Dear MEDTOX DARS Journal Reader,

Well, we here at the DARS Journal don't know where time went, but 2011 has certainly come and gone. It was an eventful year in a number of different ways. First, we collectively weathered a rapid expansion in the use of the designer drugs K2 and Spice. The synthetic cannabinoids circulated the United States in all shapes and sizes. Not far behind them were the bath salts and plant food drugs. All of the drugs are quite nasty, all inherently dangerous. Emergency rooms reported serious complications from the use of these drugs; a large number of users died from their experimentation. Fortunately, the government agencies that regulate and monitor drug use moved responsibly and swiftly to enact bans on these substances. Nonetheless, the manufacturers of these substances press on; bath salt abuse in particular has not abated in the face of government's legislation efforts.

Prescription drug abuse is still rampant, particularly abuse of prescription opioids. In fact, opioid drug overdoses claim more lives in America now than drunk and drugged drivers. The diversion of powerful narcotics has led to new user experimentation with heroin. Ironically, heroin is cheaper and generally more affordable for users; prescription opiates such as Oxycontin and MS Contin command stiff prices on the street. And then of course there's Suboxone (buprenorphine), an allegedly non-abusable drug. Designed and fashioned to assist physicians with the detoxification of opiate addicts, Suboxone itself has morphed into an abused drug in its own right. The substance abuse phenomenon is complicated, and is getting more complicated each day.

The Journal exists for the purpose of educating and informing our readers of pertinent information and events related to substance abuse, addiction, and dependency. To that end, Journal staff continually scours news and research outlets for relevant information that can be put to work immediately by you the reader. Taking this work further, the Journal has embarked on a new project that readers will see a lot of in 2012. Starting in January, MEDTOX will offer a series of short topic webinars that will focus on emerging issues that are important to our readers. These webinar workshops will be designed for substance abuse professionals, workplace drug and alcohol prevention supervisors, public safety personnel, emergency medical workers, and school and prevention counselors. Stay tuned to the Journal for announcements of the dates and times of these events.

Finally, from all of us at the Journal, please have a Merry Christmas and Happy Hanukkah. May you all have a blessed, safe, and peaceful holiday season. We'll see you all in 2012. Thank you for your readership and support.

The MEDTOX DARS Journal Writers and Editors

402 West County Road D

St. Paul, MN 55112

1-800-832-3244

Chronic cocaine abuse almost always leads to addiction and to the attendant social and health problems that ensue. High rates of relapse reflect the fact that cocaine has a unique capability to rewire and reroute important nervous system circuits in the brain. Cocaine induced changes to brain neurons are difficult to reverse and may take years to morph back into their preexisting natural condition. There are few proven drugs and pharmacotherapies available to treat cocaine induced brain rewiring. But now, there may be some hope on the horizon. A recently published report in the journal Nature on experimentation with light therapy has researchers and treatment professionals talking.  

Researchers in Switzerland at the University of Geneva focused on those parts of the brain where cocaine exerts its most profound effects, those areas dealing with pleasure, reward and motivation. Cocaine addicts devolve into patterns of frequent back-to-back dosing of the drug in order to maintain extended periods of euphoria. In doing so, cocaine hyper-energizes dopamine neurons, it over -excites them and puts them into extended periods of activation. This situation creates behavioral problems for the addict and causes him/her to experience powerful cravings that drive the desire to reuse the drug. Breaking this cycle and reversing the hyper-sensitization of the neurons might go a long way towards restoring a sense of normal brain activity.

Researchers used the power of optogenetics to spur new fields of neurons, nervous system circuits that could counteract the hyper-activated ones that were put into overdrive by cocaine. Prior research by Christian Luscher at the University of Geneva with light sensitive ion channels in algae had given researchers hope that by applying short bursts of intense light towards neurons in the nucleus accumbens the brain might suppress the neurons and slow their firing. In an unexpected twist, the experiment actually caused activity in an area of the brain called the cortex. By activation of the cortex slowed the firing of neurons in the accumbens. Ultimately, the effect of the bursts of light seemingly reversed the cocaine-induced changes in the brains of the mice.

When mice that had been given cocaine injections and were then treated with the light bursts, and then reintroduced to cocaine, their pre-sensitization to the drug was absent. These optogenetically "treated" mice were as jittery as they were when they were given the drug for the very first time. In essence, the polarizing effects of the original cocaine dosing had been reversed.

As time goes by with the addicted, the brain progresses through more and more complex change. And it may be possible that there is one key region that if neutralized or disrupted, there may be the potential to blunt the compulsive use of drugs in many types of addiction. Much more needs to be done in researching and evaluating the mechanisms that were discovered in this report, but it does stir a little Christmas-day-like excitement for professionals in the treatment community.

Wrapping up 2011 for the MEDTOX Journal is a drug of unusual characteristics and applications. It is a prescription drug, a controlled substance regulated under the terms of Schedule III. Physicians use this drug to treat narcolepsy and a related condition, cataplexy. Cataplexy is a particularly frightening condition; it is manifested by sudden muscle spasticity, or in the alternative, a near total loss of muscle tone and control. Cataleptic falls are dangerous incidents that can result in very serious injury. This month's mystery drug is quite effective in preventing those falls from happening.

This month's mystery drug has been legally deemed an "orphan drug." That means that this substance is a pharmaceutical product that has been developed for a rare medical condition. This drug helps treat a form of narcolepsy that very few people are diagnosed; therefore, the condition is considered an orphan disease. Pharmaceutical products procured for orphan diseases are produced through a special regulatory process that helps spur their development. Companies that manufacture these orphan drugs enjoy some preferential treatment by government agencies and to an extent, greater access to the research and development funding needed to bring the drug to market.

When diverted to the street, this month's drug becomes an insidious nuisance. Many recreational drug users and sexual predators have glommed on to this drug because of its unique intoxicating capabilities. In fact, out on the streets, this prescription drug product is available in an illicit formula created by clandestine drug cookers who flood the black market with the potion. Although there have been some notable cases of diversion of the pharmaceutical brand of this month's drug, by far the greatest impact on the drug using world has come from black market production of the drug. Both pharmaceutical and black market versions of this drug come in a clear, odorless liquid. Its bland constituency makes it an innocuous substance that is difficult to detect and identify.

This month's drug is considered to be a central nervous system depressant, an inhibitory transmitter. It works in a paradoxical fashion for people who suffer from excessive daytime sleepiness and manifestations of narcolepsy. For recreational drug users, the drug has profound sedating effects, yet at the same time it produces feelings of euphoria and sexual excitement that leads to a general lessening of inhibitions. In larger doses, the drug can cause catatonia, a state of near anesthesia where a user is almost incapable of speaking or moving. At high doses the drug can also cause amnesia. Users can go about any variety of physical acts and behaviors while intoxicated but become incapable of recalling any memory of what they had experienced while under the influence of the drug. Because of the drug's effects, it is a powerful and preeminent facilitator of sexual assault. As an odorless and clear liquid, this drug is nearly impossible to detect when it has been infused into a beverage. In a crowded nightclub, it is exceedingly easy for a perpetrator to pour a small amount of this month's drug into the drink of an unsuspecting victim. One of the notable characteristics of this month's drug is that it is quickly absorbed into the bloodstream. As an agent of drug facilitated sexual assault, this month's drug goes to work quickly and efficiently. Many rapes have occurred as a consequence of the illegal use of this drug.

Drug testing to detect traces of this month's drug in humans is complicated because the parent compound of the drug can be found as a naturally occurring transmitter in humans. Moreover, the drug is quickly metabolized and deconstructed into lesser-related compounds. In cases where it is rather certain that the drug was used as an anesthetic and amnesiac for a drug-facilitated sexual assault, drug test results are frequently inconclusive. Victims of this crime routinely realize their victimization many hours after the assault has occurred, and by then the forensic footprint of the drug has disappeared from blood, urine, and oral fluid.

This month's drug in both pharmaceutical and clandestine forms can be very addictive. Some years ago, this drug was a staple in health clubs and gyms in America. Especially for body builders who used steroids to amass strength and stamina. Anabolic steroids exact a heavy toll on the body builders who use them. For many, the inability to sleep and to relax is so disabling that they turn to this month's drug to come down from their steroid high. Early on, this drug appears to be a perfect counter effect to a body builder's "steroid syndrome." In products that had names like "RenewTrient", this month's drug was an ensnaring chemical monster. In short order, many weightlifters that used this drug became hopeless addicts. The direct effects of the drug were pleasant enough though. Because of fast-developing tolerance, users were compelled to escalate their dosages over time. The drug becomes an overwhelmingly powerful hypnotic.

Treating dependency and addiction to this month's drug is complicated. In fact, most drug detoxification centers are confused on the exact protocol that should be employed in treating the addicted patient. Withdrawals from the drug can be painful and dangerous, not unlike the symptoms seen with alcohol and barbiturate dependency. Withdrawal from the drug requires acute medical care. Ironically, in some countries this drug is used to treat the symptoms of patients who are undergoing painful alcohol withdrawals.

Recently, a pharmaceutical form of this drug was evaluated by the FDA for use in treating fibromyalgia, a soft tissue disease that can lead to widespread discomfort of skeletal muscle and connective tissue. The FDA declined to approve that application. Nonetheless, physicians frequently prescribe this month's drug for those patients who have more therapy-resistant forms of the disease.

Symptoms of intoxication associated with this month's drug are relatively straightforward. The drug can trigger profound cases of horizontal gaze nystagmus, vertical nystagmus, and non-convergence. Romberg clock and pulse will be slowed. Pupillary size and reaction to light should be near normal. Apart from the diagnostic yardsticks of DAR and DRE, evaluators may detect some more unusual, perhaps bizarre signs of its use. It is common for those who are intoxicated by this month's drug to be unable to talk. They may be unable to walk as a result of spastic muscles in the legs and back. They may also go through sudden movements and contortions with their arms and legs. Further, they may grimace and exhibit exaggerated facial expressions. Because of its great power as a central nervous system depressant, rarely does a recreational user become violent.

Click Here for this month's mystery drug.

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Thank you subscribers. We appreciate your dedicated readership. At MEDTOX we are committed to providing clients with the service and solutions you need to run successful drug testing programs. Our Journal is just one way that we show that commitment. We always encourage feedback from our Journal. Please send your thoughts to medtoxjournal@medtox.com.