Two cases of severe intoxication associated with analytically confirmed use of the novel psychoactive substances 25B-NBOMe and 25C-NBOMe
Clinical Toxicology January 1, 2014 DOI: 10.3109/15563650.2014.909932 via Elsevier
Summary
Two men, aged 17 and 31, became acutely ill after taking drugs labeled 'NBOMe' or 'Holland film'. They experienced confusion, agitation, high blood pressure, rapid heart rate, fever, sweating, and dilated pupils, with some also having seizures, muscle breakdown, and abnormal liver function. Treatment required benzodiazepines and other medications. Urine analysis detected 25B-NBOMe in both patients and 25C-NBOMe in one. NBOMe compounds strongly activate serotonin and adrenaline receptors, explaining the symptoms. Clinical testing for these drugs is not widely available, so clinicians and laboratory staff are key to detecting these dangerous substances.
Study at a glance
| Characteristics | Case report Peer reviewed |
|---|---|
| Sample size | 2 |
| Population | Two male patients with acute intoxication from NBOMe drugs |
| Citations | 93 |
| Key finding | 25B-NBOMe was detected in both patients' urine, and 25C-NBOMe in one, after ingestion of drugs labeled 'NBOMe' or 'Holland film'. |
Abstract
CONTEXT: A new group of novel psychoactive substance, the N-methoxybenzyl (NBOMe) derivatives of substituted phenethylamine, has recently emerged on the drug market, among which 25I-NBOMe and 25B-NBOMe have previously been implicated in clinical intoxications and fatalities. We report two cases of acute intoxication associated with these substances. CASE DETAILS: Two male patients (17 and 31 years of age) had ingested drugs labelled as 'NBOMe' or 'Holland film' and developed confusion, agitation, hypertension, tachycardia, hyperthermia, sweating and dilated pupils. Other features included convulsion, rhabdomyolysis and deranged liver function. The patients required benzodiazepines and other drugs for the control of symptoms. Urine samples from both patients were analysed using liquid-chromatography tandem mass spectrometry (LC-MS/MS) following glucuronidase digestion and solid-phase extraction. Identification was based upon comparison of the retention time and enhanced product ion scan with reference standards. In both urine samples, 25B-NBOMe was detected. Additionally, 25C-NBOMe was identified in one of the urine samples. DISCUSSION: The NBOMe compounds are highly potent 5HT2A receptor agonists and are also agonists at alpha-adrenergic receptors, which likely account for their serotonergic and sympathomimetic symptoms. The clinical testing of NBOMe drugs is not commonly available. Clinicians as well as laboratory staff play an important role in facilitating the detection of this group of potentially dangerous emerging drugs.