Routes of administration

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The method in which a substance has been ingested can greatly impact the potency, duration, and overall experience of a substance. Many substances are more effective when consumed using certain routes over others and some drugs are completely inactive using certain routes of administration. Determining a route is highly dependent on the substance consumed, the desired duration of the substance, and one's personal comfort level.

Oral

Arguably the most common route of administration for most classes of drugs, oral administration allows a substance to be absorbed through blood vessels contained in the stomach. The onset is generally slower than other methods of ingestion, varying between individual substances.[1] This method can also cause a greater propensity for nausea compared to other methods and the duration and absorption are longer as well.[2][3]

Oral cavity

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Quantity and mimic issues

  • The quantity of psychoactive substances in paper blotters prepared by someone else may vary wildly. There is not guarantee that even sheets are standardized. One way to get around this is to dissolve the blotters in alcohol and use volumetric liquid dosing with microliter syringes to prepare new blotters.
  • Common dangerous mimics can be largely avoided by avoiding sublingual, buccal, and sublabial (under the lip) administration for substances that are bioavailable orally. 25I-NBOMe is widely rumored to be orally inactive; however, oral efficacy has not been disproven and apparent overdoses have occurred via oral administration. 25I-NBOMe (and other NB's like 25x-NBOMe, 25x-NBOH) has much lower oral bioavailability than sublingual, buccal, and sublabial administration. 25I-NBOMe, which has been attributed to several deaths,[4][5][6][7] may commonly be mistaken for LSD by sellers and users.[8]


Caustic substances such as 4-FA or phenibut hydrochloride should not be used sublingually because they can burn the inside of one's mouth if left in one spot for too long.

Sublingual

Sublingual administration refers to the absorption under the tongue.[9] It is a common route of administration for drugs such as LSD. Sublingual administration can result in a faster absorption. It also circumvents the GI tract's tendency to break down certain drugs, such as 25I-NBOMe, which absorb via sublingual and buccal administration but not orally. Sublingual administration results in the substance being absorbed through the large lingual artery present underneath the tongue.

Buccal

Buccal administration refers to the absorption in the cheek and gum. This is commonly employed when ingesting drugs such as 25I-NBOMe, DOM, LSD and other substances contained within blotter paper. Like sublingual absorption, the substance is largely absorbed through the lingual artery but is also absorbed through gum lining. This method is used when chewing plant leaves such as khat, kratom, salvia divinorum, and sometimes tobacco.

Insufflation

Insufflation (also referred to as snorting) refers to introducing a substance into the sinus via the nostrils. Insufflation is a very common method for substances in powder form. Many users find this route to be painful and uncomfortable, although certain substances are easier to insufflate than others.

This method is capable of rapid absorption through mucous membranes and blood vessels in the sinus. Absorption and onset is generally much more rapid and, subsequently, a substance feels much more intense and often shorter acting than if taken orally. Insufflation is common among drugs such as cocaine and ketamine, but is also known amongst yopo rituals. Insufflating tobacco in snuff form was common practice in the 20th century.

Frequently insufflating substances can damage one's mucous membranes, induce bleeding, damage the nostril's cartilage and lining, burn the throat, and cause other trauma to the nasal passage and sinus area.[10] To reduce damage, it is recommended to grind the substance completely before use and alternate nostrils.[11] Sharing snorting equipment (straws, banknotes, bullets, etc) has been linked to the transmission of hepatitis C according to a study, the University of Tennessee Medical Center researches warned that other blood-borne diseases such as HIV, the AIDS-causing virus, could be transmitted as well.[12]

Respiratory tract

For a proper gas or smoke deposition, one are advised to take a deep initial breath, and then hold it for 10 seconds to allow for the gas or smoke to get fully absorbed in the lungs. Subjects are frequently instructed to follow the "10 seconds rule" in studies.[13][14][15]

Inhalation

Inhaled administration is used for inhalants gases such as nitrous oxide, volatile liquids such as ether, and volatile viscous compounds such as poppers or toluene containing glue. Inhalants do not require an external heat source to produce psychoactive vapors that can then be inhaled through various methods depending on the substance used. Inhaled substances are absorbed very rapidly and lead to an almost instantaneous absorption of the substance and passage through the blood brain barrier.[16] Many substances can be inhaled to achieve an altered state of consciousness, however, many industrial chemical compounds used for this purpose produce highly negative physical and neurological damage.

Smoked

Smoking substances is a common method of consumption with the most common examples including cannabis and tobacco. To smoke a substance a direct heat source, most often a flame, is applied directly to the substance with no barrier between the heat source and the substance. It is for this reason that heroin is colloquially referred to as "smoked" but is really vaporized often using tinfoil as a barrier between the substance and the flame source. The smoking of substances can lead to an almost instantaneous absorption of the substance and passage through the blood brain barrier.[17] When a substance is smoked, the substance is absorbed through blood vessels found in the bronchi tubes contained within the lungs. Like insufflation, the duration is decreased while its intensity is increased in proportion to oral absorption. Smoking a substance also bypasses the GI tract's tendency to break certain substances down, such as DMT.

The most common smoked substance is cannabis. Prolonged breath holding does not substantially enhance the effects of inhaled marijuana smoke.[18][19] Bongs that are cleaned regularly eliminates yeast, fungi, bacteria and pathogens that can cause several symptoms that vary from allergy to lung infection.[20][21][22]

Vaporized

Vaporizing substances is a common method of consumption with the most common examples including heroin and crack-cocaine. Vaporizing a substance allows for more temperature control because the flame or heat source does not come into direct contact with the substance. Even though many drugs, like heroin and oxycodone pills are colloquially referred to as "smoked" the process used to consume them is vaporization.Vaporizing substances can lead to an almost instantaneous absorption of the substance and passage through the blood brain barrier.[23] When a substance is vaporized, the substance is absorbed through blood vessels found in the bronchi tubes contained within the lungs. Like insufflation, the duration is decreased while its intensity is increased in proportion to oral absorption. Vaporizing a substance also bypasses the GI tract's tendency to break certain substances down, such as DMT.

Vaporization is commonly associated with the vaporizer pens that have become popular within the past decade, but it is not limited to ingesting the vapors from an electronic heat source. Smoking substances off of tinfoil is a common method of vaporizing substances with a flame heat source.

Due to the higher level of temperature control, vaporization is often a more efficient way to consume a substance. Especially when vaporizing off of tin foil or a oil burning pipe, the heat source can be held at different distances to create the perfect temperature to convert the substance into a vapor that can be inhaled. Smoking a substance that should be vaporized leads to a blast of heat that may burn off the active ingredient or ignite the substance itself, both of which are wasteful and incorrect.

Injection

About 0.1 mL of the solution is lost in conventional syringes through the luer lock tip and the luer lock adapter of the hypodermic needle. That can be compensated by either adding extra 10% or 5% substance in 1 mL or 2 mL syringes respectively, or by using low dead space syringes.

Intravenous

Intravenous administration refers to a drug being directly introduced into the bloodstream using a hypodermic needle. This method has the benefit of a very short onset and eliminates absorption by directly entering the bloodstream.[24] However, much greater care must be taken when compared to other methods of administration. Sterilized, unused needles and a high purity substance with little to no adulterant are required to avoid damage to the circulatory system.[25] Making sure no air bubbles are present in the reservoir before the plunger is released is also of dire importance as air bubbles in the bloodstream can easily be lethal.[26] This route is commonly used with substances such as heroin, but can be employed with almost any pure substance.

Intramuscular

Intramuscular administration refers to a drug being injected into the muscle tissue using a hypodermic needle. This method is very similar to the intravenous route, but is often more painful with a decreased onset and absorption. Some drugs (such as ketamine) are commonly administered via this route.[27] Like intravenous administration, intramuscular injection must be taken with precaution, using sterilized unused needles and not leaving any residual air bubbles in the reservoir.

Subcutaneous

Subcutaneous administration (also known as skin popping) refers to a drug being injected into the subcutis, the layer of skin directly below the dermis and epidermis. Subcutaneous administration is relatively uncommon among psychonautics, as many people are not trained how to do it or would rather use a different route of administration which they are more familiar with.

Rectal

Rectal administration, also commonly referred to as plugging, is one of the most effective methods of administration for many substances.[28][29] The absorption rate is very high compared to other methods and the onset is usually very short, generally with a higher intensity and shorter duration. This is due to a large amount of arteries located in the rectum; thus rectal administration is often superior to other methods despite social stigma. Caustic substances such as 4-FA or phenibut hydrochloride should not be plugged because they can burn the interior rectum resulting in a considerable amount of gastrointestinal distress.

Transdermal

Transdermal is a route of administration where active ingredients are delivered across the skin for systemic distribution. Examples include transdermal patches used for medicine delivery for opioids such as fentanyl [30] and transdermal implants used for medical or aesthetic purposes.

See also

External links

References

  1. http://www.nature.com/clpt/journal/v28/n3/abs/clpt1980181a.html
  2. http://journals.lww.com/anesthesia-analgesia/Abstract/1988/12000/Analgesic_and_Hyperalgesic_Effects_of_Midazolam_.10.aspx
  3. http://www.google.com/patents/US4229447
  4. Erowid. "25I-NBOMe (2C-I-NBOMe) Fatalities / Deaths". Drug Website. Erowid. Retrieved February 28, 2016. 
  5. Hastings, Deborah (May 6, 2013). "New drug N-bomb hits the street, terrifying parents, troubling cops". New York Daily News. Retrieved May 7, 2013. 
  6. Feehan, Conor (January 21, 2016). "Powerful N-Bomb drug - responsible for spate of deaths internationally - responsible for hospitalisation of six in Cork". Irish Independent. Retrieved January 22, 2016. 
  7. Iversen, Les (May 29, 2013). "Temporary Class Drug Order Report on 5-6APB and NBOMe compounds" (PDF). Advisory Council on the Misuse of Drugs. Gov.Uk. Retrieved June 16, 2013. 
  8. Iversen, Les (May 29, 2013). "Temporary Class Drug Order Report on 5-6APB and NBOMe compounds" (PDF). Advisory Council on the Misuse of Drugs. Gov.Uk. p. 14. Retrieved June 16, 2013. 
  9. http://bja.oxfordjournals.org/content/56/1/69.extract
  10. Is snorting MDMA worse for you than taking it orally? (Ask Erowid) | https://www.erowid.org/ask/ask.php?ID=41
  11. Research chemicals (MyCrew) http://www.mycrew.org.uk/drugs-information/research-chemicals
  12. https://consumer.healthday.com/infectious-disease-information-21/hepatitis-news-373/sharing-drug-snorting-straws-spreads-hepatitis-c-713114.html
  13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5152762/
  14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4968043/
  15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5152762/
  16. http://www.ct.gov/dds/lib/dds/edsupp/medadmin_recert_part_ii.pdf
  17. http://www.nature.com/clpt/journal/v28/n3/abs/clpt1980181a.html
  18. https://www.ncbi.nlm.nih.gov/pubmed/2027922
  19. https://www.ncbi.nlm.nih.gov/pubmed/2554344
  20. https://herb.co/learn/sick-dirty-bong-water/
  21. https://www.maryjanetokes.com/dirty-bong-the-dangers-of-using-one/
  22. https://www.leafscience.com/2018/07/16/dangers-dirty-bong/
  23. http://www.nature.com/clpt/journal/v28/n3/abs/clpt1980181a.html
  24. http://www.nature.com/clpt/journal/v28/n3/abs/clpt1980181a.html
  25. http://jpet.aspetjournals.org/content/279/3/1345.short
  26. http://www.ajol.info/index.php/sajr/article/viewFile/34461/6388
  27. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2007.05298.x/full
  28. http://jpet.aspetjournals.org/content/244/1/23.short
  29. http://bja.oxfordjournals.org/content/56/1/69.extract
  30. Fentanyl Transdermal Patch Medline Plushttps://medlineplus.gov/druginfo/meds/a601202.html