October 21, 2011 (San Francisco, California) — Editor's note: New drugs are being abused, and emergency physicians should become aware of the kinds of overdose they are likely to encounter.
A presentation on nontraditional, emerging, and Web-based (NEW) drugs was featured here at the American College of Emergency Physicians (ACEP) 2011 Scientific Assembly, held October 15 to 18. Medscape Medical News interviewed presenter Mark B. Mycyk, MD, attending physician at the Cook County Hospital, and director of research, Toxikon Consortium, Chicago, Illinois.
Medscape: What new drugs are showing up in emergency departments?
Dr. Mycyk: Some of the ones that are getting the most attention are mephedrone (4-methylmethcathinone) and MDPV (3,4-methylenedioxypyrovalerone).
Medscape: How are they sold?
Dr. Mycyk: They are often sold over the Internet. In my experience, mephedrone is sold as plant food, while MDPV is sold as bath salts. Some magazine articles have confused the 2.
Medscape: Are they actually used for those purposes?
Dr. Mycyk: No. You would not do your plant any good putting mephedrone on it or improve your bath by putting MDPV in it. People just label them that way to evade detection.
Medscape: What are some of the other names they are known by?
Dr. Mycyk: Mephedrone is known as "meow meow," "4-MMC," "m-cat," and "bubbles." The feline references probably come from its chemical similarity to cathinone and cathine, the active ingredients in the khat plant, which grows in the Middle East and Africa. In addition to "bath salts," MDPV is also known as NRG-1.
Medscape: What are the effects of mephedrone?
Dr. Mycyk: Mephedrone is a stimulant. It can cause euphoria and feelings of empathy or openness, decreased appetite, pupil dilation, and changes body sensations (such as flushing, sweating, chills, and goose bumps). Some users report a strong desire to take another dose as the initial euphoric rush fades. Some people have impaired short-term memory, insomnia, tightened jaw muscles, or grinding teeth. More serious effects include cardiac dysrhythmias, seizure, and renal problems such as rhabdomyolysis.
Medscape: What effects does MDPV have?
Dr. Mycyk: It is chemically similar to ecstasy, and reported effects are similar as well, but far more intense — the euphoria may be more limited, but users talk about increased energy, sociability, and sexual stimulation. They also report insomnia, hypertension, vasoconstriction, and sweating. Unlike ecstasy, it can cause psychotic-like symptoms. Like mephedrone, it can cause cardiac dysrhythmias, seizures, and renal problems (including rhabdomyolysis).
Medscape: How can emergency physicians tell if patients have taken these drugs?
Dr. Mycyk: They don't show up in emergency-department and hospital-based screens. So I think the best way is to ask the patient what they took — learn their lingo, then they'll trust you. Most drug users don't end up in the emergency room. People typically end up in the emergency room because they had a bad trip or an unexpected complication. They don't want to die. They feel and recognize that something went wrong, and they want help.
Medscape: Are any tests helpful?
Dr. Mycyk: You can do electrocardiography, urine, and standard emergency-department serum tests. You can identify the complications and treat the complications.
Medscape: Are there any special treatments?
Dr. Mycyk: You would treat them the same way you treat anybody else. Standard emergency-department care works. If the patient is very agitated, you can give benzodiazepines.
Medscape: So it's not particularly helpful to know what drug the patient took?
Dr. Mycyk: If you know what the drug is, you can look up the complications and counsel them, but exact identification is not always required to treat the complications. Too often the provider gets hung up on trying to identify the drug instead of treating the patient in front of them.
Medscape: What is the best resource for that?
Dr. Mycyk: There are some Web sites with up-to-date information. Erowid describes these NEW drugs. That's where users go, and it's where scientists go to learn about these drugs. It's well organized. The Poison Review is done by a toxicologist. Every day it has a new nugget of information. These sites are also a good way to keep up on the trends. Emergency physicians can also call their local poison control center or a toxicologist.
Dr. Mycyk has disclosed no relevant financial relationships.
Medscape Medical News © 2011 WebMD, LLC
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Cite this: 'Meow Meow' and 'Plant Food' Cropping Up in EDs - Medscape - Oct 21, 2011.