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91

GABAergics / Re: I almost died or had a stroke -- my GHB (1,4 BDO) "bad reaction" / OD? story

« Last post by smfadmin on September 17, 2023, 09:12:04 PM »

Some facts:

1,4 BDO costs as little as $USD 10-20 per kg from China.

If you are caught in Australia with one to five kilograms of 1,4 BDO then you face a mandatory 3 years' imprisonment and a $50,000 fine. The punishment more than doubles if the amount seized is between five to 10 kilograms.

Not only is it dangerous but it is also highly addictive and like alcohol, death during withdrawal is possible.

from UK-rehab.com:

Impact of Long-Term GHB Abuse on the Brain:

It is believed that GHB can cause permanent cognitive problems, including attention deficit, an inability to solve complex problems, impaired memory including an incapacity for new memories, as well as diminished spatial and verbal reasoning capabilities. Psychological disorders including psychosis and delirium have also been observed in long-term GHB users, though it is unclear to what extent they are associated with neurological damage.

The Addiction:

The addiction is both psychological and physical - see below:

While a full clinical understanding of GHB’s effects has not yet been achieved, it is thought that dependence and psychological addiction can manifest very quickly – within a matter of a few weeks. The more frequently someone consumes GHB the greater the risk that they will develop an addiction to it. If GHB becomes a regular aspect of someone’s personal and/or social life, they are in significant danger of becoming addicted to GHB.

It is often used as a date rape drug.

To read all about GHB addiction go to https://www.uk-rehab.com/drug-addiction/ghb/

Diazepam is used to slowly wean addicts off GHB and it's prodrugs.

92

GABAergics / I almost died or had a stroke -- my GHB (1,4 BDO) "bad reaction" / OD? story

« Last post by Chip on September 17, 2023, 02:00:57 PM »

see: https://m.psychonautwiki.org/wiki/1,4-Butanediol

note: there are 2 GHB prodrugs and the other one is GBL. I have had absolute confirmation that this was 1,4 Butanediol.

I was given some for free after helping a friend out. It usually costs between $AUD 5-10 per millilitre.

I last remember consuming about 7 ml of diluted 1,4 BDO (a GHB prodrug that likely had a little GHB and water added) after trying a few smaller doses for safety's sake, prior to going to bed. I had also taken a little Meth the previous day. This was about 1:30 AM and the next thing I know, i awoke in the Hospital's ICU ward.

Apparently during the night, I started screaming, moaning and thrashing around. My housemate was so worried after I rolled out of bed and fell onto the floor that she called an ambulance and 4 paramedics arrived.

Apparently I became very combative, very aggressive and even violent (which I never am otherwise) so they decided, against best practise I believe, to sedate me with Droperidol then Ketamine and Midazolam, and with Morphine to intubate me.

I woke up around 5 PM that same day and found out what happened.

I was shocked as I have never reacted badly to GHB before (and on Meth) and still can't find any documented cases like mine despite searching the internet but I did read that high doses can cause hallucinations, confusion and agitation.

My advice is to always remember that some drugs may cause certain people adverse reactions. Maybe the residual effects of the Meth aggravated the situation but I doubt it.

The doctor said that I had a bad reaction to it and to stop taking all drugs, especially at my age (I'm over 60, he said that the cutoff point is 50). He also said that it could've caused a stroke or left me brain-dead due to oxygen deprivation. He added that I was very lucky.

The dose/response curve is too non-linear !

I'm just glad to be alive ! And, oh yes, they took all my GHB too but that's fine by me.

Note: When I mention GHB, I mean 1,4 BDO.

93

Harm Reduction / Re: [CA] How prescribing safe supply is helping drug users turn their lives around

« Last post by smfadmin on September 14, 2023, 09:59:00 AM »

Absolutely ! Rep given.

94

Harm Reduction / Re: [CA] How prescribing safe supply is helping drug users turn their lives around

« Last post by Skeetermcbeaver on September 13, 2023, 09:47:04 PM »

Safe supply has to be better than the status quo. I have to believe we will eventually have that universally for those who need it.

95

Harm Reduction / Re: TRANSFORM - After the War on Drugs: Blueprint for Regulation

« Last post by Skeetermcbeaver on September 13, 2023, 09:45:15 PM »

I’m a firm believer in safe supply. It appears as if it’s on its way to us, though slowly.

96

Alcohol & Tobacco / Re: Common Alcohol and Drug Combinations and Interactions

« Last post by smfadmin on September 12, 2023, 07:48:56 AM »

*bump*

97

Treatment, Recovery and Rehabilitation / Treatment of Methamphetamine withdrawal (in trauma patients)

« Last post by Chip on September 12, 2023, 02:17:01 AM »

source: https://www.oatext.com/Treatment-of-Methamphetamine-withdrawal-in-trauma-patients.php`

see also: https://forum.drugs-and-users.org/index.php?topic=5849

note: This is an excerpt only

Treatment of Methamphetamine withdrawal in trauma patients

Few drugs have shown any clinical efficacy in managing methamphetamine-withdrawal and there is only a limited number of randomized trials available on this topic.

However, we identified clinical trials showing promising results for the acute medical management of methamphetamine-positive patients.

N-acetylcysteine (NAC), a drug used to treat acetaminophen overdose and IV contrast toxicity, has also been found to decrease methamphetamine cravings. In one controlled, double-blinded randomized study, patients receiving 1200 mg per day of oral NAC over a four-week period had decreased cravings for methamphetamine compared to placebo (P<0.001). This drug may prove useful in the acute setting.

Bupropion, a dopamine reuptake inhibitor used to treat depression and nicotine dependence, is thought to increase synaptic concentrations of dopamine. Chronic methamphetamine use results in low dopaminergic tone. One randomized, placebo-controlled trial of bupropion in methamphetamine dependence found that 150 mg BID of oral bupropion increased abstinence from methamphetamine in low to moderate users. Bupropion is fairly well-tolerated with limited side effects of insomnia, dry mouth, and nausea. In a study of 151 patients, bupropion has also been shown to produce nearly-statistically significant differences in methamphetamine abstinence when compared to a placebo (p=0.09), possibly leading to decreased recidivism in an outpatient setting.

Modafinil is a glutamate enhancer which produces many contradictory effects of stimulant withdrawal, such as increased energy, attention, wakefulness, and locomotion, while improving mood and reducing appetite. Patients dependent on cocaine who were treated with modafinil reported less use (p=0.03) when compared to a placebo group. Applying this to the use of methamphetamine, the drug may assist with the dysphoria characteristic of methamphetamine withdrawal. Modafinil may also decrease craving for methamphetamine while improving overall cognition and is currently being investigated in a number of clinical trials.

Dextroamphetamine has also shown some benefit in decreasing methamphetamine cravings and withdrawal symptoms. Researchers have used 60 mg of oral sustained-release dextroamphetamine over a period of 8 weeks to achieve these results. Dextroamphetamine may play a role in the recovery and rehabilitation of an injured patient through a mechanism similar to bupropion.

Gamma-vinyl GABA (GVG), an antiepileptic that prevents breakdown of GABA, has shown efficacy in sustaining abstinence from methamphetamine. In a study evaluating abstinence, 16 of 18 participants completing the 9-week study tested negative for methamphetamine and cocaine. GVG was started at 500 mg twice daily for days 1-3 and increased to 1.5 g once daily for days 4-7 and 2 g once daily for days 8-14. On day 15, subjects were placed on 3 g once daily for 4 weeks, and then tapered to zero over the next 3 weeks, for a total of 137 grams over the entire study. Although GVG is associated with changes in visual acuity, it was not observed in the study.

Antipsychotics have also been proposed to aid in withdrawal management. In one study, risperidone was administered at 3.6 mg/day and resulted in decreased methamphetamine use and significantly improved fine motor functioning after 30 days (p = 0.001). Antipsychotic medications can manage symptoms such as irritability, agitation, depression, increased sleeping, increased appetite, and muscle aches. Antipsychotics have been showed to resolve these symptoms within one week after discontinuation of stimulants such as methamphetamine. This lends support for antipsychotics having potential use in trauma patients with prolonged hospital stays.

Rivastigmine is an acetylcholinesterase inhibitor studied for use in methamphetamine-positive patients. Acetylcholine has been linked to the reinforcing and psychomotor activating effects of methamphetamine [10] thus, an acetylcholinesterase inhibitor may decrease such behaviors. Rivastigmine has reduced methamphetamine-associated increases in diastolic blood pressure and self-reported feelings of anxiety as well as the desire for more drugs.

Other agents have limited efficacy in managing methamphetamine-positive patients. Mirtazapine has been shown in one study to be well tolerated, although participants reported myalgia more frequently than those treated with modafinil. Of note, modafinil was noted to cause less sleep disturbance than mirtazapine. Another study of mirtazapine revealed that it may lessen anxiety and hyperarousal caused by methamphetamine withdrawal; however, other investigations have failed to duplicate these results. Imipramine has not shown any significant benefits in managing cocaine/methamphetamine-abusing patients].

Ondansetron, a 5-HT3 receptor antagonist and modulator of corticomesolimbic dopamine, functions through its low affinity for dopamine receptors and has shown potential benefit in outpatient settings. Some data in an animal-based investigation suggested that the combination of ondansetron with pergolide, ergoline-based dopamine receptor, may serve as a useful treatment for methamphetamine abuse by reducing relapse rates. Sertraline, a selective serotonin reuptake inhibitor has proven to be useful to an extent. When combined with contingency management, sertraline allowed more patients to abstain from methamphetamine when compared to patients treated with sertraline alone. Contingency management involves rewarding of good behavior and implementation of operant conditioning and reinforcement, which can be used to support drug abusers. However, in patients with symptoms of depression, sertraline did not have an improved outcome compared to placebo, and actually resulted in increased methamphetamine use and more frequent relapse (p<0.05).

Lobeline may be very useful for the treatment of stimulant abusers, including those of methamphetamine. It may interact and stimulate the vesicular monoamine transporter (VMAT), as well as the cell surface dopamine transporter (DAT), which are both action sites for methamphetamine. Lobeline has long been used to aid in smoking cessation and has a low abuse potential. A study showed that lobeline induced dopamine release in mammalian cells expressing dopamine transport proteins DAT and VMAT-2.  In methamphetamine users, dopamine release may reduce overall cravings.

Memantine, a non-competitive antagonist of the N-methyl-D-aspartate receptor (NMDA glutamate receptor), was used in a 2010 study with methamphetamine-intoxicated rats.

This study found that memantine inhibited methamphetamine-triggered behavior and reversed overall anxiety. Adverse effects of methamphetamine can be potentially treated with memantine in an attempt to prevent cognitive deficits.

Animal studies provide a plethora of information regarding certain drug treatments for methamphetamine withdrawal. For example, one study tested the usefulness of propofol in methamphetamine-intoxicated rats and found reduced cerebral oxidative stress and swelling and improved mitochondrial function].

Another study showed the protective role of melatonin on the blood brain barrier in methamphetamine-induced inflammatory responses.  More clinical trials will be necessary to investigate the potential of these drugs for the treatment of methamphetamine-withdrawal.

The PDF version is attached:

98

Treatment, Recovery and Rehabilitation / Memantine and it's benefits for Amphetamine withdrawal in rats

« Last post by Chip on September 12, 2023, 02:04:01 AM »

source: https://pubmed.ncbi.nlm.nih.gov/27085203/

see also: https://psychonautwiki.org/wiki/Memantine

I have been looking at the efficacy of memantine^Wiki when used to treat Methamphetamine withdrawal and found this document:

Memantine improves memory impairment and depressive-like behavior induced by amphetamine withdrawal in rats

Apr 13, 2016

Abstract

Amphetamine (AMPH) induces deficits in cognition, and depressive-like behavior following withdrawal.

The aim of the present study was to investigate whether pre-treatment with memantine (5mg/kg, i.p.), a noncompetitive N-methyl-d-aspartate (NMDA) receptor antagonist, attenuates memory impairment induced by withdrawal from a 1 day binge regimen of AMPH (2mg/kg, four times every 2h, i.p.), in the novel object recognition test in rats.

Herein, the influence of scopolamine (0.1mg/kg), an antagonist of the muscarinic cholinergic receptors, and the impact of MK-801 (0.1mg/kg), an antagonist of the NMDA receptors, on the memantine effect, were ascertained.

Furthermore, the impact of memantine (5; 10; 20mg/kg, i.p.) was measured on depression-like effects of abstinence, 14 days after the last AMPH treatment (2mg/kg×1×14 days), in the forced swim test. In this test, the efficacy of memantine was compared to that of tricyclic antidepressant imipramine (10; 20; 30mg/kg, i.p.).

Our study indicated that withdrawal from a binge regimen of AMPH impaired recognition memory. This effect was attenuated by administration of memantine at both 72h and 7 days of withdrawal.

Moreover, prior administration of scopolamine, but not MK-801, decreased the memantine-induced recognition memory improvement.

In addition, memantine reversed the AMPH-induced depressive-like behavior in the forced swim test in rats.

The antidepressant-like effects of memantine were stronger than those of imipramine.

Our study indicates that memantine constitutes a useful approach towards preventing cognitive deficits induced by withdrawal from an AMPH binge regimen and by depressive-like behavior during AMPH abstinence.

99

Alcohol & Tobacco / Common Alcohol and Drug Combinations and Interactions

« Last post by Chip on September 12, 2023, 12:06:21 AM »

source: https://shop.ucsc.edu/alcohol-other-drugs/overdose-prevention/common-combinations.html[

size=11pt]Common Alcohol & Drug Combinations[/size]

Alcohol and Energy Drinks/Caffeine:

When using Red Bull or Monster as a mixer or drinking pre-mixed drinks like Four Loko or Sparks, you are tricking your body into thinking it’s not tired. Your body is more intoxicated than you may feel, which can lead to alcohol poisoning. Energy drinks also increase dehydration which leads to hangovers the next day. Those who consumed both alcohol and caffeine were at least two times as likely -- compared to those drinking alcohol without caffeine -- to be hurt, need medical attention, take sexual advantage of another, or accept a ride with someone who was inebriated.

Alcohol and Painkillers:

Includes: Vicodin, Xanax, Oxycontin, Percocet, Demerol, Norco, etc.
Mixing painkillers with alcohol is dangerous. The mixture of these two substances can lead to intensified sedative effects and respiratory depression. Painkillers can lead to liver problems and disease when used recreationally, the mixture of this drug with alcohol can intensify these side-effects.

Alcohol and Cannabis:

Mixing these two substances can cause heavy vomiting, spins, very strong paranoia, decreased motor control and decreased mental concentration. Also, because marijuana suppresses the gag reflex, you may not be able to throw up alcohol when your body needs to.

Alcohol and Cocaine:

These two substances are commonly mixed with the thought that they cancel each other out; this is NOT TRUE. Combining cocaine and alcohol produces a high amount of a third unique substance, called cocaethylene. A high amount of cocaethylene in the body increases the already harmful risk of cardiovascular toxicity to a much higher extent than any other drug. Cardiovascular toxicity causes pressure and stress on the heart.

Alcohol and Heroin:

Each of these substances alone causes depression of the central nervous system, so the mixture of the two is extremely dangerous and has been proven to be fatal.

Alcohol and Ecstasy:

It is very well known that one should never mix ecstasy with any other drug substance, especially alcohol. It is known that most ecstasy related deaths have been due to the mixture of alcohol with the drug. When the two are mixed the alcohol reduces the feeling of the ecstasy’s high and puts a much greater strain on the kidneys. Also, dehydration caused by drinking alcohol occurs more rapidly when on ecstasy.

Alcohol and LSD/Acid:

Alcohol is mixed with LSD to take down or slow down the effects and relax. However, more commonly combining alcohol can make the comedown of the drug much worse with extreme nausea and vomiting.

Alcohol and Mushrooms:

Mushrooms or "Shrooms" are a psychedelic and are not meant to ever be taken with any other drugs. The mixture of alcohol and shrooms is usually to help take away the effect and high of the shrooms because alcohol is a depressant. However, the intended outcome is not a guarantee and side-effects include nausea and vomiting.

Alcohol and Antibiotics:

It is important to always read the labels on prescription medications and adhere to the warnings about alcohol intake. Drinking alcohol while on antibiotics can cause nausea, dizziness, vomiting, fatigue and in some cases convulsions, immense headache, flushing, rapid heart rate and shortness of breath. Since antibiotics and alcohol are both broken down through the liver the combination of these substances can result in liver damage. This combination also diminishes the effects of the antibiotics you are taking. Try to focus on getting healthy again. You’ll probably enjoy drinking more once you’re healthy anyway.

Alcohol and Antidepressants:

Combining alcohol with antidepressants (Zoloft, Prozac, etc.) can cause an increased response to alcohol -- For example, having one drink might feel like two. Also, the combination might create unexpected emotions and inhibit the antidepressant from doing what it's supposed to do. If it is a new prescription, try it out without drinking alcohol so you are familiar with your body's reaction first and then consult your doctor if any problems occur.

Alcohol and Antihistamines:

Drinking alcohol while taking antihistamines can cause a less effective outcome of the medication. Your body will choose to metabolize the alcohol before the antihistamines. Labels typically suggest you stay away from alcohol all together when on antihistamines so it is very important to always check any label on the drug.

Alcohol and Birth Control Pills:

Birth control pills take three full hours to get into your blood stream and be effective. If you vomit due to drinking or any other causes before that three hour window, the effectiveness of birth control pills is diminished. Mixing alcohol and birth control can make some people feel nauseous, which can cause vomiting.

Also, some women feel drunk quicker when on the pill since their bodies are metabolizing the hormones of the pill making it more difficult to metabolize the ethanol in alcohol. Plus, drinking can interfere with remembering to take your pill at the same time, which also increases the chances of pregnancy.

Alcohol and Drug Interactions

source: https://alcohol.org/mixing-with/

Alcohol and CNS Stimulants

Amphetamines alone are very risky because of the strain on the heart and the increase in blood pressure. When mixing alcohol with amphetamines side-effects can become much more serious. Consuming alcohol while taking amphetamines can make someone act very aggressive and irresponsible; it is extremely harmful to the kidneys and intensifies hangover effects.

Adderall causes one to feel like they are not as drunk as they really are. This can lead to making very dangerous decisions since you are unaware of your level of intoxication. Because alcohol is a depressant and Adderall is a stimulant, drinking alcohol while taking Adderall can cause cardiac arrhythmias, and paranoid or psychotic reactions, on top of the risks of vomiting, dizziness, muscle twitching and headaches that are more likely to increase when mixed with alcohol.
When prescribed Adderall, patients are advised not to drink alcohol. The side-effects could be much more dangerous for students using Adderall without a prescription.

While alcohol suppresses the functions of the CNS, there are numerous drugs that speed up CNS functions. Several different classes of drugs have this effect, including:

- Amphetamines that are used as dietary aids or to treat conditions that result in lethargy or sleepiness

- Prescription medications for the treatment of ADHD (attention deficit hyperactivity disorder), such as Ritalin and Concerta (methylphenidate) or Adderall (amphetamine and dextroamphetamine)

- Caffeine and several drugs classified as antihistamines or decongestants

- Numerous illicit drugs, particularly cocaine and methamphetamine (crystal meth)

When individuals use alcohol with CNS stimulants, they typically are attempting to deaden the effect of the stimulant as opposed to suppressing the effects of the alcohol. The use of alcohol and stimulants is a very common practice among college students who abuse medications designed to treat ADHD in an effort to help them study. Individuals who use illicit stimulant drugs, such as cocaine, commonly use alcohol to “take the edge off” the stimulant drug.

Combining alcohol and central nervous stimulants results in the potential for several serious issues.

- When stimulants are used for medicinal reasons, the effect of the stimulant is negated by alcohol.

- Taking stimulants and alcohol in combination leads to a significant reduction in the overall effects of both drugs that can result in an individual overdosing on one or both drugs.

- There are serious potential neurological issues that can develop when one combines alcohol with stimulants, including increased development of seizures and/or an increased potential to develop psychotic behavior, such as hallucinations or delusions.

- Serious effects occur in numerous organ systems, including the central nervous system, cardiovascular system, liver, and gastrointestinal system as a result of chronic abuse of alcohol and central nervous system stimulants.

- When an individual combines cocaine with alcohol, this produces a toxic substance known as cocaethylene. This substance can increase the potential for damage to numerous organ systems.

- Numerous other emotional issues can occur as a result of chronically mixing alcohol and stimulant drugs, including increased issues with depression, anxiety, loss of motivation, etc.

Mixing alcohol and caffeine is typically not problematic unless one uses extreme amounts of both drugs. Individuals who drink several cups of coffee after using alcohol may experience nausea, jitteriness, sweating, etc.; however, in most instances, this is not going to be a serious issue.

Everything else (PHARMACIST’S LETTER / PRESCRIBER’S LETTER)



The PDF is also attached so see below:

100

Phenethylamines / Re: Drugs (Meth/Amphetamines mainly) with Antacids on Oral Absorbtion - Resources

« Last post by Chip on September 10, 2023, 06:19:33 PM »

This thread is courtesy of @Trickster

If you need any help or a chat then IM/PM or email me, Chip