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. 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

A Comparison of Recreational Drug Use amongst Sexual Health Clinic Users in London with Existing Prevalence Data

The objective was to give an overview of self-reported recreational drug use amongst attendees of sexual health clinics in London and compare this to existing datasets. Between December 2013 and March 2014, attendees of two sexual health clinics in London were surveyed. Data collected were: sexual history, smoking and alcohol and recreational drug use. 

Data were analysed using SPSS (version 21). A total of 1472 respondents were included; 778 (52.9%) men, 676 (45.9%) women and 3 (0.2%) transgender (15 [1.0%] did not answer). Mean age was 30.6 ± 9.0 years. A total of 339 (43.6%) men were men who have sex with men, and 18 (2.4%) women were women who have sex with women. 

Lifetime prevalence of use was: alcohol 94.1%; cannabis 48.5%; 'poppers' (volatile nitrites) 28.2%; cocaine 26.8% and 3,4-methylenedioxy-methamphetamine pills 23.2%. Our population had higher current popper, methamphetamine and mephedrone use than the Crime Survey of England and Wales but lower use of cannabis, poppers and Viagra than the European MSM Internet Survey. 

Global Drug Survey and Part of the Picture respondents' use were higher than our population for all drugs. Drug use in this population had a different pattern to general population surveys and studies involving only men who have sex with men.

Purchase full article at:  http://goo.gl/AB736V

By:   Thurtle N1, Dargan PI2, Hunter LJ3, Lovett C3, White JA4, Wood DM2.

• 1Clinical Toxicology Department, Guys and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK nat_thurtle@yahoo.com.
• 2Clinical Toxicology Department, Guys and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK Clinical Toxicology Department, King's College London, London, UK.
• 3Clinical Toxicology Department, Guys and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.
• 4Genitourinary Medicine, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK. 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

A Matter of Sexual Confidence: Young Men's Non-Prescription Use of Viagra in Addis Ababa, Ethiopia

This paper examines the non-prescription use of the sexual enhancement drug Viagra by young men in Addis Ababa. Data was collected through repeated in-depth interviews with 14 Viagra users - heterosexual men between the ages of 21 and 35 - and focus-group discussions with 21 male and 22 female university students. 

Study participants turned to Viagra to impress lovers, as a 'support mechanism' when feeling weak or tired, to counteract the effects of chewing the stimulant plant khat and to satisfy what they perceived as a psychological 'addiction'. More generally, young men used Viagra to quell anxieties about what they perceived as women's growing expectations about their sexual performance - informed by changing gender relations and sexual expectations, constructions of masculinity that emphasise sexual prowess, and a misreading of women's sexual desires largely fuelled by the emergence of pornography as a new standard for sexual performance. 

While some men gained sexual confidence by using Viagra, others - particularly those who used Viagra regularly - paradoxically experienced feelings of loss of manhood.

Purchase full article at:  http://goo.gl/l4hB9L

By:  Both R1.

• 1 Amsterdam Institute for Social Science Research , University of Amsterdam , Amsterdam , The Netherlands.

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

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. 

More at:  https://twitter.com/hiv_insight