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Bath salts and polyconsumption: in search of drug-drug interactions

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Abstract

Background and rationale

Polydrug use is a widespread phenomenon, especially among adolescents and young adults. Synthetic cathinones are frequently consumed in combination with other drugs of abuse. However, there is very little information regarding the consequences of this specific consumption pattern.

Objectives

The aim of this review is to introduce this topic and highlight the gaps in the existing literature. In three different sections, we focus on specific interactions of synthetic cathinones with alcohol, cannabinoids, and the stimulants nicotine and cocaine. We then dedicate a section to the existence of sex and gender differences in the effects of synthetic cathinones and the long-term psychophysiological consequences of adolescent and prenatal exposure to these drugs.

Major findings

Epidemiological studies, case reports, and results obtained in animal models point to the existence of pharmacological and pharmacokinetic interactions between synthetic cathinones and other drugs of abuse. This pattern of polyconsumption can cause the potentiation of negative effects, and the dissociation between objective and subjective effects can increase the combined use of the drugs and the risk of toxicity leading to serious health problems. Certain animal studies indicate a higher vulnerability and effect of cathinones in females. In humans, most of the users are men and case reports show long-term psychotic symptoms after repeated use.

Conclusions

The co-use of synthetic cathinones and the other drugs of abuse analyzed indicates potentiation of diverse effects including dependence and addiction, neurotoxicity, and impaired cognition and emotional responses. The motivations for and effects of synthetic cathinone use appear to be influenced by sex/gender. The long-term consequences of their use by adolescents and pregnant women deserve further investigation.

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Abbreviations

3-FMC :

3-Fluoromethcathinone

4-CMC:

4-Chloromethcathinone

5-HT:

Serotonin

α-PHP:

Alpha-pyrrolidinohexiophenone

α-PVP:

α-Pyrrolidinovalerophenone

AB-CHMINACA:

N-(1-amino-3-methyl-1-oxobutan-2-yl)-1-(cyclohexylmethyl)-1H-indazole-3-carboxamide

AB-FUBINACA:

N-(1-amino-3-methyl-1-oxobutan-2-yl)-1-(4-fluorobenzyl)-1H-indazole-3-carboxamide)

BrdU:

5-Bromo-2′-deoxyuridine

CNS:

Central nervous system

CPP:

Conditional place preference

CXCL12:

C-X-C Motif Chemokine Ligand 12

DA:

Dopamine

DAT:

Dopamine transporter

EPC:

Environmental place conditioning

EtOH:

Ethanol

fMRI:

Functional magnetic resonance imaging

L-SPD:

Stepholidine

MDMA:

3,4-Methylenedioxymethamphetaminen

MDPV:

4-Methylenedioxypyrovalerone

MEPH:

Mephedrone, 4-methylmethcathinone

METH:

Methylone, 3,4-methylenedioxy-N-methylcathinone

mPFC:

Medial prefrontal cortex

NA:

Noradrenaline

NAc:

Nucleus accumbens

nAChR:

Nicotinic acetylcholine receptor

NPS:

Novel psychoactive substances

PND:

Post-natal day

SERT:

Serotonin transporter

THC:

Delta-9-tetrahydrocannabinol

WIN:

WIN 55,212–2

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Correspondence to Ana Belen Lopez-Rodriguez.

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Lopez-Rodriguez, A.B., Viveros, MP. Bath salts and polyconsumption: in search of drug-drug interactions. Psychopharmacology 236, 1001–1014 (2019). https://doi.org/10.1007/s00213-019-05213-3

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  • DOI: https://doi.org/10.1007/s00213-019-05213-3

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