Dissociative and sympathomimetic toxicity associated with recreational use of 1-(3-trifluoromethylphenyl) piperazine (TFMPP) and 1-benzylpiperzine (BZP)

Abstract

Introduction: There is emerging evidence of increasing use of legally available synthetic compounds as recreational drugs. While there are some changes to legislation relating to these synthetic compounds, often the emergence of the agents outpaces the effect of the legislation to curb their use, and the legal status of these agents may change as more information on their toxicity becomes known. TFMPP [1-(3-trifluoromethylphenyl) piperazine] was initially temporarily controlled under Schedule I of the Controlled Substances Act in 2002 in the US, but following further review and lack of published information on toxicity, it was removed from this control in 2004. In addition, there are very few "user reports" of effects when TFMPP is taken alone or in combination with BZP [1-benzylpiperazine].Case reports: Three patients presented to our emergency department after ingesting 4 tablets thought to be 3,4-methylenedioxy-N-methylamphetamine (MDMA, street name "Ecstasy") over the course of an evening. They presented with dissociative-type symptoms, nausea, and signs consistent with sympathomimetic toxicity. All 3 improved with conservative management and observation, within 12 hours of presentation. Serum analysis demonstrated the presence of TFMPP and BZP at concentrations of 263 Ϯ 5.8 ng/mL (range 260-270 ng/mL) and 46.7 Ϯ15.3 ng/mL (range 30-60 ng/mL), respectively. No other recreational drugs were detected in an extended toxicological screen of blood and urine samples.Discussion: This is the first case series of confirmed toxicity associated with recreational use of TFMPP in combination with BZP, with clinical features not consistent with BZP toxicity. In our view, the current legal status of TFMPP should be reviewed.

Recreational Use of Mephedrone (4-Methylmethcathinone, 4-MMC) with Associated Sympathomimetic Toxicity

“…We have previously reported the benefits of proactive ad hoc toxicological screening in individuals who self-report the use of "novel" drugs [23][24][25][26]. Detailed toxicological screening in these cases has established that the presentations were related to the use of a novel drug and contribute to the understanding of the potential toxicity of novel drugs as they enter the recreational drug scene.…”

Increases in use of novel synthetic stimulant are not directly linked to decreased use of 3,4-methylenedioxy-N-methylamphetamine (MDMA)

“…These compounds have similar pharmacological properties to the popular stimulants such as cocaine, amphetamines and 3,4-methylenedioxy-N-methylamphetamine (MDMA) [4][5][6][7][8][9]. Toxicity [10][11][12][13][14] and some deaths [15][16][17] have been associated with the recreational use of these drugs. These drugs are sometimes sold online under a variety of names, such as "bath salts" and "plant food" [18], and users often do not know the actual active ingredients when using these drugs [12].…”

“…Toxicity [10][11][12][13][14] and some deaths [15][16][17] have been associated with the recreational use of these drugs. These drugs are sometimes sold online under a variety of names, such as "bath salts" and "plant food" [18], and users often do not know the actual active ingredients when using these drugs [12].…”

Delayed onset of seizures and toxicity associated with recreational use of Bromo-dragonFLY

“…We have already reported that proactive ad hoc toxicological screening undertaken in recreational drug presentations, in which individuals self-report ingestion of novel drugs or have atypical presentations following ingestion of classical recreational drugs, can detect a range of novel or emerging recreational drugs [1][2][3][4][5]. This case also highlights that research chemical compounds, such as Bromo-dragonFLY, may also enter the recreational drug market.…”

“…In spite of this legislation, there have been many recent reports of toxicity associated with emerging "novel" recreational drugs or pharmaceutical agents misused as recreational drugs [1][2][3][4][5][6]. Often the legislation concerning these novel recreational drugs is inconsistent, with control only occurring in a limited number of countries [4].…”