The science of designer drugs: essential review
October 8, 2011, 12:07 pm
Clinical toxicology of newer recreational drugs. Hill SL, Thomas SHL Clin Toxicol 2011;49:705-719.
This essential article will probably be of most interest to chemical structure geeks (like me) and academics, but it is the best review I know that gets granular about the pharmacology of the many new designer drugs.
The authors did a comprehensive review of published medical literature involving new designer drugs. (Synthetic cannabinoids, synthetic cocaine , and GHB are not covered.) They classify these drugs into four categories:
Piperazines are synthetic chemicals that do no exist in nature. Included in this group is BZP, a sympathomimetic stimulant with effects similar to those of amphetamine. BZP inhibits re-uptake of dopamine and norepinephrine.
Phenethylamines include amphetamine, methamphetamine, and MDMA (ecstasy). Other examples are the synthetic cathinone mephedrone, MDPV (commonly found in “bath salts”), bromodragonFLY, and the 2C series. Phenethylamines are predominantly sympathomimetic stimulants, but can have varying degrees of psychoactive and hallucinogenic properties created by substitutions on the basic molecule.
Tryptamines are derived from the amino acid tryptophan. Examples include psilocybin, LSD and DMT (a component used by Ayahuasca shamans). Tryptamines are primarily hallucinogenic rather than entactogenic or stimulant.
Piperidines include desoxypipradrol (2-DPMP), a component of the designer drug “whack”. It has also been found recently in products sold as “Ivory Wave” bath salts. Piperidines are stimulants that can cause prolonged psychotic effects.
This classification scheme is very helpful in thinking about designer drugs, but has limited clinical usefulness. In fact, when dealing with a patient who has been acutely exposed to a designer drug, the clinician is never certain exactly what chemical or chemicals are involved. Street products can contain a mixture of ingredients. Therefore, there are few specific recommendations regarding medical management in this paper. The authors’ approach can be summed up by their last sentence:
The management of users with acute toxic effects is pragmatic and, in general, as for poisoning with longer established stimulant or hallucinogenic drugs such as amphetamines and MDMA.
With 169 references through 2011, this article should be in the files of anyone with more than a passing interest in the science of designer drugs.