Table V.
NPS Hallucinogens Case Histories with Clinical Symptoms, Autopsy Findings and Primary Drug and Additional Drug Concentrations
| Drug | History | Clinical symptoms/Autopsy findings | Drug results (ng/mL, unless specified) | Reference |
|---|---|---|---|---|
| 2C-E and Bromo-DragonFLY | 29 individuals (15 M, 14 F, 24–56 y/o) ingested an unknown drug; found lying on ground, shouting and screaming | Some unconscious and unresponsive; tachycardia, respiratory distress, pain, delusions, self-harm; some required sedation with benzodiazepines; all recovered within days | ‘2C-E’ Blood: <0.4 Urine: 1.5–183 ‘Bromo-DragonFLY’ Blood: 0.6–2 Urine: 1.6–35 |
(107) |
| 2-FDCK | 23 y/o M with hx of ketamine use; Insufflated what he believed was ketamine | Delirium and palpitation; BP 121/62, pulse 144 bpm, RR 20, SpO2 98% and Temp 36.3°C | Urine: 213 | (108) |
| 39 y/o M ingested instant coffee packet; admitted to ED and later to psychiatric ward with drug-induced acute psychosis and adjustment disorder | Delirium generalized weakness; BP 195/81, pulse 80 bpm, RR 20, SpO2 100% and Temp 35.6°C | Urine: 21.7 NEP 716 |
(108) | |
| 40 y/o M ingested instant coffee packet; admitted to ED and psychotic symptoms subsided 1 day later | Tactile hallucinations and vomiting; BP 132/79, pulse 134 bpm, RR 20, SpO2 93% and Temp 36.2°C | Urine: 104.8 Ketamine 121.9, norketamine 285.5, mephedrone 991.3 |
(108) | |
| 40 y/o M ingested instant coffee packet; admitted to ED and psychotic symptoms subsided 1 day later | Delirium and delusion of being monitored; BP 158/94, pulse 120 bpm, RR 20, SpO2 98% and Temp 38.4°C | Urine: 918.6 Eutylone 1007.9, mephedrone 991.3 |
(108) | |
| 22 y/o M ingested instant coffee packet; admitted to ED and discharged with consciousness recovery | Delirium, self-harm and agitation; BP 101/77, pulse 93 bpm, RR 19, SpO2 97% and Temp 36.3°C | Urine: 56.2 Eutylone 54.1, mephedrone 1,345 |
(108) | |
| Clinical case series 20 ketamine users (13 F and 7 M; 18–50 y/o) | Impaired consciousness (14), agitation (8), abnormal behavior (5), hallucination or delusion (4), loss of consciousness (4), dizziness (3), convulsion (2), hypertension (8), tachycardia (6), nausea or vomiting (3), hyperthermia (1), dyspnea (1) | Urine: + 2-Oxo-PCE (n = 9) DCK (n = 10) ketamine (n = 17) tiletamine (n = 2) |
(109) | |
| 6 DUID investigations | Suspected drug impairment | Blood: 0.005–0.48 mg/kg Hair: 0.007–0.034 ng/mg |
(110) | |
| 2-Oxo-PCE | 18 y/o M ingested instant coffee packet; admitted to ED and discharged with consciousness recovery. | Delirium and agitation; BP 111/88, pulse 140 bpm, RR 20, SpO2 100% and Temp 36.3°C; acute kidney injury, elevated creatinine kinase and lactic acidemia | Urine: 117.7 4-CEC 1950.2, eutylone 4,131.8, ethylone 1.8, methylone 119.6 |
(108) |
| 41 y/o F ingested instant coffee packet; admitted to ED and psychiatric ward with drug-induced acute psychosis and adjustment disorder | Delirium and suicide attempt by driving car into tree; BP 157/90, pulse 78 bpm, RR 17, SpO2 95% and Temp 37.5°C | Urine: 101.69 NEP 4545.61. mephedrone 91.54 |
(108) | |
| 52 y/o M found dead in bedroom; found with head hanging over bucket; drug paraphernalia at scene | Brain swelling (1410 g), moderate lung hyperhydration (420 g), inner organs filled with blood, urinary bladder moderately opened, tablets found in stomach and small bowel, acute respiratory infection, expanded right ventricle and atrium | Femoral blood: 375 DCK 7, venlafaxine 200, O-desmethylvenlafaxine 50, N-desmethylvenlafaxine 40 Heart blood: 2,159 Urine: 3468 Liver: 6,137 ng/g Bile: 3,290 Gastric contents: 3,086 |
(111) | |
| 56 clinical case series. | ‘25 cases 2-Oxo-PCE only’: impaired consciousness (21), confusion (15), abnormal behavior (11), agitation (5), aggressive behavior (6), loss of consciousness (5), convulsion (4), drowsiness (4), unstable emotion (2), psychotic symptoms (4), dizziness (1), nystagmus (1), unsteady gait (1), hypertension (20), tachycardia (10), hyperthermia (4) and rhabdomyolysis (2) | Urine: + Cocaine (n = 15), ketamine (n = 14), methamphetamine (n = 8), cannabis (n = 1) |
(112) | |
| 37 y/o M with hx of psoriasis; found collapsed at home | Hyperthermia (39.3°C), diabetic ketoacidosis and convulsion; BP 177/117, sinus tachycardia (116 bpm), GCS 8, UDS negative | Urine: + | (112) | |
| 25 y/o M found lying on ground; drowsy but agitated state; white powder in nose | Afebrile (37.1°C), GCS 9, sinus tachycardia 119 bpm, BP 143/96, UDS positive for morphine only | Urine: + | (112) | |
| 24 y/o M with no prior clinical hx found confused and wandering; white powder in nose | Afebrile (36°C), GCS 10, sinus rhythm (85 bpm), BP 146/98, UDS negative | Urine: + | (112) | |
| 3-HO-PCP | 56 y/o M with hx of myocardial infarction; admitted regular use of ‘Hexen’ (N-ethyl hexedrone) and recent 3-HO-PCP use | Hyperthermia (39.9°C), sinus tachycardia (150 bpm), reduced consciousness, ocular clonus and vertical nystagmus; GCS 6, RR 40, oxygen saturation 99%, HR 144 bpm, BP 145/93; developed rhabdomyolysis | Serum: + +3-HO-PCP metabolites, +N-ethyl hexedrone/metabolites, +clephedrone/metabolites Urine: + +3-HO-PCP metabolites, +3-MeO-PCP, +N-ethyl hexedrone/metabolites, +clephedrone/metabolites, +THC-COOH |
(113) |
| 19 y/o M hospitalized; ingestion of unknown pills | Altered state, delirious and euphoric; respiratory acidosis, right anisocoria, mydriatic pupils and hypothermia | Blood: 350 Ethanol 2 g/L Urine: 6109.2 |
(114) | |
| 21 y/o M hospitalized; nasal fracture; ingestion of unknown pills | Altered state; respiratory acidosis, right anisocoria, mydriatic pupils and hypothermia | Blood: 180.1 Ethanol 1.7 g/L Urine: 3,003.5 |
(114) | |
| 27 y/o M with hx of schizophrenia; found unconscious in car by police; reported feeling sedated and ‘loopy’; unable to remember events, denied drug use | Delusions, vital signs normal, borderline tachycardia | Urine: +(PCP screen) | (115) | |
| 2 fatal cases: 30 y/o F found murdered; 41 y/o F found dead at home | N/A | Blood: 63 and 498 Urine: 94 and 16,700 Hair: + |
(116) | |
| 19 y/o M with hx of drug use and depression; found awake at home; white powder and drug paraphernalia recovered | Tachycardic, hypertensive, tachypneic and catatonic; developed fever and lactic acidosis concomitant with psychomotor agitation and hallucinations; sinus rhythm, respiratory rate 22 bpm, pulse 130 bpm, BP 147/104, oxygen saturation 96%, GCS 11, pupils dilated | Blood: 400 ng/g | (117) | |
| 27 y/o M; found dead at home in bathtub; hx of drug use; regularly ordered hallucinogens online | Brain swelling, pulmonary edema and urine retention; burns on body from hot water | Blood: 380 ng/g | (117) | |
| 21 y/o M with suicidal intentions found unresponsive in room; hx of drug use | Brain edema, pulmonary edema, a patent foramen ovale and discrete coronary atherosclerosis | Blood: 180 ng/g Buprenorphine 2.2 ng/g, 5-MeO-MiPT 130 ng/g |
(117) | |
| 27 y/o M with psychiatric problems; found on chair in residence | Congestion of lungs and liver | Blood: 230 ng/g Methadone 440 ng/g, diazepam 530 ng/g, methamphetamine 40 ng/g, buprenorphine 0.2 ng/g |
(117) | |
| 29 y/o M with hx of bipolar disorder and drug use; found hanged in residence after leaving good-bye message; pills and drug paraphernalia at scene | Petechial hemorrhage of oral mucosa, brain edema, pulmonary congestion and edema, discrete coronary atherosclerosis and enlarged liver | Blood: 120 ng/g Flubromazolam 10 ng/g, +AB-FUBINACA, +THJ-018, buprenorphine 2 ng/g, methylphenidate 20 ng/g |
(117) | |
| 32 y/o M with hx of drug use; found dead in residence; drug materials and paraphernalia at scene | Fresh myocardial injury, congestion of internal organs and mucous membranes, pulmonary edema, brain and heart edema; incipient pneumonia and aspirated stomach content after vomiting | Blood: 60 ng/g Oxycodone 100 ng/g, amphetamine 130 ng/g, flubromazolam 9 ng/g, MT-45 110 ng/g, 4-MeO-PCP 30 ng/g, THJ-018, THC 1.1 ng/g |
(117) | |
| 27 y/o M with hx of drug use; found unresponsive in bed | Internal organ congestion, pulmonary edema, petechiae on heart surface | Blood: 50 ng/g Tramadol 60 ng/g, alprazolam 20 ng/g, fentanyl 25 ng/g, amphetamine 90 ng/g |
(117) | |
| 20 y/o F found dead in bed; reportedly taking tramadol and benzodiazepines | Pulmonary and cerebral edema and internal organ congestion | Blood: 80 ng/g Tramadol 13,000 ng/g |
(117) | |
| 40 y/o M with HIV admitted to hospital; went to bathroom to use drugs (0.2 mg IV); found lying on ground unconscious; patient survived; drug sample recovered for testing | RR 18, oxygen saturation 96%, sinus tachycardia 115 bpm and Temp 37.9°C | Drug product: + | (118) | |
| 17 y/o M purchased 3-MeO-PCP on internet; took 200 mg oral dose and admitted to ED; 7 days later returned to ED after insufflating 50 mg | BP 158/131, tachycardia (100 bpm), neurological manifestations; confusion, hypertonia, nystagmus and agitation; symptoms similar but less severe during second overdose | Blood: 17.1 Urine: 706.9 |
(119) | |
| 39 y/o F with hx of drug use; found dead at home after assault by partner | Parched horizontal ligature encircling neck; broad red area from intense subcutaneous hemorrhage; clear ligature abrasion; fractures with hemorrhage of superior horn of thyroid cartilage and right greater horns of hyoid bone; intense multi viscera congestion | Blood: 63 Urine: 94 Bile: 64 Hair: 731–893 pg/mg Ethanol 1.37 g/L, diazepam 157, cocaine 25 |
(120, 121) | |
| 41 y/o M found dead at home | Needle marks noted | Blood: 498 Urine: 16,700 |
(120) | |
| ∼ 35 y/o M with hx of cannabis and amphetamine use; found dead near lake with face in water; ingested ant poison drug prior to death | Temp 23.1°C, face, neck and eyes stowed; foam on mouth; small injuries on hands and legs | Blood: 152 Ethanol 1.2% Serum: 123 Amphetamine 85 Drug product: + |
(122) | |
| 36 y/o M found agitated on street | Confusion, aggressiveness, logorrhea, hypertonia, myosis, hypersalivation; BP 151/90, HR 100 bpm and Temp 37.3°C | Urine: + Ethanol 0.185 g/dL, +buprenorphine, +tramadol |
(123) | |
| 32 y/o M with hx of cannabis use; presented to ED for abdominal pain but painkillers inactive at high doses | BP 137/87, HR 83 bpm and Temp 36°C | Urine: + | (123) | |
| 37 y/o M admitted to ED after drug ingestion | Hypertensive (170/100), tachycardic (120), signs of psychosis and altered neurological status GCS 10–12; increased muscle tone with spastic leg postures; fluctuating state of consciousness | Serum: 49 Methamphetamine 121, amphetamine 10 |
(124) | |
| 40 y/o M with no hx drug use; referred to ED for cramps and deteriorating state of consciousness | Hypertensive (172/113), tachycardic (126), breathing spontaneously and normoglycemic; altered state of consciousness 12 GCS; did not obey commands; pupils isocoric and miotic | Serum: 66 Ethanol 1.02 g/L |
(124) | |
| 21 y/o M with hx of drug use; found naked and unresponsive; recently discharged from drug treatment; empty pill bottles recovered from person | MOD: accident; COD: acute intoxication due to polydrug consumption | Blood: 3,200 Ethanol 47 mg/dL, bupropion 1800, +delorazepam, +mitragynine, +paroxetine |
(125) | |
| 58 y/o M with hx of opiates and methamphetamine; significant health problems; found unresponsive in drug treatment facility | MOD: accident; COD: acute intoxication due to polydrug consumption | Blood: 630 +PCP (screen), methamphetamine 110 Urine: + +Amphetamine (screen) |
(125) | |
| 5-MeO-DiPT | 29 y/o M injected solution of 5-MeO-DiPT into the anus |
No abnormal signs/symptoms when presented to ED days later | Dried urine spot: 2.3 | (126) |
| 4 M suspected of using 5-MeO-DiPT | N/A | Urine: 0.3–0.8 | (126) | |
| 32 y/o M ingested LSD-like substance; found standing naked and without orientation in street; drugs recovered from residence | Agitated and aggressive; several abrasions on body and in bad state | Blood: 160 Methylphenidate 1.36, ritalinic acid 64.1, BZE 305 Urine: 3,380 + 5-MeO-MiPT metabolites, methylphenidate 671, ritalinic acid 2,230 Drug powder: + |
(127) | |
| 25B-NBOMe | 17 y/o M with hx of NPS use; ingested 25B-NBOMe tablets sublingually; friends monitored state for hours; found unresponsive by EMS and pronounced dead |
Hallucinogenic effects, convulsive episodes, various arrhythmias, led to cardiac arrest and death | Blood: 3.14 | (128) |
| 23 y/o M ingested substances labeled 25B-NBOMe 1 GR and 4-CMC 1 GR; found in residence and died in route to ED | Aggressive, agitated, moving anxiously, shouting, convulsions, heavy breathing and salivations | Blood: 66.5 4-CMC 2.14, +THC, THC-COOH 11, +ethanol |
(129) | |
| 23 y/o M ingested substances labeled 25B-NBOMe 1 GR and 4-CMC 1 GR; jumped out window of fifth floor and found dead | N/A |
Blood: 661 4-CMC 0.887, +THC, +THC-COOH, +ethanol |
(129) | |
| 24 y/o M ingested substances labeled 25B-NBOMe 1 GR and 4-CMC 1 GR; found in residence, transported to ED and lived |
Aggressive, agitated, moving anxiously, shouting | Blood: 38.4 +4-CMC, +THC, THC-COOH 13, +ethanol |
(129) | |
| 25C-NBOMe | 27 y/o M with re-admission to ED after ingestion of drugs ‘First admission’: found acting erratically, resisted arrest, was physically restrained and transported to ED ‘Second admission’: ∼ 3 weeks later; ingested tablets of 25I-NBOMe and transported to ED |
‘First admission’: aggressive, confrontational but alert; BP 139/90, HR 146, RR 28, Temp 36.6°C, oxygen saturation 98%; no evidence of trauma; tachycardia and agitated ‘Second admission’: agitated; BP 153/119, HR 120, RR 22, Temp 36.8°C and oxygen saturation 98% |
Blood: + | (130) |
| Teenage M attended party, drugs for sale; seen smoking cannabis; altered state of mind; taken home by friends; jumped in waterway and body later found downstream; plant material and blotters found on decedent | Death occurred by drowning | Peripheral blood: 2.8 25H-NBOMe 0.29, THC 15.5, THC-COOH 56 Central blood: 1.43 25H-NBOMe 0.13, THC 9.9, THC-COOH 8.5 Urine: 0.94 25H-NBOMe 0.14, THC-COOH 43 |
(131) | |
| 25I-NBOMe | 42 y/o M with no medical hx; severe headache ingested pediatric analgesic syrup replaced with ethanolic 25I-NBOMe ∼ 320 µg/mL developed restlessness | ‘Upon presentation’: vital signs unremarkable, excessively dilated pupils, strong sweating, disorientation and agitation. ‘30 min later’: severe agitation, screaming, coenesthesia, hallucinations; BP 127/97, HR 100; symptoms resolved in 6 h |
Serum: 4.2–34 25I-NBOH, 2C-I 2.1–12 Urine: 25I-NBOH 1.2, 2C-I 3.5–8.2 |
(132) |
| Two individuals insufflated white creamy powder | Impairment, altered behavior and visual hallucinations | Plasma: 37 and 72 Powder: + |
(133) | |
| Drug consumption | Forensic clinical evaluation of brain dysfunctions after cardiorespiratory arrest | Hair: 1.0–4.9 pg/mg | (134) | |
| 29 y/o M unconscious after instilling pink liquid in nose thought to be NBOMe(s) | Hypertonia, tremors, partial seizure, mydriasis, tachycardia, hypertension, hyperthermia, profuse sweating, serotonin syndrome; persistent cognitive and psychiatric abnormalities | Serum: 0.9 Urine: + + 25C-NBOMe metabolites Pink liquid: + |
(135) | |
| 17 y/o M ingested two lines of acid; found having multiple seizures and transported by EMS to ED | 2 tonic-clonic seizures, became unresponsive and apneic; BP 106/53, HR 140, Temp 38.9°C and oxygen saturation 98% | Serum: 3 2C-I 55 Urine: 10 2C-I 225 |
(136) | |
| 20 y/o with no medical hx ingested small dose of Alice in Wonderland had seizure episode during a party | Seizures, muscle swelling, diminished motor function; severe clinical toxicity and developed exceptionally massive rhabdomyolysis | Blood: 0.24 | (137) | |
| AL-LAD | 51 y/o M with hx of hyperlipidemia and vertebral artery stenosis; shot two teenagers and ignited a building; police placed individual in patrol car and he became pulseless; transported to ED in cardiac arrest | BP 73–123/54–90, HR 57–122, Temp 35.7–36.9°C, SpO2 98–100%, GCS 3, pupils 3 mm | Serum: + + lysergic acid Urine: + |
(138) |
| Diphenidine | 30 y/o M with hx of drug use found confused, agitated and unable to communicate; white powder labeled diphenidine 1 g recovered | Tachycardia (HR 160), tachypnea and miotic nonreactive pupils; agitation, disorientation and altered consciousness with GCS 9; Temp 38.0°C | Plasma: 308 Diclazepam 3.5, methylphenidate 3.0 Urine: 631 +methylphenidate, THC-COOH 120 Hair: 4,400 pg/mg Alpha-PVP 1,040 pg/mg, MDPV 120 pg/mg, methoxetamine 27 pg/mg, 4-FA 55 pg/mg, methylone Powder: + |
(139) |
| ∼ 25 y/o F; found dead in bed; NPS packages recovered | Slight abrasions on hands; no signs of natural disease; slight brain edema, pulmonary edema and organ congestion | Blood: 73 7-aminoflunitrazepam 86, 7-aminonimetazepam 27, chlorpheniramine 66 |
(140) | |
| 53 y/o M found dead in residence; ‘Heart Shot BLACK’ package with herbal material recovered and confirmed as 5F-ADB | No apparent specific injuries or internal findings | Blood: 12 ± 2.6 + Diphenidine metabolites, 5F-ADB 0.19 ± 0.04 and metabolites |
(141) | |
| DOC | Five nonfatal cases 18–23 y/o believed to ingest LSD | Severe clinical symptoms | Plasma: <18 Urine: 300–1,300 |
(142) |
| Two found dead after insufflating powder believed to be LSD; 4 years later, bodies exhumed for additional testing | No traumatic injury | Liver: 99 ng/g Spleen: 28 ng/g Bone: 14 ng/g Lung: 15 ng/g Hair: 32 pg/g |
(143) | |
| MXP | 21 y/o M with hx of bipolar disorder and drug use; patient reported use of 125–150 mg MXP purchased online; presented to ED; powder collected for testing | Agitation, aggressiveness, reported dissociative effects; Withdrawal after 7 days in hospital | Powder: + | (144) |
| 33 y/o M with hx of autism and treatment with methadone, loxapine and lorazepam; found agitated and presented to ED; small yellow pills collected from residence | Profuse sedation, hyperthermia, tachycardia (HR 140) and mydriasis; GCS 10; serotonin syndrome suspected | Urine: + + AMT Pills: + + AMT |
(145) | |
| MXPr | 26 y/o M with hx of drug use admitted to ED; drug recovered for analysis | Asymptomatic | Urine: + Drug product: + (95%) |
(146) |
5-MeO-DiPT = 5-methoxy-N,N,-diisopropyltrptamine, AMT = alpha-methyltryptamine, DCK = deschloroketamine, MOD = manner of death, UDS = urine drug screen.