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EDUCATION
The Pulse
Gallus Medical Detox Centers provides substance use alerts to inform providers and industry professionals of new and potentially dangerous trends happening across the country. With 10 years of experience treating substance use disorder patients, we have a unique front-line perspective on the medical assistance necessary to help patients overcome addiction. We’re providing “The Pulse” to alert you to the use of new substances, legal and illegal, as well as increasing severity within the opioid, benzodiazepine, and stimulant epidemics, and complications brought on by increasing polysubstance use.
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Bupropion (Wellbutrin)
Bupropion (brand name Wellbutrin) is an antidepressant drug used to treat people with major depressive disorder (MDD), seasonal affective disorder (SAD), and to help people quit smoking. People who have abused the drug have described the high from bupropion like a cocaine or amphetamine high.
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Clonidine
Clonidine is a sedative that is used to treat high blood pressure, Clonidine extended-release tablets can be used to control the symptoms of ADHD.
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Delta-8 THC
Delta-8 THC is a psychoactive substance in the cannabis plant. It’s produced naturally by the cannabis plant but not found in significant amounts, therefore it’s typically synthetically manufactured from hemp or CBD.
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Rainbow Fentanyl
It’s an incredibly dangerous, toxic, and often fatal version of fentanyl, a synthetic opioid, that resembles candy or sidewalk chalk. It has been found across the country in the past couple of weeks, from Oregon to West Virginia.
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Quetiapine
Quetiapine (brand name Seroquel) is an antipsychotic that treats schizophrenia, bipolar disorder, and depression. It can also be prescribed for general anxiety disorder, major depression, and mood disorders. Quetiapine affects the serotonin and dopamine levels in your brain.
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Tazzies
Or Tasmanian Poppy Seeds, unwashed poppy seeds can be purchased online legally from online sellers. Depending on the methods of harvesting and geographical origin of the plant, unwashed poppy seeds may have higher amounts of Schedule II opium alkaloids such as morphine, codeine, and thebaine on their seed coats when compared to washed poppy seeds.
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Flakka
Flakka (alpha-PVP), is a dangerous drug that is similar to the street drug commonly known as bath salts. Flakka is typically white or pink in color and is found in crystal form.
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U-47700
A synthetic opioid 7.5-8 times more potent than Morphine. In 2016, DEA classified it as a Schedule 1 narcotic. It has had no medical use in the United States. Originally developed by the pharmaceutical company Upjohn in the 1970s. It started emerging in 2014.
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Clonazolam
It’s a triazolobenzodiazepine, it was prescribed for veterinary practices in some regions of Africa, but is now sold online as a designer drug. It’s considered Schedule 1 in Virginia and Louisiana, but in all the other states it’s classified as research. It has similar effects as a benzodiazepine but is much much stronger. It is also sold in blotters.
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Fentanyl
It’s a synthetic opioid pain reliever that is 80 – 100 times more powerful than morphine. There is pharmaceutical fentanyl and illicitly manufactured fentanyl. Pharmaceutical fentanyl is used to treat severe pain, most commonly advanced cancer symptoms. Illicitly manufactured fentanyl is placed in eye droppers or nasal sprays, made into pills, dropped onto blotter paper and made into a powder. Chemically-similar analogs of fentanyl are also being created, and these include carfentanil, acetylfentanyl, butyrfentanyl, and furanyl fentanyl.
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Tianeptine
Tianeptine is a prescription drug used for depression in some European, Asian, and Latin American countries, but it is not FDA-approved in the United States. It is available at gas stations across the U.S., labeled as a dietary supplement.
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2c-b
2c-b is classified as a novel psychoactive drug from the phenethylamine class of drugs, similar to mescaline. Its effects vary depending on dosage, but is classified as a stimulant and hallucinogenic. It is a club drug, commonly found as an adulterant in MDMA or Ecstasy. It can also be taken alone. It comes in powder or tablet form and can be snorted, taken by mouth, or taken rectally. It causes feelings of pleasure, hallucinations. Side effects can include tremors, muscle spasms, diarrhea of other GI distress, tachycardia, hypertension, and elevated body temperature.
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Phenibut
A central nervous system depressant with anxiolytic properties. A GABA-b receptor agonist similar to Baclofen and GHB. With higher doses is a GABA-agonist, much like benzos. Developed in the Soviet Union in the 1960’s and currently the only area of the world that uses it for medical purposes. Not approved for medical use in the US. Used for insomnia, anxiety, and as a nootropic for focus and concentration.
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Mephentermine
Mephentermine was originally approved by the FDA in 1951 as a vasopressor (used to increase blood pressure) and a nasal decongestant. It’s banned in the United States, but still used in other countries. It is structurally similar to methamphetamine. It’s prohibited by the World Anti-Doping Agency – used by young athletes for its stimulant effect and improved physical performance.
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Dangers of Pill Presses
Pill presses are devices that produce counterfeit pills. Pressed pills are commonly produced with fentanyl because it’s cheaply imported. The biggest risk and danger is that people are not getting what they think they are getting. It is common that people are seeking benzodiazepines, MDMA, or other prescription opiates but it’s more often than not Fentanyl. When substances are mixed and pressed with these devices they are not balanced effectively. The pills end up with varied strength, resulting in higher risk for overdose and death.
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M-30's
M-30 is the common, or street name, for oxycodone IR 30 mg pills, called that because the pill has a ‘30’ on one side and an ‘M’ on the other. These have long been very popular with opiate users.
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Gabapentin
Gabapentin, approved in 2004, was originally prescribed for neuropathic pain, it is now also prescribed for a variety of things, including mood disorders, anxiety, and seizure disorders.
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Nitrous Oxide
Medical nitrous oxide is used for sedation and pain relief and is classified as a dissociative anesthetic. It is also used as a propellant for whipped cream and in the automotive industry to enhance engine performance. Sold as cartridges that can be discharged into another object such as a balloon or directly into the mouth and inhaled. They provide a brief, rapid euphoric high and feeling of floating or excitement. They also can cause sudden death do to profound hypoxia.
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Kratom
According to the National Institute on Drug Abuse, kratom is a tropical tree native to Southeast Asia and its leaves contain compounds that can have stimulant and opium-like effects. Traditionally, kratom leaves have been used by Thai and Malaysian natives for centuries. It’s a member of the coffee family, and it’s been utilized to enhance work productivity, cultural ceremonies, and for medicinal purposes.
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Soma
Soma is a muscle relaxer, and its generic name is carisoprodol. It’s used to treat muscle pain, and usually used with rest and physical therapy. It typically is prescribed in 350mg pills and a typical prescription is one pill 3-4 times per day.
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Cannabis Induced Psychosis
Cannabis concentrates are oils, budder, wax, and dabs that contain unnatural levels of THC (anywhere from 25 – 75%). The THC is typically extracted with a Butane solvent. Increased concentrations of THC are leading to higher rates of Cannabis Induced Psychosis.
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Long Term Benzodiazepine Use for Anxiety
Benzodiazepines are a class of drugs that induce a sedative effects. They work in much the same way as alcohol in how they interact with the Gaba receptor complex. Because of the close similarity of effects benzodiazepines are the Gold Standard for medical detox.
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GHB
Gamma Hydroxybutyrate or GHB, also known as the “date rape” drug. It’s a central nervous system depressant and at low doses it can produce effects of euphoria. High doses of this drug can cause blackouts and amnesia. Medically, it’s used to treat sleep disorders like insomnia and narcolepsy. In 1990, the FDA issued an advisory declaring GHB use unsafe and illegal except under FDA approved, physician-supervised protocols. In March 2000, GHB was placed in Schedule I of the Controlled Substances Act. However, the sodium salt of GHB is used as a prescription drug known as Xyrem (sodium oxybate). In 2002, the FDA approved Xyrem for the treatment of narcolepsy. It is a highly regulated prescription medicine classified as a Schedule III controlled substance and requires patient enrollment in a restricted access program.
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Benzodiazepines and Rebound Anxiety
Rebound anxiety is the result of consistent sedation from benzodiazepines. It is more common in short to intermediate acting meds like Xanax and Ativan but also occurs in patients taking Klonopin, a long-acting benzodiazepine. Research has proven time and time again that benzodiazepines worsen anxiety when taken daily for more than a month. Commonly people experience diminished effects from benzodiazepines leading to increased tolerance. As people take more medication to decrease anxiety, natural defenses, and coping for anxiety are degraded. Ultimately avoidance of anxiety makes people more vulnerable to distress. While providers prescribing these medications are often intending to alleviate symptoms, long-term patients are set up for failure. Cognitive Behavioral Therapy, Mindfulness, and alternative psychotropic medications are the most effective treatment for anxiety. Relief is slower with these treatments but the benefits and change is more lasting and less harmful.
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Angel Dust
Angel Dust, also known as Phencyclidine or PCP, is a psychedelic drug that causes hallucinations. It is a dissociative drug, which causes the user to see distorted colors, objects, or hear distorted sounds. It was initially developed in the ’50s as an intravenous anesthetic. But it was quickly discontinued due to its neurotoxic side effects. It can be found in tablet form, capsules, powders, which can be taken orally or snorted, and liquid form.
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Fentanyl Laced Street Drugs
Fentanyl is an opiate-based drug that is 50 times more powerful than morphine. Fentanyl analogs like Carfentanil can be up to 10,000 times more powerful. In recent news, there have been fentanyl-related deaths due to other drugs laced with fentanyl, specifically cocaine. It’s showing up across the country, and because of the potency of fentanyl, it’s causing accidental overdoses to people who were not aware.
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Para-fluorofentanyl and Metonitazene
Para-fluorofentanyl is a schedule I substance that can be found in heroin packets and counterfeit pills, it was invented in the 1960s and has been sold illegally sometimes under the name “China White”. Metonitazene is a benzimidazole-opioid that was developed in the 1950s but was never authorized for medical treatment. This combination is seen more frequently by medical examiners assessing overdose deaths.
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Xylazine
Xylazine is a non-opioid sedative and muscle relaxant, commonly used as a large animal anesthetic, and is now being found in the illicit drug market. It is commonly added to opioids because it increases the effects. It is related to Clonidine, an alpha-2 agonist, causing a decrease in heart rate, blood pressure, and sedating effects.
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Ayahuasca
It is a botanical hallucinogen from the Amazon, made from a combination of the Banisteriopsis caapi plant and Psychotria Viridis shrub. It is a traditional psychoactive sacrament that has been used for shamanic ceremonies for centuries and is acclaimed for spiritual and psychotherapeutic benefits. It is now gaining popularity in the US.
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Carfentanil
Carfentanil is an opioid agonist developed in 1974 by Janssen Pharmaceuticals and sold under the trade name Wildnil. It is an analog of the synthetic opioid Fentanyl, made as a tranquilizer for wild animals such as elephants, bears, moose, etc, typically delivered with a tranquilizer dart. Wildlife rangers are required to use protective gear when handling such as gloves, face shields, due to the ability to absorb it through the skin and respiratory tract. Veterinarians in the US also use this for the sedation of large animals such as horses.
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Isotonitazene
Isotonitazene is a potent synthetic opioid that is derived from etonitazene (an analgesic). Etonitazene is extremely powerful and addictive when it was used in studies on animals and humans, which is why it was never made commercially available. Isotonitazene emerged on the illicit drug market in April 2019. It’s commonly in pill form, but also can be found in powder form as an off-white or yellow color.
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Ibogaine
Ibogaine is a substance found in a Western African shrub called iboga. Traditionally, it was used in ceremonies by people of the Bwiti religion. In recent years, it has been utilized as a method of treatment for opiate addiction by alleviating withdrawal symptoms and reducing cravings. However, the FDA has not yet approved it for a treatment for addiction. Ibogaine is a psychoactive alkaloid and is classified as a Schedule I drug in the US. The type of dosage given will dramatically impact the drug’s effect on the body. If only a small amount is used, it acts as a stimulant. However, if given in a larger dose, ibogaine will cause an individual to go into a psychedelic state