Designer drugs: mechanism of action and adverse effects
Archives of Toxicology – April 01, 2020
Source: OpenAlex
Summary
Designer drugs, readily available through online business, pose significant public health risks. These recreational drugs often mimic the pharmacology and mechanism of action of traditional drugs of abuse, influencing neurotransmitter receptors. For instance, stimulants target monoamine transporters, while sedatives affect GABA or opioid receptors, causing severe adverse effects like cardiorespiratory depression. The chemistry of these novel substances means they frequently evade routine Forensic Toxicology and Drug Analysis. Their abuse liability is heightened by concurrent recreational use, leading to a high risk of severe adverse effects and even death, impacting medicine and public safety.
Abstract
Abstract Psychoactive substances with chemical structures or pharmacological profiles that are similar to traditional drugs of abuse continue to emerge on the recreational drug market. Internet vendors may at least temporarily sell these so-called designer drugs without adhering to legal statutes or facing legal consequences. Overall, the mechanism of action and adverse effects of designer drugs are similar to traditional drugs of abuse. Stimulants, such as amphetamines and cathinones, primarily interact with monoamine transporters and mostly induce sympathomimetic adverse effects. Agonism at μ-opioid receptors and γ-aminobutyric acid-A (GABA A ) or GABA B receptors mediates the pharmacological effects of sedatives, which may induce cardiorespiratory depression. Dissociative designer drugs primarily act as N -methyl- d -aspartate receptor antagonists and pose similar health risks as the medically approved dissociative anesthetic ketamine. The cannabinoid type 1 (CB 1 ) receptor is thought to drive the psychoactive effects of synthetic cannabinoids, which are associated with a less desirable effect profile and more severe adverse effects compared with cannabis. Serotonergic 5-hydroxytryptamine-2A (5-HT 2A ) receptors mediate alterations of perception and cognition that are induced by serotonergic psychedelics. Because of their novelty, designer drugs may remain undetected by routine drug screening, thus hampering evaluations of adverse effects. Intoxication reports suggest that several designer drugs are used concurrently, posing a high risk for severe adverse effects and even death.