- Methoxetamine Symptoms and Warning Signs
- Learn the Immediate Side Effects of Methoxetamine Abuse
- Intervention for a Methoxetamine Addiction
- Questions about Treatment
- I cannot afford private treatment – is there a cheaper option?
- What happens after treatment?
- How will I get time off work?
- “Being with a Buddha”: A Case Report of Methoxetamine Use in a United States Veteran with PTSD
- 1. Introduction
- 2. Case Presentation
- 3. Discussion
Methoxetamine Symptoms and Warning Signs
The use of drugs such as methoxetamine – or MXE as it is also known – for recreational purposes is fairly common.
Methoxetamine is often used as a substitute for ketamine as it has similar chemical properties to the hallucinogenic drug.
However, methoxetamine is said to be preferable to ketamine as it does not have the same negative impact on the bladder (although there is insufficient evidence to support such claims at the time of this writing).
Methoxetamine is a drug that can induce feelings of pleasure in the user. If you have abused it, you are ly to have experienced feelings of relaxation and euphoria. You may also have experienced a floating-type feeling, which is known as a dissociative state. This is where you feel as though your mind and body have become separated. The sensations can last for up to twenty-four hours.
Some of those who take methoxetamine, however, do not experience pleasurable effects.
Indeed, taking it in high doses can lead to feelings of agitation, paranoia, sensory distortions, and speech and communication problems.
Methoxetamine is reported to be more powerful than similar drugs, such as ketamine and PCP, and was, un them, specifically developed as a designer recreational drug rather than for pharmaceutical purposes.
This is why methoxetamine is a highly addictive substance with a very high potential for abuse. If you are using this drug you should be alert to the signs of abuse and addiction so that you can get help if you find yourself with a problem. If you are unsure if you are taking it, we have collected a number of the methoxetamine options currently known to be sold in the UK.
As mentioned above, due to its hallucinogenic properties, methoxetamine is commonly used for recreational purposes and has been classed as a designer drug.
Although a banned substance in the UK, it is often sold in other countries as a ‘research chemical’ and marked as ‘not fit for human consumption’ to bypass local restrictions and regulations.
It is often referred to as a legal high and because many people believe it to be a safer alternative to ketamine, it is regularly taken as a substitute. Unfortunately, the false assumption that it is not harmful can lead to dangerous effects.
Abuse of methoxetamine can cause harm to health and it can lead to addiction. In fact, abuse of the drug can result in immediate health issues and, when taken in high enough doses, can even be fatal. It is important to recognise the signs of abuse and act upon them before you develop an addiction.
If you are struggling to control your use of methoxetamine, you may already have a problem that needs dealing with if you are to get better. You might have noticed that your use of this drug is increasing as time goes by.
This probably has a lot to do with your body building up a tolerance to the effects of the substance. You maybe need more of it to achieve the same feelings you did from a lesser amount when you first started taking it.
You may also be allowing, consciously or otherwise, your use of methoxetamine to interfere with daily life.
When substance use becomes substance abuse, it is ly that the drug you are using is becoming increasingly more important to you. You may spend most of your time using or thinking about it.
Do not let the drug push out everything that was once important to you – friends, family, career, ideals and dreams.
Methoxetamine is a dangerous drug, despite it being marketed as a safer alternative to ketamine. It can lead to both mental and physical health problems and it has been known to cause death even with just one-time use. Are you or your closest people concerned that the habit is getting beyond your control?
If your use of methoxetamine starts to spiral control, you might begin to notice many negative consequences. As your need for the drug increases, you may begin to isolate yourself from anyone who cannot help you in your quest to feed your habit.
This includes any non-drug using individuals in your life, which can have serious implications on your relationships with others. It is difficult, if not impossible, to maintain healthy relationships with others when substance abuse is an issue.
Other areas of your life that may be affected by an eventual addiction. If you are under the influence of methoxetamine for much of the time, your ability to perform to the required standard, whether this is work or school, will be negatively affected. This could affect your current and future prospects.
You may also find yourself at a higher risk of having an accident should you spend most of your time under the influence of a drug such as methoxetamine. After all, this is a substance that can cause hallucinations and impair judgement and could cause you to take unnecessary risks without accounting for the real dangers.
Addiction occurs when your use of a substance begins to have a negative impact on your life. When you have little or no control over a substance and you feel compelled to use it despite knowing that doing so will have negative implications for you and others, you are almost certainly addicted.
It is important to consider your use of methoxetamine to determine if it is causing significant problems in your life. This will give you an idea of whether you are addicted or not. Signs of addiction include:
- allowing your use to interfere with activities and hobbies you once enjoyed
- neglecting those around you and putting no effort into maintaining relationships that were once important
- isolating from family members and friends because of your methoxetamine use
- hiding your drug use from others because ‘they wouldn’t understand’
- neglecting personal hygiene and grooming
- promising yourself that you would not use methoxetamine but being unable to resist the urge
- feeling irritable or agitated when in need of the drug
- feeling guilty or ashamed about your use of methoxetamine
Methoxetamine is a drug that has commensurate properties to other dissociative anaesthetic drugs such as ketamine and PCP. Not much is currently known about how it affects the brain, but it is thought that it works in a comparable way to ketamine in that it affects certain receptors.
It is thought that methoxetamine is a dopamine reuptake inhibitor and a non-competitive NMDA receptor antagonist. As such, it can improve mood and reduce feelings of anxiety and stress.
Learn the Immediate Side Effects of Methoxetamine Abuse
Methoxetamine is a stimulant drug with hallucinogenic properties. Examples of the immediate effects associated with abuse of this drug include:
- feeling of calm
- increased sociability
- heightened sensory perceptions
- dissociative state
- slurred speech
- trouble communicating
- muscle incoordination
The side effects of long-term abuse of methoxetamine are relatively unknown and more studies are required. However, it is believed that the long-term side effects could be those experienced by chronic ketamine users and can include:
- memory loss
- severe stomach cramps
Although ‘marketed’ as a safer drug to ketamine and one that does not cause bladder and kidney problems, some research has found that methoxetamine can lead to kidney damage and bladder inflammation in some lab animals. It is presumed that the same problems could manifest in long-term users of the drug.
Intervention for a Methoxetamine Addiction
If you are worried about someone you love and believe that he or she may have a problem with methoxetamine, it is important that you intervene as soon as possible.
Although you may be hoping that the problem will resolve itself, this is highly unly.
In fact, what is more, ly to happen is that your loved one’s problem will get worse; this is what usually happens with any type of substance addiction. Methoxetamine is no different.
If the person you are concerned about is reluctant to admit that the problem exists, you might want to consider staging a family intervention.
This is where a group of people close to the addict, alongside an experienced interventionist, will meet to discuss the problem and how it is affecting their lives.
Interventions have a high success rate and are seen as one of the most effective tools when it comes to encouraging an addicted individual into treatment.
Suddenly stopping methoxetamine can result in withdrawal symptoms such as depression and insomnia. You could also notice other symptoms that are flu’s, such as sweating, chills, fatigue, and stiff muscles.
These symptoms could be enough to send you back to the drug that you know will make them subside.
It is for that reason that you may need to detox in a supervised facility, where you have no access to methoxetamine and where experienced staff can take care of you and make sure you are safe and comfortable at all times.
Once you have dealt with the physical withdrawal symptoms associated with methoxetamine addiction, it will be necessary to address the psychological or emotional element of the illness. This takes place in a programme of rehabilitation at either an inpatient or outpatient facility.
Inpatient treatment is a good idea for anyone with a severe addiction, a chaotic home life, or those who have already tried an outpatient programme without success.
With inpatient treatment, you will be immersed in an intensive programme of recovery that will take place over the course of four to twelve weeks.
You will stay in the treatment facility for the duration of the treatment and will have no access to any temptations. This is the fastest approach to overcoming addiction.
Outpatient treatment is an alternative to residential programmes and allows you to recover in the real world. This type of programme will require an ardent desire to succeed as you will have to deal with everyday life issues and temptations while going through recovery.
Treatment for most people with a methoxetamine addiction will include various talking and behavioural therapies such as cognitive behavioural therapy. The aim is to identify the cause of the addictive behaviour and to develop new coping strategies to avoid a relapse going forward.
Questions about Treatment
If you are worried that your use of methoxetamine is becoming a problem, it is best to speak to a professional about your options.
You may not be fully convinced that you have a problem that is bad enough to warrant professional help; if this is so, we can assist.
You can call our helpline and talk to a friendly advisor who will assess your situation to determine the severity of your problem.
It may be that you could just benefit from some advice about how to cut down on your substance use; alternatively, it might be that a programme of detox and rehabilitation is best suited to your situation. Remember though, the earlier you get help the better.
I cannot afford private treatment – is there a cheaper option?
If you are worried about the cost of private addiction treatment, you should know that you have several options open to you. Free programmes are available through the NHS but there are also some provided by charities around the country. Unfortunately, the demand for such programmes tends to be quite high, so you may have to wait for a place.
In terms of private treatment, not all programmes cost the same. An average 28-day residential programme costs anywhere between four and six thousand pounds for the most part, but some are cheaper than this. Moreover, in some instances, you can spread the cost instead of having to pay it all in one go.
Treatment takes place on either a one-to-one basis or within a group setting. The environment is non-judgemental and supportive, and it encourages you to be open and honest so that you can overcome the issues that have led you to this point in your life.
With so many different options available to counsellors, it is impossible to say which treatments will form a part of your programme of care. But therapies such as individual counselling, group therapy, family therapy, and cognitive behavioural therapy may be used. Your treatment programme might also consist of some holistic therapies such as mindfulness, yoga, and massage.
What happens after treatment?
Many people worry about how they are going to cope when their treatment programme ends.
These individuals believe they will be left to fend for themselves in the world where they developed their addiction in the first place, but this is not the case.
Treatment providers will help with the transition to normal, everyday life and will ensure that you have a network of support that you can rely on when you need to.
It is ly that you will be encouraged to get involved with your local support group as this will help with the maintenance of your sobriety.
How will I get time off work?
Addiction is an illness and as such, you are entitled to take time off work for treatment. One of our doctors will provide a certificate for your employer and we can help you to claim statutory sick pay if you are entitled to it.
“Being with a Buddha”: A Case Report of Methoxetamine Use in a United States Veteran with PTSD
Methoxetamine (MXE) is a ketamine analogue with a high affinity for the N-methyl-D-aspartate (NMDA) receptor. MXE is a newly emerging designer drug of abuse and is widely available through on-line sources and is not detected by routine urine drug screens.
In this report, we describe a United States (US) veteran with posttraumatic stress disorder (PTSD) and heavy polysubstance use, who injected high dose MXE for its calming effect.
Given MXE’s structural similarities to ketamine and recent work showing that ketamine reduces PTSD symptoms, we hypothesize that MXE alleviated this veteran’s PTSD symptoms through action at the NMDA receptor and via influences on brain-derived neurotrophic factor (BDNF).
To our knowledge, this is the first case report of self-reported use of MXE in the US veteran population. More awareness of designer drugs, such as MXE, is an important first step in engaging patients in the treatment of designer drug addiction in both military/veteran settings and civilian settings.
We present a case of a young male United States (US) combat veteran with posttraumatic stress disorder (PTSD) and a complex substance use history, which included opioid use disorder treated with methadone, stimulant use disorder, and stimulant-induced psychosis. Initially unknown to clinical providers, he was also injecting large quantities of the designer drug methoxetamine (MXE) for its perceived calming effect. To our knowledge, this is the first case report of self-reported use of MXE in a US veteran .
2. Case Presentation
A is a 29-year-old US veteran with chronic PTSD (100% service-connected), heavy polysubstance use (opioid use disorder treated with methadone, stimulant [cocaine, methamphetamine] use disorder, sedative/hypnotic use disorder, hallucinogen use disorder (ketamine), cannabis use disorder, and tobacco use disorder), as well as unspecified depressive and anxiety disorders, childhood history of attention deficit/hyperactivity disorder, childhood sexual abuse, HIV on antiretroviral therapy, chronic hepatitis C, and tinnitus. He received care through the Veterans Affairs Medical Center (VAMC) and became a patient in the Opioid Treatment Program (OTP).
Three years after enrolling in the OTP, Mr. A began to describe symptoms of psychosis. These symptoms included hearing voices which talked about him, speaking his thoughts, and feeling as though someone was following him.
His urine toxicology screen was positive for amphetamines, cocaine, cannabis, and opiates. Psychosis was treated with risperidone. Other medications included methadone 140 mg daily, emtricitabine 200 mg/tenofovir 300 mg daily, and raltegravir 800 mg daily.
Over the ensuing six months, he was admitted to the VAMC psychiatric unit five times for treatment of acute psychosis. Medication trials for psychosis, depression, and anxiety included olanzapine, aripiprazole, mirtazapine, lorazepam, and gabapentin. Mr.
A’s methadone dose varied throughout this period depending on his concurrent substance use. At one point, he self-tapered methadone to discontinuation, although he later restarted it.
It was hypothesized that Mr. A’s heavy use of stimulants precipitated the development of psychosis. This was the substances that he had reported using, the substances that were present on urine drug screens, and the observation that psychosis diminished rapidly during each hospitalization.
Intermittent erythema and edema of his feet were noted, which were consistent with cellulitis and treated with antibiotics. Neurological examinations were normal during these episodes of cellulitis. Puncture marks were present on the dorsum of his left hand.
There were no other abnormalities noted on physical examination.
Four years after enrolling in the OTP, Mr. A disclosed he was injecting MXE obtained from an on-line source. He described using MXE intermittently for the past year and had progressed to using 50–70 mg daily.
He had tried ingesting it, but he preferred either intravenous or intranasal routes. When using MXE, he described feeling as if he was “being with a Buddha.” He preferred MXE to illicit use of ketamine, as he found MXE allowed him to feel more “spiritual” and “calm.
” He believed that MXE relieved the distress and dysphoria of withdrawal that accompanied his methadone tapers, and he felt that using MXE allowed him to taper methadone more rapidly. The VAMC toxicology laboratory lacked the capability to detect MXE in urine.
Thus, while urine drug screens returned positive for other substances, MXE was not identified.
Now five years after enrolling in the OTP, Mr. A continues to use MXE (70 mg, two to three times daily) along with other substances (methamphetamine, heroin, and alprazolam). Opioid replacement therapy was restarted, and his current dose of methadone is 50 mg daily. He is also prescribed olanzapine 15 mg twice daily to treat symptoms of psychosis.
The discussion focuses on this veteran’s PTSD and self-reported use of MXE to produce spiritual experiences and feelings of calm. This focus was chosen because, despite Mr. A’s concurrent use of other substances with the potential to calm or produce spiritual effects, Mr.
A attributed these effects to MXE. These effects were not reported prior to the addition of MXE to the plethora of substances he reported using. Mr. A’s use of what he believed to be MXE was self-report.
Novel psychoactive substances often contain compounds other than or in addition to those advertised [2, 3].
Mr. A is one of more than 1.8 million US troops who served in Operation Enduring Freedom (OEF) and/or Operation Iraqi Freedom (OIF) since combat began in 2001.
Large-scale studies have found that 10–18% of OEF/OIF veterans are ly to have PTSD following deployment .
Substance use disorders (SUD) are extremely common in Iraq and Afghanistan veterans with PTSD and are associated with more severe PTSD symptoms and poorer outcomes across various domains .
Commonalities exist between neurotransmitters, brain regions, and neurocircuitry involved in PTSD and comorbid SUD (Figure 1(a)).
Several key neurotransmitters, such as dopamine (DA), norepinephrine (NE), and serotonin (5-HT), play roles in reward, impulsivity, arousal, and anxiety .
Both PTSD and SUDs involve a learning and memory component, and the hippocampus and amygdala are key brain regions involved in both illnesses.
Stress-induced activation of the hypothalamic-pituitary-adrenal (HPA) axis is seen in both diseases with the resultant release of corticotropin releasing factor (CRF) and dynorphin, an endogenous opioid peptide (Figure 1(a)). The CRF system plays a role in maintaining the negative mood states and anxious behaviors which resemble components of PTSD and which drive SUDs .
Other neurochemicals interact with the HPA axis in both PTSD and SUDs (Figure 1(a)). Brain-derived neurotrophic factor (BDNF) is a key polypeptide growth factor involved in processes required for long-term learning, memory, and conditioned drug reward . BDNF appears to enhance fear extinction, and BDNF levels have been found to be significantly lower in individuals with PTSD .
BDNF signaling impacts the NMDA receptor, an ionotropic receptor located throughout the brain and involved in learning, memory, and long-term potentiation .
BDNF increases the number and activity of NMDA receptors on the plasma membrane of hippocampal neurons . Ketamine, a noncompetitive NMDA receptor antagonist, diminishes anxiety  and depression .
Feder and colleagues  demonstrated that ketamine infusion resulted in reduction of PTSD symptoms in patients with chronic PTSD.
MXE is a ketamine analogue . MXE is also a NMDA antagonist  and a 5HT2 agonist . NMDA antagonism has been associated with the antidepressant effects of ketamine . MXE is used for recreational and psychedelic effects and has been marketed as a “bladder-friendly” version of ketamine .
User Web reports and case reports describe the effects of MXE to be similar to those achieved with ketamine, although effects are often stronger and longer lasting . High doses can result in hallucinatory experiences that users refer to as the “M-hole.
” In their study of MXE user experiences, Kjellgren and Jonsson  identified ten themes, including spiritual and transcendent experiences, redosing, and addiction.
Not only did Mr. A suffer from chronic PTSD, he also suffered from the perceptual and cognitive impact of psychosis and the psychological and physical effects of sustained, heavy polysubstance use. Searching for a way to quiet this profound internal chaos, we propose Mr. A sought the calming effects of MXE.
These effects served multiple purposes: (1) reducing the fear and anxiety associated with PTSD and psychosis; (2) mitigating the anxiety associated with the activation of the sympathetic nervous system due to opioid withdrawal; and (3) mitigating the anxiety and dysphoria due to the chronic activation of the HPA axis.
Given that MXE is a ketamine analogue, we suggest the anxiolytic and antidepressant effects resulted in part from an increased translation of BDNF, which in turn increased the expression of NMDA receptors and NMDA receptor activity.
Blockade of these receptors by MXE resulted in anxiolysis and reduction of depression and PTSD symptoms (Figure 1(b)), analogous to the rapid effect of ketamine in mitigating depressive and PTSD symptoms. Mr.
A’s opioid use disorder was treated with methadone (an NMDA antagonist), which may have acted in concert with MXE to augment its calming effect.
The 5HT2 receptor has been implicated in hallucinogen-induced feelings of spirituality and mysticism [21–23], and the spiritual feelings described by this patient may be due in part to MXE action at the 5HT2 receptor (Figure 1(b)).
In summary, this is the first case report of self-reported use of MXE in a US veteran.
This veteran found MXE to exert calming effects and to allow spiritual experiences, which we hypothesize were due in part to increases in BNDF, its effect on the NMDA receptor, and MXE-induced antagonism of the NMDA receptor.
Regarding military/veteran populations, a previous report commented that MXE may “threaten military readiness” . This case report is of interest to US military/veteran medical providers, as well as providers working in civilian settings.
The authors alone are responsible for the content and writing of this paper. The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
Dr. Kalapatapu is currently funded by K23DA034883. The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
Copyright © 2017 Joan M. Striebel et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.