Unusual drugs of abuse

[Doc Samson]

Hey folks,

I'm working on a piece discussing unusual prescription drug abuse. I'm looking for abuse of drugs outside of the usual suspects (opiates, sedative-hypnotics, stimulants, steroids). I already have the articles on Seroquel abuse and anticholinergic abuse. Anyone familiar with other "zebra" abusable prescription meds?

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[PsychMD2100]

Cases of SSRI abuse have been reported. Patients without any indications for SSRIs are known to be taking the medicines. They usually obtain the SSRIs from friends and family. Delays in reaching orgasm are thought to enhance and prolong sexual experiences.

 

[OldPsychDoc]

Hey folks,

I'm working on a piece discussing unusual prescription drug abuse. I'm looking for abuse of drugs outside of the usual suspects (opiates, sedative-hypnotics, stimulants, steroids). I already have the articles on Seroquel abuse and anticholinergic abuse. Anyone familiar with other "zebra" abusable prescription meds?

Not exactly a zebra--but definitely "robotripping" (dextromethorphan abuse, particularly among teens).

 

[Hurricane]

Ketamine, although I think it's diverted more from veterinary sources...

"Sextacy" aka MDMA + viagra

 

[sdn1977]

Here I am...I won't say "favorite"....but how about "persistent" pharmacist!

How about dextromethorphan - one of the kids favorties not a prescription, but a common drug of abuse nonetheless!

Also....lomotil - used to counteract the side effects of other drugs - can be specifically crushed & mixed with ectasy to help with the GI side effects & help "bring down" someone who is "high" - lots of nonsense - it binds 'em up fast!

What about the FM personal favorite - Hycodan Syrup????? Da*n - it should be dosed q 12 hr, but works so much better if dosed q 4-6.

We have lots of fake rxs for clonidine & others used to help tx friends who are detoxing - on a friendly basis.

There's always ETOH, ETOH containing medications (Nyquil) & Provigil.

Then...there's the "oddball" ones like paraldehyde, paregoric (CIII in some states), and Benezedrex - an inhalant that coke addicts like.

Finally...there's the whole pseudoephedrine issue which our fine President has limited in supply laugh: ) by developing the Patriot Act, which is used to manufacture methylamphetamine.

You know all the others - like withdrawing the fentanyl from the patch, crushing the oxycontin, etc....all that can be mixed with a bit of talc or fructose & sold. Mix it with something that makes your heart race a bit & you can pass it off like cocaine, heroin or something else.

If I come up with any others, I'll comment, but thats a start....

 

[Hurricane]

Oh yeah, and I knew this girl in high school who swore that taking 6 Actifed would get you high. I guess that falls under anticholinergics? I never personally tested her theory though. Because...

She also said that eating a whole bunch of nutmeg would make you hallucinate. So, being young and foolish, we bought a giant container of nutmeg, cut it with Equal, and went to town. The only thing I saw was the business end of my toilet as I puked my guts out. And we all smelled like nutmeg for three days as we sweat the horrid stuff out from every pore. Ah, high school...

She's a surgeon now...

 

[sdn1977]

Ketamine, although I think it's diverted more from veterinary sources...

"Sextacy" aka MDMA + viagra

OMG - how could I forget "poppers" - amyl nitrate or a combination of any nitritate & a stimulant - a particular friend of homosexuals.

Ketamine is still a big "dissociative" drug, but more readily avilable than in years past - from ORs, plastics physicians, oral surgeons, etc.....

 

[whopper]

Cogentin is used as a drug of abuse in 3rd world countries, though rarely if at all happens here.

One of my attendings who did work in a prison told me anything with any psychotropic effects is largely abused in prison. He told me some prisoners are so hard up on getting anything to just to anything they'll go out of their way to get any med possible. He said he saw several prisoners just try to grab anything even if its not known to cause any buzzing effects to experiment.

Seroquel abuse though I know for a fact that it is going on, and actually its quite rampant in my parts is poorly documented. However...

http://en.wikipedia.org/wiki/Quetiapine

Due to its sedative side effects, reports of quetiapine abuse (sometimes by insufflating crushed tablets) have emerged in medical literature

There also is strong documentation in the literature concerning antihistamines being used to spike the high of an opioid, in fact Kaplan & Saddock documents this in their books. Seroquel as we know, its primary effect is as an antihistmamine.

http://www.ncbi.nlm.nih.gov/entrez/..._uids=16135642&query_hl=1&itool=pubmed_docsum
1: Am J Psychiatry. 2005 Sep;162(9):1755-6

Am J Psychiatry. 2004 Sep;161(9):1718. Links
Intranasal quetiapine abuse.

 

[sga430]

salvia divinorum which is legal atleast in california. it is a short term hallucogen with a philosophical buzz. not really abused as it is not addictive. it is used either by the very experienced or by high schoolers who probably cant score pot.

 

[Doc Samson]

Thanks for the thoughts. DM is being covered under the banner of opiates, so it still falls out of my "zebra" assignment. If you have any articles reporting these phenomena, links would be greatly appreciated.

 

[MBK2003]

One of my attendings posted to our listserv about a patient who meets criteria for Lyrica abuse, which appears to actually be listed on the packet info as a potentially rare side effect.

Also have heard a case where a polysubstance abusing pt was clean except for snorting Prozac.

Finally, when I was at the VA as a medical student, had a lot of pts who'd divert/steal trazodone for sexual side effects (not full blown priapism, mind you).

MBK2003

 

[50960]

I recently had a pt who took 3-4 grams of depakote with ETOH, and claimed he got high-er.

 

[Doctor Bagel]

Finally...there's the whole pseudoephedrine issue which our fine President has limited in supply laugh: ) by developing the Patriot Act, which is used to manufacture methylamphetamine.

I was thinking of this one. I actually had a claimant when I did disability work who was addicted to pseudoephedrine, not meth, but just regular unadulterated sudafed.

 

[Hurricane]

I was thinking of this one. I actually had a claimant when I did disability work who was addicted to pseudoephedrine, not meth, but just regular unadulterated sudafed.

There's a guy who abuses sudafed who regularly comes to our psych ER. I don't know where he gets that many, but he gets brought in a couple times a month yelling obscenties, goes to seclusion, sleeps it off, declines drug and alcohol counseling, then goes home. I haven't been down there since the patriot act business though.

 

[DrIng]

I'd be interested to know the number of doctors who abuse Provigil- if I were going to abuse something a drug which lets you do without sleep for a night certainly sounds handy...

 

[ntubebate]

Soma is a big drug of abuse here in the south.

In fact, many states have made if a CIV or CIII substance.

ntubebate

 

[sdn1977]

Soma is a big drug of abuse here in the south.

In fact, many states have made if a CIV or CIII substance.

ntubebate

thats because its major metabolite is meprobamate - drug abusers are stupid people !

 

[sdn1977]

Used to be lots of abuse of phenteramine & fenfluramine, but not so much now that it causes heart problems (or now that we KNOW it causes heart problems).

 

[sdn1977]

There are the "natural" products - nutmeg, valerian, kava, morning glory seeds, a variety of mushrooms.

Did you cover - the inhalants - hair spray, laquer, glue, etc????

Then...the designer drugs - lots of them - MDMA, for example...

I'll try to get you links tomorrow. To start, you can look up an old Goodman & Gilman: The Pharmacological Basis of Therapeutics.

I've heard of diabetics getting close to a diabetic coma & doing the sex thing - like the asphyxia/sex thing.....but - that may be just an urban rumor. I don't have any specific links on that.

 

[drmistga]

In a few countries some of the anti-parkinson dopamine agonists or dopamine releasing agents are used in psychiatry and actually increasing numbers of people abusing these meds here in the states-even in parkinsons patient there is a small percent who have euphoria on regular doses and it makes sense anyway with all the extra dopamine you could get a similar high to other euphoric inducers.

Like most other AD's wellbutrin is being crushed and snorted now by teens and adults-done in enough can produce a high somewhat similar to amphetamine in the cases I have read.

 

[signomi]

I've seen neurontin and benadryl abuse. Also laxative abuse amongst the eating disordered.

 

[drmistga]

Ya forgot Tramadol-not scheduled easy to obtain and was thought to have only "weak opioid agonist properties" well this drug has turned into the number 1 most abused drug by doctors in this country and is soon to be scheduled as the weak properties are no known but be a heck of alot stronger since a metabolite of the drug, its main metabolite (forget the name) after liver processing has about 10 fold more agonism than the parent tramadol which was not known when drug was originally scheduled.

Also the drugs norepie and serotonin re uptake properties add to the effect. Interestingly this drug is starting to be used in anti-depressant trials-for people refractor to conventional therapy or patients with cormorbid pain/chronic pain issues since it has a lot of the typical anti-depressant actions with NE and Sero but adds some opioid happiness to the mix but not so much that it stones ya otu of commission

 

[Anasazi23]

A friend of mine used to smoke banana peels in high school. Swore it was similar to marijuana.

He also worked at the beer store.

 

[drmistga]

haha banana peels that is a first for me-and I have seen some very creative teens haha

 

[OtisRSB]

we just discharged a guy who was injecting 1200mg of benadryl a day. he'd open the capsules, mix it with water and inject it IM. poison control is hearing more of this will little advice as to how to detox.

 

[OldPsychDoc]

haha banana peels that is a first for me-and I have seen some very creative teens haha

I grew up, umm, closer to the 60s, and there used to be jokes about this all the time.

Off topic for Doc S's request about zebra prescription abuses, but no one has mentioned khat yet. A favorite stimulant leaf among Somalis and other East African immigrant communities--and rather psychotogenic in the predisposed.

 

[watto]

I grew up, umm, closer to the 60s, and there used to be jokes about this all the time.

Off topic for Doc S's request about zebra prescription abuses, but no one has mentioned khat yet. A favorite stimulant leaf among Somalis and other East African immigrant communities--and rather psychotogenic in the predisposed.

I was just going to mention Khat! I always made sure I asked about it in the "substance use hx" of my interviews in med school - I was in Minneapolis, which has a significant Somali population, and one of the Somali interpreters I was working with actually suggested I ask about it since its use was so high in that culture. He described it as having stimulant properties, sort of like an amped-up caffeine.

 

[drmistga]

Is it easy to obtain this kaht stuff? I mean should this be asked in drug screening-heck I didnt even know what it was-interesting the stuff you pick up on these boards!

 

[primadonna22274]

I also remember a guy in my psych rotation who would load up on Benadryl and get "high". He would get his disability check, buy up 5-6 boxes of Benadryl, couple of 40's, rent a cheap motel room and take it all. Then the county mental health would hear about it from the motel staff when somebody recognized his name on the roster (he'd done this many times before) and scramble to "rescue" him. It really was ridiculous. I never could understand what he got out of it anyway...drunk and sleepy...???

 

[Anasazi23]

"bannadine"


Why not, I'm miserable on my child psych rotation anyway. I'll let you all know how it goes.

http://users.lycaeum.org/~sputnik/Humor/banadine.html

 

[joey87]

I also remember a guy in my psych rotation who would load up on Benadryl and get "high". He would get his disability check, buy up 5-6 boxes of Benadryl, couple of 40's, rent a cheap motel room and take it all. Then the county mental health would hear about it from the motel staff when somebody recognized his name on the roster (he'd done this many times before) and scramble to "rescue" him. It really was ridiculous. I never could understand what he got out of it anyway...drunk and sleepy...???

http://www.erowid.org/pharms/diphenhydramine/diphenhydramine.shtml


(what a great first post, huh?)

 

[OldPsychDoc]

"bannadine"

At least we now know that it's "not microwave soluble"!

 

[primadonna22274]

Interesting. Nice reference joey.
Gosh, all I ever get out of Benadryl is a hung-over feeling and dry mouth in the morning. My husband takes it and gets diarrhea so he avoids it.

http://www.erowid.org/pharms/diphenhydramine/diphenhydramine.shtml


(what a great first post, huh?)

 

[drwatson]

I took a Toxicology elective and, if nothing else, it taught me the variety of lengths people will go to in order to get high. Morning glory and nutmeg have been mentioned so far.

2 things worth mentioning 1-apparently multiple clonidine patches has an opioid like effect and 2- Visine is the modern "Micky Finn", OD's being reported with increased frequency in Vegas.

Clonidine abuse among opiate addicts.
Dennison SJ. Psychiatr Q. 2001 Summer;72(2):191-5.

And after a little bit of "research" I found that Visine also has the fantastic property of being able to create a false-negative on a THC immunoassay.

Mechanism of false-negative urine cannabinoid immunoassay screens by Visine eyedrops
SD Pearson, KO Ash and FM Urry
Clinical Chemistry 35: 636-638, 1989;

Great discussion topic! If you are writing a paper, I would suggest talking to Poison Control and your local Toxicologist.

PS-Watch out for those bannanadines, rumor has it they can lead to gynecomastia!

 

[ivers]

I was going to post the link for erowid, but I see someone already did that. I work in addictions and frequently use that site to check up on what other prescription and OTC meds people are abusing in various ways. Obviously it's not scientific, but it's still a useful resource nonetheless.

 

[50960]

I just remembered I saw a guy a few years back who took 10-20 mg of loperamide with some various OTC sleep meds (antihistamines) to get happy....

 

[50960]

Just remembered another. I have had several parents of autistic kids tell me their child gets very euphoric after eating certain foods..to the point they have had to not have those foods or lock them up. I think this came from the pseudoscience on leaky guts etc...but who knows??