Abstract
Illicit drug intoxications are an increasing public health problem for which, in most cases, no antidotes are clinically available. The diagnosis and treatment of these intoxications requires a trained clinician with experience in recognizing the specific signs and symptoms of intoxications to individual drugs as well as polydrug intoxications, which are more the rule than the exception. To make the diagnosis, the clinical observation and a urine toxicology test are often enough. Evaluating the blood levels of drugs is frequently not practical because the tests can be expensive and results may be delayed and unavailable to guide the establishment of a, treatment plan. Other laboratory tests may be useful depending on the drug or drugs ingested and the presence of other medical complications. The treatment should be provided in a quiet, safe and reassuring environment. Vital signs should be closely monitored. Changes in blood pressure, respiratory frequency and temperature should be promptly treated, particularly respiratory depression (in cases of opiate intoxication) or hyperthermia (in cases of cocaine or amphetamine intoxication). Intravenous fluids should be administered as soon as possible. Other psychiatric and medical complication should receive appropriate symptomatic treatment. Research on immunotherapies, including vaccines, monoclonal and catalytic antibodies, seems to be a promising approach that may yield specific antidotes for drugs of abuse, helping to ameliorate the morbidity and mortality associated with illicit drug intoxications.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Paulozzi LJ, Xi Y (2008) Recent changes in drug poisoning mortality in the United States by urban-rural status and by drug type. Pharmaco epidemiol Drug Saf 17: 997–1005
CDC (2007) Unintentional poisoning deaths — United States, 1999–2004. MMWR Morb Mortal Wkly Rep 56: 93–96
Hall AJ, Logan JE, Toblin RL, Kaplan JA, Kraner JC, Bixler D, Crosby AE, Paulozzi LJ (2008) Patterns of abuse among unintentional pharmaceutical overdose fatalities. J Am Med Assoc 300: 2613–2620
CDC (2006) Toxicology testing and results for suicide victims — 13 states, 2004. MMWR Morb Mortal Wkly Rep 55: 1245–1248
Substance Abuse and Mental Health Services Administration, Office of Applied Studies (2008) Drug Abuse Warning Network, 2006: National Estimates of Drug-Related Emergency Department Visits. DHHS Publication No. (SMA) 08-4339. Rockville, MD. DAWN Series D-30.
Paulozzi LJ, Budnitz DS, Xi Y (2006) Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiol Drug Saf 15: 618–627
Paulozzi LJ, Annest JL (2007) US data show sharply rising drug-induced death rates. Inj Prev 13: 130–132.
Snyder SH, Pert CB, Pasternak GW (1974) The opiate receptor. Ann Intern Med 81: 534–540
Schuster CR, Smith BB, Jaffe JH (1971) Drug abuse in heroin users. An experimental study of self-administration of methadone codeine, and pentazocine. Arch Gen Psychiatry 24: 359–362
Jasinski DR, Preston KL (1986) Comparison of intravenously administered methadone, morphine and heroin. Drug Alcohol Depend 17: 301–310
Kuhar MJ (1978) Opiate receptors: Some anatomical and physiological aspects. Ann NY Acad Sci 311: 35–48
Utecht MJ, Stone AF, McCarron MM (1993) Heroin body packers. J Emerg Med 11: 33–40
Cullen W, Bury G., Langton D (2000) Experience of heroin overdose among drug users attending general practice. Br J Gen Pract 50: 546–549
Tagliaro F, De BZ (1999) Heroin overdose is often the truer description. Addiction 94: 973–974
Sporer KA (1999) Acute heroin overdose. Ann Intern Med 130: 584–590
Darke S, Zador D (1996) Fatal heroin ‘overdose’: A review. Addiction 91: 1765–1772
Duberstein JL, Kaufman DM (1971) A clinical study of an epidemic of heroin intoxication and heroin-induced pulmonary edema. Am J Med 51: 704–714
Safwat AM, Daniel D (1983) Grand mal seizure after fentanyl administration. Anesthesiology 59: 78
McCann B, Hunter R, McCann J (2002) Cocaine/heroin induced rhabdomyolysis and ventricular fibrillation. Emerg Med J 19: 264–265
Cone EJ, Darwin WD (1992) Rapid assay of cocaine, opiates and metabolites by gas chromatography — mass spectrometry. J Chromatogr 580: 43–61
Cone EJ, Caplan YH, Black DL, Robert T, Moser F (2008) Urine drug testing of chronic pain patients: Licit and illicit drug patterns. J Anal Toxicol 32: 530–543
Goldberger BA, Cone EJ, Grant TM, Caplan YH, Levine BS, Smialek JE (1994) Disposition of heroin and its metabolites in heroin-related deaths. J Anal Toxicol 18: 22–28
Yang W, Barnes AJ, Ripple MG, Fowler DR, Cone EJ, Moolchan ET, Chung H, Huestis MA (2006) Simultaneous quantification of methamphetamine, cocaine, codeine, and metabolites in skin by positive chemical ionization gas chromatography—mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 833: 210–218
Dixon P (2007) Managing acute heroin overdose. Emerg Nurse 15: 30–35
Strang J (2002) Looking beyond death: Paying attention to other important consequences of heroin overdose. Addiction 97: 927–928
Strang J, Kelleher M, Best D, Mayet S, Manning V (2006) Emergency naloxone for heroin overdose. BMJ 333: 614–615
Wasiak J, Clavisi O (2002) Is subcutaneous or intramuscular naloxone as effective as intravenous naloxone in the treatment of life-threatening heroin overdose? Med J Aust 176: 495
Maio RF, Gaukel B, Freeman B (1987) Intralingual naloxone injection for narcotic-induced respiratory depression. Ann Emerg Med 16: 572–573.
Wanger K, Brough L, Macmillan I, Goulding J, MacPhail I, Christenson JM (1998) Intravenous vs subcutaneous naloxone for out-of-hospital management of presumed opioid overdose. Acad Emerg Med 5: 293–299
O’Brien CP, Greenstein R, Ternes J, Woody GE (1978) Clinical pharmacology of narcotic antagonists. Ann NY Acad Sci 311: 232–240
Gal TJ (1989) Naloxone reversal of buprenorphine-induced respiratory depression. Clin Pharmacol Ther 45: 66–71
Umans JG, Szeto HH (1985) Precipitated opiate abstinence in utero. Am J Obstet Gynecol 151: 441–444
Zuspan FP, Gumpel JA, Mejia-Zelaya A, Madden J, Davis R (1975) Fetal stress from methadone withdrawal. Am J Obstet Gynecol 122: 43–46
Dowling J, Isbister GK, Kirkpatrick CM, Naidoo D, Graudins A (2008) Population pharmacokinetics of intravenous, intramuscular, and intranasal naloxone in human volunteers. Ther Drug Monit 30: 490–496
Steinberg AD, Karliner JS (1968) The clinical spectrum of heroin pulmonary edema. Arch Intern Med 122: 122–127
Kim D, Irwin KS, Khoshnood K (2009) Expanded access to naloxone: Options for critical response to the epidemic of opioid overdose mortality. Am J Public Health 99: 402–407
Brzozowski M, Shih RD, Bania TC, Hoffman RS (1993) Discharging heroin overdose patients after observation. Ann Emerg Med 22: 1638–1639
Christenson J, Etherington J, Grafstein E, Innes G, Pennington S, Wanger K, Fernandes C, Spinelli JJ, Gao M (2000) Early discharge of patients with presumed opioid overdose: Development of a clinical prediction rule. Acad Emerg Med 7: 1110–1118
Etherington J, Christenson J, Innes G, Grafstein E, Pennington S, Spinelli JJ, Gao M, Lahiffe B, Wanger K, Fernandes C (2000) Is early discharge safe after naloxone reversal of presumed opioid overdose? Can J Emerg Med 2: 156–162
Akbarzadeh A, Mehraby M, Zarbakhsh M, Farzaneh H (1999) Design and synthesis of a morphine-6-succinyl-bovine serum albumin hapten for vaccine development. Biotechnol Appl Biochem 30: 139–146
Anton B, Leff P (2006) A novel bivalent morphine/heroin vaccine that prevents relapse to heroin addiction in rodents. Vaccine 24: 3232–3240
Bonese KF, Wainer BH, Fitch FW, Rothberg RM, Schuster CR (1974) Changes in heroin self-administration by a rhesus monkey after morphine immunisation. Nature 252: 708–710
Spector S, Berkowitz B, Flynn EJ, Peskar B (1973) Antibodies to morphine, barbiturates, and serotonin. Pharmacol Rev 25: 281–291
Wainer BH, Fitch FW, Fried J, Rothberg RM (1973) A measurement of the specificities of antibodies to morphine-6-succinyl-BSA by competitive inhibition of 14C-morphine binding. J Immunol 110: 667–673
Wainer BH, Fitch FW, Rothberg RM, Schuster CR (1973) In vitro morphine antagonism by antibodies. Nature 241: 537–538
Gay GR, Sheppard CW, Inaba DS, Newmeyer JA (1973) An old girl: flyin’ low, dyin’ slow, blinded by snow: Cocaine in perspective. Int J Addict 8: 1027–1042
Siegel RK (1984) Changing patterns of cocaine use: Longitudinal observations, consequences, and treatment. NIDA Res Monogr 50: 92–110
Siegel RK, ElSohly MA, Plowman T, Rury PM, Jones RT (1986) Cocaine in herbal tea. J Am Med Assoc 225: 40
Floren AE, Small JW (1993) Mate de coca equals cocaine. J Occup Med 35: 95–96
Jenkins AJ, Llosa T, Montoya I, Cone EJ (1996) Identification and quantitation of alkaloids in coca tea. Forensic Sci Int 77: 179–189
Jackson GF, Saady JJ, Poklis A (1991) Urinary excretion of benzoylecgonine following ingestion of Health Inca Tea. Forensic Sci Int 49: 57–64
Rump AF, Theisohn M, Klaus W (1995) The pathophysiology of cocaine cardiotoxicity. Forensic Sci Int 71: 103–115
Barnett G, Hawks R, Resnick R (1981) Cocaine pharmacokinetics in humans. J Ethnopharmacol 3: 353–366
Leri F, Bruneau J, Stewart J (2003) Understanding polydrug use: Review of heroin and cocaine co-use. Addiction 98: 7–22
Patel MB, Opreanu M, Shah AJ, Pandya K, Bhadula R, Abela GS, Thakur RK (2009) Cocaine and alcohol: A potential lethal duo. Am J Med 122: e5–e6
Renfroe CL, Messinger TA (1985) Street drug analysis: An eleven year perspective on illicit drug alteration. Semin Adolesc Med 1: 247–257
June R, Aks SE, Keys N, Wahl M (2000) Medical outcome of cocaine bodystuffers. J Emerg Med 18: 221–224
McCarron MM, Wood JD (1983) The cocaine ‘body packer’ syndrome. Diagnosis and treatment. J Am Med Assoc 250: 1417–1420
Mott SH, Packer RJ, Soldin SJ (1994) Neurologic manifestations of cocaine exposure in childhood. Pediatrics 93: 557–560
Hoffman RS, Henry GC, Howland MA, Weisman RS, Weil L, Goldfrank LR (1992) Association between life-threatening cocaine toxicity and plasma cholinesterase activity. Ann Emerg Med 21: 247–253
Havlik DM, Nolte KB (2000) Fatal “crack” cocaine ingestion in an infant. Am J Forensic Med Pathol 21: 245–248
Sherer MA (1988) Intravenous cocaine: Psychiatric effects, biological mechanisms. Biol Psychiatry 24: 865–885
Bauwens JE, Boggs JM, Hartwell PS (1989) Fatal hyperthermia associated with cocaine use. West J Med 150: 210–212
Callaway CW, Clark RF (1994) Hyperthermia in psychostimulant overdose. Ann Emerg Med 24: 68–76
Siegel RK (1977) Cocaine: Recreational use and intoxication. NIDA Res Monogr 13: 119–136
Zeiter JH, McHenry JG, McDermott ML (1990) Unilateral pharmacologic mydriasis secondary to crack cocaine. Am J Emerg Med 8: 568–569
Daggett RB, Haghighi P, Terkeltaub RA (1990) Nasal cocaine abuse causing an aggressive midline intranasal and pharyngeal destructive process mimicking midline reticulosis and limited Wegener’s granulomatosis. J Rheumatol 17: 838–840
Ribeiro M, Dunn J, Sesso R, Dias AC, Laranjeira R (2006) Causes of death among crack cocaine users. Rev Bras Psiquiatr 28: 196–202
Blaho K, Logan B, Winbery S, Park L, Schwilke E (2000) Blood cocaine and metabolite concentrations, clinical findings, and outcome of patients presenting to an ED. Am J Emerg Med 18: 593–598
Om A, Ellahham S, Ornato JP (1992) Reversibility of cocaine-induced cardiomyopathy. Am Heart J 124: 1639–1641
Willens HJ, Chakko SC, Kessler KM (1994) Cardiovascular manifestations of cocaine abuse. A case of recurrent dilated cardiomyopathy. Chest 106: 594–600
Lora-Tamayo C, Tena T, Rodriguez A (1994) Cocaine-related deaths. J Chromatogr A 674: 217–224
Finkle BS, McCloskey KL (1977) The forensic toxicology of cocaine. NIDA Res Monogr 13: 153–192
Malbrain ML, Wauters A, Demeyer I, Demedts P, Verbraeken H, Daelemans R, Neels H (1993) Drug smuggler’s delirium. BMJ 306: 1002
Nnadi CU, Mimiko OA, McCurtis HL, Cadet JL (2005) Neuropsychiatric effects of cocaine use disorders. J Natl Med Assoc 97: 1504–1515
Zagnoni PG, Albano C (2002) Psychostimulants and epilepsy. Epilepsia 43 Suppl 2: 28–31
Pudiak CM, Bozarth MA (1994) Cocaine fatalities increased by restraint stress. Life Sci 55: L379–L382
Pascual-Leone A, Dhuna A, Altafullah I, Anderson DC (1990) Cocaine-induced seizures. Neurology 40: 404–407
Kramer LD, Locke GE, Ogunyemi A, Nelson L (1990) Cocaine-related seizures in adults. Am J Drug Alcohol Abuse 16: 307–317
Lowenstein DH, Massa SM, Rowbotham MC, Collins SD, McKinney HE, Simon RP (1987) Acute neurologic and psychiatric complications associated with cocaine abuse. Am J Med 83: 841–846
Myers JA, Earnest MP (1984) Generalized seizures and cocaine abuse. Neurology 34: 675–676
Peyriere H, Mauboussin JM (2000) Cocaine-induced acute cytologic hepatitis in HIV-infected patients with nonactive viral hepatitis. Ann Intern Med 132: 1010–1011
Van der Woude FJ, Waldherr R (1999) Severe renal arterio-arteriolosclerosis after cocaine use. Nephrol Dial Transplant 14: 434–435
Merigian KS, Roberts JR (1987) Cocaine intoxication: Hyperpyrexia, rhabdomyolysis and acute renal failure. J Toxicol Clin Toxicol 25: 135–148
Menashe PI, Gottlieb JE (1988) Hyperthermia, rhabdomyolysis, and myoglobinuric renal failure after recreational use of cocaine. South Med J 81: 379–381
Ahijado F, Garcia de V, Luno J (1990) Acute renal failure and rhabdomyolysis following cocaine abuse. Nephron 54: 268
Enriquez R, Palacios FO, Gonzalez CM, Amoros FA, Cabezuelo JB, Hernandez F (1991) Skin vasculitis, hypokalemia and acute renal failure in rhabdomyolysis associated with cocaine. Nephron 59: 336–337
Herzlich BC, Arsura EL, Pagala M, Grob D (1988) Rhabdomyolysis related to cocaine abuse. Ann Intern Med 109: 335–336
Beerman R, Nunez D Jr, Wetli CV (1986) Radiographic evaluation of the cocaine smuggler. Gastrointest Radiol 11: 351–354
Hoffman RS, Thompson T, Henry GC, Hatsukami DK, Pentel PR (1998) Variation in human plasma cholinesterase activity during low-dose cocaine administration. J Toxicol Clin Toxicol 36: 3–9
Mattes CE, Lynch TJ, Singh A, Bradley RM, Kellaris PA, Brady RO, Dretchen KL (1997) Therapeutic use of butyrylcholinesterase for cocaine intoxication. Toxicol Appl Pharmacol 145: 372–380
Om A, Ellahham S, Ornato JP, Picone C, Theogaraj J, Corretjer GP, Vetrovec GW (1993) Medical complications of cocaine: Possible relationship to low plasma cholinesterase enzyme. Am Heart J 125: 1114–1117
Ostrea EM Jr, Romero A, Knapp DK, Ostrea AR, Lucena JE, Utarnachitt RB (1994) Postmortem drug analysis of meconium in early-gestation human fetuses exposed to cocaine: Clinical implications. J Pediatr 124: 477–479
Jacob P III, Lewis ER, Elias-Baker BA, Jones RT (1990) A pyrolysis product, anhydroecgonine methyl ester (methylecgonidine), is in the urine of cocaine smokers. J Anal Toxicol 14: 353–357
Lobl JK, Carbone LD (1992) Emergency management of cocaine intoxication. Counteracting the effects of today’s ‘favorite drug’. Postgrad Med 91: 161–166
Shanti CM, Lucas CE (2003) Cocaine and the critical care challenge. Crit Care Med 31: 1851–1859
Catravas JD, Waters IW, Walz MA, Davis WM (1977) Antidotes for cocaine poisoinign. N Engl J Med 297: 1238
Lange RA, Cigarroa RG, Yancy CW Jr, Willard JE, Popma JJ, Sills MN, McBride W, Kim AS, Hillis LD (1989) Cocaine-induced coronary-artery vasoconstriction. N Engl J Med 321: 1557–1562
Lange RA, Cigarroa RG, Flores ED, McBride W, Kim AS, Wells PJ, Bedotto JB, Danziger RS, Hillis LD (1990) Potentiation of cocaine-induced coronary vasoconstriction by β-adrenergic blockage. Ann Intern Med 112: 897–903
Pitts WR, Lange RA, Cigarroa JE, Hillis LD (1997) Cocaine-induced myocardial ischemia and infarction: Pathophysiology, recognition, and management. Prog Cardiovasc Dis 40: 65–76
McCord J, Jneid H, Hollander JE, de Lemos JA, Cercek B, Hsue P, Gibler WB, Ohman EM, Drew B, Philippides G, Newby LK (2008) Management of cocaine-associated chest pain and myocardial infarction: A scientific statement from the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. Circulation 117: 1897–1907
Williams RG, Kavanagh KM, Teo KK (1996) Pathophysiology and treatment of cocaine toxicity: Implications for the heart and cardiovascular system. Can J Cardiol 12: 1295–1301
Hoffman RS, Smilkstein MJ, Goldfrank LR (1990) Whole bowel irrigation and the cocaine body-packer: A new approach to a common problem. Am J Emerg Med 8: 523–527
Hoffman RS, Chiang WK, Weisman RS, Goldfrank LR (1990) Prospective evaluation of “crackvial” ingestions. Vet Hum Toxicol 32: 164–167
Martell BA, Mitchell E, Poling J, Gonsai K, Kosten TR (2005) Vaccine pharmacotherapy for the treatment of cocaine dependence. Biol Psychiatry 58: 158–164
Kosten TR, Rosen M, Bond J, Settles M, Roberts JS, Shields J, Jack L, Fox B (2002) Human therapeutic cocaine vaccine: Safety and immunogenicity. Vaccine 20: 1196–1204
Fox BS, Kantak KM, Edwards MA, Black KM, Bollinger BK, Botka AJ, French TL, Thompson TL, Schad VC, Greenstein JL, Gefter ML, Exley MA, Swain PA, Briner TJ (1996) Efficacy of a therapeutic cocaine vaccine in rodent models. Nat Med 2: 1129–1132
Koetzner L, Deng S, Sumpter TL, Weisslitz M, Abner RT, Landry DW, Woods JH (2001) Titer-dependent antagonism of cocaine following active immunization in rhesus monkeys. J Pharmacol Exp Ther 296: 789–796
Norman AB, Tabet MR, Norman MK, Buesing WR, Pesce AJ, Ball WJ (2007) A chimeric human/murine anticocaine monoclonal antibody inhibits the distribution of cocaine to the brain in mice. J Pharmacol Exp Ther 320: 145–153
Paula S, Tabet MR, Farr CD, Norman AB, Ball WJ Jr (2004) Three-dimensional quantitative structure-activity relationship modeling of cocaine binding by a novel human monoclonal antibody. J Med Chem 47: 133–142
Norman AB, Norman MK, Buessing WR, Tabet MR, Tsibulsky VL, Ball WJ (2009) The effect of a chimeric human/murine anti-cocaine monoclonal antibody on cocaine self-administration in rats. J Pharmacol Exp Ther 328: 873–881
Gao D, Narasimhan DL, Macdonald J, Brim R, Ko MC, Landry DW, Woods JH, Sunahara RK, Zhan CG (2009) Thermostable variants of cocaine esterase for long-time protection against cocaine toxicity. Mol Pharmacol 75: 318–323
Gao Y, LaFleur D, Shah R, Zhao Q, Singh M, Brimijoin S (2008) An albumin-butyryl-cholinesterase for cocaine toxicity and addiction: Catalytic and pharmacokinetic properties. Chem Biol Interact 175: 83–87
Jutkiewicz EM, Baladi MG, Cooper ZD, Narashimhan D, Sunahara RK, Woods JH (2008) A bacterial cocaine esterase protects against cocaine-induced epileptogenic activity and lethality. Ann Emerg Med, in press
Mets B, Winger G, Cabrera C, Seo S, Jamdar S, Yang G, Zhao K, Briscoe RJ, Almonte R, Woods JH, Landry DW (1998) A catalytic antibody against cocaine prevents cocaine’s reinforcing and toxic effects in rats. Proc Natl Acad Sci USA 95: 10176–10181
Zheng F, Zhan CG (2008) Structure-and-mechanism-based design and discovery of therapeutics for cocaine overdose and addiction. Org Biomol Chem 6: 836–843
Patrick KS, Straughn AB, Perkins JS, Gonzalez MA (2009) Evolution of stimulants to treat ADHD: Transdermal methylphenidate. Hum Psychopharmacol 24: 1–17
Sever PS, Caldwell J, Dring LG, Williams RT (1973) The metabolism of amphetamine in dependent subjects. Eur J Clin Pharmacol 6: 177–180
Takekawa K, Ohmori T, Kido A, Oya M (2007) Methamphetamine body packer: Acute poisoning death due to massive leaking of methamphetamine. J Forensic Sci 52: 1219–1222
Molina NM, Jejurikar SG (1999) Toxicological findings in a fatal ingestion of methamphetamine. J Anal Toxicol 23: 67–68
Logan BK, Fligner CL, Haddix T (1998) Cause and manner of death in fatalities involving methamphetamine. J Forensic Sci 43: 28–34
Lan KC, Lin YF, Yu FC, Lin CS, Chu P (1998) Clinical manifestations and prognostic features of acute methamphetamine intoxication. J Formos Med Assoc 97: 528–533
Chan P, Chen JH, Lee MH, Deng JF (1994) Fatal and nonfatal methamphetamine intoxication in the intensive care unit. J Toxicol Clin Toxicol 32: 147–155
McKetin R, McLaren J, Lubman DI, Hides L (2006) The prevalence of psychotic symptoms among methamphetamine users. Addiction 101: 1473–1478
Nixon AL, Long WH, Puopolo PR, Flood JG (1995) Bupropion metabolites produce false-positive urine amphetamine results. Clin Chem 41: 955–956
Segal DS, Kuczenski R (1997) An escalating dose “binge” model of amphetamine psychosis: Behavioral and neurochemical characteristics. J Neurosci 17: 2551–2566
Thurman EM, Pedersen MJ, Stout RL, Martin T (1992) Distinguishing sympathomimetic amines from amphetamine and methamphetamine in urine by gas chromatogrphy/mass spectrometry. J Anal Toxicol 16: 19–27
Zimmerman JL (2003) Poisonings and overdoses in the intensive care unit: General and specific management issues. Crit Care Med 31: 2794–2801
Richards JR, Bretz SW, Johnson EB, Turnipseed SD, Brofeldt BT, Derlet RW (1999) Methamphetamine abuse and emergency department utilization. West J Med 170: 198–202
Richards JR, Johnson EB, Stark RW, Derlet RW (1999) Methamphetamine abuse and rhabdomyolysis in the ED: A 5-year study. Am J Emerg Med 17: 681–685
Byrnes-Blake KA, Laurenzana EM, Carroll FI, Abraham P, Gentry WB, Landes RD, Owens SM (2003) Pharmacodynamic mechanisms of monoclonal antibody-based antagonism of (+)-methamphetamine in rats. Eur J Pharmacol 461: 119–128
Gentry WB, Laurenzana EM, Williams DK, West JR, Berg RJ, Terlea T, Owens SM (2006) Safety and efficiency of an anti-(+)-methamphetamine monoclonal antibody in the protection against cardiovascular and central nervous system effects of (+)-methamphetamine in rats. Int Immunopharmacol 6: 968–977
Gentry WB, Rüedi-Bettschen D, Owens SM (2009) Development of active and passive human vaccines to treat methamphetamine addiction. Hum Vaccin 5: 206–213
McMillan DE, Hardwick WC, Li M, Gunnell MG, Carroll FI, Abraham P, Owens SM (2004) Effects of murine-derived anti-methamphetamine monoclonal antibodies on (+)-methamphetamine self-administration in the rat. J Pharmacol Exp Ther 309: 1248–1255
Hutchings DE, Brake SC, Banks AN, Nero TJ, Dick LS, Zmitrovich AC (1991) Prenatal Δ9-tetrahydrocannabinol in the rat: Effects on auditory startle in adulthood. Neurotoxicol Teratol 13: 413–416.
Razdan RK (1986) Structure-activity relationships in cannabinoids. Pharmacol Rev 38: 75–149
Hollister LE (1974) Structure-activity relationships in man of cannabis constituents, and homologs and metabolites of Δ9-tetrahydrocannabinol. Pharmacology 11: 3–11
Lemberger L, McMahon R, Archer R, Matsumoto K, Rowe H (1974) Pharmacologic effects and physiologic disposition of Δ6a, 10a dimethyl heptyl tetrahydrocannabinol (DMHP) in man. Clin Pharmacol Ther 15: 380–386
Perez-Reyes M, Owens SM, Di GS (1981) The clinical pharmacology and dynamics of marihuana cigarette smoking. J Clin Pharmacol 21: 201S–207S
Robson P (2005) Human studies of cannabinoids and medicinal cannabis. Handb Exp Pharmacol 719–756
Williamson EM, Evans FJ (2000) Cannabinoids in clinical practice. Drugs 60: 1303–1314
Mechoulam R, Carlini EA (1978) Toward drugs derived from cannabis. Naturwissenschaften 65: 174–179
Bech P, Rafaelsen L, Rafaelsen OJ (1974) Cannabis: A psychopharmacological review. Dan Med Bull 21: 106–120
Thomas R, Chesher G (1973) The pharmacology of marihuana. Med J Aust 2: 229–237
Nahas GG (1986) Cannabis: Toxicological properties and epidemiological aspects. Med J Aust 145: 82–87
Johansson EK, Hollister LE, Halldin MM (1989) Urinary elimination half-life of Δ1-tetrahydrocannabinol-7-oic acid in heavy marijuana users after smoking. NIDA Res Monogr 95: 457–458
Leweke FM, Gerth CW, Klosterkotter J (2004) Cannabis-associated psychosis: Current status of research. CNS Drugs 18: 895–910
Johns A (2001) Psychiatric effects of cannabis. Br J Psychiatry 178: 116–122
Marcus AM, Klonoff H, Low M (1974) Psychiatric status of the marihuana user. Can Psychiatr Assoc J 19: 31–39
Hochman JS, Brill NQ (1971) Marijuana intoxication: Pharmacological and psychological factors. Dis Nerv Syst 32: 676–679
Thacore VR, Shukla SR (1976) Cannabis psychosis and paranoid schizophrenia. Arch Gen Psychiatry 33: 383–386
MacInnes DC, Milleer KM (1984) Fatal coronary artery thrombosis associated with cannabis smoking. J R Coll Gen Pract 34: 575–576
Vaziri ND, Thomas R, Sterling M, Seiff K, Pahl MV, Davila J, Wilson A (1981) Toxicity with intravenous injection of crude marijuana extract. Clin Toxicol 18: 353–366
Nihira M, Hayashida M, Ohno Y, Inuzuka S, Yokota H, Yamamoto Y (1998) Urinalysis of body packers in Japan. J Anal Toxicol 22: 61–65
Osterwalder JJ (1995) Patients intoxicated with heroin or heroin mixtures: How long should they be monitored? Eur J Emerg Med 2: 97–101
Voytek B, Berman SM, Hassid BD, Simon SL, Mandelkern MA, Brody AL, Monterosso J, Ling W, London ED (2005) Differences in regional brain metabolism associated with marijuana abuse in methamphetamine abusers. Synapse 57: 113–115
Forney R, Martz R, Lemberger L, Rodda B (1976) The combined effect of marihuana and dextroamphetamine. Ann NY Acad Sci 281: 162–170
Wall ME, Brine DR, Pitt CG, Perez-Reyes M (1972) Identification of Δ9-tetrahydrocannabinol and metabolites in man. J Am Chem Soc 94: 8579–8581
DiGregorio GJ, Sterling GH (1987) Marijuana pharmacology and urine testing. Am Fam Physician 35: 209–212
Huestis MA, Cone EJ (1998) Differentiating new marijuana use from residual drug excretion in occasional marijuana users. J Anal Toxicol 22: 445–454
Cone EJ, Johnson RE (1986) Contact highs and urinary cannabinoid excretion after passive exposure to marijuana smoke. Clin Pharmacol Ther 40: 247–256
Stuyt EB, Sajbel TA, Allen MH (2006) Differing effects of antipsychotic medications on substance abuse treatment patients with co-occurring psychotic and substance abuse disorders. Am J Addict 15: 166–173
Berk M, Brook S, Trandafir AI (1999) A comparison of olanzapine with haloperidol in cannabis-induced psychotic disorder: A double-blind randomized controlled trial. Int Clin Psychopharmacol 14: 177–180
Baldridge EB, Bessen HA (1990) Phencyclidine. Emerg Med Clin North Am 8: 541–550
Burns RS, Lerner SE (1976) Perspectives: Acute phencyclidine intoxication. Clin Toxicol 9: 477–501
McCarron MM (1986) Phencyclidine intoxication. NIDA Res Monogr 64: 209–217
Morgan JP, Solomon JL (1978) Phencyclidine. Clinical pharmacology and toxicity. NY State J Med 78: 2035–2038
Bronner W, Nyman P, von Minden D (1990) Detectability of phencyclidine and 11-nor-Δ9-tetrahydrocannabinol-9-carboxylic acid in adulterated urine by radioimmunoassay and fluorescence polarization immunoassay. J Anal Toxicol 14: 368–371
Burns RS, Lerner SE (1978) Causes of phencyclidine-related deaths. Clin Toxicol 12: 463–481
Owens SM, Gunnell M, Laurenzana EM, Valentine JL (1993) Dose-and time-dependent changes in phencyclidine metabolite covalent binding in rats and the possible role of CYP2D1. J Pharmacol Exp Ther 265: 1261–1266
Baskin LB, Morgan DL (1997) Drugs detected in patients suspected of acute intoxication. Tex Med 93: 50–58
Fallis RJ, Aniline O, Weiner LP, Pitts FN Jr (1982) Massive phencyclidine intoxication. Arch Neurol 39: 316
McCann DJ, Winter JC (1986) Effects of phencyclidine, N-allyl-N-normetazocine (SKF-10,047), and verapamil on performance in a radial maze. Pharmacol Biochem Behav 24: 187–191
Rappolt RT Sr, Gay GR, Farris RD (1980) Phencyclidine (PCP) intoxication: Diagnosis in stages and algorithms of treatment. Clin Toxicol 16: 509–529
Walker S, Yesavage JA, Tinklenberg JR (1981) Acute phencyclidine (PCP) intoxication: Quantitative urine levels and clinical management. Am J Psychiatry 138: 674–675
Barton C H, Sterling ML, Vaziri ND (1980) Rhabdomyolysis and acute renal failure associated with phencyclidine intoxication. Arch Intern Med 140: 568–569
Bessen HA (1982) Intracranial hemorrhage associated with phencyclidine abuse. J Am Med Assoc 248: 585–586
Brecher M, Wang BW, Wong H, Morgan JP (1988) Phencyclidine and violence: Clinical and legal issues. J Clin Psychopharmacol 8: 397–401
Burns RS, Lerner SE, Corrado R, James SH, Schnoll SH (1975) Phencyclidine — States of acute intoxication and fatalities. West J Med 123: 345–349
Cogen FC, Rigg G, Simmons JL, Domino EF (1978) Phencyclidine-associated acute rhabdomyolysis. Ann Intern Med 88: 210–212
Eastman JW, Cohen SN (1975) Hypertensive crisis and death associated with phencyclidine poisoning. J Am Med Assoc 231: 1270–1271
McCarron MM, Schulze BW, Thompson GA, Conder MC, Goetz WA (1981) Acute phencyclidine intoxication: Clinical patterns, complications, and treatment. Ann Emerg Med 10: 290–297
Stein GY, Fradin Z, Ori Y, Singer P, Korobko Y, Zeidman A (2005) Phencyclidine-induced multiorgan failure. Isr Med Assoc J 7: 535–537
Stein JI (1973) Phencyclidine induced psychosis. The need to avoid unnecessary sensory influx. Mil Med 138: 590–591
ElSohly MA, Little TL Jr, Mitchell JM, Paul BD, Mell LD Jr, Irving J (1988) GC/MS analysis of phencyclidine acid metabolite in human urine. J Anal Toxicol 12: 180–182
ElSohly MA, Stanford DF (1990) Cutoff of 25 ng/mL for the EMIT d.a.u. phencyclidine assay. J Anal Toxicol 14: 192–193
McCarron MM, Walberg CB, Soares JR, Gross SJ, Baselt RC (1984) Detection of phencyclidine usage by radioimmunoassay of saliva. J Anal Toxicol 8: 197–201
Walberg CB, McCarron MM, Schulze BN (1983) Quantitation of phencyclidine in serum by enzyme immunoassay: Results in 405 patients. J Anal Toxicol 7: 106–110
Grover D, Yeragani VK, Keshavan MS (1986) Improvement of phencyclidine-associated psychosis with ECT. J Clin Psychiatry 47: 477–478
Lahmeyer HW, Stock PG (1983) Phencyclidine intoxication, physical restraint, and acute renal failure: Case report. J Clin Psychiatry 44: 184–185
Rappolt RT, Gay GR, Farris RD (1979) Emergency management of acute phencyclidine intoxication. J Am Coll Emerg Physicians-JACEP 8: 68–76
Hardin JS, Wessinger WD, Wenger GR, Proksch JW, Laurenzana EM, Owens SM (2002) A single dose of monoclonal anti-phencyclidine IgG offers long-term reductions in phencyclidine behavioral effects in rats. J Pharmacol Exp Ther 302: 119–126
Laurenzana EM, Gunnell MG, Gentry WB, Owens SM (2003) Treatment of adverse effects of excessive phencyclidine exposure in rats with a minimal dose of monoclonal antibody. J Pharmacol Exp Ther 306: 1092–1098
Proksch JW, Gentry WB, Owens SM (2000) The effect of rate of drug administration on the extent and time course of phencyclidine distribution in rat brain, testis, and serum. Drug Metab Dispos 28: 742–747
Valentine JL, Arnold LW, Owens SM (1994) Anti-phencyclidine monoclonal Fab fragments markedly alter phencyclidine pharmacokinetics in rats. J Pharmacol Exp Ther 269: 1079–1085
Valentine JL, Mayersohn M, Wessinger WD, Arnold LW, Owens SM (1996) Antiphencyclidine monoclonal Fab fragments reverse phencyclidine-induced behavioral effects and ataxia in rats. J Pharmacol Exp Ther 278: 709–716
Valentine JL, Owens SM (1996) Antiphencyclidine monoclonal antibody therapy significantly changes phencyclidine concentrations in brain and other tissues in rats. J Pharmacol Exp Ther 278: 717–724
Pitas G, Laurenzana EM, Williams DK, Owens SM, Gentry WB (2006) Anti-phencyclidine monoclonal antibody binding capacity is not the only determinant of effectiveness, disproving the concept that antibody capacity is easily surmounted. Drug Metab Dispos 34: 906–912
Proksch JW, Gentry WB, Owens, SM (2000) Anti-phencyclidine monoclonal antibodies provide long-term reductions in brain phencyclidine concentrations during chronic phencyclidine administration in rats. J Pharmacol Exp Ther 292: 831–837
Lacy HM, Gunnell MG, Laurenzana EM, Owens, SM (2008) Engineering and characterization of a mouse/human chimeric anti-phencyclidine monoclonal antibody. Int Immunopharmacol 8: 1–11
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2010 Birkhäuser Verlag/Switzerland
About this chapter
Cite this chapter
Montoya, I.D., McCann, D.J. (2010). Drugs of abuse: management of intoxication and antidotes. In: Luch, A. (eds) Molecular, Clinical and Environmental Toxicology. Experientia Supplementum, vol 100. Birkhäuser Basel. https://doi.org/10.1007/978-3-7643-8338-1_15
Download citation
DOI: https://doi.org/10.1007/978-3-7643-8338-1_15
Publisher Name: Birkhäuser Basel
Print ISBN: 978-3-7643-8337-4
Online ISBN: 978-3-7643-8338-1
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)