2C-I-NBOMe, an “N-bomb” that kills with “Smiles”. Toxicological and legislative aspects

Abstract

Substituted phenethylamines are a class of designer drugs that have recently emerged in the drug abuse market. Such substances remain legal to use, possess, and supply until these compounds become classified as scheduled. 2C-I-NBOMe or 25I-NBOMe is the N-benzyl-derivative of the iodo-substituted dimethoxy-phenethylamine (2C-I) that appeared recently in the drug market under the street name "N-Bomb". Due to its high potency, intoxications and fatal cases related to 2C-I-NBOMe use are increased worldwide. The use and trafficking of this substituted phenethylamine is banned only in some countries. A comprehensive review was performed using PubMed and Medline databases, together with additional non-peer reviewed information sources, including books and publications of state authorities in different countries, regarding chemistry, availability, pharmacology, and toxicology of 2C-I-NBOMe. Intoxications or lethal cases, published or reported, as well as the current legislation on this newly introduced drug are also reviewed.

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

“…(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).…”

“…The signs and symptoms of reported intoxications with N-Bombs are merely the results of the combined features of hyperactivation of the serotonergic pathway, both centrally and peripherally, and the sympathetic autonomic nervous system, hence the most commonly reported features of intoxication are manifestations of both sympathomimetic and serotoninergic effects; these include tachycardia, hypertension, agitation and aggression, seizures and status epilepticus, hyperthermia, progressive dissociation, and drug-induced psychosis (Bersani et al, 2014;Forrester, 2014;Gee, 2015;Hill et al, 2014;Nikolaou et al, 2015;Quora.com, Hare Krishna, 2016;Rose, et al, 2015;Suzuki et al, 2014;Wood et al, 2015). 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.…”

“…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). It is sold to users in the form of blotting papers (blotters), powder, and liquid form (Bluelight.org, 2016;Wood et al, 2015).…”

“…The most commonly reported features of intoxication are induced by the activation of the serotoninergic pathway and the sympathetic nervous system, resulting in a status of hyper-stimulation of all body systems specifically the cardiopulmonary and nervous system. Hence users are frequently apprehended in a state of agitation, aggression, hyperventilation, increased physical strength, and clouded consciousness or a psychotic-like state (Bersani et al, 2014;Forrester, 2014;Gee, 2015;Hill et al, 2014;Nikolaou et al, 2015;Rose, et al, 2015;Suzuki et al, 2014;Wood et al, 2015).…”

25b-NBOMe: A Case Report of Sudden Death and Insightful View of Google Trends Data

“…The chemical substance 25b-NBOMe (Figure 1), also known as "N-Bomb" or "Smiles" signifying its high potency, is a phenethylamine derivative used for its "psychedelic" properties as a potent hallucinogen. It is a synthetic hallucinogenic compound; it belongs to the versatile spectra of novel psychoactive substances (NPS) (4). 25b-NBOMe is a serotonergic agonist via acting on the 5HT2A receptors located in the nervous system.…”