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The Name that Drug column is happy to be back! This feature of the MEDTOX Journal was scheduled for discontinuation as of April 15, but because of appeals from readers, it has been given a reprieve. We will continue this feature of the Journal until the end of the 2012 calendar year, at which time it will be reevaluated. Until then, it's time for drug detective work!

This month's drug is another one of those substances that owes its existence to serendipity. First experimented with in 1931, the chemical basis of this month's drug was used as a starting point in the development of a new class of drugs designed to reduce muscle spasm. It was designed by a research chemist who was devoted to finding medicines that reduced the pain and suffering of children who were wheelchair bound by severe spastic conditions. In 1932, Otto Eislib had his drug. Or so he thought. Unfortunately, early experiments with this drug did not bear out its putative anti-spastic value. Like many other research chemicals of that same era, it was put out to pasture. But it was not over yet. Another enterprising researcher by the name of Otto Schaumann resurrected Eislib's work and took to further examination of the drug. And low and behold, further study revealed that the drug possessed morphine-like qualities as an analgesic. Perhaps the most interesting facet of the drug at that point was that the drug was a synthesized chemical, a drug that was not extracted or refined from opium. With World War II fast approaching, this month's drug held promise to combatants as an alternative analgesic to opium-based narcotics. It quickly underwent clinical study and evaluation.  

It is quite apparent that this month's drug is a narcotic analgesic drug. It's a synthetic opiate to be more precise. And if it were an automobile, it would be a corvette. This descriptor belies the drug's significant potency and power as an analgesic. Yet at the same time, the drug is speedy; it moves quickly through the central nervous system and the body. A significant clue as to its identity is that the drug's half-life is three hours; its span of analgesic effects is less than other narcotics. This fact among others led to an early belief that this narcotic was "safer" and less prone to abuse than other drugs of its day. In particular, when compared to morphine, hydromorphone, and heroin, this month's drug appeared to have fewer drawbacks. But like any narcotic that is an agonist of the mu opiate receptor, and this drug is a potent agonist at that, it poses a significant risk as a drug of abuse.  

In fact, this month's drug has had a rather checkered history as a recreational drug. It is a medication that is almost always diverted or stolen from pharmaceutical stores. It is produced as an oral tablet and as a solution for intramuscular injection. On the street, the drug can be crushed and snorted, or crushed and dissolved in water and then injected intravenously. But as recreational users have learned, the drug is caustic at the point of entry into the body. Bloody noses and ulcerating injection sites are often the leave behinds for this month's drug. In fact, even medically necessary intramuscular injections of this drug can leave behind painful bumps and lumps in connective tissue. Abusers of the drug exhibit some very tell-tale signs of use. Because of its shorter half life, addicts of this drug are forced to use it more often and at shorter intervals. Addicts quickly realize that surface skin areas needed for injection get used up quickly. In relative short order, unseemly areas of raised, sore skin evidence the fact that an addict is injecting this drug.  

As an analgesic, this month's drug is mostly found in use in hospitals. It is relatively rare to find the drug in an outpatient setting. Despite the drug's significant potency, it is not commonly found in pain management programs, although sometimes this drug is loaded into "pain pumps." In those instances, the drug is delivered into spinal fluid by means of an intrathecal catheter; it is not administered intramuscularly. Because of its more frequent utilization in hospitals, it should not be a surprise that medical personnel often become ensnared by this drug. In the 1960s and 1970s, anesthesiologists wrestled with the drug. But with the emergence of the fentanyls in the 1980s, medical abuse and diversion of this drug rapidly tapered.  

Called pethidine in many circles, this month's drug is prescribed and abused worldwide. In the United States it is a Schedule II narcotic. Known for toxic effects caused by the metabolites of this drug, other less onerous drugs are used in its place. In-hospital patients often exhibit unpleasant side effects while being administered this drug. As a result, physicians have a tendency to use the drug intermittently; rarely is the drug used continually over a protracted period of time.   

Known more commonly in the United States as meperidine, this drug costs approximately $25 for a 50 milligram pill on the street. In some larger American cities the drug can be purchased for half of that. Oddly enough, unlike most other drugs of its class, this drug has no recognized street name. It's called by its registered product name.

Click Here for this month's mystery drug. 

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The MEDTOX DAR Journal has devoted a great deal of time and print space to coverage of "bath salt" and "plant food" designer drug abuse. There has been a lot of movement by manufacturers of these novelty powders to avoid controlled substance laws of agitated state governments and the emergency bans of the DEA. New products that hail new "legal" formulas have hit the Internet and streets. Older first-in products continue to sell as well. Most of those concoctions have undergone formulaic change. Ironically, reports from the field tend to suggest that newer powder products are as strong if not stronger than the first generation illegal compounds that they replaced. Topping that dubious list is the "scouring powder" called "Pump-It." The Journal's Reports from the Field desk has received calls from readers and others who have communicated personal testimonies of havoc wreaked by the use of Pump-It Powder. This "not for human consumption" white or slightly pink powder is also described as bath salts, plant food, or glass cleaner. But in consideration of what Pump-It Powder does to its users, a classification as a "scouring powder" seems to be quite apt.  

Many readers of this Journal are dedicated professionals who work as counselors to the addicted. A good many of these drug and alcohol counselors are themselves addicts, having worked long and hard against the disease to maintain their sobriety and lifestyles. One such Journal reader voiced her angst over her use of Pump-It Powder earlier this year. Our reader described her relapse and decent into the chaos of addiction in pretty graphic terms. Pump-It Powder was in the driver's seat; the reader was strapped in the passenger's seat holding on with all the strength of a death grip. She was uncertain if she would be able to escape before she did irreparable harm to herself and her friends.  

The story begins plainly enough. A professional woman with a painful set of experiences related to a prior cocaine addiction. She had been in recovery for years; she was almost confident in her belief that she was immune to relapse. She'd learned to deal with triggers and cues; she avoided going places where lurking memories of a cocaine-driven lifestyle were hidden. Everything was as it should be. But then, Pump-It Powder entered the scene. Introduced to the drug by a friend, on a lark, she snorted a couple of lines of this putative bath salt. What could be so bad about all of this? After all, Pump-It was legal, at least at the moment it was. If it was really bad for you, why was it being sold in gas stations and novelty stores all over the country? (A dumb question to ask nowadays) Isn't it nothing more than No-Doz pills with a little extra caffeine load? Well the answer was and still is that nobody knows for sure. The identity of the chemicals, herbs, and spices in this concoction are still undefined.  

At various points along the way, Pump-It Powder and other drugs of the genre have contained a variety of drugs, controlled and not controlled. Some of the ingredients had been identified as phenethylamines, some as piperazines, and others yet as substituted amphetamines. Other novelty powder potions have contained over-the-counter stimulants, substances that never really caught on as commercial pharmaceutical products, but that when consumed in substantial quantities can exert central effects that are stimulating and euphoric. The powders also cause racing heartbeats, explosive blood pressure, and paranoid thought processes. A $30 tin can of Pump-It Powder contains enough of the drug to foster one episode, one lone drug high. Users can decide whether they want to smoke the powder, snort it, or inject it. Pump It is versatile in the sense that any method that a user wants to employ to ingest the drug will probably work.  

The high associated with this drug is troubling; it seems to vary from user to user. For the reader, she reported symptoms that were consistent with what she remembered about her old days as a cocaine addict. There was the instant energy, a feeling of robust strength and stamina. There was a powerful overriding sense of sociability; it provoked feelings, at least initially, of social bonding. She wanted to be around others, she wanted to talk. And talk. Conversations stretched on for hours and hours following her ingestion of Pump-It. The high itself sometimes lasted for 12 hours, an effect frequently seen with the use of methamphetamine (crank, ice, and tweak). And of course as the effects of the drug wore off, she felt the pangs and cravings to do it all over again. The rest of her story was predictable. The reader engaged in compulsive and abusive use of the drug. She went broke from all the $30 purchases made over the Internet and at local gas stations. While high, her experiences changed over time. What was initially euphoria degraded into a powerfully nagging sense of dysphoria. Like cocaine, Pump-It abuse led to the settling in of a round-the-clock paranoia. She was being followed; people were staring at her and listening to her thoughts. She withdrew from her work, she ignored friends and confidants. She had digressed back into the life of an addict, living day to day trying to get money for her next fix.  

Not everyone who uses Pump-It Powder will spin out of control. But enough anecdotal evidence has accumulated to make it clear that this "scouring powder" is dangerous and potentially addictive. Although there are Internet sources that sell and ship this product, it is not clear at all what they are selling or what the product actually contains. Nevertheless, there appears to be a growing market of buyers for this powder. Some Pump-It users have switched brands. Some moved to "Tranquility," another novelty powder with characteristics similar to Pump-It. In the end, all of these designer drug powder products end in misery. They are dangerous stimulants of the central nervous system. Chronic use begets onerous symptoms of paranoia and mania. The "crash" from these drugs can be as severe as the symptoms commonly associated with the "crash" from cocaine and amphetamine abuse. These drugs drain the central nervous system of vital neurotransmitters in a way quite similar to MDMA (ecstasy). For those who are susceptible to addictive disease, these drugs are a guaranteed bad outcome. The drugs should be treated by the public like they were cocaine or methamphetamine.  

Bath salts, plant food, glass cleaner, and scouring powders may not be here to stay, but they are certainly going to be around for awhile. The Journal will continue to monitor this situation and report on any new developments that may impact the jobs and lives of our readers. If you are interested in learning more about these drugs, click the registration link below to attend the MEDTOX Journal's Spring 2012 Designer Drug Update webinar. This 90-minute seminar will update viewers with the latest information relating to K2 (Spice), novelty powders, piperazine products, plant and herbal hallucinogens, cannabis, and novel delivery systems for alcohol that are now being utilized by teenagers and young adults.

Social scientists regularly lament that the bad habits of movie stars and rock and roll artists hold sway over decisions that teenagers make about the use of alcohol and drugs. In a study recently reported in the open access BMJ Journal, investigators from a variety of American research universities reported on a study of over 6,000 U.S. adolescents who were followed and surveyed at regular intervals over a two-year period. Researchers investigated the influence of peer and family factors, as well as media alcohol exposure, as it related to the onset of drinking and to the time involved for a transition to incidence of binge drinking. Investigators also assessed risk factors to drinking such as adolescent reported peer alcohol use, frequency of parental alcohol use, availability of alcohol at home, perceived authoritative parenting, receptivity to alcohol marketing, and movie alcohol exposure.  

The results of the study confirm the intuition of many parents and adolescent substance abuse experts. After controlling for demographic variables, high peer alcohol abuse was the most powerful predictor of a start-up to drinking. Drinking onset was next most impacted by high movie exposure to alcohol. The rest of the influences ranked as follows in descending order: less-authoritative parenting (lax standards; flip-flopping), alcohol availability in the home, receptivity to alcohol marketing, and parental alcohol use. Of special interest was that high peer alcohol use was a very strong indicator as to the transition from the onset of drinking to the point where binge drinking began. Peer pressure and social conformity play an evident roll in triggering the initiation of the dangerous behaviors and habits associated with binge drinking.  

This study did not directly address the roll that the mentioned factors play in the initiation of illicit drug use (i.e. cannabis, cocaine, amphetamines, ecstasy etc.). Intuitively, however, it seems that movie exposure to drugs and soft parental stances on those issues would be catalysts in the onset of illicit substances. Nevertheless, this study is a pertinent reminder that an authoritative parental style can decrease the likelihood that adolescents will begin drinking. Parents who are firm and who adhere to rules and standards relating to alcohol consumption should be encouraged to not give in to pushback by their children. Parents who take tough stances with alcohol appear to be more successful than those who do not. But of most interest here is the dynamic effect that alcohol exposure in movies has on both onset to drinking and transition to binge drinking. The authors estimate that movie alcohol exposure accounts for 28% of transitions to drinking and 20% of transitions to binge drinking. Perhaps this data will prompt industry leaders to exert better control over content that deals with alcohol and drug abuse, especially in movies viewed by younger audiences.

With all the commotion over designer drugs and synthetic cannabinoids, there has been growing public concern about the potential for abuse with the aphrodisiac and performance-enhancing herbal blends that are sold as over-the-counter preparations in the United States. Over the course of the past two months, the DAR Hotline has received calls from clients seeking information about the abuse of herbal "performance" blends by teenagers. Of most concern were sporadic and unrelated incidents where teenagers were said to have gotten "high" off a potent tea made from the damiana leaf. Damiana is an herb, an extract of a plant that grows expansively throughout Mexico and Central America. The drug does grow naturally in some southern states in the U.S., territories where most Hotline inquiries about the herb have emanated from. Damiana is a component of many male and female aphrodisiac herbal and vitamin blends that are sold in the United States. Unlike many other herbs of its type, damiana is fairly well-studied. Experiments with rats and other laboratory animals have revealed that the plant's active ingredient is capable of boosting some aspects of sexual performance; male libido seems to be most stoked by damiana ingestion. The damiana plant is an angiosperm that produces a very strong aromatic scent. Its spice-like odor is reminiscent of chamomile. In Mexico and Central America, the plant material is pulverized and made into tea. In tea, damiana acts as a quick pick-me-up. If the drug is taken in very concentrated quantities, it is possible to become intoxicated by it. The drug's effects at very high doses are stimulative; the effect is akin to a high caused by several back-to-back cups of espresso.

As to the potential for abuse of damiana, there is scant information. Although the Internet contains stories and anecdotes about a damiana-provoked high, there is little evidence that the plant has the capacity to do so. But because of the drug's potential to cause an intoxicated effect, the state of Louisiana has banned the possession, sale, and use of damiana. The plant was assigned to a controlled substance status that includes most designer drugs (bath salts, glass cleaners, and plant food) as well as the synthetic cannabinoids (K2/Spice). Louisiana is the only state that has taken a stance on damiana.  

The potential for abuse of damiana is quite low. And the spate of calls to the DAR Hotline is suggestive of a fad that has affected high school students at the volatile time of graduation and summer vacation. It's likely that any organized and illicit use of damiana is ephemeral and will be long forgotten by the fall.  

The news has recently been filled with reports about adolescents who have poured into hospital emergency rooms with complaints of poisoning following the drinking of alcohol-based hand sanitizers. The Internet has fueled this trend. Formulas for distilling ethanol out of hand sanitizer concoctions are abound, just check the Internet for further proof. It is a simple process. No matter which method an adolescent uses, the final distillate will contain a great number of unwanted ingredients. Many an experimenting kid has turned up in a hospital emergency room with severe gastric distress. Some have exacerbated the problem by using salt as a means of separating the ethanol from the other ingredients in the gel. Salt poisoning has been the diagnosis for many kids who have made the effort to extract the booze from the commercially prepared lotions.

Many hand sanitizers contain a majority concentration of ethanol, a base formula that makes it rather easy to distill a potent alcoholic beverage. A typical 4 fluid ounce hand sanitizer can yield up an alcoholic beverage equivalent to two well-funded martinis. Some kids opt to drink the hand sanitizer without any effort to distill it. In its gel form, hand sanitizer absorbs rather poorly in the gut. An effort to liquefy the gel is necessary in order to assure the uptake of the ethyl alcohol. Sound like a lot of work for little in return? Not in the estimation of most kids. Hand sanitizer is a great value in the eyes of someone who is trying to manage a bank account of no more than $20.

And late night television is not helping. A recent Jimmy Kimmel show featured the entertainer and John Cusack downing hand sanitizer shots together. Considering the influence that movies and entertainers have on ingestion of alcohol by teenagers, we should be frightened by these episodes.

Adolescents have demonstrated a solid command of drug pharmacology; they have learned how to evaluate drug metabolism and determine how to best elicit a drug high from over-the-counter medications. They have exhibited a mastery of drugs like dextromethorphan (Robitussin) and diphenhydramine (Benadryl). In fact, abuse of these two drugs has reached epidemic proportions in some adolescent communities. Dextromethorphan and a related drug called promethazine have become widely abused substances in communities of skateboarders and rappers. These drugs are psychoactive substances that can provoke simultaneous symptoms of stimulation and sedation, especially when ingested at levels that exceed recommended over-the-counter dosages.

Teenagers will always push the envelope of sanity when it comes to the use and abuse of drugs and alcohol. But having now been put on notice, parents and authorities should be extra vigilant in the security and storage of hand sanitizing gels. Even hand foams should be guarded. Considering the track records of kids in the abuse of cough syrups and nighttime sleep aids, we all should be alarmed at the reports of adolescents who admit and attest to drinking hand sanitizers to get high.

A company by the name of WA/HH Quantum Sensations has announced to the business world that they have mastered a new alcohol (ethanol) delivery system that relies on projecting a light alcohol-filled mist under the tongue. Once sprayed under the tongue, the alcohol is quickly absorbed and delivers a supposedly fast-moving high. The entrepreneurs behind this designer device claim that the Quantum Sensations mechanism delivers a micro burst of 0.075 milliliters of alcohol into the mouth. It would take nearly 1000 single doses from this contraption to rise to the level of alcohol found in one regular alcoholic beverage. Nevertheless, early users proclaim that an alcohol-caused inebriation can be felt after one spray.  

The effects of the spray wear off quickly, within minutes. The amount of alcohol absorbed is minimal, so a spray from the device will not trigger alarms on a police breathalyzer. Regardless, this instrument does deliver a dose of alcohol. To experience an alcohol high, the drug must enter the central nervous system. Avoiding absorption in the gut can perhaps give a consumer a different experience, but it is unlikely that a dose of alcohol that small can do much of anything to anyone.  

At a suggested price of $25 per spray, it may be that few people will want a very light buzz from a mouth spray. However, this product will probably make it to American shores. Once in the United States, hopefully it will stay of college campuses. Perhaps if these inventors can somehow create a spray that gets students to class or reverses a hangover then college campuses would be a more appropriate point of sale.

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.