A Case Review of the First Analytically Confirmed 25I-NBOMe-Related Death in Washington State

Abstract

This case was submitted to the Washington State Patrol Toxicology Laboratory in September 2014. A 15-year-old male went to a party where he ingested 25I-NBOMe and mushrooms. A short time later, he started to vomit and began seizing until he eventually passed out. Resuscitation efforts were made, but were unsuccessful. He was transported to a local hospital, where he died three days later of multi-system organ failure following cardiopulmonary arrest. The hospital admission samples were negative for ethanol and basic drugs and their metabolites. The hospital serum confirmed positive for delta-9-tetrahydrocannabinol (THC) and carboxy-THC at 4.1 and 83 ng/mL, respectively. On the basis of the case history, the hospital blood and urine were sent to NMS Labs for NBOMe and psilocin confirmation. The blood was positive for 25I-NBOMe, and the urine was positive for 25C-, 25H- and 25I-NBOMe, as well as, psilocin. Antemortem and postmortem blood were also sent to AIT Laboratories for NBOMe confirmation. The antemortem blood confirmed positive for 25I-NBOMe with a concentration of 0.76 ng/mL. The manner of death was ruled an accident as a result of combined 25I-NBOMe and psilocin intoxication.

NBOMe Compounds: Systematic Review and Data Crunching of the Surface Web

“…The decedents were from multinational backgrounds including individuals from the United States, Australia, and Ireland . These data are also concordant with the cases presented in this study (section 3.6) (Andreasen et al, 2015;Byard et al, 2016;Kueppers and Cooke, 2015;Lowe et al, 2015;Poklis et al, 2014;Rose et al, 2013;Shanks et al, 2015;Suzuki et al, 2014;Tang et al, 2014;Walterscheid et al, 2014). Linear regression models (Figure 2 and 3) for these incidents (intoxications and deaths) were plotted in correlation with the trends' data in an aim to reach a potential pattern of interrelationship in between the two phenomena.…”

“…The more severe cases frequently develop acute renal and liver injury or failure, rhabdomyolysis, serotoninergic syndrome (serotonin toxidrome), and sympathomimetic toxicities, multiple discrete intraparenchymal haemorrhages, cardiac failure, pulmonary oedema, and eventually death. (Andreasen et al, 2015;Byard et al, 2016;Kueppers & Cooke, 2015;Lowe et al, 2015;Poklis et al, 2014;Rose et al, 2013;Shanks et al, 2015;Suzuki et al, 2014;Tang et al, 2014;Walterscheid et al, 2014). Serotonin toxidrome by itself can potentially produce acute toxicity involving metabolic acidosis, rhabdomyolysis, seizures, renal and liver failure, and disseminated intravascular coagulation (Bersani et al, 2014;Boyer & Shannon, 2005;Forrester, 2014;Haberzettl et al, 2013;Nikolaou et al, 2015;Wood et al, 2015).…”

“…Therefore, a typical (ab)user can experience a psychedelic effect in the milligramme range or even less, making it almost as potent as another potent hallucinogenic compound known as lysergic acid diethylamide (LSD) (Andreasen et al, 2015;Byard et al, 2016;Kueppers & Cooke, 2015;Lowe et al, 2015;Poklis et al, 2014). In fact, NBOMe products are promoted as a "legal alternative of LSD" (Bersani et al, 2014;Nikolaou et al, 2015;Wood et al, 2015), although NBOMe blotters taste distinct from LSD blotters (Psychonautwiki.org, 2016;Reddit.com, DrugsAMA, 2016).…”

“…Almost all were attributed to the most potent form (the 25i variant). These catastrophic incidents have been reported highly in the developed world including the United States, United Kingdom, Australia, Canada, China, Denmark, Netherlands, other European countries (Andreasen et al, 2015;Byard et al, 2016;Kueppers & Cooke, 2015;Lowe et al, 2015;Poklis et al, 2014;Rose et al, 2013;Shanks et al, 2015;Suzuki et al, 2014;Tang et al, 2014;Walterscheid et al, 2014). In the published literature, there are no verifiable reports of intoxication and/or fatality from the developing world.…”

NPS: Medical Consequences Associated with Their Intake

“…There are several reports of related acute toxicity events, most being related to 25I-NBOMe (2-(4-iodo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl] ethanamine; [175][176][177]). 25I-NBOMe shares some structural similarity with 2C-I (2,5-dimethoxy-4-iodophenethylamine).…”