- Email: [email protected]
New Drugs of Abuse Update: Foxy Methoxy
PHARM/TOX CORNER
New Drugs of Abuse Update: Foxy Methoxy
Author: Allison A. Muller, PharmD, CSPI, Philadelphia, Pa
Allison A. Muller is Clinical Managing Director, The Poison Control Center, The Children’s Hospital of Philadelphia, Philadelphia, Pa. For reprints, write: Allison A. Muller, PharmD, CSPI, The Children’s Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; E-mail: [email protected]. J Emerg Nurs 2004;30:507-8. 0099-1767/$30.00 Copyright n 2004 by the Emergency Nurses Association. doi: 10.1016/j.jen.2004.07.037
October 2004
30:5
A
21-year-old man who is hypertensive, tachycardic, diaphoretic, agitated, and confused presents to the emergency department 2 hours after drinking beer and ingesting a drug he purchased on the Internet. His vital signs are as follows: blood pressure, 163/60 mm Hg; heart rate, 108 beats per minute; respiratory rate, 20; and temperature, 97.9 8F. He informs ED staff that the drug he purchased was called b5-Meo-DIPT.Q The patient left against medical advice and did not receive medical treatment. Just when we think we have heard of all the bclub drugs,Q brave drugs,Q and bnew drugs of abuse,Q a new one arrives on the scene. This is not accidental. As more of the street drugs are identified and classified as Drug Enforcement Agency (DEA) Schedule I, new compounds emerge that have not been classified as such. An illustration of this is the surfacing of g-hydroxybutyric acid (GHB) derivatives following the ban of the original compound in 1999.1 We are hearing more about the use of the new synthetic tryptamine 5-Meo-DIPT (5-methoxy-N,Ndiisopropyltryptamine), known in street drug terms as bFoxyQ or bFoxy Methoxy.Q Although it began to appear as a party drug in 1999, other party drugs like GHB and ecstasy overshadowed its prevalence. By February 2003, the DEA had reported use of this drug in 12 states. In April 2003, the DEA placed bFoxyQ and a related compound, alpha-methyltryptamine (AMT), into the Schedule I category through an emergency scheduling provision of the Controlled Substances Act.2 Sources of
JOURNAL OF EMERGENCY NURSING
507
PHARM/TOX CORNER/Muller
these and other synthetic tryptamines include the Internet3,4 and chemistry laboratories.5
Other effects of Foxy include erotica and visual/auditory hallucinations. Less desirable effects include myoclonus, restlessness, insomnia, and anxiety. Its onset of action is 20 to 30 minutes, and its duration of action is 3 to 6 hours. This drug can be taken orally, smoked, or snorted. Other tryptamines that share Foxy’s pharmacologic effects include bufotenine (btoad toxinQ), psilocybin (hallucinogenic mushrooms), and methyl diethyltryptamine. Foxy is structurally different from methylenedioxymethamphetamine (MDMA or becstasyQ), but it has similar effects, because it is also a potent serotonergic agonist. This action puts users at risk for permanent damage to serotonergic neurons, leading to neuropsychiatric disorders. Users seek to achieve disinhibition and increased sociability. Other effects of Foxy include erotica and visual/auditory hallucinations. Less desirable effects include myoclonus, restlessness, insomnia, and anxiety. Its onset of action is 20 to 30 minutes, and its duration of action is 3 to 6 hours.
toxicology screen may still be of interest. Internet sites on illicit drug use have listed drugs that work synergistically with Foxy, such as marijuana, GHB, and ketamine. REFERENCES 1. Muller AA. GHB poisoning: three recent cases reflect the continuing danger. J Emerg Nurs 2003;29:177- 9. 2. Drug Enforcement Administration, Department of Justice. Schedules of controlled substances: temporary placement of alpha-methyltryptamine and 5-methoxy-N,N-diisopropyltryptamine into Schedule I. Final rule. Federal Register 2003;68: 16427-30. 3. Dailey RM, Nelson LD, Scaglione JM. Tachycardia and rhabdomyolysis after intentional ingestion of N,N-dipropyltryptamine [abstract]. J Toxicol Clin Toxicol 2003;1:742. 4. Holstege CP, Baer AB, Kirk MA. Prolonged hallucinations following ingestion of alpha-methyl-tryptamine [abstract]. J Toxicol Clin Toxicol 2003;41:746. 5. Smolinske S, Rastogi R, Schenkel S. Foxy Methoxy: a new drug of abuse [abstract]. J Toxicol Clin Toxicol 2003;41:641.
Submissions to this column are welcomed and encouraged. Submissions may be sent to: Allison A. Muller, PharmD, CSPI The Children’s Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, Pa 19104 215 590-2004
! [email protected]
Symptomatic treatment is the mainstay of therapy for users of Foxy. The most common presenting symptoms are hallucinations, agitation, and tachycardia. Symptomatic treatment is the mainstay of therapy for users of Foxy. The most common presenting symptoms are hallucinations, agitation, and tachycardia. Liberal use of benzodiazepines can combat these symptoms. Seizures are rare. However, as the use of this drug increases, the typical clinical presentation associated with Foxy may evolve. Foxy is not revealed on a routine toxicology screen. Because Foxy may be used in combination with other illicit drugs, the patient’s clinical presentation may be clouded and the
508
JOURNAL OF EMERGENCY NURSING
30:5
October 2004
New Drugs of Abuse Update: Foxy Methoxy
Author: Allison A. Muller, PharmD, CSPI, Philadelphia, Pa
Allison A. Muller is Clinical Managing Director, The Poison Control Center, The Children’s Hospital of Philadelphia, Philadelphia, Pa. For reprints, write: Allison A. Muller, PharmD, CSPI, The Children’s Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; E-mail: [email protected]. J Emerg Nurs 2004;30:507-8. 0099-1767/$30.00 Copyright n 2004 by the Emergency Nurses Association. doi: 10.1016/j.jen.2004.07.037
October 2004
30:5
A
21-year-old man who is hypertensive, tachycardic, diaphoretic, agitated, and confused presents to the emergency department 2 hours after drinking beer and ingesting a drug he purchased on the Internet. His vital signs are as follows: blood pressure, 163/60 mm Hg; heart rate, 108 beats per minute; respiratory rate, 20; and temperature, 97.9 8F. He informs ED staff that the drug he purchased was called b5-Meo-DIPT.Q The patient left against medical advice and did not receive medical treatment. Just when we think we have heard of all the bclub drugs,Q brave drugs,Q and bnew drugs of abuse,Q a new one arrives on the scene. This is not accidental. As more of the street drugs are identified and classified as Drug Enforcement Agency (DEA) Schedule I, new compounds emerge that have not been classified as such. An illustration of this is the surfacing of g-hydroxybutyric acid (GHB) derivatives following the ban of the original compound in 1999.1 We are hearing more about the use of the new synthetic tryptamine 5-Meo-DIPT (5-methoxy-N,Ndiisopropyltryptamine), known in street drug terms as bFoxyQ or bFoxy Methoxy.Q Although it began to appear as a party drug in 1999, other party drugs like GHB and ecstasy overshadowed its prevalence. By February 2003, the DEA had reported use of this drug in 12 states. In April 2003, the DEA placed bFoxyQ and a related compound, alpha-methyltryptamine (AMT), into the Schedule I category through an emergency scheduling provision of the Controlled Substances Act.2 Sources of
JOURNAL OF EMERGENCY NURSING
507
PHARM/TOX CORNER/Muller
these and other synthetic tryptamines include the Internet3,4 and chemistry laboratories.5
Other effects of Foxy include erotica and visual/auditory hallucinations. Less desirable effects include myoclonus, restlessness, insomnia, and anxiety. Its onset of action is 20 to 30 minutes, and its duration of action is 3 to 6 hours. This drug can be taken orally, smoked, or snorted. Other tryptamines that share Foxy’s pharmacologic effects include bufotenine (btoad toxinQ), psilocybin (hallucinogenic mushrooms), and methyl diethyltryptamine. Foxy is structurally different from methylenedioxymethamphetamine (MDMA or becstasyQ), but it has similar effects, because it is also a potent serotonergic agonist. This action puts users at risk for permanent damage to serotonergic neurons, leading to neuropsychiatric disorders. Users seek to achieve disinhibition and increased sociability. Other effects of Foxy include erotica and visual/auditory hallucinations. Less desirable effects include myoclonus, restlessness, insomnia, and anxiety. Its onset of action is 20 to 30 minutes, and its duration of action is 3 to 6 hours.
toxicology screen may still be of interest. Internet sites on illicit drug use have listed drugs that work synergistically with Foxy, such as marijuana, GHB, and ketamine. REFERENCES 1. Muller AA. GHB poisoning: three recent cases reflect the continuing danger. J Emerg Nurs 2003;29:177- 9. 2. Drug Enforcement Administration, Department of Justice. Schedules of controlled substances: temporary placement of alpha-methyltryptamine and 5-methoxy-N,N-diisopropyltryptamine into Schedule I. Final rule. Federal Register 2003;68: 16427-30. 3. Dailey RM, Nelson LD, Scaglione JM. Tachycardia and rhabdomyolysis after intentional ingestion of N,N-dipropyltryptamine [abstract]. J Toxicol Clin Toxicol 2003;1:742. 4. Holstege CP, Baer AB, Kirk MA. Prolonged hallucinations following ingestion of alpha-methyl-tryptamine [abstract]. J Toxicol Clin Toxicol 2003;41:746. 5. Smolinske S, Rastogi R, Schenkel S. Foxy Methoxy: a new drug of abuse [abstract]. J Toxicol Clin Toxicol 2003;41:641.
Submissions to this column are welcomed and encouraged. Submissions may be sent to: Allison A. Muller, PharmD, CSPI The Children’s Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, Pa 19104 215 590-2004
! [email protected]
Symptomatic treatment is the mainstay of therapy for users of Foxy. The most common presenting symptoms are hallucinations, agitation, and tachycardia. Symptomatic treatment is the mainstay of therapy for users of Foxy. The most common presenting symptoms are hallucinations, agitation, and tachycardia. Liberal use of benzodiazepines can combat these symptoms. Seizures are rare. However, as the use of this drug increases, the typical clinical presentation associated with Foxy may evolve. Foxy is not revealed on a routine toxicology screen. Because Foxy may be used in combination with other illicit drugs, the patient’s clinical presentation may be clouded and the
508
JOURNAL OF EMERGENCY NURSING
30:5
October 2004