Fatal white-matter damage after 2C-E overdose

[23536]

Fatal toxic leukoencephalopathy secondary to overdose of a new psychoactive designer drug 2C-E (“Europa”)

Abstract
We present a case of a fatal toxic leukoencephalopathy following ingestion of a new psychoactive designer drug known as 2C-E or "Europa." Recreational drugs, particularly hallucinogenic substances, appear to be growing in popularity, with increasing amounts of information available via the Internet to entice potential users. In addition, some newer "designer" psychoactive substances are available for purchase online without adverse legal consequences, therefore adding to their popularity. We describe magnetic resonance imaging (MRI) findings to include selective diffuse toxic injury of the cerebral white matter with sparing of the cortex and most of the deep gray nuclei. To our knowledge, this is the first reported description of cerebral findings on MRI that are likely related to a lethal ingestion of 2C-E.

Full text.

 

[Vader]

A urine toxicology screen was positive for benzodiazepines and tetrahydrocannabinol, but was otherwise negative. Serum testing was negative for alcohol, salicylates, and acetaminophen. Blood cultures were obtained, and the patient was placed on broad-spectrum antibiotics. A friend disclosed that the patient recently received 2C-E from an Internet website and had likely consumed it. Although testing for 2C-E is limited, a urine sample was positive for this substance.

Other substances are also capable of causing toxic leukoencephalopathy, including cocaine and heroin. With the patient's history of polysubstance abuse, these drugs were an etiologic consideration, although they were reliably excluded based on the toxicology screening. The patient's MRI findings had many features similar to those of cocaine overdose, including injury of the centrum ovale. In addition to causing toxic injury to cerebral white matter, cocaine typically injures portions of the basal ganglia, particularly the globus pallidi, which were minimally affected in this case (8). The use of heroin in this case was not considered a contributor, since the toxicology screen was negative and the imaging findings of heroin differ from those in this case. With heroin overdose, destruction of cerebellar white matter is frequently seen, along with involvement of the corticospinal tract and sparing of the dentate nuclei

2C-E didn't turn up on the tox screen until they knew they were looking for it, how many other RCs might they have missed? Can someone more competent with pharmacology comment on the likelihood of 2C-E causing this kind of damage?

 

[cj]

A 26-year-old man with a history of polysubstance abuse, anxiety, and depression was brought to the emergency department after being found unconscious adjacent to an empty bottle of zolpidem.

Im no doctor but if I find a guy unconscious next to an empty pill bottle I would start there and work back. Not to discount the possibility 2c-e killed him but there are tons of variables to consider.

 

[skillet]

the imaging findings of heroin differ from those in this case. With heroin overdose, destruction of cerebellar white matter is frequently seen, along with involvement of the corticospinal tract and sparing of the dentate nuclei

That it might cause brain damage in lethal overdose doesn't say anything about normal use. Like I doubt heroin causes brain damage like that if used occasionally in reasonable doses.

But yeah, the zolpidem was probably a factor! I don't see why they're just talking about 2C-E and ignoring that. Would be nice to get the levels of each...

 

[23536]

a medical critique:

I’m not so sure we can say that 2C-E “likely” specifically contributed to white matter destruction seen on MRI. There are many potential causes of leukoencephalopathy, including hypoxia, heroin, cocaine, benzodiazepines, ethanol, and toluene. Hypoxia would seem a likely culprit in this patient. The case description gives no indication of his respiratory status or oxygenation prehospital or on arrival. The authors argue that the specific MRI findings do not suggest hypoxia. I can’t authoritatively evaluate that claim, but nevertheless find it unconvincing, although it is interesting to note that a previous case report from Germany described a case of leukoencephalopathy after (very loosely documented) ingestion of ecstasy, with a very similar-looking MRI.

http://www.thepoisonreview.com/2012/10/23/4880/

 

[Vader]

They seem to spend an inordinate amount of time talking about the availability and legality of 2C-E and about the existence of sites like BL, which hardly seems relevant (or at least not proportionally to the amount of discussion it receives):

Recreational drugs, particularly hallucinogenic substances, appear to be growing in popularity, with increasing amounts of information available via the Internet to entice potential users. In addition, some newer “designer” psychoactive substances are available for purchase online without adverse legal consequences, therefore adding to their popularity.

2C-E (“Europa”) is a new recreational psychoactive drug related to MDMA (“ecstasy”) that has grown recently in popularity as an alternative to other psychoactive drugs due in part to its ease of legal acquisition via the Internet. Currently, there are social media websites devoted to creating and fostering experimentation with new ways of ingesting 2C-E and describing the resulting “trips” for prospective users (2).

2C-E or “Europa” is known chemically as 2,5-dimethoxy-4-ethylphenethylamine. Like its analogs, 2C-E causes auditory, visual, and temporal distortions, which are often user dependent and related to both mood and location. Use is via inhalation or ingestion concomitantly with other substances. It is not yet considered explicitly illegal in the United States, as it is in Europe (3); therefore, it is available for order on the Internet, where it is listed as a “research chemical.” However, it may be considered an analog to other psychoactive amines that are scheduled by the Drug Enforcement Agency (DEA), and as such prosecution may be possible for sale or possession with intent for consumption under the Federal Analog Act. Due to the increasing availability of these substances on the Internet, the DEA launched Operation Web Tryp in 2004, which targets individuals and companies illegally selling phenethylamines (3). Nevertheless, since it is not scheduled, websites often sell 2C-E through a loophole by labeling it “not for human consumption.”

Ulterior motive?