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Re: Abuse of Anticholinergic Drugs and Plants

Posted by ed_uk on January 4, 2005, at 19:38:06

In reply to Re: Dumb-drug Euphoria blanding, posted by KaraS on January 4, 2005, at 17:56:34

Abuse of anticholinergic plants........

NB. These highly toxic plants contain anticholinergics such as atropine and scopolamine (aka hyoscine).

Atropa Belladonna (Deadly Nightshade)
Read 'Experiences'

Read 'experiences'

Datura (Jimson weed etc)

Henbane (Devil's Eyes)

Abuse of anticholinergic antidepressants..................

Tricyclic antidepressants have anticholinergic properties. There have been occasional reports of abuse of tricyclic ADs, it has been suggested that high doses may (in some people) produce euphoria because of the anticholinergic action. Very high doses will cause hallucinations and delirium.

JAMA. 1978 Sep 22;240(13):1372-3.

Abuse of amitriptyline.

Cohen MJ, Hanbury R, Stimmel B.

Amitriptyline hydrocholride (Elavil) is frequently used in treating mild to moderate depressive states. A survey of 346 persons enrolled in a methadone maintenance program showed that 86 (25%) had admitted taking amitriptyline with the purpose of achieving euphoria. Thin-layer chromatography of random urine specimens over five months showed that 34% of the patients had a positive result for amitriptyline at least once during this time. These results suggest that misuse of amitriptyline is not uncommon and should be carefully considered prior to prescribing this agent to narcotic dependent persons.

(I'd like to point out that when I once took amitriptyline I found it to be very unpleasant, certainly not euphoric!)

Abuse of anticholinergic antiparkinsonian drugs.....

Misuse of anticholinergic drugs by people with serious mental illness.

Buhrich N, Weller A, Kevans P.

Department of Psychological Medicine, University of Sydney, New South Wales, Australia.

This study assessed misuse of anticholinergic drugs in a population of 50 patients with serious mental illness who were assertively managed by a community-based outreach team in Sydney, Australia. One-third of the subjects reported having misused anticholinergics over the previous month. All anticholinergics were misused, and trihexyphenidyl (benzhexol) was misused most frequently. Most subjects misused at least one other drug as well. On direct questioning, the reason given most frequently was "to get high"; on indirect questioning, reasons were related more to peer participation and feelings of futility. Marginalized patients living in the community are vulnerable to the misuse of anticholinergic drugs.

'In Jordan, the abuse of Artane (benzhexol/trihexyphenidyl) has been recognised as the most commonly abused drug among Jordanian youths.'

Therapie. 2003 Nov-Dec;58(6):541-7.

[Misuse of trihexyphenidyl (Artane, Parkinane): recent trends]

[Article in French]

Frauger E, Thirion X, Chanut C, Natali F, Debruyne D, Saillard C, Pradel V, Reggio P, Micallef J.

CEIP de Marseille (PACA-Corse, Centre Associe), Laboratoire de Sante Publique, Faculte de Medecine, Marseille, France.

Recent observations suggest the existence of trihexyphenidyl abuse linked to its hallucinogenic and euphoric effects. In order to determine the importance of this practice and the characteristics of those involved, a study based on data from the Provence-Alpes-Cote-d'Azur and the Corsica health reimbursement system was carried out. Individuals from these regions affiliated to the French health reimbursement system who had a prescription for trihexyphenidyl (Artane, Parkinane) reimbursed between January 1, 2001, and February 15, 2001, were selected. The delivery of prescriptions was monitored over a 9-month period. In total, 3028 subjects were selected. A subgroup comprising 2.1% of subjects with deviant behaviour was identified by factorial analysis and compared with the subgroup without deviant behaviour. The subjects with deviant behaviour were young and mostly male. The dosage of trihexyphenidyl was higher in these subjects (28 mg/day versus 7 mg/day) and a greater proportion used benzodiazepine and high-dose buprenorphine compared with those without deviant behaviour. The number of prescriptions delivered was higher (23.0 versus 7.7) as well the number of different physicians (4.9 versus 1.5) and pharmacies (5.0 versus 1.3) for those subjects with deviant behaviour. This study confirms the abuse and dependence potential associated with trihexyphenidyl use and the need to increase the supervision of this drug.

Int Clin Psychopharmacol. 1996 Sep;11(3):199-202.

Trihexyphenidyl (Artane) abuse in schizophrenic patients.

Zemishlany Z, Aizenberg D, Weiner Z, Weizman A.

Geha Psychiatric Hospital, Petah Tikva, Israel.

Trihexyphenidyl (THP) and other anticholinergics are liable to abuse by schizophrenic patients. Data concerning the incidence and characteristics of the abusers are scarce. In the present study an evaluation of 214 consecutive admissions of schizophrenic patients revealed 14 THP abusers, an incidence of 6.5%. The demographic and clinical variables of the THP abusers were compared with a randomized control group of 28 schizophrenic patients using the four-dimensional factors of the BPRS (Brief Psychiatric Rating Scale). No significant differences were found in demographic variables and comorbidity for antisocial personality disorder and other substances abuse. On admission, a trend towards more negative symptoms was detected among abusers. At discharge abusers had significantly higher mean BPRS scores and higher scores on the dimensional factor of hostile-suspiciousness. The results suggest that THP abuse is not rare among schizophrenic patients who may abuse anticholinergic agents to relieve negative symptoms and/or drug-induced Parkinsonism, or alternatively for its non-specific stimulant effects, on account of worsening of positive symptoms.

Zhonghua Yi Xue Za Zhi (Taipei). 1996 Feb;57(2):157-60.

Trihexyphenidyl abuse in schizophrenic patient: a case report.

Lo Y, Tsai SJ.

Department of Psychiatry, Veterans General Hospital-Taipei, Taiwan, R.O.C.

Trihexyphenidyl is a synthetic anticholinergic used in psychiatric patient for the relief of neuroleptic-induced extrapyramidal symptoms. It has been reported to have mood elevating, euphorigenic and socially-stimulating effects. The case presented is of anti-cholinergic abuse by a chronic schizophrenic who abused trihexyphenidyl, up to 200 mg per day, to achieve an euphoric effect. The drug was partly prescribed in psychiatric clinics, but mostly bought in the drugstore. The discontinuance of trihexyphenidyl produced anxiety, which was relieved by anxiolytics. The patient also feigned extrapyramidal symptoms to get anticholinergic injections during drug abstinence. A high dose of trihexyphenidyl may precipitate anticholinergic toxic psychosis and interfere with the therapeutic effects of antipsychotics by impeding their absorption. Given a large number of patients receiving this medication, clinicians should be alert when prescribing this drug, especially for patients who have abuse potential. As this agent has never been under public surveillance and is available in local pharmacies, the health authorities should be concerned with its abuse potential.

Pharmacopsychiatry. 1993 Mar;26(2):59-62.

Memory and cognitive impairments in a case of long-term trihexyphenidyl abuse.

Kajimura N, Mizuki Y, Kai S, Suetsugi M, Yamada M, Okuma T.

Department of Neuropsychiatry, Yamaguchi University School of Medicine, Ube, Japan.

We present a case of long-term trihexyphenidyl (THP) abuse in which memory and cognitive impairments were observed 23 years after the commencement of medication. This case showed a dramatic improvement after withdrawal of THP. Clinical course during admission was followed with psychometric testing and laboratory examinations. The fact that the patient showed no evidence of lowered alertness during the clinical course raises the possibility that THP can primarily induce impairment of memory and cognitive functions. This is supported by the findings on the resting EEG of the patient. This case emphasizes the need to exercise caution in prescribing high doses of anticholinergic agents for long periods, particularly in elderly patients with underlying brain pathology.

Br J Psychiatry. 1984 Sep;145:300-3.

A study of benzhexol abuse.

Crawshaw JA, Mullen PE.

The occasional abuse of anticholinergic drugs for their psychotropic and specifically hallucinogenic properties has been known for over a century, but benzhexol (trihexyphenidyl) abuse has only recently attracted attention in the literature, mainly in case reports. This paper reports on a study of 21 benzhexol abusers. They were a young, single, and disadvantaged group of polydrug abusers with poor employment, educational, and social skills, who abused benzhexol mainly for its euphorogenic properties. The two major diagnostic categories were antisocial personality disorder and schizophrenia. An unexpected finding was cognitive impairment persisting after acute intoxication.

Acta Psychiatr Scand. 1984 Jun;69(6):538-42.

Trihexyphenidyl dependence.

McInnis M, Petursson H.

Trihexyphenidyl, a synthetic anticholinergic, is frequently used concurrently with neuroleptics to control extrapyramidal side effects. We present two case reports of trihexyphenidyl abuse which concur with the increasing concern expressed regarding the abuse potential of trihexyphenidyl. In one of the cases a double-blind, placebo-controlled withdrawal was conducted and monitored on a number of physiological parameters and the Hamilton Anxiety Rating Scale. A recognizable withdrawal syndrome followed discontinuation of the drug. In addition to the abuse potential it is suggested that dependence liability be considered in maintenance therapy with trihexyphenidyl and other antiparkinsonians.

Adverse Drug React Toxicol Rev. 1997 Jun;16(2):103-12.

Benztropine abuse and overdose--case report and review.

Grace RF.

Department of Clinical Pharmacology, Royal North Shore Hospital, Sydney NSW, Australia.

The abuse and overdose of anti-cholinergic agents such as benztropine is well reported in the psychiatric and emergency medicine journals. However, despite almost 40 years since the first modern report, physicians in general remain poorly aware of anti-cholinergic abuse. A case report of recreational overdose of benztropine in a 19 year old schizophrenic patient is presented. Delirium and anti-cholinergic manifestations persisted for five days necessitating prolonged hospitalization. The literature on benztropine abuse and overdose is reviewed.




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