Archive for May 2013

Kratom: it’s a stimulant, AND it’s an opioid

May 31, 2013, 7:35 pm


Pharmacology of Kratom: An Emerging Botanical Agent with Stimulant, Analgesic and Opioid-Like Effects. J Am Osteopath Assoc 2012 Dec;112:792-799.


Kratom is a psychoactive leaf from the southeast Asian tree mitragyna speciosaa species related to the coffee and gardenia plants. Because the leaf contains over 20 active substances and its effects are dose-related, ingesting the leaf in pill …

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Can levamisole-contaminated cocaine cause pulmonary hypertension?

May 30, 2013, 4:09 pm


Aminorex poisoning in cocaine abusers. Karch SB et al. Int J Cardiol 2012 Jul 26;158:344-346.


The drug aminorex was introduced in several European countries as an appetite suppressant in 1965, but quickly withdrawn when its use was associated with cases of pulmonary hypertension (PH) and a high fatality rate.

Starting in 2004, a large percentage of cocaine batches tested …

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Shisha, recreational marijuana risks, poisoned vegetables, and “crack babies”: The Weekly Web Review in Toxicology

May 25, 2013, 4:51 pm



The Guardian (U.K.) has a feature describing that use of the drug shisha is increasing in Greece at a rate that parallels the unravelling of that country’s economy and increasing desperation, especially among the poorest segments of the population.

Much of the article seems to come from a documentary. (For more on, read this fascinating article

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Digoxin toxicity: check the magnesium level!

May 23, 2013, 4:46 pm


Digoxin Toxicity with Normal Digoxin and Serum Potassium Levels: Beware of Magnesium, the Hidden Malefactor. Rao MPR et al. J Emerg Med 2013 May 16 [Epub ahead of print]


This case report from Oman describes at 66-year-old woman (inexplicably described as “elderly”) who presented to hospital with one day of nausea, vomiting, abdominal distress, and palpitations. Her medications included …

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DSM-5 and Psychiatric Diagnosis Inflation

May 21, 2013, 5:57 pm


The New Crisis in Confidence in Psychiatric Diagnosis. Frances A. Ann Intern Med 2013 May 17 [Epub ahead of print]

Full Text

Allen Frances, professor emeritus and former chairman of the Department of Psychiatry at Duke, has long argued that the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) would be a seriously …

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Tox Tunes #73: Hush Hush (Pistol Annies)

May 19, 2013, 3:10 pm

In a recent post titled “Hashville Skyline”, Slate describes the way that references to marijuana has infiltrated into country music tracks over the last decade or so. In this single, from the Pistol Annies‘ new album Annie Upone of the singers describes how she relieved the tension surrounding a drunken family Christmas dinner by sneaking out for …

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TCA overdose, toxic beer, and allegations of a mayor on crack: Weekly Web Review in Toxicology

May 19, 2013, 2:30 pm

Tricyclic Antidepressant Overdose – Over at EMCrit Blog, Scott Weingart has posted a superb podcast discussing the presentation and treatment of TCA overdose. In severe cases not responding to standard therapy, lidocaine, lipid rescue, or ECMO may be indicated. Gastrointestinal lavage — I’m not so sure. Both the podcast and the show notes are well worth your attention.…

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Are vasopressors effective therapy in calcium channel blocker overdose?

May 17, 2013, 9:43 pm


Critical Care Management of Verapamil and Diltiazem Overdose with a Focus on Vasopressors: A 25-Year Experience at a Single Center. Levine M et al. Ann Emerg Med 2013 May 1 {Epub ahead of print]


This uncommonly interesting and thought-provoking study comes from the Department of Medical Toxicology at Banner Good Samaritan Medical Center in Phoenix. The authors note that …

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Sous Influences: Artists and Psychotropics

May 16, 2013, 8:06 pm

Sous Influences. DOCU. by lamaisonrouge

Just returned from a short stay in Paris, where I saw the art exhibit Sous Influences (Under Influences: Artists and Psychotropics) at the Maison Rouge. Although somewhat disjointed and often lacking sufficient context, the show had a number of fascinating works, including Bryan Lewis Saunders‘ series of self-portraits done under the influence of

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