Medicine
January 31, 2018
Evangelia Liakoni, Chris Yates, Alison M. Dines et al.
38 citations
Self-reported substance use by patients arriving at emergency departments with acute recreational drug toxicity matches toxicological analysis best for heroin (86.1% agreement) and cocaine (74.1% agreement). Inhalants, poppers, and magic mushrooms were self-reported but never detected analytically. Immunoassays accurately identified methadone (100% agreement) and cocaine (95.5% agreement) but were less consistent for amphetamines (81.8% agreement). Mass spectrometry confirmed MDMA, amphetamine, methamphetamine, and new psychoactive substances in many cases where immunoassays were negative, and revealed multiple-substance use. Diagnosis of new psychoactive substance use relied primarily on self-report.
Metabolites
July 27, 2020
Andrea E. Steuer, Daria Kaelin, Martina I. Boxler et al.
32 citations
Three psychoactive stimulants—MDMA, amphetamine, and the new psychoactive substance mephedrone—alter blood metabolites in overlapping but distinct ways. Using plasma samples from controlled human administration studies and liquid chromatography-high resolution mass spectrometry, researchers identified changes in metabolites linked to energy metabolism, steroid biosynthesis, and amino acid pathways. Linoleic acid and pregnenolone-sulfate shifted similarly after intake of all three drugs. Mephedrone produced a metabolic profile more like amphetamine than MDMA, particularly in energy metabolism. These findings could guide future targeted studies on pharmacological actions and help identify biomarkers of drug use.
Journal of medical toxicology : official journal of the American College of Medical Toxicology
January 1, 2025
Caitlin E Wolfe, Lachlan J Sund, John Rh Archer et al.
5 citations
In 2021, 258 UK deaths were attributed to novel psychoactive substances (NPS). Confirmatory testing for NPS is limited by cost and speed. Among 1000 acute recreational drug toxicity presentations to a central London hospital in 2019/20, 28 unique NPS were detected, compared to 31 in a 2016/17 cohort. Eight new NPS appeared in 2019/20: four benzodiazepines, two synthetic cannabinoid receptor agonists, one cathinone, and one ketamine analogue. No NPS opioids were found in either cohort. Cannabis, ketamine, and opioid detection increased significantly from 2016/17 to 2019/20, while alcohol, cathinones, GHB, and MDMA decreased. The findings align with European forensic trends and underscore the need for ongoing surveillance of emerging drugs.
Clinical toxicology (Philadelphia, Pa.)
March 1, 2025
Joep J. J. Ouwerkerk, David M Wood, Alison M. Dines et al.
1 citation
When 3,4-methylenedioxymetamfetamine (MDMA) is taken with alcohol, emergency department visits show higher odds of agitation, drowsiness, and vomiting compared to MDMA alone. Co-intoxication with other substances increases odds of bradycardia, psychosis, and coma. Mortality rates remain low across all groups. Female patients report less chest pain but more vomiting, headache, and hypotension than males. These variations suggest that physicians should consider both the type of co-intoxication and patient sex to optimize treatment.
British journal of hospital medicine (London, England : 2005)
May 18, 2026
Karen L Erskine, Paul I Dargan, David M Wood
Chronic, high-dose recreational ketamine use is associated with dependence and long-term complications affecting the urinary tract, nervous system, mental health, and liver. This narrative review describes these complications and emphasizes the need for clinicians to recognize them early for proper investigation and management.
Archives of Toxicology
November 1, 2022
Liesl K Janssens, Simon Hudson, David M Wood et al.
In 71 patients who used the synthetic cannabinoid 5F-MDMB-PICA, serum concentrations of the drug correlated with ex vivo activation of the CB1 cannabinoid receptor in a sigmoidal pattern. Two active metabolites were identified, but their overall contribution to cannabinoid activity in serum was negligible. Clinically, higher ex vivo cannabinoid activity was associated with a significant decrease in the Glasgow Coma Scale score, indicating reduced consciousness. In vitro pharmacological profiling could predict an individual's ex vivo CB1 activity, which in turn related to level of consciousness.
Substance Use & Misuse
January 28, 2017
Mark Haden, John R H Archer, Paul I Dargan et al.
MDMB-CHMICA, a synthetic cannabinoid receptor agonist found in recreational drug products across Europe since August 2014, is widely available from online suppliers. A systematic review of scientific literature and Internet sources identified 78 websites selling it, with prices decreasing for larger quantities. User reports on discussion forums from October 2014 onward described euphoria as the most common positive effect (30.6% of 36 reports), but almost all reports (91.7%) mentioned adverse effects, most frequently palpitations (30.6%), vomiting (25.0%), loss of consciousness (16.7%), visual hallucinations (16.7%), chest pain (13.9%), and anxiety (13.9%). Published literature includes two case reports of fatalities and one series of analytically confirmed intoxications. Both users and suppliers warn of its high potency.
European Journal of Clinical Pharmacology
May 1, 2012
David M Wood, Susannah Davies, Malgorzata Puchnarewicz et al.
Methoxetamine, a ketamine derivative marketed as bladder-safe, can cause acute toxicity with dissociative and sympathomimetic symptoms. Three patients aged 28 to 42 presented to an emergency department after using methoxetamine, showing a dissociative or catatonic state similar to ketamine, along with tachycardia and hypertension. All were treated with low-dose benzodiazepines and discharged after symptoms resolved. Serum concentrations ranged from 0.09 to 0.2 mg/L; one patient also had detectable levels of 6-APB/5-APB. These cases demonstrate that methoxetamine use carries acute risks, and further research is needed to assess its bladder safety.