Psychotropic Effects Research Articles

Cannabidiol (CBD) Use in Type 2 Diabetes: A Case Report.

Cannabidiol (CBD) oil has been gaining popularity as a natural alternative for numerous disease states. CBD is a phytocannabinoid obtained from the Cannabis sativa plant. Unlike its relative tetrahydrocannabinol (THC), CBD does not activate CB1 receptors in the brain and therefore lacks psychotropic effects (1). Instead, this substance is thought to work on the G-protein coupled receptor, endothelial cannabinoid receptor, and serotonin-1A receptors, among others. Diabetes is the seventh leading cause of death and affects >30 million people in the United States (2). CBD has been investigated, mostly in animal models, for its ability to help treat diabetes. It is theorized that cannabis has desirable effects on hyperglycemia through its anti-inflammatory and antioxidant properties (3). The endocannabinoid system modulates food intake and energy homeostasis by activating cannabinoid receptors. Modulation of these receptors with CBD has the possibility to reduce body weight and A1C in people with diabetes. In one study using mouse models, CBD was shown to significantly reduce the incidence of diabetes in these mice (4). This was shown by a significant decrease in pancreatic islets production of destructive insulitis and inflammatory cytokine production. The potential to use CBD as a method to treat diabetes reveals the need for studies and case reports. The following case illustrates the initiation of CBD in a patient with type 2 diabetes. A 62-year-old Hispanic obese man (weight 113 kg, BMI 39 kg/m2) with a history of type 2 diabetes for 11 years began taking CBD oil to control his blood glucose in place of insulin degludec. Initiation of this product was independent of his clinician’s recommendation and based on the patient’s personal review of information that suggested CBD was beneficial for people with type 2 diabetes. As shown in Table 1, the week before the patient’s initiation of CBD, …

Repurposing Ketamine in Depression and Related Disorders: Can This Enigmatic Drug Achieve Success?

Repurposing ketamine in the therapy of depression could well represent a breakthrough in understanding the etiology of depression. Ketamine was originally used as an anesthetic drug and later its use was extended to other therapeutic applications such as analgesia and the treatment of addiction. At the same time, the abuse of ketamine as a recreational drug has generated a concern for its psychotropic and potential long-term effects; nevertheless, its use as a fast acting antidepressant in treatment-resistant patients has boosted the interest in the mechanism of action both in psychiatry and in the wider area of neuroscience. This article provides a comprehensive overview of the actions of ketamine and intends to cover: (i) the evaluation of its clinical use in the treatment of depression and suicidal behavior; (ii) the potential use of ketamine in pediatrics; (iii) a description of its mechanism of action; (iv) the involvement of specific brain areas in producing antidepressant effects; (v) the potential interaction of ketamine with the hypothalamic-pituitary-adrenal axis; (vi) the effect of ketamine on neuronal transmission in the bed nucleus of stria terminalis and on its output; (vii) the evaluation of any gender-dependent effects of ketamine; (viii) the interaction of ketamine with the inflammatory processes involved in depression; (ix) the evaluation of the effects observed with single or repeated administration; (x) a description of any adverse or cognitive effects and its abuse potential. Finally, this review attempts to assess whether ketamine’s use in depression can improve our knowledge of the etiopathology of depression and whether its therapeutic effect can be considered an actual cure for depression rather than a therapy merely aimed to control the symptoms of depression.

Selective Fatty Acid Amide Hydrolase Inhibitors as Potential Novel Antiepileptic Agents.

Temporal lobe epilepsy is the most common form of epilepsy, and current antiepileptic drugs are ineffective in many patients. The endocannabinoid system has been associated with an on-demand protective response to seizures. Blocking endocannabinoid catabolism would elicit antiepileptic effects, devoid of psychotropic effects. We herein report the discovery of selective anandamide catabolic enzyme fatty acid amide hydrolase (FAAH) inhibitors with promising antiepileptic efficacy, starting from a further investigation of our prototypical inhibitor 2a. When tested in two rodent models of epilepsy, 2a reduced the severity of the pilocarpine-induced status epilepticus and the elongation of the hippocampal maximal dentate activation. Notably, 2a did not affect hippocampal dentate gyrus long-term synaptic plasticity. These data prompted our further endeavor aiming at discovering new antiepileptic agents, developing a new set of FAAH inhibitors (3a-m). Biological studies highlighted 3h and 3m as the best performing analogues to be further investigated. In cell-based studies, using a neuroblastoma cell line, 3h and 3m could reduce the oxinflammation state by decreasing DNA-binding activity of NF-kB p65, devoid of cytotoxic effect. Unwanted cardiac effects were excluded for 3h (Langendorff perfused rat heart). Finally, the new analogue 3h reduced the severity of the pilocarpine-induced status epilepticus as observed for 2a.

Chromatographic separation of the interconverting enantiomers of imidazo- and triazole-fused benzodiazepines

The toolbox of medicinal chemists includes the 1,4-benzodiazepine scaffold as a “privileged scaffold” in drug discovery. Several biologically active small molecules containing a 1,4-benzodiazepine scaffold have been approved by the FDA for the treatment of various diseases, with most of them being used for their psychotropic effects. The therapeutic potential of 1,4-benzodiazepines has stimulated the interest of synthetic chemists in developing new synthetic strategies to a range of substituted analogues for biological evaluation. A structural variation of the classical benzodiazepine skeleton is observed e.g. in alprazolam, midazolam, and related benzodiazepines, which contain a 1,2,4-triazole or an imidazole ring fused to the benzodiazepine core. Irrespective of the presence of the fused heterocyclic ring, the seven-membered diazepine ring is far from planar, and its shape resembles a twist chair. Then, the unsymmetrical substitution pattern around the seven membered cycle renders these molecules chiral, as they lack any reflection-type symmetry element. However, chirality of this molecules is labile at room temperature, becausea simple ring flipping process converts one enantiomer into the other, and 1,4-benzodiazepines exist as a mixture of rapidly interconverting conformational enantiomers in solution at or near room temperature. Physical separation of the interconverting enantiomers of diazepam and of other related 1,4-benzodiazepin-2-ones can be accomplished by low temperature HPLC on chiral stationary phases (CSPs). If the HPLC column is cooled down to temperatures where the interconversion rate is sufficiently low, compared to the chromatographic separation rate, distinct separated peaks can be observed, provided the CSP is sufficiently enantioselctive. The apparent rate constants for the on-column enantiomerization and the corresponding free energy activation barriers were obtained by simulation of exchange-deformed HPLC profiles using a computer program based on the stochastic model. Here we report on the dynamic HPLC investigations carried out on a set of fused imidazo and triazolo-benzodiazepines (alprazolam, midazolam, triazolam and estazolam) The experimental dynamic chromatograms and the corresponding interconversion barriers reported in this paper show that the third fused heterocyclic ring increase the energy barrier by 2 kcal/mol.

Psychotropic medicine beliefs, side effects and adherence in schizophrenia: a patient-caregiver dyad perspective.

Background Medication adherence is essential in the management of schizophrenia. Yet poor treatment uptake has negative consequences on patients and their primary caregivers. Objective To examine the association among beliefs about psychotropic medications, side effects and adherence from a patient-caregiver dyad perspective. Setting This study was conducted in a public psychiatric hospital setting in Accra, Ghana. Methods A cross-sectional study was conducted among 121 patient-caregiver dyads using an interviewer-administered data collection approach.Main outcome measure Beliefs about medicines, side-effects and medication adherence. Results The patient and caregiver-reported level of medication adherence was 28.1 %. Using the Kappa index, the level of agreement between the responses of patients and their caregivers ranged from slight to moderate. Both patients and caregivers rated necessity higher than concern (patients: 1.67 ± 0.84, caregiver: 1.79 ± 0.96). Significant positive relations between specific-necessity, necessity-concerns differential and medication adherence were recorded while specific-concern, general harm and side-effects correlated negatively with medication adherence from the dyad. The odds of adhering to medications increased by 58 and 64 % for each unit increase in specific-necessity and general overuse scores respectively. However, a unit increase in specific-concern score and high side-effects scores were associated with lower odds of adherence. Conclusions This study highlights the need for patient-caregiver collaborations in decision-making relating to medication adherence in schizophrenia. Thus, in clinical practice, there is the need to recognize that caregivers are essential partners, and patient-caregiver views about psychotropic medications are critical in enhancing adherence for positive mental health outcomes.

Symptoms of Intoxication and Withdrawal in a Sample of Egyptian Patients Using Synthetic Cannabinoids: A Cohort Study

Introduction: Novel psychoactive substances that contain synthetic cannabinoids (SCs) have recently started to be used recreationally, especially by young adults. In contrast to the decline in the use of many novel psychoactive substances such as the cathinones and piperazines, it seems that the number of SC users is increasing. Although SC drugs mimic the psychotropic effects of cannabis, their undesired effects are unpredictable and more severe than those associated with cannabis. The majority of SC detected in herbal products has greater binding affinity to the cannabinoid CB1 receptor than Δ9-tetrahydrocannabinol, the primary psychoactive compound in the cannabis plant, and greater affinity at the CB1 than the CB2 receptor. In vitro and animal in vivo studies show SC pharmacological effects to be 2 to 100 times more potent than tetrahydrocannabinol. A limited number of studies have examined SC use among patients; hence little is known about the effects of their use on patients during intoxication, withdrawal, and 1 month after cessation of use of SC. Objective: This study is a cohort study aiming to investigate the symptoms of intoxication, withdrawal, and 1-month cessation of SCs. Patients and Methods: Between February 2019 and February 2020, 92 adult patients using SCs aged 18 to 65 years from both the Outpatient Clinic and Inpatient Department of Psychiatry, Ain Shams University and Masr El Gedida (El Matar) Psychiatric Hospital, Ministry of Health were subjected to full history taking using clinical history sheet for the assessment of medical symptoms and Addiction Severity Index (the Arabic version was used). Results: There was a significant association between the use of SCs and development of multiple symptoms, both medical and psychiatric symptoms, and even serious side effects necessitating emergency management. Regarding the most common symptoms reported by the patient, the most common cardiovascular symptom during intoxication was palpitations, while the most common reported psychiatric symptom was hallucinations developed during intoxication. It was found that the patients who were hospitalized due to medical problems had higher amount and longer duration of use of SC. Conclusion: SC use can cause an array of symptoms ranging from mild medical and psychiatric symptoms to extreme side effects.

ASSESSMENT OF THE ANTINOCICEPTIVE EFFECTS OF CANNABINOID RECEPTOR AGONISTS SER 601 AND L-759,633 IN AN ACUTE PAIN MODEL IN RATS

A poorly managed pain is associated with many negative results. These results disturb patients, their families and societies. Although opioid agents have extraordinary analgesic efficacy, they may cause serious adverse consequences. For medication of pain, there is a medical need to discover possible alternatives to opioids. In animal models of acute pain synthetic cannabinoid receptor agonists demonstrated analgesic effects. Selective activation of the cannabinoid 2 receptor in the rodent models does not cause psychotropic effects therefore CB2R agonists are an appealing target for the medication of pain and other pathologies. In this study we examined the antinociceptive activity of cannabinoid receptor 2 (CB2) agonists SER 601 and L-759,633 in different doses in rat models of acute pain using the hot plate and tail flick tests. These two agents exhibited dose-dependent antinociceptive effects in acute pain model. The analgesic effects of the administrated doses of L-759,633 and SER 601 reached their peak at 60 min. In the tail flick test, the antinociceptive effects of 3, 6 and 12 mg / kg SER601 in the acute pain were more than the L-759,633 groups at the same doses.

Pharmacokinetics and Pharmacodynamics of Salvinorin A and Salvia divinorum: Clinical and Forensic Aspects.

Salvia divinorum Epling and Játiva is a perennial mint from the Lamiaceae family, endemic to Mexico, predominantly from the state of Oaxaca. Due to its psychoactive properties, S. divinorum had been used for centuries by Mazatecans for divinatory, religious, and medicinal purposes. In recent years, its use for recreational purposes, especially among adolescents and young adults, has progressively increased. The main bioactive compound underlying the hallucinogenic effects, salvinorin A, is a non-nitrogenous diterpenoid with high affinity and selectivity for the κ-opioid receptor. The aim of this work is to comprehensively review and discuss the toxicokinetics and toxicodynamics of S. divinorum and salvinorin A, highlighting their psychological, physiological, and toxic effects. Potential therapeutic applications and forensic aspects are also covered in this review. The leaves of S. divinorum can be chewed, drunk as an infusion, smoked, or vaporised. Absorption of salvinorin A occurs through the oral mucosa or the respiratory tract, being rapidly broken down in the gastrointestinal system to its major inactive metabolite, salvinorin B, when swallowed. Salvinorin A is rapidly distributed, with accumulation in the brain, and quickly eliminated. Its pharmacokinetic parameters parallel well with the short-lived psychoactive and physiological effects. No reports on toxicity or serious adverse outcomes were found. A variety of therapeutic applications have been proposed for S. divinorum which includes the treatment of chronic pain, gastrointestinal and mood disorders, neurological diseases, and treatment of drug dependence. Notwithstanding, there is still limited knowledge regarding the pharmacology and toxicology features of S. divinorum and salvinorin A, and this is needed due to its widespread use. Additionally, the clinical acceptance of salvinorin A has been hampered, especially due to the psychotropic side effects and misuse, turning the scientific community to the development of analogues with better pharmacological profiles.

A Review of Hemp as Food and Nutritional Supplement.

The term "hemp" refers to Cannabis sativa cultivars grown for industrial purposes that are characterized by lower levels of tetrahydrocannabinol (THC), the active principle responsible for Cannabis psychotropic effects. Hemp is an extraordinary crop, with enormous social and economic value, since it can be used to produce food, textiles, clothing, biodegradable plastics, paper, paint, biofuel, and animal feed, as well as lighting oil. Various parts of the hemp plant represent a valuable source of food and ingredients for nutritional supplements. While hemp inflorescence is rich in nonpsychoactive, yet biologically active cannabinoids, such as cannabidiol (CBD), which exerts potent anxiolytic, spasmolytic, as well as anticonvulsant effects, hempseed has a pleasant nutty taste and represents a valuable source of essential amino acids and fatty acids, minerals, vitamins, and fibers. In addition, hempseed oil is a source of healthy polyunsaturated fatty acids, and hemp sprouts are rich in antioxidants. This review article aims to provide a comprehensive outlook from a multidisciplinary perspective on the scientific evidence supporting hemp beneficial properties when consumed as food or supplement. Marketing of hemp-derived products is subjected to diversified and complex regulations worldwide for several reasons, including the fact that CBD is also the active principal of pharmaceutical agents and that regulatory bodies in some cases ban Cannabis inflorescence regardless of its THC content. Some key regulatory aspects of such a complex scenario are also analyzed and discussed in this review article.

Distinct Activity of Endocannabinoid-Hydrolyzing Enzymes MAGL and FAAH in Key Regions of Peripheral and Central Nervous System Implicated in Migraine.

In migraine pain, cannabis has a promising analgesic action, which, however, is associated with side psychotropic effects. To overcome these adverse effects of exogenous cannabinoids, we propose migraine pain relief via activation of the endogenous cannabinoid system (ECS) by inhibiting enzymes degrading endocannabinoids. To provide a functional platform for such purpose in the peripheral and central parts of the rat nociceptive system relevant to migraine, we measured by activity-based protein profiling (ABPP) the activity of the main endocannabinoid-hydrolases, monoacylglycerol lipase (MAGL) and fatty acid amide hydrolase (FAAH). We found that in trigeminal ganglia, the MAGL activity was nine-fold higher than that of FAAH. MAGL activity exceeded FAAH activity also in DRG, spinal cord and brainstem. However, activities of MAGL and FAAH were comparably high in the cerebellum and cerebral cortex implicated in migraine aura. MAGL and FAAH activities were identified and blocked by the selective and potent inhibitors JJKK-048/KML29 and JZP327A, respectively. The high MAGL activity in trigeminal ganglia implicated in the generation of nociceptive signals suggests this part of ECS as a priority target for blocking peripheral mechanisms of migraine pain. In the CNS, both MAGL and FAAH represent potential targets for attenuation of migraine-related enhanced cortical excitability and pain transmission.

Pregabalin abuse and dependence in various European countries: Association with substitution policies

Pregabalin was first approved in 2004 for the treatment of peripheral neuropathic pain and focal epileptic seizures, with or without secondary generalization. Prescription frequency has increased significantly since approval. In the early days, little attention was paid to the problem of misuse and dependence on pregabalin; in recent years, there has been a significant increase in the number of publications focusing on this problem. This review deals with these risk factors and risk groups of pregabalin abuse and dependence in different European countries and their drug policies. Pregabalin abuse and dependence has increased significantly since its introduction to the market. It was shown that solo abuse of pregabalin is rare. In most cases, pregabalin was combined with other substances, which is also a predictor of pregabalin abuse. There were different reasons for the non-prescription use of pregabalin; it was used to increase the psychotropic effect, on the one hand, and to alleviate withdrawal symptoms, on the other hand. Furthermore, in Sweden, pregabalin was found in 28% of fatal intoxications among drug addicts. Young people were particularly affected. Abuse of pregabalin was detected in countries with restrictive substitution programmes, while in countries with liberal drug policies, no abuse was detected. However, the data situation in Switzerland with a liberal substitution programme is based on only one study, which is why pregabalin use in liberal substitution programmes cannot be conclusively clarified. There seems to be a connection between a country's drug policy and the illegal use of pregabalin among persons in a substitution programme in that country. There are also risk factors and risk groups for pregabalin dependence and abuse.

Cannabinoids: A new friend or just another pandemic?

Cannabinoids: A new friend or just another pandemic?

Selecting the optimal treatment for depression taking into account the psychotropic and somatotropic effects of the antidepressant

Based on a clinical case, the authors consider the problem of the optimal choice of an antidepressant, taking into account not only the psychopathological structure of depression, the severity and characteristics of its triad, but also the presence of somatic symptoms. This determines the need for a comprehensive analysis of the pharmacological profile of prescribed antidepressants, their psychotropic and somatotropic effects. The switch of the patient to brintellix, which has polymodal neuroreceptor activity, at a dose of 20 mg per day, made it possible to achieve remission and reduce adverse reactions caused by SSRIs.

Neurobiology of Drug Addiction & The Treatment of Hard Drug Use Disorder

Cocaine produces its psychotropic and habit-forming effects primarily by working on the brain’s neural structure, a group of interconnected regions that regulate pleasure and motivation. An initial, short effect—a buildup of the organic compound dopamine—gives rise to high spirits and a want to require the drug once more. Researchers square measure seeking to know however cocaine’s several long term effects manufacture addiction’s persistent cravings and risk of relapse. within the author’s laboratory, work has targeted on buildup of the genetic transcription issue issue. Levels of ΔFosB within the neural structure correlate with addiction-like behaviors in mice and will precipitate terribly long changes to vegetative cell structure. any pursuit of this and similar leads square measure 1st steps toward a whole understanding of the transition from hard drug abuse to addiction—and, ultimately, more practical treatments for those that square measure alcoholic. Snorted, smoked, or injected, hard drug quickly enters the blood and penetrates the brain. The drug achieves its main immediate psychological effect—the high—by inflicting a buildup of the organic compound monoamine neurotransmitter. Dopamine acts as a pacesetter for several nerve cells throughout the brain. At each moment of our lives, monoamine neurotransmitter is answerable for keeping those cells operational at the acceptable levels of activity to accomplish our desires and aims. Whenever we want to mobilize our muscles or mind to figure more durable or quicker, monoamine neurotransmitter drives a number of the concerned brain cells to improve to the challenge.

HISTOMORPHOLOGICAL ALTERATIONS IN THE LUNGS IN ACUTE COMBINED BACLOFEN AND ETHANOL POISONING

A generic Baclofen, also known under the brand name of Lioresal, is a derivative of gamma-aminobutyric acid. Due to its psychotropic effect it is often used as a drug of abuse and for criminal poisoning. An experimental study was carried out on 5 Wistar rats (versus 5 intact rats of the control group) exposed to combined Baclofen (at a dose of 85 mg/kg) and ethanol (7 ml/kg of 40% ethanol) poisoning. We have identified a complex of pathological changes in the lungs of the rats in the early period after the experiment. The outcomes included circulatory disorders of the pulmonary microvasculature (plethora of capillaries, venules), emphysema, atelectasis and dystelectasis, infiltration of white blood cells into intraalveolar septa and thickening of intraalveolar septa due to edema. To quantify the severity of histomorphological changes in the lungs a morphometric study is required.

CLOZAPINE AND CLOZAPINE-ETHANOL POISONING AS A CAUSE OF HISTOMORPHOLOGICAL CHANGESIN THE CE

Clozapine is an atypical neuroleptic with a narrow therapeutic index which is widely used in clinical practice. Due to its psychotropic effect the drug is often misused. Experimental studies were performed on 25 outbreed mail rats. The animals were divided into 5 groups (the controls and four experimental groups). The controls included 5 intact rats. The experimental groups 1 and 2 were treated with clozapine at a dose 150 mg/kg. The experimental groups 3 and 4 received clozapine at the same dose and ethanol (2 ml/kg 70% ethanol). Severe damage to the Purkinje cells of the cerebellum was confirmed by an increase in the number of neurons that register signs of both reversible and irreversible damage. Purkinje cell alteration has increased by 24 hours from the beginning of the experiment.

A phase I single ascending dose safety study of NTRX‐07 in normal volunteers

AbstractBackgroundNTRX‐07 is a selective cannabinoid receptor type 2 (CB2) agonist that has been shown in animal models to be effective for the treatment of Alzheimer’s disease (AD). CB2 agonists have been shown to be neuroprotective in preclinical models and the lack the psychotropic adverse effects normally seen with CB1 agonists1‐4. NTRX‐07 has acceptable drug metabolism, pharmacokinetic and preclinical safety profiles.MethodThis is a double‐blind, placebo controlled single ascending dose study with 6 cohorts of normal volunteers 18‐65 years of age (n=∼48). The primary outcome is the safety and tolerability of NTRX‐07. Each cohort is randomized with 6 subjects receiving active drug and 2 placebo. Doses range from 0.3 to 8 mg/kg of NTRX‐07 in a HPMCAS‐MG excipient administered orally. Subjects are admitted to the site the night before dosing, and are observed for 24 hours post‐dose, with a safety visit 7 days later. Subjects are observed for changes in physical exam or symptoms (including questionnaires of drug effect), vitals, laboratory values and adverse events (AEs). Blood samples are obtained to determine the pharmacokinetics of NTRX‐07 in humans.ResultAt submission three cohorts have completed dosing and all cohorts will be completed for final poster submission. No treatment related AEs have been observed. Plasma levels have been higher than predicted based on preclinical studies suggesting differences in absorption or metabolism compared to animal models. Pharmacokinetics (PK) have demonstrated dose linearity and support feasibility in clinical use.ConclusionThere are currently no commercially available CB2 agonists. NTRX‐07 would represent the first‐in‐class of a new therapeutic agent to treat microglial‐mediated neuroinflammation in a variety of diseases where the CB2 receptor has been shown to be active such as AD, ALS and FTD. The next study will be a 28 day repeat dose of NTRX‐07, in patients with MCI or early AD, for safety, PK and exploratory biomarkers.

Safety Considerations in Cannabinoid-Based Medicine.

Cannabinoids are a diverse class of chemical compounds that are increasingly recognized as potential therapeutic options for a range of conditions. While many studies and reviews of cannabinoids focus on efficacy, safety is much less well reported. Overall assessment of the safety of cannabinoid-based medicines is confounded by confusion with recreational cannabis use as well as different study designs, indications, dosing, and administration methods. However, clinical studies in registered products are increasingly available, and this article aims to discuss and clarify what is known regarding the safety profiles of cannabinoid-based medicines, focusing on the medical and clinical safety evidence and identifying areas for future research. The two most well-studied cannabinoids are Δ9-tetrahydrocannabinol (THC), or its synthetic variants (dronabinol, nabilone), and cannabidiol (CBD). Across diverse indications, dizziness and fatigue are generally the most common adverse events experienced by patients receiving THC or combined THC and CBD. Patients receiving THC may experience adverse cognitive effects and impairment in psychomotor skills, with implications for driving and some occupations, while CBD may help to lower the psychotropic effects of THC when used in combination. Studies on dependency and addiction in a medical context are limited, but have shown inconsistent findings regarding misuse potential. Generally, the recommended route of administration is oral ingestion, as smoking medicinal cannabinoid products potentially releases mutagenic and carcinogenic by-products. There are several potential drug–drug interactions and contraindications for cannabinoid-based medicines, which physicians should account for when making prescribing decisions. The available evidence shows that, as with any other class of pharmaceuticals, cannabinoid-based medicines are associated with safety risks which should be assessed in the context of potential therapeutic benefits. Each patient should be assessed on an individual basis and physicians must rely on informed, evidence-based decision-making when determining whether a cannabinoid-based medicine could be an appropriate treatment option.

A comparative analysis of kratom exposure cases in Thailand and the United States from 2010-2017

ABSTRACT Background: Interest in the Southeast Asian natural remedy kratom has increased in Western countries recently, along with increasing concern over its potential toxic effects. Objective: To describe and compare demographics, common co-exposure substances, clinical effects, treatments, and medical outcomes of kratom “abuse” exposures in the United States (US) and Thailand. Methods: This is a retrospective analysis of kratom “abuse” exposures, defined as use when attempting to gain a psychotropic effect, reported to the National Poison Data System (NPDS) in the US and the Ramathibodi Poison Center (RPC) in Thailand from 2010 to 2017. Multivariate analysis identified risk factors for severe medical outcomes, defined as both ICU admissions and death. Results: Nine-hundred-twenty-eight cases were included (760 from NPDS and 168 from RPC). A greater proportion of cases involved co-exposures in Thailand (64.8% versus 37.4%; odds ratio [OR] = 3.10, 95% confidence interval [CI] = 2.15–4.47, p < .01). Both countries had a similar prevalence of opioid and benzodiazepine co-ingestions, but the US had more co-ingestions with other sedatives (4.6% versus 0%, OR = 0, 95% CI = 0–0.47, p < .01). Common clinical effects included tachycardia (30.4%), agitation/irritability (26.2%), and drowsiness/lethargy (21.1%). Six deaths occurred, including one single-substance exposure in the US, three multiple-substance exposures in the US, and two multiple-substance exposures in Thailand. Severe medical outcomes were reported more frequently in the US (OR = 18.82, 95% CI = 5.85–60.56, p < .01). Conclusions: Despite lower frequencies of co-ingestants overall, US kratom abuse exposures yielded greater clinical severity. This disparity may be attributable to differences in the products labeled “kratom,” greater sedative co-exposures in the US, and/or differences in population genetics or use patterns.

Editorial: New Trends of Substance Abuse: Looking for New Psychotropic Effects of Chem Sex Drugs, Cognitive Enhancers, and New Psychoactive Substances

Editorial: New Trends of Substance Abuse: Looking for New Psychotropic Effects of Chem Sex Drugs, Cognitive Enhancers, and New Psychoactive Substances