Hong Kong Med J 2023 Dec;29(6):563 | Epub 9 Nov 2023
© Hong Kong Academy of Medicine. CC BY-NC-ND 4.0
LETTER TO THE EDITOR
A concerning trend of synthetic cathinone abuse in Hong Kong
HS Leung, MB, BS1,2; Magdalene HY Tang, PhD1,2; HF Tong, FHKCPath, FHKAM (Pathology)1,2; YK Chong, FHKCPath, FHKAM (Pathology)1,2
1 Hospital Authority Toxicology Reference Laboratory, Hong Kong SAR, China
2 Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Hong Kong SAR, China
Corresponding author: Dr YK Chong (cyk280a@ha.org.hk)
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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2022 (unpublished data, 2022).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.
Author contributions
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.
Conflicts of interest
All authors have disclosed no conflicts of interest.
Funding/support
This letter received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References
1. Paillet-Loilier M, Cesbron A, Le Boisselier R, Bourgine J,
Debruyne D. Emerging drugs of abuse: current perspectives
on substituted cathinones. Subst Abuse Rehabil 2014;5:37-52. Crossref
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
5. Fogarty MF, Krotulski AJ, Papsun DM, et al. N,N-dimethylpentylone (dipentylone)—a new synthetic cathinone identified in a postmortem forensic toxicology
case series. J Anal Toxicol 2023;47:753-61. Crossref