The BMJ Today: How much do you know about mind altering drugs?

tiago_villanuevaMartin Mckee, a prominent public health academic and a prolific writer for The BMJ, is featured this week in the always entertaining BMJ Confidential. As professor of European public health at the London School of Hygiene and Tropical Medicine, his work has had worldwide impact. He is constantly travelling around the world because of his work, and admits that he has always had an interest in foreign countries since he was a child. After doing the Interrail when he was 15 and visiting Greece and the Balkans, he never stopped travelling.

Actually, many of our readers, particularly in Greece, may relate to his pet hate: “Politicians who treat us like idiots, closely followed by sycophantic interviewers who fail to hold them to account.” If he was invisible for a day, he would love to peek into the decision making processes of the UK’s security services to “exclude the possibility that they are under the influence of mind altering drugs.”

In fact, we recently published an endgames case report, which looks at a 17 year old male who presented to the emergency department with severe headache, vomiting, and an altered state of mind. The attending doctors suspected an acute intoxication by a substance of misuse. Unfortunately, conventional immunoassay drug screening tests are not able to detect many psychoactive substances, which include some emerging drugs of misuse unfamiliar to most doctors, such as synthetic cannabinoids, synthetic cathinones, piperazines, phenethylamines, tryptamines, phencyclidine derivatives, as well as various plant derived psychoactive substances.

A blood specimen was eventually sent for gas chromatography and revealed the presence of two synthetic cannabinoids, which alongside cathinones, are the emerging drugs of misuse most commonly seen in clinical practice—and also possibly the most dangerous.

I’d also like to point out that we’re currently accepting submissions for a new series of endgames case reports and picture quizzes, which will be aimed at the educational needs of doctors working in primary care. So if you’re interested in writing one, please do get in touch with me.

In India, the trend of injecting synthetic opioid analgesics has been growing fast over the past 20 years, with moderately potent opioids—such as buprenorphine, nalbuphine, dextropropoxyphene, and dicycloverine—being diverted and trafficked for misuse.

It doesn’t help that access to opioid substitution therapy and government support is poor, and that there is a harrowing stigma attached to injecting drug users. Doctors also lack training in this area, so we hope that raising awareness in a new feature article will be a good starting point to help change the status quo.

I’ve been talking until now mostly about mind altering drugs, but as a doctor, have you ever felt the need to engage in a “mind altering” experience, be it learning a new language, travelling the world, doing voluntary work, or pursuing a long lasting passion such as dance or music? Rebecca Stout thinks that there are many reasons to take a break for one or more years early on in your medical career. She describes her reasons in a new BMJ blog, and boy, they seem pretty convincing to me.

Tiago Villanueva is assistant editor, The BMJ.

  • docrose

    I think we just need to talk to dread pirate roberts, whom his defence would have is still at large, and ask them to link us in with the silk road chemists so we can have a kind of MIMMS of what they are currently selling. Im sure they would accept bit coin. In NZ here the synthetic cannabinoids on the market before general reefer madness panic hit and closed down the shops were a closer buzz to the original LSD, or so was the word on the street. Too strong for children. I am not sure if we had deaths, but we def. had psychosis.