Toxicological risk assessment of various emerging drugs
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0.6 per cent of the global adult population is a problem drug of abuse user. Yearly, there are more than a million of emergency department visits worldwide due drug-induced toxicity and 1 per cent of the deaths among adults are attributed to illicit drug use. There are many types of drugs available on the Dutch market which are prohibited but also new legal drugs appears on the market which are manufactured to circumvent the law: designer drugs. Several emerging (designer) drugs are entering the Dutch market but information about the drugs is lacking: mephedrone, 4-fluoroamphetamine (4-FA), 4-methylethcathinone (4-MEC), para-methoxy-N-methylamphetamine (PMMA), methoxetamine, 4-bromo-2,5-dimethoxyphenethylamine (2C-B) and 25I-NBOMe. These drugs of abuse belong to the group of hallucinogenic drugs or stimulant drugs. We gathered information about these emerging drugs which is necessary to perform a toxicological risk assessment. Each drug has a specific profile of desired and adverse effects, although both stimulant and hallucinogenic drugs also have many similarities. The effect of the drugs depends on various factors: appearances of the drug, route of administration, dosage, multiple drug use and sensitivity (tolerance). For each drug these factors differ per person which can lead to different desired/adverse effects. For some drugs it was difficult to gather sufficient information but we can conclude that not all drugs are equally toxic and lethal. The designer drugs are labeled as not for human consumption but the drugs are taken in recreational settings and intoxications occur when taken in excess. Especially for mephedrone, PMMA and 25I-NBOMe which has a high potency to induce toxicity, especially in the presence of other psychoactive drug. The adverse side effects have been associated with many hospitalizations and fatalities worldwide, compared with other emerging drugs. In the Netherlands mephedrone, 2C-B and PMMA are illegal but 25I-NBOMe, 4-MEC, 4-FA and methoxetamine have a legal status. However, no guidelines are available after purchasing the drug so there is no data available about the appropriate dose.