Abstract
Purpose
There is increasing interest in the use of pipradrol and pipradrol derivatives, such as diphenylproplinol [diphenyl-2-pyrrolidinemethanol (D2PM)] and desoxypipradrol [2-diphenylmethylpiperidine (2-DPMP)], as recreational drugs. There is limited information on the acute toxicity related to both D2PM and 2-DPMP. We report here a case series of five individuals with acute toxicity related to the use of D2PM.
Case series
Five patients aged between 21 and 33 years old presented to the Emergency Department (ED) on unrelated occasions having used a range of different novel psychoactive substances; none had actually purchased D2PM. They presented with ongoing prolonged neuropsychiatric symptoms of agitation, anxiety and insomnia lasting 24–96 h post-ingestion. None had evidence of sympathomimetic toxicity on presentation to the ED. All were reassured and discharged home after review.
Toxicological screening
Urine collection at the time of presentation to the ED was subsequently analysed by gas chromatography—mass spectrometry (GC-MS). All of the urine samples tested positive for D2PM and benzophenone. Additional screening by liquid chromatography tandem mass–spectrometry (LC-MS-MS) demonstrated that the benzophenone detected was an analytical artefact due to the high-injection temperature of the GC-MS analysis.
Conclusions
This descriptive case series provides more detailed information on the acute toxicity related to the use of D2PM. This information is useful for clinical pharmacologists and clinicians managing these individuals to be able to provide more appropriate advice on the acute toxicity associated with the use of D2PM, particularly in relation to the prolonged neuropsychiatric symptoms seen.
Similar content being viewed by others
References
EMCDDA–Europol 2010 Annual Report on the implementation of Council Decision 2005/387/JHA In accordance with Article 10 of Council Decision 2005/387/JHA on the information exchange, risk-assessment and control of new psychoactive substances. (2010) Available from: http://www.emcdda.europa.eu/attachements.cfm/att_132857_EN_EMCDDA-Europol%20Annual%20Report%202010A.pdf. Accessed 23 August 2011
Gibbons S, Zloh M (2010) An analysis of the 'legal high' mephedrone. Bioorg Med Chem Lett 20:4135–4139
Wood DM, Ramsey J, Dargan PI (2008) Detecting novel and emerging recreational drugs on the ‘club scene’. Irish Psychiatrist 9:223–228
Dargan PI, Sedefov R, Gallegos A, Wood DM (2011) The pharmacology and toxicology of the synthetic cathinone mephedrone (4-methylmethcathinone). Drug Test Anal 3:454–463
Wood DM, Davies S, Greene SL, Button J, Holt DW, Ramsey J, Dargan PI (2010) Case series of individuals with analytically confirmed acute mephedrone toxicity. Clin Toxicol (Phila) 48:924–927
Davies S, Wood DM, Smith G, Button J, Ramsey J, Archer R, Holt DW, Dargan PI (2010) Purchasing 'legal highs' on the Internet–is there consistency in what you get? QJM 103:489–493
Ramsey J, Dargan PI, Smyllie M, Davies S, Button J, Holt DW, Wood DM (2010) Buying 'legal' recreational drugs does not mean that you are not breaking the law. QJM 103:777–783
Brandt SD, Sumnall HR, Measham F, Cole J (2010) Analyses of second-generation 'legal highs' in the UK: initial findings. Drug Test Anal 2:377–382
Lidder S, Dargan P, Sexton M, Button J, Ramsey J, Holt D, Wood D (2008) Cardiovascular toxicity associated with recreational use of diphenylprolinol (diphenyl-2-pyrrolidinemethanol [D2PM]). J Med Toxicol 4:167–169
Dargan PI, Button J, Hawkins L, Archer JR, Ovaska H, Lidder S, Ramsey J, Holt DW, Wood DM (2008) Detection of the pharmaceutical agent glaucine as a recreational drug. Eur J Clin Pharmacol 64:553–554
Wood DM, Dargan PI, Button J, Holt DW, Ovaska H, Ramsey J, Jones AL (2007) Collapse, reported seizure–and an unexpected pill. Lancet 369:1490
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2009) Report on the risk assessment of BZP in the framework of the Council Decision on new psychoactive substances. Available at: http://www.emcdda.europa.eu/attachements.cfm/att_70975_EN_EMCDDA_risk_assessment_8.pdf. Accessed 23 Aug 2011
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2011) Report on the risk assessment of mephedrone in the framework of the Council Decision on new psychoactive substances. Available at: http://www.emcdda.europa.eu/attachements.cfm/att_116646_EN_TDAK11001ENC_WEB-OPTIMISED%20FILE.pdf. Accessed 23 Aug 2011
Advisory Council on the Misuse of Drugs (ACMD) (2010) Consideration of the cathinones. Available at: http://www.homeoffice.gov.uk/publications/alcohol-drugs/drugs/acmd1/acmd-cathinodes-report-2010?view=Binary. Accessed 23 Aug 2011
Advisory Council on the Misuse of Drugs (ACMD) (2008) Control of 1-benzylpiperazine (BZP) and related compounds. Available at: http://www.homeoffice.gov.uk/publications/alcohol-drugs/drugs/acmd1/ACMD-BZP-Report?view=Binary. Accessed 23 Aug 2011
Advisory Council on the Misuse of Drugs (ACMD) (2010) Consideration of the naphthylpyrovalerone analogues and related compounds. Available at: http://www.homeoffice.gov.uk/publications/alcohol-drugs/drugs/acmd1/naphyrone-report?view=Binary. Accessed 23 Aug 2011
James DA, Potts S, Thomas SHL, Chincholkar VM, Clarke S, Dear J, Ramsey J (2011) Clinical features associated with recreational use of ‘Ivory Wave’ preparations containing desoxypipradrol. Clin Tox 49:201
Herbert JX, Daly F, Tracey JA (2010) “Whacked!” BMJ letters. Available at: http://www.bmj.com/content/341/bmj.c3564.full/reply#bmj_el_238830. Accessed 23 Aug 2011
Rovinskia VI (1989) A case of hallucinogen-like action of glaucine. Klin Med (Mosk) 67:107–108
Rovinskia VI (2006) Acute glaucine syndrome in the physician’s practice: the clinical picture and potential danger. Klin Med (Mosk) 84:68–70
Brandt SD, Sumnall HR, Measham F, Cole J (2010) Second generation mephedrone. The confusing case of NRG-1. Br Med J 341:c3564
Pyrrolidine derivatives US patent application [webpage on the Internet]. Patent application by Jackson PF and Guildford Pharmaceuticals; Patent number 5,650,521 [22 July 1997]. Available at: http://v3.espacenet.com/origdoc?CY=gb&LG=en&DB=EPODOC&IDX=US5650521&DOC=dcb65d04ab6724e097530cc48c44ebbb62. Accessed 23 Aug 2011
Competing interests
DW and PD have acted as scientific advisors to the UK Advisory Council on the Misuse of Drugs (ACMD) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wood, D.M., Puchnarewicz, M., Johnston, A. et al. A case series of individuals with analytically confirmed acute diphenyl-2-pyrrolidinemethanol (D2PM) toxicity. Eur J Clin Pharmacol 68, 349–353 (2012). https://doi.org/10.1007/s00228-011-1142-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00228-011-1142-0