Showing posts with label toxicology. Show all posts
Showing posts with label toxicology. Show all posts

Sunday, 14 July 2019

LSD - Between Good and Bad Trip


Few years back, I got a frantic phone call from a friend. It was 4 AM so between my annoyance being woken up before dawn, I asked him what the hell happened. He told me he was on this party and they did some drugs. At that moment, I just knew this wouldn’t be a nice phone call. He said he took some ‘acid’ and now he didn’t feel well. Everything around him seemed distorted. He was ‘seeing sounds’ and ‘hearing colours’. When I told him to go to the hospital, he fearfully told me he couldn’t because the medics would turn him in.

He had a good point, though ... the laws concerning narcotics in Indonesia is pretty strict. So out of desperation, I told him to find himself a green coconut water somewhere. What else could I do? His friends left him when he got too ‘high’. They just dumped him back at his place and left. So much for good friends.

Some of you might heard about LSD or ‘Acid’. They usually looked like stamps and people put them on their tongue. It was known as drugs used by hippies, besides marijuana. There is even a song about it, ‘Lucy in the Sky with Diamonds’. There are several positive ‘reviews’ on how LSD influence arts and society. Many said it was an enlightning experience, getting high on acid. However, I’m going to write a little bit about LSD and its effect.

Hasil gambar untuk LSD

Lysergic acid diethylamide (LSD) is a classic hallucinogen drug. It worked by binding to the serotonin receptors in human brain, that mediates the hallucinogenic effect by activating the frontal cortex glutamate transmission. It mimics the effect of the chemicals on your brain called ‘glutamate’, causing an increasing activity of the part of your brain – the sensory and cognitive processing. LSD also binds the adrenergic and dopaminergic receptions, which is not the case for other classic serotogenic hallucinogens.

On a studies using validated psychometric scale on 2017, the subjective effects of LSD were predominantly positive in controlled settings. However at the dose of 200 μg negative effects also reported. LSD at this dose also used in LSD-assisted psychotherapy in Switzerland.

 

The picture showed us which part of the brain activity is increasing after LSD exposure (right). This lasts for about eight hours. The hallucination or ‘psychadelic’ effect, was said to be a result of the increasing visual cortex communication with the other areas of the brain. This was similar to the psilocybin or ‘magic mushroom’. There was also a reduce in blood flow, so the neurons that normally act together lost its synchronization. Some volunteers in the experiment said that they feel themselves ‘becoming less a singular entity and melded with people and things around them’. However, the ‘good’ effects are vary. Some reported effects include : flashbacks, euphoria, anxiety and paranoid. 

LSD is relatively safe when used in medical settings and according to safety guidelines. However in unsupervised settings LSD could causes harm to the users. Acute adverse effects up to 10–24 hours after LSD administration included difficulty concentrating, headache, dizziness, lack of appetite, dry mouth, nausea, imbalance, and feeling exhausted. Headaches and exhaustion may last up to 72 hours. In my friend’s case, he said he’s not feeling well for good three days afterwards.

A case report on 2015 wrote that the user of LSD experience feelings of ‘trapped’, increasing heart rate, hallucinations and the subject was driven to the point of attempted suicide. The LSD was ‘25I-NBOMe’ a hallucinogen synthesized for research purposes. It has even higher affinity in the receptor. Thus, the ffects are also stronger. Most common adverse reaction is an acute episode of anxiety or panic (“bad trip”) that resolves with reassurance and the use of benzodiazepines. This NBOMes also caused tachycardia, palpitations, clonus, pyrexia, elevated creatine kinase, severe agitation, delirium, tonic-clonic seizures, renal failure, fatal overdoses and traumatic deaths.

There isn’t any ‘directions’ on the drugs one get form the street. The risks of overdose are pretty high, because one cannot measure the dose alone. We also can never tell which one is the real LSD and which one is not, as well as when will we get the good or the bad ‘trip’. The NBOMes is one of the drugs that difficult to detect, due to the high potency and small dose ingested. In conclusion, when one wishes to get high or hallucinating using the ‘acid’ they get from the street, they must remember that (1) the careless way the maker might use to make it and (2) one should not use it alone without a sober ‘friend’ and last but not least (3) the narcotics law.

Further reading : 
Cormier, Z., 2016. Nature.com. [Online]
Available at: https://www.nature.com/news/brain-scans-reveal-how-lsd-affects-consciousness-1.19727 [Diakses 14 July 2019].


Liechti, M. E., 2017. Modern clinical research on LSD. Neuropsychopharmacology, XLII(11).
Suzuki, J., Poklis, J. L. & Poklis, A., 2015. My friend said it was good LSD : a suicide attempt following analytically confirmed 25l-NBOMe I

Friday, 21 June 2019

Gorilla Marijuana

Hasil gambar untuk Ganja gorila


Gorilla marijuana / gorilla 'tobaco' is one of the terms for synthetic marijuana sold in Indonesia. The news had shown a lot of people got caught due to this. What is gorilla marijuana? What makes it more 'special' than regular marijuana? Well, the name of 'gorilla marijuana' was given because the effect of this synthetic marijuana was like 'being squashed by gorilla'. People who do drug abuse often said that the drug is a lot better than regular marijuana, the effect is more severe. Because some articles mentioned that marijuana is actually less harmless than some substances, it msut be safe, no?

Well first of all, the therapeutic use of synthetic cannabinoid is inconclusive. We all have heard the medical use of marijuana. But first, I want to introduce the two receptor of cannabinoids in our body. Receptors are parts of our cells that accept chemical (such as active substance from drugs) and the binding between the two will lead to chain reactions that create the drug effect. There are two cannabinoid receptors in our body :


Gambar terkait

The research goal is to find synthetic marijuana without the psychoactive effect, yet work well in modulating the immune cells (that binds more to CB2 receptors). Some research also seek for the therapeutic use of synthetic cannabinoid for nervous system disturbance such as Alzheimers or Dementia. The results, however, is still inconclusive and in need of further research.

The synthetic cannabinoid manufactured outside medical purposes, however ... are more potent and efficacious cannabinoid receptor agonists than THC plus they have additional ingredients such as preservatives, additives, fatty acids, amides, esters, benzodiazepines, and O-desmethyltramadol- an active metabolite of the opioid medication tramadol. The mixtures were used to mask the result of the drug examinations. 

Now, synthetic cannabinoid is different from the regular one because the effect is a lot more potent. Synthetic cannabinoid is not derived from cannabis, they're the full agonists at cannabinoid receptors with biologically active metabolites. Thus, the effect. Adverse effects including respiratory difficulties, hypertension, tachycardia (raise of heart rate), chest pain, muscle twitches, acute renal failure, anxiety, agitation, psychosis, suicidal ideation, and cognitive impairment. To put in summary : it is definitely not a recreational drug. 

In Indonesia, there was a report on a pilot of commercial airplane, who used this 'Gorilla tobacco' . Before the flight, the pilot was seen staggering during his walk accross the x ray. Passengers started to get panic when they heard he's slurring words from the cockpit. The worried, scared and angry passengers approached the cockpit. 

How bad was it? Well ... : 

During the x ray examination: 

On the cockpit : 

The translation of the dialogue : 
People are trying to make him cancel the flight, but he's saying "No! I don't wanna get off this plane. You know me right? I'm just tired. I'm just woken up. I'm okay. Let's go!" 

He's obviously suspended after the incident. There are also a lot of case reports regarding the adverse effect of synthetic cannabinoid abuse. They are not 'just getting high' and could easily being laughed off *until someone gets hurt, that is. You can read the case report here, but some of the cases are : 

1. 13 years old girl who was found intermittently responsive and combative at her home after using synthetic marijuana called 'K2'. Her heart rate increases rapidly and after sedated at the hospital, her respiratory rate decreasing. She's finally being put in intubation to help her breathing.


2. 13 years old boy was found unresponsive in a park. At the hospital he required significant amounts of sedatives due to periods of agitation and combativeness. During his hospitalization the patient developed aspiration pneumonia, but could finally discharged. 

3. 40 years old woman admitted into the hospital with a seizure after using synthetic marijuana. The EKG (heart recording) showed increasing heart rate. The electroenchepalogram (brain wave recording), also showed unremarkable abnormality. She was put into sedated state and using intubation as well. 

4. 20 years old man admitted into the hospital waith hyperthermic (rise of body temperature), increasing heart rate and unconscoious with decorticate position. Laboratory analysis demonstrated significant rhabdomyolysis and acute renal failure. Later, the clinical examination was consistent with anoxic brain injury. A brain magnetic resonance imaging (MRI) scan confirmed these findings. Care was eventually withdrawn due to the grim prognosis, and the patient died on HD seven.

There are still some case reports regarding the adverse use of synthetic cannabinoids. So please, do be careful in using new 'exciting' substance. Putting yourself in serious danger in order to be 'edgy' is not worth it. Many people survive drug abuse effects, but it's always like Russian roulette. You might survive, but next time you might not be so lucky. Also, people who 'make' these kind of drugs are getting more and more experimental, mixing various substances here and there in order to increasing the effect / masking the drug tests result / etc. when the adverse effect started to get too bad, the 'mixtures' might clash with the life-saving efforts in the hospital. 


Reference / Further Reading :  
1. Cohen K and Weinstein AM (2018) Synthetic and Non-synthetic Cannabinoid Drugs and Their Adverse Effects-A Review From Public Health Prospective. Front. Public Health 6:162. doi: 10.3389/fpubh.2018.00162. 
2. Katz et al (2016) Case Series of Synthetic Cannabinoid Intoxication from One Toxicology Center. West J Emerg Med 17 : 3. doi : 10.5811/westjem.2016.2.29519 
3. Mills et al (2015). Synthetic Cannabinoids. American Journal of Medical Sciences 350 : 1. doi :  https://doi.org/10.1097/MAJ.000000000000046

Ambis

  Just yesterday another hullabaloo happened in twitter (surprise, surprise). This time it was about an infamous stand-up comedian slash inf...