Salvia divinorum and Kratom are unscheduled dietary supplements that activate opioid receptors and produce distinct psychoactive effects. Salvinorin A, from Salvia divinorum, is a highly selective kappa-opioid receptor agonist that causes visual hallucinations and synesthesia. Kratom's main alkaloid, mitragynine, acts as a partial opioid agonist with morphine-like effects, while its minor alkaloid 7-hydroxymitragynine is more potent than morphine. Both Kratom alkaloids activate supraspinal mu- and delta-opioid receptors, which explains their use by chronic narcotics users to ease opioid withdrawal. Despite widespread Internet availability, these substances elude traditional toxicologic monitoring, and the article aims to inform toxicologists and poison control specialists about them.
Adolescents may use the Internet to learn about illicit substances, and partisan websites that downplay drug risks can encourage unsafe behavior. A case is reported of an adolescent who used online information and suffered severe poisoning after combining harmaline (a monoamine oxidase inhibitor) with 5-methoxydimethyltryptamine (5-MeO-DMT), a hallucinogenic tryptamine. Adverse outcomes from Internet-sourced drug advice are rarely documented.
A pilot study found that Transcendental Meditation (TM) training was feasible for emergency clinicians during the COVID-19 pandemic and led to significant reductions in burnout, depression, anxiety, stress, and sleep disturbance. Of 31 emergency clinicians (physicians, nurses, and physician-assistants) from two urban hospitals, 90.6% attended at least six of eight training sessions, and 80.6% meditated at least once daily. Burnout decreased significantly (Cohen's d = 0.43-0.45), and psychological symptoms showed larger improvements (Cohen's d = 0.70-0.87). TM appears to be a safe and effective tool for improving clinician well-being.
Dextromethorphan, an over-the-counter dissociative drug, is increasingly abused by younger adolescents. Its toxic effects vary with dose and formulation ingredients. Most cases resolve with supportive care, but severe intoxication may require significant medical attention. Early identification and treatment of dextromethorphan abuse may help prevent broader substance abuse in this age group. Clinicians should recognize, treat, and refer patients presenting with intoxication from this drug.