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Detection of unsuspected cathinone and piperazine-type drugs in urine samples positive for methamphetamine and amphetamine collected in emergency departments

Gomila Mu√Īiz I, Lendoiro E, de-Castro-R√≠os A, Elorza Guerrero MA, Puiguriguer Ferrado J, Sahuquillo Fr√≠as L, Sanch√≠s Cort√©s P, Barcel√≥ Mart√≠n B

Clinical Analysis Service, Hospital Universitario Son Ll√†tzer, Palma de Mallorca, Spain. Grupo de Investigaci√≥n en Toxicolog√≠a Cl√≠nica, Instituto de Investigaci√≥n Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain. Toxicology Service, Institute of Forensic Sciences ‚ÄúLuis Concheiro‚ÄĚ, University of Santiago de Compostela, Spain. Clinical Analysis Service, Clinical Toxicology Unit, Hospital Universitario Son Espases, Palma de Mallorca, Baleares, Spain. Emergency Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain. Clinical Analysis Service, Hospital Can Misses, Ibiza, Spain. Department of Chemistry, University of the Balearic Islands, Palma de Mallorca, Spain.

Objectives. To detect the presence of unsuspected and/or undeclared cathinone and piperazine-type designer drugs in methamphetamine (METH) and amphetamine users treated in emergency departments, and to compare clinical and toxicologic profiles.
Method. Retrospective observational study of emergency department patients treated for confirmed acute intoxication by recreational drugs (METH and amphetamines) between March 2019 and December 2020. We ordered high-performance liquid chromatography with tandem mass spectrometry to detect cathinones (methylone, fluoromethcathinone, mexedrone, fluoromethamphetamine, mephedrone, methylenedioxypyrovalerone) and synthetic piperazines (meta-chlorophenylpiperazine and trifluoromethylphenylpiperazine). Demographic, clinical, and toxicologic variables were analyzed with SPSS software (version 23).
Results. Thirty-nine patients were included: 24 (61.5%) had used METH and 15 (38.5%) an amphetamine. Synthetic cathinones were detected in samples from 11 patients (28.2%), 10 (90.9%) in the METH group and 1 (9.1%) in the amphetamine group (P = .028). The METH users had taken mephedrone (8 patients) or methylone (2 patients); the amphetamine user had taken mephedrone. None of the patients had declared use of a cathinone; nor was use suspected. The mean (SD) number of substances involved was higher among users of cathinones (3.5 [1.13] vs 2.5 [1.40] in those who took no cathinones; P = .036). Among the cathinone users, 90.9% were men, 90.9% had used METH, and 45.5% had practiced chemsex. HIV positivity was significantly associated with cathinone use (in 45.5% vs 10.7% of those not using cathinones; P = .028). All 5 of the patients who had taken cathinones and also practiced chemsex were HIV positive. Significantly more patients who had taken cathinones presented with anxiety (72.7% vs 21.43%; P = .007). No differences in clinical management were found.
Conclusions. Detection of METH in intoxicated patients should raise suspicion of probable use of a synthetic cathinone. Patients in whom new psychoactive substances are detected should be kept under observation, and clinical protocols should include referring them to addiction treatment centers.

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