Home' Australian Pharmacist : Australian Pharmacist September 2016 Contents Australian Pharmacist September 2016 I © Pharmaceutical Society of Australia Ltd.
David Clancy is a community pharmacist at
Westmead in Sydney, NSW.
‘Drugs take you to Hell, disguised as Heaven.’
Potential abuse from
unexpected sources (Part 3)
BY DAVID CLANCY MPS
This is the third and final part of a three
part series discussing and highlighting
that other prescription or OTC medications
besides narcotics can be abused.
To a certain degree, any medication
possessing psychoactive effects has
the potential for abuse if taken in large
These drugs can include:
Cough and cold preparations
Muscle relaxants and
Caution is exercised well by practitioners
and pharmacists with narcotics.
However, these other drugs may not
receive adequate attention. They can
easily slip by unnoticed; viewed as
innocuous and necessary therapy.
Indeed the majority of these drugs are
taken appropriately by patients except
for those few individuals where vigilance
may be deemed necessary.
As no adequate formal reporting
mechanism exists for these products,
the incidence of abuse is unquantifiable
even though it is known to occur.
A yard-stick measurement for abuse
is the increase in presentation at
emergency departments by patients for
these drugs. An increased incidence and
frequency of nonmedical use is evident.
While the majority of Schedule 4
prescriptions and over-the-counter
(OTC) medications are taken
appropriately, abuse of drugs for their
psychoactive effects occurs. Addicts
search for effects that include sedation,
hallucinations, increased energy,
euphoria and relaxation (SHEER).
Sedation – Taking advantage of
sedating effects, some will abuse
olanzapine, tricyclics, gabapentin,
baclofen, orphenadrine, and clonidine.
Stimulation – Stimulant effects are
achievable with pseudoephedrine,
tranylcypromine, bupropion, fluoxetine
Euphoria – Euphoric effects are
associated with anticholinergic agents
and tricyclic antidepressants.
Skeletal muscle relaxants
Baclofen is a GABA receptor agonist.
It can cause ataxia or excessive sedation in
doses greater than 80mg/day. Structurally
related to gamma hydroxybutyrate
(GBH), the ‘date rape’ drug, it can
produce euphoria, an increased sexual
drive, lowered inhibitions, drowsiness,
clumsiness, dizziness or headache,
sedation and amnestic properties.
In one report a group of adolescents
took between 60 mg and 300 mg of
baclofen with the result that 14 needed
hospitalisation and nine received
Baclofen with alcohol or benzodiazepines
greatly increases the chance of
overdose. Baclofen with amphetamines
or ecstasy puts an enormous strain on
the body and the risk of seizures.
Orphenadrine is abused in high doses
to produce pleasant disperceptions and
mood enhancement. It has euphoric
effects. When overdosed, orphenadrine
is toxic and typically induces
amounts of diphenhydramine and
8-chlorotheophylline) in large doses
produces psychotropic effects.
Drug users prefer it for its hallucinogenic
and euphoric effects while psychiatric
patients desire its anxiolytic
and anticholinergic properties.
Dimenhydrinate is an H1 receptor
agonist which interacts additionally
with acetylcholine, norepinephrine,
serotonin, opioid and adenosine
receptors. Due to this, concerns arise
even in patients taking correct dosages.
Promethazine is a histamine(H1)
receptor antagonist, muscarine
(M1) antagonist and dopamine (D2)
antagonist used as a sedative and
antiemetic, often in conjunction
with opioids but has relatively little
dopamine antagonist activity compared
to the phenothiazine antipsychotics.
Abuse of cough mixtures containing
codeine and promethazine occur in
young adults to produce euphoric
effects and self-medication for coping
Purple Drank is an addictive drink made
up by the drug abuser. The primary
intoxicating ingredient is promethazine
mixed with Sprite or Mountain Dew.
‘Swooning euphoria’ is the resultant
high and the concoction is nicknamed
‘Lean’ as it can cause some people to
feel they need to lean on objects for
support. Common signs displayed by a
user will include slurred speech, blurred
vision, euphoria, sedation, drowsiness,
impaired motor skills, lethargy and
dissociation from one’s body.
Donald Lyn Frost
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