Cathinones Use in Paris

BACKGROUND:

The pattern of recreational drug use has changed over the last decade and now includes a multitude of substances sold as "research chemicals" or new psychoactive substances, "NPS". In France, synthetic cathinones emerged in 2008 (while first mentioned by the French police force in 2007 first alerts among users appeared in 2008) and have grown to be popular drugs of abuse. Under the Official Journal dated 11th June 2010, only mephedrone has been listed as narcotics but "designer drugs" have synthesized new substitute cathinones in order to avoid anti-drug laws. However, since July 2012, in France, all synthetic drugs from the cathinones family have been banned and listed as narcotics following the example of United Kingdom. Despite their recent classification and inclusion on narcotic list, they are readily available on Internet and used widely. Paris Addictovigilance Centre observed a signal of derivate cathinones abuse (21 cases over a two-year period).

OBJECTIVE:

Paris Addictovigilance Centre and Marmottan Hospital wanted to describe the use of cathinones in the Paris area and alert the health care community about the abuse identification and risk assessment problems of these compounds. After a review of derivated cathinone's chemical structure, pharmacology and toxicology, this article seeks to provide patricians with a clinical description and treatment's modality.

RESULTS:

Most users of synthetic cathinones will experience euphoria, increased energy, talkativeness, openness and increased sexual arousal. Signs and symptoms of toxicity are consistent with a sympathomimetic toxidrome. The main reasons for care access are psychiatric (hallucinations, psychotic symptoms, agitation) and addiction disorders. Somatic complications were described with various patterns of symptoms such as headache, tachycardia, confusional states, rhabdomyolysis with renal failure or serotonin syndrome. The most important fact is the apparition of the "slam" phenomenon among men who have sex with men (MSM). The "slam" is a compound of three characteristic elements: injection, sexual party and psychostimulant drug. According to users, "slam" is convenient for group sex and is used it to put them into a good mood and a disinhibition state. These compounds cause fast dependence syndrome with strong craving and prolonged psychiatric symptoms and increase infectious risk (HIV, VHC, VHB…). The cathinones family is not detected in conventional urine drug screenings. We point out the lack of confirmatory analytic testing data which remains the only way to determine the actual etiology of the clinical effects observed since drug users do not always know exactly what they took. These substances can be identified by special analyses using gas chromatography or liquid chromatography and mass spectroscopy technology.

CONCLUSION:

This injection drug is used in order to increase sexual desire, delay orgasm and decrease sexual inhibition and is prevalent in many studies on MSM samples. Cathinones would popularize the "slam". Harm reduction policy requires specific MSM interventions on both sexual and drug addiction networks.

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By:  Batisse A1, Grégoire M2, Marillier M3, Fortias M3, Djezzar S3.

• 1CEIP-Addictovigilance, hôpital Fernand-Widal, 200, rue du Faubourg-Saint-Denis, 75010 Paris cedex 10, France. Electronic address: anne.batisse@lrb.aphp.fr.
• 2Centre Marmottan, 17-19, rue d'Armaillé, 75017 Paris, France. Electronic address: murielgreg@hotmail.com.
• 3CEIP-Addictovigilance, hôpital Fernand-Widal, 200, rue du Faubourg-Saint-Denis, 75010 Paris cedex 10, France. 
• Encephale. 2016 Feb 1. pii: S0013-7006(15)00163-3. doi: 10.1016/j.encep.2015.09.002. 

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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.

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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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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.

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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. 

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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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