Acute psychiatric disorders related to fake cathinone: Ephylone

Objective To describe 5 cases of acute psychiatric disorders related to ephylone use that occurred during the period of February to July 2018. Case history Five male patients (median age: 36 years) were hospitalized at the University Hospital of Montpellier-Nimes for NPS intoxication. They presented similar symptoms, namely severe psychiatric disorders: delusional state, auditory hallucinations, paranoia, and dissociative effect. In some cases, these effects lasted several days. The evolution was favorable except for one patient (unknown evolution). They all have consumed in a chemsex context (sexual practices under the influence of psychoactive substance), psychoactive substances supposed to contain cathinones (mephedrone (3 cases), 3-methylmethcathinone (3-MMC, 1 case)) or methamphetamine (1 case). Methods Urinary and blood screening were realized (LC-MS/MS) and an analysis of the powder was carried out for all cases through the SINTES program (National Toxic Products and Substances Identification System) of the OFDT (French Monitoring Centre for Drugs and Drug Addiction). It allows the analysis of any substance that has caused unusual and/or undesirable effects, or any new, rare, or suspected particularly dangerous illicit substance. Results In all cases urinary screening were negative for these substances. In one case, urine screening was positive for cocaine and amphetamines but these substances were not detected in the blood, indicating a probable non-recent consumption. In all cases, the consumed substance was not the expected substance but ephylone (content: 47%, n = 1). Discussion Ephylone, a new psychoactive substance (NPS), has psychostimulant and hallucinogenic properties and acts by increasing the levels of dopamine, serotonin and norepinephrine through interaction with transporters and monoamine receptors. This substance belongs to the family of synthetic cathinones. Ephylone does not seem to be sought in France but would be most often sold for another molecule (2-CB, 3-MMC, MDMA…). Using SINTES program, 6 analyzes in 2017 and 8 in 2018 made it possible to identify this substance. Among these analyzes, only one mentioned the ephylone as expected product. According to SINTES, NPS are the subject of many “scams” including 3-MMC, one of the most requested cathinones, particularly among peoples practicing chemsex. This product was in short supply for a few months in 2017, during which some websites continued to claim to sell it while they replaced it with other cathinones. Conclusion Currently, there is limited available data on ephylone but the reports are alarming involving serious reactions, including deaths. Ephylone appears to be more potent than other cathinones, 100 mg would be considered as a high dose, what could explain the observed symptoms. While delirious states are well documented with cathinones, dissociative effects are poorly reported. Moreover, since ephylone is a new product, it is not always included in the toxicology laboratory database, making it difficult to detect this substance in biological fluids.