Driving under the influence of synthetic phenethylamines: a case series

Abstract

New psychoactive drugs, so-called legal highs, have gained more and more popularity during the last years. One of the most important groups of these legal high substances are the synthetic phenethylamines that share a common phenethylamine moiety. Based on certain structural characteristics, these synthetic phenethylamines can be divided into further subclasses, among which the synthetic cathinones ('bath salts') are particularly noteworthy. Synthetic cathinones are characterized by an additional carbonyl group attached at the beta position on the amino alkyl chain. Consumption of synthetic phenethylamines can lead to impairments similar to those observed after the use of, for instance, amphetamine or 3,4-methylenedioxy-N-methylamphetamine (MDMA, 'ecstasy'). These impairments include diverse neurological and psychological symptoms which can affect a safe driving behaviour. Although several reports on clinical symptoms and poisonings due to these substances have been published, most of these publications do not contain any analytical data. Additionally, there is still a lack of information concerning pharmacological and toxicological effects of these rather new psychoactive substances. In particular, the knowledge of the impact on the ability to drive following consumption of synthetic phenethylamines is relevant for the police as well as for forensic toxicologists. In this publication, several cases of individuals driving under the influence (DUI) of synthetic phenethylamines (4-fluoroamphetamine, mephedrone (4-methylmethcathinone, 4-MMC), 2-DPMP (desoxypipradol), methylenedioxypyrovalerone (MDPV), benzedrone, N-ethylamphetamine (etilamfetamine), 3-methylmethcathinone (3-MMC)) are presented, focusing on analytical results and signs of impairment.

Pharmacokinetic properties of 4‐fluoroamphetamine in serum and oral fluid after oral ingestion

“…Oral exposure like this is reported to be most frequent but compared to nasal insufflation, absorption may have been slower and bioavailability may have been lower due to first‐pass metabolism. In cases of suspected driving under the influence of drugs (DUID), 4‐FA concentrations were in 13 cases in median 0.021 (whole blood, range 0.006 to 0.43) mg/kg, 90.0 and 89.9 ng/mL and 350 and 475 ng/mL . In the four cases with concentrations in the range of 320 to 500 ng/mL concentrations were higher than the C max found in the present study after ingestion of a dose of 100 mg (Table ) and were in the range of the C max values found after ingestion of the 150 mg dose, which confirms estimations on typical dosages (40–200 mg).…”

Prevalence of new psychoactive substances and prescription drugs in the Belgian driving under the influence of drugs population

“…Phenylethylamines and their subgroup, SCs, result in euphoria, mood enhancement, increased feelings of sociability and energy and sexual stimulation. However, side‐effects such as panic, paranoia, hallucinations, disorientation, dizziness, agitation, insomnia, verbal confusion, and aggression also occur . As 71% of the samples containing a phenylethylamine also contained another stimulating drug, such as cocaine, amphetamine, or MDMA, no statement can be made whether the stimulating effects come from the NPS or rather the classic drug.…”

“…According to the 2014 Flash Eurobarometera survey of over 13 000 young adults aged 15-24the NPS use prevalence in Belgium is 3%. 11 The NPS abusing population in our study is predominately male (87%) and has a mean age of 25 (range [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Of course, these samples are taken in the driving population, meaning that the tested subjects are at least 18 years old.…”

“…Recent knowledge on NPS toxicodynamics demonstrates that these compounds can have a potential effect on driving ability. Several DUID case reports have already been published, often after an additional screening was performed to identify possible NPS in cases of accidents or when standard toxicological drug analyses revealed negative results …”

“…Several DUID case reports have already been published, often after an additional screening was performed to identify possible NPS in cases of accidents or when standard toxicological drug analyses revealed negative results. [13][14][15][16][17][18][19][20][21] In this article, it was our aim to estimate the NPS positivity rate in the general driving population. In addition, the prevalence of co-use of other illegal or prescription drugs was evaluated.…”