Designer Drugs: Effects and Management; A Critical Review
Mr. Ananda Kudari*
Associate Professor, Department of Medical Surgical Nursing, SDM Institute of Nursing Sciences, Sattur, Dharwad, 580009, Karnataka, India
When you hear the word ''drugs,'' a variety of thoughts may come to mind. You may think of strung-out addicts wasting their lives away. You might conjure up images of shady characters handing over substances in dark alleys. On the other hand, you might think of prescription drugs monitored by physicians and handed out carefully. The term used for those illegal drugs that are created synthetically in a lab called as designer drugs. They are made to mimic the effects of existing drugs. Since many are essentially homemade substances, they often contain common household ingredients, including harsh cleaning chemicals and sometimes poisons. Designer drugs have provided many users with a way to circumvent the law since people can simply use their own devices and ingredients to create substances similar to illegal drugs. These drugs are having bad effects on body which includes unexplained weight loss or gain, changes in hygiene or personal appearance, confused or disoriented behavior, paranoia, problems with sleeping: insomnia, restlessness, nightmares, stealing money from family members, and decline in performance at school or work, trouble maintaining relationships and many more. An antidote is not available for designer drug addiction. Assessment and management is necessary to combat with designer drugs.
Designer drugs usually are synthesized for the first time in an attempt to create an analogue of some better-known chemical. Designer drugs, in popular usage, illegal synthetic, laboratory-made chemicals. Although the term is not precisely defined, it is understood to refer to commonly abused drugs such as fentanyl, ketamine. Analogues of certain legal drugs have been produced by pharmaceutical companies in order to make the drugs safer, more effective, or more readily available to a mass public, and indeed the term designer drug originally referred to legal pharmaceuticals.
It began to be applied to illegal substances in the 1980s, when authorities in the United States became concerned about the use of synthetic heroins. The development of designer drugs may be considered a subfield of drug design. The exploration of modifications to known active drugs such as their structural analogues, stereoisomers, and derivatives gives drugs that may differ significantly in effects from their "parent" drug. In some instances, designer drugs have similar effects to other known drugs, but have completely dissimilar chemical structures. Designer drug is a term that has been used recently to describe of abuse. It is not a precise scientific term and has been indiscriminately applied to a variety of contemporary drugs of abuse. More correctly this term should be applied to only those drugs those are synthesized from common chemicals and exempt from control by the drug enforcement administration because of their unique chemical structure and skillfully marketed under attractive, often exotic names. [1-3]
Illegal drugs are defined in terms of their chemical formulas. To circumvent these legal restrictions, underground chemists modify the molecular structure of certain illegal drugs to produce analogs known as designer drugs.
A designer drug is a structural or functional analog of a controlled substance that has been designed to mimic the pharmacological effects of the original drug.
A drug synthesized to have properties similar to a known hallucinogen or narcotic but having a slightly alteredchemical structure, usually in order to evade restrictions against illegal subs ances.
History of designer drugs:
Following the passage of the second international opium convention in 1925, which specifically banned morphine, the diacetyl ester of morphine, heroin, and a number of alternative esters of morphine quickly started to be manufactured and sold. The most notable of these were dibenzoylmorphine and acetylpropionyl morphine, which have virtually identical effects to heroin but were not covered by the Opium Convention.
During the 1960s and 1970s, a number of new synthetic hallucinogens were introduced, with a notable example being the sale of highly potent tablets of DOM in San Francisco in 1967. The late 1970s also saw the introduction of various analogues of phencyclidine(PCP) to the illicit market. [4-8]
The modern use of the term designer drug was coined in the 1980s to refer to various synthetic opioid drugs, based on the fentanyl molecule (such as α-methyl fentanyl). When the term was coined in the 1980s, a wide range of narcotics were being sold as heroin on the black market. Many were based on fentanyl or meperidine. One, MPPP, was found in some cases to contain an impurity called MPTP, which caused brain damage that could result in a syndrome identical to full-blown Parkinson's disease, from only a single dose. Other problems were highly potent fentanyl analogues, which were sold as China White that caused many accidental overdoses.
In the late 1990s and early 2000s, there was a huge explosion in designer drugs being sold over the internet. In 2004, the US Drug Enforcement Administration raided and shut down several Internet-based researches chemical vendors in an operation called Web Tryp. With help from the authorities in India and China, two chemical manufacturers were also closed. Many other internet-based vendors promptly stopped doing business, even though their products were still legal throughout much of the world.
The late 1990s and early 2000s also saw the first widespread use of novel anabolic steroids by athletes in competition. Steroids had been banned by the International Olympic Committee since 1976, but due to the large number of different anabolic agents available for human and veterinary use, the ability of laboratories to test for all available drugs had always lagged behind the ability of athletes to find new compounds to use. The introduction of increasingly formalized testing procedures, especially with the creation of the World Anti-Doping Agency in 1999, made it much more difficult for athletes to get away with using these drugs without detection, which then led to the synthesis of novel and potent anabolic steroid drugs such as tetrahydrogestrinone (THG), which were not detectable by the standard tests. [9-12]
While through recent history most designer drugs had been either opioids, hallucinogens, or anabolic steroids, the range of possible compounds is limited only by the scientific and patent literature, and recent years have been characterized by a broadening of the range of compounds sold as designer drugs. These have included a wide variety of designer stimulants such as geranamine, mephedrone, MDPV and desoxypipradrol, several designer sedatives such as methyl methaqualone and premazepam, and designer analogues of sildenafil (Viagra), which have been reported as active compounds in "herbal" aphrodisiac products.
Today, there are thousands of designer drugs and very little or nothing at all is known about many of them. New drug inventions crop up regularly with each drug seeming to be more potent than the last. Some of the most common designer drugs used in the modern world include:
· GHB- This liquid drug can cause feelings of drunkenness, vomiting, coma and overdose. It is commonly used as a “date rape drug.”
· China White- This drug is similar to heroin but much, much stronger and much more deadly.
· Rohypnol- is similar to Valium but more potent; it can be used as a “date rape drug.”
· Ecstasy- This drug is experiencing a resurgence among young people, known for causing hallucinations, feelings of closeness to others, and brain damage.
· YABA- This is a drug taken in pill form that is similar to methamphetamine. The drug produces very long and potentially fatal highs.
List of designer drugs:
Designer drugs fell into several different categories, including opioids, dissociatives, stimulants, and hallucinogens.
· Ecstasy (stimulant and hallucinogen).
· Methamphetamine (stimulant).
· Tryptamine (psychoactive).
· Phenethylamine (psychoactive).
· Anabolic steroids (synthetic variation of testosterone).
· Heroin (opioid).
· Cocaine (stimulant).
Common designer drugs in recent years include:
· Spice (synthetic marijuana)
· Ecstasy (“Molly”—synthetic psychoactive drug similar to amphetamines and mescaline)
· Bath salts (a lot of substance variability, but often contains one or more synthetic chemicals related to cathinone)
· Methylenedioxypyrovalerone (MDPV) (one of the chemicals found in bath salts)
· Mephedrone (commonly found in bath salts)
· Methylone (commonly found in bath salts)
· 2C family (synthetic hallucinogens)
· Krokodil (a less-expensive heroin substitute; like heroin, it is a synthetic morphine derivative).
· Depending upon the drug taken, a person may experience feelings of Exhilaration,
· Prolonged periods of wakefulness,
· Decreased appetite,
· Extreme relaxation,
· Amnesia and feelings of detachment.
· Panic attacks,
· Aggressive behavior or feelings of paranoia.
· Significant changes in blood pressure,
· Slurred speech and
· These drugs can even cause coma and death.
In the case of designer drugs, many of the signs of abuse are similar to the signs of addiction to alcohol or street drugs:
· Changes in behavior: isolation from family; defensive about drug use
· Unexplained weight loss or gain
· Changes in hygiene or personal appearance
· Confused or disoriented behavior
· Problems with sleeping: insomnia, restlessness, nightmares
· Stealing money from family members
· Decline in performance at school or work
· Trouble maintaining relationships
· Loss of interest in former friends and activities Some of the signs that someone you know may be abusing designer drugs:
· Discarded glass vials, or small plastic bags, with traces of white powder
· Pipes, inhalers or syringes
· Paranoid or delusional behavior
· Visual disturbances or hallucinations.
Designer drugs can produce some dangerous side effects:
· Physical and psychological addiction
· Mood changes
· Sleep disturbances
· Psychotic behavior
· Hyperthermia (overheating)
· Heart failure
· High blood pressure
· Fatal respiratory problems
· Coma and even death
Since designer drugs are created in illegal labs, their ingredients and potency vary a lot, making it nearly impossible to know what is actually in them or what they can do to you. Some identified withdrawal symptoms are:
· Tremors, and sweating,
· Physical dependence and addiction.
· Nausea and vomiting,
· Cold sweats
· Rapid heart rate and
· High blood pressure.
Designer drugs management and treatment:
Management of acute intoxication from designer drugs is especially difficult because no antidotes are available. Acute and long-term treatment is also a challenge and must rely heavily on counseling while encouraging young, impulsive patients to change their behavior.
· Activated charcoal is not useful unless there has been significant oral ingestion.
· Most non-psychiatric symptoms appear self-limited and resolve within one to several days with supportive treatment.
· Unpleasant psychological effects of acute intoxication, such as anxiety, agitation, or paranoia, may be managed with supportive treatment.
· Placing the distraught user in a quiet environment and maintaining gentle contact is often sufficient until the acute effects subside.
· Psychosis due to synthetic cannabinoid and intoxication has been managed with monitored observation.
· For psychopathologic clinical features, benzodiazepines have been used to treat anxiety, agitation, and seizures.
· For agitation antipsychotics are second-line agents, due to the lowered seizure threshold with use of cathinone and phenethylamine designer drugs.
· Sedation may be required if the patient is markedly agitated and at risk for harm to self or healthcare staff.
· Since some designer drug-associated psychosis may be severe and require prolonged inpatient treatment, psychiatric consultation is indicated, in particular for those with persistent symptoms.
· Patients can be treated with supportive care by intravenous fluids and antiemetics if necessary.
· If marked psychiatric symptoms persist longer than one or more weeks after discontinuation, the patient should be evaluated carefully to determine whether there is a co-occurring primary psychiatric disorder, which then should be treated with specific therapy. Treatment of prolonged anxiety, depression, or psychosis is the same as when these conditions are not associated with recent designer drug use.
· For a significant number of patients, the high level of illness severity warrants admission to critical care. Intoxicated patients should be placed initially on continuous cardiac monitoring with pulse oximetry and frequent neurologic assessments.
· Adequate administration of intravenous fluids is encouraged to ensure good urine output, as these patients often are dehydrated. Fluid administration in the presence of rhabdomyolysis can help prevent acute renal failure.
· Intensive monitoring allows for early detection and intervention for serious consequences such as myocardial infarction. [13-17]
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Received on 17.04.2017 Accepted on 14.07.2017
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