title: Ethylphenidate: availability, patterns of use, and acute effects of this novel psychoactive substance.
abstract: OBJECTIVE
  Ethylphenidate is a novel psychoactive substance that is an analogue of methylphenidate. This paper describes its availability, patterns of use, and acute effects.
  
  
  METHODS
  Searches of the scientific and grey literature (publicly accessible Internet resources) were undertaken, using the keywords "Ethylphenidate", "Ethyl phenidate", "Ethyl phenyl(piperidin-2-yl)acetate", and "Nopaine", to identify information on the prevalence and patterns of use, desired effects, and toxicity of ethylphenidate. An Internet snapshot survey was performed on 10 February 2015 to provide information on availability and cost of ethylphenidate.
  
  
  RESULTS
  The literature search identified 1 case series of acute recreational ethylphenidate toxicity, 1 case report of ethylphenidate dependence, 1 qualitative analysis of user reports on Internet drug forums, 2 conference abstracts for surveillance studies, 1 report of two cases of ethylphenidate detected in post-mortem analyses, and 198 user reports on Internet discussion forums and social media sites. The Internet snapshot survey found 83 websites selling ethylphenidate, with purchase prices ranging from £28.20 ± 0.63 (€37.71 ± 0.85) per gram for a 500-mg amount to £2.64 ± 0.57 (€3.53 ± 0.77) per gram for 1 kg. The published cases and Internet user reports suggest the acute effects of ethylphenidate are similar to other stimulant drugs; the most common route of use was by nasal insufflation. The most common desired effects were euphoria, stimulation, and increased concentration, sociability, and energy levels; the most common unwanted effects included anxiety, palpitations, insomnia, and paranoia.
  
  
  CONCLUSIONS
  This review of the scientific and grey literature has demonstrated that the acute harms associated with its use are stimulant in nature and that ethylphenidate is widely available to users over the Internet, with significant discounts for bulk purchases.
authors.affiliation: Clinical Toxicology, St. Thomas̕ Hospital, 3rd Floor, Block C, South Wing, Westminster Bridge Road, London, SE1 7EH, UK.|Emergency Department, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.
authors.forename: James H
authors.initials: JH
authors.lastname: Ho
authors.affiliation: Clinical Toxicology, St. Thomas̕ Hospital, 3rd Floor, Block C, South Wing, Westminster Bridge Road, London, SE1 7EH, UK.|Emergency Department, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.
authors.forename: George P
authors.initials: GP
authors.lastname: Bailey
authors.affiliation: Clinical Toxicology, St. Thomas̕ Hospital, 3rd Floor, Block C, South Wing, Westminster Bridge Road, London, SE1 7EH, UK.
authors.forename: John R H
authors.initials: JR
authors.lastname: Archer
authors.affiliation: Clinical Toxicology, St. Thomas̕ Hospital, 3rd Floor, Block C, South Wing, Westminster Bridge Road, London, SE1 7EH, UK.|King's College London, London, UK.
authors.forename: Paul I
authors.initials: PI
authors.lastname: Dargan
authors.affiliation: Clinical Toxicology, St. Thomas̕ Hospital, 3rd Floor, Block C, South Wing, Westminster Bridge Road, London, SE1 7EH, UK. david.wood@gstt.nhs.uk.|King's College London, London, UK. david.wood@gstt.nhs.uk.
authors.forename: David M
authors.initials: DM
authors.lastname: Wood
mesh_terms: D000697:Central Nervous System Stimulants / Q000191:economics / Q000494:pharmacology* / Q000600:supply & distribution; D004333:Drug Administration Routes; D006801:Humans; D013287:Illicit Drugs / Q000191:economics / Q000494:pharmacology* / Q000600:supply & distribution; D020407:Internet; D008774:Methylphenidate / Q000031:analogs & derivatives* / Q000191:economics / Q000494:pharmacology / Q000600:supply & distribution; D015995:Prevalence
chemical_list: D000697:Central Nervous System Stimulants; D013287:Illicit Drugs; D008774:Methylphenidate; C042400:ethylphenidate
keywords: Ethylphenidate; Novel psychoactive substance; Recreational drug; Toxicity