Pharmacology and toxicology of N-Benzyl-phenylethylamines (25X-NBOMe) hallucinogens

25X-NBOMe compounds are potent synthetic hallucinogens and stimulants that act as highly efficacious agonists at the 5HT2a receptor, with binding affinities in the low nanomolar range. The most common variants—25I-, 25B-, and 25C-NBOMe—are sold as blotter papers, powders, liquids, or tablets and can be taken sublingually, buccally, nasally, by smoking, or rarely intravenously. These drugs have been identified worldwide and produce sympathomimetic, hallucinogenic, and possibly serotonergic toxidromes. Severe toxicity and deaths have been reported, so clinicians should watch for signs of poisoning, especially in patients who report using blotters or substances sold as LSD.

Study at a glance

Abstract

Abstract 25X-NBOMe compounds are halogenated, phenethylamine-related novel psychoactive drugs, with hallucinogenic and stimulant effects. NBOMes are potent and highly efficacious agonists at the 5HT2a receptor with binding affinities in the low nanomolar range, accounting for their psychoactive and toxic effects. 25I-, 25B-, and 25C-NBOMes are the most frequently encountered compounds; they are typically sold as blotter papers, or in powder, liquid, or tablet forms, and administered by several routes including sublingual or buccal ingestion, nasal insufflation, through smoking or more rarely through intravenous injection. 25X-NBOMes have been identified worldwide and are associated with clinical presentations consistent with sympathomimetic, hallucinogenic, and possibly serotonergic toxidromes. 25X-NBOMEs have been associated with cases of severe toxicity and death, and therefore physicians should remain vigilant for features that may be consistent with toxicity, particularly in those who report ingesting using blotters or LSD. In this chapter, the current understanding of 25X-NBOMe pharmacology and toxicology is reviewed