In 2020 and 2021, the Schedule I drug eutylone—typically sold as ecstasy, Molly or MDMA—was the most commonly encountered synthetic stimulant in forensic casework. While regulated in countries beside the U.S., including Canada, the UK, Sweden and Germany, eutylone is not controlled under the 1961, 1971 or 1988 United Nations Conventions.
Stakeholders are seeking to change that, and in September 2021, the drug was recommended for international control. Less than a year later, the Center for Forensic Science Research & Education (CFSRE) has issued a public health alert surrounding the emergent synthetic stimulant N,N-dimethylpentylone.
“[The international control recommendation] likely created a shift in the novel psychoactive substance drug market, which would later be noted by declining eutylone positivity and increasing N,N-dimethylpentylone positivity,” according to the CFSRE.
N,N-Dimethylpentylone was first identified in toxicology samples in the U.S. in late-2021. To date, N,N-dimethylpentylone has been identified in 32 toxicology cases, including 26 postmortem. Cases have mostly been restricted to the east coast of the U.S., with the exception of one in Arkansas. Eight states have seen two or less cases, with Virginia recording five and Florida reporting an unprecedented 17.
The signs and symptoms of N,N-Dimethylpentylone use are the same as other synthetic stimulants, including agitation, hallucinations, excitement, elevated pulse, arrhythmias and serotonin syndrome.
Unlike eutylone, N,N-Dimethylpentylone is not explicitly scheduled in the U.S.; however, it could be considered an isomer of N-ethyl pentylone, which is a Schedule I drug. Of note, pentylone is a metabolite of N,N-Dimethylpentylone. In fact, pentylone was detected in 23 of the 32 cases recently recorded.
Unsurprisingly, forensic analysis also revealed the presence of fentanyl/opioids in 13 of the 32 recorded N,N-Dimethylpentylone toxicology cases through March 2022. Methamphetamine was found in 11, while eutylone was only noted in five. In eight cases, no other drugs were found.
As the use of N,N-dimethylpentylone is predicted to increase, CFSRE suggests forensic laboratories prioritize the testing of drug material samples and utilize non-targeted testing protocols to ensure correct identification.
The non-profit educational center also suggests the use of mass spectrometry-based screening—specifically gas chromatography-mass spectrometry—as opposed to ELISA screening. ELISA screening for synthetic stimulants may not be specific or specialized for the newest generation of drugs, whereas mass spectrometry methods offer high enough sensitivity to detect varying concentrations of synthetic stimulants in biological specimens.
For medical examiners and coroners, the CFSRE recommends testing for new synthetic stimulants and their biomarkers in any suspected stimulant-related cases.
As with all NPSs, the more data is shared between local health departments, forensic scientists, and related communities, the better chance stakeholders have of confirming and tracking novel identifications.