TPR Podcast Episode #6: I’m tripping and I can’t get down

October 6, 2014, 11:52 pm

TPR Podcast Episode 6: I’ve Tripped and I Can’t Get Down

Written by Theresa Kim, MD




1)     Synthetic cathinones

2)     Piperazine compounds

3)     Gamma-hydroxybutyric acid (GHB)

4)     25C-NBOMe



This month’s podcast was inspired by the New York Times article “A Year After Drug Deaths, the Electric Zoo Music Festival Tries Again” which covered designer drug related deaths associated with summer music festivals



Synthetic Cathinones


o   examples: mephedrone, methedrone, MDPV, methylone

o   “bath salts” generally contained one or more synthetic cathinones

o   Schneir et al performed a comprehensive analysis of the composition of “bath salts”, finding great variability in components and concentrations

  • Synthetic cathinones release norepinphrine, dopamine, serotonin

o   Norepinephrine > sympathomimetic manifestations

o   Serotonin > serotonin syndrome, hallucinations

o   Dopamine > abuse potential

  • Routes: oral , nasal, parenteral
  • Effects: euphoria, agitation, paranoia, tachycardia, sweating, confusion, chest pain, palpitations, restlessness
  • Complications: hyponatremia, hyperpyrexia, serotonin syndrome, rhabdomyolysis, agitated delirium, multi-system failure
  • Treatment: supportive

o   chemical restraint, aggressive cooling if indicated, fluids, anticipate potential complications




  • purely synthetic compounds with no naturally occurring form
  • piperazine was initially produced/licensed in the 1950s as a veterinary anti-helminthic drug
  • examples: BZP, MDBZP, TFMPP
  • generally stimulate actions of norepinephrine, dopamine, and serotonin
  • route: usually ingestion in pill or loose powder form
  • effects similar to those of MDMA and amphetamines: anxiety, palpitations, sweating, confusion, agitation, vomiting, hallucinations, hyperventilation
  • can cause false positive results on amphetamine screen
  • complications: seizures, metabolic acidosis, hyponatremia, hyperthermia, multi-organ failure, psychosis, seizures
  • treatment: supportive
  • Symptoms commonly persist > 24 hrs





Gamma-Hydroxybutyric Acid (GHB)


  • colorless oily chemical
  • GABA analogue
  • effects: CNS depression, disinhibition, nausea, dizziness, agitation, urinary incontinence, aggression
  • Complications: coma, respiratory depression, rhabdomyolysis
  • relatively short duration (generally < 3 hours)
  • treatment: supportive





  • Structural analogue of ketamine
  • often (mistakenly) touted as “bladder friendly”
  • street names include MXE, mexxy, KMax, rolfcoptr,” legal” ketamine, minx, jipper
  • NMDA receptor antagonist
  • routes: insufflation, oral, sublingual, rectal, paranteral routes reported
  • effects: similar to ketamine
  • Animal studies show that prolonged exposure of mice to methoxetamine results in renal toxicity and bladder fibrosis in a similar way that ketamine has been known to do
  • treatment: supportive


Synthetic Cannabinoids


  • synthetic versions of , delta-9-tetrahydrocannabinol (THC), the active psychoactive component found in marijuana
  • action: cannabinoid receptor agonism
  • route: usually smoked or vaporized
  • effects: euphoria, altered perception, cognitive slowing
  • Complications: cases of acute kidney injury, myocardial infarction, and psychosis have been reported
  • treatment: supportive



  • derivative of the psychedelic compound phenethylamine 2C-C MOA: partial agonist of 5-HT2A receptor
  • routes: sublingual, buccal, inhalation
  • Complications: vasoconstriction, serotonin syndrome, hyperthermia, hypertension, metabolic acidosis, rhabdomyolysis, seizures, renal failure, disseminated intravascular coagulation
  • treatment: supportive


Past Quizzler


Q: Which founding father owned a paper mill that incorporated hemp into its paper making production?

A: Benjamin Franklin

Congratulations Jessica Folk!


Current Quizzler


Posted at the end of the podcast

Submit responses and any feedback to

The first correct response wins a $10 amazon gift card and a Poison Review t-shirt (bonus prize!)



Thank you for listening, and please subscribe on iTunes and submit any responses either via iTunes or email at



Bersani, F.S., Ornella, C., Albano, G., Valeriani, G., Santacroce, R., Posocco, F.B.M., Cinosi, E., Simonato, P., Martinotti, G., Bersani, G., Schifano, F. (2014). 25C-NBOMe: preliminary data on pharmacology, psychoactive effects, and toxicity of a new potent and dangerous hallucinogenic drug. Biomed Research International.


Feuer, A. (2014, Aug 15). A year after drug deaths, the electric zoo music festival tries again. The New York Times.


Schneir, A., Ly, B.T., Casagrande, K., Darracq, M., Offerman, S.R., Thorton, S. , Smollin, C., Vohra, R., Rangun, C., Tomaszewski, C., Gerona, R.R. (2014). Comprehensive analysis of “bath salts” purchased from California stores and the internet. Clinical Toxicology 52, 651-658


Smith, C., & Robert, S. (2014). ‘Designer drugs’: update on the management of novel psychoactive substance misuse in the acute care setting. Clinical Medicine 14(4), 409-415.


Zawilska, J.B. (2014). Methoxetamine – a novel recreational drug with potent hallucinogenic properties. Toxicology Letters.






  1. Lars Says:

    It seems somewhat sensationalistic to me to single out the use of piperazine as an anthelmintic. It is a heterocycle, found in a number of different drug classes: Antipsychotics, ED medications, antihistamines, and yes, recreational drugs. Describing it this way reminds me of those people who say “phenothiazine is a yellow dye. Oh noes, all drugs based on it must be bad”.

  2. Sean R. Says:

    Talking about the Poppers making a comeback….
    I have already had took care of two cases of “isobutyl nitrite poppers” a google search will take you to plenty of web sits Selling these as being the same thing as Amyl nitrite, will be keeping an eye out to see if sold at “truck stops” “head shops” an any call to our Regional Poison Center.

  3. Leon Says:

    Lars: That’s a valid point, but I wouldn’t say sensationalistic as much as “imprecise.” The term “piperazine” refers to a large number of compounds based on the structure of a 6-sided ring with nitrogen atoms at opposite ends. A number of specific chemicals built on this structure (eg., piperazine hydrate and piperazine citrate) have been used as anti-helminthics. They work by paralyzing the worms, which then are eliminated in the stool.

    Sean R: Any signs of methemoglobinemia in your cases?