Findings of synthetic cathinones in post-mortem toxicology

Synthetic cathinones (SCs) are a group of new psychoactive substances with amphetamine-like effects but generally higher potency. The aim of this study was to assess the incidence and significance of SCs in post-mortem (PM) investigations in Finland, focusing on the three most prevalent substances: α-PVP, α-PHP, and α-PiHP. All PM cases positive for SCs during 2018-2023 were investigated with respect to cause and manner of death, PM blood and urine concentrations, and concomitant use of other drugs of abuse. There were 136 findings of α-PVP, α-PHP, or α-PiHP in 118 death cases, in which the median age at death was 35 years and 82 % were males. Concomitant opioids, stimulants, or sedatives were found in 69-92 % of cases, and cannabis in 39-47 %. In two cases (1.7 %), SCs were the only findings of abused drugs. Thirty-four fatal poisonings (29 %) were identified in which at least one of the three SCs was implicated in the cause of death. The median (range) femoral blood concentrations of α-PVP, α-PHP, and α-PiHP in these poisoning cases were 0.18 (0.03-2.6) mg/L, 0.16 (0.02-0.58) mg/L, and 0.14 (0.03-2.1) mg/L, respectively. α-PVP, α-PHP and α-PiHP were found in 4.0 % of all drug abuse cases and in 2.7 % of all fatal poisonings related to drug abuse, while for amphetamine/methamphetamine, these figures were 44 % and 21 %, respectively. Despite their lower prevalence in PM cases, SCs appear to have similar abuse liability and similar drug use patterns to amphetamine.