Progress in brain research
January 1, 2018
John Martin Corkery
62 citations
Ibogaine, a hallucinogenic alkaloid from the Iboga shrub, has been used for centuries in West African religious ceremonies for spiritual enlightenment. Since the 1960s, it has been used in detoxification treatments to reduce cravings for substances like alcohol, cocaine, methamphetamine, opiates, and nicotine, often in non-medical settings without robust clinical trials. This chapter overviews potential benefits of such research while highlighting serious adverse effects from undiagnosed conditions or concurrent drug use. It updates the 33 known deaths globally, including 5 in the UK. A safer congener, 18-MC, is undergoing clinical trials. The chapter calls for better opiate detoxification treatments amid rising opioid fatalities and urges careful risk assessments, accurate recording of outcomes, and publication of deaths.
Experimental neurology
May 1, 2021
Fabrizio Schifano, Stefania Chiappini, Andrea Miuli et al.
49 citations
Several new psychoactive substances (NPS) can trigger serotonin syndrome, a dangerous condition of excessive serotonin activity marked by altered mental status, neuromuscular effects, and autonomic hyperactivity. A systematic review of three retrospective studies, two case series, and five case reports identified implicated substances including psychedelic phenethylamines (2C-I, 25I-NBOMe, 5-IT) and synthetic cathinones (mephedrone, MDPV, methylone, butylone, NRG3, AMT, MXP), as well as the antidepressant bupropion when misused at high doses or combined with other serotonergic drugs. Most substances were taken orally, though nasal insufflation and sublingual administration occurred. Psychiatric history was negative for most subjects. Clinicians should recognize NPS risks and diagnostic challenges due to undetectability in routine drug screenings.
Brain sciences
April 22, 2025
Fabrizio Schifano, Stefania Bonaccorso, Davide Arillotta et al.
14 citations
Chemsex involves using drugs like synthetic cathinones, GHB/GBL, ketamine, methamphetamine, and others to enhance and prolong sexual experiences. Stimulants increase sexual arousal, performance, and social interactions; MDMA-like drugs foster emotional closeness; GHB/GBL promotes disinhibition, leading to condomless sex with multiple partners; ketamine facilitates receptive anal intercourse or fisting. Polydrug use can cause serotonergic syndrome, seizures, drug interactions, and sympathomimetic overstimulation, along with psychopathological conditions that may lead to misuse of opioids, gabapentinoids, or antipsychotics. Reducing stigma and providing multidisciplinary medical, psychological, and social support are key to managing these challenges.
Journal of psychopharmacology (Oxford, England)
July 1, 2025
John Martin Corkery, Caroline Copeland, Fabrizio Schifano
2 citations
Diarylethylamine drugs, including diphenidine and methoxyphenidine (MXP), are dissociative substances with strong addictive potential. A systematic review of global mortality data found 48 deaths involving these drugs, with 37 occurring in the UK between 2014 and 2019. Most decedents were male (91%), White (95%), with a mean age of 37.2 years. Deaths were primarily accidental (89%) from acute drug toxicity (92%), often involving polysubstance poisoning with opioids, benzodiazepines, or stimulants. One-third of deaths involved MXP or diphenidine alone, suggesting these molecules are relatively toxic. Although diarylethylamine deaths are rare, these substances remain available, indicating ongoing risk.
Journal of Substance Use and Addiction Treatment
July 1, 2026
Alessio Mosca, Stefania Chiappini, Andrea Miuli et al.
Management of ketamine misuse relies on supportive care, psychotherapy, and off-label medications, but robust evidence is lacking. A systematic review of 73 studies found that approaches include symptomatic medical care, psychotherapeutic interventions such as motivational interviewing and cognitive-behavioral therapy, and pharmacological treatments including benzodiazepines, SSRIs, naltrexone, lamotrigine, and gabapentinoids, with varying effectiveness. Multidisciplinary strategies addressing both psychiatric and somatic complications, such as 'K-bladder' and 'K-cramps', are essential. High relapse rates and limited follow-up weaken the evidence, and there is an urgent need for controlled studies and standardized treatment protocols.
Clinical Neuropsychopharmacology and Addiction
January 4, 2026
Amira Guirguis, John Martin Corkery, Fabrizio Schifano
Ketamine-related deaths in Scotland rose twentyfold between 2013 and 2024, with 88 deaths recorded. Most decedents were male (81.8%), average age 35, and 84% of deaths were accidental. Polysubstance use was common: opioids (58%), stimulants (55%), benzodiazepines (48%), gabapentinoids (25%), and alcohol (22%) were often co-implicated. Acute drug use was the primary cause in 85% of cases. The upward trend mirrors increases elsewhere in the UK. Combining ketamine with opioids or benzodiazepines adds fatal risk via central nervous system depression. The findings underscore the need for clearer public health messaging, targeted harm reduction, and monitoring of misuse and prescribing trends.