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EU bans 'meow meow' party drug
Matt Pearson, a year-old white male, is brought to the emergency department ED by his wife about an hour after snorting 1 g of mephedrone. He is agitated, hallucinating, and diaphoretic. His wife states he has a history of cocaine abuse and cardiovascular problems, most likely inherited from his father. On his arrival at the ED, the nurse who admits Mr. Electrocardiography shows supraventricular tachycardia. Blood tests are negative except for an elevated sodium level. Although alert, Mr. Pearson is incoherent. He complains of extreme thirst. Over the past few years, numerous patients especially adolescents and young adults have presented to EDs with life-threatening arrhythmias, dehydration, and hallucinations after ingesting mephedrone—a synthetic stimulant and psychoactive drug known by such street names as bath salts, plant food, Meow Meow, M Cat, meph, and moonshine. Considered a legal high until the U. Drug Enforcement Administration DEA banned it in September, mephedrone contains compounds derived from plant and fungal material that could easily be purchased on the Internet without restriction. The effects of mephedrone mirror those of cocaine, Ecstasy, and methamphetamines. The drug contains the stimulant cathinone, found in Catha edulis, whose leaves are chewed for medicinal effects in Somali, Yemeni, and Ethiopian communities. Cathinone derivatives are similar structurally to amphetamine. Mephedrone has been marketed aggressively on the Internet since By , it was being used in France, Denmark, and Australia. It owes its popularity to its easy access and desired physiologic and psychological effects—increased alertness, confidence, euphoria, sociability, plus stimulation and auditory enhancement. Many young people reportedly have decreased their use of cocaine, Ecstasy, and amphetamines in favor of mephedrone. Users typically take mephedrone in higher dosages than they would amphetamines and Ecstasy. The drug is hard to stop using once started and can lead to toxic physiologic and psychological effects. After mephedrone became popular in the UK, its increased use and devastating side effects including numerous deaths quickly led to legislation banning the drug in In the UK, mephedrone is now a Class B controlled substance. Widespread international restrictions rapidly increased; currently, the drug is a controlled substance in Denmark, Israel, Sweden, Norway, Germany, Finland, and Australia. In , the United States began to see a similar surge in mephedrone use. One Michigan ED saw 71 mephedrone-related visits in 6 months; before that, it saw none. In Louisiana, 84 people reportedly were admitted to EDs for paranoia, fighting, hallucinations, suicidal thoughts, hypertension, and tachycardia related to mephedrone use. Such reports have occurred throughout the United States. In September, the DEA invoked its emergency authority to temporarily ban mephedrone and two other stimulants 3,4-methylenedioxypyrovalerone and methylone. The action makes possessing or selling these drugs or the products that contain them illegal for at least 1 year while the DEA and U. Department of Health and Human Services study whether they should be permanently controlled. Mephedrone acts as a powerful central nervous system CNS stimulant by promoting release of monoamine neurotransmitters and inhibiting their reuptake. It binds with dopamine, noradrenaline, and serotonin transporters. Common physiologic effects include excessive sympathomimetic stimulation such as agitation, tachycardia, systolic hypertension, seizures, nausea, headache, increased libido, and cold blue fingers. Some people use the drug to attain such psychological effects as increased alertness, confidence, euphoria, sociability, stimulation, auditory enhancement—with little or no hangover effect the next day. The drug comes in capsules, tablets, and powder. The most common administration routes are nasal insufflation snorting and oral ingestion. Snorting produces effects within a few minutes. Dissolved in water, mephedrone can be used rectally and I. Currently, no treatment guidelines exist. The key to effective care is rapid treatment of signs and symptoms, as described below. Anxiety: Benzodiazepines are the drugs of choice to manage agitation; higher-than-normal dosages may be needed. Provide emotional support and comfort measures throughout the acute anxiety phase. Allow family members to comfort the patient, if possible. Seizures: If seizures occur, rule out other possible causes, such as dehydration, hyperthermia, or metabolic acidosis. As ordered and needed, give benzodiazepines. Follow seizure precautions according to facility protocol. Hallucinations: No medications are available to manage hallucinations. Keep the patient safe and provide one-to-one care if sufficient staff are available. Tremors, bruxism, mild muscle clenching, headache, pupil dilation, blurred vision, and numbness: Reassurance and support may be the only effective interventions until mephedrone is metabolized. Benzodiazepines may be used in severe cases. Reassure patients, and tell them that continuous cardiac monitoring and use of appropriate medications most likely will resolve cardiovascular adverse effects until mephedrone is metabolized by the body. Tachycardia: Review laboratory results for indicators of dehydration. Be aware that tachycardia may result from increased sweating and decreased fluid intake. Treatment may include fluid replacement. Hypertension: As mephedrone is metabolized, hypertensive crisis may resolve. Alpha or beta antagonists or vasodilators may be given, if needed. Chest pain: Mephedrone can cause severe vasoconstriction, impairing oxygenation to coronary arteries. Standard vasodilators, such as nitroglycerin and analgesics, are recommended. Rapid respiratory rate: Provide supplemental oxygen and bronchodilators as needed and ordered for bronchoconstriction. Monitor pulse oximetry values continuously until the respiratory rate returns to normal. Stay with the patient during respiratory distress and provide comfort measures to reduce anxiety and fear. Advise patients to stop using mephedrone immediately due to its harmful effects. If they choose to continue using it, advise them to avoid using it with other stimulants, alcohol, or depressants. Caution them not to inject the drug because of possible impurities, toxic effects on the veins, and quick onset of slow breathing and numbness. Teach them to maintain adequate hydration and avoid getting overheated during mephedrone use. Suggest drug and alcohol rehabilitation services for patients who use the drug repetitively or have become addicted. Provide information and support to the patient and family; as appropriate, refer the patient for an evaluation for treatment or rehabilitation. Some patients may need psychological counseling and support to prevent further use. Mephedrone use has been the source of countless life-threatening incidents and has caused numerous deaths. Unfortunately, epidemiologic evidence is scant. Your understanding of presenting symptoms and emergency care can promote rapid treatment. Take steps to raise public awareness of the dangers of mephedrone and other synthetic drugs. Education can be a powerful tool in reducing both its use and its devastating consequences. American Association of Poison Control Centers. Accessed September 22, Instability of the ecstasy market and a new kid on the block: mephedrone. Drugs Forum. McConnaughey J. Drugs disguised as bath salts send users to ERs. Updated December 23, Tweaking, bombing, dabbing, and stockpiling: the emergence of mephedrone and the perversity of prohibition. Drugs Alcohol Today. Psychopharmacology Berl. Drug Enforcement Administration. DEA moves to emergency control synthetic stimulants. September 7, Mephedrone, new kid for the chop? Clinical pattern of toxicity associated with the novel synthetic cathinone mephedrone. Emerg Med J. Catherine P. Lovecchio is an assistant professor in the nursing department at the University of Scranton in Scranton, Pennsylvania. Save my name, email, and website in this browser for the next time I comment. Powered by www. No part of this website or publication may be reproduced, stored, or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the copyright holder. The weekly email newsletter from the publishers of American Nurse Journal. Sign up today to start your free subscription to NurseLine! Sign in. Log into your account. Forgot your password? Create an account. Sign up. Password recovery. Recover your password. Get help. American Nurse. Clinical Topics. November 11, Rapid rise in use and regulation After mephedrone became popular in the UK, its increased use and devastating side effects including numerous deaths quickly led to legislation banning the drug in Pharmacologic effects Mephedrone acts as a powerful central nervous system CNS stimulant by promoting release of monoamine neurotransmitters and inhibiting their reuptake. Mephedrone at a glance Please click the PDF icon above to view. CNS adverse effects Anxiety: Benzodiazepines are the drugs of choice to manage agitation; higher-than-normal dosages may be needed. Cardiovascular adverse effects Reassure patients, and tell them that continuous cardiac monitoring and use of appropriate medications most likely will resolve cardiovascular adverse effects until mephedrone is metabolized by the body. Respiratory adverse effects Rapid respiratory rate: Provide supplemental oxygen and bronchodilators as needed and ordered for bronchoconstriction. Patient teaching Advise patients to stop using mephedrone immediately due to its harmful effects. Help raise awareness Mephedrone use has been the source of countless life-threatening incidents and has caused numerous deaths. Manghi R. Khat use: lifestyle or addiction. J Psychoactive Drugs. Tags bath salts cathinone mephedrone sympathomimetic stimulants. Previous article Benzocaine puts a patient in a bind. Next article Emergency nursing: A specialty unlike any other. My Nurse Influencers. Read more. 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