Case series: toxicity from 25B-NBOMe – a cluster of N-bomb cases

Abstract

Background A new class of hallucinogens called NBOMes has emerged. This class includes analogues 25I-NBOMe, 25C-NBOMe and 25B-NBOMe. Case reports and judicial seizures indicate that 25I-NBOMe and 25C-NBOMe are more prevalently abused. There have been a few confirmed reports of 25B-NBOMe use or toxicity. Report Observational case series. This report describes a series of 10 patients who suffered adverse effects from 25B-NBOMe. Hallucinations and violent agitation predominate along with serotonergic/stimulant signs such as mydriasis, tachycardia, hypertension and hyperthermia. The majority (7/10) required sedation with benzodiazepines. Analytical method 25B-NBOMe concentrations in plasma and urine were quantified in all patients using a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. Peak plasma levels were measured between 0.7-10.1 ng/ml. Discussion The NBOMes are desired by users because of their hallucinogenic and stimulant effects. They are often sold as LSD or synthetic LSD. Reported cases of 25B- NBOMe toxicity are reviewed and compared to our series. Seizures and one pharmacological death have been described but neither were observed in our series. Based on our experience with cases of mild to moderate toxicity, we suggest that management should be supportive and focused on preventing further (self) harm. High doses of benzodiazepines may be required to control agitation. Patients who develop significant hyperthermia need to be actively managed. Conclusions Effects from 25B-NBOMe in our series were similar to previous individual case reports. The clinical features were also similar to effects from other analogues in the class (25I-NBOMe, 25C-NBOMe). Violent agitation frequently present along with signs of serotonergic stimulation. Hyperthermia, rhabdomyolysis and kidney injury were also observed.

Toxic Leukoencephalopathy in a Teenager Caused by the Recreational Ingestion of 25I-NBOMe: A Case Report and Review of Literature

“…Serotonin is responsible for many functions in the body including platelet aggregation, gastrointestinal motility, vasoconstriction, bronchoconstriction, mood, appetite, wakefulness, and personality [11][12][13]. Currently, 25I-NBOMe is considered one of the most potent 5-HT 2A receptor agonists in the world [8][9][10].…”

“…Doses and concentrations often vary depending on the formulation of the drug, the product that contains it, and how it is applied to the mucous membranes (blotter paper, powder or crystal form). These variations in dosing and applications increase the likelihood of toxicity and fatal overdoses which are appearing anecdotally in the medical literature [8][9][10]. Although users may think that blotter paper laced with 25I-NBOMe is the safest method of ingestion, since each square is thought to contain a pre-measured amount of the drug, manufacturer variability and lack of production standards result in significant variations in drug concentrations resulting in the reports of fatal overdoses from all forms and routes of administration of 25I-NBOMe.…”

“…The addition of the N-methoxybenzyl group to the 2C compound significantly increases the compounds affinity for the 5-HT 2A receptor. To illustrate the increase in potency from the parent compound to 25I-NBOMe, a normal clinical dose of 2C-I is 20 mg, whereas the common dose of 25I-NBOMe is as little as 50 -100 μg [7][8][9]. Common routes of administration include the sublingual, buccal, and intranasal routes.…”

Phantom menace: novel psychoactive substances and the UK Armed Forces

“…Gee et al report on a case series of 10 patients who took 2C series phenylethylamines; common findings were hypertension (8/10) and tachycardia (10/10; ranging from 100 to 175 bpm) 47. Due to their action at the 5HT2A serotonin receptor, coronary vasospasm and peripheral vasoconstriction would be anticipated.…”

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

“…Most of these cases required admittance to emergency units and intensive care units for life support, hydration, intubation and assisted ventilation. The less severe cases of intoxication were actually managed using intravenous hydration, sedation with benzodiazepines (intravenous), the use of anticholinergic agents, and other symptomatic and supportive measures (Gee et al, 2016;Hill et al, 2016;Rose et al, 2012;Suzuki et al, 2015). The onset and duration of the NBOMe-induced effects largely depend on the doses and the routes of administration.…”