Abuse of 3-MMC and forensic aspects: About 4 cases and review of the literature (2019)

In recent years, the recreational use of new psychoactive substances (NPS) has increased all around the world. They are designed to cause similar effects to controlled drugs and are considered as alternative to illegal drugs. Among NPS, derivatives of cathinone, one of the psychoactive ingredients of the plant khat, have emerged in the recreational drug market. 3-methylmethcathinone or 3-MMC is a structural isomer of mephedrone (4-MMC) and a psychostimulant and hallucinogenic drug. Furthermore, to get intense recreational effect, 3-MMC can often be combined with other drugs, by chemsex practitioners. Users report a soft feeling of energy and increased concentration, as well as a feeling of well-being, euphoria and unbridled libido. There is a risk of significant psychological dependence after repetitive 3-MMC exposures. Very limited data about clinical, psychological and forensic aspects of 3-MMC abuse are available in the medical literature. The authors report 4 cases of subjects abusing 3-MMC and other drugs, involving two intoxications and two deaths. Biological samples were analysed by ultra-high performance liquid chromatography system coupled to a tandem mass spectrometry (UPLC-MS/MS™). 3-MMC was detected in concentrations ranging from 3 to 613 ng/mL in blood, and from 14 pg/mg to 17.1 ng/mg in hair. In view of these values, and those from the very limited literature, it is difficult to establish an impairment concentration or a lethal threshold of 3-MMC.