Intoxication with 3-MeO-PCP alone

Abstract

Rationale: 3-Methoxyphencyclidine (3-MeO-PCP) is a new psychoactive substance derived from phencyclidine. Although it can lead to severe intoxications, the main manifestations and optimal management have not been well characterized. Here, we report 2 cases of 3-MeO-PCP intoxication in the same patient, and summarize the manifestations of this intoxication reported in literature. Patient concerns: A 17-year-old male purchased a bag of 3-MeO-PCP on the Internet but took an oral dose (200 mg) that corresponds to the less active isomer 4-MeO-PCP. He developed high blood pressure (158/131 mm Hg), tachycardia (100 bpm), and neurological manifestations (confusion, hypertonia, nystagmus, and then agitation). A maculopapular rash appeared, although this may have been related to the administration of midazolam. Hyperlactatemia (2.6 mmol/L) was the main laboratory finding. Seven days later, he returned to the emergency department after sniffing 50 mg of 3-MeO-PCP. High blood pressure, tachycardia, and neurological manifestations (psychomotor impairment and dysarthria) were present but less severe than after the first intoxication. Diagnosis: In the first intoxication, the blood and urine 3-MeO-PCP concentrations were, respectively, 71.1 ng/mL and 706.9 ng/mL. Conventional toxicity tests were all negative. In the second intoxication, biological samples were not available. Interventions: In the first intoxication, treatment consisted of intravenous hydration and midazolam. The patient was transferred to an intensive care unit for monitoring. After the second intoxication, he was monitored for 12 hours. Outcomes: The patient's condition improved quickly in both cases. Lessons: These cases provide additional information on the manifestations of 3-MeO-PCP intoxication. These manifestations are mainly cardiovascular (high blood pressure, tachycardia) and neurological. The fact that second (50 mg) intoxication was less severe than the first (200 mg) is suggestive of a dose–effect relationship for 3-MeO-PCP. The first case also emphasizes the risk of dosing errors caused by the similarity between the names “3-MeO-PCP” and “4-MeO-PCP.”

Analytical Characterization of 3-MeO-PCP and 3-MMC in Seized Products and Biosamples: The Role of LC-HRAM-Orbitrap-MS and Solid Deposition GC-FTIR

“…All immunoassay toxicological screening for common drugs of abuse (not including PCP) performed in urine and serum samples were negative, which is the same as what occurred in other cases ( Berar et al, 2019 ). If the immunoassay screening had included the PCP test (not a routine test in most European toxicology laboratories), a positive result would probably have been obtained considering the cross-reactivity of MeO-PCP analogs in several PCP immunoassay systems ( Bäckberg et al, 2015a ; Bakota et al, 2016 ; Chang and Smith, 2017 ; Mitchell-Mata et al, 2017 ; Gomila et al, 2019 ; Larabi et al, 2019b ).…”

“…MMC and MeO-PCP analogs may show quite similar chromatographic and, especially, mass spectrometric behaviors, which may hinder their full characterization in the case of unavailability of reference standards for all isomers, and/or their metabolites in case of biosample analysis. These analytical challenges have been addressed by several authors by means of different analytical approaches, for the discrimination of 2-MMC, 3-MMC, and 4-MMC ( Power et al, 2011 ; Power et al, 2012 ; Jamey et al, 2016 ; Maas et al, 2017 ; Zuba and Adamowicz, 2017 ; Nowak et al, 2018 ; Kranenburg et al, 2019 ; Kranenburg et al, 2020a ; Kranenburg et al, 2020b ) and 3-MeO-PCP and 4-MeO-PCP ( Bäckberg et al, 2015a ; Bakota et al, 2016 ; Bertol et al, 2017 ; Johansson et al, 2017 ; Mitchell-Mata et al, 2017 ; Zidkova et al, 2017 ; Ameline et al, 2019b ; Berar et al, 2019 ; de Jong et al, 2019 ; Kintz et al, 2019 ). However, such discriminative analyses were in most cases carried out with all the necessary reference standards available.…”

“…Thus, even in the absence of the powder, sd-GC-FTIR analysis of biological samples would have been sufficient to clarify the existence of a specific MeO-PCP positional isomer. Compared to the application of single GC, LC, and MS techniques for the discrimination of MMC and MeO-PCP analogs in non-biological drug samples, which can be problematic due to their quite similar chromatographic and, especially, mass spectrometric, behaviors ( Berar et al, 2019 ), the application of sd-GC-FTIR affords unambiguous identification of positional isomers.…”

“…4-MeO-PCP is less potent than 3-MeO-PCP, while 2-MeO-PCP is very weak ( Kalir, 1981 ; Wallach and Brandt, 2018 ), probably explaining why the latter is almost absent from the recreational market. Instead, the relatively large worldwide diffusion of the most potent 3-MeO-PCP represents the cause of many non-fatal and fatal intoxication cases ( Stevenson and Tuddenham, 2014 ; Bäckberg et al, 2015a ; Bakota et al, 2016 ; Bertol et al, 2017 ; Johansson et al, 2017 ; Mitchell-Mata et al, 2017 ; Zidkova et al, 2017 ; Ameline et al, 2019b ; Ameline et al, 2019c ; Berar et al, 2019 ; de Jong et al, 2019 ; Grossenbacher et al, 2019 ; Kintz et al, 2019 ).…”

“…The combined use of different techniques may be required to gather complementary data supporting the submitted case. In a very recent report on a fatal intoxication case, the simultaneous combination of nuclear magnetic resonance ( 1 H NMR), ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS), and GC-MS was deemed as necessary to discriminate the structural isomers of MeO-PCP in the biological specimens of the victim ( Berar et al, 2019 ).…”