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.