2-(4-Iodo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine (25I-NBOMe): Clinical Case with Unique Confirmatory Testing

Abstract

Introduction 2C designer drugs have been in use since the 1970s, but new drugs continue to develop from substitutions to the base phenethylamine structure. This creates new clinical profiles and difficulty with laboratory confirmation. 2-(4-Iodo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine (25I-NBOMe) is a relatively new 2C drug that is more potent than structural 2C analogs; exposure reports are rare. Testing for 2C drugs is developing; specific testing for new analogs such as 25I-NBOMe is a challenge. These drugs do not reliably trigger a positive result on rapid drug immunoassays. Additionally, most facilities with confirmatory testing capabilities will not identify 25I-NBOMe; methods for detecting 25I-NBOMe in biological samples have not been clearly described nor have optimal metabolic targets for detecting 25I-NBOMe ingestion. Case Report An 18-year-old female presented following use of 25I-NBOMe. She had an isolated brief seizure, tachycardia, hypertension, agitation, and confusion. She improved with intravenously administered fluids and benzodiazepines and was discharged 7 h postingestion. Urine was analyzed using quantitative LC-MS/MS methodology for 25I-NBOMe, 2-(4-chloro-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)-methyl] ethanamine (25C-NBOMe), and 2-(2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine (25H-NBOMe). 25I-NBOMe was found at a concentration of 7.5 ng/mL, and 25H-NBOMe was detected as well. Additional testing was pursued to characterize the metabolism of 25I-NBOMe; the sample was reanalyzed with UPLC-time-of-flight mass spectrometry to identify excreted metabolites. The sample was additionally analyzed for the presence of 2,5-dimethoxy-4-iodophenethylamine (2C-I), 4-bromo-2,5-dimethoxyphenethylamine (2C-B), and 1-(2,5-dimethoxy-4-ethylphenyl)-2-aminoethane (2C-E). Discussion This is a report of a patient presenting following exposure to 25I-NBOMe, a dangerous member of the evolving 2C drug class. The exposure was confirmed in a unique manner that could prove helpful in guiding further patient analysis and laboratory studies.

Rapid Screening Method for New Psychoactive Substances of Forensic Interest: Electrochemistry and Analytical Determination of Phenethylamines Derivatives (NBOMe) via Cyclic and Differential Pulse Voltammetry

“…Only a few pharmacologic studies on humans have been conducted on these drugs. Reports of adverse effects after ingestion began to appear in the scientific literature in 2013, describing prominent neuropsychiatric effects and instability 6,[10][11][12][13][14][15][16] . In severe cases death can occur even after ingesting a single dose 14 .…”

“…Presently, NBOMe are not a part of routine drugs-of-abuse screening and there are no rapid color screening tests or pointof-care devices that can quickly detect them 11 . Just a few commercial reference laboratories offer a qualitative test to identify those compounds 12 .…”

Ingestion of Synthetic Street Drug “25-I” (25I-NBOMe) Causing Type B Lactic Acidosis and Multi-Organ Dysfunction

“…It can present with sympathomimetic and serotonergic symptoms [1][2][3]. Reported adverse effects include multi-organ failure, hypertension, tachycardia, aggression, hallucinations, seizures, hyperthermia, acidosis, and acute kidney injury [1,2,4]. Among the 12 reported cases in the medical literature, three have died [1][2][3][4][5].…”

Analysis of Blotter Papers Employed in the Commercialization of New Hallucinogenic Substances of the 2,5-Dimethoxy-N-(2-methoxybenzyl) Phenethylamine Series Seized in the City of Bogotá by Applying Gas Chromatography Coupled to a Selective Mass Ion Trap Detector

“…6 Few scientific studies have shown the toxicological effects caused by the ingestion of NBOMe series substances. [6][7][8] Research has been primarily focused on human post mortem detection 9,10 and in some cases, in the field of clinical pharmacology; [11][12][13] in Colombia, the only study that has been reported was performed in 2010 and focused on the analysis of substances commercialized in the city of Bogotá under the name synthetic drugs. 14 Colombian law, unlike that of other countries, 15 does not regulate the production and distribution of derivatives of the NBOMe series because these derivatives are not officially included in the lists for control and supervision of psychotropic substances provided by the United Nations.…”

“…Moreover, recent research shows that these substances can be used as adulterants of traditional drugs. [3][4][5][6][7][8][9][10][11][12][13][14][15] The aim of the present study is to propose a method for the qualitative analysis of substances of the NBOMe series found in blotter papers using gas chromatography coupled to a selective mass ion trap detector (GC-MS IT). This analytical method was tested using samples collected in the city of Bogotá with the aim of providing evidence regarding the marketing of new psychoactive substances.…”