Public alert from the United States.

Purpose: The objective of this announcement is to notify public health and safety, law enforcement, first responders, clinicians, medical examiners and coroners, forensic and clinical laboratory personnel, and all other related communities about new information surrounding the emergent synthetic stimulant N,N-dimethylpentylone. 

Background: Synthetic stimulants are chemically manufactured drugs with sub-classifications based on their structural relation to amphetamine or cathinone. Synthetic stimulants, including substituted cathinone analogues (e.g., eutylone), can retain both stimulant and hallucinogenic properties, and can cause associated health risks. Synthetic stimulants are often prepared and distributed in powder, capsule, or tablet form, and may be sold as “Ecstasy”, “Molly”, or “MDMA” (3,4-methylenedioxymethamphetamine) on recreational drug markets. In the United States (U.S.), synthetic stimulants have been associated with adverse effects and linked to cardiac effects resulting  n death. Adverse effects can include hyperthermia, dehydration, arrhythmias, hallucinations, and serotonin syndrome.

Summary: In 2020 and 2021, the substituted cathinone eutylone was the most commonly encountered synthetic stimulant to appear in forensic casework, despite the drug being considered federally scheduled as an isomer of pentylone since March 2017 according to the U.S. Drug Enforcement Administration (DEA). In September 2021, eutylone was recommended for international control. It is this notice that likely created a shift in the NPS drug market, which would later be noted by declining eutylone positivity and increasing N,N-dimethylpentylone positivity. N,N-Dimethylpentylone was first identified in toxicology samples in the U.S. in Q3 2021, marking the initial insurgence of this drug into the supply and the beginning of its proliferation. To date, N,N-dimethylpentylone has been identified in 32 toxicology cases, including antemortem and postmortem investigations, in addition to drug material cases. N,N-Dimethylpentylone is not explicitly scheduled in the U.S.; however, it could be considered an isomer of N-ethyl pentylone (Schedule I). Of note, pentylone is a metabolite of N,N-dimethylpentylone