Toxicological Findings in a Fatal Multidrug Intoxication Involving Mephedrone

The distribution of mephedrone in the body fluids and tissues of a subject found dead after the concomitant intake of cocaine and mephedrone is reported. 

Mephedrone (4-methylmethcathinone) is a designer drug of the phenethylamine family that is able to cause central nervous system stimulation, psychoactivity and hallucinations and that is becoming popular among youth as a recreational drug. Mephedrone has been available in Europe since 2007, and it is sold through the internet and by local shops as bath salt or plant food. 

In the case reported here, a 25-year-old man was found dead in the apartment of a friend after a night spent in several local clubs. A fragment of a blue diamond-shaped pill was found in the pocket of the trousers worn by the decedent. 

During the autopsy, no evidence of natural disease or trauma was found to account for this death. Blood, urine and gastric content samples were collected and submitted for toxicological analysis. Moreover, bile, brain, lung and hair samples were collected as additional matrices. The content of the pill was submitted to a general screening analysis in order to determine its composition. 

Mephedrone was detected in the blood, urine, gastric contents and in the additional matrices using an expressly validated GC/MS method. The blood and urine concentrations were 1.33mg/L and 144mg/L, respectively. 

Contextually, cocaine and cocaethylene were found in the blood and urine specimens. The distribution of mephedrone in the body organs was evaluated by analyzing the brain, bile and lung specimens. Hair analysis revealed a past exposure to mephedrone, ketamine, MDMA and cocaine. Sildenafil was identified as the main component of the blue, diamond-shaped pill. 

The quantitative determination of mephedrone in several body fluids and tissues provides significant knowledge about the distribution of this new drug of abuse in the human body after massive ingestion.

Purchase full article at: http://goo.gl/ST1k1c

By:  Gerace E1, Petrarulo M2, Bison F3, Salomone A4, Vincenti M5.

• 1Centro Regionale Antidoping "A. Bertinaria" - Laboratorio Regionale di Tossicologia, Regione Gonzole 10/1, Orbassano, Turin 10043, Italy. Electronic address: enrico.gerace@antidoping.piemonte.it.
• 2A.O. Ordine Mauriziano, Largo F. Turati 62, Torino 10128, Italy.
• 3Dipartimento di Scienze della Sanità Pubblica e Pediatriche - Sezione di Medicina Legale, Università degli Studi di Torino, corso G. Galilei 22, Turin 10126, Italy.
• 4Centro Regionale Antidoping "A. Bertinaria" - Laboratorio Regionale di Tossicologia, Regione Gonzole 10/1, Orbassano, Turin 10043, Italy.
• 5Centro Regionale Antidoping "A. Bertinaria" - Laboratorio Regionale di Tossicologia, Regione Gonzole 10/1, Orbassano, Turin 10043, Italy; Dipartimento di Chimica, Università degli Studi di Torino, via P. Giuria 7, Turin 10125, Italy. 

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Significant Misuse of Sildenafil (Viagra) in London Nightclubs

There is anecdotal evidence of misuse of erectile dysfunction medication, particularly to counteract some of the unwanted effects of recreational drugs on erectile function. However, there is little data from the United Kingdom (UK).

To evaluate the prevalence of sildenafil misuse in a UK population that has previously been shown to have high recreational drug use.

Individuals attending nightclubs catering for the men who have sex with men (MSM) community in South London were asked about lifetime and last year use of recreational drugs and sildenafil.

313 individuals were surveyed over four nights in 2013: 

• 282 (90.1%) were males and 248 (79.2%) were MSM. 
• Last year use of recreational drugs was high: 
• mephedrone (74.1%), 
• cocaine (61.3%), 
• MDMA/Ecstasy (59.2%), 
• GHB/GBL (52.8%), 
• cannabis (51.8%), and 
• ketamine (50%). 
• 136 (49.1%) MSM versus 6 (18.8%) non-MSM clubbers had misused sildenafil in the last year (p < .001). 
• Amongst the MSM clubbers, 
• 232 (93.5%) had heard of sildenafil, 
• 161 (64.9%) reported misuse of sildenafil in their lifetime and 
• 133 (53.6%) had misused sildenafil in the last year. 

This study demonstrates a high prevalence of sildenafil misuse in a population who are heavy users of recreational drugs; it is not likely that this young population have underlying erectile dysfunction as a reason for legitimate sildenafil use. There is the potential for interaction with other recreational drugs used including cocaine and volatile nitrites. Further work is required in to determine the extent and reason for the misuse.

Full article at: http://goo.gl/xyOdfh

By: Chan WL1, Wood DM2, Dargan PI2.

• 1a Emergency Department, Tan Tock Seng Hospital , Singapore.
• 2b Guy's and St Thomas' NHS Foundation Trust, Clinical Toxicology, St Thomas' Hospital , London , United Kingdom. 

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