Mephedrone toxicity in a Scottish emergency department

To review and improve the evidence base regarding the toxic effects of Mephedrone, a cathinone derivative which was first believed to have been synthesised and propagated in 2007. On the 7th April 2010 the Misuse of Drugs Act 1971 (Amendment) Order 2010 was passed, declaring 4-Methylmethcathinone and other substituted cathinones Class B drugs as of 16 April 2010. This took place despite a perceived lack of evidence as to its potential harms.

We undertook a critical review of the available literature to see what evidence existed for the potential effects of mephedrone ingestion. We then conducted our own retrospective consecutive case series of all patients presenting to the Aberdeen Royal Infirmary Emergency Department from the 1st December until the 16th April (the date at which Mephedrone was officially proscripted). The notes were examined for amounts, timings, sources and reasons for ingestion. Symptoms, biometric, ECG and blood analysis data were also recorded along with management and disposal outcomes.

11 articles relating to mephedrone toxicity were identified and reviewed. 89 subjects were found for our case series. This compared to only 27 patients presenting with ingestion of substances (heroin, cocaine, cannabis) at that time illegal. 30 patients stated ingestion of mephedrone in isolation and a further 27 patients stated ingestion of mephedrone with alcohol in addition.

A profile of largely psychoactive and cardiovascular toxicity is described with drug naivety perhaps explaining the high rates of bingeing and addiction reported.