Medical Toxicology of Drug Abuse: Synthesized Chemicals and Psychoactive Plants

1068 Pages·2012·17.62 MB·English

by  Donald G. Barceloux(auth.)

MEDICAL TOXICOLOGY OF DRUG ABUSE
MEDICAL TOXICOLOGY
OF DRUG ABUSE
Synthesized Chemicals and Psychoactive Plants
DONALD G. BARCELOUX, MD, FAACT, FACMT, FACEP
Clinical professor of medicine, department of emergency medicine
David geffen school of medicine
University of california at los angeles
Los angeles, california
Senior partner, cep america
Emeryville, california
Staff physician, department of emergency medicine
Pomona valley hospital medical center
Pomona, california
Associate editor
Robert b. palmer, phd, dabat, faact
Toxicology associates, pllc
Denver, colorado
Rocky mountain poison & drug center
University of colorado school of medicine
Denver, colorado
University of wyoming college of health sciences
Laramie, wyoming
A JOHN WILEY & SONS, INC., PUBLICATION
Copyright © 2012 by John Wiley & Sons, Inc. All rights reserved
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Library of Congress Cataloging-in-Publication Data:
Barceloux, Donald G.
Medical toxicology of drug abuse : synthesized chemicals and psychoactive plants / Donald G. Barceloux.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-471-72760-6 (cloth)
1. Drugs–Toxicology. 2. Substance abuse. I. Title.
[DNLM: 1. Drug Toxicity. 2. Central Nervous System Agents–pharmacokinetics. 3. Central Nervous System Agents–toxicity. 4. Plants,
Toxic. 5. Substance-Related Disorders. QV 600]
RA1238.B35 2011
616.86'071–dc22
2011012205
Printed in the United States of America
10 9 8 7 6 5 4 3 2 1
To my wife, Kimberly; my son, Colin; my daughter, Shannon; and my son -i n - law, Michael,
whose love and support sustains me through this continuing project.
CONTENTS
FOREWORD xi
PREFACE xiii
CONTRIBUTORS xv
REVIEW PANEL xvii
ACKNOWLEDGMENTS xix
PART 1 SYNTHETIC and SEMISYNTHETIC CHEMICALS 1
I Amphetamines and Phenethylamine Derivatives 3
1 Amphetamine and Methamphetamine 3
2 Methylphenidate 57
3 Prolintane 69
4 Propylhexedrine 72
II Club Drugs 77
5 Flunitrazepam 77
6 Gamma Hydroxybutyrate and Related Drugs 89
7 Ketamine 110
8 Methcathinone, Mephedrone, and Methylone 120
9 Methylenedioxymethamphetamine (Ecstasy, MDMA) 126
Nicholas A. Buckley, MD
10 Psychoactive Phenethylamine, Piperazine,
and Pyrrolidinophenone Derivatives 156
Brandon Wills, DO, MS, Timothy Erickson, MD
11 Tryptamine Designer Drugs 193
vii
CONTENTS
III Eating Disorders and Appetite Suppressants 200
12 Diuretics, Ipecac, and Laxatives 200
Cyrus Rangan, MD
13 Noradrenergic Agents 233
Cyrus Rangan, MD
14 Serotoninergic and Mixed Agents 255
IV Ergogenic Agents and Supplements 275
15 Anabolic-Androgenic Steroids 275
16 Clenbuterol and Salbutamol (Albuterol) 295
James Rhee, MD, Timothy Erickson, MD
17 Erythropoietin Stimulation and Other Blood Doping Methods 306
James Rhee, MD, Timothy Erickson, MD
18 Human Chorionic Gonadotropin 326
19 Human Growth Hormone and Insulin-Like Growth Factor 334
20 Nutritional Supplements 351
V Ethanol 365
21 Ethanol 365
VI Lysergic Acid Diethylamide 452
22 Lysergic Acid Diethylamide (LSD) 452
VII Older Sedative Hypnotic Drugs 467
23 Barbiturates
(Amobarbital, Butalbital, Pentobarbital, Secobarbital) 467
24 Ethchlorvynol 486
25 Glutethimide 491
26 Meprobamate 497
27 Methaqualone and Related Compounds 504
VIII Opioids 514
28 Buprenorphine 514
29 Dextromethorphan 527
30 Fentanyl Analogues 539
31 Heroin and the Opium Poppy Plant (Papaversomniferum L.) 546
32 Methadone 579
33 1-Methyl-4-phenyl-1,2,5,6-tetrahydropyridine (MPTP) 603
IX Phencyclidine 608
34 Phencyclidine and Phencyclidine Analogues 608
viii
CONTENTS
X Volatile Substances of Abuse 633
35 Volatile Substance Abuse 633
A Anesthetics 642
36 Chloroform 642
37 Ethers 647
38 Halogenated Ethers (En(cid:223) urane, Iso(cid:223) urane,
Methoxy(cid:223) urane, Sevo(cid:223) urane) 653
39 Halothane 664
40 Nitrous Oxide 670
B Fluorinated Alkanes 676
41 Fluorinated Alkanes 676
C Industrial Hydrocarbons 684
42 Butane, Isobutane, and Propane 684
43 Ethyl Chloride 691
44 Gasoline 695
45 n-Hexane 702
46 Methanol 709
47 Naphthalene and para-Dichlorobenzene (Mothballs) 716
48 Toluene 725
49 Trichloroethane 737
50 Trichloroethylene 743
D Nitrogen Compounds 751
51 Amyl and Butyl Nitrites 751
PART 2 PSYCHOACTIVE PLANTS 759
52 Absinthe 761
53 Ayahuasca, Harmala Alkaloids, and Dimethyltryptamines 768
54 Betel Quid and Areca Nut 781
55 Caffeine 788
56 Cocaine 805
57 Ibogaine (Tabernantheiboga Baill.) 867
58 Khat (Catha edulis (Vahl) Forsskal ex Endl.) and Cathinone 873
59 Kratom
[Mitragyna speciosa (Korth.) Havil.] 880
60 Marijuana (Cannabis sativa L.) and Synthetic Cannabinoids 886
ix
CONTENTS
61 Mate Tea (Ilex paraguariensis A. St. Hil.) 932
62 Morning Glory Family (Convolvulaceae) 938
63 Peyote [Lophophora williamsii (Lem. Ex Salm-Dyck)
Coult.] and Mescaline 944
64 Psilocybin and Hallucinogenic Mushrooms 950
65 Salviadivinorum Epling & Jativa and Salvinorin A 961
66 Tobacco, Nicotine, and Pituri 968
INDEX 993
x
FOREWORD
It is a great pleasure for me to write this Foreword, as agents that are abused, including newer designer drugs
I have known Don Barceloux professionally for many and psychoactive plants. Detailed information is pro-
years and we have collaborated on various projects vided on the pathophysiology, toxicokinetics, clinical
particularly for the American Academy of Clinical effects (including the features associated with abstinence
Toxicology. Dr. Barceloux fi rst established himself as a syndromes and reproductive abnormalities), treatment,
distinguished and successful author with the publication and prevention of drug abuse. In addition, there are sec-
in 1988 of the fi rst edition of Medical Toxicology: tions on epidemiology, on the chemical structure and
Diagnosis and Treatment of Human Poisoning , which he physiochemical properties of the abused substances, on
co - authored with the late Matthew Ellenhorn. impurities introduced during synthesis, on the interpre-
Dr. Barceloux ’ s reputation for producing systematic tation of the results of laboratory testing, and on the
books of great quality was further enhanced in 2008 by characteristics and geographical distribution of psycho-
the publication of the fi rst volume (of four) of Medical active plants. All but six of the 66 chapters in the present
Toxicology , which was entitled the M edical Toxicology volume were authored by Dr. Barceloux himself; the
of Natural Substances: Foods, Fungi, Medicinal Herbs, remainder have been written by other acknowledged
Plants and Venomous Animals ; he wrote 171 of the 185 experts. After reading the book in proof I am confi dent
chapters. At the time of publication, this book had no its impact and usefulness will be similar to volume 1.
rival, and that continues to be the case. I use it on a daily I commend this excellent book to the reader.
basis in my clinical practice.
While a substantial number of textbooks on clinical Professor Allister Vale md frcp frcpe frcpg ffom
toxicology have been published in the last two decades, faact fbts ho n frcpsg
none has focused primarily on drug abuse. Equally,
many books on drug abuse have been published over National Poisons Information Service (Birmingham
the same period, but none has been written from the Unit) and West Midlands Poisons Unit, City Hospital,
perspective of the clinical/medical toxicologist. Birmingham, UK; School of Biosciences and College of
For this reason I welcome, and indeed have been Medical and Dental Sciences, University of
waiting eagerly for, the publication of the second volume Birmingham
in the Medical Toxicology series, which uses the same Past - President of the British Toxicology Society;
helpful format as volume 1. M edical Toxicology of Drug Past - President of the European Association of Poisons
Abuse : Synthesized Chemicals and Psychoactive Plants Centres and Clinical Toxicologists; Past - Trustee of the
provides in - depth up - to - date coverage of psychoactive American Academy of Clinical Toxicology
xi
PREFACE
Medical Toxicology of Drug Abuse : Synthesized decisions regarding the sources, effect, regulation, and
Chemicals and Psychoactive Plants is the second book management of toxic exposures. The following list pro-
in the Medical Toxicology Series that divides Medical vides organizational details on the material under the
Toxicology into the four following areas: Natural headings for each drug:
Substances, Drugs of Abuse, Occupational and Environ-
mental Exposures, and Pharmaceutical Overdose. The History includes facts about the discovery, past abuse,
book series is designed to provide in - depth, evidence - and earlier complications of drug abuse.
based coverage of the most important toxins affecting
Botanical Description helps the reader identify the
humans. This book covers a variety of older psychoac-
characteristics and geographic distribution of psychoac-
tive drugs and newer designer drugs of abuse including
tive plants.
recently popularized drug (e.g., methcathinone, mephed-
rone, Salvia divinorum , kratom). Information on a par- Identifying Characteristics includes the chemical struc-
ticular substance is discussed in the book commonly ture, physiochemical properties, and the terminology
associated with the subject. Consequently, the most associated with the specifi c drug of abuse.
important psychoactive plants are discussed in the Drug
Exposure discusses the epidemiology, trends, sources,
Abuse book rather than the Natural Substances book,
production processes, impurities added during synthesis
so the reader interested in information on drug abuse
of the drug, profi ling of confi scated drugs, and common
will not have to search two books. Pharmaceutical
methods of misuse.
drugs (e.g., hydrocodone, morphine, oxycodone) used
Dose Effect covers clinical data on the drug doses asso-
primarily for therapeutic purposes will be covered in the
ciated with overdose and fatalities in humans. The book
book on Pharmaceutical Overdose. Conversions for
emphasizes dose- related effects rather than adverse or
length and temperature in metric and imperial systems
idiosyncratic reactions.
are provided to ease the use of this book by an interna-
tional readership, whereas the metric system for mass Toxicokinetics discusses the disposition of the drug in
and concentrations are retained to limit any confusion the body including the absorption, distribution, bio-
about doses in the United States. This book is designed transformation, and elimination along with maternal
as a convenient reference for answers to questions and fetal kinetics, tolerance, and drug interactions.
regarding exposure, pathophysiology, clinical effect,
Histopathology and Pathophysiology presents informa-
detection, and treatment of toxicity associated with
tion on the mechanisms of action and toxicity, autopsies,
drugs of abuse.
and postmortem changes associated with drug abuse.
The format of this book follows the fi rst book in
the Medical Toxicology Series, Medical Toxicology of Clinical Response provides data on the clinical
Natural Substances: Foods, Fungi, Medicinal Herbs, features of toxicity following the illicit use of the drug
Plants, and Venomous Animals . When the reader is including the onset, duration, and type of clinical
familiar with the templates used in the book series, the effects (behavioral abnormalities, mental disorders,
consistency of the organization allows the reader to medical complications). Additionally, this section dis-
easily locate the appropriate information necessary for cusses reproductive abnormalities, fatalities, and any
xiii