12/9/16

Channeling Your DXM Personality

5© ljupco | 123rf.com

5© ljupco | 123rf.com

June of 2016 was a confusing month for DXM. Alaska became the 11th state to limit the sale of products containing dextromethorphan (DXM) to individuals 18 and older. Representative Charisse Millett of Anchorage thanked her colleagues for passing a bill that will protect Alaska teens. On the other hand, there was a study published in the journal, Substance Abuse Treatment Prevention, and Policy by Spangler, Loyd and Skor that same month which said DXM was a safe, effective cough suppressant, available without a prescription since 1958. The article reported how the annual prevalence of DXM abuse has sharply decreased since 2010. So why would so many states be restricting the sale of a “safe, effective cough suppressant”?

Adding to the issue, there is H.R. 3250, The DXM Abuse Prevention Act, which was sent to both the House and Senate for consideration on April 27, 2016. H.R. 3250 seeks to prevent the abuse of DXM and would restrict its sale to individuals 18 and over. Civil penalties for retailers violating H.R. 3250 would range from a warning for a first offense up to $5,000 for four or more violations. If implemented, the federal law would take precedence over any existing state legislation.

The pro-drug website Erowid noted that while DXM is still unscheduled in the US, and legal to buy, possess and ingest without a prescription, it is becoming increasingly difficult to purchase. “Some pharmacies and mega-stores like WalMart have instituted voluntary procedures to reduce the sale of DXM-containing products to minors.” Erowid listed and commented on the legal status of DXM in 25 different states and was soliciting more information on its status in other states.

In 2007 the DEA requested that the FDA evaluate whether dextromethorphan should be scheduled as a controlled substance. Three years later the FDA held an Advisory Committee meeting on the matter. After hearing presentations on DXM and its abuse potential, the committee voted 15 to 9 against scheduling DXM. An Erowid assessment of the presenters was they did not believe that scheduling was warranted, but were concerned about abuse.

The DXM article by Spangler, Loyd and Skor said that to address reports of abuse, the Consumer Healthcare Products Association (CHPA) initiated a plan to raise awareness of the behavior and “address prevention by focusing on the factors that impact teen behavior.” All three authors were employees of the CHPA, “which represents manufacturers of over-the-counter medicines and dietary supplements.”  And funding for the research, collection of the data, analysis, interpretation, plan implementation, and writing of the manuscript was provided by CHPA member companies. They concluded:

It is noteworthy that the annual prevalence of over-the-counter cough medicine abuse has sharply decreased since 2010. While a true cause-and-effect relationship cannot be assured, the Consumer Healthcare Products Association and its member companies believe that the increased awareness of the issue since the 2010 Food and Drug Administration Advisory Committee meeting, and the subsequent implementation of a well-delivered and targeted abuse mitigation plan that addressed the levers influencing teen decisions is contributing to the observed reduction in abuse. During the period of 2010–2015, reported abuse of dextromethorphan by 8th, 10th, and 12th graders decreased 35 %. The authors believe this reduction supports the view of the Consumer Healthcare Products Association at the outset of the abuse mitigation plan effort and today: Controlled substance scheduling or prescription requirements would result in a reduction in the legitimate use of this medicine that has benefits that far outweigh its risks. Instead, there are more targeted, more effective, and less disruptive interventions to address dextromethorphan abuse.

Writing for The Fix, John Lavitt reported that one in 30 adolescents use DXM to get high because it is cheap and accessible. In 2014 there were six DXM-related deaths, according to the American Association of Poison Control Centers. Non-medical use of DXM leads to around 6,000 ER visits per year. Adolescents account for almost 50% of those visits. The effects range from mild stimulation to euphoria and hallucinations. There can be an out-of-body dissociative state, complete dissociation with unresponsiveness and even overdose.

Medline Plus lists some of the many products that contain DXM, including NyQuil, DayQuil, TheraFlu, Tylenol Cold, Dimetapp DM, Robitussin DM, Triaminic DM, and Alka-Seltzer Plus Cold and Cough.  Some of the symptoms of a DXM overdose listed included: breathing problems, bluish-colored fingernails and lips, blurred vision, coma, Convulsions, drowsiness, hallucinations, heart palpitations, nausea and vomiting, rapid heart beat.

Now here is some DXM history from Erowid. It was approved by the FDA in 1958. In the early 1960s, there were reports that beat poets like Allen Ginsberg and Peter Orlovsky and the author Jack Kerouac were using DXM in the form of Romilar tablets. Incidentally, Romilar was introduced as a replacement for codeine cough remedies in an attempt to cut down on abuse. In 1973, Romilar DXM tablets were removed from the market after an increase in recreational use was noted. DXM continued to be available as a syrup, with the thinking that consuming large quantities of syrup would be deterrent for recreational use. OTC DXM tablets have been back on the market now for number of years. In the late 1980s DXM use was prominent among the punk subculture.

By the way, codeine cough syrup is main ingredient in the concoction “Sizzurp” that sent rapper Lil Wayne to the hospital with multiple seizures. He even wrote a song about his love for Sizzurp, “Me and My Drank.”  Then there’s Justin Beiber and his street-racing-DUI-Sizzrup arrest. Teens and others without ready access to a codeine prescription cough formula can substitute OTC DXM formulas in their Sizzurp knockoff. Add some Jolly Ranchers to make the concoction more drinkable.

So while DXM may be safe and effective when used as recommended, it was being used as a recreational high almost from the time it came onto the market as a substitute for codeine. It has ebbed and flowed in its consideration for classification as a controlled substance. Currently it isn’t one. However, it does seem likely to face restricted sales to anyone under the age of 18. Eleven states have already passed legislation to that effect, and larger chains like WalMart, Walgreens, Target, Rite-Aid and others now require ID and limit sales to two DXM-containing products. And there is pending federal legislation that has a 38% of passing that would make it illegal to sell DXM products to minors. The last word on DXM is from Erowid.

Recreational DXM use continues. A number of deaths have been documented due to the recreational use of DXM although a majority of these have been the result of products (such as Coricidin Cough and Cold) that combine DXM with other substances that become dangerous in high doses.

So if you decide to try and contact your inner beat poet, or channel your punk rock personality through DXM, be careful.

09/27/16

The Secret of Kratom

36473493 - tablet with the chemical formula of kratom (mitragyna speciosa) mitragynine. drugs and narcotics

© Vitally Vodolazskyy | 123rf.com

So you’ve never heard of kratom? A CDC study of kratom exposures reported to poison centers showed a tenfold increase from 26 in 2010 to 263 in 2015. If kratom becomes more widely known and used, those figures will be increasing. The CDC published a report on kratom on June 29, 2016, citing its potential as an “emerging drug of abuse.” The cited NIDA document, “Drug Facts: Kratom,” does not refer to it as an emerging drug of abuse as claimed, but it does say, “Like other opioid drugs, kratom may cause dependence.” The CDC report itself suggested it was an emerging public health threat.

Kratom use appears to be increasing in the United States, and the reported medical outcomes and health effects suggest an emerging public health threat. Members of the public and health care providers should be aware that the use of kratom can lead to severe adverse effects, especially when consumed in combination with alcohol or other drugs.

Kratom is a tropical tree-like plant native to Thailand, Malaysia, Myanmar and other countries in Southeast Asia. It has a long history of use as a stimulant in low doses. Kratom is often brewed as a tea, but it can also be smoked or swallowed in capsules. Southeast Asian laborers and farmers chew the leaves for energy to work harder and to relieve muscle strains. It has been used as a substitute for opium when opium is not available. And it’s used to manage opioid withdrawal symptoms. Long-term kratom use has produced anorexia, weight loss, insomnia, skin darkening, dry mouth frequent urination and constipation.

The DEA included kratom on its Drugs of Concern list and recently announced its intention classify kratom and two of its psychoactive chemicals temporarily as a Schedule I controlled substances. “The two chemicals are called mitragynine and 7-hydroxymitragynine. By banning the active chemicals, the DEA is making sure that both the plant and any synthetic versions of it are included in the new regulation.” STAT reported the DEA is authorized to temporarily place substances in Schedule I for up to two years when it believes they are a potential public health threat. If their studies demonstrate there is a threat, the ban will remain. If not, it will revert to being legal.

Like marijuana, it contains multiple alkaloids, but mitragynine and 7-hydroxymitragynine are the primary active one in the plant. At lower doses, it produces stimulant effects. Users report increased alertness, physical energy, talkativeness and sociable behavior. At higher doses, opiate effects, including sedation and euphoria occur. “Effects occur within 5 to 10 minutes of ingestion and last 2 to 5 hours.” The DEA announcement described the following health risks from kratom in some detail.

Several deaths associated with kratom have been reported, often when it is mixed with other substances. There are also reports of drug-induced liver damage, psychosis, seizures, weight loss, insomnia, tachycardia, vomiting, poor concentration and hallucinations. Fifteen of the reported deaths occurred between 2014 and 2016. There was a cluster of nine deaths reported in Sweden from a kratom product called “krypton.” See “Krypton Can Kill You.”

The CDC kratom study said 24.5% of the reports on adverse events were for minor complications; 41.7% required some treatment and were considered to be moderate complications. There were major complications—meaning life-threatening signs or symptoms, with some residual disability—for 7.4% of the kratom exposures. The adverse effects included: tachycardia [abnormally rapid heart beat] in 25% of the reported cases, agitation or irritability in 23.8%, drowsiness in 19.4%, nausea in 14.7% and hypertension in 11.7%.

A recent article in the International Journal of Legal Medicine by Warner, Kaufman and Grundmann reported the death of a young adult who had mixed kratom with prescribed medications—Prozac and Lamictal. Another article, “A Drug Fatality Involving Kratom,” noted a 17-year-old male with a history of heroin abuse and chronic back pain who died from a “possible Kratom toxicity.” He had mixed kratom, benzodiazepines and over-the-counter cold medications (containing DXM?).

In “Pharmacology of Kratom,” Prozialeck et al. found there was an increasing level of kratom use, especially among college students. They also noted a large number of online vendors and general information websites for kratom. An Internet search they did with Google had more than 2 million hits in February of 2012. When I repeated the search in August of 2016, I had over 6.36 million hits. Prozialeck et al. said their search of websites indicated kratom was being used for pain management as well as a recreational drug.

Kratom is regulated as an herbal product in the U.S. and is currently considered a legal substance, despite the CDC concern for its abuse potential. Along with the DEA declaration that there isn’t a legitimate medical use for kratom, this meant: “it cannot legally be advertised as a remedy for any medical reason.”

Pharmacologically, the mitragynine in kratom activates the μ, δ, and κ opioid receptors. Its main activity is on the μ receptor, the one that produces the analgesic and euphoric effects with opioids; and of course results in physical dependency. Despite kratom’s reputation as a “legal opioid,” there have been few scientific studies that addressed its psychoactive properties. Most of the available information is in anecdotal reports, like those on the website, Erowid.

Erowid has a plethora of Kratom reports categorized in groups such as: First Times, Combinations, Preparation/Recipes, Difficult Experiences, Health Problems, Addiction & Habituation, Mystical Experiences and Medical Use. A nondrinking male reported it caused liver toxicity in “Killing My Liver.” A more serious reaction resulted in a hospital stay for a drug–induced hepatic injury in “”Almost Destroyed My Liver.” Then there was a disturbing report under Addiction & Habituation called “This Thing Is a Secret.”

A man with a history of drug and alcohol addiction hadn’t used any “hard stuff” like heroin, alcohol, amphetamines or cocaine in five years. He was active in Alcoholic Anonymous. Then in January of 2005, he decided to order some kratom on a whim from an online vendor. When it kicked in, it had a “Definite opiate effect.” Nine months later, when he wrote his report for Erowid, he said he was using it daily. If he forgets to place his order in time, he’ll have to go a day without it. It was just like the withdrawals from his hydrocodone/Ambien habit.

His wife doesn’t know. No one knows, except the people he orders kratom from. He said he felt guilty spending family money of the stuff, but not guilty enough to stop. “Maybe I’ll quit some time, but for now, things are maintaining. It’s better than shooting heroin or oxycontin or any stuff like that…”

 Naturally, I don’t go around blabbing to my AA associates about how I am using this plant every day. They are some of the best people I have ever met and cherish their friendship. We have a saying in AA, ‘your secrets keep you sick.’ This Kratom thing is a secret.

Prozialeck et al. reported that as kratom use has expanded to Europe and the U.S., there have been increasing reports of individuals becoming physically dependent or addicted to kratom. Most of the published studies, like this one by McWhirter and Morris were case reports. They described a case of kratom dependence in a 44-year-old man with a history of alcohol dependence and anxiety disorder. His withdrawal symptoms were consistent with mild opioid withdrawal: anxiety, restlessness, tremors, sweating and cravings.

Evidence suggests that kratom is being used extensively for both medical and nonmedical purposes. Recent studies have shown that kratom contains a variety of active compounds that produce major pharmacologic effects at opioid and other receptors. Kratom and kratom-derived drugs may potentially be used for the management of pain, opioid withdrawal symptoms, and other clinical problems. At the same time, serious questions remain regarding the potential toxic effects and the abuse and addiction potential of kratom. This issue is further confounded by the lack of quality control and standardization in the production and sale of kratom products. The possibilities of kratom products being adulterated or interacting with other drugs are also serious concerns. Until these issues are resolved, it would not be appropriate for physicians to recommend kratom for the treatment of patients. Nevertheless, physicians need to be aware that patients may use kratom or kratom-based products on their own. Further studies to clarify the efficacy, safety, and addiction potential of kratom are needed.

Regulating kratom presents issues similar to what we are now facing with marijuana. Both plants contain dozens of compounds with some potential medical use. Both are currently not viewed by the U.S. government as having any medical use.  Where marijuana’s classification as a Scheduled I controlled substance makes scientific research into its potential medical uses difficult, the limited use and knowledge of kratom contributes to it being understudied. Each also has one or two dominant psychoactive ingredients.

There is also a lack of quality control with both. The strength of THC or CBD in marijuana and mitragynine or 7-hydroxymitragynine in kratom can vary widely. Products containing these herbal substances cannot be guaranteed to carry similar doses of the active ingredients. And they are likely to have contaminants, such as pesticides, if grown commercially. The limited, scientifically reliable knowledge of their medical usefulness, and the lack of regulation with regard to that knowledge, results in a wide variety of anecdotal claims similar to past the age of patent medicines.

What is to be done? Federal funding of research into kratom’s potential medical uses needs to occur. The two-year temporary classification as Schedule I can be extended another year if more time is needed while the studies of it medical uses are completed. A permanent classification of kratom as a Schedule I Controlled substance seems inadvisable. Remember that hasn’t worked very well with marijuana. Future classification as a controlled substance seems reasonable, given its activation of the μ, δ, and κ opioid receptors. But let’s base it upon reliable scientific information.

08/9/16

The Wrong Doorway

© captainvector | 123rf.com

© captainvector | 123rf.com

Laughing gas or nitrous oxide (N20) has a surprising variety of uses or effects. The World Health Organization lists it as an essential medicine because of its anesthetic and analgesic effects. It’s used as an oxidizer in rockets and motor racing to increase the power output of engines. N20 is also a major greenhouse gas, with a per unit mass impact that is between 265 and 310 times that of carbon dioxide. And it is in the top ten most popular recreational drugs globally.

The English chemist Joseph Priestley discovered nitrous oxide gas in 1772. Priestley is also known for his discovery of oxygen. Humphrey Davy experimented with N20 on himself and others in 1799. He coined the term ‘laughing gas’ after observing its effects on people who inhaled it. Although he reported its analgesic effects in 1800, this property was not tested or used for another 45 years. During that time, it was primarily a ‘party’ or entertainment drug.

A British dentist in 1845 was the first person to demonstrate the anesthetic properties of nitrous oxide. However, it was not widely used in dentistry until 1863. Gardner Quincy Colton and his partners opened a series of dental institutes using laughing gas. Within five years, they had performed a reported 75,000 extractions. A history of reported nitrous oxide users includes: Allen Ginsberg, Samuel Taylor Coleridge, Ken Kesey, Winston Churchill and William James.

In 1882 James published an article titled: “The Subjective Effects of Nitrous Oxide,” in the journal Mind.  He said his use of N20 helped him develop a greater understanding of Hegel’s philosophy and he strongly urged his readers to repeat the experiment. “With me, as with every other person of whom I have heard, the keynote of the experience is the tremendously exciting sense of an intense metaphysical illumination.” Truth was almost blindingly obvious. “The mind sees all logical relations of being with an apparant subtlety and instantaniety to which its normal consciousness offers no parallel.”

But as he “sobered up,” the feeling faded. James was left with a few disjointed words and phrases—like staring at a black cinder left after the fire has gone out. James said he had sheet after sheet of phrases written during intoxication with N20 that to his sober mind seemed to be “meaningless drivel.” The most coherent and articulate sentence that came to him was the following: “There are no differences but differences of degree between different degrees of difference and no difference.”

In his later, seminal work, The Varieties of Religious Experience, James again reflected on the significance of intoxication by alcohol and anesthetics. He said the influence of alcohol over humanity was due to its power to stimulate the mystical faculties of human nature. Sobriety diminishes; drunkenness expands. “The drunken consciousness is one bit of the mystic consciousness and our total opinion of it must find its place in our opinion of that larger whole.”

Nitrous oxide, according to James, stimulated the mystical consciousness to an extraordinary degree. “Depth beyond depth of truth seems revealed to the inhaler.” But that truth fades as the individual sobered up. Nevertheless, a profound sense of meaning persisted. “I know more than one person who is persuaded that in the nitrous oxide trance we have a genuine metaphysical revelation.” He then went on to describe his own previous experiments with N20 described in his 1882 article.

In an article for The Atlantic, “The Nitrous Oxide Philosopher,” Dmitri Tymoczko noted how the experience James had with nitrous oxide remained with him throughout his life. He wrote a second article about it in 1898, “Consciousness Under Nitrous Oxide.” Then in his last essay, completed in 1910, he implied N20 had had an abiding influence on his thinking. Tymoczko thought N20 was a ‘passport’ for James to see religion from the believer’s perspective. “Drugs helped James to understand what religious belief was like from the inside.”

 James’s experiences with nitrous oxide helped to crystallize some of the major tenets of his philosophy. His writings emphasize, for instance, the notion of pluralism, according to which “to the very last, there are various ‘points of view’ which the philosopher must distinguish in discussing the world.” Nitrous oxide had revealed in the most dramatic way possible the existence of alternate points of view.

Tymoczko used William James’s experience with nitrous oxide to argue how drugs can contribute to human well being; sometimes fulfilling an authentic religious need. He reasoned that drugs could allow even the most skeptical people to experience temporary periods of “pleasing falsehood,” dividing their life into periods of sober rationality and “ecstatic religious intoxication”, like William James. “Indeed, this is the real religious significance of drug use, from the Jamesian point of view–that it lets us choose, if only vaguely and temporarily, what to believe.”

He even referenced R. Gordon Wassson, who proposed that religion itself originated with drugs. According to Wasson, religion was a confused reaction to intense experiences provoked by the accidental ingestion of psychoactive plants. There have been examples where religious ritual has been entwined with the use of drugs. Some Native American cultures used psychedelic mushrooms in their rituals; and the Greek cult of Dionysus used wine to provoke visions. But Tymoczko went too far onto the magical mystery tour when he suggested that the use of wine by Christians could be a remnant of similar practices.

The Bible clearly puts the use of bread and wine within the context of a meal; not a mystical psychedelic religious rite. Tymoczko also failed to make a distinction made by James in The Varieties of Religious Experience that separated what James called institutional religion, like Christianity, from personal religion. James defined personal religion as “the feelings, acts, and experiences of [the] individual . . . in their solitude, so far as they apprehend themselves to stand in relation to whatever they may consider the divine.” James was looking at examples of personal religion, not institutional religion in The Varieties of Religious Experience. See “Spiritual, Not Religious Experience” for more on this distinction by James.

So now back to nitrous oxide. The significance of nitrous oxide to William James personally or to his philosophical and other writings has little to tell us about religious experience today. It may resonate with the increased interest in psychedelic drug rituals for therapeutic healing (See “Back to the Future with Psychedelics”). But before walking the path of Timothy Leary and Aldous Huxley, let’s take a look at what modern science tells us about N20—information that wasn’t available to James when he was doing his inhaling.

The Global Drug Survey, annually conducted by Adam Winstock and others, found that nitrous oxide was the seventh most popular drug in the world. More than 7% of the global survey respondents said they had used nitrous oxide in the past year. In the UK, it was used by 23.7% of respondents sometime over the past year. A recent article in the Journal of Psychopharmacology by Kaar et al., Winstock was a coauthor, indicated that the reported lifetime use of nitrous oxide for the UK and US was 38.6% and 29.4% respectively.

Most people using nitrous oxide recreationally do so infrequently without any serious side effects. But there is a subpopulation of heavy users. Quoted in an article for The Fix, Winstock said: “The majority of people who use it don’t use it very often, and only around 3% of heavy users say they have experienced negative health effects.” The Global Drug Survey found nitrous oxide use was associated with hallucinations (27.8%), confusion (23.9%), persistent numbness (4.3%) and accidental injury (1.2%). Accidental injury seems to be dose-dependent—injury is associated with higher numbers of ‘hits’ per session.

The pro-drug website, Erowid, has a ‘vault’ of information on nitrous oxide. Chronic exposure can effect reproduction in women. Immunological problems such as recurrent infections, decreased white blood cell counts and weakness have also been reported. There were also neurological issues with chronic N20 use.

A 1978 article in the British journal Lancet reported that a neurological disorder called myleneuropathy developed in 15 individuals with prolonged exposure to nitrous oxide. R.B. Layzer reported that: “The neurological picture is similar to that of subacute combined degeneration of the spinal cord, and it is possible that nitrous oxide interferes with the action of vitamin B12 in the nervous system.” A 1993 article by Flippo et al. in JAMA Surgery also described the dangers of neurologic degeneration from nitrous oxide. The abstract said:

Five cases (four from the literature and one new case) are presented in which patients unsuspected of having vitamin B12 deficiency developed subacute combined degeneration of the spinal cord following nitrous oxide anesthesia. Patients with vitamin B12 deficiency are exceedingly sensitive to neurologic deterioration following nitrous oxide anesthesia. If unrecognized, the neurologic deterioration becomes irreversible and may result in death.

Happily, some of these issues can be reversed. A 2003 article in the Wisconsin Medical Journal by Waclawik et al. described a case study of an individual who was a chronic nitrous oxide user whose neurological deficit was reversed after administering vitamin B12.

Sporadic use of N20 does not appear to be associated with serious health risks. But chronic exposure is another story. William James may have been influenced by experiences he had with nitrous oxide, just as Sigmund Freud’s use of cocaine shaped his psychoanalytic theories. N20 also fits with the current trend of looking for therapeutic healing or personal insight with psychedelics like LSD, ecstasy and even ayahuasca or ibogaine. But it is better suited as an anesthetic or analgesic in medical procedures; or an oxidizer in rocket engines than it is a doorway to religious experience.

04/26/16

MDMA—Not!

Ecstasy tablets © portokalis | 123rf.com

Ecstasy tablets © portokalis | 123rf.com

There are a handful of names for 3,4-methylenedioxymethamphetamine (MDMA), including: E, X, XTC, Rolls, Adam, Molly and Ecstasy. The pro-drug website Erowid noted it is one of the most popular recreational psychoactives, known for its euphoric, stimulant and empathogenic (feelings of oneness, emotional openness, empathy or sympathy) effects. This last effect indicates it has a past and current history of use in psychotherapy. But when you see a warning that, “Ecstasy tablets are notoriously impure, often containing chemicals other than MDMA,” be forewarned you may not be actually using MDMA.

The MDMA timeline on Erowid indicated MDMA was first synthesized and patented by Merck Pharmaceuticals in 1912. And the first animal testing of MDMA occurred at Merck in 1927. An article titled, ‘The Origin of MDMA (“Ecstasy”)’ indicated the 1912 Merck patent was a procedural patent, meaning MDMA was a precursor compound for another therapeutic and was not isolated as a drug in its own right. “Obviously, it was never intended for sale. MDMA was not tested pharmacologically in 1912.” The 1927 experiments were only aimed at exploring the potential pharmacological actions of MDMA. You can also read about MDMA and it history here on Wikipedia.

The first scientific paper on MDMA wasn’t published until 1960—in Polish. Alexander Shulgin resynthesized MDMA in 1965 while working at Dole Pharmaceuticals, but did not try it on himself at this time. Between 1967 and 1975 there were reports of small underground batches of MDMA being used recreationally, but Erowid said it had no clear documentation of its use before the mid 1970s. It didn’t become widely available as a street drug until around 1977.

Schulgin first heard of the psychoactive effects of MDMA from a student, and he tried it himself in September of 1976. He then reported on MDMA at a conference in December of 1976. Along with David Nichols, Schulgin wrote and published a report on the drug’s psychoactive effects in 1978. They described MDMA as inducing “’an easily controlled altered state of consciousness with emotional and sensual overtones”’ comparable ‘to marijuana, to psilocybin devoid of the hallucinatory component, or to low levels of MDA.’” Schugin referred to MDMA as “window”, because it allowed users to strip away habits and perceive the world clearly.

Because of its disinhibiting effects, Schulgin thought it could be useful in psychotherapy, so in 1977 he gave some to Leo Zeff, a psychotherapist. Zeff was so impressed with the effects, he came out of semi-retirement to promote its therapeutic use. Reportedly, he eventually trained an estimated four thousand therapists in the therapeutic use of MDMA. Zeff referred to MDMA as “Adam”, as he saw it putting users into a state of “primordial innocence.” It is believed that MDMA eliminates fear and increases communication in therapeutic users.

Concerned that MDMA would become an illegal substance like LSD and mescaline, early advocates tried unsuccessfully to restrict the available information and use of MDMA while they conducted informal research on its properties. By the late 1970s, there was a small recreational market for MDMA. By the early 1980s, it began to take hold as a “club drug” in places like Studio 54.

In 1984, Michael Clegg put together some financial backing, coined the term “Ecstasy” for MDMA, and mass-produced it in a Texas lab. “Ecstasy parties” were advertised at bars and discos. MDMA use quickly became a common sight on college campuses. “By May 1985, MDMA use was widespread in California, Texas, southern Florida, and the northeastern United States.”

Concern over the recreational use of MDMA resulted in its temporary placement as a Schedule I controlled substance on July 1, 1985. As a result of a hearing challenging the placement of MDMA as a Schedule I controlled substance, it was removed from its Schedule I status because of an improper procedure when it was originally scheduled on December 22, 1987. Within a short period of time, the DEA administrator reclassified MDMA as Schedule I, and it was permanently placed as a Schedule I controlled substance on March 23, 1988.

Ecstasy has remained a common recreational substance, particularly at dance clubs and raves. But it also persisted as a potential psychotherapeutic agent. The non-profit organization MAPS—Multidisciplinary Association for Psychedelic Studies—is currently funding clinical trials of MDMA as a “tool to assist psychotherapy” in the treatment of PTSD. Rick Doblin, the executive director of MAPS, founded it in 1986. His pre-MAPS organization, Earth Metabolic Design, held a conference on MDMA in March of 1985, in the midst of the fight over whether MDMA should become an illicit controlled substance.

MAPS is undertaking a roughly $20 million plan to make MDMA into a Food and Drug Administration (FDA)-approved prescription medicine by 2021, and is currently the only organization in the world funding clinical trials of MDMA-assisted psychotherapy. For-profit pharmaceutical companies are not interested in developing MDMA into a medicine because the patent for MDMA has expired. The idea of using MDMA to assist psychotherapy of any kind for any specific clinical indication has long been in the public domain.

The development of psychoactive substances like MDMA, LSD, Ibogaine and Ayahusca as psychotherapeutic “tools” has gained momentum in recent years. In part, this is because of the growth of concerns over the adverse effects and long-term use of FDA approved medications like antidepressants and antipsychotics. MAPS supports research into the therapeutic use of each of the above-named psychoactive substances. The following quote illustrates how MAPS presents the therapeutic benefits of MDMA-assisted psychotherapy: “MDMA is only administered a few times, unlike most medications for mental illnesses which are often taken daily for years, and sometimes forever.”

Along with Erowid, MAPS cautions that substances sold as “Ecstasy” or “molly” may not be pure MDMA. “Substances sold on the street under these names may contain MDMA, but frequently also contain unknown and/or dangerous adulterants.” The rise of novel or new psychoactive substances (NPS) such as “bath salts” has meant that many partygoers who think they are using MDMA aren’t. Media outlets such as Newsweek and The Fix have reported on a recently published study in the journal Drug and Alcohol Dependence that tested hair samples from ecstasy users for the presence of NPS. The lead author of the study, Joseph Palmer, said in an NYU press release on his research that:

Given the sharp rise in poisonings and recent deaths at dance festivals related to ecstasy use, research was needed to examine whether nightclub/festival attendees who use ecstasy or Molly have been unintentionally or unknowingly using “bath salts.”

The researchers surveyed young adults outside of nightclubs and dance festivals in the summer of 2015 about their use of ecstasy and other drugs.  The participants were asked if they had knowingly used any of a list of more than 35 NPS; and whether or not they had knowingly used ecstasy, MDMA or “molly.” Then they were asked if they would submit a lock of their hair for the researchers to test for NPS. “We collected hair samples from about a quarter of the survey sample to be tested for novel drugs.”

A lot of people laughed when they gave us their hair saying things like “I don’t use bath salts; I’m not a zombie who eats people’s faces.”

However, the researchers found that among individuals who reported they had not knowingly used bath salts or some unknown substance, 40% tested positive for “bath salts” and other NPS. Among participants reporting they had used ecstasy, half the samples tested positive for MDMA and half tested positive for bath salts and other NPS. One sample tested positive for alpha-PVP, flakka.

Ecstasy wasn’t always such a dangerous drug, but it is becoming increasingly risky because it has become so adulterated with new drugs that users and the scientific community alike know very little about. . . .   Users need to be aware that what they are taking may not be MDMA.

03/15/16

Gone Wild

© jdwfoto | dreamstime.com

© jdwfoto | dreamstime.com

It surprised me not only to see that a synthetic marijuana bust occurred 30-minutes from where I live; but that it made both the local and national news. ABC News, The Fix, a small local paper called The Cranberry Eagle among others reported on the joint operation by the PA State Attorney General’s bureau of Narcotics Investigation and the state police Southwest Strike Force. About 360 pounds in total of synthetic marijuana with an estimated street value of $1.6 million was seized. Intriguingly, three of the four individuals arrested were senior citizens. Talk about putting away something for your retirement.

Two of the individuals owned and operated several tobacco and drug-paraphernalia shops in the tri state area of Pennsylvania, Ohio and West Virginia.  According to court records, they would receive shipments of synthetic marijuana from out-of-state suppliers at their Cranberry Township shop, where they would allegedly break down the packages for resale. They were both charged with multiple offenses, including dealing in unlawful proceeds, criminal conspiracy and possession with intent to deliver synthetic marijuana. They were released on $50,000 bail.

In October of 2013 investigators seized about 73 pounds of synthetic marijuana at the UPS facility in Jackson Township. A few days later they seized two additional packages containing another 109 pounds of the drug. Multiple packages had been shipped to the Cranberry Township shop between December 2012 and October 2013 from the same individual in Tampa Florida. The grand jury received testimony that the shop’s owners also imported 3,000 to 4,000 packets of synthetic marijuana from New York and Massachusetts suppliers between October 2013 and November 2014. Search warrants obtained in November of 2014 led to the discovery of another 148 pounds of synthetic marijuana.

The Cranberry shop is one of six retail stores within a company known as “Glass Gone Wow.” All six stores are in the tri state area of Ohio, Pennsylvania and West Virginia. They are all upscale head shops. The home page for “Glass Gone Wow” highlights areas for Elite Glass, Electronics and Wellness. Also look at the Glass Gone Wow facebook page. The Elite Glass products are from several glass and water pipes companies. Yes, you can technically smoke tobacco in them, but I don’t think that is what the vast majority of Glass Gone Wow customers put in their pipes.

When I was on their website, there wasn’t any content under the Electronics link, but it would be for products like e-cigarettes, e-juice flavors and vaporizers.  The Wellness Center sells CBD Hemp products, and ‘exotic’ herbs such as Kratom, Kava, Blue Lotus and Damiana. The herbs are all legal, but three of them—Kratom, Kava and Blue Lotus—have psychoactive properties. Kratom is used as an opium substitute. Kava and Blue Lotus will produce mild psychoactive effects alone and more intense effects if mixed with other drugs. Look up these substances on Erowid, if you want to confirm what I’ve said here. Erowid is a pro-drug website offering extensive information on the history, effects and dangers of various psychoactive plants and chemicals.

CBD or cannabidiol is one of the 85 or so cannabinoids found in cannabis. THC or tetrahydrocannabinol is the primary psychoactive cannabinoid in marijuana, while CBD has the greatest medical potential. See “Let’s Not Get Ahead of Ourselves,” or “Clearing Away the Medical Marijuana Smoke” for more on medical marijuana. But the CBD Hemp products may not have the therapeutic effects they claim. First, any CBD product cannot make a medicinal claim without FDA approval. So the products are sold as dietary supplements, which the FDA has limited control over.

In order to force a company to remove a dietary supplement from the market, the FDA has to complete scientific studies and undertake complex legal procedures to support its recommendation. Simply put, it is usually more trouble than it’s worth. So dietary supplements abound, with little or no reliable scientific evidence to support their claims. We are largely going back to the days of the bogus claims of snake oil salesmen when it comes to these “dietary supplements.”

For example, there is a company named GreenGardenGold that sells “CBD-Rich products.” Their “About Us” page said it is one of the first companies to market CBD rich edibles. The company says their products are infused with CBD obtained from reliable providers and are legally shipped in all 50 states. They direct the reader to Project CBD for more information on the “potential therapeutic use of CBD. ”  There is then a list of 51 “Potential Therapeutic Uses of Hemp.” In the small print at the bottom of the list is the following:

Green Garden Gold makes no claim as to the efficacy of our products of the use of CBD in treating or combating the symptoms of the above list of medical conditions. We encourage our customers to sample our products for taste and quality. If, as a result of improved health is experienced, then we are delighted for the added bonus our products have provided.

Writing for Forbes, on March 9, 2016, Debra Borchardt indicated that the FDA sent out a number of warning letters to companies that make and sell products containing CBD. A spokesman for the FDA said the companies receiving the warning letters were in part selected because of the flagrant claims made about their products. He said:

Many of these products are claiming in their marketing and promotional materials that they are intended for the use in the diagnosis, cure, mitigation, treatment or prevention of diseases, including, for example: cancer, various infections, psychiatric disorders, multiple sclerosis, arthritis and diabetes.

The companies were told in their letters that they had 15 days to notify the FDA about how they were going to take steps to correct their violations, which include products with little or no CBD in them. Borchardt wrote: “No consumer should be sold an expensive product that claims to have CBD, but then has none whatsoever. Consumers should also get truthful information on the products they buy, i.e. the labels need to be correct.”

Looking at the FDA announcement, it seems that products from “Cali Stores” tested by the FDA were found to have no CBD in them at all. Green Garden Gold was one of the companies who received a warning letter from the FDA. You can read a copy of the letter sent to them by the FDA here. The levels of CBD in the two products tested by the FDA indicated there had .096% and .079% CBD. The range of CBD within the tested products went from 0% to 35%. The Green Garden Gold products were on the lower end of that range. The FDA announcement said:

In February 2016, FDA issued eight warning letters to firms that market unapproved new drugs that allegedly contain cannabidiol (CBD). FDA had previously issued six such letters in February 2015. FDA has tested these products, and many were found to not contain the levels of CBD they claimed to contain. It is important to note that these products are not approved by FDA for the diagnosis, cure, mitigation, treatment, or prevention of any disease. Consumers should beware purchasing and using any such products.

In October of 2014, writing for High Times, Mike Adams wrote about the proliferation of “knockoff CBD treatments.” He noted how CBD has become “rock star” popular in the medical marijuana industry because it can treat a variety of medical conditions. But CBD is still illegal in most of the U.S. This has resulted in “an opportunity for some hemp businesses to market a variation of knockoff CBD treatments that they claim have the same healing power as popular strains such as Charlotte’s Web.” Adams then noted where Project CBD launched a “full-blown investigation” into the matter.

He went on to say these products were only technically similar and “do not provide the same health benefits as high-CBD cannabis strains.”  Martin Lee, the director of Project CBD, wrote in the introduction of the report: “We believe that industrial hemp is not an optimal source of CBD, but it can be a viable source of CBD if certain hemp cultivars are grown organically in good soil and safe extraction and refinement methods are employed.”

The report focused on three companies that were operated by the same controlling interest.  You can read a copy of the report here. On page 13 of the report is a quote from a press release of the Hemp Industries Association stating its position on CBD Extracts Misbranded and Marketed as “Hemp Oil”.

It is important for America farmers and processors of hemp to understand that most CBD in products mislabeled as ‘hemp oil’ is a co-product of large-scale hemp stalk and fiber processing facilities in Europe where the fiber is the primary material produced at a large scale. CBD is not a product or component of hemp seeds, and labeling to that effect is misleading and motivated by the desire to take advantage of the legal grey area under federal law. Hemp seed oil does not contain any significant quantity of CBD.

The Glass Gone Wow shops were apparently used as fronts to sell synthetic marijuana. At least that is what the grand jury indictment of their owner-operators implies. The shops legally sell water pipes and other paraphernalia commonly used in smoking marijuana. Although I don’t know if the vape pens sold at Glass Gone Wow can be used with hash oil or marijuana, there are e-cigarettes that can be modified to do so. See “E-Cigarettes and E-Joints.” It is also evident that the CBD Hemp Products sold there do not contain high-CBD from medical marijuana. According to High Times, Project CBD and the Hemp Industries Association, their hemp products will only have a serendipitous effect on your health, as was implied in the Green Garden Gold advertisement: “If, as a result improved health is experienced, then we are delighted for the added bonus.”

But there is one final piece of information to leave you with. All six of the Glass Gone Wow stores are located within 2 miles of a high school, middle school or elementary school. This seems to be more than just coincidental, when teenagers are prime consumers of the company’s products. The webpage “About Money” gave the following tip for finding the right location for a retail store: “You know who your customers are, so make sure you find a location where your customers live, work and shop.”

This location claim is easily verified. Go to the Glass Gone Wow location page. Use Google maps to get directions between each site location and local schools. Gateway High School is 1.7 miles from the Monroeville store. There is a middle school 1.5 miles from the Cranberry store. There is an elementary school and a park just across the street from the Robinson store. There was even some concern voiced about this by the Montour Elementary PTA. There is a school 1.9 miles from the South Side store. In Morgantown West Virginia, a school is .8 miles away; and in Boardman Ohio, a school is 1.6 miles away.

11/23/15

Cocaine’s Secret Ingredient

© lldipapp | Dreamstime.com

© lldipapp | Dreamstime.com

Writing for Time back in 2010, Maia Szalavitz described how the connection between levamisole and cocaine first came to light. In the summer of 2008, a man and a woman in their twenties were both admitted to a Canadian hospital with fevers, flu-like symptoms and dangerously low white blood cell counts. Although the symptoms were consistent with agranulocytosis, at the time it was only known as rare disease found in chemotherapy patients and others taking certain antipsychotic medications. Neither of the Canadian patients fit that profile. But they had one thing in common: they used cocaine. A search of the medical literature at the time didn’t find any studies linking agranulocytosis with cocaine.

But in April of 2008, a New Mexico lab had notified the New Mexico Department of Health (NMDOH) of a cluster of unexplained agranulocytosis cases in the preceding two months. The NMDOH launched their own investigation and “identified cocaine use as a common exposure in 11 cases of otherwise unexplained agranulocytosis.” In November of 2008, the NMDOH investigation and the Canadian public health officials connected with one another. In January of 2009 the NMDOH posted a notification of its findings on the CDC’s Epidemic Information Exchange. In a still separate investigation, public health officials in Seattle Washington identified 10 cases of agranulocytosis among persons with a history of cocaine use between April and November of 2009.

In the midst of this growing public health mystery, two high profile overdose deaths occurred. Celebrity disk jockey Adam Goldstein, better known as DJ AM, died of an overdose of cocaine and prescription drugs in September of 2009. Among the drugs found in his system was levamisole. Goldstein had been a fixture on the A-list party circuit and was a well-known cocaine user. Ted Koppel’s son Andrew accidentally overdosed in June of 2010. The medical examiner found a combination of drugs in his system at the time of death, including cocaine and levamisole. It was likely that neither men knew they had been snoorting any levamisole.

SAMHSA, the Substance Abuse and Mental Health Administration, posted a public health alert the same month of Adam’s death warning of the dangers of levamisole. Citing information from the DEA, the report said the percentage of cocaine specimens containing levamisole tested in its labs has steadily risen since 2002. In July of 2009, 70% of the illicit cocaine tested contained levamisole. They said there had been around 20 cases agranulocytosis, including two deaths associated with cocaine adulterated with levamisole.

Levamisole is used in veterinary medicine as a deworming agent for cattle, sheep and pigs. In the past, it was approved for use with humans to treat autoimmune diseases and cancer. It’s been increasingly found as an additive to cocaine in samples tested worldwide. It has some serious side effects like a weakened immune system, painful sores and wounds that don’t heal—the above noted condition called agranulocytosis. Left untreated, it could lead to death. Here is a short video on Adam’s death and some pictures of individuals with agranulocytosis from cocaine use. Don’t watch it if you have a weak stomach.

A recent case report in the British Medical Journal described a 42 year-old woman who came to an outpatient clinic in Britain suffering from vasculitis, an inflammation of the blood vessels. She had severe joint pain, muscle pain, intermittent abdominal pain and lesions. Initially, she repeatedly denied any cocaine use, but eventually admitted using it in the past. Hair testing done was positive for her recent use of levamisole-contaminated cocaine.

Erowid, a pro-drug website cautioned its readers to be honest with healthcare providers about their illicit substance use when they seek treatment for conditions like high fever that could be from levamisole to improve their chances of proper diagnosis and quick recovery. In other words, don’t do what the woman in the BMJ case report did. There was an informative article there on levamisole that noted how widespread levamisole-tainted cocaine is: Australia, Canada, Colombia, France, Guyana, Italy, Jamaica, the Netherlands, Spain, Switzerland, the United Kingdom, and the United States. Speculating why cocaine is adulterated with levamisole, Erowid said:

According to the DEA, levamisole–as well as other adulterants–is apparently present in some shipments of cocaine intercepted before they are broken up for further distribution to consumers. Considering that, in one batch, only 6% by weight of the total product sold as cocaine was levamisole, it seems possible it is more than simply a bulking agent. One theory is that levamisole or other adulterants boost the effects of cocaine, permitting material to pass for higher-quality product despite additional cuts made down the line. Another theory is that levamisole or other adulterants are added as chemical signatures used to track distribution of material.It may be that levamisole has been used because it has similar solubility properties to cocaine and therefore is difficult to remove and has not previously been considered a serious health hazard. As of October 1, 2009, there is no definitive answer as to why it is used as a cocaine adulterant.

Kim Gosmer, a chemist specializing in narcotic samples at the Department of Forensic Medicine as Aarhus University in Denmark speculated that levamisole-tainted cocaine originated from South America. Cited in a Vice article, he said that forensic chemists are finding levamisole-tainted cocaine all over world, increasingly from every level of distribution. Gosmer believed this suggested the adulterant is added to the cocaine in South America before it is exported. “So the question is: Why bother diluting high-grade cocaine that costs almost nothing to produce (compared to street prices) with a compound that’s more expensive than other adulterants and diluents?”

He went on to say that the amount of levamisole found in cocaine is typically not very large. So it’s not added strictly to cut the cocaine. But one of its metabolites called aminorex has amphetamine-like properties. Another possibility is that levasimole increases the amount of dopamine released by glutamate levels in the brain. “Levasimole could potentially increase the effect of cocaine through its release of dopamine.”

Casual cocaine users purportedly don’t have to worry; but habitual users should worry. With upwards of 70% of the cocaine from around the world testing positive for levamisole, the typical cocaine user will snort some levamisole sooner or later. SAMHSA warned levamisole was a dangerous substance and that agranulocytosis was a very serious illness that needed to be treated at a hospital. Remember the similar warning given by Erowid. So if you use cocaine, watch out for:

  • high fever, chills, or weakness
  • swollen glands
  • painful sores (mouth, anal)
  • any infection that won’t go away or gets worse very fast, including sore throat or mouth sores -skin infections, abscesses -thrush (white coating of the mouth, tongue, or throat) -pneumonia (fever, cough, shortness of breath).”

It used to be that you could trust drug dealers to only cut their cocaine and heroin with inert ingredients. It seems that the cost of snorting cocaine is going up in more ways than one.

03/30/15

Killer Caffeine

© : Santi Sinsawad | 123RF.com

© : Santi Sinsawad | 123RF.com

I knew of a woman who had a dual addiction to marijuana and caffeine. Yes, caffeine. She drank several pots of coffee throughout the day along with smoking marijuana. While a resident in a long-term rehab for women, she repeatedly denied that she had caffeinated coffee. But the staff “knew” she was somehow getting it and using it because of the coffee stains on the rug in her room. Several room searches were done to no avail. Finally she was busted. What the woman had done was smuggle a Melita filter and caffeinated coffee into the facility when she out for an appointment. In all the years I’ve worked with substance use/abuse disorders, this was the only time I’d ever seen such classic addictive behaviors with caffeine.

The last several years have seen the marketing of energy drinks with high caffeine content, and the use of products like 5-hour ENERGY “shots.” Many of the individuals I meet in early recovery are drawn to energy drinks, so I’ve been watching for news and research on them. I’ve heard of some concerns about their safety. And recently I heard about powdered caffeine. Just one teaspoon contains 3,200 mg of caffeine.

So let’s start with some basic information about caffeine before we get to the reported deaths from using caffeine powder. According to Wikipedia, caffeine is the world’s most widely consumed psychoactive drug. It is legal and unregulated in most countries worldwide. In North America, 90% of adults consume caffeine daily. I am one of them. A seven-ounce cup of coffee contains 80 to 175 mg of caffeine, depending upon how it is prepared (drip, percolation or espresso). Toxic doses of caffeine for an adult are over 10 grams—twenty times higher than the average consumption of 500 mg per day.

Caffeine’s positive effects have to do with reducing fatigue and preventing drowsiness. It can even stimulate faster and clearer thought flow, increased focus and better general body coordination. Consistent with this last effect, moderate doses of caffeine can improve athletic performance, but the improvements are not usually substantial. There can be some undesired effects, such as mild anxiety, insomnia, and jitteriness. Although there are caffeine-induced disorders in the DSM-5, caffeine use is usually not considered to be addictive.

Caffeinism can occur when 400 to 500 mg at one time, or 1,000 to 1,500 mg per day or more of caffeine is consumed. Winston et al. noted that the symptoms that occur (restlessness, agitation, excitement, rambling thought and speech, and insomnia) overlap with those of several psychiatric disorders. Extreme overdose can result in death. The estimated lethal dose in humans is estimated to be equivalent to 150 to 200 milligrams per kilogram of body mass; the caffeine in roughly 80 to 100 cups of coffee for an average adult. You can read further about caffeine in a 1981 article, “Caffeine: Psychological Effects, Use and Abuse.” As always with psychoactive substances, you can also see what Erowid has to say about caffeine.

Now, let’s look at caffeine powder. In May of 2014, 18-year-old Logan Stiner died after ingesting 23 times the amount of caffeine found in a typical cup of coffee. Given the above noted information, Logan would have consumed 1,850 to 4,025 mg of caffeine.  While the estimated lethal dose given above would seem to be higher than Logan’s intake of caffeine powder, he still clearly consumed roughly four to eight times the dose needed for caffeinism. Several reports have indicated that a teaspoon of caffeine powder, the equivalent of 25 cups of coffee, can be lethal. Logan’s use of caffeine powder did approach that level. Caffeine powder is a pure chemical. And as Mary Clare Jalonick reported:  “the difference between a safe amount and a lethal dose is very small.”

The FDA has warned against the use of powered pure caffeine. They are particularly concerned about Internet sales of bulk bags of it. “Pure caffeine is a powerful stimulant and very small amounts may cause accidental overdose. Parents should be aware that these products may be attractive to young people.” Michael Landa, the Director of FDA’s Center for Food Safety and Applied Nutrition, reported having a December 2014 meeting with Logan’s parents and the parents of a 24-year-old who died after ingesting powdered caffeine. He said:

I cannot say strongly enough how important it is to avoid using powdered pure caffeine. The people most drawn to it are our children, teenagers, and young adults, especially students who want to work longer to study, athletes who want to improve their performance, and others who want to lose weight.

The FDA doesn’t have the legal authority to just pull these products off the shelf. Caffeine powder is sold as an unregulated dietary supplement—unlike caffeine added to soda and other drink products. This is a common way of getting around regulation with several other potentially harmful psychoactive substances (see Krypton Can Kill You; Kava is not a Magic Bullet).

Michael Taylor, the FDA’s deputy commissioner of foods, said it was inherently irresponsible to market such a potentially dangerous product. “I would hope that people would get the message that they just ought to stop selling it.” So far, they don’t seem to be getting that message.

David Templeton, of the Pittsburgh Post-Gazette, reported that six senators have sent a letter to the FDA urging them to ban the retail sale of caffeine powder. The letter stated that pure caffeine is unsafe. Overdosing is easy and virtually unavoidable. Powered caffeine sold in bulk was said to be markedly different than other caffeine products, on the market, such as energy drinks, energy shots and others. “Because of the risk powdered caffeine poses to consumers, these products merit swift and significant action by the FDA.” The Council of Responsible Nutrition, a trade association for the supplement industry, recently stated their support for an FDA ban against the retail sale of caffeine powder. NutraKey, a major online marketer of caffeine powder did not respond to requests for comment.

03/16/15

Krypton Can Kill You

© Jason Yoder | 123RF

© Jason Yoder | 123RF

Krypton can kill you—even if you’re not Superman. And I’m not talking about the home planet of Superman. Krypton is a combination of powdered kratom and O-desmethyltramadol (O-DSMT), an active metabolite of Tramadol. Four researchers in Sweden published a case report in the Journal of Analytical Toxicology that investigated the deaths of nine individuals from their use of Krypton. One of alkaloids in kratom, mitragynine, is a mu-receptor agonist, as is O-DSMT. The mu-receptor is the primary receptor activated by opioid drugs such as morphine, hydrocodone (Vicodin), and oxycodone (OxyContin).

Combining these two mu-receptor agonists makes Krypton more powerful than kratom or Tramadol alone. Even pro-kratom websites are warning people about Krypton. O-DSMT is also reported to be considerably more potent as a mu-agonist than Tramadol. At the current time, both are legally available substitutes for prescription and illicit opioids.

Although kratom is currently not controlled under the Controlled Substances Act, it is on the DEA list of Drugs and Chemicals of Concern. And there is no current legitimate medical use for kratom in the U.S. So it cannot be legally advertised as a remedy for any medical condition. However, it is widely used for medicinal reasons, largely pain management issues and opiate withdrawal. Kratom is also reported to be a stimulant in small doses; a sedative and relaxant in larger doses; a mood and concentration enhancement; and others. Prozialeck et al. indicated there are more than 20 active compounds that have been isolated from kratom so far.

In Southeast Asia, kratom has a long history of use for pain management and opium withdrawal. As the West experiences an increased use of opioids for recreation and pain management, kratom has begun to be used in a similar way. Despite the kratom’s reputation as a “legal” opioid, there have been very few published scientific studies of its psychoactive properties and no well-controlled clinical studies of the effects of kratom on humans. However, there are several anecdotal reports available online, such as those on Erowid.

A variety of adverse effects from kratom use have been reported, consistent with its dose-related stimulant and opioid activities. Stimulant effects at lower doses can be anxiety, irritability, and increased aggression. Opioid-like effects at higher doses can include sedation, nausea, constipation and itching. Chronic high-dose usage has been associated with hyperpigmentation of the cheeks, tremors, anorexia, weight loss, and psychosis. There have been several reports of seizures.

Given that kratom is available as an herbal supplement, there is a lack of regulation and standardization related to the production and sale of kratom. Thus the problems with products like Krypton. Although it is typically seen as less addictive than classic opioids, there are many reports that it can be highly addictive. In Southeast Asia, individuals will seek out and abuse kratom for its euphoric and mind-altering effects. Chronic users can become tolerant of and physically dependent on kratom. Withdrawal symptoms are similar to those from traditional opioids.

Prozialeck et al. said that kratom and kratom-derived drugs could potentially be used for managing pain, opioid withdrawal symptoms and other clinical issues. Yet there remain serious questions about the potential toxic effects, as well as the abuse potential of kratom. The lack of quality control and standardization in the production and sale of kratom further complicates these questions.

In the meantime, remember that even pro-kratom websites are warning about Krypton. Kratom Online has put out a warning that a product called “Krypton Kratom” is being marketed and sold as a kratom product, when it is a blend of caffeine and O-DSMT.

Well, disingenuous marketers have tried to pull a fast one on the public by using the kratom name on a product that is not kratom. This blend of synthetic opiates is extremely strong and some say extremely toxic. In fact, taking just .5 grams of Krypton is said to be the equivalent of 60 grams of morphine. This is an extremely dangerous dose and could lead to severe health problems.

They cautioned buyers to be alert for anything marked as “Krypton Kratom” and called it “an instantly dangerously addictive substance.” We seem to be moving back to the days of free-wheeling patent medicines, when products like Krypton and even kratom can be legally sold, but not regulated to prevent their abuse potential.

02/4/15

Kava is not a Magic Bullet

© Eliaviel | Dreamstime.com - Kava Drinking Photo

© Eliaviel | Dreamstime.com – Kava Drinking Photo

In “Nature’s Legal Relaxant,” KeptItLegal said he decided to try Kava after learning about it in an Anthropology class. He ordered some online and mixed up a batch with the blender/strainer method in the directions on the bag. Within a few sips, his mouth was slightly numb. There were no dramatic effects on his vision or his sense of balance. Mentally, he felt clear minded and rather normal. Emotionally, he felt calm and collected, rather than ecstatic.

The fact that my girlfriend had asked for a split earlier that day no longer irked me. I felt it was something I could handle. . . . All in all, I found Kava’s effects enjoyable without being inhibiting.

Before you go rushing out to buy some listen to the rest of the story on Kava. There are potentially serious health consequences from Kava. Cases of liver damage and even some deaths have been reported with kava use. In 2002 the FDA issued a warning that kava can cause liver damage. As a result of the health risks, it has been banned or restricted in many countries, including: Germany, Switzerland, France, Canada, and Great Britain. While some groups dispute the reports of liver damage, there seems to be “convincing evidence in some cases of severe hepatitis ending in full hepatic failure, requiring liver transplantation, and even leading to death.” Three medical case histories of either acute liver failure and death or acute hepatitis are described here.

A 22 year-old woman presented with a 3-week history of nausea, fatigue and then jaundice 4 months after starting kava (240 mg daily) for depression. She received a liver transplant, but died six months after transplant from multi-organ failure. A 56 year-old woman taking an herbal medication containing kava for three months developed the same acute hepatitis-like syndrome. She had no risk factors for viral hepatitis, no history of liver disease and drank minimal amounts of alcohol. She died of circulatory failure during transplant surgery.

Kava is derived from the roots of the Piper methysticum plant (meaning intoxicating pepper), a member of the pepper family found in the Western and South Pacific. It is used throughout the Polynesian cultures in Hawaii, Vanuati, Melanesia and some parts of Micronesia. In Fiji, a formal yaqona (kava) ceremony will often accompany important social, political, religious functions, usually involving a ritual presentation of the bundled roots as a gift and drinking of the yaqona itself.

The active ingredients are kavapyrones (kavelactones), which have alcohol-like effects. It is believed to help with anxiety, stress, and insomnia. Kava has analgesic, muscle relaxing and anticonvulsant effects. These effects vary widely according to the kind of kava plants and the amount used. Kava experiences on the pro-drug website Erowid ranged from mildly euphoric, to zombified and a hallucinogenic dream where a humanoid figure in black robes said: “Welcome to the Black church. Prepare for Death.”

Of course, that individual had taken 2400 mg of Ginko Biloba, 10.6 g of Valerian Root and 1 tablet of kava to help him sleep. “The night before was filled with rails of Modafinil, Flexeril, and Vicodin, ounces and ounces of liquid vicodin, and hydroponically grown Cannabis. Simply put, my brain was fried.”

Potential drug interactions occur, as would be expected, with alcohol and CNS depressants such as benzodiazepines and barbiturates. Also avoid taking them with sleep-aides such as Lunesta and Ambien. You should avoid combining kava with all psychotropic medications. A common side effect when using kava is nausea. Severe side effects that you should seek immediate medical attention can include:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blood in the urine; changes in vision; enlarged pupils; lack of coordination; muscle weakness; puffy face; red eyes; shortness of breath; weight loss.

There have been some studies on the potential  usefulness of kava. The Australian & New Zealand Journal of Psychiatry reported that four out of six studies supported the use of kava to treat anxiety. However, they cautioned it should not be used with alcohol and other psychotropic medications. “Avoidance of high doses if driving or operating heavy machinery should be mandatory.” Regular users should get routine liver function tests.

In “Kava and Relapse,” Terence Gorski cautioned that kava could be a factor in the progression of a relapse into active substance use for a recovering addict or alcoholic. “Kava impairs judgment and impulse control and generally does not produce the desired high or the desired mood altering effect of the drug of choice.” The impaired judgment and poor impulse control that occurs before a lapse into active use could rationalize going back to using a drug of choice.

In the U.S., kava is legal and fairly easy to obtain. Although it does appear to have some potential as an anti-anxiety agent, it seems counterintuitive to use it to treat anxiety when the jury is still out on whether or not it contributes to liver problems. The mind-altering effect of kava is a danger for the recovering addict, because the part of the brain it relaxes is the same part of the brain used in recovery to exercise self-control over thoughts and desires to get high.  Kava does not seem to be a magic bullet for anxiety and depression.