To the Editor—Synthetic cathinones constitute a class of new psychoactive substances that are derivatives of cathinone, a naturally occurring compound in the khat plant with stimulant properties.1 Historically, our laboratory has encountered a limited number of synthetic cathinone cases. From 2009 to 2017, we identified only seven instances.2 Subsequently, an additional six cases were recorded between 2018 and 2022 (unpublished data, 2022). However, in the first half of 2023 alone, we have identified eight additional cases, seven of which involved intoxication with N,N-dimethylpentylone.

Since its identification in toxicology samples in the United States in 2021, the abuse of N,N-dimethylpentylone has become increasingly prevalent.3 This substance has also been detected in New Zealand and Spain through on-site pill testing, analysis of seized materials, and wastewater-based epidemiological investigations.4 The use and abuse of synthetic cathinones can result in a sympathomimetic toxidrome characterised by agitation, tachycardia, hyperthermia, convulsions, rhabdomyolysis, cardiovascular collapse, and ventricular arrhythmias. N,N-dimethylpentylone has been identified in at least 18 post-mortem forensic toxicology cases.5

N,N-dimethylpentylone has been sold as 3,4-methylenedioxymethamphetamine (MDMA; commonly known as ecstasy). In our experience, co-ingestion of N,N-dimethylpentylone and MDMA is common. Considering the potential morbidity and mortality associated with N,N-dimethylpentylone, the medical profession must remain vigilant in monitoring and describing the toxicological profile of the compound. Importantly, traditional toxicology analyses are often unable to detect new psychoactive substances; specific detection methods are required. When clinicians encounter a suspicious clinical history or unfamiliar/unusually severe clinical toxidromes, they are encouraged to utilise the services provided by our laboratory, including target analyses by liquid chromatography–tandem mass spectrometry.

All authors had full access to the data, contributed to the study, approved the final version for publication, and take responsibility for its accuracy and integrity.

All authors have disclosed no conflicts of interest.

This letter received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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2. Tang MH, Hung LY, Lai CK, Ching CK, Mak TW. 9-year review of new psychoactive substance use in Hong Kong: a clinical laboratory perspective. HK J Emerg Med 2019;26:179-85. Crossref

3. Walton S, Fogarty M, Papsun D, Lamb M, Logan B, Krotulski A. N,N-dimethylpentylone—an emerging NPS stimulant of concern in the United States. Toxicol Analy et Clin 2022;34:S67-8. Crossref

4. Rousis N, Bade R, Romero-Sánchez I, et al. Festivals following the easing of COVID-19 restrictions: prevalence of new psychoactive substances and illicit drugs. Environ Int 2023;178:108075. Crossref

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