A non-fatal intoxication and seven deaths involving the dissociative drug 3-MeO-PCP.
BACKGROUND
3-methoxyphencyclidine (3-MeO-PCP) appeared on the illicit drug market in 2011 and is an analogue of phencyclidine, which exhibits anesthetic, analgesic and hallucinogenic properties. In this paper, we report data from a non-fatal intoxication and seven deaths involving 3-MeO-PCP in Sweden during the period March 2014 until June 2016.


METHODS
The non-fatal intoxication case, a 19-year-old male with drug problems and a medical history of depression, was found awake but tachycardic, hypertensive, tachypnoeic and catatonic at home. After being hospitalized, his condition worsened as he developed a fever and lactic acidosis concomitant with psychomotor agitation and hallucinations. After 22h of intensive care, the patient had made a complete recovery. During his hospitalization, a total of four blood samples were collected at different time points. The seven autopsy cases, six males and one female, were all in their twenties to thirties with psychiatric problems and/or an ongoing drug abuse.


METHODS
3-MeO-PCP was identified with liquid chromatography (LC)/time-of-flight technology and quantified using LC-tandem mass spectrometry.


RESULTS
In the clinical case, the concentration of 3-MeO-PCP was 0.14μg/g at admission, 0.08μg/g 2.5h after admission, 0.06μg/g 5h after admission and 0.04μg/g 17h after admission. The half-life of 3-MeO-PCP was estimated to 11h. In the autopsy cases, femoral blood concentrations ranged from 0.05μg/g to 0.38μg/g. 3-MeO-PCP was the sole finding in the case with the highest concentration and the cause of death was established as intoxication with 3-MeO-PCP. In the remaining six autopsy cases, other medications and drugs of abuse were present as well.


CONCLUSIONS
Despite being scheduled in January 2015, 3-MeO-PCP continues to be abused in Sweden. Exposure to 3-MeO-PCP may cause severe adverse events and even death, especially if the user does not receive life-supporting treatment.
Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden. Electronic address: anna.johansson@rmv.se.
Anna
A
Johansson
Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
Daniel
D
Lindstedt
Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
Markus
M
Roman
Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
Gunilla
G
Thelander
Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden.
Elisabet I
EI
Nielsen
Department of Surgical Sciences/Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden.
Ulrica
U
Lennborn
Department of Forensic Medicine, National Board of Forensic Medicine, Uppsala, Sweden; Department of Surgical Sciences/Forensic Medicine, Uppsala University, Uppsala, Sweden.
Håkan
H
Sandler
Department of Surgical Sciences/Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden.
Sten
S
Rubertsson
Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden; Department of Medical and Health Sciences, Division of Drug Research, Linköping University, Linköping, Sweden.
Johan
J
Ahlner
Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden; Department of Medical and Health Sciences, Division of Drug Research, Linköping University, Linköping, Sweden.
Robert
R
Kronstrand
Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden; Department of Medical and Health Sciences, Division of Drug Research, Linköping University, Linköping, Sweden.
Fredrik C
FC
Kugelberg
D000328:Adult; D017109:Akathisia, Drug-Induced; D002389:Catatonia / Q000139:chemically induced; D002853:Chromatography, Liquid; D015198:Designer Drugs / Q000009:adverse effects* / Q000032:analysis / Q000506:poisoning*; D005260:Female; D006207:Half-Life; D006213:Hallucinogens / Q000009:adverse effects* / Q000032:analysis / Q000506:poisoning*; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D008297:Male; D010622:Phencyclidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000032:analysis / Q000506:poisoning; D019966:Substance-Related Disorders / Q000175:diagnosis; D013610:Tachycardia / Q000139:chemically induced; D059246:Tachypnea / Q000139:chemically induced; D053719:Tandem Mass Spectrometry; D055815:Young Adult
D015198:Designer Drugs; D006213:Hallucinogens; C578785:methoxydine; D010622:Phencyclidine
3-MeO-PCP; Dissociative drugs; Intoxication; Phencyclidine; Postmortem blood concentrations