Designer drugs: Review and implications for emergency management

Pourmand, Ali; Mazer‐Amirshahi, Maryann; Chistov, Sonya; Li, A; Park, M

doi:10.1177/0960327117698542

Cited by 20 publications

(18 citation statements)

References 36 publications

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“…Behavioral factors such as physical exercise [68] and healthy dietary lifestyle measures via an increased anti-oxidative capacity have been shown to be a promising approach in the management of psychostimulant addiction [69]. There is currently no remedy for SC intoxication, except for supportive care [70]; however, the oxidative stress mechanistic pathway suggests the possibility of efficacious antioxidant pharmacotherapies for attenuating SC-induced ROS production [71]. Considering that mitochondrial dysfunction plays a critical part in SC-induced neurotoxicity, the enhancement of mitochondrial function [72] and mitochondrial transplantation [73] have received attention as strategies that might ameliorate the associated mitochondrial neurodegeneration.…”

Section: Discussionmentioning

confidence: 99%

Synthetic Cathinones Induce Cell Death in Dopaminergic SH-SY5Y Cells via Stimulating Mitochondrial Dysfunction

Leong

Philp

Simone

et al. 2020

IJMS

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Increasing reports of neurological and psychiatric complications due to psychostimulant synthetic cathinones (SCs) have recently raised public concern. However, the precise mechanism of SC toxicity is unclear. This paucity of understanding highlights the need to investigate the in-vitro toxicity and mechanistic pathways of three SCs: butylone, pentylone, and 3,4-Methylenedioxypyrovalerone (MDPV). Human neuronal cells of SH-SY5Y were cultured in supplemented DMEM/F12 media and differentiated to a neuronal phenotype using retinoic acid (10 μM) and 12-O-tetradecanoylphorbol-13-acetate (81 nM). Trypan blue and lactate dehydrogenase assays were utilized to assess the neurotoxicity potential and potency of these three SCs. To investigate the underlying neurotoxicity mechanisms, measurements included markers of oxidative stress, mitochondrial bioenergetics, and intracellular calcium (Ca2+), and cell death pathways were evaluated at two doses (EC15 and EC40), for each drug tested. Following 24 h of treatment, all three SCs exhibited a dose-dependent neurotoxicity, characterized by a significant (p < 0.0001 vs. control) production of reactive oxygen species, decreased mitochondrial bioenergetics, and increased intracellular Ca2+ concentrations. The activation of caspases 3 and 7 implicated the orchestration of mitochondrial-mediated neurotoxicity mechanisms for these SCs. Identifying novel therapeutic agents to enhance an altered mitochondrial function may help in the treatment of acute-neurological complications arising from the illicit use of these SCs.

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Section: Discussionmentioning

confidence: 99%

Synthetic Cathinones Induce Cell Death in Dopaminergic SH-SY5Y Cells via Stimulating Mitochondrial Dysfunction

Leong

Philp

Simone

et al. 2020

IJMS

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“…It has been demonstrated that awareness and confidence of clinicians can be significantly influenced by targeted training/education. [43] ED physicians should be trained in recognizing the presentation features of the intoxications caused by the main illicit substances and support the vital functions [20,23,25], the indications to the available antidotes [18,19,47], and the prevention of severe withdrawal symptoms [34].…”

Section: Discussionmentioning

confidence: 99%

“…Popular designer drugs include synthetic cannabinoids (K2, Spice), synthetic cathinones (bath salts), nontraditional opioids (kratom, salvia, Krokodil), opioid analogs (U-47700), and dissociative agents (PCP, ketamine, dextromethorphan) [20].…”

Section: Synthetic Drugsmentioning

confidence: 99%

“…In the last decade, many physicians did not feel confident in caring for a patient with synthetic drug exposure; today, ED physicians are becoming more prepared since it has become clear that the treatments for most intoxications subsequent to the abuse of synthetic drugs are similar and consist of supportive measures such as ABC stabilization, the maintenance of normal body temperature, control agitation, the management of dehydration and rhabdomyolysis, and guaranteeing the safety of the patient [20].…”

Section: Synthetic Drugsmentioning

confidence: 99%

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Risk Management in First Aid for Acute Drug Intoxication

Piccioni

Cicchinelli

Saviano

et al. 2020

IJERPH

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Drug abuse (cannabis, cocaine, opiates, and synthetic drugs) is an increasing phenomenon, especially in the younger population, thus leading to more cases of intoxication requiring evaluation in the emergency department and subsequent hospitalization. In 2017, 34.2% of students reported having used an illegal psychoactive substance in their lifetime, while 26% reported having done so over the past year. We made a review about the effectiveness of the role of the temporary observation unit in the emergency department to improve management of acute drugs intoxication. We checked medical literature from the last 10 years (2009–2019). The following electronic databases were systematically searched: MEDLINE-PubMed, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials. Then, a systematic review was carried out according to the Preferred Reporting Items for Systematic Review standards. Intoxicated patients usually display a favorable medical course, few diagnostic and therapeutic interventions, a short stay in the hospital, and, when hospitalization is needed, semi-intensive therapy is a feasible solution; therefore, intoxicated patients are ideal candidates for a temporary observation unit. The emergency department is very important to manage intoxicated patients; however, the hospitalization of these patients is often not necessary.

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“…In the past, most drug abuse and addiction cases involved amphetamines, cannabis, cocaine and heroin, whereas nowadays NPS are an increasing problem. The European Monitoring Centre for Drugs and Drug Addiction notes that > 450 NPS have been introduced for illegal use since 2004 [28,29].…”

Section: Discussionmentioning

confidence: 99%

A retrospective observational study on patients intoxicated by drugs and other xenobiotics

Sawicka¹,

Kartuszyńska²,

Kuczyńska

et al. 2019

Int J Occup Med Environ Health

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Objectives: Many research studies conducted in various toxicology centers point to drugs as the most common cause of intoxication. Long-term observations make it possible to clarify the nature of these poisonings. The aim of this study was to examine the trends and reasons of intoxication in patients hospitalized over a 10-year observation period (2005-2015), as well as to compare the number of patients poisoned with nonsteroidal anti-inflammatory drugs (NSAIDs), mainly over-the-counter (OTC) drugs. Material and Methods: A retrospective observational study examined the medical documentation of patients hospitalized in the Department of Toxicology and Internal Diseases of the T. Marciniak Lower Silesian Specialist Hospital in Wrocław in 2005-2015, including the analysis of the causes of intoxication as well as total poisoning-related death statistics. Quarterly and annual analyses of the numerical data, and comparisons of the frequency of poisonings were included. The patient population from the area of Lower Silesia, Poland, was examined. Results: The number of hospitalized patients has increased, with attempted suicide being the leading cause of death. Male intoxication and mortality have been found to predominate. Drugs are the most common cause of poisoning, and among these the most common are sedatives and psychotropic drugs. Intoxication due to NSAIDs, especially OTC drugs, increased significantly in the observation period. In 2005 no fatal cases were reported as a result of NSAID intoxication, while in 2015 mortality significantly increased to 43%. Conclusions: The lack of a common trend in poisonings is observed but the number of hospitalized patients has increased, especially among young people, which is consistent with global trends. Drugs are the most common cause of mortality, and a significant increase in NSAID (mainly OTC) poisonings in particular indicates the growing prevalence of an uncontrolled use of these drugs.

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Designer drugs: Review and implications for emergency management

Cited by 20 publications

References 36 publications

Synthetic Cathinones Induce Cell Death in Dopaminergic SH-SY5Y Cells via Stimulating Mitochondrial Dysfunction

Synthetic Cathinones Induce Cell Death in Dopaminergic SH-SY5Y Cells via Stimulating Mitochondrial Dysfunction

Risk Management in First Aid for Acute Drug Intoxication

A retrospective observational study on patients intoxicated by drugs and other xenobiotics

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