A 36-year-old man was drugged and sexually assaulted; the novel synthetic cathinone N-ethyl-pentedrone (NEPD) was found in his blood and urine. Five synthetic cathinones have been linked to drug-facilitated sexual assault: methylenedioxypyrovalerone, 4-methylethcathinone, α-pyrrolidinopentiophenone, mephedrone, α-pyrrolidinohexiophenone, and methylone—the most common. Methylone, a β-keto analog of MDMA, shares its entactogenic effects. NEPD, however, produces only slightly entactogenic effects in a minority of users, making it more suited to chemsex than to drug-facilitated sexual assault, though the boundary between these contexts can be blurry.
Genetic factors influence individual responses to MDMA, which is being studied for treating PTSD and substance use disorders. The catechol-O-methyltransferase (COMT) Val158Met polymorphism has been linked to cognitive and cardiovascular effects, and polymorphisms in the serotonin-linked promoter region (5HTTLPR) have been associated with mood disorders. However, only a few associations have been found, and many genes involved in MDMA metabolism and targets remain poorly investigated. Large-scale controlled pharmacogenomics studies are needed to optimize therapeutic use and minimize risks.