title: [MT-45--a dangerous and potentially ototoxic internet drug].
abstract: During the last years several synthetic opioids have been introduced on Internet sites selling new psychoactive substances (NPS). One of these, called MT-45, a piperazine derivative originally synthesized as a therapeutic drug candidate in the 1970s, has recently been detected in 21 deaths, according to unpublished data from the Swedish National Board of Forensic Medicine. We present clinical data from 12 analytically confirmed hospital cases of MT-45 poisoning. The cases demonstrate that MT-45, like other opioids, can induce potentially life threatening respiratory depression and loss of consciousness in users and that symptoms are usually reversed by standard doses of the opioid receptor antagonist naloxone. Significant auditory symptoms with transient tinnitus and hearing loss occurred in two cases and a pronounced sensorineural hearing loss still present at two weeks follow-up in one case. This indicates that MT-45 may be an ototoxic substance, illustrating the ubiquitous risk of unintended adverse effects NPSs pose to users.
authors.affiliation: Läkemedelsverket - Giftinformationscentralen Stockholm, Sweden Läkemedelsverket - Giftinformationscentralen Stockholm, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Lindeman
authors.affiliation: Läkemedelsverket - Giftinformationscentralen Stockholm, Sweden Läkemedelsverket - Giftinformationscentralen Stockholm, Sweden.
authors.forename: Matilda
authors.initials: M
authors.lastname: Bäckberg
authors.affiliation: - Stockholm, Sweden - Stockholm, Sweden.
authors.forename: Mark
authors.initials: M
authors.lastname: Personne
authors.affiliation: Karolinska Institutet - Labmed Stockholm, Sweden Karolinska Institutet - Labmed Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Helander
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000506:poisoning*; D015198:Designer Drugs / Q000506:poisoning*; D006319:Hearing Loss, Sensorineural / Q000139:chemically induced*; D006801:Humans; D013287:Illicit Drugs / Q000506:poisoning; D020407:Internet; D008297:Male; D009270:Naloxone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D010879:Piperazines / Q000506:poisoning*; D011039:Poison Control Centers / Q000706:statistics & numerical data; D011619:Psychotropic Drugs / Q000506:poisoning*; D012131:Respiratory Insufficiency / Q000139:chemically induced; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D015198:Designer Drugs; D013287:Illicit Drugs; D009292:Narcotic Antagonists; D010879:Piperazines; D011619:Psychotropic Drugs; D009270:Naloxone