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What’s on the street & What’s in your ED

It often very hard to target the causative agent, and there are often many at one time.

Treatment is symptomatic relief, protection of patient and staff, and monitoring for end-organ damage.

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Methoxetamine

• Related to Ketamine
  • Dissociative anesthetic
• Often white powder
• Routes: nasal, sublingual, inhale, IV/IM
• Onset 10-20 min, lasts 2-3 hours
• Clinical effects
  • Hypertension, tachy, hyperthermia
  • Agitation, hallucination, dissociation
  • Positive: euphoria, sense of calm
  • Negative: distortion, loss of sensory perception
• References
  • Ketamine-like Effects After Recreational Use of Methoxetamine
  • Methoxetamine (MXE) – A Phenomenological Study of Experiences Induced by a “Legal High” from the Internet

1. Methoxetamine
2. Cathinones
3. Salvia
4. Kratom

Methoxetamine

• Related to Ketamine
  • Dissociative anesthetic
• Often white powder
• Routes: nasal, sublingual, inhale, IV/IM
• Onset 10-20 min, lasts 2-3 hours
• Clinical effects
  • Hypertension, tachy, hyperthermia
  • Agitation, hallucination, dissociation
  • Positive: euphoria, sense of calm
  • Negative: distortion, loss of sensory perception
• References
  • Ketamine-like Effects After Recreational Use of Methoxetamine
  • Methoxetamine (MXE) – A Phenomenological Study of Experiences Induced by a “Legal High” from the Internet

Cathinones

• Synthetic form of cathinone
  • stimulant derived from Khat plant, native tHorn of Africa
• Many different forms made by different side chains
  • Varying onset, duration, and effects
• Mimic effects of MDMA, cocaine, and/or meth
• Routes: nasal, inhale, IV, pills, alsreported “eyeballing”
• Clinical effects
  • Hypertension, tachy, hyperthermia
  • Combative, self-mutilation, homicidality
  • Positive: Increased alertness, euphoria, sociability, openness, talkativeness
• References
  • Synthetic Cathinones: A New Public Health Problem
  • Synthetic Cathinones (“Bath Salts”)

Salvia

• Salvinorin A is active chemical from Salvia Divinorum
• Agonist of kappa opioid receptor
  • Causes hallucinations without respiratory depression of other opioid receptors
• Routes: inhaled, chewing (ingestion causes inactivation of chemical by gastric acids)
• Onset within seconds, lasts 20-30 minutes
• Clinical effects
  • Tachycardia (some studies show ncardiac effects)
  • Hallucinations, disorientation, giddiness
  • Positive: creativity, calm feeling, feeling of well being
  • Negative: dizziness, fear/terror, loss of control of situation
• References
  • Salvia divinorum: A Unique Hallucinogen
  • Salvia divinorum: exposures reported to a statewide poison control system over 10 years
  • Study of Controversial Hallucinogen Salvia Shows Intense and Novel Effects in Humans

Kratom

• Derived from leaves of Mitragyna speciose (Southeast Asia)
• Agonist of mu opioid, delta opioid, and alpha 2 adrenergic receptors
• Low doses primarily stimulant, high doses opioid-like depressant
• Routes: chew, pills, tea/tincture, inhale
• Clinical effects
  • Low dose
    • Tachycardia, hypertension
    • Alertness, high energy, talkative
  • High dose
    • Hypotension
    • Respiratory depression
    • Euphoria
• References
  • Kratom: A New Wonder Drug or Physician Nemesis?
  • Kratom (Mitragynine) Ingestion Requiring Naloxone Reversal
  • Kratom, a Legal Drug of Abuse
  • Kratom: An Emerging Drug of Abuse

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