TL neuro

September 5, 2012

A review of deaths associated with 4-methylmethcathinone (mephedrone).

Filed under: 4-MMC/Mephedrone, Cathinones, Drug Overdose — Tags: — mtaffe @ 10:10 am

A new paper reviews a series of fatal cases reported via coroners in the UK which involved suspicion of mephedrone / 4-methylmethcathinone (4-MMC) involvement.

Schifano F, Corkery J, Ghodse AH.J Suspected and Confirmed Fatalities Associated With Mephedrone (4-Methylmethcathinone, “Meow Meow”) in the United Kingdom. Clin Psychopharmacol. 2012 Aug 24. [Epub ahead of print] PubMed

The lead author is a familiar name from similar overviews of MDMA-associated fatalities.

In this new paper, out of 128 reported cases, there were 62 in which 4-MMC was confirmed (no 4-MMC in 25 cases, toxicology was still pending for 13 cases* and apparently inquest forms were unavailable for an additional 7 cases).

As with many surveys of human recreational drug-related fatality the data are messy. Recreational drug users have often been using multiple psychoactive substances that might be expected to be risky themselves, induce multi-drug interactions and to generally complicate interpretation. There is also the reality that the mechanism of death in “drug-related” fatality can vary. This report identifies acute drug toxicity (4-MMC alone or with other drugs) in 26 cases, self-inflicted harm (18 cases), at risk behavior (6 cases) and at-risk sexual behavior** (2 cases).

As best I can tell from the paper, 4-MMC was determined to be the sole cause of death in 8 cases. It is very unclear if this represents what we might view as straight-up drug overdose but this appears to be the case. I.e., this number doesn’t count the risky-behavior part although there is a case to be made that changes in behavior, behavioral inhibition and risky decision making are no less “straight-up overdose” than cardiovascular or other physiological regulatory events.

The paper also identifies 5 cases in which 4-MMC intake was followed by multiple days in the hospital and eventual death (3 cases of multi-organ/liver failure). A further 5 cases involved collapse while attending a party; interestingly high body temperature was confirmed in only one case.

These final observations sound very much like the overall picture for MDMA-related fatality and morbidity.

This is unsurprising given recent neurotoxicological and neurochemical studies indicating a similarity of 4-MMC to MDMA.

Nevertheless, we’ve been finding that the thermoregulatory effect of 4-MMC in rats differs from what would be expected for MDMA. Human fatalities related to MDMA often feature high body temperature (start with the Schifano papers linked above). In rat models, MDMA produces hyperthermia, including to a fatal degree, if the ambient temperature is above about 25 degrees Celsius. We have found no evidence of increased body temperature in rats when dosed with mephedrone at 30 degrees Celsius. This suggests that at least for this particular risk category, 4-MMC may have a lower impact than does MDMA.

__
*I think peer review should have insisted they not include these 13, personally. Doesn’t really add to the paper.
**Not specified. At a guess, auto-erotic asphyxiation.

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