Management overview for novel stimulant drug poisoning
Novel stimulant drugs are designed to mimic established recreational stimulant drugs, such as metamfetamine (methamphetamine). These drugs are accessible over the internet and ‘darknet’1. They are typically sold as powders or pills to be snorted or ingested, but can also be injected or smoked.
Novel stimulant drugs increase synaptic concentration of dopamine, serotonin and noradrenaline to varying extents, and the ratios produce the desired effects.
Cathinones are the most common of the novel stimulant drugs. They are a heterogeneous group of ketonated amfetamines with higher toxic potential than established amfetamines. Examples of cathinones and their common street names are:
- mephedrone (4-methylmethcathinone)—‘MCAT’, ‘miaow-miaow’
- alpha-pyrrolidinovalerophenone (alpha-PVP)—‘flakka’
- methylenedioxypyrovalerone (MDPV)—‘ivory wave’
- methylone (methylenedioxymethcathinone)—‘bubbles’.
‘Bath salts’ is a general street name for a cathinone drug, typically mephedrone, MDPV or methylone. Alpha-PVP and MDPV are responsible for most of the poisonings.
Management of novel stimulant drug poisoning is supportive care, aiming to prevent the serious complications of serotonergic toxidrome and sympathomimetic toxidrome. Complicating factors in treatment include the diverse and nonspecific symptoms of acute intoxication, frequent ingestion of multiple recreational drugs, and the drug(s) taken often not being what they were purported to be.