Several drugs used in addiction treatment and substances of abuse inhibit the efflux transporters P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP) in vitro, which could alter their distribution in the body, including across the blood-brain barrier. Norbuprenorphine, buprenorphine, methadone, ibogaine, and THC inhibited P-gp in a concentration-dependent manner, with norbuprenorphine being the strongest. Buprenorphine, norbuprenorphine, ibogaine, and THC inhibited BCRP. Cocaine, amphetamine, nicotine, morphine, and others did not inhibit either transporter. Norbuprenorphine and methadone were transported by P-gp, but no tested compounds were transported by BCRP. The clinical relevance of norbuprenorphine's interaction with P-gp remains unclear.
A chronic user of GHB, 3-MMC, and methoxetamine lost consciousness during a chemsex session and was admitted to intensive care, recovering quickly. Analysis of ten plasma samples over 29.5 hours, plus urine, hair, and a seized crystal, using liquid and gas chromatography, mass spectrometry, and nuclear magnetic resonance, confirmed exposure to multiple drugs including GHB, two benzofurans, two cathinones, and a new psychoactive substance: deschloro-N-ethyl-ketamine (O-PCE), an arylcyclohexylamine. Molecular networking identified 27 O-PCE metabolites, some previously unreported. O-PCE had an elimination half-life of about 5 hours. Lipid metabolism was markedly altered, likely from polydrug use.
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.