G'day folks,
I work for a harm reduction agency and in mental health. I don't mess around with these sorts of chemicals anymore (I'm becoming a boring old man) but in my work I meet lots of people using all sorts of substances.
In the last month I've seen two people who have suffered psycho-stimulant induced psychotic episodes which were apparently due to high dose binge use of ethylphenidate (EP).
Both had been using high purity EP sourced from an online RC vendor- one was importing it directly, the other was buying gram bags from the user-dealer he normally bought methamphetamine from, but they were still in their original packaging (complete with a label with the molecular diagram and the "not for human consumption" warning).
Both people indicated that they injected it because when they tried snorting it, it painfully burned their nasal passages and septum. Both stated it hurt a bit to inject and one reported localised inflammation or vein damage.
The first case is a person with no previous episodes of psychosis and no family history of mental illness. She reported using escalating doses over about 4 weeks, culminating in a psychotic episode that resolved completely within 24 hours. They haven't used any EP since, (the episode was 4 weeks ago now) and they appear to be back to normal.
The second person also has no previous history or family history. He reported using EP for about 8 weeks, in escalating doses and frequency of use over the last three weeks. He went through 8g of the stuff in the last week. They were displaying classic symptoms of psycho-stimulant psychosis- especially florid delusions of persecution, eg smashiong his mobile because "they" had hacked his phone to track him, dismantling his car because he thought "they" had planted drugs to set him up, etc. His behaviour became quite alarming, to the point that he was planning to kill two acquaintances he believed were involved in this conspiracy to set him up. I have known this second person for twenty years (on and off). He has a very long history of methamphetamine use (on and off) at times taking it in high doses every day for extended periods. He has never exhibited any of these sorts of symptoms before. In fact he is a very stable calm individual even in crisis situations - I would describe him as VERY psychologically robust. He was not using any meth when this happened. It looks like just 2 months of excessive EP use tipped this guy (who has always been bulletproof) completely over the edge.
He hasn’t taken any further doses for the last three weeks and appears to be recovering ok, he has good insight that he suffered a drug induced episode and that he had become delusional, although when I saw him last night he still had some odd thought content going on.
Anecdotal report of effects from both people indicate a very rewarding and intense “rush” with a very fast onset of action when injected, followed by a pleasurable amphetamine like “high” that only lasts about two hours. This sound like a recipe for rapidly escalating binge use.
I hope I'm not giving the impression that I'm being alarmist. I just wanted to post these case histories to warn people that they should play safe. EP sounds like a pretty fun chemical but pay attention to how much you are taking and how often you are taking it. And please look after your mates. EP apparently is a stronger re-uptake inhibitor of dopamine, a weaker re-uptake inhibitor of noradrenaline, and does nothing significant to serotonin.
Accordingly I would expect that EP toxicity is more likely to provoke anxiety or delusions and psychosis-like symptoms than to provoke the cardiac, vascular, or serotonin syndromes associated with Methamphetamine or MDMA. High doses of EP could of course cause all the same physiological problems as any other drug that elevates catecholamines, and some of the products I've seen tested also contain mixtures of MDPV or other cathinones in active quantities as well.
re: Ethylphenidate as an active metabolite of Ritalin + alcohol;
Ethylphenidate (EP) is an active metabolite of methylphenidate consumed in combination with ethanol. Ethylphenidate is produced as a by-product of liver metabolism, (via hepatic trans-esterification, in a similar fashion to the in-vivo synthesis of cocaethylene (ethylbenzoylecgonine) when alcohol and cocaine are consumed in combination) however my understanding was that even with very high combined doses of Ritalin and alcohol the body doesn't convert enough of the Ritalin to EP to result in a significant or active dose.
Logan et al
http://www.ncbi.nlm.nih.gov/pubmed/10440465
However this later study indicates that in very high doses it may contribute to poly-drug toxicity;
http://www.ncbi.nlm.nih.gov/pubmed/10820132
.
Hope this is helpful,
Outrigger.
