Α-Pyrrolidinoisohexanophenone (Α-PIHP) in three fatal

Dinis, Pedro; Machado, Francisca; Franco, João; Margalho, Cláudia

http://hdl.handle.net/10400.26/53940

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Background & Aims The New Psychoactive Substances (NPSs) are widely spread worldwide through the illicit markets and are increasingly the cause of intoxication deaths. Alpha-pyrrolidinoisohexanophenone (α-PiHP) is a positional isomer of α-pyrrolidinohexanophenone (α-PHP) and has been reported for the first time in 2016 at seized materials in China. Both substances are pyrovalerone derivatives from the synthetic cathinones group, and mainly exert cardiovascular, psychological, and neurologic effects. In addition, as published in literature and regardless of their isomerism, both cathinones can appear separately or together in a mixture. This work presents three forensic fatal cases associated with the consumption of α-PiHP and/or α-PHP: case 1 involves a 41-year-old man, drug user, mostly of “bloom”, who committed suicide by hanging; case 2 reports to a 32-year-old man, addicted to synthetic drugs, associated with a sample of “weed” collected next to the corpse; case 3 concerns to a 58-year-old male drug addict, who died after being admitted to the emergency department in a state of coma. Methods The toxicological analyses were carried out in peripheral blood in the three cases and, in case 2, the sample of “weed” was also analysed. Samples (500µL) were prepared with 0.1 M phosphate buffer, extracted by solid-phase extraction and analysed through gas chromatography coupled with mass spectrometry (GC-MS) in full-Scan monitoring mode to search for unknown substances. Subsequently, the samples were analysed in single-ion monitoring mode to confirm the substances detected in full-Scan. The ions 140, 98 and 77 were monitored for α-PiHP; 140, 105 and 77 for α-PHP; and 185 for cocaine-d3 (internal standard). Results & Discussion In case 1 was detected and confirmed α-PiHP. Other substances were also detected and confirmed such as tramadol, fluoxetine, diazepam, nordiazepam, cyamemazine, olanzapine, paliperidone and risperidone. Regarding case 2, in the “weed” we were able to detect several cannabinoids (cannabicyclol, cannabichromene, cannabidiol, cannabidivarol, cannabigerol, cannabinol, delta-9-tetrahydrocannabinol, delta-8-tetrahydrocannabinol and tetrahydrocannabivarin), nicotine and α-PiHP. In peripheral blood was confirmed α-PiHP, cocaine and its metabolites (benzoylecgonine and ecgonine methyl ester), delta-9-tetrahydrocannabinol and 11-nor-9-carboxy-delta-9-tetrahydrocannabinol, phenacetine (a cocaine cutting agent), morphine, paracetamol, alprazolam, nordiazepam, sertraline and mirtazapine. In case 3, both α-PHP and α-PiHP were detected and confirmed in peripheral blood, such as paracetamol. Therefore, the toxicological results of the three cases are relevant to complement the case histories since the presence of α-PiHP in the peripheral blood can be related with the death of individuals. Conclusion With the three cases presented in this work, we can conclude that the search for NPS in biological and non-biological specimens plays an important role, especially in cases of drug-related deaths. The concomitant use of traditional drugs of abuse, prescription medication, α-PHP and α-PiHP, either separately or in combination, increases the possibility of a fatal intoxication since both substances have a high toxic potential.