Karol Kula

Cathinones derivatives-related deaths as exemplified by two fatal cases involving methcathinone with 4-methylmethcathinone and 4-methylethcathinone

In association with sociocultural changes that have occurred in European and worldwide societies within the last decades, the consumption of amphetamine-related substances in order to achieve altered states of consciousness has become a popular practice. New stimulants with chemical structures similar to the amphetamine group – the cathinones – were synthesized in order to bypass legislation, which is constantly being updated. It can be assumed that despite their illegal status, cathinone-related compounds will continue to be the prevalent drugs of abuse for the foreseeable future. They are considered ‘new designer drugs’ or ‘legal highs’, sold as ‘bath salts’ or ‘plant food’ and labelled ‘not for human consumption’. Such compounds are often sold as ‘research chemicals’ by several on-line distributors; seen from the perspective of the most recent changes in the legislature, as possession of an increasing amount of new designer drugs is penalized, the term ‘legal high’ is going out of use. In view of the method and rate of producing new compounds, the term ‘research chemicals’ seems to be an apt description of newly emerging chemicals. Yet, following reports presented by the EuropeanMonitoring Centre for Drugs and Drug Addiction (EMCDDA), the authors are inclined to accept the term ‘novel psychoactive substances’ (NPSs). Cathinone is the principal active constituent of the khat plant (Catha edulis) responsible for the stimulant effects that have led khat to be known as a natural amphetamine. Synthetic cathinones are derivatives of this compound demonstrating both amphetamine-like properties and the ability to inhibit reuptake of serotonin, causing distinct psychotropic effects. In addition to the desired effects, such as increased energy, empathy, openness, and increased libido, cathinone usage triggers adverse effects, such as cardiac, psychiatric, and neurological symptoms. Searching for new sensations leads to creatingmixtures of various recreational substances; at a certain stage, the outcome becomes unpredictable and may finally lead to death. The emergence of new substances on the worldwide market has led to the emergence of novel research fields, including analytical, clinical, and medico-legal studies that favour compilation of systemic databases. In the face of the thus formulated problem, in the present paper the authors discuss complex intoxication with substances belonging to the cathinone group as exemplified by two fatalities represented by 4-methylmethcathinone (mephedrone, 4-MMC) with

Medicolegal aspects of PMA-related deaths.

Unlike amphetamine, amphetamine-like substances accessible on the drug market are less expensive and more easily available; they also produce hallucinogenic effects expected by the users. Such properties render them more attractive as compared to amphetamine. On the other hand, the knowledge of the toxicity of these compounds is very limited, what in consequence generates problems that create ever-expanding research areas, including analytical, clinical and medicolegal issues, thus leading to development of systemic databases. An example here is paramethoxyamphetamine (PMA), which appeared on the drug market in recent years as a result of creative inventiveness of producers of psychoactive substances, who aimed at PMA replacing the popular ecstasy (MDMA) as a less expensive and more available product. It is more potent than MDMA, but has a slower onset of action, which encourages users to take more. The problem is illustrated in the present paper by three fatal cases involving PMA, which were comprehensively investigated taking into consideration case histories, pathological and toxicological findings obtained with the use of LC-MS-MS method. In blood samples taken from all the three victims, very high concentrations of PMA were found (in the range of 10-27mg/L) and thus the cause of deaths was determined as overdoses of PMA with the underlying mechanism of acute cardiorespiratory failure.