Recurrent acute poisoning with synthetic cathinone α-pyrrolidinohexanophenone (α-PHP) in a chronic drug abuser

Abstract

We aim to present a case of recurrent acute α-PHP intoxications in a chronic drug abuser documented by plasma concentration monitoring in order to describe α-PHP monointoxications. We developed and validated a specific HPLC-MS-MS method for the quantification of α-PHP in plasma and urine. Samples were extracted with a glacial acetonitrile deproteinization protocol. Quantitative analysis was performed in multiple reaction monitoring mode and the precursor-to-product ion transitions of m/z 246.2 > 91.2 (quantification), 246.2 > 140.2 (confirmation), 284.3 > 149.1 were used for α-PHP, and MDPV-D8 (IS), respectively. The authors describe the case of eight α-PHP recurrent intoxications in a 36-year-old man over 5 months. The reported ingested dose ranged from 3.5 to 10 grams of α-PHP. Interval from the last intake and the first blood sample ranged from 4 to 24 hours. Plasma α-PHP concentrations ranged from 15 to 364 ng/mL and from 8500 to 20,100 ng/mL in urine. To the best of our knowledge, this is the highest α-PHP plasma concentration measured in alive patient. We observed severe neurologic disorders (hallucinations, agitation and aggressiveness) with α-PHP plasma concentration higher than 200 ng/mL. This series describe eight α-PHP monointoxications and suggest a tolerance as well as a potential link between plasma concentration and toxicity of α-PHP that need to be confirmed on larger studies.