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Scopolamine
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Scopolamine, known by the names levo-duboisine and hyoscine, is a tropane alkaloid drug with muscarinic antagonist effects. It is obtained from plants of the family Solanaceae (nightshades), such as henbane, jimson weed and Angel's Trumpets (Datura resp. Brugmansia spec.), and corkwood (Duboisia species ).
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Scopolamine, known by the names levo-duboisine and hyoscine, is a tropane alkaloid drug with muscarinic antagonist effects. It is obtained from plants of the family Solanaceae (nightshades), such as henbane, jimson weed and Angel's Trumpets (Datura resp. Brugmansia spec.), and corkwood (Duboisia species ). It is among the secondary metabolites of these plants. Therefore, scopolamine is one of three main active components of belladonna and stramonium tinctures and powders used medicinally along with atropine and hyoscyamine. Scopolamine was isolated from plant sources by scientists in 1881 in Germany and description of its structure and activity followed shortly thereafter and much knowledge was acquired prior to 1881 as the alkaloid was known for a number of years as levo-duboisine.
Scopolamine has anticholinergic properties and has legitimate medical applications in very minute doses. As an example, in the treatment of motion sickness, the dose, gradually released from a transdermal patch, is only 330 microgrammes (µg) per day.
An overdose can cause delirium, delusions, dangerous elevations of body temperature, stupor and death.
Etymology
Scopolamine is named after the plant genus Scopolia. The name "hyoscine" is from the scientific name for henbane, Hyoscyamus niger.
Physiology
Scopolamine acts as a competitive antagonist at muscarinic acetylcholine receptors, specifically M1 receptors; it is thus classified as an anticholinergic,anti-muscarinic drug. (See the article on the parasympathetic nervous system for details of this physiology.)
Medical use
In medicine, scopolamine has these uses:
- Primary:
- Less often:
- As a preanesthetic agent
- As a drying agent for sinuses, lungs, and related areas.
- To reduce motility and secretions in the GI tract -- most frequently in tinctures or other belladonna or stramonium preparations, often used in conjunction with other drugs as in Donnagel original forumulation, Donnagel-PG (with paregoric), Donnabarb/Barbadonna/Donnatal (with phenobarbital), and a number of others
- Uncommonly, for some forms of Parkinsonism.
- As an adjunct to narcotic analgesia, such as the product Twilight Sleep which contained morphine and scopolamine, some of the original formulations of Percodan and some European brands of methadone injection.
- To enhance the pain-killing ability of various opioids.
- As an occasional sleep aid, and was available in some over-the-counter-products in the United States for this purpose until November 1990.
Nausea
Its use as an antiemetic in the form of a transdermal patch is the drug's most common medical application in the United States.
Ophthalmic
The drug is used in eye drops to induce mydriasis (pupillary dilation) and cycloplegia (paralysis of the eye focusing muscle), primarily in the treatment of eye disorders that benefit from its prolonged effect, e.g. uveitis, iritis, iridocyclitis, etc.
Memory research
Because of its anticholinergic effects, scopolamine has been shown to prevent the activation of medial temporal lobe structures for novel stimuli during spatial memory tasks.
Addiction
Scopolamine has been used in the past to treat addiction to drugs such as heroin and cocaine. The patient was given frequent doses of scopolamine until they were delirious. This treatment was maintained for 2 to 3 days after which they were treated with pilocarpine. After recovering from this they were said to have lost the acute craving to the drug to which they were addicted.
Currently, scopolamine is being investigated for its possible usefulness alone or in conjunction with other drugs in assisting people in breaking the nicotine habit. The mechanism by which it mitigates withdrawal symptoms is different from that of clonidine meaning that the two drugs can be used together without duplicating or canceling out the effects of each other.
Other medical uses
- It can be used as a depressant of the central nervous system, and was formerly used as a bedtime sleep aid.
- Anesthetic; Its use in general anesthesia is favored by some due to its amnesic effect. Scopolamine causes memory impairments to a similar degree as diazepam.
- In otolaryngology it is used to dry the upper airway (anti-sialogogue action) prior to instrumentation of the airway.
- In October 2006 researchers at the US National Institute of Mental Health found that scopolamine reduced symptoms of depression within a few days, and the improvement lasted for at least a week after switching to a placebo.
- Due to its effectiveness against sea-sickness it has become commonly used by scuba divers.
Routes of administration
Scopolamine can be administered by transdermal patches, oral, subcutaneous, ophthalmic and intravenous routes.
The transdermal patch (e.g. Transderm Scop) for prevention of nausea and motion sickness employs scopolamine base. The patch is effective for up to 3 days. The oral, ophthalmic and intravenous forms are usually scopolamine hydrobromide (for example in Scopace, soluble 0.4 mg tablets or Donnatal).
Recreational use
The use of medical scopolamine/opioid combination preparations for euphoria is uncommon but does exist and can be seen in conjunction with opioid use.
Another separate group of users prefer dangerously high doses, especially in the form of datura preparations, for the deliriant and hallucinogenic effects. The hallucinations produced by scopolamine, in common with other potent anticholinergics, are especially real-seeming, repetitive, boring and unpleasant. An overdose of scopolamine is also physically exceedingly unpleasant and can be fatal, unlike the effect of other more commonly used hallucinogens. For these reasons, naturally occurring anticholinergics are rarely used for recreational purposes.
Scopolamine in transdermal, oral, sublingual, and injectable formulations can produce a cholinergic rebound effect when high doses are stopped. This is the opposite of scopolamine's therapeutic effects: sweating, runny nose, abdominal cramps, nausea, vomiting, vertigo, dizziness, irritability, and diarrhea. Psychological dependence is also possible when the drug is taken for its tranquilizing effects.
Potential use in interrogation
"The Use of Scopolamine in Criminology" by Robert E. House appeared in the Texas State Journal of Medicine in September, 1922 and was reprinted in The American Journal of Police Science, Vol. 2, No. 4, Jul. - Aug., 1931.
The use of scopolamine as a truth drug was investigated in the 1950s by various intelligence agencies, including the CIA as part of Project MKULTRA. Nazi doctor Josef Mengele experimented on scopolamine as an interrogation drug.
Criminal use and urban legends
Scopolamine poisoning is sometimes reported as a way used by murderers or robbers, although largely exaggerated in many unfounded rumors.
For instance, traces of scopolamine were discovered in the body found in the cellar of Hawley Harvey Crippen, executed for the murder of his wife. It is unclear whether this caused death, and there is said to be some doubt that the body found was that of his wife.
Scopolamine has been reported to be used under the name burundanga in Venezuelan and Thai resorts in order to drug and then rob tourists. However, there are unfounded circulating rumors that a transcutaneous delivery mechanism using business cards, pamphlets or flyers laced with the drug, could be effective. Indeed, the quantity of toxin diffusing through the skin barrier after one short contact of the fingers with an object is much too small to be readily absorbed in the body and to have any significant effect. The use of burundanga impregnated visit cards to attack and to rob isolated people is often propagated by chain emails and is presently reported as hoax or urban legend by many specialised web sites . Meanwhile, spiked alcoholic drinks (direct ingestion) could have been occasionally used. In recent years the criminal use of scopolamine has become epidemic in Colombia. Approximately one in five emergency room admissions for poisoning in Bogotá have been attributed to scopolamine.
Victims of this crime are often admitted to a hospital in police custody, under the assumption that the patient is experiencing a psychotic episode. A telltale sign is a fever accompanied by a lack of sweat.
In June 2008, more than 20 people were hospitalized with psychosis in Norway after ingesting counterfeit Rohypnol tablets containing scopolamine.
Shamanic use
In Colombia a plant admixture containing scopolamine called Burundanga has been used shamanically for decades.
Witchcraft and sorcery
Scopolamine was one of the active principles in many of the "flying ointments" used by witches, sorcerers and fellow travellers of many countries and cultures from millennia ago ostensibly down to the late 19th century or even to the present day. Scopolamine and related tropanes contributed both to the flying sensations and hallucinations sought by users of these compounds. Potions, solids of various types, and other forms were also used in some cases.
These ointments could contain any number of ingredients with belladonna, henbane, and other plants of the belladonna and datura families being present almost invariably; they were applied to the vaginal and/or anal mucosa and/or large areas of the skin and other mucous membranes (often using a broom as an applicator, the origin of the image of a witch riding a broom) with the objective being to see the Devil and/or be transported to the Sabbat.
The hallucinations, sensation of flying, often a rapid increase in libido, and other characteristic effects of this practice are largely attributable to the CNS and peripheral effects of scopolamine and other active drugs present in the ointments such as atropine, hyoscyamine, mandragorine, scopoline, solanine, optical isomers of scopolamine and other tropane alkaloids.
The inclusion of belladonna/datura type plants amongst the dozens of ingredients in the Haitian zombie drug is thought by some authorities to be at least somewhat likely, although scopolamine-bearing plant matter is almost certainly not the main active ingredient, which has been theorised to possibly be Tetrodotoxin or a related substance.
Adverse effects
The common side effects are related to the anticholinergic effect on parasympathetic postsynaptic receptors: dry mouth, throat and nasal passages in overdose cases progressing to impaired speech, thirst, blurred vision and sensitivity to light, constipation, difficulty urinating and tachycardia. Other effects of overdose include flushing and fever, as well as excitement, restlessness, hallucinations, or delirium. These side effects are commonly observed with oral or parenteral uses of the drug and generally not with topical ophthalmic use.
Use in scuba diving to prevent sea sickness has led to the discovery of another side effect. In deep water, below 50–60 feet, some divers have reported pain in the eyes that subsides quickly if the diver ascends to a depth of 40 feet or less. Mydriatics can precipitate an attack of glaucoma in susceptible patients, so the medication should be used with extra caution among divers who intend to go below 50 feet.
Drug interactions: side effects and use against pain
When combined with morphine, scopolamine is useful for pre-medication for surgery or diagnostic procedures and was widely used in obstetrics in the past; the mixture also produces amnesia and a tranquillised state known as Twilight Sleep, also the name of a proprietary drug available in the past in ampoules of injectable fluid containing morphine sulphate and scopolamine hydrobromide (and in some cases the phenothiazine anti-nauseants prochlorperazine or promethazine as a third ingredient). Although originally used in obstetrics, it is now considered dangerous for that purpose for both mother and baby.
History
Scopolamine was one of the earlier alkaloids isolated from plant sources and has been in use in isolated, purified forms such as free base and various salts, especially hydrochloride, hydrobromide, hydroiodide and sulphate, since its isolation by German chemists in 1881 and in the form of plant-based preparations since antiquity and perhaps pre-historic times.
Scopolamine was one of the active ingredients in Asthmador, an over the counter smoking preparation marketed in the 1950s and 60's claiming to combat asthma and bronchitis.
Scopolamine was used from the 1940s to the 1960s to put mothers in labor into a kind of "twilight sleep" that did not stop pain, but merely eliminated the memory of pain by attacking the brain functions responsible for self-awareness and self-control. Often, this caused a kind of psychosis, followed by post-traumatic stress-like memories in thousands of new mothers.
Scopolamine was an ingredient used in some over-the-counter sleep aids before November 1990 in the United States, when the U.S. Food and Drug Administration forced several hundred ingredients allegedly not known to be effective off the market. Scopolamine shared a small segment of this market with diphenhydramine, phenyltoloxamine, pyrilamine, doxylamine and other first generation antihistamines, many of which are still used for this purpose in drugs like Sominex, Tylenol PM, NyQuil, etc.
Popular culture
Scopolamine's use as a truth serum features in a number of fictional works such as Farewell, My Lovely, The Guns of Navarone and the Matarese Dynasty. In 1957 scopolamine achieved a moderate level of notoriety via its mention in the film I Was a Teenage Werewolf, where Dr. Alfred Brandon uses it as part of his endeavor to regress the titular character to his "primitive roots." According to Dr. Liz Kingsley's film review site And You Call Yourself a Scientist, Brandon's line "Prepare the scopolamine!" is "the only scientifically accurate line in the whole film."
Its recreational use is recounted in a letter from Tangier to Allen Ginsburg, William S. Burroughs recounts an incident in which he shot up a series of ampoules of a morphine preparation containing scopolamine without considering the effect of the latter drug; later in the evening he was reportedly red as a beet, had totally disrobed and was running around yelling and trying to get away from monsters; he needed to be restrained by the owner of the building in which he rented an apartment. In Fear and Loathing In Las Vegas by Hunter S. Thompson, the narrator's attorney mentions an incident in which he was given an entire datura root as a gift, ate the entire thing at once and went blind, had to be taken back to to house in a wheelbarrow and started making noises like a raccoon.
In Carlos Castaneda's series of books The Teachings of Don Juan: A Yaqui Way of Knowledge, the Datura plant is the favored shamanic, revelatory drug of the titular character. The book explores, in depth, Castaneda's alleged experiences under the influence of the drug, as well as the alleged rites surrounding its use and preparation.
Its use to combat addiction is portrayed in Stephen King's novel Misery, which depicts the protagonist self-administering a morphine-scopolamine injectable to stave off pain and withdrawal symptoms (after being deliberately given narcotic analgesics to produce physical dependence subsequent to being rescued after an automobile crash by a nurse with a huge stash of narcotics who also wanted the main character to re-write previous novels to suit her ideas about how they should have ended) during an escape attempt.
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