SOFT 2004 Meeting Abstracts - Society of Forensic Toxicologists

C7
METHCATHINONE: A NEW POSTINDUSTRIAL DRUG
H.Belhadj-Tahar 1 ' ,N.Sadeg 2
1. Groupe Sante Recherche Toulouse, 35 rue Bernard de Ventadour, 31300 Toulouse, France.
2. Laboratoire Claude Bernard, Centre Hospitaiier Rene Dubois, 95303 Pantoise, France.
Methcathinone is an illicit drug also known as ephedrone, which is a methyl derivative of cathinone, a
stimulant found in the « khat» plant, Catha edulis, and which can be easily manufactured by oxidation
from pseudoephedrine. Target consumers of this drug seem to be well-educated people aware of the risks
and precautionary measures 1 • Therefore, it is difficult to diagnose and to cure properly and it becomes even
more complicated as there are misleading symptoms related to intoxication by cathinone derivatives of
synthetic or natural (derived from the khat) origin. Thus far, reports of methcathinone intoxication
documented and based on reliable analyses are rare since it is not systematically detected. This paper
describes a case of reiterated coma due to an overdose of pure methcathinone dissolved in alcohol and
mixed with bromazepam.
Case report: At 10 pm, a 29-year-old woman was admitted in emergency department from Paris suburbs
for a coma of toxic origin. Medical history showed that it is the second episode occurring under similar
circumstances and at one month interval. In both cases, the patient took Lexomil® dissolved in alcohol.
Besides, the family indicated that the patient presented signs of depression, incoherent behavior. She is an
amphetamine-like drug consumer. Clinical examination revealed a Glasgow coma score 9 and symmetrical
reactive pupils with mydriasis. The patient presented a polypnoea. Her blood pressure was 93/53mmHg.
The rest ofthe examination was unremarkable.
Biological check-up: the ionogram and the blood gas analyses were normal, the blood alcohol level was
1.67 gIL. Urinalysis revealed benzodiazepines, pH 5.4, along with a high concentration of amphetamines
dosed by FPIA (Axsym, Abbott - USA) and identified by HPLC (Remedi, Biorad USA) as follows:
methcathinone (17.24 mglL), ephedrine (11.60 mglL) and methylephedrine (1 LIO mglL). Serum analysis
by HPLC revealed concentrations of bromazepan (8.89 mglL), methcathinone (0.50 mgIL) and
methylephedrine (0.19 mgIL). The patient was kept in quiet room: the hemodynamic and neurological
functions evolved quite favourably in the next hours.
Discussion: This case illustrates a coma mainly due to a combined bromazepam and methcathinone
intentional intoxication. This coma is not only ascribable to bromazepam and ethanol. Indeed, on one hand,
the blood alcohol level at 1.67 gil, the absence of anionic and basic deficit related to an acetate outbreak
eliminates the hypothesis of ethylic coma and, on the other hand, the paradoxical presence of polypnoea
instead of respiratory distress eliminates the hypothesis of a coma due to benzodiazepine overdose.
Therefore, we can affirm that cathinone altered typical clinical symptoms of bromazepamlalcohol
intoxication, namely hypotension and respiratory distress. Methylephedrine detection at infratoxic doses
could be a chemical precursor resulting from the alkylation of primary amine for monomethylamine
(pseudoephedrine) and dimethylamine (methyl ephedrine) synthesis (Belhadj-Tahar H. et al. Therapie,
2003,59: 265-271). It seems to be chemical tag of a fraudulent origin.
Conclusion: This case describes an example of a new addictive behaviour of "well educated" people
involving the intake of methcathinone, a postindustrial psychostimulant intentionally combined with anticonvulsant
benzodiazepine.
Keywords: methcathinone, ephedrone, illicit drug
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