescription stimulants (Lauren Schrock) .............................................................................. 115 Salvia divornum (Vinayak Shankar) ........................................................................................ 117 Scopolamine (Sydney Pelnick) ............................................................................................... 119 Toad venom (5-MeO-DMT) (Maria Tan) ................................................................................ 121 Wormwood (Savanna Thompson) ......................................................................................... 123 Yohimbe (Yasasvi Obeyesekera) ............................................................................................ 125

4

OTC Analgesics: Acetaminophen Fall 2022 Kristen Mouser, Student Pharmacist

History of Use and Abuse Acetaminophen was approved as an over-the-counter

Kristen Mouser (OTC) analgesic by the FDA in 1955.1 It is currently the most common drug ingredient, being incorporated into over 600 different medications. 2 With it being used in so many patients at an uncontrolled rate, comes a high amount of overdose. A study done in 2021 reveals that around 56000 emergency room visits and 26000 hospitalizations are due to acetaminophen overdoses each year.3 The use of the medication continues to grow, and overuse tends to occur due to self-treating and the addition of OTC acetaminophen to an already prescribed medication with acetaminophen in it.4 A research article evaluating the use of nonprescription analgesics, reveals that in a study of 39767 people 38.3% reported having used acetaminophen more than once a week for the past month.4 Then even more specifically, 10.6% of participants reported utilizing it at least once daily in the past month. 4 These results reveal the frequency of acetaminophen use in the population.

The majority of patients who reported using high amounts of acetaminophen, also reported having intermittent opioid use and chronic pain (71.5%).

4 Chronic pain is defined as pain that lasts more than 3 months.5 Patients experiencing this use analgesics to make themselves more comfortable, but the problem is developing tolerance and dependence, which ultimately can lead to an increased risk of overdose.

Tolerance is established from the frequent exposure to a medication where they begin developing a resistance to it, meaning they will need a higher dose to elicit the same response.6 Then dependence is also due to the frequent use of a medication where they grow accustomed to it being in the body. 6 This can create an environment where the body wont function without the medication and even if the pain resolves, the patient will feel the need to continue utilizing it.

same reasons as many other drugs. Unlike opioids or illicit substances there is no “high” or sense of euphoria. However, a few studies show that it may reduce emotional response.7 This indicates that those who use acetaminophen at a higher than recommended level may have reduced neural responses and has shown a decrease in both positive and negative emotions.7 Other Names for Acetaminophen -

Pain meds Liver killers Painkillers

Pharmacology/ Drug Effects

https://www.flaticon.com/free-icon/pain_387630

Acetaminophen is used as an analgesic and antipyretic, but unlike NSAIDs it does not show peripheral anti inflammatory effects. The mechanism of action is still unknown; however, it is thought to work by inhibiting the COX pathway which blocks prostaglandin secretion in the central nervous system.8 By acting on the hypothalamus the medication is able to play a role on temperature and reduce fever. Then there is thought to be an antinociceptive effect that occurs by activating the descending serotonergic pathways. 9 This is the response mechanism of sensory neurons to toxicities, injuries, or pain.9 With this occurring in the central nervous system it is possible this is also the cause of the reduced emotional response.

An acetaminophen addiction is not usually due to the https://www.coreimpodcast.com

Drug interactions/ toxicology

Professional opinion

Acetaminophen doesn’t have any severe interactions with other medications. However, it does have drug disease interactions with alcoholism and liver disease.10 Elevated and sometimes prescribed amount of acetaminophen can cause hepatotoxicity indicated by elevated serum aminotransferase.11 When there is an overdose, it can result in jaundice, confusion, acute liver injury and failure that can lead to death or need for a liver transplant. 11

I would recommend Acetaminophen as a short term, as needed therapy for pain and fever management. I would consider it to be safe and have a low chance of addiction. The main concern is it is easy to overdose, patients need to be properly educated on maximum dosing and the large incorporation of acetaminophen into combination products. ~ K. Mouser References 1.

2.

3. https://www.shutterstock.com/image-illustration/conceptual-image-druginducedhepatotoxicity-3d-illustration-774287005

Laws Currently there are no laws concerning OTC acetaminophen. In the past there have been actions made to limit the amount of drug to 325mg per unit in combination products.12 This is to make the product safer for patients by reducing risk of accidental overdose. 12 Monitoring/ drug screens Patients frequently using acetaminophen should first be informed of the maximum daily dosage of 4 grams a day in patients with normal liver function. It is also important to monitor for signs and symptoms of hepatic toxicity.13 These include dark colored urine, light colored bowel movements, jaundice, and loss of appetite.13 If there is an overdose the serum or blood acetaminophen level should be obtained after 4 hours of ingestion.13 If the level is at or above 150 mcg/mL then begin on acetylcysteine, the medication used to manage an acute overdose.13 If the acetaminophen level remains elevated an ALT or AST will be obtained after the acetylcysteine infusion.13 Then the infusion will continue until an ALT of less than 50% and an acetaminophen value of 10 mcg/mL.13 5%

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

Leichty J. Selection of Acetaminophen for Consideration for Listing .

US FDA. https://oehha.ca.gov/media/dockets/19653/19710u.s._food_and_drug_administration_fda/fda_comments_notice_of_avai lability_of_hazard_identification_materials_for_acetaminophen_11420 19.pdf. Published 2019. Accessed October 10, 2022.

Acetaminophen. Consumer Healthcare Products Association. https://www.chpa.org/our-issues/otcmedicines/acetaminophen#:~:text=Acetaminophen%20is%20the%20m ost%20common,%2C%20cold%2C%20and%20allergy%20medicines.

Published 2022. Accessed October 13, 2022.

What Happens if you Take Too Much Acetaminophen? Piedmont Healthcare. https://www.piedmont.org/living-better/what-happens-ifyou-take-too-muchacetaminophen#:~:text=%E2%80%9CAcetaminophen%20overdose%2 0is%20one%20of,patients%20aged%2015%20to%2024.%E2%80%9D. Accessed October 13, 2022.

Dale, O., Borchgrevink, P.C., Fredheim, O.M.S. et al. Prevalence of use of non-prescription analgesics in the Norwegian HUNT3 population: Impact of gender, age, exercise and prescription of opioids. BMC Public Health 15, 461 (2015). https://doi.org/10.1186/s12889-0151774-6 Commonly used terms. Centers for Disease Control and Prevention. https://www.cdc.gov/opioids/basics/terms.html. Published 2021.

Accessed October 13, 2022.

Acetaminophen - over-the-counter pain medication abuse. New Beginnings Drug Rehab. https://www.newbeginningsdrugrehab.org/acetaminophen. Published 2019. Accessed October 13, 2022.

Grey H. Tylenol relief from emotional distress. Healthline. https://www.healthline.com/health-news/tylenol-relieve-hurtfeelings#May-blunt-positive-emotions,-too. Published 2017. Accessed October 13, 2022.

Gerriets V, Anderson J, Nappe T. Acetaminophen. Stat Pearls. https://www.ncbi.nlm.nih.gov/books/NBK482369/. Published 2022.

Accessed October 14, 2022.

Dogrul A, Seyrek M, Akgul EO, Cayci T, Kahraman S, Bolay H. Systemic paracetamol-induced analgesic and antihypera lgesic effects through activation of descending serotonergic pathways involving spinal 5-HT₇ receptors. Eur J Pharmacol. 2012;677(1-3):93-101. doi:10.1016/j.ejphar.2011.12.016 Acetaminophen interactions checker. Drugs.com. https://www.drugs.com/drug-interactions/acetaminophen.html.

Accessed October 13, 2022.

Toxic hepatitis. Mayo Clinic. https://www.mayoclinic.org/diseasesconditions/toxic-hepatitis/symptoms-causes/syc-20352202. Published 2022. Accessed October 13, 2022.

Prescription acetaminophen products to be limited to 325 mg per dosage. U.S. Food and Drug Administration. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drugsafety-communication-prescription-acetaminophen-products-belimited-325-mg-dosage-unit. Published 2018. Accessed October 13, 2022.

Tylenol® Products & Professional Resources. TYLENOL® Professional. https://www.tylenolprofessional.com/. Accessed October 13, 2022.

Arianna Dollinger, Student pharmacist

Pharmacology of alcohol Alcohol binds directly to acetylcholine (ACh), serotonin, GABA, and the NMDA receptors for glutamate. GABA and glycine receptors mediate the sedative effects of alcohol. Alcohol is a dehydrating agent and disrupts the osmotic homeostasis across cell membranes. There are two main pathways for alcohol metabolism: alcohol dehydrogenase (ADH) pathway and microsomal ethanol-oxidizing system (MEOS).

https://www.harryschocolateshop.com

Street names

2016

3,000 - 2,000 B.C.

16th & 17th Century

Beer was made in Ancient Mesopotamia. Alcohol was used in sacrificial settings.

Intoxication and drunkenness became a crime in the 1600s.

Britain began taxing alcohol in 1643.

488,000 adolescents (12-17) have had an alcohol use disorder. 10.9 million adults (> 26) have had an alcohol use disorder.

2,000 B.C.

17th - 20th Centuries

The earliest vineyards were established by the Ancient Greeks and the Greek god of wine – Dionysus. Alcohol was used as currency, medicine, and religious offering to the gods.

Banning alcohol as payment resulted in extreme labor strike.

By 1830, Americans consumed an average of 7.1 gallons per person each year. This equates to ~55 handles of alcohol.

In 1860, the U.S. produced ~88 million gallons of liquor per year. In 1952, the American Medical Association first defined alcoholism.

Drug Interactions: Aspirin and acetaminophen Can cause liver damage Antihistamines, such as diphenhydramine Increased drowsiness, sedation, and decreased motor skills Anticoagulants: warfarin Acute alcohol consumption may increase anticoagulation by decreasing warfarin metabolism Chronic alcohol consumption decreases anticoagulation by increasing warfarin metabolism Benzodiazepines, such as alprazolam, lorazepam Increased drowsiness, sedation, and decreased motor skills NSAIDs: ibuprofen, naproxen Increased risk of GI bleeding MANY OTHERS!!

Monitoring/Testing Alcohol Laws: Minimum Legal Drinking Age (MDLA) of 21 years old in the United States.

National Highway System Designation Act of 1995 requires a zero-tolerance law prohibiting drivers < 21 from operating a motor vehicle with 0.02% BAC. Public intoxication is a class B misdemeanor in Indiana.

Blood alcohol concentration test: Blood test that shows blood alcohol levels up to 12 hours after drinking Breathalyzer: Estimates blood alcohol content in deep lung air

Professional Opinion: I believe that alcohol is okay in moderation. However, it is extremely important to be educated on its effects and interactions with other substances and medications. Alcohol is a drug and does need to be treated as such, although it is legally and socially acceptable. ~ A. Dollinger

References: 1. Street names and nicknames for alcohol. Drug Rehab Options. Published September 28, 2022. Accessed October 13, 2022. https://rehabs.com/blog/street-names-and-nicknames-for-alcohol/.

2. The history of alcohol throughout the world. Recovery.org. Published July 18, 2022. Accessed October 13, 2022. https://recovery.org/alcohol-addiction/history/.

3. Ethanol. Uses, Interactions, Mechanism of Action. DrugBank Online. https://go.drugbank.com/drugs/DB00898. Accessed October 13, 2022.

4. Chapter 23: The alcohols. AccessMedicine. Accessed October 13, 2022. https://accessmedicine.mhmedical.com/content.aspx?bookid=2249§ionid=175218881#1148435877.

5. Weathermon R, Crabb DW. Alcohol and medications interactions. Alcohol Res Health. 1999;23(1):40-54. PMID: 10890797; PMCID: PMC6761694.

6. Minimum legal drinking age of 21 saves lives. Centers for Disease Control and Prevention. Published April 19, 2022. Accessed October 14, 2022. https://www.cdc.gov/alcohol/fact-sheets/minimum-legal-drinkingage.htm#:~:text=Minimum%20Legal%20Drinking%20Age%20(MLDA)%20laws%20specify%20the%20legal%20age,varied%2 0from%20state%20to%20state.

7. Blood alcohol level: Medlineplus medical test. MedlinePlus. Accessed October 14, 2022. https://medlineplus.gov/lab-tests/bloodalcohol-level/#:~:text=A%20blood%20alcohol%20concentration%20(BAC,of%20alcohol%20that%20you%20drank.

Alpha-Methyltryptamine Jasmine Ahn, Student Pharmacist Fall 2022

History and Background Alpha-methyltryptamine, also known as AMT, is a tryptamine derivative. AMT was first studied in the 1960s by a couple of pharmaceutical companies as a possible antidepressant due to its MAOI properties. AMT was studied by the Upjohn Company, but it was concluded that AMT was a toxic substance and produces psychosis. AMT was an available prescription in the 1960s in the Soviet Union, under the name of Indopan in 5 mg and 10 mg tablets. As of today, there is not much known due to little to no formal research on the drug. There are no currently accepted medical uses in the United States. Recently, AMT has been emerging in club and rave scenes for recreational use for its hallucinogenic effects and is used as a substitute for MDMA. The abuse of AMT has led to two emergency department admissions and one death.

Slang Terms: Amtrak, Amthrax, Spirals

https://www.erowid.org/archive/rhodium/chemistry/it-290.html.

Pharmacology and Drug Effects AMT’s molecular formula is C11H14N2 and the molecular weight is 174.74 g/mol. The class of the drug is tryptamines and all are composed of a substituted monoamine group. The drug works by inhibiting MAOs which causes an impact on the brain's chemicals. It can be taken in crystal powder, capsule, or tablet form. AMT is usually taken by ingestion, smoking, or insufflation, although oral ingestion is the most common route. Common dosages include 20-40 mg for oral dosage and 6-10 mg for smoked dosage. The duration of action for AMT is 12-16 hours and the stimulant activity is due to the presence of an alpha carbon methyl group.

There are many ways of synthesis for AMT from different compounds: indole, tryptophan, indole-3-carboxaldehyde gramine, and 2-nitropropene. The pyrrole of the indole ring appears to be essential for hallucinogenic activity.

AMT is considered a synthetic hallucinogen that can alter the user’s perception, thought, and mood. Effects of this substance include an increase in energy, hallucinogens with both visual and auditory distortions, euphoria, empathy, and emotional distress. Some also report nervous tension, irritability, restlessness, inability to sleep, blurry vision, and dilated pupils.

Drug Interactions and Toxicology

Drug toxicology can be separated into mild to moderate poisoning and severe poisoning. For mild to moderate, tryptamines have the potential to cause pleasant or frightening hallucinations and unpredictable behavior. Some adverse effects include nausea, vomiting, anorexia, dizziness, paresthesias, anxiety, mood alterations, time distortion, and confusion. For severe poisoning, the signs are severe anxiety, possible agitation, hypertension, sinus tachycardia, rhabdomyolysis, and hyperthermia. To show a range of toxicity based on doses; 5-10 mg is reported to be mood-lifting, 20 mg causes euphoria, and 30 mg can induce hallucinations.

Drug interactions can occur with any other MAO inhibitors, SSRIs, cold preparations, cough medications with decongestants, dextromethorphan, Demerol, sinus medications, and nose drops or nasal sprays. AMTs also interact with amphetamines, MDMA, MDA or “MD” compounds, and cocaine.

Laws AMT is a Schedule I substance under the Controlled Substances Act in the United States. It was regulated on April 4, 2003. In Germany, it is supposedly illegal to sell or possess AMT.

Monitoring and Drug Screens To monitor patients on AMT, check the core temperature and mental status. Hospitals can monitor serum electrolytes, liver enzymes, renal function, and urinalysis. Check the patient's ECG and conduct continuous cardiac monitoring. If patients have prolonged agitation, monitor creatine kinase. Assess for myoglobinuria and hemoglobinuria following significant exposure.

Recent research has yielded how AMT can be detected but there are no available screens now.

AMT is not tested in standard and extended drug tests. The detection period in urine for AMT is unknown.

Professional Opinion

Due to the current potential of psychedelic-assisted therapies like MDMA and psilocybin for PTSD and depression, AMT can be a potential treatment with more research on efficacy and safety. ~ J. Ahn

References

1. Dialtonez. AMT FAQ. Erowid AMT Vault. https://www.erowid.org/chemicals/amt/amt_faq1.shtml. March 12, 2003.

Accessed October 13, 2022.

2. Rhodium. Synthesis of Alpha-Methyltryptamine (IT-290; AMT). https://www.erowid.org/archive/rhodium/chemistry/it-290.html. August 2004.

Accessed October 13, 2022.

3. Hallucinogenic Tryptamines. Micromedex (electronic version). IBM Watson Health; 2019.

Accessed October 13, 2022. https://www.micromedexsolution.com 4. Vorce SP, Sklerov JH. A general screening and confirmation approach to the analysis of designer tryptamines and phenethylamines in blood and urine using GC-EI-MS and HPLC-electrospray-MS. J Anal Toxicol. 2004;28(6):407-410. doi:10.1093/jat/28.6.407 5. Drug Enforcement Administration. Alpha-Methyltryptamine. February 2020. Accessed October 13, 2022. https://www.deadiversion.usdoj.gov/drug_chem_info/amt.pdf

Amanita Muscaria Austin Ignatovich, Second Year Professional Student Fall 2022

History and Background

https://en.wikipedia.org/wiki/Amanita_muscari a https://www.inaturalist.org/taxa/48715-Amanita-muscaria https://edu.rsc.org/feature/the-drink-of-the-gods/2020250.article

Amanita is a native mushroom to forests in the northern hemisphere and has spread to all parts of the world. A common use for amanita is as an insecticide on certain organic farms. They also were used in religious gatherings by Siberian Shamans to reach spiritual growth and enter a “trance-like state”. Across history, Amanita usage is relatively low, but it does have some relevance between 500 BCE and 1700 AD where it was known as a mushroom for immortality and before battle.

Slang Terms

https://www.hipsandhaws.com/7th-nov-2021-foraging-wildcraftingseries-fly-agaric-folklor e-mystique-magic-toadstool/

Fly Agaric Magic Mushrooms / Shrooms Fairy Tale mushroom Death cap

Pharmacology & Drug Effects A compound found in amanita is muscimol (bottom right), which is a psychoactive ingredient, and inhibits neuronal function. The precursor to muscimol is ibotenic acid (top right), a neurotoxin.

Some common effects that users may experience after 2-3 hours include dizziness, changes in visual and audio perception, lack of time awareness, space distortion, and increased energy.

https://psychonautwiki.org/wiki/Ibotenic_acid, https://www.caymanchem.com/product/13667/muscimol

Interactions and Toxicology

https://www.pinterest.com/pin/fungi--623467142171881365/

There are no known drug interactions. Sometimes known as the death cap, amanita is very poisonous and dangerous. It does irreversible damage to the liver and kidney and causes RNA polymerase inhibition, leading to cell death. This process ultimately leads to a coma and death. Eating these orally is strongly recommended against. Amanitas are less toxic when dried and crushed up in tea.

Never consume Amanita with a white cap.

Laws

https://www .dhs.gov/laws -regulations

Amanita is legal to possess, sell, cultivate, and transport in the United States except in Louisiana. It is legal to do the same in other countries although illegal in Australia, Romania, Thailand, and the Netherlands.

https://ww w.tecan.com /blog/consid ering-massspec-fortherapeuticdrugmonitoring

Monitoring Although there is controversy on what to monitor to determine amanita poisoning, the most reliable signs to test for are prothrombin time and coagulation factor V, which are early signs of liver failure.

References

Professional Opinion

Psychoactive Amanitas. EROWID. Available at: https://www.erowid.org/plants/amanitas.

Accessed November 6, 2022.

Amanita is a very dangerous yet legal hallucinogen.

Consuming this mushroom orally is not recommended unless thoroughly dried. Once dried, it can be taken orally or crushed and added to tea and still provide hallucinogenic activity to users. If used with caution it is not as dangerous. Although it is best to avoid usage, make sure to be in a safe space with people you know and trust while using this in case adverse effects occur or you need medical help. ~ A. Ignatovich

Amanita Muscarina: The Fascinating History of The Fairy Tale Fungus. Natura Mushrooms. Available at: https://naturamushrooms.com/blogs/news/amanita -muscaria-the-fascinating-history-of-the-fairy-talefungus. Accessed November 6, 2022.

Garcia J, Costa VM, Carvalho A, et al. Amanita phalloides poisoning: Mechanisms of toxicity and treatment. Food Chem Toxicol. 2015;86:41-55. doi:10.1016/j.fct.2015.09.008 The Ultimate Guide to Amanita Muscarina. The Third Wave. Available at: https://thethirdwave.co/psychedelics/amanit a-muscaria/. Accessed November 6, 2022.

Anthony Jewett Student pharmacist

Fall 2022

Anabolic Steroids

History

Slang

The first anabolic steroids were synthesized in Germany 1935 to treat hypogonadism. They were later discovered to be used in Soviet powerlifting competitions, and were subsequently banned by the International Olympic Committee in 1975. The Anabolic Steroids Control Act of 1990 placed anabolic steroids as a schedule III drug.

• • • • • • •

Arnolds Gym Candy Juice Pumpers Roids Stackers Weight Trainers

Pharmacology Anabolic steroids are drugs which mimic naturally occurring male sex hormones testosterone and dihydrotestosterone.

medlineplus.gov/anabolicsteroids.html

These drugs bind to and activate androgen receptors in the body. Anabolic steroid use results in increased protein synthesis and buildup of cellular tissue, especially within muscles.

Drug Interactions and Toxicology Long-term use and misuse of anabolic steroids causes hepatoxicity, cardiovascular complications, and endocrine system damage.

Anabolic steroids interact with warfarin and increases the risk of bleeding when used in combination. Also, steroid use in addition to cyclosporine is not recommended due to increased risk of hepatotoxicity. sciencedirect.com/article/abs/pii/S245 1965019300912

Anabolic Steroids Monitoring

Laws

Common tests to obtain when monitoring patients using anabolic steroids:

Anabolic steroids are currently listed as schedule III drugs under the Controlled Substances Act.

• • • •

Liver function tests Lipids (especially low density lipoprotein (LDL) Complete blood count Electrocardiogram

A urinalysis is the most common test used to detect anabolic steroids.

Anabolic steroid use is banned in most professional sports organizations.

Professional Opinion

bleacherreport.com/articles/1648362

In my professional opinion, anabolic steroids should remain a schedule III drug. I believe that they do have medicinal value, however steroids can easily be misused. Long-term use of anabolic steroids can lead to lifethreatening conditions and those using steroids must be monitored properly. ~ A. Jewett

References 1. Albano GD, Amico F, Cocimano G, et al. Adverse Effects of Anabolic-Androgenic Steroids: A Literature Review. Healthcare (Basel). 2021;9(1):97. Published 2021 Jan 19. doi:10.3390/healthcare9010097 2. Anabolic Steroids. Alcohol and Drug Foundation Published 8 Dec. 2021. Accessed November 9, 2022. https://adf.org.au/drug-facts/steroids/.

Kicman AT. Pharmacology of anabolic steroids. Br J Pharmacol. 2008;154(3):502-521. doi:10.1038/bjp.2008.165 3. What are the side effects of anabolic steroid misuse? National Institute Drug Abuse.

Updated April 12, 2021. Accessed November 9, 2022. https://nida.nih.gov/publications/ researchreports/steroids-other-appearance-performance-enhancing-drugs-apeds/what-areside-effects-anabolic-steroid-misuse.

Anorectics History & Background Drugs that reduce appetite with the goal of weight loss Approval in 1940s for treatment of obesity Abuse due to perceived effects of amphetamines Common Anorectic Drugs: benzphetamine (Didrex), diethylproprion (Tenuate, Tepanil, Amfepramone), fenfluramine (Pondimin), mazindol (Sanorex, Mazanor), phendimetrazine (Bontril) Typically intended for use on a short-term basis due to abuse potential

https://www.webmd.com/dr ugs/2/drug7858/diethylpropionoral/details

https://www.webmd.com/d rugs/2/drug7858/diethylpropionoral/details

Ravani Sansoya Student Pharmacist Fall 2022

Slang Term Diet Pills Pharmacology & Drug Effects

diethylpropion

Anorectics have a structure closely related to amphetamines

amphetamine

Act on hypothalamus, the satiety center- producing anorexic effect and decreased appetite Metabolize fat and carbohydrates Euphoria occurs with dexamfetamine, phenmetrazine and benzfetamine Therapeutic effect seens after several weeks

Drug Interactions & Toxicology Moderate to high interaction with monoamine oxidase inhibitors Low interaction with antihypertensive drugs Toxic effects of anorectics may occur and include hypertension, tachycardia or psychosis

Laws Anorectic drugs are FDA approved for weight loss: Wegovy , Saxenda®, Contrave®, Qsymia® Qsymia® is a C-IV drug due to phentermine In order to qualify for a Qsymia® Rx, patients must have a BMI >30 kg/m2 TM

References Colman E. Anorectics on trial: a half century of federal regulation of prescription appetite suppressants. Ann Intern Med. 2005;143(5):380-385. doi:10.7326/00034819-143-5-200509060-00013 Craddock D. Anorectic drugs: use in general practice.

Drugs. 1976;11(5):378-393. doi:10.2165/00003495197611050-00002 Ehud Grossman, Franz H. Messerli: Chapter 71 - DrugInduced Hypertension. Mosby. 2007,Pages 883-893, 9780323039611, Karam, Nardine. A Review of FDA-Approved Medications for Chronic Weight Management. Drug Topics; 2021.

Monitoring & Drug Screens Wegovy : monitor heart rate Saxenda®: for patients with T2D, monitor blood glucose, monitor depression for mental health disorders Contrave®: monitor blood pressure, heart rate, and mood Qsymia®: monitor for hypokalemia; REMS safety required from FDA due to risks of teratogenicity Anorectics are not normally monitored in standard drug tests; however, phenteramine can cause a false positive for amphetamine TM

Professional Opinion If a patient meets the criteria for anorectic drugs, I feel that it can be helpful short-term for appetite suppression. I would stress the importance of a discussed upon diet and exercise regimen as medication is not stand alone treatment.

Ravani Sansoya Student Pharmacist

Ayahuasca Alexis Clarke, 2nd Professional Year pharmacy student Fall 2022

https://www.floridarehab.com/drugs/ ayahuasca/

HISTORY/BACKGROUND OF USE Ayahuasca originates from the Banisteriosis caapi vine and is typically consumed as a brew. It produces a hallucinogenic effect upon its users and is sometimes combined with other hallucinogens to extend its properties. Ayahuasca has been used in religious ceremonies and is believed to have healing properties.

The first record of Ayahuasca use for psychoactive effects was recorded in 1852 in the Brazilian Amazon. The drug was most likely used for these effects many years before this; however, it was not recorded. Ayahuasca became popular in Western culture during the late 1900s through writing and other recordings of its effect. Most uses of the drug are reported in South America, as people desire to experience it in a “traditional setting.”

SLANG TERMS Appane, Caapi, Chacrona, Cacruna, Chaliponga, Daime, Hoasca, Jagube, Jurema, Kawa, Mariri, Mihi, Natem, Ooasca, Orhoasca, Queen, Rainha, Soulvine, Yagé, Yajé

PHARMACOLOGY & DRUG EFFECTS Ayahuasca exhibits its acute effects at about 15-30 minutes after ingestion, then reaches its peak level at about 1.5-2 hours after ingestion. Its duration is approximately 2-6 hours.

Ayahuasca is traditionally used for its neurologic and CNS effects. It has been used for the treatment of depression and anxiety and has been shown to decrease blood perfusion in areas of the brain associated with these disorders. However, it is also thought that the treatment of depression or anxiety from ayahuasca is simply placebo effect.

There has been research on using ayahuasca for patients experiencing addiction. It was shown in a small trial that taking ayahuasca twice during a 4-day period improved feelings of hopefulness and empowerment.

https://en.wikipedia.org/wiki/Ayahuasca

Drug Interactions and Toxicology There is not much evidence regarding the use of ayahuasca with OTC or prescription drugs. The one known interaction is between ayahuasca and MDMA or ayahuasca and antidepressants. Ayahuasca contains MAOIs, so combining it with other drugs that alter serotonin levels could be dangerous and should be avoided.

https://www.enigmaperu.com/blog/what-is-ayahuasca/

Laws Ayahuasca and the other plants that make up the brew are not specifically defined as illegal in the United States. However, DMT is Schedule I in the US, and ayahuasca does contain DMT, so it can be treated as an illegal substance. https://www.tikvahlake.com/blog/understanding-ayahuasca/

Monitoring and Drug Screens

References

There are not typical drug monitoring screens for ayahuasca use. In one study, researchers were able to use a participant’s sweat to detect the main components of ayahuasca and this did show to be effective.

1. Ayahuasca. The Vaults of Erowid. Accessed October 12, 2022. https://www.erowid.org/chemicals/ayahuasca/

Professional Opinion Ayahuasca is a strong psychedelic that is traditionally used for religious ceremonies.

It is becoming more popular in media, so I can see that more people will want to try this drug. I think it is important for people to consider the effects this could have on their mental status and consider the fact that there is not much clinical data regarding the after effects of using the drug. ~A. Clarke

2. Ayahuasca. Natural Medicines. Accessed October 12, 2022. https://naturalmedicinestherapeuticresearchcom.ezproxy.lib.purdue.edu/databases/food,herbssupplements/professional.aspx?productid=1550 3. Ayahuasca. Alcohol and Drug Foundation.

Accessed October 12, 2022. https://adf.org.au/drug-facts/ayahuasca/ 4.) Tavares L, Monedeiro F, Bordin DM, De Martinis BS. Investigation of Ayahuasca βCarboline Alkaloids and Tryptamine in Sweat Samples from Religious Community Participants by GC-MS. J Anal Toxicol.

2020;44(6):601-609. doi:10.1093/jat/bkz116

Benzodiazepines Bill S. Tchachito, Third-year professional student

https://en.wikipedia.org/wiki/Benzodiazepine#/media/File:Benzodiazepine.svg

Slang terms: Alprazolam: Xannies, Bars, Brick, Planks, Upjohn Clonazepam: K, K-pin Diazepam: Yellow V’s, Blue V’s, Tranqs, Old joes, Howard, Downers

History/Background The history of benzodiazepines started in 1955 when a German chemist with the name of Hoffman-La Roche. He accidentally identified the first benzodiazepine and entitled it to chlordiazepoxide (Librium). The history of benzodiazepine started in 1955 when a German chemist with the name of Hoffman-La Roche. He accidentally identified the first benzodiazepine and entitled it to chlordiazepoxide (Librium). The problem of abuse was pointed out long ago by many Scientifics, but the problem became important when in 1982 a British scientist named Malcolm directed a study of these drugs to create a change in the brain that led people to become more dependent on the drug. For some unknown reason, the documentary was sealed secret in the UK and was revealed in 2014.

Pharmacology 1,4 benzodiazepines exert effect for the acute treatment of generalized anxiety disorder and panic disorder through binding to the benzodiazepine site of gamma-aminobutyric acid-A (GABA) receptors in the brain and enhances GABA-mediated synaptic inhibition.

Pharmacokinetics Plasma levels of alprazolam increase proportionally to the dose over the range of 0.5 to 3.0 mg.

Absorption Following oral administration, the peak plasma concentration of alprazolam (Cmax) occurs in 1 to 2 hours post-dose.

Distribution Alprazolam is 80% bound to human serum protein, and albumin accounts for the majority of the binding.

Elimination The mean plasma elimination half-life (T1/2) of alprazolam is approximately 11.2 hours (range: 6.3 to 26.9 hours) in healthy adults.

Metabolism Alprazolam is extensively metabolized in humans, primarily by cytochrome P450 3A4 (CYP3A4), to 2 major active metabolites in the plasma: 4-hydroxyalprazolam and α-hydroxyalprazolam. The plasma circulation levels of the two active metabolites are less than 4% of the parent. The reported relative potencies in benzodiazepine receptor binding experiments and animal models of induced seizure inhibition are 0.20 and 0.66, respectively, for 4-hydroxyalprazolam and α-hydroxyalprazolam. The low concentrations and low potencies of 4-hydroxyalprazolam and α-hydroxyalprazolam indicate that they are unlikely to contribute much to the effects of alprazolam.

Benzophenone derived from alprazolam is also found in humans. Its half-life appears to be similar to that of alprazolam.

Excretion: Alprazolam and its metabolites are excreted primarily in the urine.

Drug Interactions Since benzodiazepines are primarily metabolized by the enzyme CYP3A4 drugs that will inhibit or increase the activity of the enzyme will impact the efficacy of a drug, such as ketoconazole, itraconazole, nefazodone, fluvoxamine, erythromycin, cimetidine, fluoxetine, carbamazepine, oral contraceptives, sertraline, warfarin, ritonavir, imipramine. There could be interactions with some natural products and drinks such as St John’s wort and grapefruit juice.

https://hemaware.org/ sites/default/files/images

Toxicology Common signs and symptoms of overdose are primarily sedative-hypnotic effects and are a result of CNS and respiratory depression and may include sedation, dizziness, amnesia, ataxia, slurred speech, lethargy, problems with coordination, and respiratory difficulties. Acute, single-drug ingestions are typically mild and exhibit reversible symptomatology. Severe toxicity, albeit uncommon and more often associated with co-ingestions, may result in coma, hypotension, hypothermia, and respiratory depression and failure.

Laws

All benzodiazepines are currently categorized as schedule IV drugs in the United States. This means that a form of legal identification is required when picking up the medication. Contrary to other typical drugs, for which the length of the prescription is one year, a prescription for a benzodiazepine is only valid for six months. All prescriptions must include: date prescription was issued, prescriber’s signature, patient’s full name, medication name, strength, dosage form, quantity prescribed, direction of use, prescriber’s name, address, and registration number.

Monitoring and/or Drug Screening There are no major monitoring parameters when taking a benzodiazepine. A toxicology screen might be performed in cases of an overdose to see how much drug and presence of metabolites are in the bloodstream.

Personal opinion There are numerous medications available on the market or even on the black market that have therapeutic effects, but some people abuse the drugs to the point where they become dependent on them. This often leads to the development of legislation to halt the abuse. This is highlighted in the benzodiazepine class of pharmaceuticals. These drugs have a wide range of therapeutic applications, including the treatment of seizures, migraines, depression, and other medical disorders. If people could only use drugs when necessary and not just because there is access to them, I believe the phenomena of drug abuse would shrink and the regulations governing its availability would change. I believe benzodiazepines are great medicines for treating a wide range of medical ailments. Users should exercise greater caution when using them, and manufacturers and healthcare professionals should do more to educate the public about the dangers of these medications and their potential for addiction. ~Tbist

References A Brief History of Benzodiazepines. Benzodiazepine Information Coalition. https://www.benzoinfo.com/a-brief-historyof-benzodiazepines/ A Brief History of Benzodiazepines. Benzodiazepine Information Coalition. Accessed October 11, 2022. https://www.benzoinfo.com/a-brief-history-of-benzodiazepines/ Popular Street Names for Benzodiazepines (Benzos). Published October 8, 2020. Accessed October 11, 2022. https://floridarecoverygroup.com/street-names-for-benzodiazepine/ DailyMed - XANAX- alprazolam tablet. Nih.gov. Published 2018. Accessed October 11, 2022. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=388e249d-b9b6-44c3-9f8f-880eced0239f Purdue Web Authentication. Purdue.edu. Published 2015. Accessed October 14, 2022. https://online-lexi-com.ezproxy.lib.purdue.edu/lco/action/doc/retrieve/docid/310/1253640.

Alprazolam: MedlinePlus Drug Information. medlineplus.gov. Published May 15, 2021. Accessed October 13, 2022. https://medlineplus.gov/druginfo/meds/a684001.html

Bromo-Dragonfly Camryn Cardinal, Pharmacy Student Fall 2022

https://prevenco.co/fenetilaminas/

Slang Terms 1. Bromo – dragonfly 2. Fly 3. DOB-Dragonfly 4. BDF 5. 3C – Bromo – Dragonfly

History • • • •

https://drughealtheffects.wordpress. com/2015/04/29/bromo-dragonfly/

•

Bromo-dragonfly is named after the shape of the molecule because it has a bromine atom on it and the shape of the structure resembles a dragonfly.

The way this drug is used is by oral ingestion using blotter paper, powder or liquid.

The drug was first developed in 1998 by Matthew Parker as a research chemical for looking at the structure and activity of the brain’s serotonin receptors in animal studies.

The main active ingredient of this drug is 1-(8-bromobenzo (1,2 – b; 4,5- b) difuran-4-yl)- 2-aminopropane.

The class of drug that this is listed under is a synthetic hallucinogen.

Pharmacology • • • • • •

The mechanism of action of Bromo-dragonfly is on the serotonin system in the body.

The serotonin receptors in the central nervous system are the main target and the drug is an agonist for those receptors.

This drug has similar effects to 5-HT-2A hallucinogens.

It is similar to LSD in potency, but has a longer duration of action. The onset will occur in 20-90 minutes, peaking over those next few hours.

The plateau effect lasts for 6-12 hours and after this period the effects will start to wear off.

The total amount of time the drug will act on the body can last up to 36 hours, but it is usually 12-24 hours.

Drug Effects • • • • • • • • • • • • •

Mood lift Visual changes Increase in energy Decrease in appetite Visual distortion Short term memory scramble Muscle tension Confusion Severe, vivid, frightening hallucinations Agitation Vasoconstriction Ego softening Tissue necrosis in limbs

Drug Interactions • • • •

Lithium à when taking with psychedelics it increases the risk of psychosis and seizures Cannabis à increase risk of anxiety, paranoia, panic attacks, psychosis because of synergy effect Stimulants àincrease risk of anxiety, paranoia, panic attacks, and thought loops Tramadol à lowers the seizure threshold and this drug increases seizure risk

Toxicology •

There have been reported cases of overdoses and deaths from this drug.

• There is not extensive knowledge on this drug, which makes it difficult to treat overdoses.

• This drug is also often dosed in micrograms, while many other hallucinogens are dosed in milligrams, which makes the likelihood of overdose even higher.

Some of the toxic side effects from this drug include:

Laws • • • •

Bromo-dragonfly is not a scheduled drug in the United States It is not regulated It is not approved for human consumption Possible analog of DOB or 2C-B, which could allow for prosecution under the Federal Analogue Act if it is sold for human consumption or possession.

• • • • • • •

Death Seizure Vomiting blood Stopped heart or increased heart rate Nausea, diarrhea, stomach cramps Muscle spasms Terror inducing hallucinations

https://erowid.org/chemicals/bromo_dragonfly/ bromo_dragonfly.shtml

References 1. Bromo-Dragonfly. Erowid Bromo-Dragonfly Vault. https://www.erowid.org/chemicals/ bromo_dragonfly/. Accessed October 13, 2022.

2. Bromo-Dragonfly. Rosecrance. https://rosecrance.org/wpcontent/uploads/2018/11/USbromo_dragongfly.pdf.

Accessed October 14, 2022.

3. Bromo-dragonfly. Addictionlink.fi. https://paihdelinkki.fi/en/info-bank/articles/ drugs-and-other-intoxicants/bromo-dragonfly.

Published March 19, 2020.

Accessed October 13, 2022.

4. What you should know about bromo-dragonfly.

TestCountry. https://testcountry.com/pages/allyou-need-to-know-about-lsd-acid. Accessed October 13, 2022.

5. Bromo-dragonfly. PsychonautWiki. https://psychonautwiki.org/wiki/BromoDragonFLY#Toxicity_and_harm_potential.

Published October 7, 2022.

Accessed October 14, 2022.

Professional Opinion Overall, bromo-dragonfly is a very dangerous drug and has many toxic side effects that come with it. One thing that has been seen frequently is people assuming they are buying LSD and then end up taking BDF, and end up overdosing because it was not known what they are taking. There is not a lot of research on this drug, which makes many of the outcomes very unpredictable and dangerous. ~ Camryn Cardinal, Pharmacy Student

•

•

Monitoring and Drug Screens

There is a urine test for Bromodragonfly that is a conditional confirmation, meaning that there will be a secondary procedure confirming the presence again.

There is also another test that uses liquid chromatography-tandem mass spectrometry technique. This is a quantitative procedure that can detect with a limit of 1 ng/mL.

BUPRENORPHINE Mackenzie Carr, Student pharmacist Fall 2022

The opioid epidemic is a public health emergency that has killed over 750,000 americans since 1999.

Since then, several medications have been manufactured to help patients manage symptoms of withdrawal.

STREET NAMES Big Whites Buse Oranges Small Whites

Sobos Stops Strips Subs

Buprenorphine, sold under the brand name Subutex®, is a partial opioid agonist used to treat opioid addiction. Buprenorphine therapeutics research began back in the 1920s, and provides pain relief, which is seen as a benefit to many.

CLINICAL INDICATION • treatment of opioid detoxification • opioid maintenance of either prescription or illegal drugs • pain management

CLINICAL EFFECTS • • • • • • •

constipation nausea vomiting headache increased sweating insomnia increased pain

GET HELP HERE! SAMHSA National Helpline: 1-800-662-4357

DRUG INTERACTIONS

INDIANA LAWS

• alcohol: may enhance CNS depressant effect of buprenorphine • amphetamines: may enhance analgesic effect • anticholinergic agents (benadryl, meclizine, oxybutynin): may enhance risk of urinary retention and constipation • cannabinoid-containing products: may enhance CNS effects • diuretics: buprenorphine may diminish therapeutic effect of diuretic

• C-III: moderate to low potential for abuse/dependence • manufacturing, dealing, or financing: level 6 felony • 1-5g: level 5 felony • 5-10g: level 4 felony • 10-28g: level 3 felony • >28g: level 2 felony

TOXICOLOGY

• The rate of death from prescription opioid overdose has quadrupled in the last decade • signs of toxicity: respiratory depression, miosis, decreased bowel motility, CNS depression

MONITORING PARAMETERS

PROFESSIONAL OPINION Compared to other medications that help with symptoms of opioid withdrawal like methadone, buprenorphine is less addictive, safer to use during pregnancy, and is more convenient for patients to use, making it an optimal therapy of choice. ~M. Carr

• Risk for dependence: monitor patients • BP: monitor for hypotension during initiation and titration • LFTs: measure liver function before initiation and throughout therapy for 300mg maintenance treatment with extended release injection

REFERENCES

• Bezrutczyk D, Parisi T. Drug street names. Addiction Center. Published September 14, 2022. Accessed October 12, 2022. https://www.addictioncenter.com/drugs/drug-street-names/.

• Buprenorphine. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 13, 2022. http://online.lexi.com • Indiana drug laws, penalties, & defenses. Avnet Law. Published March 21, 2021. Accessed October 13, 2022. https://avnetlaw.com/2018/09/17/indiana-drug-laws/.

• NIDA. Study highlights effectiveness of methadone and buprenorphine. National Institute on Drug Abuse website.

February

28,

2020

Accessed

October

13,

2022.

https://nida.nih.gov/news-events/science-highlight/study-

highlights-effectiveness-methadone-buprenorphine.

• Thornton P. Buprenorphine sublingual uses, dosage, side effects. Drugs.com. Published August 30, 2022. Accessed October 13, 2022. https://www.drugs.com/buprenorphine.html.

Cannabinol/Cannabigerol (CBN/CBG) Fall 2022

Hojun Chang (John)

SLANG NAMES Hash oil, Hemp oil, gummies, oil tincture, sleep oil

CBG vs. CBN: What are the differences. Area 52. Accessed October 12, 2022. https://area52.com/CBG-VS-CBN/

HISTORY Cannabigerol (CBG) was first discovered by Raphael Mechoulam and Yehiel Gaoni in 1964, while cannabinol (CBN) was discovered by Robert Cahn in early 1930s.

BACKGROUND CBG is federally legal in most states since it is young hemp derived. However, CBN is legal as long as it is derived from hemp, instead of marijuana. CBN is currently out in the market for use of sedative, anticonvulsant, and anti-inflammatory properties. CBG is not psychoactive unlike CBN, but it has an anti-inflammatory property. In addition, CBG does not have any potential of addiction.

CBG vs. CBN: What are the differences.

Area 52. Accessed October 12, 2022. https://area52.com/CBG-VS-CBN/

CBN is an oxidized form of tetrahydrocannabinol (THC).

CBN exerts a weak psychoactive effect. It binds to CB2 receptor more selectively than CB1 receptor. However, it still mildly binds to CB1 receptor.

CBG binds to two types of cannabinoid receptors: CB1 and CB2. CB1 is expressed in brain and nervous system, while CB2 is expressed in immune system. It plays a role in enhancing pleasure, regulating sleep, and improving pain. However, it does not give a high.

DRUG INTERACTION / TOXICOLOGY CBN is metabolized in liver, involving the enzymes: CYP1A1, CYP2C9, CYP3A4, CYP2B6, CYP2C9, CYP2E1.

CBG may have alpha-2 adrenergic effect; it may interact with cardiovascular medications.

CBN and CBG overdose is when one ingests extremely large doses. It may cause extreme tiredness, fatigue, and GI disorders.

LAWS

Cornwell AM. What’s the Difference between CBN and CBG. Oracle. Accessed October 12, 2022. https://cbdoracle.com/ cannabinoids/cbn-vs-cbg/

CBG is currently legal under federal law; but CBN is not federally legal. Hemp flowers are defined as cannabis flower which contains no more than 0.3% of THC. As long as CBG is derived from the hemp flowers, they are legal. However, CBN is only legal in some states where recreational or medical marijuana are legal.

MONITORING / DRUG SCREENS

CBG is non-psychoactive drug, while CBN may exert a mild psychoactive effect. They help reducing anxiety and calming one. Side effects are very mild, and they are known to be safe.

Both CBN and CBG may test for positive on a drug test, though CBN is known to have higher chances of testing positive. Because CBG has a different chemical structure from THC, it has lower chances, yet it still comes from hemp flowers. However, CBN resembles THC more than CBG does.

PROFESSIONAL OPINION

CBN and CBG have not been studied as much as cannabidiol (CBD). Without potential for addiction, they seem promising to treat many different diseases: pain, insomnia, neuropathy, and inflammation. However, there needs more studies for efficacy and safety in order to be approved by FDA. ~ H. Chang

CBG vs. CBN: What are the differences. Area 52. Accessed October 12, 2022. https://area52.com/CBG-VS-CBN/

REFERENCES

1. CBG: Researched Benefits. Realm of Caring. Accessed October 12, 2022. https://realmofcaring.org/CBG-RESEARCHED-BENEFITS/ 2. Pertwee RG. Cannabinoid pharmacology: the first 66 years. British Journal of Pharmacology. 2006;147:S163–S171. DOI:10.1038/ sj.bjp.0706406 3. CBG vs. CBN: What are the differences. Area 52. Accessed October 12, 2022. https://area52.com/CBG-VS-CBN/ 4. CBD vs CBN: Benefits and Differences. Healthline. Accessed October 12, 2022. https://www.healthline.com/health/cbd-vs-cbn#cbnbenefits-uses 5. Ohwovoriole T. What is Cannabigerol (CBG). Verywellmind. Published September 16, 2022. Accessed October 12, 2022. https://www.verywellmind.com/cannabigerol-cbg-uses-and-benefits-5085266 6. Gritters J. Is CBG the new CBD. Elemental. Published July 8, 2019. Accessed October 12, 2022. https://elemental.medium.com/is-cbgthe-new-cbd-6de59e568008 7. Morales P, Hurst DP, Reggio PH. Molecular Targets of the Phytocannabinoids-A Complex Picture. Prog Chem Org Nat Prod.

2017;103:103–131. DOI:10.1007/978-319-45541-9_4 8. Cannabinol-Uses, side effects, and more. WebMD. Accessed October 12, 2022. https://www.webmd.com/VITAMINS/AI/ INGREDIENTMONO-1611/CANNABINOL-CBN 9. Roberts C. Why CBG, a new and legal cannabis plant product, is surging. Published December 10, 2020. Accessed October 12, 2022. https://observer.com/2020/12/WHATS-CBG-LEGAL-CANNABIS-BENEFITS-USES/#:~:TEXT=IN%20FACT%2C%20LIKE%20CBD% 2C%20CBG,CARDIOVASCULAR%20MEDICATIONS%2C%E2%80%9D%20VRANA%20WROTE. 10.Is Dad grass safe (and Can you overdose on CBD?). Dad grass. Accessed October 12, 2022. https://dadgrass.com/blogs/dad-grassblog/is-dad-grass-safe-and-can-you-overdose-on-cbd

HTTPS://WWW.EVERYDAYHEALTH.COM/DIETNUTRITION/CAN-CBD-HELP-YOU-LOSEWEIGHT/

CANNABIDIOL

CBD CHLOE CORYEA, Student pharmacist FALL 2022 BEYOND ECSTASY

HISTORY/BACKGROUND

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PHARMACOLOGY/ DRUG EFFECTS The exact mechanism of action of CBD is not fully known.

However, it is known that CBD acts on cannabinoid receptors as a part of the endocannabinoid

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DRUG INTERACTIONS/ TOXICOLOGY CBD has many known drug interactions due to its metabolism by several enzymes. Examples of some drug classes that it interacts with include anticonvulsants, CNS depressants, hepatotoxic drugs, and mechanistic target of r apamycin inhibitors.

LAWS CBD is legal in most states if it has been FDA approved, derived from hemp instead of marijuana, and is under state THC limits.

MONITORING DRUG/ SCREENS Many drug tests do not screen for CBD because it does not cause intoxicating effects. However, one may still fail a drug test CBD if it is contaminated with THC.

PROFESSIONAL OPINION In my professional opinion, there is not enough clinical evidence about CBD's safety and efficacy for me to feel comfortable recommending a patient this drug as treatment.

There are several drug interactions with CBD and there is potential contamination with THC. Until more clinical data is published on the use of CBD, I will not recommend it to patients.

-C. Coryea, PharmD Student

REFRENCES CANNABIDIOL (CBD).

HTTPS://ONLINE.LEXI.COM/LCO/ ACTION/H OME. ACCESSED OCTOBER 14, 2022.

DOES CBD SHOW UP ON A DRUG TEST?MEDICAL NEWS TODAY. HTTPS://WWW.MEDICAL NEWSTODAY.COM/AR TICLES/DOESCBD-SHOW-UP-ON-A-DRUGTEST#SUMMARY. ACCESSED OCTOBER 14, 2022.

JULIA N. WHAT IS THE HISTORY OF CBD? CFAH. HTTPS://CFAH.ORG/ HISTORY-OF-CBD/. PUBLISHED MARCH 1, 2022. ACCESSED OCTOBER 14, 2022.

FOR THE AGELESS. CBD GLOSSARY. FOR THE AGELESS. HTTPS:// WWW.FORTHEAGELESS.COM/ PAGES/C BD-GLOSSARY. ACCESSED OCTOBER 14, 2022.

DRUGBANK ONLINE: DA TABASE FOR DRUG AND DRUG TARGET INFO. DRUGBANK ONLINE |DATABASE FOR DRUG AND DRUG TARGET INFO. HTTPS://GO.DRUGBANK.COM/.

ACCESSED OCTOBER 14, 2022.

IS CBD LEGAL? FINDLAW. HTTPS://WWW.FINDLAW.COM/ CRIMINAL/CRIMI NAL-LAW-BASICS/ IS-CBDLEGAL.HTML#:~:TEXT=FEDERAL% 20CANNABIDIOL% 20LAWS&TEXT=BOTH%20HEMP% 20AND%20MARI JUANA% 20CAN,FROM%20MARIJUANA%2C% 20IT%20IS%20ILLEGAL. PUBLISHED JULY 12, 2021. ACCESSED OCTOBER 14, 2022.

Cocaine Fall 2022

History

https://americanaddictioncenters.org/ wp-content/uploads/2015/10/cocaineuse.jpg

People have chewed coca plants for thousands of years. Cocaine was first isolated from coca plants in 1859 from the Erythroxylon coca plant. Cocaine was widely used medically in the 19th century with the rise of many cocaine-containing tonics and elixirs that made claims to treat a variety of symptoms from headache, depression, and sexual impotence. Cocaine’s popularity skyrocketed in 1886 thanks to the creation of Coca-Cola and recreational use began to rise well into the 20th century.

Background → Cocaine is a naturally derived stimulant derived from the Erythroxylum coca plant grown in the Andean region of South America. → Cocaine is often snorted but also can be injected or used orally → Freebase cocaine, known as crack, is created from powdered cocaine made for smoking and has quicker, more intense effects

Pharmacology/Drug Effects Onset → 0-5 minutes Onset (crack) → Immediate, often before exhaling Duration → 20-40 minutes Duration (crack) → 5-15 minutes Desired Effects → euphoria, mental/physical stimulation, increased sociability, increased energy, erotic/sexual stimulation Neutral Effects → numbness and appetite suppression Negative Effects → desire to do more cocaine, post-nasal drip, irritation in throat, dry mouth, insomnia, anxiety, paranoia, anger

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Jerry Connolly, Student pharmacist

Street Names Coke Blow Snow Nose Candy Crack (freebase cocaine)

Drug Interactions Severe interaction with alcohol! → Cocaine combines with alcohol in liver to form cocaethylene which intensifies euphoric effects and increases risk of sudden death

Toxicology Signs of overdose/toxicity → heart arrythmia, acute psychosis, tachycardia, seizure, death from heart attack or severe arrythmias https://smarmore-rehab-clinic.com/wp-conntent/uploads/2022/05/ Effects-of-cocaine-2.jpg

Laws Cocaine is currently labeled as a schedule II drug under the Controlled Substances Act passed in 1971. It is illegal to sell without a DEA license and illegal to buy or possess without a license or prescription

Drug Screening → Cocaine use is most commonly screened for and monitored via urine tests

https://www.google.com/url?sa=i&url=https%3A%2F%2Fen.wikipedia.org%2Fwiki% 2FLegal_status_of_cocaine&psig=AOvVaw1N3sRBsyeSOAJPQOOC6sR3&ust=166579 3265293000&source=images&cd=vfe&ved=0CAwQjRxqFwoTCID4sNG53voCFQAAAA AdAAAAABAK

→ is metabolized in the liver creating a primary metabolite benzoylecgonine which can be detected in urine up to eight days after consumption

Professional Opinion Cocaine is one of the most commonly used illicit substances and there are no known medical benefits that outweigh the severe negative complications caused by cocaine use. ~ J. Connolly

References 1.

2.

3.

4.

The history of cocaine - where does cocaine come from? - drug-free world. Foundation for a Drug-Free World. https://www.drugfreeworld.org/drugfacts/cocaine/a-short-history.html. Accessed October 13, 2022.

Erowid cocaine vault. https://erowid.org/chemicals/cocaine/cocaine.shtml. Accessed October 13, 2022.

Cocaine: Effects, hazards & warnings. Drugs.com. https://www.drugs.com/illicit/cocaine.html. Accessed October 13, 2022.

O’Malley GF, O’Malley R. Cocaine - special subjects. Merck Manuals Professional Edition. https://www.merckmanuals.com/professional/special-subjects/recreational-drugs-andintoxicants/cocaine?ruleredirectid=249&qt=&sc=&alt=. Published September 26, 2022. Accessed October 13, 2022.

FALL 2022

Datura

Danielle Bellamy, Student pharmacist

What Is It?

Datura Innoxia. Wikimedia Foundation. https://en.wikipedia.org/wiki/Datura_innoxia. Accessed October 14, 2022

What does It do?

The alkaloids In Datura compete with acetylcholine at muscarinic receptors and stimulate dopaminergic neurons causing euphoria, realistic auditory and visual hallucinations, slurred speech, amnesia and extreme disorientation and delirium sometimes resulting in dangerous behaviors. Users often lose sense of time

Datura is an herb that is part of a group of plants known as "belladonnas." Italian women commonly used belladona to dilate their pupils, which was considered beautiful. Native to Asia but also found In the West Indies, Canada, and the US, datura has a history of being used for its hallucinogenic effects and intoxicating abilities to poison unsuspecting used. It's use is well-documented in Chinese medicine and sacred rituals. The plant contaings anticholinergic agents including atropine, scopolamine, and hyoscyamine. For this reason, it has also been used as a smokable asthma tratment to relax airways.

Nicknames

This plant produces white, pink, purple, or yellow trumpet-shaped flowers and can grow up to two meters tall. Both the flower and the plant emit a foul odor, earning its nickname Stinkweed. Datura is also known as: Jimson Weed, Devil's Apple, Thorn Apple, Devil's Weed, Malpitte, Moonflower, and Tolache.

Home. Scientific American. https:// www.scientificamerican.com/. Accessed October 14, 2022

https://www.google.com/url?sa=i&url=https% 3A2F2Fwww.newscientist.com%2Fdefinition%2Fpsychedelic% 2F&psig=AOvVaw1y7rBGM9ia0zqhuyZcUKue&ust=1668128355567000& source=images&cd=vfe&ved=0CA8QjRxqFwoTCLiogMO0ovsCFQAAAAA dAAAAABAF IIs it legal?

Datura is currently un-scheduled under the Controlled Substances Act and unregulated under federal law.

While It's legal to possess and distribute Datura

without requiring a license or prescription, It may

show up on a drug screen. Only specialist laboratory tests can reliably detect the alkaloids present, but they're not routinely used for drug screening.

Metabolism

Datura Is readily absorbed and partially metabolized by the liver. It's mostly eliminated In the urine with a halflife of about four hours. It's not currently believed to

be addicting and users are unlikely to develop physical

Is It Safe?

There is no way to determine a reasonably safe dose of Datura due to the variation in the potency of the plant material. Only 45g of dried Datura leaves can contain a lethal dose of alkaloids. Patients with moderate to severe toxicity may experience coma, seizure, delirium, severe agitation, and combativeness sometimes requiring restraints. Users' behavior is often irrational, putting them at risk for accidental injury. Datura causes an Inability to perspire, which can cause dangerous and potentially life-threatening hyperthermia at high doses.

or psychological dependence. No withdrawal effects have been reported.

Interactions

Datura users should avoid taking other anticholinergic drugs, as this puts patients at a higher risk of

experiencing undesired side effects. Additionally, Datura should be stopped two weeks before any

surgery to avoid dangerously decreased respirations.

References Lexidrugs, https://online.lexi.com/lco/action/home. Accessed October 14, 2022.

Erowid Datura Vault, https://www.erowid.org/plants/datura/ datura.shtml. Accessed October 14, 2022 Datura Wrightii: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews. WebMD. https:// www.webmd.com/vitamins/ai/ingredientmono-1491/daturawrightii. Accessed October 14, 2022 Corporate Author US Dept of Justice. Jimsonweed Datura Stramonium. https://www.ojp.gov/ncjrs/virtual-library/ abstracts/jimsonweed-datura-stramonium#:~:text=With% 20all%20the%20potential%20harmful,of%20legislat ion%

So.... Should I Take It?

An overwhelming majority of users describe experiences as extremely unpleasant, both mentally and physically.

The experience can be over whelming and uncomfortable, some even report lingering "weirdness" affecting coordination and speech for up to a week afteward. ~ D. Bellamy

SARA SANS, Pharmacy student

FALL 2022

DELTA 8&9 THC

DELTA-8-TETRAHYDROCANNABINOL & DELTA-9-TETRAHYDROCANNABINOL

Marijuana: Medline Plus. Google Images.https://images.google.com/

Marijuana DrugFacts. Google Images. https://images.google.com/

HISTORY/ BACKGROUND THC, the active ingredient in cannabis sativa, has been used recreationally and for medical purposes worldwide for thousands of years, until made illegal in the US in 1937. It remains one of the highest used recreational drugs, and is progressively being decriminalized and legalized across many states today.

Delta 8 became popular when the US had an overproduction of hemp, where CBD comes from, and the industry used CBD to create delta 8 THC. This became a popular item for states that have no legalized cannabis products.

WHAT'S THE DIFFERENCE?

Delta 8 stems from hemp (part of cannabis plant containing <0.3% THC) and delta 9 THC is derived for the marijuana part of the plant. Delta 8 is an analog to delta 9, making the structure just a difference in a singular double bond placement. Due to this, delta 8 THC has a weaker effect, about half as potent as delta 9, and many states can sell it at smoke shops or convenience stores.

Delta 8 THC Vs. Delta 9 THC. Mary Jane's CBD Dispensary. Google Images. https://images.google.com/

SLANG TERMS weed pot grass mary jane ganja reefer bud

Delta-8 specifically: marajuana-lite diet weed legal weed

PHARMACOLOGY Inhalation: THC and other cannabinoids present make way to the bloodstream from the lungs when smoked. From there, THC binds to cannabinoid receptors in the brain and in other organs. The effect of THC achieves peak levels in 6-10 minutes. After absorption, the liver receives THC and it's metabolites to either clear it, or it will re-circle back to the bloodstream. It is lipophilic and taken up by adipocytes to be released slowly, therefore, the half life runs from 1- 13 days depending on chronic use.

Oral: THC is absorbed in the stomach and small intestine, which takes longer to reach peak effect, about 1-2 hours. It travels from the bloodstream to the liver, and is mostly excreted in the feces, but some metabolites re-enter the circulation. Edibles have a stronger effect due to the liver converting THC into a stronger metabolite when received from the GI tract.

Both routes have effects that usually last around 1-4 hours.

Higher doses are more likely to produce stronger psychoactive effects.

DRUG EFFECTS

Short term effects: Paranoia, Dry mouth, Nervousness, Increased heart rate, Coughing, Reduced lung capacity, Psychoactive effects Long term effects: Potential risk of heart problems (ongoing trials), Worsening of some mental illnesses, Short-term memory impairment.

DRUG INTERACTIONS & TOXICOLOGY

There has never been any confirmed cases of death caused by cannabis when taken by itself.

Severe adverse events include hallucinations, vomiting, tremors, loss of consciousness, and extreme anxiety. These are more commonly reported with edibles.

Since THC is broken down mainly by CYP2C9 and CYP3A4, drugs metabolized by these in the liver may have interactions with THC. Some of these drugs are: benzodiazepines, statins, corticosteriods, PPIs, azole antifungals, and more. Interactions are still being studied. It is important to note that research has showed that THC increases effects of alcohol, and users should never drive due to increased of accidentrelated deaths.

LAWS Hemp derived products (delta-8) are legal on a federal level, although some states have restrictions. Delta-9 products are not federally legal, but legal in states like Colorado, that have legalized recreational marijuana.

There are currently 20 states with legalized use of delta 9.

Delta-8 is legal due to the 2018 Farm Bill. It states that hemp can be sold and grown legally as long as it contains <0.3% THC.

MONITORING & DRUG SCREENS

There is no regulatory oversight of delta-8 products, while delta-9 products are highly regulated by government parties before sold in dispensaries is legal states. Tested delta 8 products commonly find other cannabinoids and by-products.

THC can be tested by urine, blood, saliva, or hair, and detection varies across tests, Saliva will only show positive within hours after use, but hair will show use up to 90 days before. Test kits can be bought over the counter or persons can be tested in a lab.

USE

THC is mostly used through smoking or vaping, and cooked into a oil for edible ingestion. There are other medically used routes of administration, such as pills, transdermal patches, topicals, and powders.

Medical marijuana is used for symptom relief for chronic pain, MS, and neuropathic pain, and prescribed for diseases such as AIDS, cancer, and glaucoma. It is seen mostly used with chemotherapy patients, as it improves symptoms from therapy.

PROFESSIONAL OPINION

Due to no known deaths of monotherapy, and a debunked theory of marijuana being a gateway drug, in my professional opinion I believe both forms of THC should be legalized and decriminalized. THC should still be mildly used to do potential long term effects, but usage recommendations should be similar to alcohol.

Use of cannabis should be regulated by restriction of amount purchased, regulatory overview of governing parties, and legal sales only coming from licensed dispensaries. ~ S.Sans

REFERENCES 1. 5 things to know about delta-8 tetrahydrocannabinol – delta-8 THC. Food and Drug Administration. Updated May 4,2022.

Accessed October 12, 2022. https://www.fda.gov/consumers/consumerupdates/5-things-know-about-delta8-tetrahydrocannabinol-delta-8-thc 2. Cannabis. The Vaults of Erowid. Updated May 27, 2022. Accessed October 13, 2022. https://www.erowid.org/plants/cannabis /cannabis.shtml 3. Eckerson BE. Delta-8-THC craze concerns chemists. Chemical & Engineering News.

Accessed October 12, 2022. https://cen.acs.org /biological-chemistry/natural-products/Delta8-THC-craze-concerns/99/i31 4. Virginia Code Guidance Document 110-32.

Cannabis: Potential Drug Interactions.

Adopted June 6, 2022.

5. Julia N. Is Delta 8 THC Legal? Overview of D8 Legality by State. The Center for Advancing Health. Updated August 22, 2022. Accessed October 13, 2022. https://cfah.org/is-delta8-thc-legal/ 6. Chayasirisobhon S. Mechanisms of Action and Pharmacokinetics of Cannabis. The Permantente Journal. 2021;25:1. doi.

10.7812/TPP/19.200

7. Marijuana (THC) Testing. Testing.com.

Updated November 19, 2021. Accessed October 13, 2022. https://www.testing.com /tests/marijuana-thc-testing/

DEXTROMETHORPHAN TIANA DUNCAN, Student pharmacist FALL 2022

HISTORY AND BACKGROUND Dextromethorphan is a cough suppressant for treating dry cough. It has been available over the counter since 1958 and is found in over 120 cough and cold products. It has overtaken codeine as the most widely used cough suppressant. Abuse traditionally involved drinking large volumes of the liquid cough syrups. However, new tablet and gel capsule formulations containing higher doses makes it much easier to consume and conceal at school or work.

Dextromethorphan powder is another formulation that is sold over the Internet, which offers snorting as another route of administration. Dextromethorphan can also be illicitly manufactured and dispensed in tablets mixed with other drugs, like pseudoephedrine or met hamphetamine. Abuse is most prevalent in teenage and young adult population, but is still misused by individuals of all ages. Since 2010, the prevalence of OTC cough medicine abuse has been declining due to efforts by the Consumer Healthcare Products Association to raise awareness to teens and their parents.

SLANG TERMS

o o o o o

DXM robo rojo velvet skittles https://www.youtube.com/watch? v=ACSur7II7SQ&ab_channel=D emystifyingMedicineMcMaster

PHARMACOLOGY Dextromethorphan belongs to the antitussive medication group. It exerts its ph armacological action by crossing the blood-brain barrier to activate sigma op ioid receptors in the medullary cough center. It desensitizes the cough receptors and therefore, suppresses the cough reflex. It is structurallly related to codeine and a non-opioid derivative of morphine.

DRUG EFFECTS When taken at high doses, dextromethorphan has a hallucinogenic effect that induces euphoria and other psychoactive effects, including confusion, agitation, sedation, loss of motor coordination and paranoia. Typical adverse effects are dizziness, drowsiness, nausea, and stomach upset.

o o o o o o o

DRUG INTERACTIONS

LAWS

MAO inhibitors SSRIs memantine disulfram CNS depressants (alcohol) quinine methotrimeprazine

Dextromethorphan is a legally marketed cough suppressant sold over-the-counter without a prescription. It is not considered a controlled substance and is not regulated under the Controlled Substance Act.

MONITORING AND DRUG SCREENING Dextromethorphan can cause falsepositive results for PCP urine drug screens. However, it is unlikely that consumption of dextromethorphan will produce a false-positive for opiate urine drug screens. Many states now require patients to be 18 years or older to purchase products containing dextromethorphan.

PROFESSIONAL OPINION When used at the recommended doses and for its intended purpose, dextromethorphan is safe and effective. It can be sold behind the counter, like pseudoephedrine, in order to keep track of how much and how often someone is buying it. This could provide context for recognizing a pattern of behavior, so we can talk to patients to see what they are using it for and help them understand the risks of taking too much. ~ T. Duncan

REFERENCES 1.

2.

3.

4.

5.

6.

7.

Spangler DC, Loyd CM, Skor EE. Dextromethorphan: a case study on addressing abuse of a safe and effective drug. Subst Abuse Treat Prev Policy. 2016;11(1):22. Published 2016 Jun 23. doi:10.1186/ s13011-016-0067-0 DXM drug fact sheet. Department of Justice/Drug Enforcement Administration. Accessed October 5, 2022. Available at: https://www.dea.gov/sites/default/files/2020-06/DXM-2020.pdf Intelligence bulletin DXM (dextromethorphan). US Department of Justice. Accessed October 5, 2022.

Available at: https://www.justice.gov/archive/ndic/pubs11/11563/11563p.pdf The misuse of dextromethorphan. Demistifying Medicine McMaster. Accessed Ocotober 5, 2022.

Available at: https://www.youtube.com/watch? v=ACSur7II7SQ&ab_channel=DemystifyingMedicineMcMaster Dextromethorphan. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 5, 2022. Available at: https://online.lexi.com Michael F. Neerman, PhD, FACB, Chinemerem L. Uzoegwu, BSN, RN, Is Dextromethorphan a Concern for Causing a False Positive During Urine Drug Screening?, Laboratory Medicine, Volume 41, Issue 8, August 2010, Pages 457–460, https://doi.org/10.1309/LMC384VVWIPJFXCZ Storrow AB, Magoon MR, Norton J. The dextromethorphan defense: dextromethorphan and the opioid screen. Acad Emerg Med. 1995;2(9):791-794. doi:10.1111/j.1553-2712.1995.tb03273.x

DIHYDROEPIANDROSTERONE (DHEA) BRETT DUNCAN SECOND YEAR PROFESSIONAL STUDENT FALL 2022

BACKGROUND: DHEA IS A NATURAL HORMONE FOUND IN THE BODY. IT IS PRODUCED IN THE ADRENAL GLANDS AND IS A PRECURSOR TO OTHER HORMONES LIKE TESTOSTERONE.

SLANG TERMS/OTHER NAMES: HISTORY: A GERMAN BIOCHEMIST NAMED ADOLF BUTENANDT FIRST ISOLATED DHEA IN THE 1930S. DHEA IS USED AS AN ANABOLIC STEROID FOR BOOSTING IN SPORTS. PLAYERS WOULD USE IT TO INCREASE PERFORMANCE. THESE PLAYERS LIKE BARRY BONDS WOULD GAIN MASS AMOUNTS OF MUSCLE AND WOULD BREAK RECORD AFTER RECORD IN THEIR RESPECTIVE SPORTS

ANABOLIC STEROIDS DHEA PERFORMANCE ENHANCEMENTS 3B-HYDROXY-ANDROST-5-ENE-17-ONE ANDROSTENOLONE DEHYDROEPIANDROSTERONE DHEA-S GL701 PRASTERONE.

HTTPS://FINESTGEARS.TO/HOW-ANABOLICSTEROIDS-CAME-TO-BE/

LAWS: THE FDA BANNED DHEA SALES THAT WERE OTC BUT SINCE THE IMPLEMENTATION OF THE DIETARY SUPPLEMENT HEALTH AND EDUCATION ACT OF 1994 DHEA IS AVAILABLE AND SOLD AS A DIETARY SUPPLEMENT. THIS PRODUCT IS BANNED UNDER WORLD ANTIDOPING CODE AND THE NATIONAL COLLEGIATE ATHLETIC ASSOCIATION.

HTTPS://ALONGTHEBOARDS.COM/2020/ 05/28/ANABOLIC-STEROIDS-FOR-SALE/

PHARMACOLOGY/DRUG EFFECTS:

DRUG INTERACTIONS/ TOXICOLOGY: • ANTIPSYCHOTICS • CARBAMAZEPINE • ESTROGEN • TESTOSTERONE • LITHIUM • SSRIS • TRIAZOLAM • VALPROIC ACID DHEA HAS BEEN SHOWN TO BE A CARCINOGEN IN RODENTS BUT NOT IN HUMANS. OTHER STUDIES SHOW CANCER PROTECTIVENESS. SIDE EFFECTS INCLUDE HIRSUTISM, GYNECOMASTIA, TESTICULAR WASTING, REDUCED HDL, INCREASED BLOOD PRESSURE

DHEA IS USED TO HIT MANY DIFFERENT RECEPTORS INCLUDING NMDA, GABA, T-TYPE CALCIUM CHANNELS, PPAR-ALPHA, AND MANY MORE. THIS PRODUCT IS ALSO METABOLIZED TO FORM ESTROGEN AND TESTOSTERONE FOR MUSCLE BUILDING, SEX HORMONES, AND MUCH MORE.

MONITORING/SCREENING: PLAYERS IN THE NCAA AND OTHER SPORTS ORGANIZATIONS ARE SCREENED YEAR-ROUND. TYPICALLY, SEVEN PLAYERS ARE RANDOMLY PICKED EACH WEEK FOR SCREENING. THEY ARE SUBJECTED TO A DRUG TEST TO SEARCH FOR VARIOUS DRUGS INCLUDING DHEA.

PROFESSIONAL OPINION:

HTTPS://WWW.NORTHCOUNTRYPUBLICR ADIO.ORG/NEWS/NPR/11662481/BONDSSHATTERS-BASEBALL-S-BIGGEST-RECORD

IN MY PROFESSIONAL OPINION I WOULD SUGGEST USING THIS PRODUCT FOR VAGINAL ATROPHY, DEPRESSION, AGEING AND OSTEOPOROSIS. THE USE OF DHEA AS A PERFORMANCE ENHANCEMENT SHOULD NOT BE ALLOWED BECAUSE IT GIVES PEOPLE MORE OF AN ADVANTAGE. DHEA COULD ALSO LEAD TO FURTHER COMPLICATIONS IF USED INCLUDING ACNE AND HIRSUTISM IN WOMEN, GYNECOMASTIA AND TESTICULAR WASTING IN MEN, UNFAVORABLE EFFECTS ON LIPID METABOLISM LIKE REDUCED HDL, AND INCREASED BLOOD PRESSURE IN BOTH GENDERS. ~B Duncan

REFERENCES 1.

2.

3.

4.

KLINGE CM, CLARK BJ, PROUGH RA. DEHYDROEPIANDROSTERONE RESEARCH: PAST, CURRENT, AND FUTURE. VITAM HORM. 2018;108:1-28.

DOI:10.1016/BS.VH.2018.02.002 DEHYDROEPIANDROSTERONE. PEDIATRIC DRUGS ONLINE. LEXICOMP. WOLTERS KLUWER HEALTH, INC. RIVERWOODS, IL. ACCESSED SEPTEMBER 14, 2022.

HTTP://ONLINE.LEXI.COM DHEA. DRUGS.COM. PUBLISHED FEBRUARY 12, 2021. ACCESSED OCTOBER 11, 2022. HTTPS://WWW.DRUGS.COM/MCA/DHEA 2. NCAA BANNED SUBSTANCES. NCAA.ORG. PUBLISHED JULY 14, 2022. ACCESSED OCTOBER 11, 2022. HTTPS://WWW.NCAA.ORG/SPORTS/2015/6/10/NCAABANNED-SUBSTANCES.ASPX

DMT N,N-dimethyltryptamine Hunter Duncan Student Pharmacist Fall 2022

Q: If I'm a new patient with no prior mental health treatment, will the doctor still be able to treat me?

A: Of course. This is absolutely normal, as a majority of our new patients have never seen a mental https://www.talktofrank. health provider before.

History & Background Where does DMT originate?

DMT was first synthesized by Richard Manske in 1931, but its hallucinogenic properties were discovered in 1956 when Stephen Szara extracted DMT from the Mimosa hostilis plant and injected intramuscularly.

com/drug/dimethyltrypta mine

Slang terms Businessman's Trip Fantasia https://www.thelancet.co m/ journals/lanonc/article / PIIS147020451070153 4/fulltext

Why DMT? Hallucinogenics like DMT are commonly sought out as they impact effects on perception and behavior. Hallucinatory experiences are thought to help better understand the human brain.

Pharmacolo󿵋 DMT is a part of a class called "tryptamines" which regulate amounts of serotonin which regulates mood, appetiite, sleep, and memory throughout the central nervous system. It impacts the serotonin 2C receptor which induces hallucinogenic effects through dopamine and adrenaline pathways.

Professional Opinion

Because DMT is a Schedule 1 Controlled Substance, it should not be used outside of approved clinical trials. There is proposed benefit in the mental health realm, but evidence is not concrete. Hallucinogenics perpetuate 'out of body' experiences that can be harmful to the substance user and those surrounding. With this, DMT should not be used recreationally. ~ H. Duncan

References:

https://adf.org.au/drugfacts/dmt/

Laws DMT is a Schedule 1 controlled substance which means it is illegal to manufacture, distribute, buy, or possess DMT. There are instances where DMT can be approved for studies to conduct medical use research.

Interactions/ Toxicolo󿵋 DMT interacts with monoamine oxidase inhibitors (MAOIs) like selegiline by prolonging the duration and intensity of DMT.

1. Barker SA. N, N-Dimethyltryptamine (DMT), an Endogenous Hallucinogen: Past, Present, and Future Research to Determine Its Role and Monitoring/ Function. Front Neurosci. 2018;12:536. Published 2018 Aug 6. doi:10.3389/fnins.2018.00536 Drug Screen 2.

Palo Alto Medical Foundation. Dimethyltryptamine.

DMT is rapidly metabolized by the SutterHealth. Updated October 2013. Accessed October 12, 2022. https://www.sutterhealth.org/ body - takes effect health/teens/drugs/dimethyltryptamine-dmt quickly and falls 3. Release. DMT. Accessed October 12, 2022. below drug https://www.release.org.uk/drugs/dmt/pharmacol screening detection ogy#:~:text=Dimethyltryptamine%20(DMT)%20belo ngs%20to%20a,throughout%20the%20central%20 levels quickly as nervous%20system well. Ayahuasca preparations or 4. Smith L. Is DMT a controlled substance? Recovered.

Updated August 31, 2022. Accessed October 12, MAOIs can 2022. https://recovered.org/hallucinogens/dmt/ increase dmt-controlled-substance detectability.

5. Smith L. How long does DMT stay in your system?

Recovered. Updated October 11, 2022. Accessed October 12, 2022. https://recovered.org/hallucino gens/dmt/how-long-dmt-in-system

Ergot history Ergot is a fungus that grows on rye and other grasses like wheat. Originally, it was used to speed labor, but it was then realized that it was causing stillbirths. It used to be common to get ergotism from eating rye bread, but that is no longer a problem we face.

From 1000 BCE – 392 BCE, it was said that week-long celebrations involved drinking something that caused hallucinations and it had ergot derivatives in it. In 1039, the first outbreak of ergotism occurred in France, and once rye was introduced to Europe, ergotism breakouts were more common. In the middle ages, females used ergot during labor in order to quicken labor and reduce postpartum bleeding. 1807 is when ergot was first introduced in the US, and scientific research was beginning to be conducted. In the late 19th century, ergot derivatives were used to treat migraines. In 1938, a chemist in Switzerland discovered the compound LSD-25, and additionally found that LSD is a derivative of ergot.

ELANA CHUAPRASERT STUDENT PHARMACIST

FALL 2022

pharmacology Indications: migraine and vascular headaches, acromegaly, parkinson’s, uterine atonia

DRUG ACTION Neurological: serotonin and dopamine agonist Cardiovascular: alpha-adrenergic agonist, serotonin agonist Musculoskeletal: Cause uterine smooth muscle contraction

EFFECTS Ergotism, also called St. Anthony’s Fire, causes hallucinations, loss of limbs, and death

slang terms Mother of Rye Cockspur Rye Hornseed Spurred Rye

Rabbione M. Ergot in crops. Feed Navigator. https://www.feednavigator.com/Article/2019/10/14/Ergotpresence-in-feed-crops-a-concern-in-the-US. Accessed October 13, 2022.

drug interactions Cytochrome P4503A4 inhibitors: Drugs that inhibit CYP34A may increase the risk of ergot toxicity (e.g., amiodarone, clarithromycin, diltiazem) Ergot derivatives: Increase risk of adverse effects when used with ergot. (e.g., bromocriptine, dihydroergotamine, ergotamine) Serotonergic drugs: Ergot derivatives act as serotonin agonists, so using them with serotonergic drugs may increase risk of serotonergic side effects such as Serotonin syndrome, cerebral vasoconstrictive disorders) (e.g., fluoxetine, sertraline, sumatriptan) Stimulant drugs: May increase the risk of vasoconstriction (e.g., albuterol, dopamine, pseudoephedrine )

drug screens The MycoSep® 150 Ergot test is used to find ergot alkaloids in all food and feed commodities.

REVEAL® Q+MAX is a simple rapid lateral flow test to identify ergot alkaloids.

the law Ergot itself is legal to possess.

However, it is considered a poison, so anything made from ergot needs to be labeled "external use only" and "poison."

Jacquin D. Barley grains with ergots. Wikipedia. https://en.wiktionary.org/wiki/ergot#/media/File:Hordeu m_vulgare_Claviceps_purpurea_23-7-2009.JPG. Published July 23, 2009. Accessed October 13, 2022.

professional opinion Although ergot doesn’t have good evidence proving that it should be used it practice, ergot is seen to be used for menstrual periods, expelling placenta after childbirth, and more. There is also not enough evidence to determine a dose for patients, but it is widely accepted that ergot is unsafe to be taken by mouth. ~E. Chuaprasert

references 1. Ergot. EROWID. Updated November 15, 2015. Accessed October 13, 2022. https://www.erowid.org/plants/ergot/2.

2. Ergot timeline. EROWID. Updated October 16, 2017.

Accessed October 13, 2022. https://www.erowid.org/plants/ ergot/ergot_timeline.php 3. Ergot. Natural Medicines. Updated December 10, 2021.

Accessed October 13, 2022. https://naturalmedicinestherapeuticresearchcom.ezproxy.lib.purdue.edu/databases/food,-herbssupplements/professional.aspx?productid=431 4. Ergot legal status. EROWID. Updated September 16, 2016.

Accessed October 13, 2022. https://erowid.org/plants/ergot/ ergot_law.shtml 5. Ergot Alkaloid Testing. Romer Labs. Accessed October 13, 2022. https://www.romerlabs.com/en/analytes/mycotoxins/ ergot-alkaloid/

B ey o n d E c st a sy

Issue #486

WATCH OUT: Fentanyl Hits the Streets!!!

Luke Eckert Student Pharmacist Fall 2022 What is fentanyl?

History Behind fentanyl

Fentanyl is a synthetic opioid that is 50-100 times stronger than morphine.

Pharmaceutical fentanyl was developed to manage pain for specifically cancer treatment. It comes as a patch that is applied to the skin. It is used for abuse because of its powerful opioid properties.

Fentanyl is added to other drugs, mainly heroine, on the street to increase its potency. Normally, this is masked from the buyer which often results in overdose deaths of the user.

It was first developed in 1959 in Mexico and introduced to the United States in the 1960s. In the time span of 2011-2018, fatal overdoses and abuse of the drug both drastically increases. According to the CDC fentanyl was involved in 2,600 overdose deaths in 2011 and it increased dramatically each year. In 2018, the overdoses deaths involving fentanyl and its analogues were 31,335.

Image: Kounang N. What you need to know about fentanyl.

CNN. Published November 5, 2018. Accessed October 10, 2022. https://www.cnn.com/2016/05/10/health/fentanylopioid-explainer/index.html.

Pharmacology of fentanyl The effects of the drug Fentanyl acts on the mu-o pioid receptor. It has a rapid onset and effects with a short duration.

Fentanyl has a rapid onset because it passes throug h the blood-b rain barrier. Fentanyl is abused for its euphoric effects. It can cause muscle rig idity at a hig her frequency unlike other opioid receptor ag onists.

Fentanyl, unlike other opioid receptor ag onists, does not release histamine and only has minimal depressant effects on the heart.

Image: Thrasybule L, Sullivan K, Rauf D, Rapaport L, Jagoo KK. What is Fentanyl?

EverydayHealth.com. Accessed October 10, 2022. https://www.everydayhealth.com/opioidaddiction/fentanyl/.

Fentanyl is like other commonly used opioids. It produces effects on the body such as relaxation, euphoria, pain relief, sedation, confusion, drow siness, dizziness, nausea, vomiting , urinary retention, pupillary constriction, and respiratory depression.

The effects on the body during an overdose can include stupor, chang es in pupillary size, cold and clammy skin, cyanosis, coma, and respiratory failure that can lead to death. If the patient is in a coma, has pinpoint pupils and respiratory depression then the patient has opioid poisoning .

Slang names of fentanyl Street Names

Slang terms of fentanyl

Slang terms of fentanyl Derived from the color/origin

Crazy One, Dance Fever, Dragons Breath, Fire, Friend, Goodfella, Great Bear, He-Man, Heineken, Jackpot, Murder 8, Nal, Nil, Tango Crash, TNT

Street names played on

Color: Blue Diamond, Blue Dolphin, Blues, China White, Gray Stuff, King Ivory, Snowflake, White Girl or Ladies

the name F, Fent, Fenty, Freddy, Fuf, Opes

Origin: China Girl, China Town, China White, Chinese Buffet, Pharmacy, Lollipop

B ey o n d E c st a sy WATCH OUT: Fentanyl Hits the Streets!!!

D r u g I n t er a c t i o n s?

Toxicology of fentanyl Fentanyl is a depressive agent. It depresses the central nervous system and respiratory function. Due to this, over exposure to fentanyl can be fatal. It is 50-100 times more potent than morphine and 100s of times more portent than heroine.

Drug Interactions: Fentanyl should not be used at the same time with macrolide antibiotics or azole-antifungal agents, and protease inhibitors. The use of fentanyl and these three drug classes should be avoided because it can increase the plasma concentrations of fentanyl which increases the opioid drug action and exacerbating the opioid induced respiratory depression.8

L aw s The possession of fentanyl is a felony. Possessing even the smallest amount of fentanyl will lead to felony charges. If one possesses more than a gram worth of fentanyl, they will be looking at third and second-degree felony charges. If a person is in possession of a certain amount of fentanyl, really depends on the state, they can be charged with a first-degree felony.5 When it comes to prescription fentanyl it is dosed in mcg per hour, and can be prescribed in many ways like a spray, a patch, a transdermal lozenge, buccal tablets, etc.6

M o n i t o r i n g/ D r u g Sc r een s: There are fentanyl testing strips that can detect the presence of fentanyl in drugs before a person uses the drug. This can help prevent fentanyl overdosing.

When a patient is given fentanyl in the hospital, the doctor might have to change the dosages of medicines and will monitor the patient very carefully.7

P r o f essi o n a l O p i n i o n : Fentanyl will always be a problem until people quit producing it, which will be never. I think because of this the regulations on it should be kept the same, and if someone is caught with it, they should be charged with a felony. I also believe all adults should be taught on everything wrong and current going on with fentanyl. They should be taught how to test for fentanyl in drugs. They should be taught how to give Narcan to reverse an overdose for fentanyl and other drugs like it. I believe they should be taught all about this because drug dealers are starting to produce fentanyl has tiny colorful tablets to sell them to kids and get them addicted. This is a current problem going on called “Rainbow Fentanyl.” L. Eckert Image: Jones C. Education on fentanyl, other drugs often optional in California schools, if offered at all.

EdSource. Published October 5, 2022. Accessed October 10, 2022. https://edsource.org/2022/education-on-fentanyl-other-drugs-often-optional-in-schools-if-offered-atall/679216.

R ef er en c es:

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4.

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7.

8.

9.

Drug Enforcement Administration Diversion Control Division Drug. Accessed October 10, 2022. https://www.deadiversion.usdoj.gov/drug_chem_info/fentanyl.pdf.

Drug fact sheet: Fentanyl - dea.gov. Accessed October 10, 2022. https://www.dea.gov/sites/ default/files/2020-06/Fentanyl2020_0.pdf.

Slang for fentanyl (street names). The Hope House. Published July 24, 2022. Accessed October 10, 2022. https://www.thehopehouse.com/opioid-addiction/related/fentanyl-street-names/.

Fentanyl - StatPearls - NCBI Bookshelf. Accessed October 10, 2022. https:// www.ncbi.nlm.nih.gov/books/NBK459275/. 5.

Possession of fentanyl. The Law Office of Kevin Bennett. Published April 22, 2022. Accessed October 10, 2022. https://www.kevinbennettlaw.com/drug-charges/possession-of-fentanyl/.

Fentanyl Dosage. Drugs.com. Last Updated March 31, 2022. Fentanyl Dosage Guide + Max Dose, Adjustments - Drugs.com Fentanyl test strips to prevent drug overdose. Accessed October 10, 2022. https://www.health.state.mn.us/communities/opioids/documents/ftsforph.pdf.

Fentanyl: Medlineplus drug information. MedlinePlus. Accessed October 10, 2022. https://medlineplus.gov/druginfo/meds/a605043.html.

Fentanyl: Incapacitating agent. Centers for Disease Control and Prevention. Published May 12, 2011. Accessed October 10, 2022. https://www.cdc.gov/niosh/ershdb/ emergencyresponsecard_29750022.html.

Fall 2022

PEARL FENG, STUDENT PHARMACIST

FLAKKA ALPHA-PVP

SLANG HTTPS://WWW.INFORMEDFAMILIES.ORG/BLOG/PARENT-ALERT-FLAKKA

HISTORY The chemical compound is found in khat leaves in Arabia and East Africa, where it is was chewed on to create a stimulant effect.

(1,2) Alpha-PVP itself used to be used for ADHD or narcolepsy after it was patented in 1967. It was first dispensed in the United States in 2013 and popularized in 2014, but then became a schedule 1 drug so it was not dispensed.

PHARMACOLOGY AND DRUG EFFECTS

This drug is a cathinone and works similarly to amphetamine.(2,3) When taken in extreme doses, it leads to paranoia and hallucinations, both of which can cause violent aggression and self-injury. Typical effects are euphoria, extreme focus, stimulation, and an increased sex drive and sociability.

GRAVEL FLOCKA, ZOMBIE DRUG CRYSTAL LOVE VANILLA SKY SNOW BLOW

DRUG INTERACTIONS AND TOXICOLOGY Adverse effects of this drug include liver and renal failure, hypertension, arrhythmias, heart attacks, strokes, aneurysms, and eventually death.(4) Since this drug is similar to amphetamines, it would likely have similar drug interactions with antidepressants such as duloxetine or bupropion.(5) It would also likely act as duplicate therapy for amphetamines like Adderall, increasing the chances of adverse effects.

MONITORING AND DRUG SCREENING

https://www.pharmadrugtest.com/urine-drugtests/109-flakka-alpha-pvp-urine-test.html

The standard urine drug test does not detect Flakka. However there is a specific kind of test that does detect Flakka amongst other bath salt drugs called the Synthetic Cathinones Test Kit.(6) Flakka is also detectable through a blood test.

LAWS

Flakka became a Schedule I drug 2014, thus being defined as highly addictive with very limited medicinal use.(7) Possession of Flakka can lead to at least a 10 year prison sentence, as well as fines and felony charges. hthttps://delamere.com/blog/top-10-most-dangerousdrugs

REFERENCES

https://depositphotos.com/100283954/stock-illustrationred-round-stop-sign.html

PROFESSIONAL OPINION

In my professional opinion, I believe that flakka is a drug that deserves to be a Schedule I drug and has no real purpose in being spread. With it causing violent behavior, its presence in the US should be eradicated. ~ P. Feng

1. Flakka (alpha-PVP). DEA. Accessed October 2, 2022. https://www.dea.gov/factsheets/flakka-alpha-pvp 2.Flakka Addiction And Abuse. Addiction Center. Accessed October 2, 2022. https://www.addictioncenter.com/drugs/flakkaaddiction-abuse/ 3. Swain E. Flakka (Zombie Drug). Addiction Group.

Accessed October 2, 2022. https://www.addictiongroup.org/drugs/illegal/flakka/ 4. Rhonda A. Everything You Wanted to Know About Flakka.

On The Wagon. Accessed October 2, 2022. https://www.onthewagon.org/flakka/ 5. Amphetamine Interactions. Drugs.com. Accessed October 2, 2022. https://www.drugs.com/druginteractions/amphetamine.html 6. Synthetic Cathinones (Bath Salts) Cathinones Test Kit. M.M.C. Store. Accessed October 2, 2022. https://shop.narcotictests.com/products/specialnarcotic-tests/synthetic-cathinones-bath-saltscathinones-test-kit/details 7. Flakka Drug Lawyers. Legal Match. Accessed October 2, 2022. https://www.legalmatch.com/lawlibrary/article/flakka-drug-lawyers.html

FLUMAZENIL Abby Fisher, Student Pharmacist Fall 2022

https://mms.mckesson.com/ product/787797/Hikma-PharmaceuticalsUSA-00143978410

HISTORY AND BACKGROUND Received FDA approval on December 20, 2021 First benzodiazepine antagonist approved for clinical use Used for the complete or partial reversal of the sedative effects of benzodiazepines in conscious sedation and general anesthesia in adult and pediatric populations

SLANG TERMS Benzodiazepine antagonist Antidote MECHANISM OF ACTION Antagonizes the actions of benzodiazepines on the central nervous system Competitively inhibits the activity at the benzodiazepine recognition site on the GABA/benzodiazepine receptor complex

DRUG EFFECTS Dizziness

Sweating

Nausea

Blurred vision

Vomiting

Flushing

Headache

Injection site pain

DRUG INTERACTIONS AND TOXICOLOGY Black Box Warning: Seizures No known drug-drug interactions Contraindicated in patients who have been given a benzodiazepine for control of a potentially lifethreatening condition and in patients who are showing signs of serious cyclic antidepressant overdose

PROFESSIONAL OPINION I believe flumazenil is an appropriate therapy option when patients present with anesthesia, conscious sedation, or overdose and are receiving the drug for reversal of a single benzodiazepine exposure ; however, it is critical to monitor these patients closely to ensure positive health outcomes.

– Abby Fisher

LAWS MONITORING AND DRUG SCREENS

Flumazenil is not a controlled substance

Monitor patients for respiratory depression, benzodiazepine withdrawal, and other residual effects of benzodiazepines

Because it is only available as a sterile parenteral dosage form for intravenous administration, it must be given in a clinical setting

Monitor patients for possible return of sedation

REFERENCES 1. Flumazenil. Package insert. Akorn-Strides, LLC; 2008.

2. Flumazenil uses, side effects & warnings. Drugs.com. https://www.drugs.com/mtm/flumazenil.html. Accessed October 13, 2022.

3. Evidence based medicine - statpearls - NCBI bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470182/. Accessed October 13, 2022.

4. Flumazenil. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 13, 2022. http://online.lexi.com.

Gabapentin/Pregabalin

Mikey Franks PHPR 486 Fall 2022

Gabapentin-specific denoted with (G); Pregabalin-specific denoted with (P)

Slang Terms: • Gabbies (G) • Johnnies(G) • Budweisers(P) • Buds(P) Gabapentin, 300mg

https://online-lex icom.ezproxy.lib.purdue.edu/lco/action/doc/retriev e/docid/patch_f/6961?cesid=04P4Ro4T1zi&search Url=%2Flco%2Faction%2Fsearch% 3Fq%3Dgabap entin%26t%3Dname%26acs%3Dfalse%26acq%3D gabapentin#images-tab -content

Pregabalin, 25mg

https://online-lexicom.ezproxy.lib.purdue.edu/lco/action/doc/retriev e/docid/patch_f/152621?cesid=0jM f1dArBu1&sear chU rl=%2Flco%2Faction%2Fsearch%3Fq%3Dpreg abalin%26t%3Dname%26acs%3Dfalse%26acq% 3 Dpregabalin#images-tab-content

History/Background: Gabapentin was approved by the FDA in 1993. It was originally used as a muscle relaxer and an anti-spasmodic. It was later found to have significant anti-convulsive properties. Because the mechanism of action of gabapentin was not initially understood, it was believed to have a low addiction potential.

Pregabalin was approved by the FDA in 2004 for neuropathic pain associated with various conditions. Pregabalin is one of the top 30 most prescribed medications.

Both drugs are notable for their many off-label uses. Both are used for recreational drug withdrawal has lead to an increase in abuse.

Those addicted to recreational drugs have found the effects, in high enough doses, to be similar to drugs such as cocaine.

Pharmacology/Drug Effects: Gabapentin and pregabalin are structurally similar to gamma-aminiobutyric acid (GABA), however, they have not been found to interact with any GABA receptors. Both have a high affinity to voltagegated calcium channels, specifically in the alpha-2-delta-1 subunit. Upon binding, they inhibit the release of excitatory neurotransmitters including: norepinephrine, dopamine, serotonin, glutamate, substance P, and calcitonin gene-related peptide receptors.

By inhibiting these excitatory neurotransmitters, these two drugs effectively reduce anxiety, seizures, restless leg syndrome, pain associated with neuralgia, and withdrawal (alcohol and cocaine).

Pharmacokinetics:

https://pubs.asahq.org/anesthesiology/article/119/5/1215/13675/Periope rative-GabapentinoidsChoice-of-Agent-Dose

Bioavailability • 60%-27%; inversely proportional to dose (G) • >90% (P) Time to Peak • 2-4 hours; 8 hours for extended release (G) • 8 hours for extended release with food (P) Half-life Elimination: • 5-7 hours; increased with renal impairment(G) • 6.3 hours (P) Absorption Variable; absorbed by proximal small bowel by L-amino transport system. Pregabalin absorption is a saturable process. The higher the concentration of drug saturating transporters, the less bioavailable it becomes.

Interactions/Toxicology: Bioavailability is reduced if either is taken on an empty stomach. Administer with food. There have not been any reports of serious overdoses of gabapentin or pregabalin.

Overdose could lead to mild sedation, confusion, apathy, and rarely seizures. Gastric lavage and single-dose charcoal activated charcoal are common treatments for overdose.

Common side effects include bradycardia, hypotension, diarrhea, nausea, vomiting, dizziness, drowsiness, lethargy, slurred speech, tremor Gabapentin/pregabalin withdrawal symptoms include anxiety, difficulty sleeping, nausea, pain, and sweating.

Worsened withdrawal and rebound symptoms occur if either are not gradually discontinued Laws: Gabapentin is not controlled everywhere in the US except Kentucky.

Pregabalin is classified as a Schedule V drug Rising abuse has called into question the previous classifications of both gabapentin and pregabalin

Avoid use with: • Other CNS depressants • Alcohol • Cocaine • Antisiezure drugs • Sedatives Monitoring/Drug Screens: When patient is taking either, it is important to monitor the following: • Efficacy (pain intensity/seizure frequency) • Degree of sedation • Mental alertness • Suicidal thoughts • Respiratory depression (Respiratory impairment) • Assess for history of drug abuse Screening: • Blood: 5-7 hours • Urine: three days • Hair follicle: 90 days • Saliva: Undetectable Abuse Potential:

Professional Opinion: While Pregabalin is classified as a controlled substance, I believe that Gabapentin should become classified as well.

The urgency of monitoring for abuse increases sharply as a substance becomes controlled. This is especially important as both, when abused, can increase suicidal thoughts in patients. Although the lethal overdose potential of both has been determined as low, the risk of severe harm when unregulated is very high. ~ M. Franks

Studies have shown that patients with a history of opioid use and psychiatric disorders are at a higher risk of abusing gabapentinoids.

An increasing number of fatalities has been observed in people who abuse gabapentinoids with other psychoactive substances simultaneously.

Pregabalin is more commonly misused than gabapentin

References: 1.

2.

3.

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6.

7.

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10.

Extern. Pregabalin: Guidance for People Working with Pregabalin Users. https://www.publichealth.hscni.net/sites/default/files/Pregabalin%20Guidance%20Booklet%20A4%20Final%20Web_0.pdf Hoeg N, Parisi T, Bhatt A. Gabapentin Addiction And Abuse. Addiction Center. Published July 17, 2022. Accessed October 5, 2022. https://www.addictioncenter.com/drugs/gabapentin/#:~:text=The%20drug’s%20known%20street%20names,changes%20in%20a%20user’s%20behavior.

Lexicomp. Gabapentin. Published 2022. Accessed October 5, 2022. https://online-lexicom.ezproxy.lib.purdue.edu/lco/action/doc/retrieve/docid/patch_f/6961?cesid=46zBOwf4Dbg&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dgabapentin%26t%3Dname%26a cs% 3Dfalse%26acq%3Dgabapentin# Lexicomp. Published 2022. Accessed October 6, 2022. https://online-lexicom.ezproxy.lib.purdue.edu/lco/action/doc/retrieve/docid/patch_f/152621?cesid=5qpKs1xAmep&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dpregabalin%26t%3Dname%26 acs% 3Dtrue%26acq%3Dpregabalin#foi Cross AL, Viswanath O, Sherman Al. Pregabalin. [Updated 2022 Jul 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470341/ Yasaei R, Katta S, Saadabadi A. Gabapentin. [Updated 2022 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493228/ Schifano F. Misuse and abuse of pregabalin and gabapentin: cause for concern? CNS Drugs. 2014 Jun;28(6):491-6. doi: 10.1007/s40263-014-0164-4. PMID: 24760436.

Rietjens SJ, Sikma MA, Hunault CC, Lange DW, Hondebrink L. Pregabalin poisoning: Evaluation of dose-toxicity relationship. British Journal of Clinical Pharmacology.

2021;88(3):1288-1297. doi:10.1111/bcp.15073 Erowid Gabapentin (Neurontin) Vault : Law. Erowid.org. Published 2017. Accessed October 6, 2022. https://www.erowid.org/pharms/gabapentin/gabapentin_law.shtml Hägg S, Jönsson AK, Ahlner J. Current Evidence on Abuse and Misuse of Gabapentinoids. Drug Saf. 2020 Dec;43(12):1235-1254. doi: 10.1007/s40264-020-00985-6. PMID: 32857333; PMCID: PMC7686181.

Gamma hydroxybutyrate (GHB) Jake Frederick, PharmD student Fall 2022 Background/History GHB is a depressant that was developed in 1960 as an anesthetic for surgery due to its ability to cause patients to sleep and induce a medical coma. However, it failed due to its inability to mask pain and seizurelike symptoms. In the late 80s, it saw overthe-counter use as a sedative and a growth hormone stimulator for bodybuilders, but was banned by the FDA in 1991 due to adverse reactions. Today, it is used frequently at parties as a euphoriant and aphrodisiac. Due to these effects on the body, it is a substance that has been identified as a “date rape” drug.

Slang Terms • G • Grievous bodily harm • Liquid ecstasy • Liquid E • Liquid X • Georgia Home Boy • Soap • Cherry meth • Blue nitro • Fantasy

Pharmacology/Drug Effects GHB is an agonist of the GABA-B receptors in the central nervous system and acts as a depressant, similar to ethanol. However, ethanol acts on the GABA-A receptor complex to act. When these GABA-B complexes are activated, they reduce the rate that nerve transmissions occur, causing sedation.

Figure 1: GHB chemical structure. Source: https://www.google.com/imgres?imgurl=http s%3A%2F%2Fwww.emcdda.europa.eu%2Fsite s%2Fdefault%2Ffiles%2FGHB.png&imgrefurl=ht tps%3A%2F%2Fwww.emcdda.europa.eu%2F media-library%2Fmolecular-structureghb_en&tbnid=gv3oJI6ATr6r5M&

Drug Interactions/Toxicology • GHB taken with alcohol and other sedative medications (such as benzodiazepines) can increase the sedative effect of the drug.

• Taking GHB with amphetamines and other stimulants can lead to an increased incidence of side effects due to opposing mechanisms of action.

• GHB increases the risk of seizures, so using it with an anticonvulsant would decrease these medications’ effectiveness in preventing seizures • Naloxone (Narcan) can decrease GHB action on the brain • Overdose can cause blackouts, memory loss, confusion, loss of consciousness, and death.

Figure 2: GHB. Source: https://www.google.com/imgres?imgurl=https%3 A%2F%2Fwww.aidedrogue.ca%2Fwpcontent%2Fuploads%2F2022%2F01%2Fdar-ghbscaled.jpg&imgrefurl=https%3A%2F%2Fwww.aide Laws drogue.ca%2Fen%2Fthe-differentsubstances%2Fghb%2F&tbnid=b5feqsU-xpUp until 2000, there were no znM&vet=12ahUK

restrictions on the use of GHB. However, President Bill Clinton signed H.R. 2130 (the Hillory J. Farias and Samantha Reid Date-Rape Drug Prohibition Act of 2000) into law, and now GHB is a schedule-I drug.

Monitoring/Drug Screens GHB is primarily used in the teenager and young adult population, but screening should be utilized for everyone. The HEADSS (home life, education, activities, drugs, suicide, sex) assessment as well as a social history should be taken at medical office visits. If the patient confirms they are using GHB, the provider should inform the patient of GHB use and provide resources for rehabilitation programs

Professional Opinion Due to its lack of studies in human subjects, side effects, overdose potential, and use as a date rape drug, GHB should remain a schedule-I drug. In the past it has been used in the medical setting, but the drawbacks far outweighed the benefits, meaning that there is no place for it in the medical field let alone the general population. – J. Frederick

References Busardò FP, Jones AW. GHB pharmacology and toxicology: acute intoxication, concentrations in blood and urine in forensic cases and treatment of the withdrawal syndrome. Curr Neuropharmacol. 2015;13(1):47-70. doi:10.2174/1570159X13666141210215423.

Gamma-Hydroxybutyrate (GHB): Overview, uses, side effects, precautions, interactions, dosing and reviews. WebMD. https://www.webmd.com/vitamins/ai/ingredientmono-950/gamma-hydroxybutyrate-ghb. Accessed October 13, 2022.

GHB. GHB - Alcohol and Drug Foundation. https://adf.org.au/drug-facts/ghb/#:~:text=Other%20names,meth%2C%20blue%20nitro%2C%20fishies.

Accessed October 13, 2022.

O'connell T, Kaye L, John J. Plosay I. Gamma-Hydroxybutyrate (GHB): A newer drug of abuse. American Family Physician. https://www.aafp.org/pubs/afp/issues/2000/1201/p2478.html. Published December 1, 2000. Accessed October 13, 2022.

Sam Frey, 2nd Year Professional Program Pharmacy Student

Fall 2022

Hashish Street Drug Monograph

Names Hash, Dry Herb, Hay1

What is it?

Hashish is a cannabis product made from the trichomes (flowering buds containing resin glands) of the cannabis plant that have been compressed or purified. It can be smoked or used orally.2

History Hashish has been used for several thousand years. Some of the first records of its use come from 900 AD in Arabia. Its use spread to Europe in the 1800s.3 Modern popularity rose in the 1960s, becoming popular in the US for those with “alternative lifestyles”. Many Western tourists also were exposed to Hashish when traveling to India and Nepal.3

Pharmacology Hash contains the same cannabinoids found in other cannabis products (such as marijuana), but at a higher concentration. For example, Hashish resin usually contains 20-60% THC.4 Cannabinoids are fat soluble, meaning that it can stay in the body for longer than water soluble substances. It has a half life of seven days in the body. Cannabinoids are metabolized the in liver, and are secreted 25% in the urine and 65% in the GI, leading to reabsorption.

They interact with cannabinoid receptors (CB1 and CB2), increasing dopamine secretion.

People are able to develop resistance to cannabinoids.4

Effects Cannabinoids have anxiolytic, sedative, analgesic, and psychedelic properties. They can also increase appetite, lead to euphoria or dysphoria, distorted space and time perception, and (at high doses) hallucinations. They can lead to long term impairment with chronic use.4

Drug Interactions ● ● ● ● ● ● ●

Increases clearance of drugs metabolized by CYP1A2.5 Decreases clearance of drugs metabolized by CYP2C19.5 Additive effects with sympathomimetics (tachycardia, hypertension).5 Additive effects with CNS depressants (drowsiness, ataxia).5 Additive effects with anticholinergics (tachycardia, confusion).5 Increases bleeding risk of Warfarin.5 CYP3A4 and CYP2C9 inhibitors can increase cannabinoid effects.5

Laws and Regulation Cannabis products are illegal at the federal level, but state legislation varies heavily.

Indiana: “Possession of more than two grams of hashish or concentrate, or if the person has a prior conviction of an offense involving marijuana, hash oil, or hashish and is in possession less than two grams, then the crime is a level 6 felony, punishable by six months to 2 ½ years imprisonment and a maximum fine of $10,000.”6

Monitoring and Drug Screening Drugs to detect THC exist in urine, blood, and hair forms.7 The most common type of test are urine tests. If someone tests positive with a urine test, they usually perform a second, more-sensitive urine test to rule out false positives.7 These tests can appear positive 3-30 days after cannabis use.7

Professional Opinion Hashish is higher potency than other cannabis products, increasing the risk of overdose. With cannabis products, overdose is almost impossible when smoked, but oral products carry a higher risk.

Cannabis can be a good alternative to other, more dangerous substances. It can still be dangerous, especially when driving or performing other tasks requiring high alertness. ~ S. Frey

Sources 1. Difference Between Hashish And Marijuana? | Sunrisehouse.com. Sunrise House. Accessed October 6, 2022. https://www.google.com/url?q=https://sunrisehouse.com/quit-abusing-marijuana/hashish/&sa=D&source=docs&ust=1665082878697254&usg =AOvVaw0ci1NtV_udsl9L3cbvZBm0 2. What is Hashish (Hash Drug)? (Effects, Addiction & Withdrawal). Published May 14, 2021. https://www.addictiongroup.org/drugs/other/hash/ 3. Hashish—A Short History. Narconon International. https://www.narconon.org/drug-information/hashish-history.html 4. Ashton CH. Pharmacology and effects of cannabis: A brief review. British Journal of Psychiatry. 2001;178(2):101-106. doi:10.1192/bjp.178.2.101 5. Antoniou T, Bodkin J, Ho JMW . Drug interactions with cannabinoids. CMAJ. 2020;192(9):E206-E206. doi:10.1503/cmaj.191097 6. Indiana Laws and Penalties. NORML. Accessed October 6, 2022. https://norml.org/laws/indiana-penalties-2/ 7. Marijuana (THC) Testing | Labcorp. www.labcorp.com. https://www.labcorp.com/help/patient-test-info/marijuana-thc-testing

Images https://weedmaps.com/learn/dictionary/hash https://www.istockphoto.com/photo/hemp-or-cannabis-leaf-isolated-on-white-background-top-view-flat-lay-template-or-gm1158372978-3163 96506

Hawaiian Baby Woodrose Allison Gerber, Student Pharmacist Fall 2022

History/Background Hawaiian Baby Woodrose is considered to be a climbing vine characterized with light purple flowers and seeds that grow in pods.

This natural plant is native to India and it has been introduced to Hawaii, the Caribbean, as well as other tropical or subtropical climates.

For thousands of years, Hawaiian Baby Woodrose has been cultivated in various cultures for medicinal (treatment of pain) and religious purposes.

https://www.alamy.com/stock-photo/hawaiian-baby-woodrose.html

Slang Terms/Other Names There are very few slang terms for this drug, but the following equivalent names were found: Argyreia Nervosa Woolly Morning Glory Elephant Creeper LSA https://www.worldseedsupply.com/product/hawaiian-babywoodrose-ayurvedic-strain-seeds/

Drug Effects/Pharmacology The seeds contain a chemical called LSA, which is similar to LSD, a hallucinogen. LSA is a weak agonist of the dopamine type-2 receptor, so dopamine levels will be altered.

The number of seeds eaten will determine the level of psychoactive effects that the user will experience. Users have reported being in a dream-like state when using Hawaiian Baby Woodrose.

https://sensiseeds.com/en/blog/hawaiian-baby-woodrose-plant-what-isit-and-what-is-it-used-for/

Drug Interactions/Toxicology Hawaiian Baby Woodrose and SSRIs have a moderate drug interaction due to the combined action of increasing serotonin levels in the brain.

Serious side effects can result from this drug interaction. These side effects include severe headache, confusion, anxiety, loss of temperature control, and heart problems.

Laws There are no restrictive laws or regulations about the possession of Hawaiian Baby Woodrose, however it is not approved for human consumption.

Once LSA is extracted from the seeds, it is considered to be an illegal possession. LSA is regulated in the US as a Schedule III drug.

Monitoring/Drug Screens No information was found on drug screenings for Hawaiian Baby Woodrose.

Monitoring parameters can include watching for side effects, such as nausea, vomiting, sweating, dizziness, blurred vision, hallucinations, dilated pupils, and increased heart rate and blood pressure.

Professional Opinion In my professional opinion, Hawaiian Baby Woodrose should be illegal to freely purchase and possess by the average person. /ƚ ŚĂƐ ƚŚĞ ƉŽƚĞŶƚŝĂů ƚŽ ďĞ ĂďƵƐĞĚ ĨŽƌ ͞ƚƌŝƉƐ͟ similar to LSD, so there need to be tight regulations and laws on the use of Hawaiian Baby Woodrose.

The risks outweigh the benefits, so I would advise looking into different treatment options. ~ A. Gerber

References: 1.

Hawaiian Baby Woodrose Plant ʹ What Is It and What Is It Used For? Sensi Seeds. Updated September 9, 2020. Accessed October 12, 2022. https://sensiseeds.com/en/blog/hawaiian-baby-woodrose-plant-what-is-it-and-what-is-it-used-for/ 2.

Hawaiian Baby Woodrose ʹ Uses, Side Effects, and More. WebMD. Accessed October 12, 2022. https://www.webmd.com/vitamins/ai/ingredientmono-325/hawaiian-baby-woodrose 3.

Hawaiian baby woodrose seeds. The Mix. Accessed October 12, 2022. https://www.themix.org.uk/drink-and-drugs/legal-highs/hawaiian-baby-woodrose-seeds-9848.html 4.

Hawaiian Baby Woodrose Legal Status. The Vaults of Erowid. Accessed October 12, 2022. https://erowid.org/plants/hbw/hbw_law.shtml

HEROIN

Dope, Smack, H, or Junk Rachel Gerdt PharmD student Purdue University College of Pharmacy November 9 2022

HISTORY/BACKGROUND 1874: Heroin is synthesized for the first time by CR Alder Wright at St. Mary's hospital in London.

1897: Heroin is made by Felix Hoffman at Bayer Pharmaceutical. Company recognized drug's potential and began marketing it for the treatment of respiratory ailments.

1898: Bayer began exporting heroin to other countries. Use became widespread as people saw the drug was more effective than morphine and thought it had less side effects.

1911: many experiments were done that determined heroin is as addictive as morphine.

1913: Bayer stops production of heroin.

1920: House of Delegates of the American Medical Association announced that heroin be eliminated from all medicinal preparations and should not be prescribed or dispensed.

1924: All legitimate production of heroin stopped due to Heroin Act. 1965-1970: Vietnam war was happening and people blamed U.S. involvement in the war for an increase in illegal heroin being imported into the U.S. 1971: It was found that many American soldiers were addicted to heroin.

PHARMACOLOGY

Synthesized from the acetylation of morphine (diacetylmorphine) The activate metabolites are 6-O-acetylmorphine and morphine.

Drug is an opioid analgesic and euphoric depressant Binds and activates the mu-opioid receptors of the CNS. This binding mediates respiratory depression, euphoria, and physical dependence.

Due to nature of the receptor, tolerance is obtained quickly Route of Administration includes snorting, smoking, or injecting intravenously.

FUN FACT: Heroin was most likely named from "heroisch", the German term meaning large, powerful, or one with pronounced effect even in small doses.

PHARMACOLOGY

Bonkers Institute. 2008. 1901 Bayer Heroin ad. http://www.bonkersinstitute.org/medshow/bayer heroin1901.html

TOXICOLOGY Short Term Adverse Effects: flushing of the skin, dry mouth, nausea, vomiting, severe itching, drowsiness, respiratory depression, and decreased heart action.

Long Term: Deterioration of brain white matter, tolerance, and withdrawal symptoms.

The respiratory and heart depression can lead to death Concurrent use of Alcohol or Benzodiazepines can increase CNS depression.

MONITORING/DRUG SCREENS Can be detected in standard and extended drug tests.

Detected in urine for 1-4 days.

LAWS

NEUROtiker. March 7 2007. Heroin. https://en.wikipedia.org/wiki/Heroin

Heroin is a schedule 1 controlled substance.

For possession of heroin a person can face up to 1 year in prison and a minimum fine of 1000 dollars.

Law regarding trafficking of heroin are as follows: trafficking involves movement of 100-999 grams of heroin.

First offense not less than 5 years and not more than 40 years in prison. Fine of 5 million if individual person and 25 million if not an individual.

Second Offense not less than 10 years and not more than life. If death of serious injury occur penalty if life in prison. Fine of 8 million dollars if an individual and 50 million if not an individual.

PROFESSIONAL OPINION After research and learning more about heroin I think that it should remain a schedule 1 drug. Although it does have powerful analgesic effects, the toxicities and addiction risk associated with heroin make it unsafe to use in any medical setting. Furthermore, newer and safer options have been developed since the time that heroin was discovered for treatment of respiratory ailments. ~ R. Gerdt

Susan Wittig Albert. 2022. Opium Poppy. https://susanalbert.com/the-opium-poppy-a-plant-to-die-for/

RESOURCES: Heroin street names, nicknames & slang terms. American Addiction Centers. https://americanaddictioncenters.org/heroin-treatment/ slang-names. Published July 13, 2022. Accessed October 13, 2022.

Heroin. Erowid heroin vault : Timeline. https://www.erowid.org/chemicals/heroin/heroin_timeline.php. Accessed October 13, 2022.

S; H. [heroin, part III: The pharmacology of heroin]. Acta pharmaceutica Hungarica. https://pubmed.ncbi.nlm.nih.gov/15112443/#:~:text=The%20analgesic%20effects%20of%20heroin,depression%2C%20euphoria%20and%2 0physical%20dependence. Accessed October 13, 2022.

University leadership. University Leadership | Seattle Pacific University. https://spu.edu/university-leadership. Accessed October 13, 2022.

UNODC - Bulletin on narcotics - 1953 issue 2 - 003. United Nations : Office on Drugs and Crime. https://www.unodc.org/unodc/en/dataand-analysis/bulletin/bulletin_1953-01-01_2_page004.html. Accessed October 13, 2022.

IGOBAINE

Abigail Gick Student Pharmacist Fall 2022

USES

OTHER NAMES

Ibogaine has been used for its psychoactive and stimulatory effects, but it has also been used to treat opioid addiction and withdrawal symptoms2.

Other names include Iboga, Bois Sacré, and Eboka with the scientific name of Tabernanthe iboga1.

HISTORY

MONITORING/DRUG SCREENING

Iboga is a naturally psychoactive stimulating drug found in the Ibogaine plant. The drug is more concentrated in the root than in other parts of the plant. It is found in various countries in Africa including Republic of Congo, Gabon, Cameroon, and Guinea and has been used in various religious activities. One such example is the Bwiti religion. It was discovered by European countries in the 1800s where it was continuously researched until 1901 when the compound was experimentally isolated. France was a country that started to sell ibogaine as Lambarene for a stimulant in the 1930s-1960s until it became illegal in 1966. In addition to France making it illegal, the World Health Organization (WHO) and Food and Drug Administration (FDA) also declared Ibogaine as illegal and classified it as a Schedule I drug1,2.

There is not much monitoring/drug screening done for ibogaine as it is not used clinically in the United States. Research has been done with varying results showing that ibogaine is helpful in reducing opioid withdrawal symptoms and helped people recover from an opioid addiction. One study showed that most of the people who used ibogaine relapsed after treatment while another study showed that it reduced opioid cravings of the participants2,4.

https://scottsdalerecovery.com/what-is-ibogaine/

Drug Interactions/Toxicology There are many toxicological effects of ibogaine throughout the body.

The use of ibogaine has been shown to cause dysrhythmias, “agitation, hallucinations, vomiting, ataxia, muscle spasms, weakness, seizures, paralysis, arrhythmias, urinary retention, respiratory insufficiency, and cardiac arrest”3.

There are no absolute contraindications with this drug nor are there any documented interactions. It has been shown though to cause more fatalities with people who take this and have comorbidities including opioid use, cardiovascular disease, depression, schizophrenia, and other autonomic nervous system disorders3.

Laws Ibogaine is a Schedule I hallucinogenic drug that is illegal in the United States of America1.

Pharmacology/Drug Effects

Professional Opinion

Ibogaine has been classified as a Schedule I hallucinogenic with many different possible mechanisms of action. It appears to have various effects with different doses. At a lower dose, it works mainly on the cerebella of the sympathetic nervous system and causes euphoria and an increase in muscle strength and endurance. This happens through many ways including kappa agonist effects, serotonergic effects, and nicotinic and N-methyl-Daspartate (NMDA) antagonism2. Some of these are considered options for why ibogaine could be used to treat opioid withdrawal symptoms. The kappa agonist effects increase the concentration of the chemical dynorphin, which creates cocaine aversion. The NMDA antagonism can help reduce the withdrawal symptoms. Also, the ibogaine metabolite noribogaine can treat opioid withdrawal as it binds to mu receptors2.

At a medium dose, it starts to produce psychedelic effects and the person can experience dreams while awake.

It also starts to stimulate the parasympathetic nervous system which can be so drastic as to cause a “feigned death”. It can decrease the amount of time spent in the rapid-eye movement (REM) stage of sleep which is a factor in the stimulatory effects. At a high dose, it causes hallucinations which is due to it being an indole alkaloid2,3.

While ibogaine has been shown to have some effect reducing opioid withdrawal symptoms and helping people transition out of substance abuse, not enough studies have been done to demonstrate its superiority to other treatments.

Additional studies also need to be done proving types of dosing and the safety of the drug in general. Due to its main psychedelic effects of hallucinations and its lack of clinical efficacy, people should not be taking this drug and it should remain illegal in the United States. ~ A. Gick

References 1.

2.

3.

4.

Iboga. Natural medicines - databases. https://naturalmedicines.therapeuticresearch.com/datab ases.aspx. Accessed October 11, 2022.

Scottsdale Recovery Center. What is ibogaine?

Scottsdale Recovery Center. https://scottsdalerecovery.com/what-is-ibogaine/.

Published August 19, 2019. Accessed October 11, 2022.

Iboga. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 11, 2022.

Mash DC, Duque L, Page B, Allen-Ferdinand K. Ibogaine detoxification transitions opioid and cocaine abusers between dependence and abstinence: Clinical observations and treatment outcomes. Frontiers in Pharmacology. 2018;9. doi:10.3389/fphar.2018.00529

Justin Young, Student pharmacist

Fall 2022

Isoflurane anesthetics https://redwoods medicaledge.com /2012/10/19/putme-to-sleepanesthesiology/

https://vetpharma.com /producto/isoflurane/

History

The need for a new generation of nonflammable volatile anesthetic originated around 1960 when Ohio Medical Products initiated a research project with the goal to synthesize non-flammable fluorinated ethers and hydrocarbons anesthetic with less cardiovascular toxicities and more ideal metabolism than the first generation of fluorinated compounds. Ohio Medical Products assigned two senior chemists, Louise Speers Croix, Ph.D. and Ross C. Terrell Ph.D. to synthesize fluorinated methyl ethyl ethers and fluorinated methyl isopropyl ethers, which resulted in the discovery of isoflurane. After meeting all required standards of volatility, nonflammability, stability, it was improved for clinical use in 1972.

Background

Primary therapy for preoperative sedation and adjunctive anesthesia maintenance to intravenous anesthetic agents in the perioperative setting. It induces muscle relaxation and reduces pains sensitivity by altering tissue excitability. Inhaled anesthetics allow for rapid introduction of an agent into arterial blood via the pulmonary circulation, essentially the significance of rapid therapeutic effects allows for efficient induction and discontinuation of sedation induced by these agents.

Drug Abuse

Flurane anesthetics cause effects such as dysphoria, intoxication, and hallucinations. Abusers may sniff or snort fumes from a dispenser or aerosol directly into their nose. The high from inhalants only last a couple of minutes so abusers prolong repeating sniffing over several hours. Some abusers may pour inhalants onto their shirt collar and sniff it periodically.

Slang terms: Poppers, Snappers

www.dnaindia.com/india/reportdna-exclusive-children-glued-toinhalants-as-drugs-1860440/amp

Pharmacology

The mechanism of action of inhaled anesthetics consists of deregulating neurotransmission of excitatory paths involving acetylcholine, glutamate, and serotonin within the central nervous system triggering respiratory depression. It may depress myocardial contractility, decrease blood pressure through a decrease in systemic vascular resistance, and decrease sympathetic nervous activity.

Onset- 7-10 minutes post-inhalation, Metabolism: Minimally hepatic (<0.2%), predominantly CYP2E1,minimal biotransformation in man, Excretion: Exhaled gases, Renal Excretion 0.17%

Drug interactions

https://www.istockp hoto.com/illustration s/anesthesia-maskcartoon

Risk X: Avoid combinations due to enhanced CNS depression, hypertensive effect, or arrhythmhttps://www.istockphoto.com/ illustrations/anesthesia-mask-cartoonogenic effects: azelastine, bromperidol, dexmethylphenidate, ephedra, ephedrine, flunarizine, isoproterenol, Kratom, levoketoconazole, metaraminol, olopatadine, orphenadrine, oxomemazine, paraldehyde, pimozide, sertindole, thalidomide Minor decrease in metabolism occurs with CYP2E1 inhibitors and minor increased metabolism with CYP2E1 inducers

Toxicology

Acute exposure- Nephrotoxicity, dizziness, loss of consciousness, asphyxia, due to airway irritation. Chronic exposure-nausea, dizziness, fatigue, headache, irritability, https://medicare24.onlin reduced mental performance, liver and kidney disease, carcinogenicity, teratogenic/ e/details/disease/1097 birth defects (crosses the placenta), and reproductive effects: sterility or infertility.

Warning- All anesthetic gases have shown a depression of cardiac contractility. Decrease in BP is dose dependent due to peripheral vasodilation; cardiac output is maintained. Use caution in patients who are hypovolemic, hypotensive, or hemodynamically compromised; use caution in patients with coronary artery disease to avoid risk of myocardial ischemia. May prolong the QT interval and rarely torsades de pointes; use caution in patients at risk of QT prolongation

Laws

The average of 50 ppm for isoflurane has been defined as a non-regulatory occupational exposure limit by the American Conference of Governmental Industrial Hygienists (ACGIH). The exposure limit for isoflurane is 50 ppm since OSHA has not developed a regulation permitted exposure level for it.

Monitoring/drug screens

Blood pressure, electrocardiogram, serum potassium, oxygen saturation, respiration, end-tidal CO2 and QT interval in patients at risk for QTc prolongation. Isoflurane concentrations should be monitored prior to and throughout anesthesia QT interval in patients at risk for QTc prolongation

Professional opinion

I believe this form of volatile gas inhalant anesthetics are more beneficial than harmful. They are less abuse prone than the majority of other inhaled anesthetics such as nitrous oxide or chloroform. This class of inhalants are mostly present in surgical settings oppose to easily accessible items such as cleaners or sprays. ~ J. Young

References 1. Anesthetic gases - statpearls - NCBI bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK537013/.

Accessed October 14, 2022.

2. Pubs.asahq.org. https://pubs.asahq.org/anesthesiology/article/108/3/531/8240/TheInvention-and-Development-of-Enflurane. Accessed October 13, 2022.

3. Isoflurane. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 13, 2022. http://online.lexi.com 4. Isoflurane Anesthetic Gas Guidelines. Isoflurane Anesthetic Gas Guidelines | Environmental Health and Safety. https://ehs.research.uiowa.edu/isofluraneanesthetic-gas-guidelines. Accessed November 7, 2022.

5. Luo A, Zhang X, Li S, Zhao Y. Sevoflurane addiction due to workplace exposure: A case report and literature review. Medicine (Baltimore). https://www.123rf.com/clipart2018;97(38):e12454. vector/anesthesia_anaesthesia.htm

SLANG TERMS:

1. Spice/K2 2. Bliss 3. Black Mamba 4. Blaze 5. Bombay Blue 6. Snax

SARAH PENSYL Student pharmacist FALL 2022

7. Fake Weed 8. Legal Weed 9. Genie 10. Zohai 11. Red X 12. Dawn Scooby Skunk

PHARMACOLOGY: DRUG EFFECTS:

“Spice” binds to and acts on the same receptor as marijuana.

These receptors are known as cannabinoid receptors (CB1 and CB2). Currently, synthetic cannabinoids like Spice/K2 are not well tested or well understood resulting in very minimal understanding of its pharmacology. Despite minimal research, scientists do know that Spice/K2 binds to cannabinoid receptors more strongly than marijuana. This gives it the capability to produce much stronger effects on the human body. The drug appears to be metabolized via the liver and excreted through the urine and feces.

Spice/K2 has a range of effects. Some of these are similar to the effects of marijuana. These effects include elevated mood, relaxation, altered perception, and symptoms of psychosis. Psychotic effects have also been seen with synthetic cannabinoid usage. These effects include extreme anxiety, confusion, paranoia, and hallucinations.

HISTORY:

BACKGROUND:

“Spice” is another term for synthetic marijuana which was first used in Europe and the United States in 2004 and 2008, respectively, although; the chemicals used to make Spice were first created in laboratories decades prior. Components of synthetic marijuana created by experimentation include CP 47,497 (developed by Pfizer in the 1980’s), HU-210 (developed in 1988 at Hebrew University in Jerusalem), and JWH-018 (founded at Clemson University in 1995). Its use has been difficult to track.

Once a chemical was illegalized, a new chemical, not tested for on a drug screen, would be made in the lab to replace it.

“Spice” is a synthetic form of tetrahydrocannabinol (THC), a psychoactive ingredient that is typically found in marijuana. It often comes as an herbal mixture that contains a mixture of plant material that has been sprayed with chemical additives that create its psychoactive effects. It can resemble the appearance of potpourri, so it is often labeled with “not for human consumption”. Users consume this substance by smoking it or inhaling it through ecigarettes or other devices.

The picture to the left is a photo highlighting the process of rolling spice into a form that can be smoked by Spice/K2 users U.S. Army. Accessed November 9, 2022. https://www.army.mil/article/157559/substance_abuse_coodinator_ warns_of_spice_dangers

NOVEMBER 9, 2022

PROFESSIONAL OPINION: The capability of manufacturers to develop new synthetic cannabinoids in a laboratory quickly and the inconsistency in the make-up of Spice/K2 makes this substance both dangerous and unpredictable. This combined with the drug’s capability to effect the mind with delusions severe agitation and violence makes this drug a danger to the public leading me to the conclusion that this drug should stay illegalized and not be used for medical treatment.

– S.Pensyl

DRUG INTERACTIONS: “Spice” is a substrate for various P450 isoforms. These isoforms include CYP2C9 and CYP1A2. Drugs that are inhibitors of these enzymes possess the ability to cause drug-drug interactions with Spice/K2. These drugs include: 1. CYP2C9 inhibitors (valproic acid, sertraline) 2. CYP1A2 inhibitors (ciprofloxacin, fluvoxamine) “Spice” is metabolized in part by CYP2C9 which can affect the metabolism of other drugs that utilize this enzyme like warfarin, phenytoin, tolbutamide, losartan, and ibuprofen.

TOXICOLOGY: The Centers for Disease Control has associated the use of Spice/K2 to overdose deaths as a result of myocardial infarction. In addition, the smoked substance has led to acute kidney injury requiring hospitalization and dialysis. The drug has an extensive list of adverse effects including tachycardia, elevated blood pressure, tremors, vomiting, hallucinations, and agitation.

LAWS: Due to the lack of medical benefit and high potential for abuse, there is currently no accepted medical use for Spice/K2 in the United States, and it is illegal to buy and sell. For this reason, 26 synthetic cannabinoids are currently listed as schedule I substances under the Controlled Substances Act, in addition to many other substances that meet the definition for cannabimimetic agent. However, there are a few synthetic cannabinoid substances that have been sold as the result of a workaround, selling the product as incense or potpourri. There is an act termed the Controlled Substance Analogue Enforcement Act that has allowed these uncontrolled synthetic cannabinoids to be subject to persecution as a Schedule 1 controlled substance if a list of criteria is met.

DRUG SCREENING: Due to the ever-evolving list of synthetic cannabinoid substances and components, it can be hard to design tests that target this type of drug. There are blood, hair, urine, and saliva tests that can detect levels of Spice. Saliva tests have proved useful and have shown detection 20-60 minutes after inhaling the drug.

REFERENCES: “Synthetic Marijuana: A Short History.” Foundation for a Drug-Free World, https://www.drugfreeworld.org/drugfacts/synthetic/syntheticmarijuana-short-history.html.

“Spice/ K2, Synthetic Marijuana.” DEA, https://www.dea.gov/factsheets/spice-k2-synthetic-marijuana.

“Spice (Synthetic Marijuana).” National Institute of Drug Abuse, https://nida.nih.gov/sites/default/files/pdf/nmassist.pdf.

“Synthetic Cannabinoids (Spice, K2).” Release, 28 Jan 2019, https://www.release.org.uk/drugs/synthetic-cannabinoids-salvia-spicek2/pharmacology Tai S, Fantegrossi WE. Pharmacological and Toxicological Effects of Synthetic Cannabinoids and Their Metabolites. Curr Top Behav Neurosci.

2017;32:249-262. doi:10.1007/7854_2016_60

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Kava Kava is a depressant drug. It slows down the messages traveling between the brain and STUDENT PHARMACIST the body.

Kava Kava works by: • blockage of voltage-gated sodium ion channels enchanced ligand binding to GABA type A receptors • diminished excitatory neurotransmitter release due to calcium ion channel blockade • reduced neuronal reuptake of noradrenaline • reversible inhibition of monoamine oxidase B Kava Kava has been used in and suppression of the synthesis of the the Pacific Islands as a eicosanoid thromboxane A2, which ceremonial drink^1. It is made from antagonizes GABA-A receptor function the root or the stump of the keva Kava Kava can be used to treat anxiety and shrub^2. Kava Kava can cause insomnia. It can also create a similar effect to similar effects as alcohol. The alcohol. It has a sedative, anxiolytic, antistress, roots of this plant are ground up analgesic, local anesthetic, anticonvulsant, and and then added to cold water neuroprotective properties. that results in a “thick brew.” It is a Kava Kava can be used to treat anxiety and drink that is prestigious and is insomnia1. It also creates a similar effect to offered to guests. It can be used alcohol1. It has sedative, anxiolytic, antistress, to relax, “elevate mood, well-being, analgesic, local anesthetic, anticonvulsant, and and contentment.” It can also be neuroprotective properties. used to treat some disorders including anxiety, insomnia, and other types of nervous disorders^1.

KAVA-KAVA

https://www.nccih.nih.gov/health/kava

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PHARMACOLOGY

EN D O

SLANG TERMS

KAWA

WAKA LEWENA KAVA-KAVA2

LAWS PROFESSIO N OPINION AL

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KNOW

G N I R O MONIT DRUG SCREENS Kava Kava will not show up on drug tests due to the fact that the tests most organizations use do not look for it. If a drug screen identifies it, kava kava can be found in the urine, blood, or hair.

DRUG INTERACTIONS Can have drug interactions with drugs that share the mechanism of action with kavalactones.

https://www.natrol.com/products/kava-kavamood-stress-capsules?bvstate=pg:2/ct:r

Kava Kava is legal in the United States and is sold as a dietary supplement.

Studies have shown that kava kava can reduce the symptoms of anxiety. It was significantly more effective when compared to a placebo. It has also been found to improve mood and cognitive function.

TOXICOLOGY Kava Kava can cause liver toxicity. It can also cause dermopathy with prolonged use.

There have also been reports of skin lesions.

References

1. Kava Kava. Mount Sinai Health System. https:// www.mountsinai.org/health-library/herb/kavakava. Accessed October 13, 2022.

2. Kava. Kava - Alcohol and Drug Foundation. https://adf.org.au/drug-facts/kava/ #:~:text=Other%20names,and%20wati%20(New%2 0Guinea). Accessed October 13, 2022.

3. NN; SYNS. Therapeutic potential of kava in the treatment of anxiety disorders. CNS drugs. https:// pubmed.ncbi.nlm.nih.gov/12383029/#:~:text=The% 20pharmacological%20properties%20of% 20kava,reduced%20neu ronal%20reuptake%20of% 20noradrenaline%20. Accessed October 13, 2022.

4. Singh YN, Singh NN. Therapeutic potential of kava in the treatment of anxiety disorders CNS drugs. SpringerLink. https:// link.springer.com/ article/10.2165/00023210-200216110-00002.

Published August 29, 2012. Accessed October 13, 2022.

5. Is kava legal where I live? Kava laws around the world. Kava Guides. https://kavaguides.com/ kava-laws/. Published August 18, 2021. Accessed October 13, 2022.

6. Does Kava show up on drug tests? Kava Guides. https://kavaguides.com/kava-drug-test/.

Published August 21, 2021. Accessed October 13, 2022.

Cassidy Hardin, Purdue student

Fall 2022

Drug Name: Ketalar

History/Background

Ketamine is typically produced commercially in many countries.

It is an injectable, short-acting anesthetic used in surgery. It’s considered a dissociative anesthetic that makes the user feel detached from their pain and environment. The patient’s vital signs need to be monitored closely by the anesthesiologist once administered for the procedure.

Ketamine comes in a clear liquid when injected, but it can also come in a white or off-white powder. The powdered form is packaged in small glass vials, bags, capsules.

It is abused for its ability to produce dissociative sensations and hallucinations and has been used to facilitate sexual assault.

• • • • • • • • • •

Special K Cat Valium Kit Kat K Super Acid Super K Purple Special La Coke Jet Vitamin K

Picture from teepublic.com

Ketamine is a general anesthetic. These render patients reversibly unconscious and unresponsive.

It prevents the patient from feeling pain and will likely cause some memory loss upon waking.

• Hallucinatory effects last 30-60 minutes • Distorts sights and sounds • Induces feelings of calmness and relaxation • relief from pain • immobility • amnesia

Cassidy Hardin, Purdue student

Fall 2022

•

Drug Interactions

Reacts with other drugs that make you sleepy or slows your breathing; such as opioids, anxiety medications, sleeping pills, and muscle relaxers; making it take longer to wake from the anesthesia.

•

It is possible to test for the presence of ketamine metabolites in urine, blood, & hair.

But ketamine is not standardly tested for in the basic drug test nor in extended drug tests.

•

Ketamine is a Schedule III substance under the Controlled Substances Act.

Toxicology

May cause: painful/difficult urination, increased urination, loss of bladder control, blood in urine, light-headed feeling, bradycardia, weak/shallow breathing, jerky muscle movements, confusion, or dream-like feeling.

•

Professional Opinion

Ketamine is a good and safe drug to use as an anesthetic for surgical operations. It almost always should be used in an operating room as it has the potential to be abused. It has recently been found to be helpful for treating depression though, so it could also be used in that manner as well. ~ C. Hardin

Ketamine: Drug Testing. Erowid. Updated March 8, 2020. Accessed October 10, 2022. https://www.erowid.org/chemicals/ketamine/ketamine_testing.shtml • Ketamine. Just Think Twice. Accessed October 10, 2022. https://www.justthinktwice.gov/drugs/ketamine • Ketamine. Drugs.com. Updated October 10, 2022. Accessed October 10, 2022. https://www.drugs.com/mtm/ketamine.html Ketamine Molecule Rainbow Chemistry Sticker. TeePublic. Accessed October 10, 2022. https://www.teepublic.com/sticker/12570586-ketaminemolecule-rainbow-chemistry Burness, A. Colorado Doctors' Group: Ketamine Safe, With More Oversight. EMSworld. Published December 3, 2021. Accessed October 10, 2022. https://www.hmpgloballearningnetwork.com/site/emsworld/news/colorado-doctors-group-ketamine-safe-more-oversight •

•

386 drugs are known to interact/affect ketamine, so all current medications need to be disclosed before use.

Picture from puragraft.com

The breakdown product of ketamine, norketamine, is detectable in blood and urine for 7-14 days.

Laws

Prescription and over-the-counter medicines, vitamins, and herbal products may also affect ketamine.

Clark Hawkins Fall 2022

Khat Street names Abyssinian Tea, Chat, Catha, Oat History Khat is a flowering shrub scientifically known as Catha edulis. Originally, Khat became accepted as a ritualistic custom in African and Arabian culture. Its use dates back to the 13th century in Abyssinia (also known as Ethiopia) and brought to Yemen in the early 15th century. It became a large part of Yemeni culture where it is used in religious and social settings. In Yemen, 90% of males use Khat multiple times daily.

73% of women and almost 20% of children also use Khat on a daily basis.

How is it used?

Khat is most commonly chewed. You can find users stuffing wads of this shrub into their cheeks similar to tobacco. It can also be dried and put into tea, incorporated into food, and smoked. The global distribution has sharply increased in the modern era due to the development of cathinone (Khat’s active ingredient) capsules and other synthetic forms of cathinone.

Pharmacology Many different compounds can be extracted from this plant. The main active ingredient in Khat, cathinone, is known to cause a stimulated, euphoric state of mind. The major effects of Khat come from its action on the nervous system causing increased alertness, dependance, tolerance, and other psychiatric symptoms. It also acts on the gastrointestinal tract causing constipation, urine retention, and acute cardiovascular effects. Cathinone is pharmacologically unstable and begins to decompose once the plant is harvested. This is why fresh Khat leaves are preferred among its users. It is believed that other compounds in this plant have been overlooked and understudied and are thought to contribute to Khat’s vast effects on the body. Khat chewers were shown to have increased depression and psychological distress due to their dependance.

Chronic khat use has been shown to have effects on fetal development and lactation. Pregnant mothers are at increased risk of becoming anemic during pregnancy. The drug may also reduce placental blood flow causing lower birth weights. Its psychoactive effects may also cause increased motor and cognitive dysfunction as well as dependance to the fetus.

Drug Interactions The gastrointestinal absorption of Khat is shown to decrease the bioavailability of certain antibiotics, thus making them less effective. Nicotine and caffeine increase the stimulatory effects of Khat. Concurrent use of these substances is common.

Khat is also known to cause increased blood pressure which may compete with antihypertensive medications.

Adverse Reactions The most serious adverse reactions to Khat include: depression, insomnia, suicidal ideation, loss of appetite, nausea, vomiting, numbness, severe migraines and difficulty concentrating.

Laws Khat is illegal in the United States. Cathinone is classified as a Schedule I Stimulant and Cathine (another known active ingredient) is a Schedule IV stimulant under the Controlled Substance Act. This means there are no known medical uses with a high potential for abuse. Today, Khat consumption is limited to East Africa and Southwestern Arabia. It has been made illegal in nearly all Arab Gulf states except for Yemen.

Monitoring Cathionone and cathine can be detected in urine and picked up on a urine drug screen. Khat users should monitor for decreased cognitive function as well as abnormal heart rate.

Professional Opinion Khat began as an accepted drug for religious and social matters. At that point it was just a plant and not widely accepted as a drug for abuse. With the modern production of cathinone tablets, we are seeing a dramatic increase in the distribution and abuse of this compound. With its many negative effects on the cardiovascular and nervous system, it is becoming an issue for the health and finances of specified countries. More research must be done to truly understand the effects of Khat’s compounds on the human body. ~ C. Hawkins

References El-Menyar, A., Mekkodathil, A., Al-Thani, H., & Al-Motarreb, A. (2015, March). Khat use: History and heart failure. Oman medical journal.

Retrieved November 9, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412450/#:~:text=Origin%20and%20spread%20of%20 khat%20use text Griffiths, P., Lopez, D., Sedefov, R., Gallegos, A., Hughes, B., Noor, A., & Royuela, L. (2010, May 7). Khat use and monitoring drug use in Europe: The current situation and issues for the future. Journal of Ethnopharmacology. Retrieved November 9, 2022, from https://www.sciencedirect.com/science/article/pii/S037887411000303X?via%3Dihub Home | dea.gov. (n.d.). Retrieved November 9, 2022, from https://www.dea.gov/sites/default/files/2020-06/Khat-2020_0.pdf Lexicomp. Khat. Login. (n.d.). Retrieved November 9, 2022.

Kratom Haylie Dickson Fall 2022

History/background Kratom is an herbal extract native to Southeast Asia and has a scientific name of mitragynine and 7-hydroxymitragynine. Users commonly brew it into tea, swallow it as a pill, crush the pills and smoke it, or chew on the leaves.1 Kratom can also be made into a liquid form that is used for muscle pain, cramps, diarrhea, or to suppress hunger.2

Slang terms

Practical Pain Management. Is Kratom a Viable Alternative to Opioids? Accessed October 13, 2022.

Patient.practicalpainmanagement.com

• • • • •

Thang Kakuam Thom Ketum Biak

Pharmacology/drug effects At low doses, kratom acts as a stimulant and binds to the opioid receptors in the brain.2,3 The mu-opioid agonist effects of kratom is thought to be ten times as potent as morphine. Users may feel energetic and have increased alertness while taking it. With higher doses, euphoria and relief of pain can happen for the user. With the use of very high doses, it is thought to act as a sedative.

Drug interactions/toxicology Kratom can interact with CNS depressants, sympathomimetics, and drugs that are metabolized by the CYP-450 enzymes.4 Addiction is a risk with this drug and the patient can go through withdrawal symptoms that are similar to other stimulant withdrawals. Symptoms like dry mouth, drowsiness, and constipation are also common with kratom.

Verywell mind. What is Kratom? Accessed October 13, 2022.

Verywellmind.com/kratom-for-painmanagement

Laws In 2016, the DEA wanted to classify kratom as a schedule I drug, but was met with protests and petitions by people who are for the drug.

Before this decision, kratom was considered an herbal product and was legal in most parts of the US. The abuse potential was a huge concern to the DEA, but the backlash from the public caused them to delay making a decision on the matter. Currently, kratom is legal at the federal level, but states may vary on their policies regarding the drug. 5

Monitoring/drug screens

Professional opinion

Users should watch out for respiratory depression, hallucinations, and overdose with high doses of drug.

Kratom cannot be detected with a standard drug test, but can be found with a urine or blood test for an average of 5 days after use.6

Kratom has cultural significance that should be respected, but clinical use of the drug has not been thoroughly studied. Using this drug for opioid withdrawal symptoms is not recommended, as kratom has some abuse potential itself. ~ H. Dickson

References

1. Kratom. Natural Medicines. Therapeutics Research Center. Stockton, CA. Accessed October 13, 2022. https://naturalmedicines-therapeuticresearch.com 2. Mayo Clinic. Kratom: Unsafe and ineffective. Accessed October 13, 2022. https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/kratom/art-20402171 3. DEA. Kratom. Accessed October 13, 2022. https://www.dea.gov/factsheets/kratom 4. Kratom. Natural Products Database. Facts & Comparisons eAnswers. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 13, 2022. http://online.factsandcomparisons.com 5. US Pharmacist. The DEA Changes Its Mind on Kratom. Accessed October 13, 2022. https://www.uspharmacist.com/article/the-dea-changes-its-mind-on-kratom 6. The Recovery Village. How Long Does Kratom Stay in the System? Accessed October 13, 2022. https://www.columbusrecoverycenter.com/blog/how-long-does-kratom-stay-in-system/

KrokodiL

Katrina hoang Student Pharmacist Fall 2022

Background Desomorphine, commonly referred to as krokodil, is a highly abused Schedule 1 substance, derived from codeine. Krokodil is often formulated in a home environment and may contain solvents such as gasoline, paint thinner, iodine, hydrochloric acid, red phosphorus, or lighter fluid. Long term users of the drug often develop skin ulcers and gangrene, a skin condition characterized by its green, gray, or black scale-like texture. Other common side effects of krokodil include damage to vein structure, soft tissue necrosis, bone infection, kidney damage, liver damage, and motor skill impairment.1

https://novarecoverycenter.com/drugs/krokodil/

https://www.drugaddictionnow.com/drug-information/krokodil/

Other Commonly Used names: Crocodil, Russian Magic, Poor Man’s Heroin, and Zombie Drug 1 Pharmacology Similar to other opioids and heroin, desomorphine has analgesic and sedating effects. The drug is administered intravenously, and its effects begin within two to three minutes. However, its duration of action is less than two hours. As a result, many users repeat administration continuously to avoid withdrawal symptoms. Desomorphine is more potent than morphine and considered to be more toxic.1 The drug works similarly to other opiods; when the opioid enters the central nervous system, it binds to opioid receptors resulting in both pain relief and dopamine release. Dopamine elicits feelings of pleasure and euphoria, making opioids highly addictive.2

https://pubs.acs.org/doi/pdf/10.1021/acschemneuro.0c00495

Drug Interactions Opioid medications should not be used in conjunction with alcohol, anti-seizure medications, some antibiotics, some antidepressants, some antifungals, medications for psychiatric disorders, muscle relaxants, sedatives, or other opioid medications.3

Laws Krokodil has no known or accepted medical uses and is labeled as a Schedule 1 substance.1 There are few regulations about the possession and distribution of krokodil specifically; however, there are limits on the sale of medications containing codeine within the United States. Krokodil use within the United States is controlled in comparison to heroin and other opioid use. Since 2004, there have been limited reports of krokodil distribution.4

Monitoring and Drug Screening According to Time Magazine, krokodil is the drug of choice for many across Eastern Europe because it can be easily made using medications easily obtained in the pharmacy and solvents found within the home. Typical signs of krokodil use include open ulcers, rotting gums, tooth loss, speech impairment, motor impairment, and difficulty focusing.4 Liquid chromatography tandem mass spectrometry is used to detect trace amounts of desomorphine in a urine sample. The urine sample must have a volume of at least 3 mL and be stored in a plastic container without preservatives. The expected turnaround time for the test is 7 to 21 days.5

https://www.redlakenationnews.com/story/2 013/10/30/news/krokodil-recipe-for-disfiguri ng-addiction/17077.html

Professional Opinion Although more effective than morphine and cheaper than heroin, desomorphine is highly toxic and should be avoided due to its high addiction profile and dangerous side effects. ~ K. Hoang

References 1. Krokodil Drug Facts: Effects, Abuse & Warnings. Drugs.com. https://www.drugs.com/illicit/krokodil.html. Accessed October 13, 2022.

2. Opioids and the brain - how do changes in the brain begin? PursueCare. https://www.pursuecare.com/opioids-and-the-brain.

Published October 8, 2021. Accessed October 13, 2022.

3. Medications O. Risks for other drugs interacting with opioid medications - mayo clinic news network. Mayo Clinic. https://newsnetwork.mayoclinic.org/discussion/risks-for-other-drugs-interacting-with-opioid-medications/. Published May 16, 2018. Accessed October 13, 2022.

4. Krokodil: The newest opioid to hit the United States. Northpoint Washington. https://www.northpointwashington.com/krokodil-newest-opioid-hit-united-states/. Published May 3, 2017. Accessed October 13, 2022.

5. Desomorphine, Screen and Confirmation, Urine. Laboratory Corporation of America. https://www.labcorp.com/tests. Accessed November 8, 2022.

LSD (Lysergic acid Diethylamide) Fall 2022 History/Background of Use

Pharmacology/ Drug Effect

Seoyeon (Yuna) Hong Student pharmacist

1938: Accidentally discovered by Sandoz pharmaceuticals while searching for lysergic acid’s active derivative 1950: Introduced to induce temporary psychotic like states in normal people. Then, later used to enhance psychotherapeutic treatments 1960s, People began using LSD for recreational and spiritual purposes

Semi-synthetic product of lysergic acid (a natural substance from parasitic rye fungus) Dose dependent hallucination effect Active at multiple receptors: 5-HT1A, 5-HT2A, and 5-HT2C serotonergic receptors and serotonin transporter (SERT), but also active at the D1, D2, D4 dopaminergic receptors, the NMDA, mGlu2/mGlu3 glutamatergic receptors, and the TAAR1 receptor High bioavailability (71%), a threshold dose of 15mcg, and duration up to 8-12 hours

SLANG TEMRS: “Superman” “Mellow yellow” “Pane acid” “Looney tunes” Flashbacks “Blotter acid” “Blue heaven” “Boomers” “Yellow Altered sounds sunshine”

High BP

Changes in mood Distorted visual perception Increased feeling of euphoria and relaxation Confusion and trouble concentrating Mind altering, hallucination Dilated pupil, increased heart rate

Could Microdosing LSD Make You Happier. The Human Behavioral pharmacology Laboratory. Accessed September 30, 2022. http:// hbpl.uchicago.edu/what-are-we-doing.

Toxicology/Drug Interaction Toxicity mediated by alterations in serotonin concentration within CNS LSD acts in CNS as partial agonist of serotonin receptor Leads to distorted transmission, What to Know About LSD Use. Dotdash Meredith. Accessed September 30, processing, and perception of external 2022. https://www.verywellmind.com stimuli Drug interactions: Antidepressant, Alcohol: Increase risk of serotonin syndrome Amphetamine/Ecstasy: Increase chance of bad trip and panic Other drug/OTC: Unpredictable and dangerous.

Law

LSD TOXICITY INCLUDES: Respiratory arrest Coma, emesis Hyperthermia Autonomic instability Fear of death, panick attack Impaired perception and identity

ILLEGAL Schedule 1 Controlled Substance: No currently accepted medical use and high abuse potential Monitoring and Drug Screen No Monitoring parameter Most routine drug screens do NOT detect LSD (Recent) Radioimmunoassay can detect pharmacologically inactive metabolite of LSD in urine: 2-oxy-lysergic acid

These 10 Medications can cause a False positive on Drug Tests. GoodRx Health.

Accessed September 30, 2022. https://www.goodrx.com/drugs/

Professional Opinion: While it may be used for psychiatric treatment at very low dose, its risk for addiction and side effects offsets its benefit. LSD addiction is very strong and success rates of treatments are known to be very low. Providers should educate patient on ways to seek psychological assistance and importance of avoiding needle share. ~ S. Hong

References: 1. Passie T, Halpern JH, Stichtenoth DO, Emrich HM, Hintzen A. The pharmacology of lysergic acid diethylamide: a review. CNS Neurosci Ther. 2008;14(4):295-314. doi:10.1111/ j.1755-5949.2008.00059.x 2. Hwang KAJ, Saadabadi A, eds. Lysergic Acid Diethylamide (LSD. National Library of Medicine. 1st ed. Treasure Island ,FL: Stat Pearls Publishing;2022.

3. Lysergic acid diethylamide. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed September 30, 2022. http://online.lexi.com 4. Alcohol & Drugs: LSD. Alcohol and Drug Foundation. Accessed September 30, 2022. https:// touchbase.org.au/alcohol-and-drugs/lsd.

The Latest News on Street Drugs - November Edition

Street Drugs Today Featuring: MDMA Hunter Skelton, Student Pharmacist

What is MDMA? 3,4-methylenedioxymethamphetamine, MDMA, or “ecstasy” is a synthetic (manmade) drug that affects mood and perception of reality. It has stimulant and psychedelic effects on the body, which can create senses of euphoria, energy, and distortions of time and place.1 MDMA is derived from methamphetamine and amphetamine, and therefore produces similar effects on the mind and body. MDMA has been tested clinically in patients with PTSD and other mental disorders with some efficacy, but it was not approved by the FDA and was deemed illegal in 1985 by the DEA.2

Fall 2022

What does MDMA do to the body?

MDMA affects brain chemicals associated with energy and mood changes.

Unfortunately, MDMA will also produce unwanted effects in the body.

Increased dopamine in the brain results in increased energy and activation of the reward system. This causes the user of MDMA to feel good and continue using the drug.

However, this feeling will fade over time and cause damage to the reward system.

Physical effects: muscle tension and cramps, tremors, teeth clenching, chills, sweating (due to increased body temperature), nausea, or blurry vision.

Increased serotonin in the brain results in emotions like trust, empathy, and sexual arousal (the high levels of serotonin are thought to be mostly responsible for the psychedelic effects of MDMA). The user may also experience mood, appetite, and sleep changes.1,2,4

It is not usually known to cause physical dependence, but it can cause psychological dependence due to its strong euphoric effects.

Those who consistently use MDMA and wish to quit should seek out behavioral therapy to help with any emotional stress they may experience during the process.3

Psychological effects: confusion, depression, anxiety, sleep issues, paranoia, and cravings.1

Common Street Names

https://www.bbc.com/news/uk-wales-61734334

Often called a “party drug”, MDMA gained its popularity at raves and parties for making people feel social, empathetic, and energized.

However, it has now made its way out of just the nightclub venue.1

Increased norepinephrine results in increased heart rate and blood pressure. Therefore, MDMA should be avoided in people who have heart issues.

Colorful tablets are the most

common, but MDMA can also come in capsules, powder, and liquid form.

Ecstasy, Molly, XTC, X, Beans, Adam, E, Love Drug, Peace, STP, Go, Scooby Snacks, and more.

Street Drugs Today

https://positivechoices.org.au/img/library/Ecstasy-gGlnx.png

Drug Interactions and Toxicology Monitoring MDMA Effects of MDMA can occur within 30-45 minutes of ingesting the drug, and they usually last 4-6 hours, but they may stick around for days or weeks. Taking another dose of MDMA while the first dose is still in the body will prolong its presence in the body and increase the risk of unwanted side effects.

MDMA is detectable in blood and saliva tests for 3 days after last use, up to 5 days after for urine tests, and for months in strands of hair.3

“Ecstasy” tablets may come as MDMA mixed with other substances such as methamphetamine, cocaine, ketamine, heroin, and others. Unless the substance is tested for purity before ingesting, there is no way to really know its contents.

MDMA and alcohol interact together to enhance and increase the euphoric effects of both substances.

Amphetamine-like substances (such as MDMA) can interact with opioids and cocaine to produce too much serotonin, resulting in serotonin syndrome. If it is too severe, the user may need to seek medical attention.

Opioids, cannabinoids, ketamine, and alcohol can produce central nervous system depression when taken together.5,6

MDMA is heavily metabolized by CYP2D6 enzymes in the liver. Some of the metabolites are reactive and can cause damage to the liver, causing jaundice, hepatitis, bleeding, and even liver failure if not taken care of.

As mentioned earlier, the increase in norepinephrine can lead to increased heart rate and blood pressure, leading to cardiovascular issues like heart failure.

Since MDMA can affect the body’s ability to regulate temperature, it can lead to high fevers and dehydration. The body may also experience irregular water retention in the body from alterations in hormones. Changes in temperature and water retention can lead to seizures or compression of the brain. High body temperatures can also lead to other tragic events such as muscle degradation, kidney failure, and serotonin toxicity.2

Laws and Regulations

Monitoring MDMA

MDMA has a high abuse potential, no accepted medical use in the U.S., and lacks safety information. This makes it a Schedule I substance (under government discretion) and is therefore considered illegal to use or posess.1

Effects of MDMA can occur within 30-45 minutes of ingesting the drug, and they usually last 4-6 hours, but they may stick around for days or weeks. Taking another dose of MDMA while the first dose is still in the body will prolong its presence in the body and increase the risk of unwanted side effects.

MDMA is detectable in blood and saliva tests for 3 days after last use, up to 5 days after for urine tests, and for months in strands of hair.3

References

https://media.istockphoto.com/photos/guy-taking-drug-pill-young-people-is-having-fun-in-night-club-with-pictureid1324037312?k=20&m=1324037312&s=612x612&w=0&h=WdTzsaf5t_oVp5ZaBfJFfgJBROSUMpWwyBD8afm_m6E=

Professional Opinion: Hunter Skelton, Student Pharmacist

“Although not everyone has used ecstasy, many people have probably heard about it. MDMA is being considered for therapeutic use in certain patient populations. Putting stigma aside and testing MDMA in safe and ethical ways might prove its efficacy in psychotherapy. It should always be remembered that ecstasy off the street may not be pure, and therefore can be very dangerous to unsuspecting users. Negative effects from polydrug use may lead to some of the stigma associated with ecstasy, but the use of any substance can cause harm.”

1. DEA. Ecstasy/MDMA. DEA.gov. Home. DEA.gov.

2. Kalant H. The pharmacology and toxicology of "ecstasy" (MDMA) and related drugs. CMAJ. 2001;165(7):917-928.

3. NIDA. MDMA (Ecstasy/Molly) DrugFacts. National Institute on Drug Abuse website. https://nida.nih.gov/publications/drugfacts/mdmaecstasymolly. June 15, 2020 Accessed October 13, 2022.

4. Hardey S, Thomas S, Stein S, Kelley R, Ackermann K. Is Ecstasy (MDMA) Addictive?

American Addiction Centers.

5. Drug Interactions. IBM Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Accessed October 13, 2022.

6. Mori T, Iwase Y, Uzawa N, et al. Synergistic effects of MDMA and ethanol on behavior: Possible effects of ethanol on dopamine D2 receptor-related signaling. Addict Biol.

2021;26(4):e13000. doi:10.1111/adb.13000

https://www.drugfoundation.org.nz/matters-ofsubstance/archive/matters-of-substance-november2014/about-a-drug-mescaline/

MESCALINE Ingrid Lund-Mikkelsen Fall 2022

WHAT IS MESCALINE? Mescaline is a hallucinogen that is found naturally in the peyote cactus.¹

HISTORY OF USE Mescaline has been used for many years.

Most interestingly, it has been used by indigenous groups from southwest USA and northern Mexico for religious ceremonies.²

https://www.economist.com/books-andarts/2019/06/29/a-mind-bending-history-of-mescaline

WHAT ARE THE EFFECTS OF MESCALINE? Mescaline is a hallucinogen. It causes the user to experience euphoria and hallucinations. It can also cause anxiety, shakiness, increased heart rate, and increased blood pressure.¹

COMMON SLANG TERMS² buttons cactus mesc peyoto

https://www.forbes.com/sites/benjaminadams/2021/07 /07/is-mescaline-a-key-component-in-the-future-ofmedicine-xphyto-aims-to-find-out/?sh=79ddb47a1e90

WHAT ARE DRUGS THAT INTERACT WITH MESCALINE? IS MESCALINE LEGAL? Mescaline is a schedule 1 drug meaning it serves no clinical purpose. Mescaline is not legal to possess or purchase in the United States. However, it is allowed to be used during certain Native American religious ceremonies.³

No studies exist to show significant drug interactions with other medications.

However, due to the effects of mescaline on the CNS and circulatory system, it may cause issues if taken with antidepressants, antipsychotics, or medications that increase heart rate and blood pressure.³

HOW DO WE SCREEN FOR MESCALINE USE?

PROFESSIONAL OPINION ON MESCALINE

A urine test can be used to screen for mescaline in a person's system.⁴

Mescaline serves no clinical purpose as of now.

Because of this, there is no reason to legalize mescaline to be marketed to the public. However, it does not benefit society to criminalize use of mescaline. ~ I. Lund-Mikkelsen

REFERENCES 1. Abuse NI on D. Commonly Used Drugs Charts. National Institute on Drug Abuse. Published August 20, 2020. Accessed October 14, 2022. https://nida.nih.gov/researchtopics/commonly-used-drugs-charts#mescaline 2. WHAT ARE PEYOTE and MESCALINE? WHAT IS ITS ORIGIN? What Is Its Effect on the Body?

Which Drugs Cause Similar Effects? What Are Common Street Names? What Does It Look Like? https://www.dea.gov/sites/default/files/2020-06/Peyote%20and%20Mescaline2020_0.pdf 3. Mescaline (hallucinogen) Uses, Effects & Hazards. Drugs.com. https://www.drugs.com/illicit/mescaline.html 4. Mescaline. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed September 19, 2022. http://online.lexi.com

hhttps://www.lucid.news/mescaline-is-resurgent-yetagain-as-a-potential-medicine/

Methadone Jilian Banzon, 3rd year Professional Student, Fall 2022

History/Background Methadone is a medication approved by the Food and Drug Administration (FDA) to treat Opioid Use Disorder (OUD) as a medication-assisted treatment (MAT), as well as for pain management. Methadone's origin started when German scientists wanted to develop a drug to help avoid opiate withdrawal due to the opium supply being cut off in World War 2. As a result, methadone was synthesized and the drug not only worked, but also lasted a long time. https:// americanaddictioncenters.org/ wp-content/uploads/2018/10/ how-long-does-methadone-stayin-your-system.jpg

Slang terms/Street names Methadone goes by numerous slang terms or street names and on streets it is commonly referred to as Amidone, chocolate chip cookies, fizzies, Maria, pastora, Salvia, street methadone and water. https://img.medscape.com/ thumbnail_library/gty_220713 _opiods_methadone_syringe_800x450.jpg

Pharmacology/drug effects Methadone is a synthetic full agonist at the m-opioid receptor. It has an asymmetric carbon atom, and the racemic mixture is generally used in maintenance therapy.

When a user takes methadone they use it for detoxification and maintenance of opioid addiction and as a pain reliever for moderate to severe pain. When someone uses methadone they can experience physical symptoms like sweating, itchy skin, or sleepiness. When use is stopped, individuals may experience withdrawal symptoms including Anxiety, muscle tremors, nausea, diarrhea, vomiting, and abdominal cramps.

https://s3.wp.wsu.edu/uploads/ sites/2797/2021/1 0/ iStock-503756218_wp.jpg

Drug interactions/Toxicology

https:// janaburson.files.wordpress.com /201 4/03/aaaapilsfighting.jpg

People who use methadone at high doses, or in naïve users or idiosyncratically at much lower doses, depresses respiration and may interfere with cardiac function, either or both of which can lead to death. Methadone is a central nervous system (CNS) depressant, and there is a very high risk of negative complications when it is combined with other depressants such as alcohol and benzodiazepines.

Laws Methadone is a Schedule II drug under the Controlled Substances Act. While it may legally be used under a doctor’s supervision, its non-medical use is illegal. It is considered a schedule II drug due to its high potentially addictive qualities.

Methadone is a highly regulated drug and while it has medicinal purposes the fact that it is a powerful opiate is the reason why it is highly regulated when used as a medical treatment for opioid use disorder.

https://t4.ftcdn.net/ jpg/02/64/61/61/360_F _264616158_kbEUYZlEbdVjyUJXL5RIG Yn pbqlK5Qkf.jpg

Monitoring/drug screens

https://cdn.jjkeller.com/wcsstore/ CVCatalogAssetStore/images/ product/1000x1000/59978.jpg

Since methadone is a highly regulated drug, patients who are prescribed Methadone in an outpatient setting have to go to a clinic every day to be administered their dose. After a period of stability, patients may be allowed to take methadone at home between program visits. Patients on methadone must also be on the drug for a minimum of 12 months. Methadone is not usually screened for on a urine drug test unless otherwise specifically requested.

Professional opinion In my professional opinion, I believe that is properly regulated and the medical use for the drug is justified. Since it is a highly powerful opiate I understand the need for patients to come to a methadone clinic , but that still doesn't prevent medical professional to have a negative stigma towards people wanting to use methadone for opioid use disorder. I believe that methadone is a useful and effective drug for users and it should continue its current use in the medical world. ~J. Banzon

References 1. Methadone. SAMHSA. https://www.samhsa.gov/medication-assisted-treatment/medications-counselingrelated-conditions/methadone. Accessed October 14, 2022.

2. McDermott P. McDermott's Guide to the Depressant Drugs. Erowid opiates vault : Mcdermott's guide. https://www.erowid.org/chemicals/opiates/opiates_mcdermotts_guide.shtml. Accessed October 14, 2022.

3. Methadone. DEA. https://www.dea.gov/factsheets/methadone. Accessed October 14, 2022. Drug fact sheet: Methadone - dea.gov. https://www.dea.gov/sites/default/files/202006/Methadone-2020.pdf. Published April 2020. Accessed October 14, 2022.

4. Methadone addiction and abuse. Addiction Center. https://www.addictioncenter.com/opiates/methadone/. Published April 14, 2022. Accessed October 14, 2022.

5. Green M, Kellogg S, Kreek M. Methadone: History, pharmacology, neurobiology, and use -westbridge. https://www.westbridge.org/wp-content/uploads/2014/06/Enc-of-Neuroscience-Methadone.pdf. Accessed October 14, 2022.

6. Lipman J. The methadone poisoning "epidemic". DEA Meetings and Events. https://www.deadiversion.usdoj.gov/mtgs/. Accessed October 14, 2022.

Medical Advisory Secretariat. Optimum methadone compliance testing: an evidence-based analysis. Ont Health Technol Assess Ser. 2006;6(21):1-54.

Methamphetamine James Dycus, Student pharmacist

Fall 2022

https://ew.com/tv/10-essential-moments-breaking-bad-first-episode/

https://www.apsf.org/article/practice-considerations-for-the-anesthesia-professional-formethamphetamine-substance-use-disorder-patients/

Slang terms

There are many slang terms for Methamphetamine some of them include: -Meth -Speed -Chalk -Ice -rocket fuel -Cyrstal

https://twitter.com/idmethproject/status/1064571740506992642?lang=gu

Pharmacology/drug effects The effect of the drug comes from the substantial increase of the release of dopamine in the brain. This causes the feeling of euphoria, increased attention, decreased fatigue, and increased activity. If taken long term it will cause changes to your brain's dopamine system and causing bad side effect like paranoia, violet behavior, confusion, memory loss, and hallucinations.

History & background Methamphetamine is a highly addictive stimulant that acts on the central nervous system.

It is chemically similar to amphetamine which is used to treat ADHD and narcolepsy. It was first synthesised by a japanese chemist in 1893 . It was used for a variety of things such as asthma, weight loss, and narcolepsy. It was also used to keep soldiers awake on both the axis and allies powers during WWII.

https://breakingbad.fandom.com/wiki/Blue_Sky

https://www.emcdda.europa.eu/publications/drug-profiles/methamphetamine_en

The Law

Methamphetamine is a schedule 1 drug meaning it has medical use and it's highly addictive. In the US its illegal to manufacture, possess, transport, or sell illicit methamphetamine. If caught you are fined and could spend time in jail.

Drug interactions/ toxicology

Methamphetamine has many drug and disease interactions. It has over 209 drug interaction Monitoring/ drug with 43 of them being major screens interactions. Most of the major interactions are antiMonitoring and drug testing depression/anxiety and for Methamphetamine are benzodiazepines drugs. This drug easy. You can find a 10 also has over 15 drug-disease panel or 14 panel drug urine interactions. Some of the major test at a local pharmacy ones are Cardiovascular and that will detect for psychiatric disorders. In layman's methamphetamine. terms this drug is very toxic. It is methamphetamine can highly addictive and can cause stay in urine for up to 2-4 https://www.walgreens.com/store/c/ some serious adverse effects. drugconfirm-14-drugs-home-drug-test/ID=300406944-product days after use. https://www.radiotimes.com/tv/drama/ better-call-saul-bob-odenkirk-interview/

Professional opinion

https://en.wikipedia.org/wiki/Los_Pollos_Hermanos

In my professional opinion Other References: 1. https://nida.nih.gov/publications/drugfa Methamphetamine is not cts/methamphetamine good and should be taken. It 2. https://www.history.com/topics/crime/h istory-of-meth is highly addictive and has 3. https://americanaddictioncenters.org/ many long term side effects. meth-treatment/slang-names 4. https://www.drugs.com/drugIf you or you know someone interactions/methamphetaminethat is addicted call index.html?filter=3 1-800-662-4357 to get help.

5. https://drugpolicy.org/drug~ J. Dycus facts/current-meth-laws

Jailyn Jones, Student Pharmacist Fall 2022

- MG Seeds1 - Glories1 - Heavenly Blue1 - Pearly Gates1 - Summer Skies1 - Wedding Bells1 - Blue Stars1

https://gardenerspath.com/plants/flowers/save-morningglory-seeds/

https://sandiegoseedcompany.com/product/flowers/color-mix-morning-glory-seeds/

- Morning glory seeds were used anciently for their medicinal properties on the human mind among the indigenous peoples of Mexico.1 - The Aztecs would take morning glory in religious ceremonies.1 - They referred to the seeds as tlitliltzin (black) Turbina corymbose (round thing).1 - In 1959, Albert Hofmann, the Chemist who discovered LSD, identified the main psychoactive constituent to be lysergic acid amide (LSA).1

- The vine of morning glory blooms only in the morning.2 - The seeds of morning glory vine contain some of the bioactive ergot alkaloids that are present in LSD causing a hallucinogen effect on the mind. 2 - The seeds can be taken whole, or the active alkaloid (LSA) is able to be extracted.3

- Due to structural similarities of the active component of morning glory seeds, LSA, with LSD, many of the drugs that interact with LSD also interact with LSA. 4 - The following are drug interactions with LSD/LSA o MAOI1 o MDMA (ecstasy)4 ▪ LSD increases the potency of MDMA which can cause a bad trip. o Alcohol4 ▪ Enhances the effect of alcohol which leads to increased nausea, vomiting and blackouts.

- Morning glory seeds are not regulated by the US federal government.3 - Both plants and seeds are regularly sold by botanical supply companies.3 - LSA (the active chemical in morning glory), is a schedule III drug.

- When the LSA is extracted from morning glory, it is illegal to possess. In Arizona, the consequences are 1st or 2nd degree misdemeanor.3

https://www.amazon.com/Morning-Glory-SeedsHeavenly-Blue/dp/B075T7ZTQQ

- Morning Glory is not tested for in standard or extended drug tests.5 - You can test for LSA specifically.5 - LSA may show up positive when testing for LSD due to the structural similarities.5 References

- Morning glory resembles the actions of LSD due to the active component LSA. It can cause mental alterations such as hallucination which can be worsened by alcohol. Morning glory can cause severe toxicities and should not be used recreationally due to these risks.

(J. Jones)

1.

2.

3.

4.

5.

Beard D. Morning Glory Guide: Seeds, Effects, Common Uses, Safety. Reality Sandwich. Published June 6, 2020. Accessed October 10, 2022. https://realitysandwich.com/morning-gloryguide/ Bronston B. Study shows common flower species holds promise for beneficial psychedelic drugs. Published December 21, 2021.

Accessed October 10, 2022. https://news.tulane.edu/pr/studyshows-common-flower-species-holds-promise-beneficialpsychedelicdrugs#:~:text=The%20best%2Dknown%20ergot%20alkaloid,pro duced%20by%20their%20fungal%20partners.

Morning Glory Legal Status. Erowid. Published June 07, 2001.

Updated September 15, 2016. Accessed October 10, 2022. https://www.erowid.org/plants/morning_glory/morning_glory_l aw.shtml LSD. Alcohol and Drug Foundation. Updated August 26, 2022.

Accessed October 10, 2022. https://adf.org.au/drug-facts/lsd/ LSA Drug Testing. Erowid. Updated February 10, 2015. Accessed October 10, 2022. https://www.erowid.org/chemicals/lsa/lsa_testing.shtml

MUSCLE RELAXANTS Claudia Chiang, Student Pharmacist, Fall 2022

https://ntbg.org/database/ plants/detail/chondroden dron-tomentosum

Muscle relaxants were known as curare and were introduced to Europe from South America during the 1700s. Curare was known as “arrow poison” at the time and was used for hunting.

Hunters used plants to create a paste and apply it to their arrowheads. When preys were struck by the arrowhead, it died within minutes. The mechanism of how curare worked was found to act as a competitive antagonist of nicotinergic neuromuscular synaptic junctions. Curare was first used clinically in anesthetic practice in 1942. This began the start of discovering derivates and developing modern drugs.

An example of an abused muscle relaxant is cyclobenzaprine which targets the CNS to relieve muscle spasms. When this medication is abused, patients commonly report effects of sedation, relaxation, and euphoric “highs.”

It is commonly abused in many ways of administration such as taking it orally, crushing it to snort, mixing with other drugs, or dissolving it into alcohol. Abusing cyclobenzaprine, and other muscle relaxants targeting the CNS, can lead to an increased risk of addiction and dependence.

Slang Terms

Wallace 200's Soma Coma Holy Trinity Houston Cocktail

Las Vegas Cocktail DS DANCE

https://truespinebend.com/m uscle-relaxers/

History/ Background of Use/Abuse

Pharmacology/Drug Effects Muscle relaxants can target cells in the muscle, neurons, or in the central nervous system (CNS). To relax the muscles, the relaxants work by the following mechanisms: Releasing excitatory neurotransmitters which inhibit afferent nerves Inhibit interneuron activity which leads to prevention of nerve signal transmission Release of acetylcholine, the neurotransmitter involved with muscle contraction, is blocked Prevent release of calcium in the skeletal muscle cells; decrease in calcium activity Increase GABA levels which results in neuronal activity being blocked Depress CNS which leads to sedation and relaxation in muscles

Drug Interactions Toxicology

Monitoring/Drug Screens

Consuming alcohol can be toxic

Alcohol amplifies the effect of muscle relaxants, especially depressant effects in the CNS, and the combination of the two can lead to overdose risks. It can also cause increased risk of addiction.

Medications that cause drug-drug interactions include opioid drugs, benzodiazepines, tricyclic antidepressants, monoamine oxidase inhibitors, fluvoxamine (SSRI), and ciprofloxacin (antibiotic).

There are many factors that indicate how long a drug can stay in the system based on the type of muscle relaxant, the amount of dose taken, the type of drug test used, and biological measurements of the patient.

For instance, it may take 5.5 to 16.5 days for cyclobenzaprine to clear out of a patient’s system. Carisoprodol, on the other hand, has a shorter duration of about four days. https://www.gnhindia.c om/products/usndc/carisoprodolsoma-0037-2001/ https://www.dailymed.nlm. nih.gov/dailymed/fda/fdaDr ugXsl.cfm?setid=b12fb4ea182e-462b-b6edcfd2f6bb71e8&type=display

Laws There are a select few muscle relaxants that are controlled substances. carisoprodol and diazepam are schedule IV-controlled substances. Schedule IVcontrolled substances are drugs that can result in limited dependence and abuse potential. As these are controlled substances, these medications require prescriptions. There are also medications that are not under the Controlled Substances Act, like cyclobenzaprine, but still require a prescription to be legally obtained.

Professional Opinion Based on my opinion, I would still recommend the use of muscle relaxants. From a clinical standpoint, muscle relaxants can be a useful treatment option for many patients that experience severe pain. There are risks for abuse in all drugs, but there are ways to reduce harmful abuse by giving patients proper education and counseling. ~C. Chiang

References

1. Carl J, Schwarzer M, Klingelhoefer D, Ohlendorf D, Groneberg DA. Curare--a curative poison: a scientometric analysis. PLoS One. 2014;9(11):e112026. Published 2014 Nov 19. doi:10.1371/journal.pone.0112026 2. Suitable Treatment for Cyclobenzaprine (Flexeril) Abuse. American Addiction Centers. Updated September 15, 2022. https://americanaddictioncenters.org/cyclobenzaprine-flexeril-abuse.

3. Muscle Relaxer Addiction: Side Effects, Detox, Withdrawal, and Treatment. Nova Recovery Center. Accessed October 13, 2022. https://novarecoverycenter.com/drugs/muscle-relaxer/#h-street-names-for-muscle-relaxers.

4. Khan S. How Do Skeletal Muscle Relaxants Work? Rxlist. Updated September 22, 2021. Accessed October 13, 2022. https://www.rxlist.com/how_do_skeletal_muscle_relaxants_work/drug-class.htm.

5. Can You Mix Muscle Relaxers and Alcohol? Healthline. Updated on June 24, 2019. Accessed on October 13, 2022. https://www.healthline.com/health/muscle-relaxers-and-alcohol#if-youve-already-had-alcohol.

6. Controlled Substance Schedules. Diversion Control Division. Accessed October 13, 2022. https://www.deadiversion.usdoj.gov/schedules/.

7. Drug Scheduling. United States Drug Enforcement Administration. Accessed October 13, 2022. https://www.dea.gov/druginformation/drug-scheduling.

8. Cyclobenzaprine. Diversion Control Division. Updated March 2020. Accessed October 13, 2022. https://www.deadiversion.usdoj.gov/drug_chem_info/cyclobenzaprine.pdf.

Katy Bedka, Student pharmacist Fall 2022

Naloxone History and Background Naloxone was created in the 1960's as an attempt to reduce one of the adverse effects of opioid use: constipation. It gained FDA approval in 1971 and was first used as a response to the heroin epidemic in Italy in the 1990's. Many programs in countries across the world implemented naloxone as harm reduction in the early 2000's.

Other Names

https://www.cdc.gov/ stopoverdose/nalo xone/index.html

Narcan® Kloxxado

https://www.kelley-ross.com/polyclinic/naloxone/

Naloxone is an opioid reversal agent. It is an opioid antagonist that attaches to the opioid receptor and reverses/blocks the effect of other opioids in the system. It allows for the return of normal breathing if the person's breathing had become labored or stopped due to the opioid overdose. It has no negative effects if it is given to someone who has no opioids in their system.

Pharmacologic Effect

naloxone is LIFE SAVING in the event of an overdose.

Laws • As of July 1st 2017, all 50 states and District of Colombia have enacted naloxone access laws, including immunity for persons who administer the drug.

• These laws also discuss third party prescribing and enabling pharmacists to prescribe naloxone without a patient-specific prescription through a standing order, collaborative practice agreement, or pharmacist prescribing power • In Indiana, the Senate Enrolled Act 406-2015 "Aaron's Law" allows Indiana residents to get a prescription of naloxone if they know someone they think is at risk of an opioid overdose. Previously only emergency responders could carry naloxone.

Toxicology Side effects of naloxone are very rare, but people may have allergic reactions to the medication.

People who have a physical dependence on opioids may go into withdrawal within minutes of administering naloxone and experience symptoms such as headaches, sweating, vomiting, tremors, and rapid heart rate.

Monitoring Naloxone reverses an opioid overdose for 30 to 90 minutes.

Opioids can remain in the system for longer than that, so it is important to call 911 so the patient can receive the medical attention they need.

Professional Opinion I believe that the more widely available naloxone becomes, the closer we will get to helping stop the opioid crisis. Naloxone is an extremely safe drug. If someone were to administer naloxone to a person who was not overdosing on an opioid, there would be zero adverse effects. All health care professionals should be discussing naloxone with their patients if they or someone they are close to use opioids. -K Bedka references

• Campell N. Naloxone as a technology of solidarity: history of opioid overdose prevention. Canadian Medical Association Journal. 2019; 191(34): E945-E946. doi: 10.1503/cmaj.190257 • NIDA. Naloxone DrugFacts. National Institute on Drug Abuse website. https://nida.nih.gov/publications/drugfacts/naloxone. Accessed October 11, 2022.

• DOL: Overdose Prevention (Aaron's Law). Accessed October 11, 2022https://www.in.gov/dol/overdose-prevention-aaronslaw/#:~:text=Senate%20Enrolled%20Act%20406%2D2015,signed%20into% 20law%20April%202015.

--PDAPS. Naloxone Overdose Prevention Laws. Accessed October 13, 2022.https://pdaps.org/datasets/laws-regulating-administration-ofnaloxone-1501695139

NIGHTSHADE B y K o r t l y n K i m b r o u g h ( F e r n u n g ) , Student pharmacist

Fall 2020

History of Nightshade: Nightshade or Atropa Belladonna is a Eurasian perennial. Other names for this plant are Devil’s Berries, Naughty Man’s Cherries, Death Cherries, Beautiful Death, and Devil’s Herb. Historically women have used the herb’s oils to dilate and enlarge the pupils for seductive effect. It is best known as the plant of choice for assassins throughout history. This plant grows wildly in many parts of the United States. It grows mostly in dumps, quarries, near old ruins, under shade trees, or atop wooded hills. The toxins that grow in this plant cause delirium and hallucination. Deadly nightshade berries pose the greatest danger to children since they are attractive and sweet at first bite. Two berries are enough to kill a child and it takes 10-20 to kill an adult. A single leaf being consumed is enough to kill a human.

https://medium.com/@magicalhistoricity/d

eadly-nightshade-garden-on-roof-of-coittower-blooms-six-years-early8ef938cd4084

https://allth atsinteresti ng.com/dea dlynightshade.

William Delong, 2021

Slang Terms: à Atropa Belladonna à Devil’s Berries à Naughty Man’s Cherries à Beautiful death

Pharmacology Uses: à Minor burns, abrasions, and skin irrigations Dosing à

1 to 3 g/day usually given as decoction or infusion in 250 mL of water Adverse Reactions à Dilated pupils à GI effects Mechanism of action: à

The active components of belladonna act as competitive antagonist at muscarinic receptors and block the binding of acetylcholine to the CNS and parasympathetic postganglionic muscarinic receptors.

Botany:

Bittersweet Nightshade is a member of the same family as the potato, tomato, and belladonna. It is a vine like perennial that can grow to three meters. It has alternating heart-shaped oval leaves that have two small ear like segments at their bases. It’s star shaped flowers bloom from April to September. These flowers are a pink-purple color with bright yellow stamens. The flowers produce berries that turn bright red when mature.

Toxicology:

Laws regarding Nightshade: à

Both the immature and ripened fruit are toxic.

The FDA classifies this as an unsafe poisonous herb because of the presence of the toxic spirosolane glycoalkaloids. These cause hemolytic and hemorrhagic damage to the GI tract.

Nightshade is uncontrolled in the United States. This means that all parts of the plant and its extracts are legal to cultivate, buy, possess, and distribute without a license.

Symptoms of poisoning

à Circulatory and respiratory depression à Convulsions à Diarrhea à Dilated pupils

Professional opinion: This drug in the last history was used to help women feel young by the dilution of their eyes. This drug has tons of interactions and has such a fatal dose. I would not recommend this drug or plant to anyone, since th e berries are so potent and easy to kill ~ K. Kimbrough

Botany gone bad. Zack Sterkenber. https://www.ambius.com/blog/botany-gonebad-the-history-of-the-deadly-nightshadeplant/

Monitoring Nightshade: The flowers are easy to spot from midMay to late fall. It is important to monitor these areas.

Drug testing monitoring: Scopolamine Test

Anastasiia Nastyna. Drawing of Nightshade. https://www.dreamstime.com/hand- drawn-deadly-nightshadeflower-set-purple-flowers-green-leaves-buds-berries- beigebackground-vector-floral-elements-image157108244

à

References: Nightshade. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 13, 2022. Http://online.lexi.com à Nightshade. The Vaults of Erowid. Accessed October 13, 2022. https://www.erowid.org/herbs/nightshade/nightshade.shtml à 6 Facts You Didn’t Know about Nightshade. Accessed October 13, 2022. https://chhs.source.colostate.edu/6-facts-didnt-know-nightshades/ à Michael Largo. The Big, Bad Botany: Deadly Nightshade. https:// slate.com/technology/2014/08/poisonous-plants-belladonnanightshade-is-the-celebrity-of-deadly-flora.html

Nitrous oxide (NO) Kelly Gole Student pharmacist Fall 2022

History and Background The discovery of nitrous oxide was in the year 1772 by an English scientist named Joseph Priestly. It was first used by a dentist named Dr. Horace wells as an anesthetic for dental procedures. 2 It is gas drug and is taken by inhaling froma mask in a dentist’s office, or fromsomething like a balloon or a canister when it is abused.1

Slang Terms

Drug Effects

The following are other names used for nitrous oxide1

Some effects a person uses nitrous oxide will feel are1

Laughing Gas

N2O

Euphoria

Numbness

NOS

Nitro

Sedation

Uncontrolled Laugh

Nangs

Whippet

Blurry Vision

Confusion

Hippy Crack

Balloons

Sweating

Fainting

Hypotension

Weakness

Drug Interactions and Toxicology There are a fair amount of different interactions nitrous oxide has with other medications. Of note, any drugs that may also cause CNSdepressant effects such as alcohol, opioids, and other medications like Ambien. Therefore, it is very important to avoid taking this medication while on any other depressants, because of the enhanced depressive effect.3

Monitoring and Drug Screens When this drug is being used, it is important to watch for any rebound hypertension that can result.3 Also, it is not on routine drug screening panels, but can be detected in the urine.5

Professional Opinion My professional opinion about the use of nitrous oxide is that it is applicable for dental procedures, but should not be prescribed for any other reason than anesthesia to help prevent supply from reaching the general public. ~K. Gole

Laws It is illegal for a person to possess or sell nitrous oxide with the intention of abusing it. It is also illegal to sell this medication to anyone under the age of 18. However, this medication is not a controlled substance. Therefore, it is able to be prescribed by providers. It is specifically supposed to be used as an anesthetic for dental procedures.4

References 1.

2.

3.

4.

5.

Nitrous oxide - Alcohol and Drug Foundation. Adf.org.au. Accessed October 7, 2022. https://adf.org.au/drug-facts/nitrousoxide/#:~:text=Other%20names Nitrous Oxide common use is also called laughing gas or happy gas due to its intoxicating effects when inhaled. www.cornerstonedentistrybrantford.ca. Accessed October 7, 2022. https://www.cornerstonedentistrybrantford.ca/site/blog/2016/04/05/a-brief-history-of-happy-gas-nitrousoxide#:~:text=Nitrous%20Oxide%20is%20also%20called Nitrous Oxide. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 13, 2022. http://online.lexi.com Is Nitrous Oxide Legal - What You Need to KnowAbout N2O. ARISE® Network. Accessed October 7, 2022. https://www.arisenetwork.com/is-nitrous-oxide-legal/ Jamanetwork.com. Published 2022. Accessed October 13, 2022. https://jamanetwork.com/journals/jamapediatrics/fullarticle/204517#:~:text=Inhaled%20nitrous%20oxide%20can%20be

NUTMEG – WHAT IS IT? IS IT ABUSIVE?

BY JEREMY SEO KIM, 2ND PROFESSIONAL YEAR PURDUE COLLEGE OF PHARMACY FALL 2022

SLANG TERMS Buah Pala, Jaatipatree, Jaiphal, Jatiphal, Jatiphala, Jatiphalam, Magic, Muscade, Muscade et Macis, Muscadier, Muskatbaum, Muskatnuss, Myristica, Myristica Oil, Myristicae Semen, Noix de Muscade, Noix de Muscade et Macis, Nuez Moscada, Nuez Moscada y Macis, Nutmeg, Nux Moschata, Ron Dau Kou

HISTORY OF NUTMEG Nutmeg and mace are two commonly used spices originating from the same tree, Myristica fragrans. The tree is indigenous to the Banda Islands of Indonesia, and is now cultivated in other tropical regions, such as Malaysia and the Caribbean.

Nutmeg from Indonesia is known to have been in the medieval diet of peoples living as far away as the modern Czech Republic. There are reports of nutmeg intoxication dating back to 1576. During the 1990s, plant drugs such as nutmeg increased in popularity among recreational drug users. More recently, the nutmeg challenge has involved the ingestion of large quantities of nutmeg by children in order to gain a natural "high."

PHARMACOLOGY/DRUG EFFECTS Analgesic effects Traditionally, nutmeg is used topically as an analgesic. There is evidence from animal research that nutmeg has analgesic effects, possibly by decreasing the inflammatory enzyme cyclooxygenase-2.

Antidepressant effects Nutmeg has traditionally been used for anxiety.

Some evidence from animal research suggests that nutmeg extracts exhibit antidepressant-like activity. This is possibly related to the activation of either the 1-adrenoceptors or dopamine (D2) receptors.

Sexual effects Nutmeg is traditionally used as an aphrodisiac.

Evidence from animal research suggests that oral intake of 50% ethanol extract of nutmeg increases libido and potency in male rats.

www.medicalnewstoday.com

DRUG INTERACTIONS/TOXICOLOGY Cholinergic Drugs Evidencefromanimal research suggests that nutmeg extract can inhibit acetylcholinesterase and might increase acetylcholine levels. Theoretically, concurrent use of nutmeg with other cholinergic drugs might have additive effects and increase the risk of cholinergic side effects.

Phenobarbital Some evidence from animal research suggests that myristicin, a constituent of nutmeg, can reduce sleeping time in rats pretreated with phenobarbital.

Theoretically, concomitant use may decrease the therapeutic effects of phenobarbital.

LAWS BEHIND NUTMEG Nutmeg legal in all states. ABC news in 2010 wrote an article about nutmeg saying that “FDA has no plans to regulate the spice.”

DRUG SCREENS FOR NUTMEG

REFERENCES

The drug screenings for nutmeg are not very common for patients. According to a search on PubMed, there were evidence that when high dose of nutmeg was ingested, it would show up in the urine. To detect the nutmeg in the urine, the researchers had to isolate it by gas chromatography and mass spectroscopy.

1. Maloney C. Indonesia's great frontier and migration policy. UFSI Rep. 1987; (30):1-11.

2. Culíková V. Assortment of the plants in the Medieval diet in Czech countries (based on archaeobotanical finds).

Acta Univ Carol Med (Praha).

2000;41(1-4):105-118.

3. Atherton RR. The 'Nutmeg Challenge': a dangerous social media trend [published online ahead of print, 2020 Jul 3]. Arch Dis Child.

2020;archdischild-2020-319407. doi:10.1136/archdischild-2020-319407 4. Nutmeg, Natural Medicine. TRC. Accessed October 11, 2022. https://naturalmedicines.therapeuticre search.com/ 5. Nutmeg Treated as Drug for Hallucinogenic High. ABC News.

Accessed October 12, 2022. https://abcnews.go.com/Health/largedoses-nutmeg-hallucinogenichigh/story?id=12347815 Beyer J, Ehlers D, Maurer HH. Abuse of nutmeg (Myristica fragrans Houtt.): studies on the metabolism and the toxicologic detection of its ingredients elemicin, myristicin, and safrole in rat and human urine using gas chromatography/mass spectrometry.

Ther Drug Monit.

2006;28(4):568-575. doi:10.1097/0000769 1-200608000-00013 6. Neukamm MA, Schwelm HM, Vieser S, Schiesel N, Auwärter V. Detection of nutmeg abuse by gas chromatography-mass spectrometric screening of urine. J Anal Toxicol.

2020;44(1):103-108. doi:10.1093/jat/ bkz054

https://www.news-medical.net/

PROFESSIONAL OPINION

https://www.costco.com/

Nutmeg is a very common spice we can find in grocery stores. A lot of products in the grocery store also include nutmeg as an ingredient. Since it is a very common spice as an ingredient, I believe that someone or some child could accidentally overdose on nutmeg.

I believe that nutmeg is not a type of ingredient/drug where frequent substance users would go out and intentionally ingest large amount of nutmeg. In conclusion, I believe that nutmeg is a safe and should not be regulated, but just to be careful when adding too much of nutmeg as an ingredient. ~ J. Kim

A Guide to Phencyclidine Jacob Lindsey Student Pharmacist Fall 2022 Pharmacology/ Drug Effects

American Addiction Center. Accessed Oct 13, 2022. https://americanaddictioncenters.org/pcp-abuse/effects-and-dangers

History of PCP/ Background of Use/ Abuse

Phencyclidine is believed to have many effects throughout the brain. Primarily it has a strong affinity for the NMDA receptor where it binds and blocks it. This causes reduced activity of glutamate, which is an excitatory neurotransmitter in the brain that deals with memory and cognitive function.

PCP was first synthesized in 1956. It was initially tested as an intravenous anesthetic with potential to be more effective than other drugs used in the same way. Soon, it became evident that PCP can lead to harmful side effects like severe agitation and delirium.

Additionally, PCP deals with serotonin, norepinephrine, and dopamine modulators. The drug blocks the reuptake of these neurotransmitters so that more is readily available in the brain. Since, these chemicals are associated with reward, alertness and happiness, the mechanism of action and drug effects correspond.

Even though it was soon restricted to veterinary medicine, PCP became a popular drug of abuse. As a powder, the drug can be rolled and smoked. The crystalline form as well as the powder can be injected.

PCP also has stimulatory effects on the enzyme tyrosine hydroxylase. This enzyme works to convert tyrosine to molecules like dopamine and norepinephrine. In turn, even more dopamine and norepinephrine become available in the brain.

Small doses of PCP are reported to give the user a feeling of numbness. As doses increase, users note feelings associated with analgesia as well as effects like hallucinations and confusion.

Slang terms Just like many illicit drugs, there are a plethora of slang terms used to identify PCP. Some examples of these terms include Angel dust, belladonna, black whack, CJ, cliffhanger, crystal joint, Detroit pink, elephant tranquilizer, hog, magic, Peter Pan, sheets, soma, TAC, trank, white horizon and zoom.

What is PCP. Partnership to End Addiction. Accessed Oct. 13, 2022. https://drugfree.org/drugs/what-is-pcp/

Panel Drug Test Kit. Amazon. Accessed Oct. 13, 2022. https://www.amazon.co m/Prime-Screen-PanelMulti-TDOA7125/dp/B072B5T14T

Drug Interactions/Toxicology At around 2-5 mg of PCP, effects of the drug are often described as euphoria, unpredictability, disorientation, and aggression. By the time the dose is increased to 25 mg, PCP becomes a lot more toxic. 25 mg of PCP is associated with coma, hyperthermia, convulsions and death.

The effects of PCP can be magnified when the drug is used alongside other drugs with similar effects.

For example, severe hypotension can result from the combined use of PCP and chlorpromazine. In addition, drugs like barbiturates and alcohol become much stronger CNS depressants in the presence of alcohol.

Laws PCP is an illegal substance. It is recognized as a Schedule II drug according to the Controlled Substance Act. This means that the drug has a very high potential for abuse. The conscious possession of PCP is automatically a level 6 felony which constitutes at least a 6-month sentence.

Monitoring/Drug Screens PCP can be monitored through several different drug tests. These include urine, hair, and saliva drug tests. Testing the urine will detect PCP that has been in the system for five hours to two weeks.

The hair test will detect PCP that has been in the system for up to 90 days. The saliva test will detect the drug for up to three days after use.

Professional Opinion On the matter of PCP, I believe that this drug had some promising effects as an anesthetic. However, due to its ability to cause aggression and irritability, it is rightfully not used often. With this in consideration, a Schedule II designation is appropriate because PCP obviously has a high abuse potential with little therapeutic use. ~ J. Lindsey

References The PCP story. California Narcotics Officers’ Association.

Published Oct 13, 2012. Accessed Oct 13, 2012. https:// www.cnoa.org/documents/NPCP.pdf A parent’s guide: drug slang. Department of Behavioral Healthcare Developmental Disabilities and Hospitals.

Published Oct 2015. Accessed Oct 13, 2012. Dhttps:// bhddh.ri.gov/sites/g/files/xkgbur411/files/docu ments/ Drug-Slang---guide-FINAL.pdf Bey T, Patel A. Phencyclidine intoxication and adverse effects: a clinical and pharmacological review of an illicit drug. Cal J Emerg Med. Feb 2007;8(1):9-14.

Daubner SC, Le T, Wang S. Tyrosine hydroxylase and regulation of dopamine synthesis. Arch Biochem Biophys.

Apr 1, 2011;508(1):1-12. doi: 10.1016/j.abb.2010.12.017 Effects and Dangers of PCP use. American Addiction Centers. Updated Sep 9, 2022. Accessed Oct 13, 2022. https://americanaddictioncenters.org/pcp-abuse/effectsand-dangers Fort Wayne attorney defends PCP charges throughout Indiana. The Law Offices of Ryan E. Lackey. Accessed Oct 13, 2022. https://www.defendingfortwayne.com/practiceareas/drug-crimes/pcp/ Phencyclidine (PCP) Drug Test. National Drug Screening, Inc. Accessed Oct 13, 2022. https://www.nationaldrugscreening.com/phencyclidinedrug-test/

Finding Professional PCP Addiction Treatment. New Beginnings.

Accessed Oct. 13, 2022. https://www.newbeginningsdrugrehab.org/pcp-rehab/

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figure 1 Jon . Jtbnson. Peyote. nt10S://wn.medlcI1news1oaay.cIm/artlcleS/peyote. Published June 21, mo. Access OCll118tir,'1Dn.

History/Background

Slang .terms

Peyote is a cactus containing the hallucinogen mescalineThe crown of the cactus is full of small disc like buttons.

It is native to the southwestern United States and northern Mexico but is cultivated all over the world. Peyote has been used in tribal ceremonies by indigenous cultures in North America since 1000 BC.l)

Drug slang and code words are often used to describe controlled substances, designer drugs, and synthetic compounds, which may cause confusion for clinicians attempting to treat patients under the influence.

Some slang terms for peyote are black button, britton, button, cactus; green button, half moon, hikori, hikuli, hyatari, nubs, seni, shaman, or tops.2)

,

.

Pharmacology/drug effects The secondary metabolites found in peyote produce psychosis-like symptoms and can alter perception, feelings, thoughts, and mood, without being addictive. Peyote is reported to initiate states of introspection and insight that have been described as being of a spiritual nature. Hallucinogens bind with high affinity and activate the serotonin 5-hydroxytryptamine receptor.3)

Rgure !.Nali1nI1 ceater tor 1101ee11no1ogy 1n1onaatlon. PubCb111 compound summary tor CID 1076, 11escatine. hllJls://Dubchem.ncbl.Dlm.oluovIcc,mpoaod/Mescallne. Accessed Ocl n, 20n.

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None well documented, but additive effects are likely if used with other hallucinogenic compounds. . · Mescaline from peyote is distributed to the liver and brain. A revie_w of the California Poison Control System database records from 1997 to 2008 suggest mild to moderate toxicity from peyote consumption or . insufflation; adverse reactions include hallucinations, tachycardia, agitation, and mydriasis. Addiction and dependence are mostly absent, and most intoxications appear to be mild and unlikely to produce life­ threatening symptoms.3) By 1930, over a dozen states in the United States had outlawed possession of peyote, and in 1967, peyote was banned nationwide by ,.I.

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PROPOFOL

Lauren Martinez Student pharmacist, Purdue University College of Pharmacy Fall 2022

Propofol Injection 1% 10mg/mL 20mL Vial. DV Medical Supply, Inc. Accessed October 12, 2022. https://dvmed.com/PropofolInjection-1-10mgmL-20mL-Vial_p_4726.html

Other Names

History & Background

Diprivan® (Brand)

Propofol was approved by the FDA in 1989 for induction and maintenance of anesthesia during surgeries.

"Milk of Anesthesia"

It is also indicated for ICU sedation of intubated and mechanically ventilated patients.

It was initially developed as an alternative for thiopental and methohexital, which both had significant post-op fatigue, nausea, vomiting, and cognitive impairment.

Propofol gained worldwide attention in 2009 when singer Michael Jackson died of a propofol overdose while using the drug as a sleep aid.

Today, propofol abuse is almost exclusively seen in medical professionals, especially anesthesia providers.

Propofol abuse accounts for 1.6% of all healthcare addiction cases.

Animal studies have found that propofol use can result in physical dependence due to dose-dependent symptoms of a "high".

Propofol (2,6-Diisopropylphenol) MedChemExpress. Accessed October 12, 2022. https://www.medchemexpress.com/propofol.html

Pharmacology Propofol is thought to produce its sedative/anesthetic effects by positive modulation of the inhibitory function of the neurotransmitter GABA through GABAa receptors.

IV Propofol usually induces anesthesia within 40 seconds after the start of administration.

The duration of sedative action is 3 to 10 minutes depending on the dose, rate, and duration of treatment.

Half-life is bi-phasic, with the initial being 40 minutes and the terminal being 4 to 7 hours.

Propofol has a large volume of distribution and is highly lipophilic.

Metabolism is mainly hepatic, and excretion is via urine.

Interactions/Toxicology

Laws & Restrictions

Propofol should be avoided in use with other CNS depressants such as alcohol, azelastine, bromperidol, flunarizine, kratom, olopatadine, orphenadrine, oxomemazine, and thalidomide.

In a statement by AANA and ASA: “Whenever propofol is used for sedation/anesthesia, it should be administered only by persons trained in the administration of general anesthesia, who are not simultaneously involved in these surgical or diagnostic procedures. ... failure to follow these recommendations could put patients at increased risk of significant injury or death.”

Propofol may enhance the QTc- prolonging effect on QT-prolonging agents and combination may increase the risk for ventricular arrhythmias.

Propofol may cause bradycardia and should be used with caution with other medications such as betablockers, neostigmine, neuromuscular blockers, and opioids.

Propofol can cause hypertriglyceridemia, which can lead to acute pancreatitis.

Propofol may cause severe hypotension and should be used with caution in those with hypovolemia, sepsis, and shock.

Propofol abuse has been linked to mortality rates greater than 33%.

References

White PF, Warner DS. Propofol: its role in changing the practice of anesthesia. Anesthesiology. 2008; 109:1132–1136. doi:10.1097/ALN.0b013e31818ddba8 Study shows rising rate of propofol abuse by health care professionals. ScienceDaily. Accessed October 12, 2022. https://www.sciencedaily.com/releases/2013/03/130318131212 .htm Propofol: the drug that killed Michael Jackson. Harvard Health.

Accessed October 12, 2022. https://www.health.harvard.edu/blog/propofol-the-drug-thatkilled-michael-jackson201111073772#:~:text=Aglio%20showed%20me%20a%20small Propofol. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 12, 2022. http://online.lexi.com ​Statement on Safe Use of Propofol. www.asahq.org. https://www.asahq.org/standards-and-guidelines/statementon-safe-use-of-propofol Propofol Injectable Emulsion. Package insert. Dr. Reddy's Laboratories Inc; 2017 Office of the Federal Register. Schedules of Controlled Substances: Placement of Propofol Into Schedule IV; Proposed Rule. 2010.

Propofol Drug Test. Health Street. Accessed October 13, 2022. https://www.health-street.net/drugtests/substances/prescription/propofol/#:~:text=to%20Quick% 20Links-

In 2010, the US DEA proposed the classification of propofol as a schedule IV controlled substance, which was not successful.

There are currently no federal or state laws surrounding propofol use or administration, and it is not considered a controlled substance.

Monitoring/Drug Screens Per the American Society of Anesthesiologists, vital signs should be taken continuously during propofol administration to monitor signs of hypotension, bradycardia, apnea, airway obstruction, or oxygen desaturation, as well as to assess consciousness.

Exhaled CO2 should also be monitored.

Exposed neonates should be monitored for hypotonia and sedation.

Propofol can be detected by Health Street’s Propofol Hair Test approximately 90 days back, although it is not normally included in standard drug tests.

Professional Opinion

In my opinion, I believe that propofol should be considered a controlled substance due to the increasing abuse by healthcare professionals and the high instances of mortality (>33%) resulting from abuse. I also find that the proven physical dependence after use qualifies the drug to be classified as a controlled substance.

Since propofol is an IV drug and is only available for use in in-patient settings, classification as a controlled substance would not directly affect patient acquisition for anesthesia, but instead would increase security of storage and decrease the ease of access for medical professionals.

- Lauren Martinez

PSILOCYBIN

Kristen Lyons, 2nd-Year Professional Student Fall 2022

Shutterstock. Mexican Magic Mushroom. https://sciencenordic.com/mushroom-society-and-culture/headingtowards-mushroom-wonderland/1969857

History

Slang Terms

There are over 180 different types of mushrooms that contain psilocybin. They have been used in different parts of Mexico for over 2,000 years. It has also been used in spiritual and ritual ceremonies. 2

Magic Mushrooms, Shrooms, 1 Boomers, Mushies, and God's flesh

Is it Legal?

https://www.npr.org/sections/health-shots/2019/05/07/720828367/ a-growing-push-to-loosen-laws-around-psilocybin-treat-mushrooms-asmedicine

Psilocybin is an illegal substance. It is a Schedule 1 under the Controlled 1 Substance Act. In 1968, the possession of psilocybin mushrooms became illegal in the 1 United States

Pharmacology

Psilocybin is a prodrug that gets converted to psilocin which has 1 psychedelic properties similar to LSD.

How is it abused?

Psilocybin-containing mushrooms are one of the most commonly available natural psychedelics The mushrooms are ingested orally.

They can be brewed into tea or mixed 3 with other flavors to hide their taste.

iStock; Adobe Stock. Mushrooms like Chaga, shown here, are known as adaptogens, which help the body adapt to stress.https://www.everydayhealth.com/diet-nutrition/mushroomtea-will-it-make-you-healthier/

Erowid. Psilocybin. https:// www.erowid.org/plants/ show_molecule.php? i=mushrooms/ psilocybin_3d.jpg

Erowid. Psilocin. https:// www.erowid.org/plants/ show_molecule.php? i=mushrooms/ psilocybin_3d.jpg

It has a high potential for abuse and there is no known medical 5 benefit for it in the United States

PSILOCYBIN

Shutterstock. Mexican Magic Mushroom. https://sciencenordic.com/mushroomsociety-and-culture/heading-towards-mushroom-wonderland/1969857

Kristen Lyons, 2nd-Year Professional Student Fall 2022

Drug Interactions This drug should not be taken with MOA Inhibitors such as antidepressants 4

You should not drive or operate machinery while taking this drug

Peter Dejong, AP File. Magic Mushrooms. https://www.nbcnews.com/news/us-news/denver-voters-weigh-decriminalizationmagic-mushrooms-n966256

Professional Opinion Since there are no known medical benefits, psilocybin mushrooms are not accepted by the medical society or the general public. ~ K. Lyons

References 1. Psilocybin Mushroom Basics. Erowid. Created January 29, 2000.

Updated November 9, 2018. Accessed. October 12, 2022. https://www.erowid.org/plants/mushrooms/mushrooms_basics. shtml.

2. Psilocybin Fast Facts. National Drug Intelligence Center. Created August 2003. Accessed October 12, 2022. https://www.justice.gov/archive/ndic/pubs6/6038index.htm#:~:tex t=To%20Top-,Is%20psilocybin%20illegal%3F,purpose%20in%20the% 20United%20States.

3. Psilocybin. American Chemical Society. Published October 2, 2022. Accessed October 12, 2022. https://www.acs.org/content/acs/en/molecule-of-theweek/archivepsilocybin.html#:~:text=In%201958%2C%20Swiss%20ch emist%20Albert,%E2%80%9Cfather%20of%20LSD%E2%80%9D.) 4. Psilocybin. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 12, 2022. Available at: http://online.lexi.com 5. Lowe H, Toyang N, Steele B, et al. The Therapeutic Potential of Psilocybin. Molecules. 2021;26(10):2948. Published 2021 May 15. doi:10.3390/molecules26102948

Do they show up in a drug test?

Psychadelic mushrooms do not show up in a common 5, 8, 10, 12 panel test, but there are drug screens specifically designed to detect mushrooms

Effects

Getty Images. Psilocybin is a natural hallucinogen. https://www.medicalnewstoday.com/articles/308850

The main physical effects include nausea, vomiting, euphoria, muscle weakness, relaxation, lack of 1 coordination, and drowsiness

Onset: the effects are normally seen within 30-60 minutes Duration: When taken orally, the effects usually last 4-6 hours Visual effects: the pupils will dilate which makes colors seem brighter. Colors can shift and the visual field 4 can seem smeared The experience is called "tripping" or "shrooming"

PSUEDOEP HEDRINE Austin Lowe Student Pharmacist Professional Year 2 Fall 2022

https://en.wikipedia.org/wiki/ Pseudoephedrine

It was first characterized in 1889, by the German chemists Ladenburg and Oelschlägel, who used a sample that had been isolated from Ephedra Vulgaris by the Merck pharmaceutical corporation of Darmstadt, Germany.

Pseudoephedrine as we know it has been around since the 1920s. Although the drug occurs naturally in certain plants (eg, ma huang), the majority that is produced derives from the yeast fermentation of dextrose in benzaldehyde.

Pharmacology Pseudoephedrine causes vasoconstriction which leads to a decongestant effect. It has a short duration of action unless formulated as an extended release product. Patients should be counselled regarding the risk of central nervous system stimulation.

Pseudoephedrine is a sympathomimetic with a mixed mechanism of action, direct and indirect. It indirectly stimulates alpha-adrenergic receptors, causing the release of endogenous norepinephrine (NE) from the granularity of neurons, while it directly stimulates beta-adrenergic receptors [11,12,13].

Drug Interactions

https://americanaddictioncenters.org/over-the-counter-medications/pseudoephedrine

Some products that may interact with this drug include stimulants (such as caffeine, dextroamphetamine, methamphetamine, herbal products like ephedra/ ma huang), and terbutaline.

Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.

Pseudoephedrine may decrease the effectiveness of blood pressure medications (such as beta blockers, calcium channel blockers, guanethidine, and methyldopa).

The Law The Combat Methamphetamine Epidemic Act of 2005 has been incorporated into the Patriot Act signed by President Bush on March 9, 2006. The act bans over-the-counter sales of cold medicines that contain the ingredient pseudoephedrine, which is commonly used to make methamphetamine.

The sale of cold medicine containing pseudoephedrine is limited to behind the counter. The amount of pseudoephedrine that an individual can purchase each month is limited and individuals are required to present photo identification to purchase products containing pseudoephedrine. In addition, stores are required to keep personal information about purchasers for at least two years.

Drug Screens Pseudoephedrine is commonly used for sinus and nasal congestion, pseudoephedrine may cause false positive test results for amphetamine or methamphetamine.

Slang Terms Pseudoephedrine has no street nicnames by it self its street names most coincide with what drug it is being used in to make. Some examples of those slang terms include Chalk, Crank, Meth, Speed.

Yhttps://www.walmart.com/ip/Sudafed-Sinus-Congestion-Maximum-Strength-Decongestant-Tablets-24-ct/10801491

History and Background

https://imgflip.com/i/pydyc

Professional Opinion Pseudoephedrine (PSE) is a drug with a long history of medical use; it is helpful in treating symptoms of the common cold and flu, sinusitis, asthma, and bronchitis. Due to its central nervous system (CNS) stimulant properties and structural similarity to amphetamine, it is also used for non-medical purposes. The substance is taken as an appetite reducer, an agent which eliminates drowsiness and fatigue, to improve concentration, and as a doping agent.

According to the Pharmaceutical Journal “Pseudoephedrine is a proven nasal decongestant, for which there is subjective and objective evidence that it reduces blockage, improves breathing and helps patients feel better."

The onset of action occurs after 30 min and after 1–4 hours the 8 drug reaches its maximum concentration in the blood.

When using the extended-release formulation, this time is twice as long.

Abuse Teens may be more likely to abuse pseudoephedrine and a common practice is to combine it with alcohol. This practice is very dangerous and may result in overdose because the stimulating effects of pseudoephedrine can dampen the effects of alcohol, making a person more likely to drink more than they normally would.

The most common form of pseudoephedrine abuse is using it to make methamphetamine.

This involves chemically altering the pseudoephedrine into an ingredient that can be used in the meth “cooking” process. While the process of converting pseudoephedrine to make meth is fairly simple, it’s also extremely dangerous and can cause explosions or fires.

Misusing pseudoephedrine in this way is extremely addictive and meth can cause serious physical and psychological side effects that can last for weeks, months, years, or even a lifetime.

Although the Combat Methamphetamine Epidemic Act has made pseudoephedrine more difficult to acquire, the abuse of methamphetamine is still rampant in the U.S. and contributes to the number of ER visits, law enforcement resources used, crimes committed, and serious health problems plaguing Americans.

References

Pseudoephedrine. React (Auckl). 1988;213(1):11-11. doi:10.1007/bf03280830 PubChem. Pseudoephedrine. Nih.gov. Accessed November 7, 2022. https://pubchem.ncbi.nlm.nih.gov/compound/Pseudoephedrine Głowacka K, Wiela-Hojeńska A. Pseudoephedrine-benefits and risks. Int J Mol Sci. 2021;22(10):5146. doi:10.3390/ijms22105146 Bezrutczyk D. Drug street names. Addiction Center. Published November 8, 2018. Accessed November 7, 2022. https://www.addictioncenter.com/drugs/drug-street-names/ Drugs.com. Accessed November 7, 2022. https://www.drugs.com/druginteractions/pseudoephedrine.html Center for Drug Evaluation, Research. Legal Requirements for the Sale and Purchase of Drug Products Containing Pseudoephedrine, Ephedrine, and phenylpropanolamine. U.S. Food and Drug Administration. Accessed November 7, 2022. https://www.fda.gov/drugs/information-drugclass/legal-requirements-sale-and-purchase-drug-products-containing-pseudoephedrineephedrine-and Gragnolati AB. 10 medications that can cause a false positive on drug tests. GoodRx. Published July 18, 2017. Accessed November 7, 2022. https://www.goodrx.com/drugs/side-effects/thesemedications-can-cause-a-false-positive-on-drug-tests Bryan J. Pseudoephedrine is a tough product to challenge as a nasal decongestant. The Pharmaceutical Journal. Published July 17, 2012. Accessed November 8, 2022. https://pharmaceutical-journal.com/article/news/pseudoephedrine-is-a-tough-product-tochallenge-as-a-nasal-decongestant

https://imgflip.com/i/hhm7g

Fall 2022

Pyro (nitazine) Mariah McKinney, Student Pharmacist

History/Background: • Nitazenes were developed about 60 years ago and were originally used for pain relief.

• Nitazenes are synthetic opioids- they are not naturally occurring.

• They are easy to manufacture and cheap to make.

• They are being compared to fentanyl.

• Nitazenes are 20 times more powerful than fentanyl, which is 50 times more potent than other opioids!!

• They were originally sourced from China and recently brought into the United States.

Slang terms: •

•

There are no real slang terms because nitazene is “slang” for the synthetic benzimidazole Similar to fentanyl and fentanyl slang terms include: o Murder 8 o Shine o Friend o Goodfella o TNT o Percopop o China Girl

CH

https://www.dea.gov/stories/2022/2022-06/2022-06-01/newdangerous-synthetic-opioid-dc-emerging-tri-state-area.

Pharmacology/drug effects: • In the form of a powder, ISO (isotonitazene) can look yellow, brown, or off-white in color.

• Side effects from Nitazenes overdoses can include: o shallow, slow, or stopped breathing o bluish nails or lips o pale or clammy skin o confusion o drifting in and out of consciousness o limp muscles o pinpoint pupils o vomiting o weak or no pulse

https://www.dea.gov/stories/2022/2022-06/2022-06-01/newdangerous-synthetic-opioid-dc-emerging-tri-state-area.

Fall 2022 Drug interactions/Toxicology: • Nitazenes may be laced with illicit drugs o including illicitly sold marijuana.

• Nitazene overdose is common.

Laws: • •

There are currently no laws specifically for nitazenes.

However, o Illegal forms of fentanyl are usually in the form of powders or pressed into counterfeit tablets. o Fentanyl is illegal to possess if it is not prescribed to you. o Fentanyl is a schedule II drug since it has a high potential for abuse.

Monitoring/drug screens: • Since nitazene is being compared to fentanyl, the fentanyl drug screens can be done with o Urine o Hair (past 90 days) o Blood (not as

Professional opinion: This drug is new and recently introduced to the United States. With that being the case, there is not a ton of information available regarding this drug. I think it would be best for officials to get ahead of the making and distribution of this drug since it is being compared to fentanyl which is incredibly dangerous and has a high abuse rate.

o common) References: 1. Silverman SH. Dangerous opioid nitazene - a deadly newcomer in the current drug epidemic.

American Addiction Foundation. https://www.americanaddictionfoundation.com/news/dangerous-opioid-nitazene-a-deadlynewcomer-in-the-current-drug-epidemic/. Published December 28, 2021. Accessed October 13, 2022.

2. B M. Nitazenes: New opioids 20 times stronger than fentanyl. American Addiction Foundation. https://www.americanaddictionfoundation.com/news/nitazenes-new-opioids-20-times-strongerthan-fentanyl/. Published December 31, 2021. Accessed October 14, 2022.

3. New, dangerous synthetic opioid in D.C., emerging in Tri-State Area. DEA. https://www.dea.gov/stories/2022/2022-06/2022-06-01/new-dangerous-synthetic-opioid-dcemerging-tri-state-area. Accessed October 14, 2022.

4. Opioid use terms. Opioid Help. https://www.opioidhelp.com/opioids/opioid-use-terms/.

Published August 19, 2020. Accessed October 14, 2022.

5. Fentanyl Drug Test. National Drug Screening. https://www.nationaldrugscreening.com/fentanyldrug-test/. Accessed October 14, 2022.

Pyrovalerone Natalia Fijas, Student pharmacist FALL 2022

common Names

1

Bath salts Ivory wave Vanilla sky Energy-1 MDPV

Structure of Pyrovalerone

https://www.google.com/imgres? imgurl=https%3A%2F%2Fupload.wikimedia.org%2Fwikipedia%2Fcommons%2Fthumb%2F2%2 F22%2FPyrovalerone.svg%2F1200pxPyrovalerone.svg.png&imgrefurl=https%3A%2F%2Fen.wikipedia.org%2Fwiki%2FPyrovalerone& tbnid=fZPSbLXiSolRlM&vet=12ahUKEwjg_5KZpN76AhVJbDABHY4UBhwQMygAegUIARCQAQ..i &docid=EhF_nFO8U2tsWM&w=1200&h=778&q=Pyrovalerone&ved=2ahUKEwjg_5KZpN76AhVJ bDABHY4UBhwQMygAegUIARCQAQ

Mechanism of Action

https://www.google.com/url? sa=i&url=https%3A%2F%2Fwww.aacc.org%2Fcln%2Farticles %2F2014%2Fmarch%2Fbathsalts&psig=AOvVaw0rIafKHu8pICtV8EtN4Tee&ust=16657877 37346000&source=images&cd=vfe&ved=0CAwQjRxqFwoTC Oj4-oal3voCFQAAAAAdAAAAABAE

Pyrovalerone is a synthetic cathinone. Cathinones act by inhibiting dopamine, serotonin, and norepinephrine transporters in the central nervous system. As a result, extracellular concentrations of these neurotransmitters 1,2,3 are increased leading to increased activity of them.

History of Drug Abuse The class of this drug, cathinone, was discovered in the 18th century as a stimulant alkaloid located in the leaves of the khat bush. It used to be commonly consumed in teas. Substances within this drug class were not seen to be abused until the early 21st century when people began to sell them on internet sites as "legal alternatives" to MDMA.4

Khat Bush

https://www.google.com/url? sa=i&url=https%3A%2F%2Fstock.adobe.com%2Fimages%2Ffresh -leaves-of-a-khat-or-qat-bush-cathaedulis%2F300202119%3Fas_campaign%3Dftmigration2%26as_c hannel%3Ddpcft%26as_campclass%3Dbrand%26as_source%3Df t_web%26as_camptype%3Dacquisition%26as_audience%3Duser s%26as_content%3Dclosure_asset-detailpage&psig=AOvVaw3vQzdk8sIzUaihFmE7HfcB&ust=16657902190 28000&source=images&cd=vfe&ved=0CAwQjRxqFwoTCLiJoKWu 3voCFQAAAAAdAAAAABAm

5

how is it used?

Snorted swallowed injected Rectally smoked

Laws about Pyrovalerone In 2012, the DEA classified substances found in bath salts, including pyrovalerone, as Schedule I controlled substances. This means there is no legally defined medical use for pyrovalerone and that it has a high potential for abuse.6

Drug Screening for 7 pyrovalerone Blood tests

urine tests

Interactions with prescription Medications The class of drugs pyrovalerone lands under, cathinones, has an overlapping metabolic pathway with antidepressants and ADHD medications. When combined, cathinones can increase the serum 3,4 concentrations of these medications.

Hair sample

Professional Opinion

https://www.forbes.com/site s/melaniehaiken/2012/06/04 /bath-salts-a-deadly-newdrug-with-a-deceptivelyinnocent-name/? sh=77c0a4d1121e

SYmptoms to 5 watch for

Pyrovalerone is a complex drug with a high risk for abuse. It is interesting to see how it used to be tried to be sold as a legal euphoria alternative to MDMA but shortly after was defined as a Schedule I controlled substance with no medical use. I believe the government has taken the necessary steps and percautions to ensure the safety of ↑ concentraion/alertness people and hopefully prevent the use of this drug. ~N. Fijas

references: 1. Drug Enforcement Administration. 3,4-Methylendioxypyrovalerone (MDPV).

2019.

2. Bauman MH, Bukhari MO, Lehner KR, et al. Neuropharmacology of 3,4Methylenedioxypyrovalerone (MDPV), Its Metabolites, and Related Analogs. Curr Top Behav Neurosci. 2017;32:93-117. doi:10.1007/7854_2016_53.

3. Souders CL, Davis RH, Qing H, et al. The psychoactive cathinone derivative pyrovalerone alters locomotor activity and decreases dopamine receptor expression in zebrafish (Danio rerio). Brain Behav. 2019;9(11). doi:10.1002/brb3.

4. Karila L, Megarbane B, Cottencin O, et al. Synthetic Cathinones: A New Public Health Problem. Current Neuropharmacology. 2015;13(1):12-20. doi:10.2174/1570159X13666141210224137

hallucinations talkativeness rapid heart rate

dilated pupils

5. Pucky M. Bath Salts Drug. Drugs.com. Updated May 19, 2022. Accessed October 13, 2022. https://www.drugs.com/illicit/bathsalts.html 6. Erowid. MDPV Legal Status. The Vaults of Erowid. Accessed October 13, 2022. https://www.erowid.org/chemicals/mdpv/mdpv_law.shtml 7. Lindsay Glicksberg, Kelsie Bryand, Sarah Kerrigan. Identification and quantification of synthetic cathinones in blood and urine using liquid chromatography-quadrupole/time of flight (LC-Q/TOF) mass spectrometry. Journal of Chromatography B. 2016;1035:91103.

History/Background Rohypnol, generically known as flunitrazepam., originated in Switzerland when Hoffman La Roche Pharmaceuticals developed it for insomnia and anesthesia induction in 1975.¹ It was then used recreationally in Europe in the late 1970s. In 1983, Rohypnol received a Schedule IV classification, making it illegal to use without a prescription.¹ However, the FDA banned the use of it in the USA, so it was only used in foreign countries. In the early 1990s, it began being imported to the USA illegally, mainly through Mexico, and started to be used as a date-rape drug due to its sedating effects.¹ Rohypnol was seen mainly throughout the 1990s and early 2000s and has since fallen off, though use of it is still seen in the USA, mainly in states bordering Mexico and in cocaine users who use Rohypnol to relieve the uncomfortable side effects of cocaine.

ROHYPNOL MADI ROBERTSON

2nd YEAR PROFESSIONAL STUDENT

FALL 2022

https://www.dea.gov/sites/default/files/2020-06/Rohypnol-2020_

Roofie Ruffies Circles Forget-me-pill La rocha Lunch money drug Mexican Valium Wolfies²

SLANG TERMS

Pharmacology/Drug Effects

Rohypnol is a benzodiazepine used as a sleep medication. It comes in both tablet and suppository dosage form with strengths of either 0.5 or 1 mg. It was developed specifically for sleep, as it has a very rapid onset and long duration. Rohypnol binds nonspecifically to benzodiazepine receptors BNZ1 and BNZ2, thus enhancing the effects of GABA, resulting in a hyper-polarized cell membrane that cannot excite the cell further. The half-life of Rohypnol is over 14 hours, and it has an active metabolite, thus increasing its duration even more.

Rohypnol slows down the functioning of the CNS, so patients taking it will feel drowsiness, decreased anxiety, impaired judgement and mental functioning, confusion, aggression. Rohypnol is so potent that patients can often experience amnesia and pharmacological hypnotic sleep.

Drug interactions/toxicology

Rohypnol interacts poorly with other CNS depressant drugs. Some examples of those include alcohol and heroin. When taken in combination, it significantly increases the risk of overdose. Sedation, slowed heart rate, unconsciousness, and even death can result from the breathing suppression that happens as a result of these interactions.

https://www.dea.gov/sites/default/files/2020-06/Rohypnol-2020_0.p

LAWS

Rohypnol is currently a Schedule IV substance. It is not approved for manufacturing, use, sale, or importation in the United States. This is only in the United States, though, as Rohypnol is manufactured and used legally in other countries.

Monitoring/ Drug Screens: Rohypnol is not tested for in Standard Drug Tests, but it can be tested for in Extended Drug Tests, usually only when use is suspected. Rohypnol can be detected in the urine for 2-4 days after use.

Professional Opinion

Studies have shown that Rohypnol, as a benzodiazepine, works well. It produces muscle relaxant effects, anti-anxiety effects, and sedation. Its long duration helps with insomnia patients, however, its misuse can have extremely damaging and scary effects. The United States views the drug as "not worth the risk", whereas it is used clinically around the world. With the availability of so many other benzodiazepines that do not have such an infamous history, Rohypnol is not a medication whose legal status needs to be reconsidered. ~ M Robertson

References

1. Hoffman La Roche History. Roche. Accessed October 13, 2022. http://www.roche.com/home/company/com_hist_intro 2. Staten C. Roofies: the new 'date rape' drug of choice. Emergency Response & Research Institute. Accessed October 13, 2022. http://www.emergency.com/roofies 3. Inaba D, Cohen W, Holstein M et al. Uppers, downers, and all arounders. CNS. Accessed October 13, 2022. http://www.erowid.org/library/books/uppers_downers 4. Rohypnol. United States Drug Enforcement Administration. Accessed October 13, 2022. http://www.dea.gov/factsheets/rohypnol

Methylphenidate (Concerta, Ritalin)

RX STIMULANTS FOR ADHD – “STUDY DRUGS” Laura Schrock, Student pharmacist Fall 2022

and Amphetamine (Adderall, Vyvanse) AKA Vitamin R, R-ball, Rids, Rit, Diet Coke, Kiddie Cocaine, Skippy, Pineapple, Skittles, Smarties, Poor Man’s Cocaine and Addys, Uppers, Speed, Dexies, Zing, Beans, Black Beauties, Pep Pills

HISTORY OF ADHD DRUGS

Image From: Reference 11

ADHD has been described since the early 1900s, the first report coming from Sir George Frederick Still in 1902.

However, it wasn’t until 1937 that the first medication— Benzedrine (a racemic mixture of amphetamine)—was used for ADHD. Ritalin came to the market in 1955 followed by Obetrol (now known as Adderall) in 1960, and since then these prescription drugs have found their way onto the streets. Also known as “study drugs,” these stimulants are known to enhance concentration and increase energy.

PHARMACOLOGY ADHD stimulants work by increasing the amount of dopamine and norepinephrine (NE) in the brain.

Methylphenidate does this by blocking the reuptake of these neurotransmitters. Amphetamines are sympathomimetics that promote the release of these neurotransmitters and may also block their reuptake.

Increased levels of dopamine and NE can improve memory, concentration, wakefulness, motivation, and attention. Amphetamines also may increase serotonin, histamine, and epinephrine levels, which may lead to other effects such as improvement of mood.

Drug Interactions: •

Antidepressants

•

MAOIs

•

Antihypertensive drugs

•

Other CNS stimulants

Toxicology

•

Alcohol

Too much dopamine and NE can have negative effects such as anxiety, disorganized thinking, and the “jitters.”

Negative physiologic effects include increases in blood pressure and heart rate and decreased sleep.

•

Caffeine

•

Antacids

Fun fact: In 2014, 20% of college students reported abusing prescription stimulant drugs.

Image From: Reference 12

LAWS Prescription ADHD stimulants are classified as Schedule II controlled substances, which identifies them as having a high potential for abuse and dependence. While these are legal prescription drugs, possession without a prescription can lead to substantial lawful penalties. The federal penalty for possession of a CII (1st offense) can be up to a year in prison, a $1000 fine, or both. A 2nd offense can be up to two years in prison, a $2500 fine, or both. Illegal sale and distribution of CIIs can lead to up to 20 years in prison, a $1 million fine, or both.

Monitoring: References: 1.

Street or Slang Names for Drugs. Snohomish Health District. Accessed October 5, 2022. https://www.snohd.org/DocumentCenter/View/2516/Drug_Names_Sla ng_2019_05_09?bidId 2. Iannelli, Vincent. ADHD History and Medication Timeline. Verywell Mind. Updated May 12, 2022. Accessed October 5, 2022. https://www.verywellmind.com/adhd-history-of-adhd-2633127 3. Gunnerson, Tate. A Brief History of ADHD. WebMD. Updated August 25, 2022. Accessed October 5, 2022. https://www.webmd.com/addadhd/adhd-history 4. History and Statistics of “Study Drugs.” American Addiction Centers.

Updated May 6, 2022. Accessed October 5, 2022. https://drugabuse.com/stimulants/adderall/history-and-statistics-ofstudy-drugs/ 5. Pirius, Rebecca. Sale and Possession of Amphetamines: Criminal Penalties and Laws. Criminal Defense Lawyer. https://www.criminaldefenselawyer.com/resources/distributionamphetamines-criminal-penalties-and-laws 6. Methylphenidate. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 5, 2022. http://online.lexi.com 7. Amphetamine. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 5, 2022. http://online.lexi.com 8. Estrellado, Nicko. Methylphenidate (Ritalin) Interactions. Addiction Group. Updated September 15, 2022. Accessed October 5, 2022. https://www.addictiongroup.org/drugs/stimulants/ritalin/methylphenid ate-interactions/ 9. How Long does Ritalin Stay in your System? American Addiction Centers. Updated August 19, 2022. Accessed October 5, 2022. https://americanaddictioncenters.org/ritalin/how-long-in-system 10. Amphetamines Drug Test. National Drug Screening Inc. Accessed October 5, 2022. https://www.nationaldrugscreening.com/amphetamines-drug-test/ 11. Coping with an Adderall Crash. Medical News Today. Accessed October 5, 2022. https://www.medicalnewstoday.com/articles/321492 12. Sohl, Dalya. Adderall Abuse. The Evanstonian. Accessed October 5, 2022. https://www.evanstonian.net/archivedfeature/2014/03/10/adderall-abuse/

2

Methylphenidate and amphetamine can be detected with a drug urine analysis for 1-3 days following use.

Many drug tests used by employers will include amphetamines on the drug panel.

Professional Opinion: Prescription stimulants have been used for many years to treat ADHD and narcolepsy. They are effective drugs in medical conditions that may benefit from an increase of dopamine and NE. However, because they act on these popular neurotransmitters, these drugs have the potential for abuse and addiction, which has been verified by the reports of misuse over the years.

However, I don’t think it is beneficial to remove these drugs from the market, since they have positive medical effects and are not as deadly as other abusive drugs. ~L. Schrock

Vinayak Shankar, 2nd Year Professional Student

Fall 2022

Salvia divinorum Background: Salvia divinorum belongs to the mint family, it is a perennial that is often used due to its hallucinogenic effects. This plant is found in Mexico, more specifically the Sierra Mazatec region in Oaxaca. This plant was used in rituals by the Native Mazatec people as a means of ‘medical divination’. They used salvia to treat illness and symptoms that were caused by spiritual means or by evil sorcerers.

Salvia would also be used for spiritual and learning purposes through religious leaders using it to induce ‘shamanic visions’.

Slang terms Ska Pastora

Shepherdess’s Herb Sally-D

Magic Mint

https://www.wwf.org.mx/que_hace mos/programas/oaxaca/

ska Maria Pastora

yerba de Maria

Sage of the Seers

Pharmacology/Drug Effects: Salvia contains a compound names Salvinorin A, which is a selective full agonist of the kappa-opioid receptor. Binding to this receptor is the main cause of the hallucinogenic side effects of salvia; this is interesting as other hallucinogens often bind to serotonin receptors. Some of the most common symptoms people face while using salvia, include vivid and random hallucinations, inability to distinguish time and location, and in some cases can cause psychotic disturbances. After the hallucinations wear off, users often feel dizzy, exhausted and sometimes have no memory of the time they were hallucinating.

https://www.emcdda.europa.eu/publications/drugprofiles/salvia_en

https://psychonautwiki.org/wiki/Salvia_divinorum

https://myplantin.com/plant/3042

Vinayak Shankar, 2nd Year Professional Student

Fall 2022 Drug Interactions/Toxicology: As of now there is limited information regarding any drug interactions with Salvia divinorum, more tests need to be done in order to see whether it is contraindicated along with other therapies. In terms of its toxicity, there has been no documented case of death directly as a result of Salvia divinorum use.

Laws: Salvia is not approved for medical use in the US and is not controlled under the Controlled Substance Act. There are individual states that have decided to control salvia. Due to its lake of control, there are many online sites and individual producers who advertise Salvia as a legal alternative to other hallucinogenic drugs.

Monitoring/Drug Screens: Salvia’s subtypes like hispanica and miltiorrhiza are considered as plants and are completely legal. Salvia Divinorum is not commonly tested for on standard drug tests. Most times you would need to request a specially ordered, very expensive, test to detect it. It is difficult to test for it as it does not show up in sweat and we don’t have a way to test for it in hair. The only ways to test for it are through urine, spit and blood tests. Another limitation on testing is that it does not last very long in the body, there are minimal studies determining the exact amount of time it lasts in the body as well.

Utestdrugtesting.com

Professional Opinion: Salvia divinorum is a plant rooted in the history of the native Mazatec people.

While it may still be used in religious rituals for certain groups of people, recreational use of salvia is still questionable. The lack of studies around its use and potential of interactions are of concern, but we still haven’t come across a case where salvia has caused death. It should be up to the user to do their own research about salvia use and make an educated decision on whether or not to use it. -V. Shankar References • Drug fact sheet: Salvia divinorum - dea.gov. https://www.dea.gov/sites/default/files/202006/Salvia%20Divinorum-2020_0.pdf. Accessed October 14, 2022.

• Salvia Divinorum. Erowid salvia divinorum (ska pastora) vault. https://www.erowid.org/plants/salvia/salvia.shtml. Accessed October 14, 2022.

• Cambron M. A comparison of historical and current use of salvia divinorum in the United States and Mexico. lakeforest.edu. https://www.lakeforest.edu/news/a-comparison-of-historical-and-current-useof-salvia-divinorum-in-the-united-states-and-mexico. Accessed October 14, 2022.

• Salvia Divinorum Drug Profile. emcdda.europa.eu. https://www.emcdda.europa.eu/publications/drugprofiles/salvia_en. Accessed October 14, 2022.

• LaNeve N. How long does salvia stay in your system? - columbus recovery center: Ohio Drug and Alcohol Rehab Facility. Columbus Recovery Center | Ohio Drug and Alcohol Rehab Facility. https://www.columbusrecoverycenter.com/blog/longevity-of-salvia-in-your-system/. Published August 3, 2021. Accessed October 14, 2022.

Scopolamine "Devil's Breath"

https://www.theweek.co.uk/65068/devils-breath-one-of-the-most-dangerous-drugsin-the-world

By: Sydney Pelnick , Student pharmacist Fall 2022

Pharmacology and Drug Effects Scopolamine is an anticholinergic drug that is often used to help prevent and/or treat motion sickness, as well as postoperative nausea and vomiting. It works by competitively inhibiting muscarinic receptors, causing peripheral 1 antimuscarinic effects as well as central sedative, antiemetic and amnestic effects.

By prescription, this medication is available as a transdermal patch.2 However, this drug can also be administered via oral, intravenous and inhalation routes, which seem to be the common methods causing intoxication and overdoses. Toxic doses can present clinically as tachycardia, dry mouth, blurred vision disorientation and insomnia. It has been noted throughout different articles that high doses may result in hallucinogenic properties in addition to amnesia, which could leave someone incapacitated.3

History and Background of Use “Devil’s Breath”, more commonly referred to as scopolamine, originates from the flower of the borrachero shrub found most often within South America. Extracts from the seeds can be made into a powder, which is then referred to as burundanga. According to literature, native South Americans have used borrachero in spiritual rituals for hundreds of years. This drug is chemically similar to scopolamine, and is thought to have amnesic and 2 hallucinogenic effects. Though there is not sufficient evidence to support this claim, it has been rumored that this drug has historically been used by the Nazis and Soviets as a “truth serum”, as well as being used to render victims incapacitated to perform robberies and 4 sexually assault.

Slang Terms Scopolamine Devil's Breath Transderm Scop "Zombie Drug" "Date-Rape Drug" Burundanga

https://rxdruglabels.com/lib/rx/rx -meds/scopolamine/page/4/

Drug Interactions Drugs that are contraindicated with the use of scopolamine include potassium and potassium citrate, which can lead to an increased risk of GI irritation and ulcers.

Drugs that increase the risk of anticholinergic side effects: Revefenacin, Quetiapine, Amantadine Drugs that can cause a reduced seizure threshold: Donepezil, Bupropion, Amifampridine Drugs that may cause CNS depression: Methacholine, Oxybates

Laws Scopolamine is not a controlled substance in the US, but requires a prescription. There are no other specific laws or regulations regarding the use of this drug.

Monitoring and Drug Screens 5 Scopolamine is not commonly included in drug screens since it is rarely used recreationally, however, it can be detected by urine toxicology tests. Though detection of this drug is possible, it is often challenging because it is fully excreted unchanged in the urine within only 12 hours of use.

Professional Opinion In my professional opinion, I do not believe that there is sufficient evidence to support the addition of regulations to the prescribing of scopolamine.

Though high doses of this drug are potentially dangerous, the misuse of scopolamine does not seem to be very prevalent. Additionally, very little evidence exists to prove that this drug is what is being used to commit these alleged crimes. While I do not think changes to the regulation of this medication should be made, I do believe that it would be beneficial to bring awareness to the adverse effects that this class of drug can cause.

- S. Pelnick

References 1. Micromedex Products.

Micromedexsolutions.com. Published 2019. https://www.micromedexsolutions.c om/micromedex2/librarian/PFDefa ultActionId/evidencexpert.DoIntegra tedSearch? navitem=topHome&isToolPage=true # 2. Drugs.com. Devil’s Breath: Urban Legend or the World’s Most Scary Drug? Drugs.com. Published September 7, 2015. https://www.drugs.com/illicit/devil s-breath.html 3. Reichert S, Lin C, Ong W, Him CC, Hameed S. Million dollar ride.

Canadian Family Physician.

2017;63(5):369-370. Accessed November 9, 2022. https://www.ncbi.nlm.nih.gov/pmc /articles/PMC5429053/ 4. “Devil’s breath”: one of the world’s most dangerous drugs?. The Week UK. Accessed November 9, 2022. https://www.theweek.co.uk/65068/ devils-breath-one-of-the-mostdangerous-drugs-in-the-world 5. Devil’s Breath: Why Scopolamine Abuse is So Terrifying. Northpoint Washington. Published May 9, 2019. https://www.northpointwashington. com/blog/devils-breathscopolamine-abuse-terrifying/ 6. Inc MP. Scopolamine - Mylan Pharmaceuticals Inc., Page 4.

RxDrugLabels.com. Accessed November 9, 2022. https://rxdruglabels.com/lib/rx/rx -meds/scopolamine/page/4/

Toad Venom (5-MeO-DMT) , N A T A I

BY MARharmacist Student p

Fall 2022

History and Background: A species of toad, Bufo Alvarius, native to the Sonoran Desert produces a psychoactive chemical, 5-methoxy-N,Ndimethyltryptamine, or 5-MeO-DMT.1 5MeO-DMT is a tryptamine that also naturally occurs in seeds, bark, and leaves in the Amazonian rainforest. The chemical was mainly consumed by licking the toad’s back, but for many years now, shamans in Mexico and southwest US have been collecting the venom, make it into a dry paste, and smoking the venom. Five minutes after ingestion of the substance, the hallucinogenic effect takes place that causes a hour long trip.

Laws: 5-MeO-DMT is a Schedule I controlled substance in the US. There is a 10-year prison sentence for possession of 5-MeO-DMT. Chemical structure of 5-MeO-DMT by Chemspider http:// www.chemspider.com/ChemicalStructure.1766.html

Psychedelic toads by Symbolika https://symbolika.com/products/bufo-alvarius-men-t-shirt-made-to-orderchoice-of-colours-1

Slang Terms: Toad Venom, Cane Toad, Colorado River Toad, Sonoran Desert Toad, and Otac (the venom).

Pharmacology Drug Effects: 5-MeO-DMT is a non-selective serotonin (5-HT) receptor agonist.4 It has the highest affinity for the 5-HT1A subtype. The substance can cause decreased locomotor activity, investigatory behavior, and disturbed thalamocortical oscillations, which are behaviors selective to 5-HT1A receptor activation. The effects of this substance are like other tryptamine psychedelics such as psilocybin and DMT. Toad venom can cause effects like visual, auditory, and time perception distortions, memory impairment, and emotional experiences.

Drug Interactions/Toxicology: There are only a few studies of 5-MeO-DMT in rodents and animals.

In mice , administering 5-MeO-DMT with a low dose of monoamine oxidase inhibitor blocks MAOA-dependent elimination. In rodent studies, there were potential drug interactions with THC, mitragynine, lithium, haloperidol, benzodiazepines, and antidepressants. There are studies of 5-MeO-DMT toxicity in rodents, cats, sheep, and monkeys; high doses can cause ataxia, mydriasis, lateral head weaving, head nodding, tremors, shivering, convulsions, tachycardia, loss of consciousness, and respiratory failure.

Psychedelic toad photo by Goddess Garden on January 7, 2022 https://thegoddessgarden.com/bufo-alvariushistory-of-this-sacred-medicine/

Professional Opinion: I think that there is not enough research and data on toad venom. Although, there are a few articles suggesting toad venom's anticancer qualities and ability to treat depression.

There needs to be more studies conducted on the substance. I do not think it should be used recreationally. The outcomes could be detrimental to one's health. ~ M. Tan

Colorado river toad by GETTY on February 2, 2020 https://www.forbes.com/sites/davidcarpenter/2020/02/02/5-meo-dmt-the-20minute-psychoactive-toad-experience-thats-transforming-lives/?sh=25f73c2e38a1

Monitoring/Drug Screening: There are no clinical studies on toad venom suggesting the importance of monitoring and screening. The Hofmann DMT spot kit can identify 5-MeO-DMT.

References 1. Psychoactive toad venom. Erowid. Updated February 28, 2020. Accessed October 9, 2022. https://www.erowid.org/animals/toads/toads.shtml 2. Reckweg JT, Uthaug MV, Szabo A, et al. The clinical pharmacology and potential therapeutic applications of 5methoxy-N,N-dimethyltryptamine (5-MeO-DMT). J Neurochem. 2022;162(1):128-146. doi:10.1111/jnc.15587 3. Hilliard, Jena. Psychedelic toad venom is the new trendy hallucinogen. Addiction Center. Published October 11, 2019.

Accessed October 9, 2022. https://www.addictioncenter.com/news/2019/10/trendy-psychedelic-toad-venom/ 4. Ermakova AO, Dunbar F, Rucker J, Johnson MW. A narrative synthesis of research with 5-MeO-DMT. J Psychopharmacol. 2022;36(3):273-294. doi:10.1177/02698811211050543 5. Li FJ, Hu JH, Ren X, Zhou CM, Liu Q, Zhang YQ. Toad venom: A comprehensive review of chemical constituents, anticancer activities, and mechanisms. Arch Pharm (Weinheim). 2021;354(7):e2100060. doi:10.1002/ardp.202100060

Wormwood “green ginger, madder wort, wormwood sage” Savanna Thompson, Student Pharmacist Fall 2022

What is It? An extract and main ingredient in absinthe, a toxic liquor that causes “absinthism” Absinthism is a syndrome characterized by addiction, hallucinations, brain damage, epilepsy, GI problems, and increased risk of psychiatric illness and suicide Pharmacology thujone, the volatile oil component of wormwood →produces excitement →is strong convulsant Dosage Forms Available in essential oil, capsule, tablet, tincture, and aqueous extract

https://www.verywellhealth.com/wormwood-5082001

Use and Abuse This perennial herb has been used for thousands of years with multiple indications including use as a(n) 1. antiparasitic 2. component of alcoholic beverages 3. “general remedy for all diseases” in the Middle Ages.

Botanical Aspects: Artemisia absinthium (wormwood) is a perennial herb with a strong sage order that blooms annually between July to September.

https://substanceabusepolicy.biomedcentral.com/ articles/10.1186/1747-597X-1-14

History of the “Green Fairy” • In B.C. times, wine-soaked wormwood leaves were used to alleviate labor pains, menstrual cramps, and rheumatism.

• A bitter spirit containing wormwood is called absinthe and was such a popular drink in the late 19th century in Europe that numerous bars and cafes would have “green hour” and famous artists such as Van Gogh would paint while indulging in the hour.

• In the 20th century, severe neurological disorders were found among the heaviest consumers of the absinthe.

Still Life with absinthe (Paris 1887)

by Vincent van Gogh https:// substanceabusepolicy.biomedcentral.com /articles/ 10.1186/1747-597X-1-14

Interactions and Toxicity • The toxic component of wormwood is attributed to the volatile oil of Artemisia absinthium which stimulates the CNS system in such a way that it may cause damage, mental deterioration, and even seizures.

• The toxicity of this essential oil is predominantly caused by the toxic ketone monoterpene β-thujone component of the essential oil from the herb.

May have negative drug Interactions with: 1. phenobarbital – by lowering seizure threshold 2. warfarin – may enhance coagulant effect 3. Proton pump inhibitors (PPIs), antacids, histamine receptor antagonists, and sucralfate - efficacy affected

https://www.history.com/news/francesgreen-fairy-flies-again

Potential Drug Effects 1. reducing inflammation such as in Crohn’s disease & arthritis (more research needed) 2. reducing pain - bellieved to have antioxidants 3. improving digestion - such as heartburn and constipation HOWEVER, the FDA classifies wormwood as unsafe for internal use unless thujone free!

Professional Opinion Consumption of wormwood should be avoided unless used as a last line treatment for a condition that has failed all other treatment methods. Risks greater than benefits ~ S. Thompson

Drug Screening Wormwood will only show up on a drug test if it contains thujone Unlikely to produce a positive test unless person consumed absinthe

https:// substanceabusepolicy.biomedce ntral.co m/ articles/10.1186/1747-597X-1-14

Laws and Prohibitions in the USA • Only thujone-free absinthe is legal in the U.S. • This is referred to as “American Absinthe” and must contain less than 5-10ppm (10mg/L).

• Note: this is nowhere near what pre-ban absinthe used to be that was known for its hallucinogenic and dangerous nature → pre-ban absinthe as high as 260mg/L

REFERENCES 1. Wormwood. Lexi-Drugs. Lexicomp. Wolters Kluwer Health Inc. RIverwoods, IL. Accessed October 13, 2022. http://online.lexi.com 2. Curtis L. What is Wormwood? Verywell Health. https://www.verywellhealth.com/wormwood-5082001. Accessed October 13, 2022.

3. Artemisia absinthium. Artemisia Absinthium - an overview | ScienceDirect Topics. https://www.sciencedirect.com/topics/agricultural-andbiological-sciences/artemisia-absinthium. Accessed October 13, 2022.

4. Padosch SA, Lachenmeier DW, Kröner LU. Absinthism: A fictitious 19th century syndrome with present impact - substance abuse treatment, prevention, and policy. BioMed Central. https://substanceabusepolicy.biomedcentral.com/articles/10.1186/1747-597X-1-14. Published May 10, 2006. Accessed October 13, 2022.

5. Fairy GA. Illegal absinthe - absinthe legal status in the United States. Absinthe Original. https://www.originalabsinthe.com/absinthe-blog/ absinthe-united-states-legal-status.html. Published September 30, 2021. Accessed October 13, 2022.

Yohimbe

Yasasvi Obeyesekera, Student Pharmacist Fall 2022

1.

https://www.nccih.nih.gov/health/yohimbe

History/Background

Yohimbe, an herbal supplement, is made from an evergreen tree bark native to central and western Africa. Traditionally, yohimbine, a coumpund found in the bark is used to treat erectily dysfunction, low sex drive in women, or unwated sexual sideffects of antidepressent medications. Yohimbe is also promoted as an aphrodisiac and used for fatigue, high blood pressure, diabetic neuropathy, and heart problems. There are reports of patients using yohimbe to increase athletic performance or lose weight.

Yobimbine hydrocholifde, a starndardized form of yohimbine, is available in the United States as an FDA prescription drug.

However, this product is different from the dietary supplement, yohimbe. Yohimbe is an unproved, unstudied treatment with no standard dose that has less key components and benefits.

2.

3.

Slang Terms There are several names for Yohimbe: aphrodien, corynanthe yohimbi, corynine, johimbi, Pausinystalia yohimbe, and quebrachine.

Phamacology

The exact mechanism for use has not been fully studied.

However, it has been concluded that Yohimbe works by blocking alpha -2 aderbergic receptors that inhibition erections while simultaniously acting as a sympatholytic and stimulating nerve centers in the spine, thereby improving capacity for erection without increasing sexual excitement.

Yohime is also thorugh to promote the release of nitric oxide that can lead to dilation of blood vessels and increased blood flow to sexual organs. The increase in sympathetic drive also increases norepinephrine release and firing rate of cells in the brain for dopamine, serotonin, and cholinergic receptors.

4.

Drug Effects

Some side effects include skin flushing, rash, agitation, anxi insomnia, dizziness, rapid heartbeat, increased urination, headache, nausea, and vomiting.

There are more serious risks associated with yohimbe including chest pain, heart attack, atrial fibrillation, kidney failure, and seizures. High doses have been shown to cause breathing problems, paralysis, low blood pressure, heart failure, and death. https://www.amazon.c om/Puritans-PrideYohimbe-2000Count/dp/B004R671O6

5.

Drug Interactions/Toxicology

Yohimbe has shown to interact with antidepressants, stimulants such as caffeine, diabetes drugs, antihistamines, blood pressure, tranquilizers, and antibiotics. Patients should take caution if using supplements, monoamine oxidase inhibitors, or are eating foods high in tyramine such as wine, aged cheese, and cured meats.

6.

https://entranceexam.concor dlawschool.edu/pages/cours es/course/? course_code=CLSEXAM

7.

Laws

Dietary supplements are not strictly regulated by the FDA. There have been reports of inaccurate labeling of the amount of yohimbe in a product. The inaccuracy can lead to harmful side effects.

Yohimbe has been FDA approved in animals, however, not in humans.

Monitoring/Drug Screening

No conclusive information was found on monitoring and drug screenings. The drug is rapidly absorbed upon oral administration, however, bioavailability has been found to be highly variable. Yohimbe undergoes extensive metabolism in livers and kidneys, however precise method has not been fully determined. Route of elimination has not been determined. For safety, patients with low renal clearance and liver function should take caution with yohimbe containing drugs. Patients should also be monitored for adverse effects and toxicities such as anxiety, weakness, overstimulation, paralysis, hallucinations.

8.

Professional Opinion

Yohimbe is not recommended for the treatment of sexual performance. It has a narrow therapeutic index with a small dosing range. It is unclear if yohimbe is safe as there is evidence of the drug benign associated with heart attacks, seizures, anxiety, and other conditions. The drug is also not FDA approved for the treatment of erectile dysfunction. ~ Y. Obeyesekera

9.

References

1. Griffin RM. Yohimbe. WebMD. Accessed O ctober 12, 2022. https://www.webmd.com/diet/supple ment-guide-yohimbe 2. Yohimbe. NCCIH. https://www.nccih.nih.gov/health/yohimbe 3. Yohimbe: Benefits, Uses and Side Effects. Healthline. Published October 13, 2017. Accessed October 12, 2022. https://www.healthline.com/nutrition/yohimbe#TOC_TITLE_HDR_3 4. Yohimbine. go.drugbank.com. https://go.drugbank.com/drugs/DB01392 5. What Is Yohimbe? Verywell Health. https://www.verywellhealth.com/safety-concerns-ofyohimbe-89535