Table IV.

NPS Stimulant Case Histories with Clinical Symptoms, Autopsy Findings and Primary and Additional Drug Concentrations

Drug	History	Clinical symptoms/Autopsy findings	Drug results (ng/mL unless specified)	Reference
4F-MPH	26 y/o F admitted ED for severe psychomotor agitation, confusion, disorientation, confabulation, incoherent speech and crying after sniffing powder purchased on internet	Palpitations and mild tachycardia (100 bpm). BP, Temp and chemistries normal on admission. Tachycardia lasted 2 days until discharge	Blood: 32 Urine: 827	(84)
α-EAP and 4F-α-PVP	28 y/o M unconscious at home, previous psychiatric hx and depression, also admitted to hospital 2 months earlier with loss of consciousness and aspiration pneumonia. During second admission admitted inhalation of ‘BON’S CRYSTAL’	Time 1: ED GCS 4, SBP 117 mmHg, DBP 37 mmHg, HR 118 bpm, RR 14/min, 35°C, CT: diffuse bilateral ground glass opacity, diagnosed diffuse alveolar hemorrhage, admitted ICU and ventilated for 4 days, discharged on Day 7. Time 2: Unconscious, bilateral pulmonary infiltrate recurrence less serious than Time 1. Discharged on Day 2	Drug material confirmation: α-EAP and 4 F-αPVP	(85)
α-PHP	39 y/o M took picture through bathroom window screaming ‘a ghost is there’, ran speaking incomprehensibly. Found covered in mud in rice field, transported to ED with hallucinations, delusion, fear, anxiety and restlessness	GCS 14, HR 101 bpm, SBP 131 bpm, DBP 68 mmHg, Temp 37°C, pO2 85%, biochemical exam revealed mild hepatic dysfunction, increased creatinine kinase and white blood cell counts	Serum: 175 (on admission) 64.6 (24 h), 43.6 (48 h), 27.0 (72 h), 15.7 (96 h), 13.4 (120 h), 6.75 (144 h), 2.98 (192 h), 1.79 (216 h)	(86)
Dibutylone	32 y/o F found deceased in bed; drug OD expected	N/A	Femoral blood: 383 Butylone 92.5, THC 2.8, THC-COOH 11 Urine: 3,100 Butylone 69.7 Vitreous: 250 Butylone 108 Liver: + +Butylone	(87)
	46 y/o M found deceased in hotel room	N/A	Femoral blood: <10 Butylone 385, alprazolam 11, BZE 1,600, hydrocodone 400, oxycodone 12, tramadol 340 Urine: 16,500 Butylone 3,060	(87)
	38 y/o M in fatal motor vehicle crash	N/A	Femoral blood: 61.5 Butylone: 6.55, ethanol 190 mg/dL, +4-FA, methylone 31, +dimethylone, ethylone <10 Urine: 2,140 Butylone 149, ethylone 269	(87)
	F unknown age suspected OD	N/A	Femoral blood: 1,400 Butylone 600	(87)
	49 y/o M suspected bath salt use	N/A	Femoral blood: 10 +4-Chloro-alpha-PVP	(87)
	M unknown age no hx	N/A	Central blood: 10	(87)
	M unknown age no hx	N/A	Femoral blood: 13 Butylone 12	(87)
	M unknown age, alleged Molly use	N/A	Postmortem Blood: 14	(87)
	F unknown age, suspected OD	N/A	Postmortem Blood: 40 Butylone 15.3, +p-FIBF	(87)
	37 y/o M with hx of recreational drug use. MDMA at electronic dance music festival. Ingested three capsules within 24 h of sample collection	N/A	Oral fluid: 123 Butylone 206, +dimethylone, +MDMA, +MDA	(87)
	22 y/o M with hx of recreational drug use MDMA at electronic dance music festival. Ingested two capsules within 24 h of sample collection	N/A	Oral fluid: 138 Butylone 291, +dimethylone, +MDMA, +MDA	(87)
	Unknown sex, age and hx; at electronic dance music festival	N/A	Oral fluid: 1,926 Butylone 1,761, +dimethylone, +MDMA, +MDA	(87)
	29 y/o M with no hx; at electronic dance music festival	N/A	Oral fluid: + +Butylone	(87)
	18 y/o F with hx of recreational drug use, ingested two Molly within 24 h of sample collection at electronic dance music festival	N/A	Oral fluid: + +Butylone	(87)
	26 y/o M with unknown hx; at electronic dance music festival	N/A	Oral fluid: + +Butylone, +cocaine	(87)
EPH	32 y/o M with unknown hx	N/A	Femoral blood: 110 Ritalinic acid 2140, +methadone, +EDDP, +Morphine, +Fentanyl, +MPH Urine: 987 Liver: 180 ng/g Pericardium fluid: 131 Stomach contents: 20.7 (200 mL)	(72)
	38 y/o M with unknown hx	N/A	Femoral blood: 23 Ritalinic acid 943, +pregabalin, +fentanyl, +norfentanyl	(72)
	38 y/o M with unknown hx	N/A	Femoral blood: >2,000 +Tramadol, +acetaminophen, +morphine and metabolites, +6-AM, +acetone	(72)
	33 y/o F with unknown hx	N/A	Femoral blood: 1,900 +Methadone, +procyclidine, +propranolol, +morphine and metabolites, +diazepam, +temazepam and metabolites, +THC-COOH, +pregabalin, +methylthienylpropamine	(72)
	31 y/o F with unknown hx	N/A	Femoral blood: 1,200 +Ethanol, +morphine and metabolites, +diazepam and metabolites	(72)
	27 y/o M with unknown hx	N/A	Femoral blood: 760 +Ethanol, +diazepam and metabolite, +methylthienylpropamine	(72)
	37 y/o M with unknown hx	N/A	Femoral blood: 610 +Diazepam and metabolite, +mirtazapine	(72)
	31 y/o F with unknown hx	N/A	Femoral blood: 470 +Lignocaine, +methadone, +mirtazapine, +promethazine	(72)
	34 y/o M with unknown hx	N/A	Femoral blood: 410 +Ethanol, +methadone, +diazepam and metabolites, +THC-COOH	(72)
	38 y/o M with unknown hx	N/A	Femoral blood: 350 +α-Methyltryptamine, +etizolam, +diphenhydramine	(72)
	20 y/o M with unknown hx	N/A	Femoral blood: 320 +Fluoxetine and metabolite, +pregabalin, +zuclopenthixol, +morphine and metabolites, +etizolam, +pyrazolam, +2-MeO-diphenidine	(72)
	40 y/o M with unknown hx	N/A	Femoral blood: 250 +Methadone, +olanzapine, +diazepam and metabolites, +THC-COOH	(72)
	35 y/o M with unknown hx	N/A	Femoral blood: 140 +Methadone	(72)
	33 y/o F with unknown hx	N/A	Antemortem blood: 460 Femoral blood: 130 +Dihydrocodeine, +hydrocodone, +morphine, +nordiazepam, +ketamine, +acetaminophen, +alfentanil	(72)
	54 y/o M with unknown hx	N/A	Cardiac blood: 41 +Dihydrocodeine	(72)
	45 y/o M with unknown hx	N/A	Femoral blood: 40 +Diazepam and metabolites, +methadone, +morphine and metabolites, +6-AM	(72)
	44 y/o M with unknown hx	N/A	Femoral blood: 28 +Methadone, +diazepam and metabolites	(72)
	42 y/o M with unknown hx	N/A	Femoral blood: 15 +Ethanol, +dihydrocodeine, +morphine and metabolites, +diazepam and metabolites	(72)
	46 y/o F with unknown hx	N/A	Femoral blood: 10 +β-hydroxybutyrate, +mirtazapine, +codeine, +morphine, +diazepam and metabolite, +fluoxetine and metabolite, +acetaminophen	(72)
	25 y/o M with unknown hx	N/A	Femoral blood: 10 +Diazepam and metabolite, acetaminophen, +codeine and metabolites, +morphine and metabolites, +6-AM, +mirtazapine	(72)
	45 y/o M with unknown hx	N/A	Antemortem blood: 30 Femoral blood: 8 +Ethanol, +morphine and metabolites, +6-AM, +acetaminophen, +methadone, +nordiazepam Serum: 8	(72)
	M with unknown age and unknown hx	N/A	Femoral blood: 2,180	(72)
	M with unknown age and unknown hx	N/A	Femoral blood: 1,370 +BZE, +sertraline, +diphenhydramine	(72)
	M with unknown age and unknown hx	N/A	Femoral blood: 870 +Dothiepin, +methiopropamine, +ethanol	(72)
	M with unknown age and unknown hx	N/A	Femoral blood: 110 +Methadone, +EDDP, +zopiclone, +sertraline, +aripiprazole, +dehydroaripiprazole, +2-aminoindane, +ethanol	(72)
	M with unknown age and unknown hx	N/A	Femoral blood: 140 +Morphine, +codeine, + ketamine, +cocaine, +BZE, +venlafaxine, +O-desmethylvenlafaxine	(72)
	M with unknown age and unknown hx	N/A	Femoral blood: 30 +Methiopropamine, +5-APB/6-APB	(72)
	M with unknown age and unknown hx	N/A	Femoral blood: 110 +Diazepam, +nordiazepam, +temazepam, +oxazepam, +morphine, +codeine	(72)
MPHP/4-MEAP	39 y/o M with hx of drug addiction, found deceased in caravan	Multiple injection sites. Pulmonary and pericerebral edema and multivisceral congestion	Femoral blood: 47/1.6 THC 1.4, THC-COOH 6.6 Cardiac blood: 97/3.5 ethanol 50 mg/dL Urine: 2380/49,700	(88)
NEH	21 y/o M with hx of drug and alcohol abuse taken to ED with aggression, disorientation and loss of consciousness. Sudden cardiac arrest 5.5 h after admission and unable to revive. Plastic bag with white powder found in underwear	At ED, hyperthermia and wide pupils that reacted to light. Tachycardia, tachypnea, blood pressure and anuria present. At autopsy, lung congestion, mild focal pulmonary edema, swelling and brain congestion, left ventricular hypertrophy and focal liver steatosis	Femoral blood: 145 Amphetamine 12, THC-COOH <5	(89)
	25 y/o M driver did not stop at road check. Stopped after a brief chase and officers noticed unnatural behavior. Driver appeared stimulated, cheerful with blurred speech. Driver admitted to taking mephedrone and 2 bags containing white powder	Subject exhibited clear speech, steady gait, normal pupils and normal pupillary reaction. Negative Romberg’s test and finger–nose test	Blood: 34	(90)
	27 y/o M involved in road crash resulting in death	N/A	Blood: 37 3-fluorophenmetrazine 9	(90)
	18 y/o M DUID	N/A	Blood: 8 THC 1.6, THC-COOH 8.7	(90)
NEP	22 y/o M brought to ED with agitation and acute psychosis after ingesting instant coffee packet	Elevated temp, tachycardia, rhabdomyolysis and acute kidney and liver injuries	Urine: +N-ethylnorpentylone	(91)
	22 y/o M admitted after ingesting instant coffee packet	39.6°C Temp, delirium and agitation. Multiple organ failure	Urine: +N-ethylnorpentylone	(91)
	29 y/o M with hx of depression, admitted to ER agitated with visual hallucinations, delirium, mydriasis and nausea	Tachycardia 100 bpm, nonspecific ST interval alteration on ECG. Laboratory evaluation showed neutrophil leukocytosis and mild rhabdomyolysis	Urine: + *Urine positive 4 days postadmission	(92)
	31 y/o M with hx of cathinone use for 3 years and HIV, IV 0.2 g twice	Subject experienced bad trip and asthenia for 4 days	Blood: + Urine: + Powder: +	(93)
	36 y/o M with hx of cathinone use for 2 years, IV 0.2 g twice	Paranoia and auditory hallucinations for 4 days	Blood: + Urine: + Powder: +	(93)
	38 y/o M with hx of cathinone use last 3 years and HIV, IV injected 2 g drug	Dissociative effects, auditory hallucinations and paranoia for 5 days	Blood: + Urine: + Powder: +	(93)
	33 y/o M no hx of substance abuse and under pre-exposure prophylaxis with emtricitabine-tenofovir, insufflated drug with GHB	Delusional disorder and pharmacopsychosis for 2 days	Blood: + Urine: + +cocaine, +amphetamines Powder: +	(93)
	44 y/o M with hx of NPS use and HIV, oral ingestion	Delusional disorder	Blood: + Urine: + Powder: +	(93)
	32 y/o M attending rave party displayed psychomotor agitation and aggressiveness before fainting. Decedent died en route to hospital	At autopsy, facial swelling, cyanosis of extremities and yellow liquid coming from mouth and nostrils. Internal exam revealed generalized hemorrhage of pulmonary alveoli and abnormal liver size	Postmortem Blood: 170	(94)
	18 y/o M admitted to ED from rave party. Agitated and signs of several injuries	Tachycardia, mydriatic pupils, oscillation between psychomotor agitation and neurological depression	Serum: 7 Urine: +	(94)
	26 y/o F arrived at ED after report to poison control center. Found unconscious with sphincter release. Consumed ecstasy and cannabis at a party the night prior	At ED, subject confused, sleepy with tongue injuries from intentional biting, disconnected speech and visual hallucinations. Anterograde amnesia at discharge. Creatine kinase elevated	Urine: + +MDMA	(94)
	19 y/o attended rave and consumed alcohol and various drugs including 5 ecstasy tablets, 1 LSD blotter, 2 packs cigarettes and drank unknown amount of Catuaba	Subject conscious and oriented but agitated with palpitations and tachycardia (180 bpm). Creatine kinase elevated	Serum: 19 MDMA 54, ethanol 0.8 g/L Urine: + +MDMA, +caffeine, +cotinine	(94)
	35 y/o M with hx of alcohol and drugs over 2 days, found unconscious	Neurological depression GCS 5 and anisocoria. Elevated creatine kinase and lactase. At 6 h post admission, neurogenic shock and decerebration. 6 days postadmission vertebral artery dissection and cerebrovascular hemorrhage of brain stem. At 35 days, subject discharged in vegetative state with neurological damage to third cranial nerve	Serum: 149 Urine: +	(94)
	26 y/o M with hx of mental disorders admitted to psychiatry for differential diagnosis of drug misuse	Subject presented with psychosis, paranoia, sleeplessness and inconsistent speech. Elevated creatine kinase	Serum: 61	(94)

4F-α-PVP = 4-fluoro-alpha-pyrrolidinovalerophenone, DBP = diastolic blood pressure, EDDP = 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine, EMS = emergency medical services, HIV = Human Immunodeficiency Virus, MDA = 3,4-Methylenedioxyamphetamine, pO₂ = partial oxygen pressure, SBP = systolic blood pressure, GHB = gamma-hydroxybutyrate, 5-APB = 5-(2-Aminopropyl)benzofuran, 6-APB = 6-(2-Aminopropyl)benzofuran, GR = gram.