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Methamphetamine – the Respiratory System & Covid-19: Bad Combination
The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities.
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While it's a drug that's widely considered as ‘safe’, nitrous oxide can cause serious harm.
Medical professionals are calling for tighter restrictions on the sale of nitrous oxide gas cartridges, colloquially known as ‘nangs’, due to potentially serious harm for users including lasting neurological damage. Nitrous oxide or ‘laughing gas’ is normally used by dentists and medical professionals to provide sedation and pain relief to patients undergoing minor procedures. It’s also a food additive, used to aerate whipped cream, and sold in gas cartridges online and in convenience stores.
An increasing number of Australians are also using nitrous oxide recreationally, inhaling the gas to produce a fleeting feeling of euphoria and excitement. Many people who use the drug consider it to be relatively harmless, but according to experts from the National Drug and Alcohol Research Centre (NDARC) at UNSW Sydney, this is far from the case.
‘Nangs’ are increasingly popular – Among people who regularly use ecstasy and/or other illicit stimulants, surveyed by NDARC as part of the Ecstasy and Related Drugs Reporting System (EDRS), nitrous oxide use has jumped in recent years. From 2003 to 2015, approximately one-quarter of the group reported nitrous oxide use in the past six months. This proportion doubled to 50 per cent in 2018 and has remained at a similar level since. The frequency and quantity of nitrous oxide use among these participants has remained relatively low and stable over time.
Less is known about nitrous oxide use in the general population, but this also appears to be increasing over time. The Australian Institute of Health and Welfare (AIHW) reported in their National Drug Strategy Household Survey that past year use of inhalants, which included nitrous oxide, increased from 0.4 per cent of participants in 2001, to 1.7 per cent in 2019.
Acute dangers and long-term neurological effects – With increased use of nitrous oxide among some groups, there have been increased reports of harm. For example, in a recent study of 60 emergency departments across New South Wales, presentations related to nitrous oxide use have increased from less than 10 in 2012 to more than 60 in 2018.
According to Professor Shane Darke from NDARC, recreational nitrous oxide use has the potential for harmful effects in the short and longer term.
“If you’re in a medical situation and you’re being given nitrous oxide… it’s mixed with oxygen. These people aren’t doing that. What they’re doing is covering their faces and inhaling pure gas,” Professor Darke said.
“Now the problem with that is there’s no oxygen. You run the risk of asphyxia.”
While using nitrous oxide, people are also at risk of entering a delirious state, according to Professor Darke. “They can be a risk to themselves and others. There have been spontaneous suicides and accidents.”
Emergency physicians have also started noticing people presenting with jerking and odd movements after using nitrous oxide. That’s not just an unsteady gait due to intoxication – rather, a sign of significant nerve damage.
“[Nitrous oxide] interferes with the absorption of Vitamin B12. This leads to neurological damage and eventually in severe cases, spinal degeneration,” Professor Darke said. “In an acute case you might be able to reverse that with infusions of B12. But in chronic cases it’s irreversible.”
It’s important to note people with neurological symptoms have been heavy users of nitrous oxide, inhaling the gas every day for months and consuming hundreds of canisters at a time. More research is needed to understand the effects of light to moderate use, which may still carry risk of nerve damage.
For complete article go to Nitrous oxide – not a laughing matter | UNSW Newsroom
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New psychoactive substances (NPS) are a diverse group of substances designed to replicate the effects of substances like cannabis, cocaine and ecstasy. The nature of the ever-changing NPS market raises concerns about their chemical, metabolic and toxicity profiles, and the linked physical, social and mental health harms.
Over the past months, ISSUP has put together a webinar series on the topic. The recordings for the webinars can be found here. Additionally, this reading list provides links to resources, publications and research exploring the subject.
1) EMCDDA has put together a webpage that provides an overview of new psychoactive substances. As well as sharing information, the website also includes the latest events and news on the subject.
2) This early warning advisory, published by UNODC, shares an overview of new psychoactive substances, examines the risks and provides an overview of the different ways that UNODC is assisting governments in this area.
3) This review, which was published in therapeutic advances in psychopharmacology, explores the nature of NPS and the physical and mental health harms, which are commonly associated with their use.
4) This book provides an analysis of the social and economic impact of the NPS. It presents an overview of the international regulation, policy and market structure and covers topics such as organized crime, drug markets, and clinical evidence on NPS.
5) Emerging Trends in Drugs, Addictions, and Health is a new international journal devoted to the rapid publication of authoritative papers on Novel Psychoactive Substances (NPS), Addiction and associated health phenomena. You can read the new open-access journal here.
6) The Handbook of Novel Psychoactive Substances (NPS) provides an overview of the challenges that clinicians face when dealing with NPS. Written by experts in the field, the handbook provides information on symptoms, psychopathology, toxicity, and overall clinical management.
7) This document, developed by NEPTUNE, provides guidance on the clinical management of harms resulting from acute intoxication and from the harmful and dependent use of club drugs and Novel Psychoactive Substances (NPS).
8) Here, you can access training modules, developed by project NEPTUNE and the Royal College of Psychiatrists, to improve clinical practice in the management of harms resulting from the use of club drugs and novel psychoactive substances.
Source New Psychoactive Substances| International Society of Substance Use Professionals (issup.net)
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The importance of non-targeted testing to keep pace with a rapidly evolving synthetic opioid market.
The synthetic opioid market…is constantly evolving. Once a new substance is identified, it may only be prevalent for three to six months before it’s replaced by something new and yet to be identified by forensic laboratories.
For example, over one weekend in July 2018, Philadelphia-area hospitals experienced a surge of more than 100 patients with suspected opioid overdoses. Following the administration of naloxone, patients would become combative – an unusual reaction for an opioid overdose.
To help local public health and public safety agencies identify what was causing this troubling trend, the NPS Discovery drug early warning system at the Center for Forensic Science Research and Education (CFSRE) acquired a sample of “Santa Muerte,” the drug linked to the large number of overdoses. Advanced mass spectrometry analysis found within the sample a combination of fentanyl, heroin, and a synthetic cannabinoid – a combination not often seen in the region. Given the unique side effects that overdose patients were experiencing, it was thought this may be a synthetic drug combination worth tracking closely.
However, substances containing fentanyl and synthetic cannabinoids did not last long and were only a fraction of the whole drug supply in the region. After about six to nine months following the July overdoses involving “Santa Muerte,” these substances were largely replaced by new synthetic drug products, primarily fentanyl cut with xylazine.
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(This is where the term ‘overdose’ is legitimate. Any drug not legally prescribed cannot be ‘overdosed’ on. Taking these drugs is an act of self-poisoning.)
In general, barbiturates can be thought of as so-called brain relaxers. Alcohol is also a brain relaxer. The effects of barbiturates and alcohol are very similar, and when combined can be lethal. Pain medicines, sleeping pills, and antihistamines also cause symptoms similar to those of barbiturates.
People who abuse barbiturates use them to obtain a “high,” which is described as being similar to alcohol intoxication, or to counteract the effects of stimulant drugs.
- In small doses, the person who abuses barbiturates feels drowsy, disinhibited, and intoxicated.
- In higher doses, the user staggers as if drunk, develops slurred speech, and is confused.
- At even higher doses, the person is unable to be aroused (coma) and may stop breathing. Death is possible.
It is important to note that the difference between the dose causing drowsiness and one causing death may be small. In the medical profession, this difference is called a narrow therapeutic index, which is the ratio of a drug's toxic dose to its therapeutically desirable dose. This is the reason why barbiturates are dangerous. It is also why barbiturates are not often prescribed today.
Symptoms of withdrawal
Symptoms of withdrawal or abstinence include tremors, difficulty sleeping, and agitation. These symptoms can become worse, resulting in life-threatening symptoms, including hallucinations, high temperature, and seizures.
Barbiturate Names
Generic Name |
Street Name |
Amobarbital |
Downers, blue heavens, blue velvet, blue devils |
Pentobarbital |
Nembies, yellow jackets, abbots, Mexican yellows |
Purple hearts, goof balls |
|
Secobarbital |
Reds, red birds, red devils, lilly, F-40s, pinks, pink ladies, seggy |
Tuinal |
Rainbows, reds and blues, tooies, double trouble, gorilla pills, F-66s |