Designer stimulants (DS) are a part of a large category of drugs known as new psychotropic substances (NPS). Global usage of NPS reached its highest point during the last decade, fueled by public demand for alternatives to banned substances.
Their use is alarming because NPS are unapproved and have not been properly tested for their effects, dosages and toxicity, putting users at high risk. What’s more, NPS pose significant challenges to safeguarding public health and enacting and enforcing drug policies.
One classic example of DS is the well-known recreational drug Ecstasy (MDMA) and its variations. Because MDMA is banned, man-made stimulants known as synthetic cathinones (SC, a group that includes bath salts) have become popular on the recreational drug scene since 2006 as replacements for MDMA. Consequently, lab results testing positive for MDMA and other early-generation DS became rare in the United States. Instead, laboratories were finding a large number of positive human samples for SC.
In 2011 and 2012, the most common drugs identified through lab testing were MDPV, methylone and mephedrone, chemicals with similar effects as amphetamines. Usage of these drugs has increased to the point where the total combined positivity rate among drug tests reached 12 percent. That was higher than positivity for traditional amphetamines in the same population tested. Detection frequency of these SC sharply declined following their scheduling under the U.S. Controlled Substances Act and subsequent availability of new SC, such as α-PVP. Not surprisingly, this was followed by a rapid succession of new SC such as flephedrone, ethylone, butylone, buphedrone, pentedrone, 4-MEC, pentylone, ethcathinone and many others.
The frequency of laboratory detection in urine shows that each subsequent generation of SC remains on the market for a shorter period of time than the previous one with the exception of α-PVP, which demonstrated a remarkable longevity. For the last four years, positivity for SC was only 1-2 percent in the tested population, with α-PVP being the most frequently detected. There is also a significant geographical difference between abuse patterns of particular cathinones. For example, positive urine samples from Florida showed high α-PVP prevalence, while areas in the central east coast showed a high rate of positivity for ethylone and dibutylone. Even greater differences in usage of different SC may exist in other parts of the world.
Laboratory testing suggests that usage of DS in the U.S. is winding down. But new SC continue to be identified in laboratory testing. Their detection in urine and chemical identification remain challenging. Lack of standards, extensive metabolism of some SC and cost and duration of laboratory method development and validation are major obstacles. Unfortunately, the expected duration of a new SC arriving on the market is shorter than the time and effort necessary to develop a fully validated laboratory test to identify them. Addressing these challenges will require a coordinated effort among legislators to allow labs to quickly develop and implement new testing methods on an emergency basis.
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