Cluster of acute poisonings associated with an emerging ketamine analogue, 2-oxo-PCE.
Magdalene H Y Tang, Y K Chong, Candace Y Chan, CK Ching, C K Lai, Y K Li, Tony W L Mak
Forensic Science International September 1, 2018 DOI: 10.1016/j.forsciint.2018.07.014 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective chart review Peer reviewed |
|---|---|
| Sample size | 56 |
| Population | Patients presenting with acute poisoning associated with 2-oxo-PCE between October and November 2017 |
| Topics | Esketamine Ketamine |
| Keywords | 2-oxo-pce Arylcyclohexylamine Deschloro-n-ethyl-ketamine New psychoactive substance Toxicity |
| Key findings | 2-oxo-PCE, a new arylcyclohexylamine analogue, caused a cluster of acute intoxications with ketamine-like toxidrome, undetected by standard ketamine immunoassay. |
Abstract
Ketamine and phencyclidine are well-known drugs of abuse of the arylcyclohexylamine class, the backbone of which is used for the synthesis of new psychoactive substances (NPS). In October 2017, a cluster of acute intoxications was encountered where patients presented with ketamine-like toxidrome. Upon initial toxicology screening, however, neither ketamine nor other causative agents were detected in the patients' urine. Instead, an unidentified substance was consistently detected. Further investigations using gas- and liquid-chromatography mass spectrometry led to the identification of an arylcyclohexylamine analogue, 2-oxo-PCE. The present study reports the analytical and toxicological profile of this emerging NPS. Chart review found, in total, 56 cases of 2-oxo-PCE associated acute poisoning between October and November 2017. Laboratory analysis confirmed the presence of 2-oxo-PCE in the urine of all patients; nasal swab samples from three patients revealed the lone presence of 2-oxo-PCE. Urine bedside immunoassay for ketamine was found not to cross-react with 2-oxo-PCE. In 55% of the cases, other drugs of abuse were detected on toxicology analysis; whilst in the remainder, 2-oxo-PCE was used alone. The main clinical symptoms associated with sole 2-oxo-PCE use include impaired consciousness (84%), confusion (60%), abnormal behaviour (44%), hypertension (80%) and tachycardia (40%). Convulsion (16%) was also observed relatively frequently. Management was mainly supportive, whilst three patients required intensive care. All patients recovered uneventfully. In conclusion, frontline clinical and laboratory personnel should be highly vigilant in the lookout for 2-oxo-PCE, a dangerous emerging arylcyclohexylamine analogue.
Comparable studies
Other observational and cohort studies on ketamine, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Taming the Ketamine Tiger Volunteers from a prison population | 2010 | Observational study | n = 20 |
| Increased spontaneous MEG signal diversity for psychoactive doses of ketamine, LSD and psilocybin Humans | 2017 | Observational study | |
| Disruption of Frontal–Parietal Communication by Ketamine, Propofol, and Sevoflurane Surgical patients undergoing induction of anesthesia with intravenous ketamine | 2013 | Observational cohort | n = 30 |
| Do the dissociative side effects of ketamine mediate its antidepressant effects? Treatment-resistant inpatients with major depressive disorder or bipolar disorder | 2014 | Observational cohort | n = 108 |
| Concomitant BDNF and sleep slow wave changes indicate ketamine-induced plasticity in major depressive disorder Patients with treatment-resistant major depressive disorder | 2012 | Observational cohort | n = 30 |
Citations in the library
Cited by 9
- Reports of Adverse Events Associated with Use of Novel Psychoactive Substances, 2017–2020: A Review Journal of Analytical Toxicology April 20, 2022
- Stimulant and hallucinogenic novel psychoactive substances; an update Expert Review of Clinical Pharmacology November 2, 2023
- 2-Fluorodeschloroketamine has similar abuse potential as ketamine. Addiction Biology May 1, 2022
- A combined toxicokinetic and metabolic approach to investigate deschloro-N-ethylketamine exposure in a multidrug user. Journal of Pharmaceutical and Biomedical Analysis June 15, 2024
- Structure identification and analysis of the suspected chemical precursor of 2-fluorodeschloroketamine and its decomposition products. Drug Testing and Analysis June 1, 2022
and 4 more in the library
Cites 11
- Taming the Ketamine Tiger Anesthesiology August 6, 2010
- From PCP to MXE: a comprehensive review of the non-medical use of dissociative drugs. Drug Testing and Analysis 2014
- The new drug phenomenon Drug Testing and Analysis July 1, 2014
- Methoxetamine‐related deaths in the UK: an overview Human Psychopharmacology: Clinical and Experimental July 1, 2015
- Two Cases of Non-fatal Intoxication with a Novel Street Hallucinogen: 3-Methoxy-Phencyclidine. Journal of Analytical Toxicology May 1, 2017
and 6 more in the library