Psychoactive cocktail consumption on Reunion Island: a case report

Area of Science:

• Forensic Toxicology
• Pharmacology
• Clinical Toxicology

Background:

• Reunion Island exhibits unique drug use patterns compared to mainland France.
• Diverted prescription medications, such as trihexyphenidyl, are misused.
• Recreational use of crushed medication mixtures poses public health risks.

Purpose of the Study:

• To report a case of atypical intoxication in an adolescent.
• To identify the substances involved in the intoxication.
• To investigate the potential for recreational use of mixed prescription drugs.

Main Methods:

• High-resolution mass spectrometry (HRMS).
• Liquid chromatography-mass spectrometry (LC-MS).
• Analysis of patient biological samples (plasma, urine) and a seized powder mixture.

Main Results:

• The patient presented with confusion, hallucinations, and sinus tachycardia after consuming cannabis and a powder.
• HRMS and LC-MS identified citalopram/escitalopram, paroxetine, sertraline, venlafaxine, and trihexyphenidyl in the patient's samples and the powder.
• The identified drug combination was atypical and not prescribed together clinically.

Conclusions:

• This case highlights the dangers of combining diverted prescription drugs for recreational purposes.
• The analysis of the powder mixture was critical in understanding the intoxication.
• There is a need for increased awareness regarding the circulation and use of crushed medication mixtures for non-medical use.