title: Seven fatalities associated with ethylphenidate.
abstract: Ethylphenidate is a stimulant novel psychoactive substance that is an analogue of the prescription drug methylphenidate (Ritalin(®)). Methylphenidate is used commonly for the treatment of attention deficit hyperactivity disorder. Due to its stimulant effects ethylphenidate is being abused. There is a single case report of a death associated with ethylphenidate in Germany, and a case series of 19 deaths in the East of Scotland, but otherwise, the contribution of ethylphenidate to death is poorly documented. We report the analytical results of 7 cases (between February 2013 and January 2015) in which ethylphenidate was detected and quantitated with a validated liquid chromatography tandem mass spectrometry method (LC-MS/MS). The individuals (all male) ranged in age from 23 to 49 years (median 25 years). The concentration of ethylphenidate in the cases ranged from 0.026mg/L to 2.18mg/L in unpreserved post-mortem femoral blood. Only one case had ethylphenidate present as a sole drug. All other cases had at least 2 other drug classes present (benzodiazepines, heroin, methadone antipsychotics, other new psychoactive compounds). Ethylphenidate toxicity was the sole contribution to the cause of death in one case. Hanging was the cause of death in 2 cases, with the other 4 cases being reported as having occurred due to mixed drug toxicity. These data will further help with the interpretation of post-mortem ethylphenidate levels.
authors.affiliation: Department of Chemical and Forensic Sciences, School of Applied Sciences. University of Huddersfield, Huddersfield, HD1 3DH, UK. Electronic address: p.dmaskell@hud.ac.uk.
authors.forename: P D
authors.initials: PD
authors.lastname: Maskell
authors.affiliation: Forensic Toxicology Unit, Department of Clinical Chemistry and Metabolic Medicine, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, LE1 5WW, UK.
authors.forename: P R
authors.initials: PR
authors.lastname: Smith
authors.affiliation: Forensic Toxicology Unit, Department of Clinical Chemistry and Metabolic Medicine, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, LE1 5WW, UK.
authors.forename: R
authors.initials: R
authors.lastname: Cole
authors.affiliation: Forensic Toxicology Unit, Department of Clinical Chemistry and Metabolic Medicine, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, LE1 5WW, UK.
authors.forename: L
authors.initials: L
authors.lastname: Hikin
authors.affiliation: Forensic Toxicology Unit, Department of Clinical Chemistry and Metabolic Medicine, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, LE1 5WW, UK.
authors.forename: S R
authors.initials: SR
authors.lastname: Morley
mesh_terms: D000328:Adult; D000697:Central Nervous System Stimulants / Q000506:poisoning*; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D049429:Forensic Pathology; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000031:analogs & derivatives* / Q000506:poisoning; D011041:Poisoning / Q000175:diagnosis; D011180:Postmortem Changes; D055815:Young Adult
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate; C042400:ethylphenidate
keywords: Case study; Ethylphenidate; Methylphenidate; Poisoning; Post-mortem