The drugs which had historically been largely associated with ‘Rave’ parties over the past 20 years: LSD, MDMA, GHB, Meth and Ketamine are now being replaced by new and sometimes more deadly designer drugs.
Recognizing the street names and being familiar with the clinical presentations may help you and your toxicologist identify the offending agents that are now showing up on the streets.
How familiar are you with “Sizzurp?” Have you seen “Molly?” What are “Facebook“pills?
Here are some of the New Kids on the Block.
This list will grow as new designer drugs make their way into the mainstream.
1. Purple Drank
(aka. sizzurp, syrup, lean, purple jelly.)
The main ingredient is prescription-strength cough-syrup with codeine (a narcotic) and promethazine (an antihistamine). Some mixtures may also contain dextromethorphan.
The name ‘Purple Drank’ comes from the purple dye in the cough syrup. It’s often mixed with carbonated beverages or alcohol.
Side effects include sedation, respiratory depression and/or respiratory arrest.
Unlike ecstasy pills (MDMA), which have been known to be laced with caffeine or methamphetamine, Molly is marketed as a pure crystalline form of MDMA and has been around for almost a decade. Surprisingly, many samples Molly tested in labs actually contain Methylone, a close analog of MDMA.
Molly is ingested as a tablet or powder containing capsule. It’s effects are very similar to MDMA, increasing neurotransmitter levels of serotonin, dopamine and norepinephrine, as well as oxytocin and vasopressin. Side effects include but are not limited to: euphoria, tachycardia, hypertension, hyperthermia, diaphoresis, muscle spasm, bruxism and blurry vision.
The Poison Review
NIH: National Institute on Drug Abuse
NIH: National Institute on Drug Abuse – MDMA (ecstasy)
CMAJ: Canadian Medical Association Journal
Medscape: MDMA Toxicity
3. Desmethyl Fentanyl
(aka. Facebook pills) a Fentanyl derivative is said to be 40x more potent than heroin and 80x more potent than morphine. Patients will likely present with an obvious opioid toxidrome: miosis, sedation, respiratory depression or arrest which may presumably not respond to the typical initial dosing of Naloxone.
As this new designer drug has just recently made its debut as of May 2013, there is not much information yet available.
4. “Green Rolex” Pills
Are being sold as ecstasy tablets currently in Ireland and the U.K., however, instead of MDMA, these pills contain para-Methoxy-N-methylamphetamine (PMMA) an amphetamine with psychedelic effects which has serious health risks.
Patients may present with hyperthermia, arrhythmias, delirium, hypoglycemia, hyperkalemia, rhabdomyolysis, seizures and cerebral hemorrhage. There is no specific antidote for PMMA and treatment is symptomatic with rapid cooling.
To be continued…..