Emergence of new psychoactive substance 2-fluorodeschloroketamine: Toxicology and urinary analysis in a cluster of patients exposed to ketamine and multiple analogues

•2-Fluorodeschloroketamine (2F-DCK) is a newly emerged psychoactive substance.•This ketamine analogue was identified in multiple poisoning patients.•2F-DCK was found to have similar metabolic and clinical profiles as ketamine.•Alarmingly, most patients had co-exposure to ketamine and multiple of its...

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Bibliographic Details
Published in:Forensic science international 2020-07, Vol.312, p.110327, Article 110327
Main Authors: Tang, Magdalene H.Y., Li, Terence C., Lai, C.K., Chong, Y.K., Ching, C.K., Mak, Tony W.L.
Format: Article
Language:English
Subjects:
2-Fluorodeschloroketamine
Adolescent
Adult
Arylcyclohexylamine
Chromatography, Liquid
Consciousness
Deschloroketamine
Drugs
Emergence
Exposure
Female
Forensic sciences
Forensic Toxicology
Humans
Hypertension
Identification
Illicit Drugs - chemistry
Illicit Drugs - urine
Ingestion
Ketamine
Ketamine - analogs & derivatives
Ketamine - chemistry
Ketamine - urine
Laboratories
Male
Mass Spectrometry
Medical personnel
Metabolism
Metabolites
Middle Aged
Molecular Structure
New psychoactive substance
Oxidation
Patients
Psychotropic Drugs - chemistry
Psychotropic Drugs - urine
Substance-Related Disorders - diagnosis
Substance-Related Disorders - urine
Tachycardia
Tiletamine - chemistry
Tiletamine - urine
Toxicity
Toxicology
Urine
Young Adult
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Summary:•2-Fluorodeschloroketamine (2F-DCK) is a newly emerged psychoactive substance.•This ketamine analogue was identified in multiple poisoning patients.•2F-DCK was found to have similar metabolic and clinical profiles as ketamine.•Alarmingly, most patients had co-exposure to ketamine and multiple of its analogues. New psychoactive substances (NPS) emerge continually, amongst which is a growing class of ketamine analogues with an arylcyclohexylamine backbone. Recently we reported a poisoning outbreak associated with 2-oxo-PCE (deschloro-N-ethyl-ketamine). The present report describes the emergence of another ketamine analogue, 2-fluorodeschloroketamine (2F-DCK). The compound was first detected in a patient’s urine, its identity confirmed by accurate mass analysis and comparison with reference standard. Four putative metabolites were identified, including nor-2F-DCK, dehydronor-2F-DCK (major metabolite) and two hydroxylated derivatives of nor-2F-DCK. Between January and July 2019, 20 cases of analytically confirmed 2F-DCK exposure were encountered. In 19 out of 20 cases, at least one more ketamine-type drug was detected concurrently with 2F-DCK, including ketamine (90%), deschloroketamine (DCK, 50%), 2-oxo-PCE (45%) and tiletamine (10%). In particular, six of the cases showed the presence of 4 ketamine-type drugs in the same urine sample. The clinical effects observed in patients exposed to 2F-DCK are predominantly neurological (impaired consciousness, agitation, abnormal behaviour) and cardiovascular (hypertension, tachycardia); five patients had loss of consciousness or convulsion. Management was mainly supportive; all patients recovered uneventfully. This is the first clinical case series involving 2F-DCK and frontline medical personnel are urged to be aware of this rapidly expanding class of NPS, in particular the co-ingestion of multiple ketamine analogues.
ISSN:0379-0738
1872-6283
DOI:10.1016/j.forsciint.2020.110327