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These datasets underpin the analysis presented in the agency's work. Most data may be viewed interactively on screen and downloaded in Excel format. All countries. Topics A-Z. The content in this section is aimed at anyone involved in planning, implementing or making decisions about health and social responses. Best practice. We have developed a systemic approach that brings together the human networks, processes and scientific tools necessary for collecting, analysing and reporting on the many aspects of the European drugs phenomenon. Explore our wide range of publications, videos and infographics on the drugs problem and how Europe is responding to it. All publications. More events. More news. We are your source of drug-related expertise in Europe. We prepare and share independent, scientifically validated knowledge, alerts and recommendations. About the EUDA. The plant is endemic to a limited area of the highlands of the Mexican Oaxaca state, where the Mazatec Indians ingest its fresh leaves or leaf preparations for divinatory rituals, healing ceremonies and medical purposes. Smoking the dried and crushed leaves provides short-lived but intense hallucinations. The effective dose of salvinorin A , the active ingredient of the plant, is comparable to that of the synthetic hallucinogens LSD or DOB. The toxicity of Salvia divinorum is currently poorly understood. The main ingredient responsible for the psychoactive effect of the plant is a neoclerodane diterpene called salvinorin A. Unlike classical natural or synthetic hallucinogens, salvinorin A does not contain a nitrogen atom — it is not an alkaloid. The dried leaves, leaf extracts and pure salvinorin A are stable at ambient temperature in the absence of light or air, although there is no systematic study on this. Salvinorin A is unstable in basic solutions and is soluble in conventional organic solvents, including acetone, acetonitrile, chloroform, dimethyl sulfoxide and methanol, but is essentially insoluble in hexane and water. Salvia divinorum is a 0. It can be easily recognised from its square-shaped and hollow stem and opposite pairs of ovate-lanceolate, jagged-edged leaves, which are usually velvety or hairy. The characteristic flower of the plant has a white corolla surrounded by a violet blue calyx. Salvia divinorum hardly ever sets seeds, and even when produced, they are rarely viable. The propagation of the plant is thus exclusively vegetative and most of the Salvia divinorum plants now cultivated worldwide are clones of a few early Oaxaca collections. Dried and crushed leaves fortified with extracts from other leaves are dark green, brownish or even blackish green, due to concentrated pigments. Pure salvinorin A forms colourless crystals with a melting point of — o C. Salvinorin A has a unique mode of action and pharmacology. Salvinorin A shows no significant binding to over 50 other psycho pharmacologically important receptors, transporter proteins and ion channels. In humans, salvinorin A induces short-lived, profound hallucinations. Inhalation of doses equivalent to — micrograms of salvinorin A leads to loss of control over physical movements incapacitation ; uncontrollable laughter; vivid, colourful and often bizarre, dream- or film-like hallucinations. It has been reported that this can last for hours after the hallucinations have disappeared. Common after-effects include tiredness, dizziness and amnesia. Emergency reports have described lasting psychosis in vulnerable individuals. Although preliminary experiments by Mowry et al. Because Salvia divinorum seeds are difficult to obtain, the plant is propagated from cuttings. Seedlings as well as dried leaves are readily available either from Internet suppliers or specialised shops in countries where no regulatory restrictions exist. Home cultivation of plants is possible and instructions describing optimal growing conditions, the use of fertilisers and pest control chemicals are available on the Internet in several languages. Salvinorin A is found in the resin secreted by special, hairy epidermal cells trichomes , which are especially abundant on the leaves. Preparations of one leaf fortified by extracts of 4 to 49 other leaves the respective products then labelled as 5X to 50X extracts are also available online and in specialised shops. However, the actual salvinorin A concentration of Salvia divinorum products is generally unknown. Pure, crystalline salvinorin A does not appear to be offered on markets neither online or in smartshops but illustrated procedures for its isolation are available on the Internet. Chemical total syntheses of salvinorin A have recently been completed but they are too complex to be used for the production of the substance. To date, salvinorin A has not been found in any other Salvia species analysed. Alternatively, the fresh foliage is crushed by hand or ground on a milling stone which can be used for making a drinkable infusion. At least six fresh leaves are needed to achieve noticeable effects, which manifest after about 10 minutes and lasts for 45 minutes or longer. For recreational use, the most common way of administration is smoking the crushed dried leaves from a pipe or water bong, providing short-lasting 15—20 minute hallucinations within a minute. Typically, 0. Chewing the bitter leaves as a quid gives a longer lasting effect and the typical dosages to produce mild to medium effects are 10—30 grams of fresh leaves or 2—5 grams of dried leaves. Sublingual application of aqueous ethanol tinctures made from leaves results in an onset taking 5—10 minutes and lasting up to 2 hours. Drinking tea made by steeping the leaves in hot water is relatively ineffective because salvinorin A is readily degraded in the gastrointestinal tract. Health risks of inhaling the vapours of pure salvinorin A are high because the inhaled amount cannot be controlled. Names in other European languages include: French — sauge des devins, sauge divinatoire; German — Wahrsagersalbei. The salvinorin A content of botanical samples can be analysed by thin layer chromatography or high performance liquid chromatography with UV detection. The UV spectrum of the methanolic solution of salvinorin A shows a maximum at nm. The characteristic absorption bands in the infra-red spectrum of salvinorin A in KBr pellet are at 3 , 1 , 1 , 1 , and cm For the unequivocal identification of powdered plant material, DNA fingerprinting methods can be used. Salvinorin A and the other diterpenoids of the plant are not detected by conventional drug screening methods. However, in recent years both Salvia divinorum and its active principle salvinorin A have become controlled under drugs legislation in Belgium, Denmark, Italy, Latvia, Lithuania, Romania and Sweden, in Australia and Japan as well as in a number of states of the US. Croatia, Germany, Poland and Spain only regulate the plant. In Estonia, Finland and Norway, Salvia divinorum falls under medicines legislation. There is no approved medicinal use for Salvia divinorum or salvinorin A. However, there is intensive research to explore the therapeutic potential of structurally related KOR agonists or antagonists. Albertson, D. Appel, J. Baggott, M. Erowid, F. Bertea, C. Beerepoot, P. Biglete, S. Braida, D. Capasso, R. Carlezon, W. Chavkin, C. Epling, C. Giroud, C. Gruber, J. Grundmann, O. Hanes, K. Harding, W. Hofmann, A. Hooker, J. Imanshahidi, M. Jermain, J. Khey, D. Lange, J. Li, Y. McDonough, P. Medana, C. Mowry, M. Nozawa, M. Ortega, A. Paulzen, M. Pfeiffer, A. Pichini, S. Prisinzano, T. Przekop, P. Roth, B. Scheerer, J. Schmidt, M. Seeman, P. Siebert, D. Siemann, H. Tsujikawa, K. Vohra, R. Vortherms, T. Wolowich, W. Zhang, Y. Homepage Quick links Quick links. GO Results hosted on duckduckgo. Main navigation Data Open related submenu Data. Latest data Prevalence of drug use Drug-induced deaths Infectious diseases Problem drug use Treatment demand Seizures of drugs Price, purity and potency. Drug use and prison Drug law offences Health and social responses Drug checking Hospital emergencies data Syringe residues data Wastewater analysis Data catalogue. Selected topics Alternatives to coercive sanctions Cannabis Cannabis policy Cocaine Darknet markets Drug checking Drug consumption facilities Drug markets Drug-related deaths Drug-related infectious diseases. Recently published Findings from a scoping literature…. Penalties at a glance. Frequently asked questions FAQ : drug…. FAQ: therapeutic use of psychedelic…. Viral hepatitis elimination barometer…. EU Drug Market: New psychoactive…. EU Drug Market: Drivers and facilitators. Statistical Bulletin home. Quick links Search news Subscribe newsletter for recent news Subscribe to news releases. Breadcrumb Home Publications Drug profiles Salvia divinorum drug profile. Salvia divinorum drug profile. Molecular structure of salvinorum A.

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Official websites use. Share sensitive information only on official, secure websites. Ontario St. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Patients may misunderstand the substance they have been exposed to, there are rarely any readily available laboratory confirmatory tests for these substances, and the exact substances being abused may change on a near-daily basis. This review will attempt to group legal agents into expected toxidromes and discuss associated common clinical manifestations and management. A focus on aggressive symptom-based supportive care as well as management of end-organ dysfunction is the mainstay of treatment for these patients in the emergency department. Keywords: legal highs, novel psychoactive substances, toxicology, opioid toxidrome, anticho-linergic toxidrome, sympathomimetic toxidrome, hallucinogens, inhalants. After the Geneva Opium Convention attempted to establish international control over morphine, drug manufacturers started flooding the market with uncontrolled morphine chemical derivatives. Patients may misunderstand what the substance is they have been exposed to, there are rarely any readily available laboratory confirmatory tests for these substances, and the exact substances being abused may change on a near-daily basis. Recognizing these challenges we will attempt to group legal agents into expected toxidromes and discuss associated common clinical manifestations and management. Producing the toxidrome of tachycardia, mydriasis, urinary retention, dry mucosal membranes, skin flushing, and hypo-active bowel sounds, anticholinergic agents have long been abused for their hallucinogenic, euphoric, and stimulant effects. The belladonna alkaloids are atropine, hyoscyamine, and scopolamine, which are found in large concentrations in plants such as deadly nightshade Atropa belladonna , Jimson weed Datura stramonium , and moonflower Datura inoxia. Belladonna alkaloid overdoses manifest as anticholinergic toxicity. An analysis of cases reported to American poison centers revealed no attributable fatalities. In addition to supportive care, management of belladonna alkaloid plant toxicity centers around treating agitation as well as reversing severe anticholinergic effects if needed. Decontamination with activated charcoal is controversial, as most patients will present for medical care when clinically intoxicated and agitated. The classic signs of diphenhydramine overdose are an anticholinergic toxidrome combined with profound sedation and at times marked agitation. Management of diphenhydramine toxicity centers around control of agitation and hyperthermia, as well as treating rhabdomyolysis, potential tachyarrhythmias, and seizures. Widely available, nutmeg is known to provoke hallucinogenic effects in high dosages. According to available case reports, nutmeg reached a peak of abuse in the s and s. Nutmeg produces a biological effect similar to an anticholinergic toxidrome, with altered mental status, skin flushing, dry mucus membranes, tachycardia, and hypertension. The clinical toxidrome of fly agaric has been said to mimic that of an anticholinergic toxidrome, with flushing, fever, and pupillary dilation. Treatment is supportive, with consideration of GI decontamination with charcoal. As the USA grapples with unprecedented levels of opioid abuse, there has been an increased push among prescribers and regulatory bodies to curb long-term prescribing of these medications. Management of loperamide toxicity includes extended consideration of decontamination, treatment of respiratory depression, and monitoring and treatment of potential cardiotoxicity. Although opium and the poppy plant itself are controlled in the USA, poppy seeds are completely unregulated and can be bought in bulk. Although they do not contain any psychoactive opiates, poppy seeds have been shown to have trace amounts of opium latex containing morphine and codeine on their surface. Although official case reports of fatalities are sparse, scattered fatalities in the popular media have been reported among young people using PST. Kratom is the common name for the plant Mitragyna speciosa , a large leafy tree which is indigenous to Southeast Asia, containing psychoactive alkaloids with dose-dependent stimulatory and opioid-like effects. The safety profile of kratom has not been fully evaluated. Well-controlled data on the toxic effects of kratom on human subjects are lacking, and case reports of toxicity are relatively rare. There have been scattered case reports of intractable seizures that are refractory to benzodiazepines in patients with acute kratom ingestions, although many cases are associated with co-ingestion of other prescription and illicit drugs. However, it would be reasonable to give naloxone in the setting of a kratom ingestion with respiratory depression. Kratom has been frequently adulterated with other opioid receptor agonists such as O -desmethyltramadol, resulting in 9 deaths in 1 case series. In an effort to stem the flood of these agents, the DEA has continuously added synthetic opioids to Schedule I, including U, AH, and many fentanyl analogs. Still unscheduled, an opioid known as MT, a piperazine derivative, has found abuse as a legally available opioid. A more substantial public health threat than MT is the re-emergence of fentanyl and a wide range of fentanyl analogs to the illicit drug market. Many of them are abused by those seeking similar effects as the classic illicit psychostimulants such as cocaine, methamphetamine, and 3,4-methylenedioxy-N-methylamphetamine MDMA. Others are abused for their serotonin-mediated hallucinogenic effects, but are notable for producing sympathomimetic toxicity. Many of these agents will share similarities in their treatment approach, which entails benzodiazepines, active cooling for hyperthermia, and specific management of end-organ complications related to hypertension and vasoconstrictive effects. A Schedule I substance, cathinone is a monoamine amphetamine analog with stimulatory properties found in the shrub Catha edulis , commonly known as khat. Synthetic cathinones reached a peak of reports in , declining to in , 58 likely due to federal and state efforts at scheduling and regulating these psychoactive substances. Chemical similarity of amphetamine, cathinone, and mephedrone; note the addition of the ketone functional group to the latter two compounds. The toxicologic effects of synthetic cathinones mimic those of the amphetamines as well as MDMA, and treatment is primarily supportive around managing the agitation, fever, hyponatremia, and end-organ complications that can sometimes occur with these agents. The subjective effects of benzofurans have been described as much like MDMA, but with more adverse effects in the form of nausea, dry mouth, dry eyes, insomnia, diarrhea, palpitations, headache, and various adverse psychological symptoms, including visual and auditory hallucinations. Like many of the NPS, detailed toxicological information on the benzofurans are lacking, and acute ingestions are often concurrent with other intoxicants. The benzodifurans, commonly known as the Bromo-dragonFLY compounds, refer to a relatively novel group of hallucinogenic drugs that saw escalating amounts of abuse as legally available research chemicals over the past decade. Case reports indicate that Bromo-dragonFLY compounds have potent sympathomimetic and vasoconstrictive toxicity. Bromo-dragonFLY overdose treatment is supportive. The single chemical difference between propylhexedrine top and methamphetamine bottom is the aromatic ring. Toxicity of propylhexedrine mimics that of the amphetamines, but with seemingly more profound end-organ complications from its relatively higher hypertensive and vasoconstrictive effects, especially with intravenous injection. Clinical toxicity presents with a sympathomimetic-like toxidrome but with profound tachycardia and hypertension. Mescaline is a serotonergic phenethylamine hallucinogen most famously found in peyote, a small spineless cactus found in the deserts between the USA and Mexico that has been traditionally consumed by Native American tribes. Mescaline is chemically related to amphetamines, and cases of toxicity produce a sympathomimetic-like toxidrome. N-methyl-D-aspartate NMDA receptor antagonists such as phencyclidine PCP and ketamine are abused in recreational settings for their dissociative effects. Ketamine was officially scheduled in , 78 and in the decade to follow the recreational drug market saw the synthesis and emergence of legal ketamine analogs such as methoxetamine and others. Furthermore, the over-the-counter cough remedy DXM has long been abused for its dissociative effects. Methoxetamine, an analog of ketamine that has NMDA antagonist activity, has been marketed via the internet as a legal high, and oftentimes as a safer alternative to ketamine abuse. Much of the morbidity of methoxetamine and other novel dissociative psychoactive substances seem to be centered around their neurocognitive effects as well as sympathomimetic qualities and propensity to be taken with other stimulatory psychoactive substances. The subjective effects of DXM abuse have been noted to entail 3 dose-dependent plateaus, with low doses producing mild stimulant and euphoric effects, middle doses producing an effect like concurrent alcohol and marijuana intoxication, and large doses producing a dissociative effect like ketamine or PCP intoxication. The major toxic effects of DXM are managed with supportive care, and are centered around benzodiazepines for acute agitation, management of toxicity from coformulatory agents, as well as possible serotonin syndrome. A major concern with DXM ingestion, even at therapeutic dosages in concert with certain other serotonin-affective drugs, is the risk of serotonin syndrome. There have been cases of serotonin syndrome when DXM was taken at antitussive therapeutic dosages in patients on therapeutic MAOIs such as phenelzine, as well as selective serotonin reuptake inhibitors such as fluoxetine. As DXM is commonly found in bromide salt, there have been theoretical concerns that massive ingestions will result in bromide toxicity as well as false elevations of chloride and even negative anion gaps due to misidentification of bromide for chloride by laboratory autoanalyzers. However, the only available evidence of bromism in the form of elevated chloride and a low or negative anion gap in the context of DXM use comes from a single case report. There are many legal hallucinogenic compounds that lack a discrete toxidrome. Many do increase serotonergic transmission resulting in stimulatory effects, including tachycardia and hypertension. Agitation and neuropsychiatric symptoms predominate with these agents. Native to Oaxaca, Mexico, Salvia divinorum is a leafy plant of the mint family that has been long recognized for its psychoactive properties when inhaled or sublingually absorbed. There is a lack of reports of salvia intoxication resulting in any serious physiologic toxicity. Although seeds are often treated with an emetic by seed producers in order to discourage abuse, morning glory and woodrose seeds have been long abused as a legally available LSD substitute. Major side effects include nausea, vomiting, and abdominal discomfort, which are thought to limit the abuse potential of LSA-containing seeds. SCs are chemically heterogeneous but what they have in common is their affinity for cannabinoid receptors. Unlike marijuana, which contains over 50 known psychoactive chemicals, many of which have attenuating effects on THC, which is itself a partial agonist of cannabinoid receptors, many of the SCs are full agonists that demonstrate a much stronger affinity for these target receptors. Physical examination findings of those using SCs have been found to be similar to those with cannabis intoxication, with delayed pupillary light reactions, slurred speech, and retarded sequence of movements. Cases of rhabdomyolysis, acute kidney injury, and even myocardial infarction have been reported. Ayahuasca, also known as hoasca, yage, and natema, is a hallucinogenic tea brewed traditionally among Amazonian tribes for religious purposes from the jungle vine Banisteriopsis caapi together with the leaves of the Psychotria viridis plant. The most common clinical manifestations of ayahuasca intoxication as reported to poison centers were hallucinations, tachycardia, agitation, hypertension, mydriasis, and vomiting. Kava refers to a traditional beverage prepared from the tropical shrub plant Piper methysticum , native to the South Pacific. Used for centuries for its euphoric and anxiolytic effects, kava has seen increased use in the USA, where it is considered a health supplement. Reports of acute kava toxicity resulting in adverse events requiring medical care are rare, accounting for 20 cases reported nationally in Patients abusing inhalants may present with a wide variety of subjective complaints, including dyspnea, palpitations, lightheadedness, sneezing and coughing, as well as GI complaints, including nausea and vomiting. The inhalational hydrocarbons of abuse have numerous toxic effects on the body, with cardiotoxic, neurotoxic, hepatotoxic, and nephrotoxic effects having been reported. Nitrous oxide inactivates vitamin B12, decreasing conversion of homocysteine to methionine, ultimately resulting in demyelination within the central and peripheral nervous systems. However, a focus on aggressive symptom-based supportive care is the mainstay of treatment for these patients in the ED. As a library, NLM provides access to scientific literature. Open Access Emerg Med. Find articles by Charles R Caffrey. Find articles by Patrick M Lank. 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