Synthetic cathinones have recently emerged and grown to be popular drugs of abuse. Their dramatic increase has resulted in part from sensationalized media attention as well as widespread availability. They are often considered “legal highs” and sold as “bath salts” or “plant food” and labeled “not for human consumption” to circumvent drug abuse legislation. They can be obtained through “head shops,” Internet websites, and local drug suppliers.
The legal status is variable by jurisdiction and rapidly changing, however they were initially legal in the UK and Europe. “Legal high” is a term often used to refer to drugs that are considered by users to fall outside of drug regulatory laws They are generally labeled “not for human consumption” to subvert regulatory control. Prior to 2009, the UK Poisons Information Service had no telephone inquiries related to synthetic cathinones. However over a 1-year period from 2009 to 2010, the number of inquiries regarding synthetic cathinone derivatives equaled the number of calls about cocaine and MDMA [1
]. Google Insights, a web application that tracks search terms, shows almost no searches for mephedrone before 2008. There has since been a remarkable rise in the number of searches, peaking in 2009, with the highest number of searches originating from the UK [2
]. For a comprehensive review of existing data, Pubmed, Medline, Google, Google Scholar were searched using the following terms: bath salts, butylone, club drugs, dimethylcathinone, ethcathinone, ethylone, 3- and 4-fluoromethcathinone, mephedrone, methedrone, methylenedioxypyrovalerone (MDPV), methylone, plant food and pyrovalerone.
)-2-amino-1-phenyl-1-propanone) is a naturally occurring beta-ketone amphetamine analogue found in the leaves of the Catha edulis
(Khat) plant. Chewing the leaves of this plant for stimulant effects is popular in certain Middle Eastern countries, particularly Yemen [3
]. Cathinone is found in the leaves of the plants only when fresh, and for this reason leaves can be chewed for only a few days after harvesting. Cathinone causes amphetamine-like sympathomimetic effects, including tachycardia and hypertension as well as psychoactive effects euphoria and increased alertness. Khat chewing has been linked to increased risk of myocardial infarction, dilated cardiomyopathy, and duodenal ulcers [3
Synthesis of cathinone derivatives has been reported since the late 1920s. Methcathinone was synthesized in 1928 and mephedrone in 1929 [4
]. A few of these derivatives have been investigated for medical use. Currently, bupropion is the only cathinone derivative that carries a medical indication in the US and Europe. It is a ring-substituted cathinone, prescribed for the treatment of depression and for use as a smoking-cessation aid [6
]. Others have been investigated, but were ultimately unsuccessful due to severe side effect profiles. Methcathinone was used in Russia as an antidepressant in the 1930s and 1940s. Also known as “Cat” and “Jeff,” it has been used recreationally most often in countries formerly part of the Soviet Union, but also gained popularity in the United States, particularly in Michigan, in the 1990s [7
]. Another derivative, pyrovalerone was investigated for use as a prescription drug to treat chronic fatigue, lethargy, and obesity but was withdrawn due to abuse and dependency in users [8
Numerous synthetic cathinone derivatives have become popular for use as “legal highs.” Exactly when these derivatives gained popularity amongst club goers and others seeking new drugs of abuse is difficult to pinpoint, but mentions in Internet drug forums began in 2007 [11
]. Synthetic cathinones that have been found in these products include butylone, dimethylcathinone, ethcathinone, ethylone, 3 and 4-fluoromethcathinone, mephedrone, methedrone, MDPV, methylone, and pyrovalerone (see Table [6
Synthetic cathinones used as drugs of abuse with chemical names and structures
Interest in synthetic cathinones as drugs of abuse developed in part due to decreased availability and purity of the more typical abusable drugs. In 2009, police reports from the UK, showed a marked decrease in purity of cocaine from over 60% to 22%, which was attributed to an increased number of drug seizures [15
]. In the Netherlands, a change in the composition of tablets reported to contain MDMA was noted over a similar time period. Prior to 2009, analysis of “Ecstasy” tablets found that >90% contained MDMA, although in later samples fewer than half contained any of this substance. In these latter analyses, piperazine derivatives and mephedrone replaced MDMA [16