Life in the TOO fast lane?

BDF is usually sold as a “plant food” or “research chemical” and is often purchased over the Internet. It has no known medical or industrial use.

It is a phenethylamine derivative that resembles a dragonfly:

BDF has a high affinity for 5-HT2A serotonin receptors (typical of phenylethylamines) and is an alpha-1 agonist.

5-HT2A effects:

• potent hallucinogen

alpha-1 effects:

• intense peripheral vasoconstriction and hypertension
• limb ischemia
• probably can cause coronary vasospasm
• other ischemic multi-organ effects (e.g. ischemic hepatopathy)

Tachycardia, agitation and seizures may occur

BDF toxicity can be devastating and fatal

The clinical manifestations of BDF generally have:

• a delayed onset to peak effect (up to six hours)
• prolonged duration (up to several days)

It was like being dragged to hell and back again. Many times. It is the most evil [thing] I’ve ever tried. It lasted an eternity

Danish user of Bromo-DragonFLY

This drug has only been on the scene in the UK (where it is already banned) and the States over the past 3 or so years. Street names include Meow, Drone, Bubble, M-Cat, and Milton Keynes (when combined with ketamine).

Mephedrone , or 4-methylmethcathinone, has a structure similar to cathinone (Khat) and appears to be a potent sympathomimetic agent. Mephedrone has a short half life ( 30-90 min) with effects typically lasting 2-4 hours.

Mephedrone usually comes as a clear white powder hence the incorporation into ‘bath salts’. It is also found as crystals, capsules and pills. The powder form is usually mixed with water and swallowed (bombed) but can be sniffed/snorted or taken intravenously.

Sympathomimetic

• intense peripheral vasoconstriction
• palpitations, diaphoresis, tachycardia, hypertension, pupillary dilatation

CNS effects

• anxiety, panic attacks, and paranoia
• severe hallucinations with heavy use
• addictive

The expected complications and management of mephredrone toxicity are similar to that of amphetamine toxicity, as described here.

Nexus also goes by the names of Bees, Venus, Erox, Performax, Toonies, and Bromo mescaline to name a few.

It is typically supplied as a white powder or a tablet, and is usually ingested or snorted.

Like BDF, Nexus is a synthetic phenylethylamine. It is an agonist at alpha-1 adrenergic receptors and 5-HT2 serotonergic receptors.

• intense nasal pain (<30 min duration) following snorting
• CNS effects (probably predominantly due to 5HT2 agonism):
  euphoria, increased visual and tactile sensations, relaxation, synesthesia, and hallucinations
• potential for alpha-1 mediated vascoconstriction and ischemia
  (persistent neurological deficits attributed to cerebral ischemia have been reported)

Time course of the clinical effects of Nexus:

• Onset 30 to 90 min after ingestion
• Duration of effect 4-8 hours

K2/Spice is a cannabinoid analogue originally used in research to investigate different types of cannabinoid receptors (CB1R in the CNS mediates psychotrpoic effects and CB2R modulates immune cell function). The agent was subsequently synthesised by ‘street chemists’ and added to herbal mixtures and tobacco.

Little is known, though it may have stronger psychotropic effects than marijuana.

Salvia divinorum is a perennial plant in the mint family. Historically it was used by the Mazatec Indians of Mexico in shamanistic rituals for its hallucinogenic properties.

The active ingredient is salvinorin A.

Salvinorin A selectively stimulates kappa opioid receptors in the brain and spinal cord, and can be blocked by naloxone. Thus Salvinorin A is has a mechanism of action unlike most hallucinogens, which are typically  5HT2A receptor agonists

Clinical effects:

• Vivid hallucinations that may last ~10 minutes when Salvia is smoked.
• Salvinorin A can also cause spinal anesthesia.

Thus far there have been no reports of significant toxicity.

Naphyrone is a synthetic chemical derived from pyrovalerone.

It’s arrival in the wake of the banning of mephredrone in the UK highlights the the growing public health problem of rapidly emerging legal highs in an age of internet marketing.

Naphyrone is also known as NRG-1, however batch analysis of some NRG-1 samples highlights another problem with the the influx of new recreational agents: they may or may not contain the supposed active ingredient.

Naphyrone is a ‘triple uptake inhibitor’, it potently inhibits the reuptake of noradrenaline, dopamine and serotonin. The clinical effects are yet to be well characterized.

Methoxetamine is an analogue of ketamine and phenylcyclidine (PCP) that is typically sold as a ‘research chemical’.

It’s street names include: M-ket, Kmax, Mexxy and Special K (note: ketamine also appears under this street name)

This isn’t well understood — the first laboratory confirmed case was published in January 2012 — but it likely has similar pharmacodynamics to ketamine and PCP.

Compared to ketamine, methoxetamine appears to have a more delayed onset (up to 90 min) and longer duration of action (5-7 hours).

The effects described are typical of the adverse effects of ketamine:

• tachycardia, hypertension, confusion, agitation, mydriasis
• an acute cerebellar syndrome, characterised by dysarthria, nystagmus, and ataxia, that can be severe and may even last days
• Withdrawal symptoms have also been described.

Methoxetamine is purported not to cause cystitis and bladder fibrosis, two well-known effects of chronic ketamine abuse.

• Meow Meow Mephredrone
• I’m Just Trying To Get Clean Bro’
• Novel Psychoactive Substances – Recreational Drug Toxicity – David M. Wood (United Kingdom)
• Special Report: Coming Soon to an ED Near You: Bromo-Dragonfly (Not an Insect), K2 (Not a Mountain), and Venus (Not the Planet)
• Salvia divinorum: A Unique Hallucinogen
• Clandestine Drug Labs: High Risk for Fire, Explosion, and Toxic Exposure

Bath Salts

• Bath salts: calls to poison centers in Louisiana and Kentucky
• New England Journal of Medicine on “Bath Salts” New York Times on Bath Salts
• NBC’s Dateline goes undercover to investigate the “bath salt” industry
• “Bath salts” in Michigan Were “bath salts” involved in a double murder/suicide in Washington State?
• Dr. Oz on bath salts (MDPV)
• NBC’s Today Show reports on bath salts (MDPV)
• Death in Britain: “Ivory Wave” (MDPV) or diabetic ketoacidosis
• “Ivory Wave” identified as MDPV
• It’s not your mom’s bath salts

Bromo-DragonFLY

• Bromo-Dragonfly — not your father’s hallucinogen

Mephredrone

• Mephedrone (meow-meow): first confirmed case report
• Mephedrone after the ban Woof-woof: the new meow-meow?
• Mephedrone review
• Confirmed mephedrone-associated fatality
• How does the body handle mephedrone and other designer drugs?

Methoxetamine

• Methoxetamine: a designer ketamine analogue
• Acute cerebellar syndrome? Think methoxetamine

Naphyrone

• The chemistry of naphyrone
• NRG-1? Buphedrone? Flephedrone? — What will follow meow-meow and where will it come from?

New Recreational Drugs

• Comprehensive review of new designer drugs
• The science of designer drugs: essential review
• “Party pills”: review of BZP and TFMPP

Nexus/ 2-CB

• Nexus (2C-B) associated with Significant Cerebral Vasospasm

Salvia

• Johns Hopkins team investigates effects of Salvia divinorum
• Salvia divinorum and YouTube