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Intoxication cases associated with the novel designer drug 3',4'-Methylenedioxy-α-pyrrolidinohexanophenone (MDPHP) and studies on its human metabolism by high-resolution mass spectrometry.

Among the increasing number of new psychoactive substances (NPS), 3',4'-methylenedioxy-α-pyrrolidinohexanophenone (MDPHP) belongs to the group of synthetic cathinones, that are derivatives of the naturally occurring compound cathinone, the main psychoactive ingredient in the khat plant. Currently, only limited data exist for MDPHP and no information on human metabolism is available so far. We describe the toxicological investigation of nine cases associated with the use of MDPHP during the period between February to June 2019. Serum MDPHP concentrations showed a high variability ranging from 3.3 to 140 ng/mL (mean 30.3 ng/mL, median 16 ng/mL). Intoxication symptoms of the described cases could not be explained by the abuse of MDPHP alone, since in all cases co-consumption of other psychotropic drugs with frequent occurrence of opiates and benzodiazepines could be verified. Hence, the patients presented with different clinical symptoms including aggressive behaviour, delayed physical response, loss of consciousness and coma. Furthermore, liquid chromatography high-resolution mass spectrometry (LC-HR-MS) was successfully applied to investigate the human in vivo metabolism of MDPHP using authentic human urine samples. The metabolism data for MDPHP was further substantiated by analysis of human urine by gas chromatography-mass spectrometry (GC-MS). The analysis of urine samples disclosed the presence of seven phase I metabolites and three phase II metabolites as glucuronides. GC-MS spectral data for MDPHP and metabolites is provided, since the widely used systematic toxicological analysis by GC-MS is appropriate for the toxicological detection of MDPHP intake. The identified metabolite pattern corroborates the principal metabolic pathways of α-pyrrolidinophenones in humans.