title: Abuse of the over-the-counter antispasmodic butylscopolamine for the home synthesis of psychoactive scopolamine.
abstract: We report on two patients who ingested psychoactive scopolamine that was synthesized at home from butylscopolamine (Buscopan®), which is available as over-the-counter antispasmodic in nearly 100 countries worldwide. Patient 1 presented with severe central anticholinergic toxidrome, while patient 2 suffered from minor symptoms. An empty blister of Buscopan® was found in the patients' home, but initially was not suspected to be causative for the observed central anticholinergic symptoms, as Buscopan® is not able to pass the blood-brain barrier in its native form. Only later, the information by third parties and a Google search helped to identify homemade scopolamine derived from Buscopan® as the responsible agent in these two cases. Retrospectively, scopolamine could be detected in serum and urine of both patients, while it was absent in one control after ingestion of native Buscopan®.
  
  
  CONCLUSIONS
  Over-the-counter drugs can be used to synthesize psychoactives with means that are available in every household. Such knowledge can spread via social media and internet discussion boards long before appearing in medical literature. While typical clinical presentation often enables clinicians to adequately identify and treat specific toxidromes, these sources of information need to be increasingly taken into account by medical professionals for identification of its causative agent. This potential of Buscopan® might gain importance as an easily accessible source of psychoactive scopolamine.
  
  
  BACKGROUND
  • Substances with central anticholinergic effects are known for their hallucinogenic potential and may be used as psychoactives. What is New: • The over-the-counter antispasmodic butylscopolamine (Buscopan®) can be abused to synthesize anticholinergic, psychoactive scopolamine at home with means that are available in every household.
authors.affiliation: Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Duesseldorf, Germany. sebastian.kummer@med.uni-duesseldorf.de.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kummer
authors.affiliation: Institute of Legal Medicine, University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Duesseldorf, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Rickert
authors.affiliation: Institute of Legal Medicine, University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Duesseldorf, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Daldrup
authors.affiliation: Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Duesseldorf, Germany.
authors.forename: Ertan
authors.initials: E
authors.lastname: Mayatepek
mesh_terms: D000293:Adolescent; D064807:Anticholinergic Syndrome / Q000175:diagnosis*; D002086:Butylscopolammonium Bromide / Q000009:adverse effects* / Q000032:analysis; D015198:Designer Drugs / Q000032:analysis; D006801:Humans; D008297:Male; D004366:Nonprescription Drugs / Q000009:adverse effects; D010276:Parasympatholytics / Q000009:adverse effects* / Q000032:analysis; D012601:Scopolamine / Q000009:adverse effects* / Q000032:analysis
chemical_list: D015198:Designer Drugs; D004366:Nonprescription Drugs; D010276:Parasympatholytics; D002086:Butylscopolammonium Bromide; D012601:Scopolamine
keywords: Abuse; Anticholinergic syndrome; Buscopan®; Butylscopolamine; Intoxication; Microwave; Scopolamine