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Absorção via oral;

Líquido, capsulas ou inaladas;

Absorção principal no trato gastrointestinal;

Metabolismo ocorre no fígado;

Excreção - urina;

A enzima chave no metabolismo do LSD é o citocromo P450 2D6 (CYP2D6).

Dinâmica

Atua no córtex cerebral;

Atua nos receptores de serotonina 5HT ( agonista ou antagonista parcial);

Produz alterações na cognição, humor e nas percepções;

Os efeitos se iniciam de 30 a 60 min após a injeção, o pico ocorre de 02 a 04 horas, a duração total dos efeitos de 06 a 12 horas totais.

Não a leva a dependência.

Ansiedade, pânico e, em casos raros, psicose temporária.

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Drogas de clube: MDMA, gama-hidroxibutirato (GHB), rohipnol e cetamina

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Drogas de clube: MDMA, gama-hidroxibutirato (GHB), rohipnol e cetamina

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Article Sections

Club drugs are substances commonly used at nightclubs, music festivals, raves, and dance parties to enhance social intimacy and sensory stimulation. The most widely used club drugs are 3,4-methylenedioxymetham-phetamine (MDMA), also known as ecstasy; gamma-hydroxybutyrate (GHB); flunitrazepam (Rohypnol); and ketamine (Ketalar). These drugs are popular because of their low cost and convenient distribution as small pills, powders, or liquids. Club drugs usually are taken orally and may be taken in combination with each other, with alcohol, or with other drugs. Club drugs often are adulterated or misrepresented. Any club drug overdose should therefore be suspected as polydrug use with the actual substance and dose unknown. Persons who have adverse reactions to these club drugs are likely to consult a family physician. Toxicologic screening generally is not available for club drugs. The primary management is supportive care, with symptomatic control of excess central nervous system stimulation or depression. There are no specific antidotes except for flunitrazepam, a benzodiazepine that responds to flumazenil. Special care must be taken for immediate control of hyperthermia, hypertension, rhabdomyolysis, and serotonin syndrome. Severe drug reactions can occur even with a small dose and may require critical care. Club drug overdose usually resolves with full recovery within seven hours. Education of the patient and family is essential.

Although alcohol remains the primary "social lubricant," it has been joined by many newer psychoactive drugs that are used to intensify social ex-eriences. Because of the prevalence of these drugs at dance parties, raves, and nightclubs, they often are referred to as "club drugs." The most prominent club drugs are MDMA (3,4-methylenedioxymethamphetamine), also known as ecstasy; gamma-hydroxybutyrate (GHB); flunitrazepam (Rohypnol); and ketamine (Ketalar). Table 1 1 lists the various street names for these agents.

The popularity of these club drugs is due to their low cost and convenient distribution as small pills, powders, or liquids that can be taken orally. Consequently, these drugs are popular among young persons who have been educated about the hazards of drug injection and the dangers of heroin, cocaine, and methamphetamine. However, most users are unaware that MDMA is a type of methamphetamine, and incorrectly assume that substances that appear as pharmaceuticals are safe to use.

In the past 10 years, there has been a generalized decrease in the use of marijuana, cocaine, and heroin in the United States, according to statistics from the Drug Enforcement Administration, the University of Michigan Monitoring the Future Study, the Columbia University National Survey of American Attitudes on Substance Abuse, the Community Epidemiology Working Group, and the Partnership for a Drug-Free America.4 However, during this same period, the use of club drugs has dramatically increased.5 A 2001-2002 Chicago household survey6 of 18-to 40-year-old persons showed that 38 percent had attended a rave, and 49 percent of these had a taken a club drug. One Australian study7 showed that only 8 percent of club-goers had not consumed any psychoactive substance.

MDMA was developed in 1914 as an appetite suppressant, but animal tests were unimpressive, and it was never tested in humans. In 1965, psychiatrists prescribed the drug to break through psychologic defenses as an "empathy agent." By 1985, illegal laboratories were producing the drug for recreational use, and it was classified as a schedule I controlled substance.

MDMA has become the most common stimulant found in dance clubs and is available at 70 percent of raves.8 MDMA usually is sold as small tablets of variable colors imprinted with popular icons or words. A high proportion of MDMA pills are adulterated with substances such as caffeine, dextromethorphan,9 pseudoephedrine,10 or potent hallucinogens such as LSD, paramethoxyamphetamine (PMA), methylenedioxyamphetamine (MDA), N-ethyl-3,4-methylenedioxyamphetamine (MDEA), and 4-bromo-2,5-dimethoxyam-phetamine (2-CB).11 Many of these substances are "designer drugs" that are illicitly manufactured variants of pharmaceuticals and have intentional and unintentional effects. For example, MDEA ("Eve"), 2-CB, and PMA ("death") are substituted amphetamines but have primarily hallucinogenic, and often unpleasant, effects.1

MDMA ingestion increases the release of serotonin, dopamine, and norepinephrine from presynaptic neurons and prevents their metabolism by inhibiting monoamine oxidase. Effects of an oral dose appear within 30 to 60 minutes and last up to eight hours.12 A quicker onset of action can be achieved by snorting the powder of a crushed tablet. Users of MDMA describe initial feelings of agitation, a distorted sense of time, and diminished hunger and thirst, followed by euphoria with a sense of profound insight, intimacy, and well-being.13 To further enhance the sensory effects, users often wear fluorescent necklaces, bracelets, and other accessories, and apply mentholated ointment on their lips or spray menthol inhalant on a surgical mask. Unpleasant side effects of MDMA include trismus and bruxism, which can be reduced by sucking on a pacifier or lollipop.14

Adverse effects of MDMA ingestion result from sympathetic overload and include tachycardia, mydriasis, diaphoresis, tremor, hypertension,15 arrhythmias,16 parkinsonism,17 esophoria (tendency for eyes to turn inward), and urinary retention.18 However, the most troublesome potential outcome of MDMA ingestion is hyperthermia19 and the associated "serotonin syndrome." Serotonin syndrome is manifested by grossly elevated core body temperature, rigidity, myoclonus, and autonomic instability;20 it results in end-organ damage, rhabdomyolysis and acute renal failure, hepatic failure, adult respiratory distress syndrome, and coagulopathy.21

Two days after ingestion of MDMA, users typically experience depression consistent with serotonin depletion,24 which may be severe.25 One study26 showed that, compared with alcohol withdrawal, persons who are withdrawing from MDMA were more depressed, irritable, and unsociable. Repeated use of MDMA has been associated with cognitive deficits in animals and humans, with potentially permanent memory impairment.27, 28

GHB was first synthesized in France in 1960 as an anesthetic. It later achieved popularity as a recreational drug and a nutritional supplement marketed to bodybuilders.32 Nonprescription sales in the United States were banned in 1990 because of adverse effects, including uncontrolled movements and depression of the respiratory and central nervous systems (CNS).33, 34 In 2000, with 60 deaths reported from overdose and concern over its use as a "date rape" drug, GHB was reclassified as a schedule I controlled substance.35 In 2002, sodium oxybate, a formulation of GHB, was approved for the treatment of narcolepsy and classified as schedule III. Recently, sodium oxybate has been studied as a treatment for alcohol withdrawal.36, 37

GHB produces euphoria, progressing with higher doses to dizziness, hypersalivation, hypotonia, and amnesia.41 Overdose may result in Cheyne-Stokes respiration, seizures, coma, and death. Coma may be interrupted by agitation, with flailing activity described similar to a drowning swimmer fighting for air.42 Bradycardia and hypothermia are reported in about one third of patients admitted to a hospital for using GHB and appear to be correlated with the level of consciousness.43 Chronic use of GHB may produce dependence and a withdrawal syndrome that includes anxiety, insomnia, tremor, and in severe cases, treatment-resistant psychoses.44

Ketamine was derived from phencyclidine (PCP) in the 1960s for use as a dissociative anesthetic.48 It causes anesthesia without respiratory depression by inhibiting the neuronal uptake of norepinephrine, dopamine, serotonin, and glutamate activation in the N-methyl- D-aspartate receptor channel.49 This agent can cause bizarre ideations and hallucinations-side effects that limited its medical use but appealed to recreational drug users.

Because club drugs are illicitly obtained and often are adulterated or substituted, they must be considered as unknown substances. In the ever-changing world of illegal drug distribution, Internet Web sites can be helpful in identifying the rapidly changing appearances of these substances (Table 2).

The immediate concern with the use of club drugs is cardiorespiratory maintenance. Users often present with multiple drug ingestions, which may include stimulant and depressant drugs (e.g., MDMA combined with GHB or alcohol). When the predominant symptoms are controlled, the symptoms of a second underlying drug may surface. Most hallucinogens are CNS stimulants; in overdose, patients may exhibit hyperthermia, hypertension, tachycardia, anxiety, and agitation. The risk of escape or self-injury also should be considered.

No standard treatment regimen has been identified for club drug overdose. Basic management should include cardiac monitoring, pulse oximetry, urinalysis, and performance of a comprehensive chemistry panel to check for electrolyte imbalance, renal toxicity, and possible underlying disorders (Figure 1). Precautions should be taken to prevent seizures.19

Hyperthermia should be treated immediately with tepid water bathing and fanning. One study53 reported that a single tablet of MDMA resulted in fatal hyperthermia. The use of dantrolene (Dantrium) is questionable and no longer recommended.54 Alkalinization of the urine, which usually is recommended for rhabdomyolysis, should be used cautiously because it reduces the renal clearance of amphetamine. The serotonin antagonists chlorpromazine (Thorazine) and cyproheptadine (Periactin) appear to be effective in mild to moderate cases of serotonin syndrome.55

There are no specific antidotes for ingestion of club drugs, except for Rohypnol, which has the antidote flumazenil. With supportive care, patients usually will recover completely within seven hours.

Providing the patient and family with educational materials about specific substances may be helpful. These materials are available on many Web sites.

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Club Drugs: MDMA, Gamma-Hydroxybutyrate (GHB), Rohypnol, and Ketamine

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Club drugs are substances commonly used at nightclubs, music festivals, raves, and dance parties to enhance social intimacy and sensory stimulation. The most widely used club drugs are 3,4-methylenedioxymethamphetamine (MDMA), also known as ecstasy; gamma-hydroxybutyrate (GHB); flunitrazepam (Rohypnol); and ketamine (Ketalar). These drugs are popular because of their low cost and convenient distribution as small pills, powders, or liquids.