Addiction Science & Clinical Practice
March 11, 2015
Michael F. Weaver, John A. Hopper, Erik W. Gunderson
135 citations
Designer drugs, marketed as 'legal highs,' include substituted cathinones (e.g., mephedrone, methylone, MDPV), synthetic cannabinoids (e.g., Spice), and synthetic hallucinogens (e.g., 25I-NBOMe). Their availability changes rapidly to evade legal controls and detection. Young adults are the main users, with growing use in the military. Acute toxicity frequently causes severe psychiatric and medical effects such as anxiety, agitation, psychosis, and tachycardia, and deaths have been reported for each drug type. Clinicians should consider these drugs when evaluating substance use in young adults or patients with acute neuropsychiatric symptoms. Treatment of acute intoxication is supportive, while long-term treatment of designer drug use disorder lacks evidence-based guidance.
Addiction Science & Clinical Practice
September 4, 2022
Lukas Andreas Basedow, Melina Felicitas Wiedmann, Veit Roessner et al.
17 citations
Adolescent patients with both post-traumatic stress disorder (PTSD) and substance use disorders (SUDs) reported more frequent past-year use of MDMA (ecstasy) than those with SUD alone or with traumatic experiences but no current PTSD. No such differences appeared for tobacco, alcohol, cannabis, or stimulants. The link between PTSD and higher MDMA use was partly explained by using the drug to cope with mental health symptoms. This suggests a specific coping mechanism for MDMA, possibly due to its unique psychoactive effects, rather than a general pattern of self-medication across all substances.
Addiction Science & Clinical Practice
April 11, 2013
Yasuko Fuse-Nagase, Toru Nishikawa
14 citations
A 30-year-old Japanese man with no prior psychiatric history developed delusions lasting 2 months after abusing 5-MeO-DIPT (Foxy) and later a legal aromatic liquid used recreationally. His condition improved but relapsed 6 months later with prolonged delusions after again ingesting the aromatic liquid. The chronological sequence suggests that the aromatic liquids, easily purchased online, likely triggered the delusional episodes. The authors speculate that recurrent 5-MeO-DIPT abuse caused sensitization (reverse tolerance), amplifying the response and prolonging delusions. This sensitization may be a latent factor in subsequent drug-induced psychosis, and psychiatrists should consider it when evaluating acute psychosis patients.
Addiction Science & Clinical Practice
August 29, 2024
Lucinda A Grande, Tom Hutch, Keira Jack et al.
6 citations
A sub-dissociative dose of ketamine, self-administered sublingually, helped patients with opioid use disorder complete buprenorphine initiation in an outpatient setting. Over 14 months, 37 patients were prescribed 4-8 doses of sublingual ketamine 16 mg. Among the 24 patients who reported trying ketamine, 16 (67%) completed buprenorphine initiation, and 11 of the last 12 completers (92%) remained in treatment for 30 days. Most patients reported reduced or eliminated spontaneous withdrawal symptoms, and some avoided severe precipitated withdrawal. Four patients completed initiation over four days with only mild symptoms. Two patients experienced cognitive changes at higher doses. The protocol suggests ketamine can lower barriers to buprenorphine treatment, but further research is needed.
Addiction Science & Clinical Practice
February 4, 2026
Maya Appley, Jessica R Gray, Dima Abdulrahim et al.
1 citation
A young woman with severe post-traumatic stress disorder developed a severe ketamine use disorder, along with gastrointestinal toxicity and uropathy from chronic use. A multidisciplinary care plan, modeled on a UK clinic for club drug users, included specialist referrals for physical complications and mental health support. With this approach, she significantly reduced ketamine use for a time. US healthcare providers need awareness of non-medical ketamine use and its harms to counsel and treat the growing number of users. The UK's multidisciplinary clinic offers a model for patient-centered care that could inform US systems.
Addiction Science & Clinical Practice
July 21, 2025
Patricia A Cioe, Garrett S Stang, Danish Azam et al.
1 citation
People with HIV (PWH) smoke cigarettes at high rates (40–70%) and often struggle to quit with standard treatments, partly due to anxiety and depression. Psilocybin, a psychedelic designated as breakthrough therapy by the FDA, has shown promise for psychiatric symptoms and substance use disorders, including tobacco dependence; a pilot study reported 80% smoking abstinence at 6 months among people who had previously been unable to quit. In qualitative interviews with 25 PWH who smoke, five themes emerged: varied prior psilocybin experiences, uncertainty about its effects and side effects, need for trusted information and testimonials, willingness to try psilocybin-assisted therapy for tobacco treatment, and importance of the setting. Psilocybin-assisted smoking cessation treatment appears acceptable to PWH who smoke, though concerns must be addressed before it can be incorporated into clinical services.
Addiction Science & Clinical Practice
September 16, 2022
Vanessa C Somohano, Josh Kaplan, Aurora G Newman et al.
Among women with both posttraumatic stress disorder (PTSD) and substance use disorder (SUD), greater duration of formal mindfulness practice (minutes per session) predicted reduced PTSD symptoms six months after an 8-session mindfulness-based relapse prevention program. More practice was linked to lower total PTSD symptoms, trauma-related avoidance, arousal and reactivity, and negative cognitions and mood. Informal mindfulness practice did not predict any improvements. The findings suggest formal mindfulness practice may help sustain PTSD symptom reductions in this population, but further research on promoting ongoing formal practice is needed.
Addiction Science & Clinical Practice
January 19, 2020
Jennifer Rozylo, Keren Mitchell, Mohammadali Nikoo et al.
A high-risk patient with opioid use disorder who had previously failed buprenorphine/naloxone induction due to withdrawal symptoms was successfully started on a therapeutic dose using a microdosing regimen combined with assertive outreach. The team gradually increased the dose without causing withdrawal, and the patient continued consistent medication use for four weeks, gradually reducing illicit substance use. The case suggests that microdosing can minimize barriers to buprenorphine/naloxone induction and supports the need for larger studies.