Multiple-Drug Toxicity Caused by the Coadministration of 4-Methylmethcathinone (Mephedrone) and Heroin

Abstract

An accidental death caused by the combined use of a new designer drug, 4-methylmethcathinone (mephedrone), and heroin is reported. A 22-year-old Caucasian male was found unresponsive in his living quarters and was transported to the hospital where he died. During autopsy, needle marks were found along the decedent's lower legs and ankles. Investigators discovered the decedent and his roommate had been using "Black Tar" heroin and mephedrone. Routine toxicological analysis detected morphine in the decedent's blood at 0.06 mg/L. Additionally, 6-acetylmorphine, morphine, codeine, and doxylamine were detected in his urine. A designer drug screen, employing a basic liquid-liquid extraction followed by pentafluropropionic anhydride derivatization, was used to isolate mephedrone from both blood and urine specimens. The derivatized extracts were analyzed by gas chromatography- mass spectrometry (GC-MS) operating in full-scan mode. Quantitative analysis of mephedrone was performed by GC-MS operating in selective ion monitoring mode using methamphetamine-d(14) as an internal standard. Mephedrone was confirmed in the decedent's blood and urine at 0.50 and 198 mg/L, respectively. The physiological and pharmacological effects of mephedrone and any associated toxicity have not been reported. However, because of its structural similarities with methcathinone and the high concentration in the decedent's blood, the overall contribution of mephedrone to the death could not be minimized. Therefore, the medical examiner reported the cause of death as multiple-drug toxicity and the manner of death as accidental.

Mephedrone pharmacokinetics after intravenous and oral administration in rats: relation to pharmacodynamics

“…However, its relatively short duration of action, which lead to repeated dosing, is more similar to cocaine (Wilkinson et al 1980). In a recent study, 70 % of mephedrone users reported to be using it by nasal insufflation, while 30 % admitted to be taking it orally (Dickson et al 2010;Winstock et al 2011). There are numerous reports of individuals using mixed routes during a single session.…”

The Toxicology of Bath Salts: A Review of Synthetic Cathinones

“…Four additional mephedronerelated deaths are reported: stab wounds were the cause of death in one, mephedrone responsible for two, and the other case unresolved [34]. Accidental death due to multidrug toxicity occurred after use of mephedrone and heroin in a 22-year-old male [32]. Mephedrone was thought to be the cause of death in a person with excited delirium that was aggravated by blood loss from wounds sustained from breaking windows.…”

“…Urine drug screening in another series found that 16 of 17 specimens were positive for other drugs of abuse [13]. Postmortem toxicology testing has also revealed that concurrent use of other substances is common [32][33][34] Adverse Clinical Effects of Synthetic Cathinones Cardiac, psychiatric, and neurological signs and symptoms are the most common adverse effects reported in synthetic cathinone users who require medical care. There are four series detailing clinical effects of cathinones.…”

Mephedrone-Related Fatalities in the United Kingdom: Contextual, Clinical and Practical Issues

“…Previously, a Danish teenager found in possession of mephedrone died in May 2008, although toxicology reports were inconclusive (Campbell, 2009). The first mephedrone-related death in the USA involved the combined use of mephedrone and heroin (Dickson et al, 2010). More recently, the first cases from the Netherlands (Lusthof et al, 2011) and the Republic of Ireland (EMCDDA, 2011:85) have been reported.…”