Synthetic cathinone poisoning from ingestion of drug-laced “instant coffee packets” in Taiwan

Abstract

Background: Synthetic cathinone abuse is a global health issue. Synthetic cathinones emerged in Taiwan in 2009, and their prevalence rapidly rose. They are usually made into “instant coffee packets,” and these so-called “toxic coffee packets” may also contain psychoactive drugs other than synthetic cathinones. Due to the diversity of the ingredients, clinical presentations can be complex. Methods: Retrospective analysis of emergency department (ED) patients who reported ingesting toxic coffee packets at three Chang-Gung Memorial Hospitals located in northern Taiwan between January, 2015 and December, 2019. Results: Sixty patients were included. Their mean age was 28.85 ± 9.24 years and 47(78.33%) were male. The most common presentations were palpitation, agitation, hallucination, and altered consciousness. Tachycardia and hypertension were common, while hyperthermia was observed in only three patients. Three patients (5%) developed rhabdomyolysis, and one underwent transient hemodialysis. Most patients were discharged from the ED, but 15(25%) were admitted, of whom nine (15%) were admitted to the intensive care unit (ICU), and one eventually died. Confirmation tests (mass-spectrometry-based analysis) were available in 10 patients; all reported positive for at least one type of synthetic cathinone. Polysubstance exposure was common. In multivariate logistic regression analyses, Glasgow coma scale ≤13 and the presence of seizure were associated with ICU admission. Conclusion: Patients who report ingesting toxic coffee packets are very likely to have been exposed to synthetic cathinones. Polysubstance exposure is common following ingestion. Cardiovascular and neurological symptoms are the main presentations, and severe complications such as rhabdomyolysis and life-threatening dysrhythmia can occur.

The Clinical Presentations of Nitrous Oxide Users in an Emergency Department

“…Five of the 16 (31.2%) concomitant illicit drug users were polydrug use (more than three kinds). Toxic coffee packets are a popular form of synthetic cathinones consumed in Taiwan [ 23 ]. Due to the polydrug effect, these patients had diverse clinical presentations.…”

Quantitative determination and metabolic profiling of synthetic cathinone eutylone in vitro and in urine samples by liquid chromatography tandem quadrupole time‐of‐flight mass spectrometry

“…This work introduces a quantitative method for eutylone determination that can be applied to the analysis of urine samples from suspected eutylone abusers. Because instant coffee packets are mingled with poly-drugs widely abused in Taiwan, 5 This work provides forensic scientists with descriptions of method development, in vitro metabolism experiments, possible metabolic profile and potential eutylone biomarkers. However, synthetic reference materials of the metabolites still need to be obtained and phase II metabolites need to be generated to find additional biomarkers.…”

“…This work introduces a quantitative method for eutylone determination that can be applied to the analysis of urine samples from suspected eutylone abusers. Because instant coffee packets are mingled with poly‐drugs widely abused in Taiwan, 5 authentic samples have been observed to contain multiple drugs, indicating the complexity and difficulty of identifying the drugs actually used. In order to confirm eutylone consumption, eutylone metabolites were herein identified and selected as suitable biomarkers.…”

“…The NPS for which the highest cumulative amounts were detected were, in order, mephedrone [2‐methylamino‐1‐(4‐methylphenyl)propan‐1‐one], 4‐methyl‐ N , N ‐dimethylcathinone [2‐(dimethylamine)‐1‐(4‐methylphenyl)propan‐1‐one] and eutylone [1‐(1,3‐benzodioxol‐5‐yl)‐2‐(ethylamino)butan‐1‐one]. Synthetic cathinones were systematically detected in instant coffee packets mingled with phenethylamines and other NPS, and their rapid growth and development pose serious threats in Taiwan 5 …”

“…4 The NPS for which the highest cumulative amounts were detected were, in systematically detected in instant coffee packets mingled with phenethylamines and other NPS, and their rapid growth and development pose serious threats in Taiwan. 5 The analysis of emerging NPS is a key concern. In order to understand the pharmacokinetics and expand the detection window of drugs, the detection of both the parent drugs and its metabolites is important in drug urine testing.…”