Salvia divinorum

Background: Salvia divinorum belongs to the mint family, it is a perennial that is often used due to its hallucinogenic effects. This plant is found in Mexico, more specifically the Sierra Mazatec region in Oaxaca. This plant was used in rituals by the Native Mazatec people as a means of ‘medical divination’. They used salvia to treat illness and symptoms that were caused by spiritual means or by evil sorcerers. Salvia would also be used for spiritual and learning purposes through religious leaders using it to induce ‘shamanic visions’

Slang terms

https://www.wwf.org.mx/que_hace mos/programas/oaxaca/

Ska Pastora Shepherdess’s Herb ska Maria Pastora yerba de Maria

Sally-D Magic Mint Sage of the Seers https://www.emcdda.europa.eu/publications/drugprofiles/salvia_en https://psychonautwiki.org/wiki/Salvia_divinorum

Pharmacology/Drug Effects: Salvia contains a compound names Salvinorin A, which is a selective full agonist of the kappa-opioid receptor. Binding to this receptor is the main cause of the hallucinogenic side effects of salvia; this is interesting as other hallucinogens often bind to serotonin receptors. Some of the most common symptoms people face while using salvia, include vivid and random hallucinations, inability to distinguish time and location, and in some cases can cause psychotic disturbances. After the hallucinations wear off, users often feel dizzy, exhausted and sometimes have no memory of the time they were hallucinating.

Drug Interactions/Toxicology: As of now there is limited information regarding any drug interactions with Salvia divinorum, more tests need to be done in order to see whether it is contraindicated along with other therapies. In terms of its toxicity, there has been no documented case of death directly as a result of Salvia divinorum use.

Laws: Salvia is not approved for medical use in the US and is not controlled under the Controlled Substance Act. There are individual states that have decided to control salvia. Due to its lake of control, there are many online sites and individual producers who advertise Salvia as a legal alternative to other hallucinogenic drugs.

Monitoring/Drug Screens: Salvia’s subtypes like hispanica and miltiorrhiza are considered as plants and are completely legal. Salvia Divinorum is not commonly tested for on standard drug tests. Most times you would need to request a specially ordered, very expensive, test to detect it. It is difficult to test for it as it does not show up in sweat and we don’t have a way to test for it in hair. The only ways to test for it are through urine, spit and blood tests. Another limitation on testing is that it does not last very long in the body, there are minimal studies determining the exact amount of time it lasts in the body as well.

Professional Opinion: Salvia divinorum is a plant rooted in the history of the native Mazatec people While it may still be used in religious rituals for certain groups of people, recreational use of salvia is still questionable. The lack of studies around its use and potential of interactions are of concern, but we still haven’t come across a case where salvia has caused death. It should be up to the user to do their own research about salvia use and make an educated decision on whether or not to use it. -V.

Shankar

References

• Drug fact sheet: Salvia divinorum - dea.gov. https://www.dea.gov/sites/default/files/202006/Salvia%20Divinorum-2020_0.pdf. Accessed October 14, 2022.

• Salvia Divinorum. Erowid salvia divinorum (ska pastora) vault. https://www.erowid.org/plants/salvia/salvia.shtml. Accessed October 14, 2022.

• Cambron M. A comparison of historical and current use of salvia divinorum in the United States and Mexico. lakeforest.edu. https://www.lakeforest.edu/news/a-comparison-of-historical-and-current-useof-salvia-divinorum-in-the-united-states-and-mexico. Accessed October 14, 2022.

• Salvia Divinorum Drug Profile. emcdda.europa.eu. https://www.emcdda.europa.eu/publications/drugprofiles/salvia_en. Accessed October 14, 2022.

• LaNeve N. How long does salvia stay in your system? - columbus recovery center: Ohio Drug and Alcohol Rehab Facility. Columbus Recovery Center | Ohio Drug and Alcohol Rehab Facility.

https://www.columbusrecoverycenter.com/blog/longevity-of-salvia-in-your-system/. Published August 3, 2021. Accessed October 14, 2022.

Scopolamine Scopolamine

"Devil's Breath" "Devil's Breath"

https://www.theweek.co.uk/65068/devils-breath-one-of-the-most-dangerous-drugsin-the-world

Pharmacology and Drug Effects Pharmacology and Drug Effects

Scopolamine is an anticholinergic drug that is often used to help prevent and/or treat motion sickness, as well as postoperative nausea and vomiting. It works by competitively inhibiting muscarinic receptors, causing peripheral antimuscarinic effects as well as central sedative, antiemetic and amnestic effects. By prescription, this medication is available as a transdermal patch. However, this drug can also be administered via oral, intravenous and inhalation routes, which seem to be the common methods causing intoxication and overdoses. Toxic doses can present clinically as tachycardia, dry mouth, blurred vision disorientation and insomnia. It has been noted throughout different articles that high doses may result in hallucinogenic properties in addition to amnesia, which could leave someone incapacitated.

History and Background of Use

History and Background of Use

“Devil’s Breath”, more commonly referred to as scopolamine, originates from the flower of the borrachero shrub found most often within South America. Extracts from the seeds can be made into a powder, which is then referred to as burundanga. According to literature, native South Americans have used borrachero in spiritual rituals for hundreds of years. This drug is chemically similar to scopolamine, and is thought to have amnesic and hallucinogenic effects. Though there is not sufficient evidence to support this claim, it has been rumored that this drug has historically been used by the Nazis and Soviets as a “truth serum”, as well as being used to render victims incapacitated to perform robberies and sexually assault.

Slang Terms Slang Terms

Scopolamine

Devil's Breath

Transderm Scop

"Zombie Drug"

"Date-Rape Drug"

Burundanga

Drug Interactions

Drugs that are contraindicated with the use of scopolamine include potassium and potassium citrate, which can lead to an increased risk of GI irritation and ulcers.

Drugs that increase the risk of anticholinergic side effects: Revefenacin, Quetiapine, Amantadine

Drugs that can cause a reduced seizure threshold: Donepezil, Bupropion, Amifampridine

Drugs that may cause CNS depression: Methacholine, Oxybates

Laws

Scopolamine is not a controlled substance in the US, but requires a prescription. There are no other specific laws or regulations regarding the use of this drug.

Monitoring and Drug Screens

Scopolamine is not commonly included in drug screens since it is rarely used recreationally, however, it can be detected by urine toxicology tests. Though detection of this drug is possible, it is often challenging because it is fully excreted unchanged in the urine within only 12 hours of use.

Professional Opinion

In my professional opinion, I do not believe that there is sufficient evidence to support the addition of regulations to the prescribing of scopolamine. Though high doses of this drug are potentially dangerous, the misuse of scopolamine does not seem to be very prevalent. Additionally, very little evidence exists to prove that this drug is what is being used to commit these alleged crimes. While I do not think changes to the regulation of this medication should be made, I do believe that it would be beneficial to bring awareness to the adverse effects that this class of drug can cause.

-S. Pelnick

References References https://www.micromedexsolutions.c om/micromedex2/librarian/PFDefa ultActionId/evidencexpert.DoIntegra tedSearch? navitem=topHome&isToolPage=true # https://www.drugs.com/illicit/devil s-breath.html https://www.ncbi.nlm.nih.gov/pmc /articles/PMC5429053/ https://www.theweek.co.uk/65068/ devils-breath-one-of-the-mostdangerous-drugs-in-the-world Devil’s Breath: Why Scopolamine Abuse is So Terrifying. Northpoint Washington. Published May 9, 2019. https://www.northpointwashington. com/blog/devils-breathscopolamine-abuse-terrifying/ Inc MP. Scopolamine - Mylan Pharmaceuticals Inc., Page 4. RxDrugLabels.com. Accessed November 9, 2022. https://rxdruglabels.com/lib/rx/rx -meds/scopolamine/page/4/

Micromedex Products. Micromedexsolutions.com. Published 2019.

Drugs.com. Devil’s Breath: Urban Legend or the World’s Most Scary Drug? Drugs.com. Published September 7, 2015.

Reichert S, Lin C, Ong W, Him CC, Hameed S. Million dollar ride. Canadian Family Physician. 2017;63(5):369-370. Accessed November 9, 2022.

“Devil’s breath”: one of the world’s most dangerous drugs?. The Week UK. Accessed November 9, 2022.

Toad Venom (5-MeO-DMT)

Fall 2022

BY MARIA TAN, Studentpharmacist

History and Background:

A species of toad, Bufo Alvarius, native to the Sonoran Desert produces a psychoactive chemical, 5-methoxy-N,Ndimethyltryptamine, or 5-MeO-DMT.1 5MeO-DMT is a tryptamine that also naturally occurs in seeds, bark, and leaves in the Amazonian rainforest. The chemical was mainly consumed by licking the toad’ s back, but for many years now, shamans in Mexico and southwest US have been collecting the venom, make it into a dry paste, and smoking the venom. Five minutes after ingestion of the substance, the hallucinogenic effect takes place that causes a hour long trip.

Laws:

5-MeO-DMTisa

ScheduleIcontrolled substanceintheUS. Thereisa10-yearprison sentenceforpossession of5-MeO-DMT.

Slang Terms:

Toad Venom, Cane Toad, Colorado River Toad, Sonoran Desert Toad, and Otac (the venom).

Pharmacology Drug Effects:

5-MeO-DMT is a non-selective serotonin (5-HT) receptor agonist.4 It has the highest affinity for the 5-HT1A subtype. The substance can cause decreased locomotor activity, investigatory behavior, and disturbed thalamocortical oscillations, which are behaviors selective to 5-HT1A receptor activation. The effects of this substance are like other tryptamine psychedelics such as psilocybin and DMT. Toad venom can cause effects like visual, auditory, and time perception distortions, memory impairment, and emotional experiences.

Drug Interactions/Toxicology:

There are only a few studies of 5-MeO-DMT in rodents and animals. In mice , administering 5-MeO-DMT with a low dose of monoamine oxidase inhibitor blocks MAOA-dependent elimination. In rodent studies,therewerepotentialdruginteractionswithTHC,mitragynine, lithium, haloperidol, benzodiazepines, and antidepressants. There are studies of 5-MeO-DMT toxicity in rodents, cats, sheep, and monkeys; high doses can cause ataxia, mydriasis, lateral head weaving, head nodding, tremors, shivering, convulsions, tachycardia, loss of consciousness,andrespiratoryfailure.

Professional Opinion:

I think that there is not enough research and data on toad venom. Although, there are a few articles suggesting toad venom's anticancer qualities and ability to treat depression. There needs to be more studies conducted on the substance. I do not think it should be used recreationally. The outcomes could be detrimental to one's health.

~ M. Tan

Colorado river toad by GETTY on February 2, 2020 https://www.forbes.com/sites/davidcarpenter/2020/02/02/5-meo-dmt-the-20minute-psychoactive-toad-experience-thats-transforming-lives/?sh=25f73c2e38a1

Monitoring/Drug Screening:

There are no clinical studies on toad venom suggesting the importance of monitoring and screening. The Hofmann DMTspotkitcanidentify5-MeO-DMT.

References

Psychoactive toad venom. Erowid. Updated February 28, 2020. Accessed October 9, 2022. https://www.erowid.org/animals/toads/toads.shtml

Reckweg JT, Uthaug MV, Szabo A, et al. The clinical pharmacology and potential therapeutic applications of 5methoxy-N,N-dimethyltryptamine (5-MeO-DMT). J Neurochem. 2022;162(1):128-146. doi:10.1111/jnc.15587

Hilliard, Jena. Psychedelic toad venom is the new trendy hallucinogen. Addiction Center. Published October 11, 2019. Accessed October 9, 2022. https://www.addictioncenter.com/news/2019/10/trendy-psychedelic-toad-venom/ Ermakova AO, Dunbar F, Rucker J, Johnson MW. A narrative synthesis of research with 5-MeO-DMT. J Psychopharmacol. 2022;36(3):273-294. doi:10.1177/02698811211050543

Li FJ, Hu JH, Ren X, Zhou CM, Liu Q, Zhang YQ. Toad venom: A comprehensive review of chemical constituents, anticancer activities, and mechanisms. Arch Pharm (Weinheim). 2021;354(7):e2100060. doi:10.1002/ardp.202100060

Wormwood

“green ginger, madder wort, wormwood sage”

Savanna Thompson, Student Pharmacist Fall 2022

What is It?

An extract and main ingredient in absinthe, a toxic liquor that causes “absinthism”

Absinthism is a syndrome characterized by addiction, hallucinations, brain damage, epilepsy, GI problems, and increased risk of psychiatric illness and suicide

Pharmacology thujone, the volatile oil component of wormwood →produces excitement

→is strong convulsant

Dosage Forms

Available in essential oil, capsule, tablet, tincture, and aqueous extract https://www.verywellhealth.com/wormwood-5082001

Use and Abuse

This perennial herb has been used for thousands of years with multiple indications including use as a(n)

1. antiparasitic

2. component of alcoholic beverages https://substanceabusepolicy.biomedcentral.com/ articles/10.1186/1747-597X-1-14

3. “general remedy for all diseases” in the Middle Ages.

Botanical Aspects: Artemisia absinthium (wormwood) is a perennial herb with a strong sage order that blooms annually between July to September.

History of the “Green Fairy”

• In B.C. times, wine-soaked wormwood leaves were used to alleviate labor pains, menstrual cramps, and rheumatism.

• A bitter spirit containing wormwood is called absinthe and was such a popular drink in the late 19th century in Europe that numerous bars and cafes would have “green hour” and famous artists such as Van Gogh would paint while indulging in the hour.

• In the 20th century, severe neurological disorders were found among the heaviest consumers of the absinthe.

Still Life with absinthe (Paris 1887) by Vincent https://

van Gogh

substanceabusepolicy.biomedcentral.com /articles/ 10.1186/1747-597X-1-14

Interactions and Toxicity

• The toxic component of wormwood is attributed to the volatile oil of Artemisia absinthium which stimulates the CNS system in such a way that it may cause damage, mental deterioration, and even seizures.

• The toxicity of this essential oil is predominantly caused by the toxic ketone monoterpene β-thujone component of the essential oil from the herb.

May have negative drug Interactions with:

1.phenobarbital – by lowering seizure threshold

2.warfarin – may enhance coagulant effect

3. Proton pump inhibitors (PPIs), antacids, histamine receptor antagonists, and sucralfate - efficacy affected https://www.history.com/news/francesgreen-fairy-flies-again

Potential Drug Effects

1. reducing inflammation such as in Crohn’s disease & arthritis (more research needed)

2. reducing pain - bellieved to have antioxidants

3. improving digestion - such as heartburn and constipation

HOWEVER, the FDA classifies wormwood as unsafe for internal use unless thujone free!

Professional Opinion

Consumption of wormwood should be avoided unless used as a last line treatment for a condition that has failed all other treatment methods. Risks greater than benefits

~ S. Thompson

Drug Screening

Wormwood will only show up on a drug test if it contains thujone

Unlikely to produce a positive test unless person consumed absinthe https:// substanceabusepolicy.biomedce ntral.co m/ articles/10.1186/1747-597X-1-14

Laws and Prohibitions in the USA

• Only thujone-free absinthe is legal in the U.S.

• This is referred to as “American Absinthe” and must contain less than 5-10ppm (10mg/L).

• Note: this is nowhere near what pre-ban absinthe used to be that was known for its hallucinogenic and dangerous nature

→ pre-ban absinthe as high as 260mg/L

References

1. Wormwood. Lexi-Drugs. Lexicomp. Wolters Kluwer Health Inc. RIverwoods, IL. Accessed October 13, 2022. http://online.lexi.com

2. Curtis L. What is Wormwood? Verywell Health. https://www.verywellhealth.com/wormwood-5082001. Accessed October 13, 2022.

3. Artemisia absinthium. Artemisia Absinthium - an overview | ScienceDirect Topics. https://www.sciencedirect.com/topics/agricultural-andbiological-sciences/artemisia-absinthium. Accessed October 13, 2022.

4. Padosch SA, Lachenmeier DW, Kröner LU. Absinthism: A fictitious 19th century syndrome with present impact - substance abuse treatment, prevention, and policy. BioMed Central. https://substanceabusepolicy.biomedcentral.com/articles/10.1186/1747-597X-1-14. Published May 10, 2006. Accessed October 13, 2022.

5. Fairy GA. Illegal absinthe - absinthe legal status in the United States. Absinthe Original. https://www.originalabsinthe.com/absinthe-blog/ absinthe-united-states-legal-status.html. Published September 30, 2021. Accessed October 13, 2022.

Yohimbe

YasasviObeyesekera, StudentPharmacist

Fall2022 https://www.nccih.nih.gov/health/yohimbe

History/Background

Yohimbe,anherbalsupplement,ismadefromanevergreen treebarknativetocentralandwesternAfrica.Traditionally, yohimbine,acoumpundfoundinthebarkisusedtotreat erectilydysfunction,lowsexdriveinwomen,orunwatedsexual sideffectsofantidepressentmedications.Yohimbeisalso promotedasanaphrodisiacandusedforfatigue,highblood pressure,diabeticneuropathy,andheartproblems.Thereare reportsofpatientsusingyohimbetoincreaseathletic performanceorloseweight.

Yobimbinehydrocholifde,astarndardizedformofyohimbine, isavailableintheUnitedStatesasanFDAprescriptiondrug. However,thisproductisdifferentfromthedietarysupplement, yohimbe.Yohimbeisanunproved,unstudiedtreatmentwith nostandarddosethathaslesskeycomponentsandbenefits.

1. 3.

SlangTerms

ThereareseveralnamesforYohimbe: aphrodien,corynantheyohimbi, corynine,johimbi,Pausinystalia yohimbe,andquebrachine.

Phamacology

Theexactmechanismforusehasnotbeenfullystudied. However,ithasbeenconcludedthatYohimbeworksby blockingalpha-2aderbergicreceptorsthatinhibition erectionswhilesimultaniouslyactingasasympatholyticand stimulatingnervecentersinthespine,therebyimproving capacityforerectionwithoutincreasingsexualexcitement.

Yohimeisalsothorughtopromotethereleaseofnitricoxide thatcanleadtodilationofbloodvesselsandincreasedblood flowtosexualorgans.Theincreaseinsympatheticdrivealso increasesnorepinephrinereleaseandfiringrateofcellsinthe brainfordopamine,serotonin,andcholinergicreceptors.

https://www.amazon.c om/Puritans-PrideYohimbe-2000Count/dp/B004R671O6

2. 4.

DrugEffects

Some side effects include skin flushing, rash, agitation, anxi insomnia, dizziness, rapid heartbeat, increased urination, headache, nausea, and vomiting.

There are more serious risks associated with yohimbe including chest pain, heart attack, atrial fibrillation, kidney failure, and seizures. High doses have been shown to cause breathing problems, paralysis, low blood pressure, heart failure, and death.