title: Characteristics of analytically confirmed 3-MMC-related intoxications from the Swedish STRIDA project.
abstract: BACKGROUND
  3-Methylmethcathinone (3-MMC) is a synthetic cathinone stimulant structurally related to the new psychoactive substance (NPS) mephedrone (4-methylmethcathinone, 4-MMC). We describe a case series of analytically confirmed intoxications involving 3-MMC presented to emergency departments in Sweden and included in the STRIDA project.
  
  
  METHODS
  Observational case series of consecutive patients with self-reported or suspected use of NPS presenting to hospitals in Sweden between August 2012 and March 2014.
  
  
  METHODS
  NPS analysis was performed by a liquid chromatography-mass spectrometry (MS)/MS method that is updated with new substances as they appear. Data on clinical features were collected during Poisons Information Centre consultations and retrieved from medical records.
  
  
  RESULTS
  3-MMC was detected in 50 (6.4%) of the 786 cases included in the STRIDA project during the 20-month study period, with the peak occurring in August 2013. The age range of patients testing positive for 3-MMC was 17-49 years (median 24) and 76% of them were men. The 3-MMC concentration in serum ranged between 0.002 and 1.49 μg/mL (median, 0.091) and between 0.007 and 290 μg/mL (median, 3.05) in urine. Co-exposure to other NPS and/or traditional drugs was very common, and 3-MMC mono-intoxication was found in only 4 (8%) cases. The most frequent clinical features were tachycardia (48% of cases) and agitation (42%). Other features included a reduced level of consciousness (32%), dilated pupils (24%), hallucinations (20%), diaphoresis (12%), seizures (8%), and hyperthermia (6%). Most patients (60%) needed hospital care for only 1 day but in 8% for 3 days or longer.
  
  
  CONCLUSIONS
  The majority of patients with analytically confirmed 3-MMC exposure had sympathomimetic features similar to those associated with mephedrone intoxication. However, the high incidence of co-exposure to other drugs makes the clinical interpretation difficult. Nevertheless, 3-MMC was associated with a high admittance rate to intensive care (30%), and detected in two cases with a fatal outcome, suggesting that 3-MMC is a harmful drug.
authors.affiliation: Swedish Poisons Information Centre , Stockholm , Sweden.
authors.forename: Matilda
authors.initials: M
authors.lastname: Bäckberg
authors.forename: Erik
authors.initials: E
authors.lastname: Lindeman
authors.forename: Olof
authors.initials: O
authors.lastname: Beck
authors.forename: Anders
authors.initials: A
authors.lastname: Helander
mesh_terms: D000293:Adolescent; D000328:Adult; D000470:Alkaloids; D000697:Central Nervous System Stimulants; D002853:Chromatography, Liquid; D005260:Female; D006801:Humans; D013287:Illicit Drugs / Q000097:blood / Q000506:poisoning* / Q000652:urine; D008297:Male; D008694:Methamphetamine / Q000031:analogs & derivatives* / Q000097:blood / Q000506:poisoning / Q000652:urine; D008875:Middle Aged; D012189:Retrospective Studies; D015813:Substance Abuse Detection / Q000379:methods*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology; D013566:Sympathomimetics / Q000097:blood / Q000506:poisoning / Q000652:urine; D053719:Tandem Mass Spectrometry; D055815:Young Adult
chemical_list: D000470:Alkaloids; D000697:Central Nervous System Stimulants; D013287:Illicit Drugs; D013566:Sympathomimetics; D008694:Methamphetamine; C023665:cathinone; C000595610:3-methylmethcathinone; C548233:mephedrone
keywords: 2-Methylmethcathinone; 3-Methylmethcathinone; 4-Methylmethcathinone; Designer drugs; Internet drugs; Legal highs; Mass spectrometry methods; Mephedrone; New psychoactive substances; Phenethylamines; Synthetic cathinone derivatives