Food supplements are regularly found to contain pharmacologically active substances. Recently, the food supplement Dexaprine was removed from the Dutch market because it was associated with severe adverse events. Reports to the Dutch Poisons Information Center (DPIC) showed that ingestion of as little as half a tablet caused several cases of nausea, agitation, tachycardia, and palpitations and even one case of cardiac arrest. The remaining tablets of four patients were sent in by different healthcare professionals. Analysis by ultra-performance liquid chromatography quadrupole time of flight mass-spectrometry (UPLC-QTOF-MS) confirmed the presence of synephrine, oxilofrine, deterenol, yohimbine, caffeine, and theophylline. Two more compounds were found which were tentatively identified as β-methyl-β-phenylethylamines. This incident is only the next in a series of similar incidents involving dietary supplements with (undeclared) active substances that are either unsafe or have no known safety profile.

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Background After changes in European Union biocide legislation, the Dutch Poisons Information Center observed a strong increase in information requests concerning dogs and cats exposed to α‐chloralose. To investigate whether α‐chloralose‐based rodenticides are safe for non‐professional use, additional information regarding poisoning scenarios and clinical course was collected. Methods Veterinarians reporting α‐chloralose exposure over a 2.5‐year period were contacted by mail for follow‐up information concerning exposure scenario, product formulation, clinical course and treatment, and outcome. In total, information was collected for 96 dogs and 41 cats. Results Fifty‐three of 96 dogs and 17 of 19 cats known to have been exposed to α‐chloralose‐based rodenticides developed signs of central nervous system (CNS) depression or sensory‐induced CNS excitation. Mortality in dogs and cats following exposure was 1% and 18%, respectively. An additional 22 cats presented with clinical signs suggestive of α‐chloralose poisoning, with a mortality of 5%. Limitations Exposure to α‐chloralose was not confirmed by biochemical analyses. Conclusion Dogs and especially cats were at risk of poisoning from α‐chloralose. If criteria such as acute toxicity and risk of (secondary) poisoning are applied during the approval of α‐chloralose‐based rodenticides, similar to anticoagulant‐based rodenticides, it can be concluded that α‐chloralose is also not safe for non‐professional use.

Background and Aims Although European‐wide data on the new psychoactive substances (NPS) drug market are available, country‐specific data are limited. We studied recent NPS trend data relative to all recreational drugs on the Dutch drug market. Design National observational study. Setting The Netherlands. Data sources Three national indicators were used between 2013 and 2017: (1) forensic drug samples offered to the Netherlands Forensic Institute (NFI); (2) drug samples submitted by consumers to the Drugs Information and Monitoring System (DIMS); and (3) exposures in which the Dutch Poisons Information Center (DPIC) was consulted. Measurements Overall NPS incidence rate was the primary outcome. Numbers and specific categories of NPS were also studied. Changes in NPS incidence rates over time were analyzed using Poisson regression analyses [year effect expressed as incidence rate ratios (IRR)]. Findings From 2013 to 2017, NPS were involved in 1892 forensic samples, 6316 consumer samples and 481 poisons center exposures. In 2013, NPS incidence rates were 2.5, 7 and 4% versus 3, 11 and 11% in 2017, respectively, in the NFI, DIMS and DPIC samples/exposures. NPS incidence rates increased significantly in consumer samples between 2013 and 2016 [IRR = 1.23; 95% confidence interval (CI) = 1.18, 1.29] and in poisons center exposures between 2013 and 2017 (IRR = 1.19; 95% CI = 1.06, 1.35), while the trend in forensic samples appeared more stable. Phenethylamines were the largest class and were detected in 58, 80 and 63% of NFI, DIMS and DPIC samples/exposures, respectively. Detected phenethylamines mainly involved 4‐fluoroamphetamine and 2C‐x derivatives. The second largest class were cathinones, which were detected in 21, 11 and 16% of NFI, DIMS and DPIC samples/exposures, respectively. Conclusions Analysis of forensic drug samples, consumer drug samples and exposures reported to poison centers from 2013 to 2017 shows the constant presence of new psychoactive substances on the Dutch drug market and its use by the Dutch population. The two largest classes present in the Netherlands were phenethylamines and cathinones.

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<b><i>Introduction:</i></b> The number of patients with excessive nitrous oxide (N₂O) use and neurological disorders has been rising, indicating an addictive potential of N₂O. We studied the incidence of self-reported substance use disorder (SUD)-related symptoms, signs of neuropathy, and the patterns of use in N₂O-intoxicated patients. <b><i>Methods:</i></b> The Dutch Poisons Information Center (DPIC) provides information by telephone on the management of intoxications to healthcare professionals. Retrospective data on signs of neuropathy and patterns of use were collected for all N₂O intoxications reported to the DPIC in 2021 and 2022. Frequent and heavy use were self-reported as “often/frequent/weekly use” and as “use of tanks or &gt;50 balloons/session,” respectively. From this cohort, we included patients with excessive N₂O use or signs of neuropathy in a prospective observational cohort study. Online surveys were sent 1 week, 1 month, and 3 months after DPIC consultation. The survey included the drug use disorder questionnaire (validated to measure self-reported substance abuse [SA] and substance dependence [SD] based on Diagnostic and Statistical Manual of Mental Disorders [DSM]-IV-TR criteria) and questions on patterns of use and signs of neuropathy. DSM-IV-TR criteria were translated to DSM-V criteria to score for mild, moderate, or severe SUD, with 2–3, 4–5, or ≥6 symptoms, respectively. <b><i>Results:</i></b> We included 101 N₂O-intoxicated patients in the retrospective study. Of these, 41% showed signs of neuropathy (<i>N</i> = 41), 53% used N₂O tanks to fill balloons (<i>N</i> = 53), 71% used them frequently (<i>N</i> = 72), and 76% used them heavily (<i>N</i> = 77). We included 75 patients in the prospective study and 10 (13%) completed the first survey. All 10 patients fulfilled the criteria for SA and SD (DSM-IV-TR, median number of questions answered “yes” = 10/12), all used N₂O tanks to fill balloons, and 90% (<i>N</i> = 9) experienced signs of neuropathy. After 1 and 3 months, 6/7 and 1/1 patients, respectively, continued to fulfill SA and SD criteria. Translating to DSM-V criteria, 1/10 patients fulfilled the criteria for (self-reported) mild SUD, 1/10 patients for moderate SUD, and 8/10 patients for severe SUD, 1 week after consultation. <b><i>Conclusion:</i></b> The high proportion of N₂O-intoxicated patients reporting frequent and heavy use of N₂O indicates an addictive potential of N₂O. Although follow-up rate was low, all patients fulfilled self-reported SA, SD (DSM-IV-TR), and SUD (DSM-V) criteria for N₂O. Somatic healthcare professionals treating patients with N₂O intoxications should be aware of possible addictive behavior in patients. The screening, brief intervention, and referral to treatment approach should be considered to treat patients with self-reported SUD symptoms.