Journal of medical toxicology : official journal of the American College of Medical Toxicology
March 1, 2012
Christopher D Rosenbaum, Stephanie P Carreiro, Kavita M Babu
356 citations
Many new drugs of abuse available online remain unfamiliar to healthcare providers. Herbal marijuana alternatives like K2 or Spice contain synthetic cannabinoids mixed with plant matter. Synthetic cathinones ("bath salts") have caused nationwide emergency visits for severe agitation, sympathomimetic toxicity, and death. Kratom, from Mitragyna speciosa, has opioid-like effects and is used for chronic pain and opioid-withdrawal symptoms. Salvia divinorum is a hallucinogen with therapeutic potential but banned in many states due to psychiatric concerns. Methoxetamine is marketed as "legal ketamine." Piperazine derivatives (e.g., BZP, TMFPP) reemerge as "legal Ecstasy." These drugs are often perceived as safe but can cause life-threatening adverse effects. The paper covers background, pharmacology, clinical effects, detection, and management of these exposures.
Journal of medical toxicology : official journal of the American College of Medical Toxicology
March 1, 2014
Samuel J Stellpflug, Samantha E Kealey, Cullen B Hegarty et al.
92 citations
A new, highly potent designer drug called 25I-NBOMe, part of the 2C family, caused an isolated brief seizure, rapid heart rate, high blood pressure, agitation, and confusion in an 18-year-old woman who used it. She recovered with intravenous fluids and benzodiazepines and was discharged seven hours after ingestion. Standard drug tests often miss these substances. Urine analysis using advanced techniques found 25I-NBOMe at 7.5 ng/mL and also detected 25H-NBOMe, a related compound. Further testing identified excreted metabolites, aiding future detection. This case highlights the dangers of evolving synthetic drugs and the need for specialized laboratory methods to confirm exposure.
Journal of medical toxicology : official journal of the American College of Medical Toxicology
June 1, 2013
Adam Bosak, Frank Lovecchio, Michael Levine
59 citations
A 19-year-old male who insufflated the designer drug 2C-I developed recurrent seizures, hyperadrenergic state, and serotonin syndrome, leading to prolonged respiratory failure. Comprehensive drug testing confirmed 2C-I. The patient ultimately made a full recovery. This case highlights the potential for severe toxicity from this emerging phenethylamine, with effects including seizures and serotonin syndrome, and underscores the need for awareness among clinicians.
Journal of medical toxicology : official journal of the American College of Medical Toxicology
January 1, 2025
Caitlin E Wolfe, Lachlan J Sund, John Rh Archer et al.
5 citations
In 2021, 258 UK deaths were attributed to novel psychoactive substances (NPS). Confirmatory testing for NPS is limited by cost and speed. Among 1000 acute recreational drug toxicity presentations to a central London hospital in 2019/20, 28 unique NPS were detected, compared to 31 in a 2016/17 cohort. Eight new NPS appeared in 2019/20: four benzodiazepines, two synthetic cannabinoid receptor agonists, one cathinone, and one ketamine analogue. No NPS opioids were found in either cohort. Cannabis, ketamine, and opioid detection increased significantly from 2016/17 to 2019/20, while alcohol, cathinones, GHB, and MDMA decreased. The findings align with European forensic trends and underscore the need for ongoing surveillance of emerging drugs.
Journal of medical toxicology : official journal of the American College of Medical Toxicology
January 1, 2026
Shaun L Greene, Rebecca Fawcett, Jared Castle et al.
1 citation
A 32-year-old man experienced multi-system toxicity after eating a single gummy sold as a THC product, which actually contained hexahydrocannabinol (HHC), a semi-synthetic cannabinoid. Within 1.5 hours he developed nausea, vomiting, slurred speech, whole-body numbness, inability to move his head, a dissociative state, rapid heart rate (118 bpm), dilated pupils, confusion, and rapid breathing (24 breaths per minute). No other drugs were detected. Symptoms resolved within eight hours with supportive care. HHC can be manufactured from cannabidiol and is rapidly absorbed, crosses the blood-brain barrier, and is metabolized in the liver. This case highlights the dangers of unregulated cannabis products.
Journal of medical toxicology : official journal of the American College of Medical Toxicology
April 1, 2026
Aaron B Deutsch, Natalie E Ebeling-Koning, Alex J Krotulski et al.
A 29-year-old man overdosed on 3-methyl-PCP, a novel dissociative anesthetic, and arrived at the emergency department with encephalopathy, tachycardia, hypertension, nystagmus, and diaphoresis. Laboratory tests showed severe rhabdomyolysis and acute kidney injury. The patient reported obtaining the drug online, and gas chromatography-mass spectrometry and liquid chromatography-quadrupole time-of-flight mass spectrometry confirmed 3-methyl-PCP in the drug product and biological specimens. This first laboratory-confirmed case demonstrates that 3-methyl-PCP can cause severe injury and highlights the public health risks of rapidly emerging, unregulated dissociative synthetic anesthetics. Early warning systems like the CSFRE NPS Discovery Program are critical for timely clinical response and public health protection.