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Regulations, the Growth of Pharma, and Diagnostic Expansion, 1951–2013
Published in Charles E. Dean, The Skeptical Professional's Guide to Rational Prescribing, 2022
In 1951, the U.S. Food and Drug Administration (FDA) decreed that new medications were to be available by prescription only.6 This was a seismic change from the previous centuries that were awash in homemade cures and potions available to anyone. No prescription was needed, despite the toxic ingredients, including mercury, cocaine, opium, and lithium. As Gerald Posner has noted,7, pp.6–9 these compounds, some 50,000 of them, were often labeled as “miracle cures,” with sales eventually reaching $100 million yearly.7, p.24 In addition, the many small manufacturers of these compounds competed with the burgeoning pharmaceutical industry of the 19th century, which included Squibb, Wyeth, Eli Lilly, and Burroughs Wellcome. These companies heavily invested in developing and promoting opiate-based pain remedies, and, in the case of Merck, promoting cocaine for a variety of ailments, including depression, asthma, and dental pain. At one point, cocaine was listed in the top five best-selling drugs. Similarly, in 2020, we find a resurgence of interest in opioids for treatment-resistant depression and psychedelics (psilocybin, mescaline, ketamine, 3,4 methylenedioxyamphetamine [MDMA] for an ever-expanding list of psychiatric disorders).8
Missed Opportunities? Beneficial Uses of Illicit Drugs
Published in Ross Coomber, The Control of Drugs and Drug Users, 2020
Lester Grinspoon, James B. Bakalar
There are about a half dozen natural psychedelic drugs and scores of synthetic ones, most of them variants on a few chemical structures. The best known natural psychedelics are mescaline, derived from the peyote cactus, and psilocybin, found in over a hundred species of mushrooms. Among synthetic psychedelics, the best known and most potent is lysergic acid diethylamide (LSD), which is chemically related to certain alkaloids found in morning glory seeds, the lysergic acid amides. This class of drugs also includes the natural substances harmine, harmaline, ibogaine, and dimethyltryptamine (DMT), as well as a large number of synthetic drugs that are chemically described as tryptamines or methoxylated amphetamines. A few of these are diethyltryptamine (DET), 3,4,-methylenedioxyamphetamine (MDA), and 2,5-dimethoxy-4-methylamphetamine (DOM, also known as STP). Recently much attention has been focused on 3,4,-methylenedioxymethamphetamine (MDMA).
Classification and diagnosis: ICD-10 and DSM-5 and their application to substance use disorders in young people
Published in Ilana B. Crome, Richard Williams, Roger Bloor, Xenofon Sgouros, Substance Misuse and Young People, 2019
There are five new classes of substances: (1) 3,4 methylenedioxymethamphatamine (MDMA) and related drugs, including 3,4 methylenedioxyamphetamine (MDA)(2) Dissociative drugs, including Ketamine and phenylcyclidine (PCP)(3) Synthetic Cannabinoids(4) Synthetic Cathinones(5) Caffeine.
Variation of drugs involved in acute drug toxicity presentations based on age and sex: an epidemiological approach based on European emergency departments
Published in Clinical Toxicology, 2021
Òscar Miró, William S. Waring, Paul I. Dargan, David M. Wood, Alison M. Dines, Christopher Yates, Isabelle Giraudon, Adrian Moughty, Niall O'Connor, Fridtjof Heyerdahl, Knut E. Hovda, Odd M. Vallersnes, Raido Paasma, Kristiina Pold, Gesche Jürgens, Bruno Megarbane, Jacek S. Anand, Evangelia Liakoni, Matthias Liechti, Florian Eyer, Sergej Zacharov, Blazena Caganova, Jeffrey Bonnici, Julia Radenkova-Saeva, Miguel Galicia
For the present study, we extracted data on all patients included in the Euro-DEN Plus registry from October 2013 to December 2016 (39 months). We grouped the drugs reported by the user or that were primarily identified by laboratory tests (and then confirmed to be of clinical relevance after medical report review) into nine main categories, following a previous classification used by our group in previous studies [13]: 1) opioids (including methadone and pharmaceutical medications containing opioids), 2) cocaine and crack cocaine; 3) cannabis and synthetic cannabinoids, 4) amphetamines (including amphetamine, methamphetamine, MDMA, 3,4-methylenedioxyamphetamine (MDA), and others), 5) gamma-hydroxybutyrate (GHB) and gamma-butyrolactone (GBL), 6) hallucinogens (including LSD;) , 7) new psychoactive substances (NPS; this group did not include NPS included in other groups, like synthetic cannabinoids or amphetamine derivates, and it was mainly formed by alpha-pyrrolidinopentiophenone, mephedrone and other cathinones, piperidines and tryptamines), 8) benzodiazepines, and 9) ketamine. To be included in the final analysis, the patients had to have taken at least one drug classified in one of these nine drug categories and have data recorded on age and sex. When two or more drugs were identified in a single patient, either by self-reporting or by laboratory analysis, all drugs were taken into account in their respective groups, regardless of potential discrepancies. Age was managed as a continuous variable but also stratified for some analyses in age-bands of 5 or 10 years, depending on the particular analysis.
Wolff Parkinson White and recreational (meth)amphetamine use: a potentially lethal combination
Published in Acta Clinica Belgica, 2021
B. Aspeslagh, P. Calle, J. De Pooter
After resuscitation, he was transferred to a nearby hospital. His ECG showed pre-excitation, compatible with his medical history of WPW (Figure 1). Toxicology (sampled about 2 h after the collapse) was positive for 3,4-methylenedioxyamphetamine (MDA): 10 ng/mL in plasma and 231 ng/mL in urine. Analysis of a similar pill as the one ingested by the patient (handed over by his friends) revealed a content of 45 mg MDA and 15 mg MDMA. After post-resuscitation care, he woke up and was extubated two days later. He underwent electrophysiological testing 3 days later. The electrophysiological study confirmed the presence of a left lateral accessory pathway. Upon the start of atrial pacing, atrial fibrillation (AF) was induced with fast conduction over the accessory pathway resulting in hemodynamically collapse. The shortest pre-excited RR-interval during AF measured 190 ms. He underwent subsequently successful ablation of a left lateral accessory bundle of Kent (Figure 2).
Deaths related to MDMA (ecstasy/molly): Prevalence, root causes, and harm reduction interventions
Published in Journal of Substance Use, 2018
On the other hand, some underground manufacturers of ecstasy and molly use chemicals that are cheaper and more readily available than MDMA to turn a higher profit (Henry, Jeffreys, & Dawling, 1992). Although some of these other substances (e.g., 3,4-methylenedioxyamphetamine [MDA], Pentylone, and N-Ethyl-Pentylone) can resemble MDMA in their effects, studies point to many of these substitutes being more toxic than MDMA (Felgate, Felgate, James, Sims, & Vozzo, 1998; Winstock et al. 2002). PMA (paramethoxyamphetamine), a common adulterant, is sometimes used in lieu of MDMA because it causes the stimulation of the central nervous system and provides hallucinogenic effects (Bryson, 1996). But not much is known about PMA’s effects on humans (Kraner et al., 2001). Since PMA was placed into the schedule I list of the Controlled Substances Act, human research has been conducted only sparingly. However, PMA is considered to be more toxic and a more potent stimulant than MDMA (Byard, James, Gilbert, & Felgate, 1999; Felgate et al., 1998). In fact, some findings suggest that dosages of PMA above 0.5 mg can be toxic and cause death (Kraner et al., 2001). In some cases, drugs purported to be ecstasy or molly may have no MDMA content whatsoever (Center for Substance Abuse Research, 2002). The unpredictable purity of ecstasy and molly contribute to MRDs because users are not able to accurately gauge MDMA content or the presence of other potentially harmful adulterants.