Ephedrine - what it is, how it works, signs of use, consequences, addiction treatment - Narcologist at MSK Clinic

1. General information
2. Historical facts
3. Effect on the body
4. How to recognize a drug addict
5. Tests for ephedrine
6. How long does it stay in the body?
   In urine
7. In blood
8. In the hair
9. How long do drug addicts live?
10. Analogs
11. How to speed up elimination at home
12. Detoxification in hospital
13. Overdose
    How to recognize
14. First aid
15. Rehabilitation
16. Coding
17. Why you can’t undergo rehabilitation at home or on an outpatient basis
18. Working with codependents and resocialization
19. How to quit on your own

Attention! Drug use causes irreparable harm to health and poses a danger to life!

General information

Ephedrine is a psychoactive substance that is extracted from the ephedra plant. Ephedrine-based drugs have been used to combat cough, drowsiness and excess weight. But the negative effects of the drug turned out to be more dangerous and stronger than the beneficial ones. Ephedrine has been banned for use in most countries, including Russia. At the moment, the medicine is used only in the treatment of allergic swelling of the nasal mucosa.

The medicine causes psychological dependence from the very first doses. It is used to prepare harder drugs: mulk, vint or pervitin. Pervitin is similar to methamphetamine in its effects on the body.

With prolonged use of drugs with ephedrine, the psychological state is disturbed. A person becomes aggressive without a new dose, it is difficult for him to concentrate and study. People who regularly use ephedrine are very thin, their speech is rapid and incoherent.

Under the influence of ephedrine in small doses, no changes occur in the internal organs. But if the dose is increased, toxic damage to the heart and liver will develop. Over time, instability in the functioning of the nervous system will appear. If the drug is mixed with alcohol or other drugs, attacks of aggression, convulsions, and loss of consciousness are possible.

Content:

1. Application in medicine
2. Psychoactive effects
3. How drug intoxication manifests itself
4. How does ephedrine withdrawal occur?
5. Overdose
6. Negative consequences of abuse
7. Treatment of ephedrine addiction

Some plants contain alkaloids that have psychoactive effects on humans.
Such natural compounds include ephedrine. In its natural form, it is found in varieties of ephedra growing in Central Asia, Transbaikalia, and Western Siberia. The properties of this substance were used in Chinese medicine for many centuries before its scientific discovery in 1885 by Japanese pharmacologist Nagai Nagayoshi from the double-spike conifer. Chinese healers of ancient times used it for attacks of bronchial asthma, bronchitis, and also as a stimulant for the body. Since the 20th century, a way of chemical synthesis of the drug has been found, which has been supplemented with new techniques over time. Today, the active ingredient is obtained both naturally (from plant materials) and synthetically (from chemical components). Persons with a tendency to take psychoactive substances use ephedrine as a drug.

Historical facts

The Chinese and Mongols have been using ephedra for over a thousand years. Its stimulating effect allows you to make tonic infusions from it. The property of ephedra to expand the bronchi has been used in the treatment of bronchial asthma. This treatment has many side effects, but thanks to it, people did not die from airway obstruction.

The first evidence of ephedrine abuse appeared more than 30 years ago. The drug was used in the form of drops or tablets. Drops were used intranasally, tablets were used orally. At the end of the 70s, ephedrine began to be enhanced by oxidation or alkalization, thereby creating new types of drugs.

Taken from: Tiganov A.S. (ed.) ‹‹Exogenous mental disorders›› Abuse of homemade ephedrine preparations and ephedrine-containing mixtures.

At the beginning of the 20th century, ephedrine was first synthesized by Nagai Nagayoshi, but he never understood what effects the substance had. Later, starting in 1920, ephedrine began to be actively sold in China. After another 5 years, it entered the European and American markets.

In the 80s of the 20th century, ephedrine preparations became the basis for the preparation of drugs in artisanal conditions. The discoverers of the recipe are considered to be those convicted in prison. At that time, the medicine cabinet contained cough tablets, potassium permanganate and other necessary substances to obtain a drug called “vint”.

The screw was injected intravenously and received a strong psychostimulating effect. Later, having slightly changed the preparation procedure, they began to produce a drug called “mulka” from ephedrine. These events became the reason for the ban on the circulation of ephedrine and ephedrine-containing drugs on the territory of the Russian Federation. The exception is drugs in which the concentration of ephedrine does not reach 10%.

In America and some European countries, ephedrine is sold in quantities of up to 9 grams per month per person. Sales are carried out without a prescription, but with identification documents.

Ephedra alkaloids were actively used by German pilots during the Second World War. There is evidence that the first aid kit of NATO soldiers still includes ephedrine-based psychostimulants.

In 2022, the use of ephedrine as a drug has decreased significantly, as the cost of the resulting substances is too high. And the black market for drugs is filled with substances that cost less but have similar effects to ephedrine.

Effect on the body

The ephedra alkaloid begins to act 5-15 minutes after administration. Regardless of whether the substance is smoked, drunk, or taken intranasally, the effects on the body are the same. Ephedra alkaloid is a typical psychostimulant. This means that he:

• speeds up the reaction;
• increases the strength of cardiac output;
• increases body temperature;
• dilates the bronchi;
• suppresses appetite;
• increases blood glucose levels;
• slows down intestinal motility, causing constipation;
• increases diuresis;
• accelerates liver function;
• reduces saliva secretion;
• increases sweating;
• eliminates drowsiness.

The duration of the effect after intranasal and oral use is 3-4 hours. After intravenous - 1-1.5 hours.

Our body has certain reserves of norepinephrine, adrenaline and dopamine. They are a reserve and are used only in cases of danger to life or when it is necessary to quickly change the functioning of the heart and lungs (in case of blood loss, fear).

When using the drug ephedrine, all these reserves are quickly depleted. This leads to the inability of the nervous system to adequately perceive external and internal signals about disturbances in the functioning of the body.

After the end of the drug's effect, due to the depletion of mediators, a depressive state occurs, and indifference to life and the environment. This process can be called emotional burnout.

In the second phase of intoxication, patients are very fussy. They cannot sit in one place, constantly change their location, and perform unnecessary movements.

Taken from: Tiganov A.S. (ed.) ‹‹Exogenous mental disorders›› Abuse of homemade ephedrine preparations and ephedrine-containing mixtures.

A serious negative consequence of taking the pure substance is an increase in blood pressure. This leads to increased heart rate and impaired heart function. Systematic use of substances containing ephedrine can cause a heart attack or stroke.

If the drug is not used in its pure form, but after oxidation or alkalization in the form of granules for intravenous or intranasal use, then the risk of toxic damage to the liver and kidneys increases.

When preparing the drug “mulka”, the ephedra alkaloid is subjected to alkalization using potassium permanganate. This leads to the fact that, along with the drug, a large amount of potassium permanganate enters the human body, which accumulates in the brain and becomes the cause of the development of Parkinson’s disease. With a single overdose, chorea, cramps and involuntary movements in the muscles occur.

When pervitin is prepared from ephedrine, red phosphorus is used in large quantities. There are no preparation technologies, so the “output” of the drug contains a lot of red phosphorus. It is phosphorus that destroys the liver in a few months.

How to recognize a drug addict

For an ephedrine addict, life is conditionally divided into 2 phases: the time of action of the drug and the time of abstinence (the end of the drug’s effect).

In the first phase, the person is active, he is constantly drawn to talk, his speech is accelerated, unclear, his sentences are incoherent. The drug addict has dilated pupils and red eyes. He constantly sweats, constantly moves his gaze and cannot concentrate on one thing for a long time.

Movements are usually chaotic. A man quickly waves his arms, he is drawn to an active pastime. He wants to dance or go somewhere, he absolutely does not want to sleep. He has a desire to use it again so that the effect does not end. Then, in the next 20 hours, insomnia sets in, after which the person falls asleep for 12-15 hours.

At the moment of withdrawal, the person is nervous, aggressive, does not answer questions or answers in monosyllables. A drug addict in this state is ready to deceive even those closest to him. He is looking for money for a new dose. During periods of “off”, a depressive state may occur, leading to apathy and even suicide.

Drug addicts who use ephedrine for a long time are underweight. They are lethargic and get tired quickly during physical activity.

If you suspect a family member of using ephedrine, you need to inspect his personal belongings or the room in which he lives. Suspicion is caused by cough medications, yellowish or transparent crystals, and containers with clear liquid.

To confirm or refute the fact of drug addiction in a member of your family, you can conduct special rapid tests.

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Consequences of taking ephedrine

After taking the first tablet or taking an injection, you may notice an improvement in your mood. Qualities such as friendliness and sociability are enhanced. A person wants to make new acquaintances, he craves communication.

But as soon as the effect of the drug stops, the addict’s condition changes dramatically. He becomes lethargic and apathetic. Depression and fatigue come over him when he doesn’t want to do anything. In this state, uncontrollable attacks of aggression may flare up. Suicidal thoughts occur quite often.

If a person has willpower, physical dependence will go away within a few weeks. It’s more difficult with the psychological aspect. Thoughts about ephedrine will torment you for several months, and in this state it will not be difficult to relapse. That is why it is so important that there is a person nearby who would support the addict and save him from relapse.

Tests for ephedrine

The basis of any drug test is the determination of drug metabolites. To do this, they can take saliva, blood, urine or nails with hair. All methods are relatively expensive. It is much easier to use a regular rapid test for 5 or 10 drugs at once. The reliability of such a test is 99%, provided that there is no substitution of the biological fluid that is being tested.

Determination of drug metabolites occurs using immunochromatography, gas chromatography or gas chromatography-mass spectrometry. The last 2 methods are used in forensic practice and have legal force.

Rapid tests are not legally binding and can only be used for pre-screening for drug use. In addition, test tablets cannot indicate the timing of the last use and the quantities in which a person took the drug.

One of the most common tests for ephedrine is the test from Delta M. You can use analogues from, Nanoscreen or Immunochrome. The average price of the test is from 100 rubles.

How to get tested for ephedrine:

• the prepared container for collecting biological fluid must be clean, made of glass or plastic;
• the temperature of the biological fluid or material must be at least 20 degrees and not higher than 40;
• the duration of contact of the test with the biomaterial should be longer than 25 seconds. Normally - 30-35 seconds;
• the time for the result to appear on the express test is 10-12 minutes, if longer, the test may be defective;
• 2 lines in a regular drug test indicates that the result is negative (check the instructions).

If there are no changes at all in the test, no stripes appear, the test does not change color - it is spoiled. To obtain a reliable result, the test system must be changed.

In order to do the test on time, you need to know how long ephedrine stays in the body.

Legal characteristics of ephedrine crimes

Based on legislative standards, the method of obtaining the drug does not matter: criminals obtain this substance by extract, through chemical synthesis, or by purifying natural ephedra. The sale and use of ephedra and all its derivatives is strictly regulated by law, similar to narcotic drugs.

According to state legislation, a special list has been compiled, which includes all toxic and potent substances. The element and all its derivatives were included in this list. Criminal liability for use and trafficking occurs only when the substance is used in large quantities. The most important features of the classification of crimes related to trafficking are the following factors:

1. Under the current code section, there is no specific minimum weight for criminal liability;
2. The presence of direct personal intent with the possibility of obtaining any benefit;
3. The offender is over 16 years old.

In accordance with legislative innovations, innovations have been introduced in the field of gradation of potent substances and their derivatives. An element is considered a toxic prohibited substance only when the permissible concentration level increases by about 10% or more of this level. According to current regulations, a large batch volume is considered to be a portion of an element from 0.0006 to 0.006 kg, and a particularly large quantity of ephedrine is considered to be a batch of 0.006 kg or more.

How long does it stay in the body?

The more often a drug addict uses ephedrine, the longer it takes for the drug to be detected in the blood. This is due to the fact that ephedrine accumulates well in fat and bone tissue. In addition, the following factors influence the time it takes for a drug to be eliminated from the body:

• person's weight;
• liver and kidney functionality;
• experience of use;
• simultaneous use of other drugs or medications;
• amount of fluid consumed;
• age.

The better the liver and kidneys work, the faster traces of drug use are eliminated. The longer the period of use, the slower ephedrine is excreted. In patients over 25 years of age, metabolic processes gradually decrease, and the time of elimination and “processing” of the drug also slows down.

Keep in mind that before testing you should limit your intake of cough suppressants and fat burners or dietary supplements for weight loss. These products may contain traces of ephedrine.

How long does it stay in urine?

Ephedrine can be detected in urine within 5-7 days if it was taken once. If a person uses regularly, the drug can be detected in the urine within 5-10 days. You cannot cheat a urine test for ephedrine; you can only replace the biological fluid. This happens when there is no control during urine collection.

How long does it stay in the blood?

The drug stays in the blood for up to 12 hours. It is then metabolized in the liver and excreted through the kidneys. There is evidence that ephedrine can be detected in the blood within 3 days. This is possible provided that you have a modern laboratory with expensive reagents.

How long does it stay in hair?

Hair analysis for ephedrine is not performed. This is very expensive and usually ineffective. The narcotic substance is quickly metabolized and excreted well without accumulation in the hair.

How long do drug addicts live?

When using ephedrine in pharmacological doses, no significant harm to the body occurs. If the purpose of use is to obtain a narcotic effect, then one should take into account what substance the person is taking. If an addict takes pure ephedrine, the estimated life expectancy will be between 8 and 15 years. If the drug is taken through intranasal or intravenous use of ephedrine after its chemical treatment, then the life of such a drug addict lasts 5-7 years.

It is necessary to take into account not only the duration, but also the quality of life. Usually, after 1-2 years of active use of psychoactive substances, irreversible changes occur in the cerebral cortex. This leads to degradation, memory loss and a decrease in mental abilities. As a result, a person exists only to receive a new dose. Rehabilitation of such patients is very difficult, since it takes years to restore the nervous system.

The cardiovascular system suffers greatly. After “marathons” of ephedrine use, the heart muscle loses tolerance to physical activity. The person experiences shortness of breath and swelling gradually increases. Without drug treatment, the case ends in heart failure.

Liver and kidney problems rarely cause death, but they reduce quality of life. A person suffers from constant pain, disorders of bilirubin metabolism, and a decrease in the antioxidant function of the liver. Long-term use of “dirty” ephedrine can cause the development of liver tumors.

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Analogs

Among pharmaceutical drugs, all drugs that contain ephedrine are its analogues. Basically, these are cough syrups or tablets. Nowadays you can find dietary supplements that contain ephedra alkaloid. The use of such unlicensed dietary supplements is considered illegal and can cause addiction.

Pharmacy analogues that can be purchased in Russia include:

• Bronholitin;
• Bronchoton;
• Bronchocin;
• Theophedrine;
• Bronchitusen;
• Insanovin.

Caffeine and guarana have similar effects and can be considered weak analogues of ephedrine.

Among the substances on the drug market, the most similar in effects are the following:

• dexamphetamine;
• cocaine;
• crack.

All analogues of the drug are dangerous. They accumulate in the body and cause psychological dependence.

Characteristics of the drug

The most commonly used is ephedrine hydrochloride. This is a powder whose crystals have an oblong, needle-shaped shape. It dissolves well in alcohol and water, but is practically insoluble in chloroform and ether. The powder has a bitter taste. Available in the form of tablets, cough syrup and injection ampoules. The daily dose should not exceed 0.08 g. But with subcutaneous administration of the drug, the dosage can be increased to 0.15 g.

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How to speed up elimination at home

The drug is eliminated slowly. When it comes to accelerating elimination before testing, there is no effective way. In order to reduce the effects of the drug, you can try standard detoxification methods at home:

• Drink plenty of water up to 3-4 liters of water per day. You need to drink alkaline water, since many minerals are excreted in the urine and need to be replaced.
• Reception of sorbents. This is only relevant if the drug is taken orally. In other cases, the use of activated carbon or its analogues will not produce results.
• Raising body temperature. You can turn on the heater, drink hot tea or food. This will speed up sweating and drug elimination.

You should not go to the sauna or perform physical activity while under the influence of ephedrine, as this puts a lot of strain on the cardiovascular system.

The same applies to physical activity. When the drug acts, the heart pumps up to 10-15 liters of blood per minute, which is already equivalent to physical activity. Increased heart function will lead to metabolic disturbances in the myocardium and delayed disturbances in its functioning. Arrhythmias may appear.

You cannot drink coffee or energy drinks. This will only enhance the effect of ephedrine. You should also not drink alcohol, as this will lead to toxic damage to the liver and overload the nervous system. The combination of ephedrine and alcohol may cause psychosis and hallucinations.

In the Russian Federation, 7 medicinal products containing ephedrine are registered. Most drugs are in liquid form. All drugs are used to treat respiratory diseases. In addition, there are drugs in injectable forms.

Taken from a scientific article: Scientific article: “STUDYING THE FEATURES OF CIRCULATION OF MEDICINES WITH EPHEDRINE IN RUSSIA AND UKRAINE FROM THE POSITION OF FORENSIC PHARMACY” Authors: Shapovalov V.V. Shapovalova V.A. Shapovalov (Jr.) V.V. Komar L.A.

Detoxification in hospital

Detoxification in a hospital always takes place under the control of indicators of the acid-base and mineral composition of the blood. This is important because hospital detoxification is based on the following methods:

• Volume infusion therapy with 5% glucose, saline solution. If necessary, use trisol or disol. Any crystalloids will have a positive effect on the rate of drug elimination.
• Forced diuresis under the control of the mineral composition of blood plasma. After filling the blood with fluid, the patient is given diuretics. Thus, the body is freed from ephedrine metabolites. This is dangerous because potassium, sodium, calcium and other substances come out along with the liquid, which must always be kept within the physiological norm.
• Plasmapheresis or hemodialysis. A technique in which blood is passed through special filters to remove the drug without damaging internal organs. The disadvantage of this procedure is the risk of developing hepatitis or contracting HIV infection.

All detoxification measures in a hospital or special institutions are associated with the use of symptomatic therapy as any symptoms arise that threaten the patient’s life. It is impossible to protect a drug addict at home in this way.

Overdose

The cause of overdose is the development of receptor tolerance to the action of the drug. This means that each time you use ephedrine, the effect is less pronounced. Therefore, to achieve the desired narcotic effect, the addict constantly increases the dose, hoping to overcome tolerance, but the result of taking large amounts of ephedrine is depression of the central nervous system and a toxic effect on the liver.

The second dangerous point is the impurities that are used to enhance the effect of ephedrine and change its chemical structure. The same red phosphorus or potassium permanganate destroys the brain and liver, quickly causing an overdose of chemicals.

If you drink alcohol, coffee, energy drinks, antidepressants and their analogues together with ephedrine, the effect will be potentiated, that is, it will become more pronounced and more toxic. As a result, this will also lead to an overdose.

How to recognize

The person may be unconscious or hallucinating. The drug addict develops delusional ideas and paranoia; he is not oriented in time and space. Convulsions and vomiting may occur.

It is difficult to understand that an overdose of ephedrine has occurred. The symptoms of all overdoses of psychoactive substances are approximately the same. But in any case, it is necessary to provide assistance to the best of your ability.

What to do

First of all, look around for any dangers to your health. Then call an ambulance or a specialized team that treats drug addiction and overdose.

If the person is unconscious, turn their head to the side. This will help prevent vomit from entering the respiratory tract. If a person has an attack of delusion or hallucination, it is necessary to protect him from objects that could harm himself or others.

The ambulance can inject the patient with sedatives, usually from the group of tranquilizers. Doing this yourself is dangerous, since the wrong dose can cause a coma in the patient.

Interaction with other drugs

Ephedrine and pseudoephedrine:

• Weaken the effects of narcotic analgesics and sleeping pills;
• Concomitant use with other sympathomimetics increases side effects;
• Taken together with reserpine and MAO inhibitors (including furazolidone, procarbazine, selegiline) can cause headache, cardiac arrhythmias, vomiting, and a sudden strong increase in blood pressure;
• When used simultaneously with cardiac glycosides, quinidine, tricyclic antidepressants, dopamine, inhalation anesthesia agents (chloroform, enflurane, halothane, isoflurane, methoxyflurane, trichlorethylene), the risk of developing severe ventricular arrhythmias increases;
• Reduce the antihypertensive effect of diuretics, nitrates, beta-blockers (blockade of beta-adrenergic receptors can lead to the prevalence of alpha-adrenergic activity with the risk of developing arterial hypertension and pronounced bradycardia with the possible development of heart block);
• Medicines that alkalinize urine (antacids containing Ca2+ and Mg2+, carbonic anhydrase inhibitors, citrates, sodium bicarbonate) reduce the rate of excretion in urine and increase the duration of action.

Rehabilitation

Rehabilitation of such addiction occurs only in a comprehensive manner. There is not a single method or drug, after taking which a person’s addiction immediately disappears. Adequate rehabilitation is considered to be a complex of treatment methods:

• symptomatic therapy and detoxification in the first weeks;
• psychological work in a group or individually;
• combating withdrawal symptoms with antidepressants and replacement therapy;
• working with codependent people;
• resocialization of the patient.

Only in this way can the patient be put into long-term remission without breakdowns. Every point is important. If a person does not find support in the family or does not have an active social life, sooner or later he will relapse again.

If you let abstinence take its course, in 95% of cases there will be a disruption in the functioning of internal organs in the first 3 months after the start.

How does ephedrine withdrawal occur?

Withdrawal from taking a narcotic drug causes painful depression for the patient.

• He develops:
• Severe weakness.
• Decline of physical and mental strength.
• The appearance of a feeling of spiritual emptiness.
• Constant, increasing drowsiness, apathy.
• Pain syndrome in which the pain is wandering in nature.
• Irritability against a background of increasing depression.
• Disorders of the functions of the gastrointestinal tract: nausea, vomiting, diarrhea.

The severity of withdrawal depends on the patient’s age, length of time taking the drug, and state of health. Physical dependence on ephedrine is quite rare, but signs of withdrawal syndrome can be quite pronounced. Withdrawal can last 2-3 days, and in advanced cases 1-2 weeks. Patients often experience suicidal thoughts.

Why you can’t undergo rehabilitation at home

At home there is no way to provide symptomatic treatment in a timely manner. There is no possibility of daily monitoring of blood counts and checking the patient for drug use.

At home there is a greater chance of relapse, as there is easy access to friends and drug dealers. On an outpatient basis, there is no opportunity to provide psychological support and adequate support in the process of getting rid of addiction.

A house can be reminiscent of times when a person was under the influence of drugs. This will become another trigger in trying to use again.

To qualitatively restore the patient’s personality, you need to work with professionals. Only a few with great willpower and motivation can cope on their own. The rest only talk about getting started, and they themselves use the drug at the first opportunity. Therefore, it is better to treat addiction in a hospital or special institution.

Treatment of ephedrine addiction

Successful treatment for ephedrine addiction depends on early help seeking.

The healing plan includes:

• Infusion-drip cleansing and non-drug detox.
• Drug treatment of concomitant diseases.
• Motivational and family psychotherapy.
• Preparation for coding and the coding procedure itself.
• Rehabilitation stage with group formats of psychocorrection, art therapy, occupational therapy, special rehabilitation programs (12 steps, Minnesota model, Daytop and others).

The main emphasis in getting rid of drug addiction is on psychocorrection methods.

Working with codependents and resocialization

Working with codependents involves psychological preparation of family members or people close to the patient. This is necessary for the development of a stable mental connection between the patient and his environment. Only correctly established behavior patterns help an addicted person find support and not relapse again.

If this is not done, any conflict with a loved one will lead to drug use even after long-term abstinence. Codependent people must know how to behave in conflict situations, how to support the patient and take him away from the drug. With a bilateral understanding of the problem, remission will be stable and long-lasting.

The second important point is the resocialization of the patient. After the beginning, a person needs to find himself in society, to occupy his social niche. This will help him feel like a person, will help replace the devastation of the nervous system after the effects of drugs. Such distraction should play the role of psychological support and replacement therapy for the entire period of remission.

One of the tasks of resocialization is to prepare the patient for life's difficulties and for the problems that occur in the lives of ordinary people. A prepared patient tolerates all the troubles more easily and does not want to receive a new dose of the drug to calm him down.

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