Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College, Grzegórzecka 16 St., Kraków 31-531, Poland.
J Anal Toxicol. 2023 Dec 12;47(9):797-806. doi: 10.1093/jat/bkad070.
While many new psychoactive substances often disappear from the drug market rather quickly, some, such as synthetic cathinones (SCs), still remain due to their popularity among users. The current knowledge of SC concentrations in blood samples is based mainly on the published case reports of intoxications or fatalities caused by SC intake. The aim of the present study was to present and interpret the obtained toxicological analysis results of these cases, in which it was possible to determine or detect the presence of one of the isomers of chloromethcathinone (CMC) along with its intake biomarker-dihydro-CMC. These cases include 27 deaths reported at the Department of Forensic Medicine in Kraków in 2016-2022. CMC constitutes a major toxicological opinion challenge, in terms of toxicological evaluation of poisonings. As presented in this paper, a significant problem is its stability in the biological material and practices in the reporting of the obtained data. It is therefore important to monitor potential intake biomarkers that may show greater stability in the biological material than the parent drug. In the case of CMC isomers, the good biomarker of intake is the dihydro-CMC metabolite, which was detected in the blood sample in every case presented, even with the absence of the parent substance. Interpretation of the results obtained for CMC in terms of assessing their toxicity and possible cause of death is difficult. However, it should be taken into account that in cases of new psychoactive substance poisoning, an in-depth risk assessment is mandatory and the opinion of the unpredictability of the effects is taken as a principle.
虽然许多新精神活性物质通常很快从毒品市场上消失，但有些物质，如合成卡西酮（SCs），由于其在使用者中的流行，仍然存在。目前血液样本中 SC 浓度的知识主要基于 SC 摄入引起中毒或死亡的已发表病例报告。本研究的目的是介绍和解释这些案例中的毒理学分析结果，在这些案例中，有可能确定或检测到氯甲卡西酮（CMC）的一种异构体及其摄入生物标志物二氢-CMC 的存在。这些案例包括 2016 年至 2022 年在克拉科夫法医部门报告的 27 例死亡。CMC 在毒理学评价中毒物中毒方面构成了主要的毒理学意见挑战。如本文所述，一个重大问题是其在生物材料中的稳定性以及报告获得的数据的做法。因此，监测可能比母体药物在生物材料中更稳定的潜在摄入生物标志物非常重要。对于 CMC 异构体，摄入的良好生物标志物是二氢-CMC 代谢物，在所呈现的每个案例的血液样本中均有检测到，即使没有母体物质。根据评估其毒性和可能死因的角度来解释 CMC 的结果是困难的。然而，应该考虑到，在新精神活性物质中毒的情况下，必须进行深入的风险评估，并将不可预测性效果的意见作为原则。
