Prehospital Ketamine Administration for Excited Delirium with Illicit Substance Co-Ingestion and Subsequent Intubation in the Emergency Department

Introduction: Excited delirium, which has been defined as combativeness, agitation, and altered sensorium, requires immediate treatment in prehospital or emergency department (ED) settings for the safety of both patients and caregivers. Prehospital ketamine use is prevalent, although the evidence on safety and efficacy is limited. Many patients with excited delirium are intoxicated with illicit substances. This investigation explores whether patients treated with prehospital ketamine for excited delirium with concomitant substance intoxication have higher rates of subsequent intubation in the ED compared to those without confirmed substance usage. Methods: Over 28 months at two large community hospitals, all medical records were retrospectively searched for all patients age 18 years or greater with prehospital ketamine intramuscular (IM) administration for excited delirium and identified illicit and prescription substance co-ingestions. Trained abstractors collected demographic characteristics, history of present illness (HPI), urine drug screens (UDS), alcohol levels, and noted additional sedative administrations. Substance intoxication was determined by UDS and alcohol positivity or negativity, as well as physician HPI. Patients without toxicological testing or documentation of substance intoxication, or who may have tested positive due to ED sedation, were excluded from relevant analyses. Subsequent ED intubation was the primary pre-specified outcome. Odds ratios (OR) and 95% confidence intervals (CI) were calculated to compare variables. Results: Among 86 patients given prehospital ketamine IM for excited delirium, baseline characteristics including age, ketamine dose, and body mass index were similar between those who did or did not undergo intubation. Men had higher intubation rates. Patients testing positive for alcohol, amphetamines, barbiturates, benzodiazepines, ecstasy, marijuana, opiates, and synthetic cathinones, both bath salts and flakka, had similar rates of intubation compared to those negative for these substances. Of 27 patients with excited delirium and concomitant cocaine intoxication, nine (33%) were intubated compared with four of 50 (8%) without cocaine intoxication, yielding a 5.75 OR (95%, CI 1.57 to 21.05; P = .009). Conclusion: Patients treated with ketamine IM for excited delirium with concomitant cocaine intoxication had a statistically significant 5.75-fold increased rate of subsequent intubation in the ED. Amongst other substances, no other trends with intubation were noted, but further study is warranted.

Cannabidiol Modulates the Motivational and Anxiety-Like Effects of 3,4-Methylenedioxypyrovalerone (MDPV) in Mice

3,4-Methylenedioxypyrovalerone (MDPV) is a new psychoactive substance (NPS) and the most widespread and life-threatening synthetic cathinone of the “bath salts”. Preclinical research has proven the cocaine-like psychostimulant effects of MDPV and its potential for abuse. Cannabidiol (CBD) is a non-psychotropic phytocannabinoid that has emerged as a new potential treatment for drug addiction. Here, we tested the effects of CBD (20 mg/kg) on MDPV (2 mg/kg)-induced conditioned place preference and MDPV (0.05 and 0.075 mg/kg/infusion) self-administration paradigms. In addition, we assessed the effects of the co-administration of CBD and MDPV (3 and 4 mg/kg) on anxiety-like behaviour using the elevated plus maze (EPM). CBD mitigated the MDPV-induced conditioned place preference. On the contrary, CBD administration throughout the MDPV (0.075 mg/kg/infusion) self-administration increased drug-seeking and taking behaviours, but only in the high-responders group of mice. Furthermore, CBD exerted anxiolytic-like effects, exclusively in MDPV-treated mice. Taken together, our results indicate that CBD modulation of MDPV-induced motivational responses in mice varies depending on the requirements of the learning task, resulting in a complex response. Therefore, further research attempting to decipher the behavioural and molecular interactions between CBD and MDPV is needed.

Cannabidiol Modulates the Motivational and Anxiety-Like Effects of 3,4-Methylenedioxypyrovalerone (MDPV) in Mice

3,4-methylenedioxypyrovalerone (MDPV) is a new psychoactive substance (NPS) and the most widespread and life-threatening synthetic cathinone of the “bath salts”. Preclinical research has proven the cocaine-like psychostimulant effects of MDPV and its potential for abuse. Cannabidiol (CBD) is a non-psychotropic phytocannabinoid that has emerged as a new potential treatment for drug addiction. Here, we tested the effects of CBD (20 mg/kg) on MDPV (2 mg/kg)-induced conditioned place preference and MDPV (0.05 and 0.075 mg/kg/infusion) self-administration paradigm. We also assessed the effects of the combination of CBD, and MDPV (3 and 4 mg/kg) on anxiety-like behaviour using the elevated plus maze (EPM). CBD mitigated the MDPV-induced conditioned place preference. On the contrary, CBD administration throughout the MDPV (0.075 mg/kg/infusion) self-administration increased drug-seeking and taking behaviours, but only in the high-responders group of mice. Additionally, CBD exerted anxiolytic-like effects, but only in MDPV-treated mice. Taken together, our results indicate that CBD modulation of MDPV-induced motivational responses in mice vary depending on the requirements of the learning task, resulting in a complex response. More research attempting to decipher the behavioural and molecular interactions between CBD and MDPV is needed.

Tymianek - roślina o wielu zastosowaniach

Thyme has been known in Poland for centuries, initially imported, later cultivated and appreciated for its culinary and medicinal values. Currently, it is a common plant in polish region. It is most often used in the kitchen, but it should be remembered that it is included in many medicinal preparations. Found in cosmetics, used in aromatherapy as well as in floral compositions. Overview. Thyme, due to the abundance of compounds with antimicrobial and antioxidant activity, was used in respiratory diseases, anti-inflammatory and expectorant. It is supporting the functioning of the digestive system (for stomach, intestinal and liver problems). The intense aroma of thyme has been used in aromatherapy and in many cosmetics, such as pastes, creams, lotions and bath salts. Conclusions. Due to its valuable qualities, thyme is more and more often perceived as an ingredient that not only gives flavor, but also has a beneficial effect on the product. Its wide spectrum of properties causes its increasingly used in natural and modern food and cosmetic products.

Clinical structure of psychoses, associated with use of modern synthetic psychoactive substances

Psychoses associated with use of modern synthetic psychoactive substances (PAS) have significant differences in clinical features for making accurate diagnosis. These features play important role in correct diagnosis of psychoses, associated with synthetic cannabis (spice), synthetic stimulants (bath salts), and synthetic GABA-agonists (butyrates) still badly investigated. Theaimof this study was to reveal main symptoms and syndromes of psychoses associated with modern synthetic PAS. Methods: clinical and psychopathological, laboratory, statistical. Results. We examined 154patients with psychoses associated with modern synthetic PAS: 53users of synthetic cannabinoids (spices), 54users of synthetic psychostimulants (cathinones, metcathinones, bath salts), and 47users of synthetic GABA-agonists (butyrolactone). Conclusion. Differences in psychotic symptoms in different groups are described.

Risk management strategies of synthetic cannabis users

Purpose The purpose of this paper is to explore the various ways users of synthetic cannabinoids (SCs) managed the dangers associated with the consumption of this substance. Design/methodology/approach This paper is based on a parent study of the use and market of synthetic cathinones (also known as “bath salts”) in New York City, Houston, Galveston and New Orleans. Focus groups were conducted in all four cities with a total of 20 individuals who identified as users of SCs. Grounded theory was used to analyse focus group transcripts. Findings Participants were aware of drug-related risks and implemented strategies to reduce harm to health. Protective measures fell into two broad categories: marketing and consumption. They noted the instability of SC products and consumer manipulation through packaging. Harm reduction (HR) strategies included: carefully selecting SC sources; sticking to one brand; handling their own SC; managing amount of K2 consumed in one sitting; controlling the pace. Originality/value Given the small amount of data on user experience with SCs and its risk to health, it is important to learn from users themselves how they create methods to keep themselves safe. This is one of the first studies recording HR practices of SC users and can contribute to intervention programs and organisations serving substance users.