The clinical challenges of synthetic cathinones

Abstract

Aims Within the new psychoactive substances (NPS) scenario, several hundred different molecules, mostly including synthetic cannabinoids and cathinones, have been identified so far. The aims of the paper were to: (i) identify the number of synthetic cathinones mentioned in a range of psychonaut, NPS‐related, online sources; and (ii) describe the associated acute/long term clinical scenario and the related treatment/management plan. Methods After about 18 months of operation and exclusion of false positives/duplicates, some 4204 unique NPS molecules were included in the NPSfinder® crawling/navigating software database. Most popular NPS included: 1265 psychedelic phenethylamines (30.1%; confidence interval [CI] 95%: 28.7–31.5%); 1253 synthetic cannabinoids (29.8%; CI 95%: 28.4–31.2%); 429 synthetic opioids (10.2%; CI 95%: 9.3–10.2%); and 171 synthetic cathinones (4.1%; CI 95% 3.5–4.7%). Conversely, the United Nations Office on Drugs and Crime and the European Monitoring Centre for Drugs and Drug Addiction databases respectively included 169 and 140 cathinones. Overall, the 3 databases reported some 222 synthetic cathinones, and 41 were uniquely identified by the NPSfinder®. Results In terms of clinical scenarios, synthetic cathinone ingestion is initially associated with stimulant effects; however, psychopathological disturbances, violence, suicidal behaviour, hyperthermia, coma and death have also been described. Conclusion The proportion of cathinones commented on by psychonaut fora appeared to be relatively small, and similar to those reported by both the United Nations Office on Drugs and Crime and European Monitoring Centre for Drugs and Drug Addiction. This may be associated with a recent significant decline in both cathinone‐related consumption and acute medical presentation. Due to their complex behavioural and medical toxicity issues, healthcare professionals should be, however, be educated to recognise the signs and symptoms of NPS, including synthetic cathinone, ingestion.

Focus on Clozapine Withdrawal- and Misuse-Related Cases as Reported to the European Medicines Agency (EMA) Pharmacovigilance Database

“…This co-occurrence ('dual diagnosis') has a negative effect on the course of schizophrenia, due to increased rates of hospitalization, decreased compliance with medication, increased violence and suicide, general deterioration of the patients' condition, and overall increased societal costs [1,17]. In particular, the positive symptoms of schizophrenia are generally exacerbated by the intake of stimulant drugs, such as cocaine, amphetamine derivatives [24], and synthetic cathinones [25]. Due to clozapine's effectiveness, there has been support for considering the molecule in limiting substance use in patients with schizophrenia [26], to achieve both a reduction in substance use [27,28] and an improvement in positive/negative schizophrenia symptoms [29].…”

Analyzing the Open/Deep Web to Better Understand the New/Novel Psychoactive Substances (NPS) Scenarios: Suggestions from CASSANDRA and NPS.Finder Research Projects

“…The use of automatic web crawler software such as the University of Hertfordshire (UK)-coordinated NPS.finder has allowed both scanning and identification activities of a constant flow of drug-related data, providing a nearly real-time update [11,12]. Current NPS.finder research project aims include: (a) identifying and describing the large number of novel/new psychoactive substances (NPS) available as identified from a range of psychonauts', NPS-related, online sources; and (b) identifying a methodology which may be able to anticipate, for each class of NPS, the modifications of their availability levels in the real life scenarios.…”

The challenge of the novel psychoactive substances: How have we responded and what are the implications of this response?

“…1,[5][6][7] The exponential rise in the number and range NPS that have been detected and the rapidity by which substances become available has presented significant challenges in relation to our understanding of the prevalence of their use, how NPS are obtained by users, how we can detect the use of these substances, what the acute harms related to their use are, and how we respond to the potential public health risks posed by NPS. 6,8,9 In addition, clinicians treating patients presenting with acute toxicity and dependence related to the use of NPS often have less confidence in treating those patients compared to those who present with issues related to the use of established illicit drugs, despite the commonality of the issues seen. [10][11][12] In the European Union, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) has developed new monitoring tools alongside their existing indicators with the hope that these will provide a more complete picture on the risks related to NPS.…”

“…6,8,9 In addition, clinicians treating patients presenting with acute toxicity and dependence related to the use of NPS often have less confidence in treating those patients compared to those who present with issues related to the use of established illicit drugs, despite the commonality of the issues seen. [10][11][12] In the European Union, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) has developed new monitoring tools alongside their existing indicators with the hope that these will provide a more complete picture on the risks related to NPS. These new monitoring tools include syringe residue analysis, data on hospital emergency presentations from the European Drug Emergency Network Plus (Euro-DEN Plus) project, analysis of wastewater, drug checking services, and expanded web surveys.…”

“…These mechanisms are slow to respond when a new NPS is detected, with the required information to implement control taking many months or years, meaning that potential users remain at risk. 9 In an attempt to deal with these delays, individual countries have introduced legislation that allows more rapid control of new NPS prior to more formal review and control under their own pre-existing legislation. In the United Kingdom, where substances were traditionally controlled under the Misuse of Drugs Act, 1971, there have been two stepwise approaches.…”