A 6-year review of new psychoactive substances at the Centre antipoison Grand-Ouest d'Angers: Clinical and biological data (2017)

For the last 10 years, recreational use of new psychoactive substances (NPS) with hallucinogenic properties was more and more described either in a context of consumption during a rave-party or at home alone or in small group. A review of 62 cases (56 M, 6 F, 16-46 y) registered from 2011 to 2016 at the French Grand Ouest centre antipoison of Angers is presented. Some of them (n = 15) presented a severe clinical state (poison severity score, PSS = 3) and only one was a fatal intoxication (PSS = 4). Treatment of acute intoxication was mainly based on supportive care with a quick recovery in less than 48 h. A high number of these cases were documented by plasma (pl) and/or urine analyses using LC-UV, GC-MS and LC-MS². Several powders or other forms bought on the web market by the patients were also analysed. Six amphetamines derivates were detected such as methiopropamine (pl: 50 - 430 µg/L, n = 6) or 5 others (6-APB, 6-APDB, 5-EAPB, 5-MAPB, 2-FA each once). Four 2,5-dimethoxy-derivates of phenylethylamines (2Cs) or of amphetamines (DOs) were detected as 2C-P (pl: < 10-20 µg/L, n = 5), 2C-T-4 (88 µg/L) or 2C-E (only in one urine) and DOC (n = 5, pl: < 10-18 µg/L). In 24 cases, 12 different cathinones were observed in plasma samples (n = 8) as MDPV (pl: 10-40 µg/L, n = 4), 3-MMC (pl: 7-300 µg/L, n = 6), 4-MEC (pl: 240 - 890 µg/L, n = 3), mexedrone (pl: 100 and 180 µg/L) and methylone (3130 µg/L in a peripheral post-mortem blood). Others cathinones (4-MMC, µ-PVP, 4-chloro-alpha-PVP, bk-2C-B, MDPP, MPHP, pentedrone) were essentially observed in urine or in powders. Two tryptamine analogs were found as AMT (pl: 440 µg/L in one plasma sample) and 5-MeO-DALT (n = 5). The 3 ketamine-like compounds (n = 17) detected in plasma were methoxetamine (pl: 8.6-360 µg/L, n = 12), methoxphenidine (pl: 254-590 µg/L, n = 3) and diphenidine (pl: 20 µg/L, n = 1). Five other miscelleanous drugs were found in 11 cases and 9 different synthetic cannabinoids (AB-CHMINACA, AB-FUBINACA, AKB48, 5F-AKB48, 5FUB-AKB48, 5F-PB22, AM1220, MDMB-CHMICA, UR-144) were found in 7 different patients. For the same period, illicit amphetamines constituted 52 cases with amphetamine or ecstasy intake sometimes combined with NPS. These data were presented to show the increasing use of wide-range NPS in a French region and to provide quantitative data in clinical situations besides the large information on the post-mortem cases available in the literature.