Street Drugs

Kane Guthrie FCENA

Clinical Update

• Synthetic canabinoids• Designer amphetamines• Nurofen plus abuse

Street Drugs - Australia

ED’s biggest bain remains:– ETOH– Smoking

Emerging concerns:– Prescription drug abuse– Synthetic derivatives of old

Street Drugs in ED

• Resource intent• Challenging personas

Stats:• Amphetamines in ED 1.2% presentations

(Gray, 2007, MJA)

• July 2010-12 Vic ambulance • 318% increase in amphetamine related call outs

• (Helibourne, 2013, MJA)

The Web

Big Business/Clever People

Case 1

• 28 female• Known polysubstance abuse• Presents agitated, & diaphoretic• Vitals: BP 172/89, HR 128, RR 30, Temp 37.9• Given IVIH, IV Diazepam – symptoms settle

• Admits to smoking “spice”

Synthetic Canabinoids

• “K2” “Spice” – “legal Marijuana”

• Typically sold – “incense” “room fresheners”

• Labeled - not for human consumption

• Sold OTC or Internet - $20-30

Synthetic Canabinoids

• Difficult to detect

Contains:• Herbs/vegetables sprayed chemicals• Target CB1 receptors in brain

Generally smoked– Can be injected (tea), baked (cookies)

The Symptoms

• Agitation - Psychosis• Tachycardia• Hypertension• Arrhythmia's• Metabolic derangements• Seizures

ED Management

• Supportive care• Give Benzo’s – agitation, anxiety• Monitor temp• Fluids – dehydration• Look for co-ingestions

Case 2

• 22 male BIB Police• Found - agitated, palpitations, paranoid• Smoke some “Crystals”• Brought it of the net!• Vitals: BP 185/96, HR 142, Temp 38.2

Designer Amphetamines

• Mephedrone. • “Meow-Meow”, “Bath Salts”• Synthetic derivative – cathinone– Derived leaves Khat plant

Mephedrone

Synthetic stimulant:• Euphoric & psychostimulant effects• Similar to MDMA, Cocaine, Methamphet

• Illegal in Australia– Easily available over net!

Mephedrone

Presents:– Clear white powder– Crystals (bath salts), capsules , pills

Taken:– Ingested, injected, smoked

Cost:$20-$50 a hit!

Mephedrone

• Short half life – 30-90mins• Effects last 2-4 hours• Results in compulsive re-dosing

Causes pronounced peripheral vasoconstriction

ED Management

• Supportive care– Hydration, bladder care

• Give benzo’s - agitation, HR, HT, temp• Monitor Temp >39 risk MOF• Monitor for seizures, hyponatraemia

• Caution with antipsychotics

Case 3

• 35 female

Presents to ED with 2/52 hx:– Weakness– Thirst– Nausea

• Appears dehydrated, generalised weakness in all 4 limbs.

Blood Gas

Her ECG

Further History

• Admits to using 4g Nurofen+/day• Addicted to opioids

Nurofen Plus Abuse

• Emerging problem• Its all about the codeine• Cheap – available OTC• Each tablet 200mg nurofen/12.8mg codeine• Reports pt’s abusing 60-100 tablets/day

The Issues

• Renal tubular acidosis

• Metabolic complications:– Hypokalaemia– Hyperchloraemia– Hypophosphataemia

• GI Bleeds

Renal Tubular Acidosis

Essentially failure of:– H+ excretion or– HCO3 reabsorption

Causes:– Chronic renal disease, autoimmune, genetic, – Drugs – lithium, ibuprofen, toluene

ED Management

• Treat medical complications• Often require ICU/HDU • Electrolyte replacement – K, Mg

• Surgery/scopes - if bleeding• Opioid withdrawal• Excellent supportive care

Remember

‘”Every Turkey has a terminal event””

“Always consider medical causes”

Further Info/Resources

Street Drugs in 2013

• Countless new agents– Cheap & easily available

• Generally structurally variants of old• Toxicity somewhat predictable • Management principles largely the same

Questions

Thankyou