Abstract
Rationale
Current prevalence estimates of synthetic cathinone (“bath salt”) use may be underestimates given that traditional metrics (e.g., surveys, urinalysis) often fail to capture the emergent issue of synthetic cathinone adulteration of more common illegal drugs, such as ecstasy (3,4-methylenedioxymethamphetamine).
Objectives
This review examines the evolution of synthetic cathinones and prevalence of use over the past decade in the United States. We also review methods of self-report and biological testing of these compounds as well as adverse outcomes associated with adulterated drug use.
Results
Synthetic cathinone use emerged in the United States by 2009 with use associated with tens of thousands of poisonings. Reported poisonings and self-reported use have substantially decreased over the past five years. However, our review suggests that current estimates of use are underestimates due to underreporting stemming primarily from unknown or unintentional use of adulterated formulations of relatively popular illegal drugs, such as ecstasy.
Conclusions
While intentional synthetic cathinone use has decreased in recent years, evidence suggests that prevalence of use is underestimated. Testing of drugs and/or biological specimens can improve the accuracy of synthetic cathinone use estimates. Furthermore, we advocate that researchers and clinicians should become better aware that exposure to these potent compounds (e.g., as adulterants) often occurs unknowingly or unintentionally. To improve our understanding of synthetic cathinone adulteration, research utilizing a combinatorial approach (survey and biological testing) will help more accurately estimate the prevalence and impact of this public health issue.
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Abbreviations
- α-PVP:
-
α-pyrrolidinopentiophenone
- 4-MMC:
-
4-methylmethcathinone
- 5-HT:
-
serotonin
- AAPCC:
-
American Association of Poison Control Centers
- DA:
-
dopamine
- DEA:
-
Drug Enforcement Administration
- ED:
-
emergency department
- EDM:
-
electronic dance music
- MDMA:
-
3,4-methylenedioxymethamphetamine
- MDMC:
-
3,4-methylenedioxymethcathinone
- MDPV:
-
3,4-methylenedioxypyrovalerone
- NA:
-
noradrenaline
- NFLIS:
-
The National Forensic Laboratory Information System
- NPS:
-
new psychoactive substance
- PCP:
-
phencyclidine
- UHPLC-HRMS:
-
ultra high-performance-tandem mass spectrometry-high-resolution mass spectrometry
- UHPLC-MS/MS:
-
ultra high-performance liquid chromatography-tandem mass spectrometry
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Acknowledgements
SMR was supported by the National Institutes of Health, National Institute on Drug Abuse (R01 DA039139). JJP was supported by the National Institutes of Health, National Institute on Drug Abuse (K01 DA038800). SJS was supported by institutional training fellowships (T32 DA007237, T32 NS007413). HLPK was supported by institutional training fellowship (T32 DA007237). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Oliver, C.F., Palamar, J.J., Salomone, A. et al. Synthetic cathinone adulteration of illegal drugs. Psychopharmacology 236, 869–879 (2019). https://doi.org/10.1007/s00213-018-5066-6
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DOI: https://doi.org/10.1007/s00213-018-5066-6