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Marvin the Paranoid Android and Alice in Wonderland
Published in Ornella Corazza, Andres Roman-Urrestarazu, Handbook of Novel Psychoactive Substances, 2018
Pierluigi Simonato, Attilio Negri, Marco Solmi, Rita Santacroce
Marvin was a 28-years-old Caucasian man, with no past or ongoing organic illnesses. The patient had no major family history of disease; he was single and studied at the local high school and attended the university for two years at the Faculty of Herbal Techniques. He was admitted to our Dual Diagnosis Unit (Casa di Cura “Parco dei Tigli”) in 2014, because of symptoms suggestive of a depressive episode that occurred in the previous four weeks. When hospitalized, reality testing was not impaired by active hallucinations or delusions; upon arrival, he was compliant with prescribed therapy but complained of a generalized ‘lack of energy’. The blood panel did not show significant features except for elevated levels of cholesterol (220 mg/dl) and triglycerides (226 mg/dl); electrocardiography indicated normal activity. Toxicological tests and a urine sample were positive for benzodiazepines (delorazepam 246 ng/ml) and negative for cocaine, cannabis, alcohol, methadone, barbiturates, and opioids. Delorazepam was previously prescribed by his psychiatrist. At the time of Marvin’s arrival to the Dual Diagnosis Unit, he was already known to a local mental health service (CSM). He was a client of the service since he was 16 years old because of a psychotic episode induced by cannabis and skunk. He received a diagnosis of substance-induced psychosis (DSM IV-R) and was treated with antipsychotic and antidepressant medications: risperidone (4 mg/day), venlafaxine (75 mg/day), biperiden (4 mg/day), and delorazepam (2 mg/day). Marvin was also briefly followed by a local drug service (Ser.D) for his past cannabis misuse, but he never disclosed the use of other substances, particularly NPS.
Designer benzodiazepines versus prescription benzodiazepines: can structural relation predict the next step?
Published in Critical Reviews in Toxicology, 2021
Raneem E. Moustafa, Fuad Tarbah, Huda Sulaiman Saeed, Suleiman I. Sharif
Each of those two drugs produces three unique classic benzodiazepines with relatively long half-lives that will be discussed in detail in the next section. Diclazepam, for example, gets metabolized to lorazepam, lormetazepam, and delorazepam (three well known classic benzodiazepines), having elimination half-lives that are relatively long-reaching 78 h for delorazepam, 12 h for lorazepam, and 13 h for lormetazepam. This imposes an issue that has been shown by a study on diclazepam organ distribution that its metabolites get redistributed in the same manner as their parent drug which may cause toxicity and overdose-like problems due to their accumulation in addition to the parent drug (diclazepam) which already has a long half-life. This leads to long-lasting sedative effects most likely when applying high or repeated doses (Lehmann et al. 2019).
Occurrence and time course of NPS benzodiazepines in Sweden – results from intoxication cases in the STRIDA project
Published in Clinical Toxicology, 2019
Matilda Bäckberg, Madeleine Pettersson Bergstrand, Olof Beck, Anders Helander
An analytical complication is that some substances sold as NPS BZD are also precursors or metabolites of prescription BZD or other NPS BZD [14,36,37]. One example is 3-hydroxyphenazepam, which is a major metabolite of phenazepam [14]. 3-Hydroxyphenazepam has been detected in the STRIDA project since 2015, although it cannot be known if this was due to intake of this substance or of phenazepam. In addition, 3-hydroxyphenazepam is a metabolite of cinazepam, another Russian prescription BZD [38], but this substance has not been reported as an NPS in Europe [6]. Another analytical issue relates to diclazepam that entered the Swedish NPS market in late 2013. This coincided with an increasing number of lorazepam-positive samples, which caused confusion as lorazepam is not used in critical care in Sweden, so illegal use was suspected. Later on, however, lorazepam, delorazepam, and lormetazepam were identified as metabolites of diclazepam [39]. A third analytical issue relates to clonazolam and meclonazepam that are present in urine in only low concentrations [20]. For these substances, drug testing is better focused on their 7-amino- and 7-acetamino metabolites [40].
“Marvin, the Paranoid Android”: The Case of an Alpha-PVP User in the Expanding Galaxy of NPS
Published in Journal of Psychoactive Drugs, 2018
Simonato Pierluigi, Bulsis Laura, Negri Attilio, Bansal Gurjeet K, Pessa Gloria, Mioni Davide, Giuseppe Borgherini, Martinotti Giovanni, Schifano Fabrizio, Giulia Perini, Corazza Ornella
Marvin was a Caucasian man, 28 years old, with no past or ongoing organic illness. The patient came from a healthy family, he was single, he studied at Liceo Scientifico (high school), and for two years attended university, in the faculty of herbal techniques. He was admitted to the Dual Diagnosis Unit (Casa di Cura “Parco dei Tigli”) in 2014 due to symptoms suggestive of a depressive episode that occurred in the previous four weeks. When hospitalized, his reality testing was not impaired by active hallucinations or delusions; at arrival, he was compliant with prescribed therapy but complained of a generalized “lack of energy.”1This symptom reminded us the fictional character in the book The Hitchhiker’s Guide to the Galaxy, the depressed robot called Marvin. The blood panel did not show significant features except for elevated levels of cholesterol (220 mg/dl) and triglycerides (226 mg/dl); electocardiography indicated normal activity. Toxicological tests and urine sample were positive for benzodiazepines (delorazepam 246 ng/ml, was previously prescribed) and negative for cocaine, cannabis, alcohol, methadone, barbiturates, and opioids.