title: Simultaneous detection of multiple designer drugs in serum, urine, and CSF in a patient with prolonged psychosis.
abstract: This case report is considered exempt from University of California-San Diego Investigational Review Board.
  
  
  BACKGROUND
  There is a limited published experience detailing detection and toxicity of multiple novel psychoactive substances. We report a case of a patient with prolonged psychosis who had JWH-072, cannabicyclohexanol, 3',4'-methylenedioxy-α-pyrrolidinopropiophenone (MDPPP) and methylenedioxyamphetamine (MDA) identified in multiple biological samples.
  
  
  METHODS
  An 18-year-old man presented to the emergency department (ED) with acute onset psychosis after allegedly smoking "spice." Due to agitation and psychosis refractory to multiple medications, a lumbar puncture was performed and he was admitted. All blood, urine, and CSF (cerebral spinal fluid) testing was normal. He remained psychotic for almost 1 week. MDPPP, JWH-072 and MDA were detected in initial blood, urine, and CSF samples. Cannabicyclohexanol was detected only in his serum.
  
  
  CONCLUSIONS
  JWH-072 is a cannabinoid-2 receptor (CB-2) agonist which has not been reported previously in the literature. Its clinical effects are unknown. Cannabicyclohexanol is a known component of "spice" products and has been associated with agitation and psychosis. MDPPP and MDA are designer phenylethylamines likely to cause agitation and sympathomimetic symptoms. Simultaneous detection of novel psychoactive substances in multiple biological fluids has not been previously reported. This case suggests that the interaction of these particular substances may be associated with prolonged psychosis.
authors.affiliation: Department of Emergency Medicine, University of Kansas Hospital, Kansas City, KS, USA. stephenthorntonmd@yahoo.com
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Thornton
authors.forename: Jean
authors.initials: J
authors.lastname: Lo
authors.forename: Richard F
authors.initials: RF
authors.lastname: Clark
authors.forename: Alan H B
authors.initials: AH
authors.lastname: Wu
authors.forename: Roy R
authors.initials: RR
authors.lastname: Gerona
mesh_terms: D000293:Adolescent; D002186:Cannabinoids / Q000378:metabolism* / Q000506:poisoning; D003511:Cyclohexanols / Q000378:metabolism / Q000506:poisoning; D015198:Designer Drugs / Q000378:metabolism* / Q000506:poisoning; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000378:metabolism* / Q000506:poisoning; D010636:Phenols / Q000378:metabolism / Q000506:poisoning; D010880:Piperidines / Q000378:metabolism* / Q000506:poisoning; D011605:Psychoses, Substance-Induced / Q000209:etiology / Q000378:metabolism*; D015813:Substance Abuse Detection / Q000379:methods*
chemical_list: C572491:3-(2-hydroxy-4-(2-methylnonan-2-yl)phenyl)cyclohexan-1-ol; D002186:Cannabinoids; D003511:Cyclohexanols; D015198:Designer Drugs; D010636:Phenols; D010880:Piperidines; C067455:2-methyl-1,1-diphenyl-3-(1-piperidinyl)-1-propanol; D018817:N-Methyl-3,4-methylenedioxyamphetamine