April 9, 2015

Tennessee Poison Center warns against designer drug “N-bomb”

The relatively new synthetic drug 25I-NBOMe, or “N-bomb,” has been associated with the deaths of at least 17 people in the United States since 2010, when it first became available over the Internet, often marketed as “legal” or “natural” LSD.

“The recreational use of synthetic (designer) psychoactive substances with stimulant, euphoric and/or hallucinogenic properties has risen dramatically in recent years,” said Donna Seger, M.D., professor of Clinical Medicine and medical director of the Tennessee Poison Center, located at Vanderbilt University Medical Center.

The NBOMe class of drugs was developed for the very specific medical purpose to map serotonin receptors in the brain, but in recent years it has become one of the most frequently abused novel psychoactive substances, according to the United Nations Office on Drugs and Crime.

NBOMe are sold as blotter paper, powder (loose or within capsules) and liquids. The substances may be ingested, sniffed or inserted into the body rectally or vaginally, Seger said.

“The quality control on these street drugs is nonexistent, and misjudging a dose could lead to significant toxicity,” Seger said. “Some of the symptoms of toxicity may include hypertension, rapid or irregular heartbeat, hyperthermia, dilated pupils, agitation, aggressive behavior, delirium, hallucinations, seizures and even renal failure or coma,” she said.

From a poison control point of view, the goal of treatment is to manage agitation and prevent organ damage. Heavy sedation may be required to calm aggressive or violent patients, and external cooling measures may be needed for patients with hyperthermia, Seger said.

“This is a dangerous drug, it is potentially deadly, and parents, law enforcement, first responders and physicians need to be aware of its existence and its effects.”

The illegal status of classic recreational substances such as cocaine, ecstasy and cannabis has encouraged users and suppliers to seek alternative options in order to evade current drug legislation. These substances are usually created by modification to the molecular structures of existing illicit compounds to produce similar effects but offer the advantages of being less expensive, readily available, likely undetectable by routine drug abuse screens, or having more desirable and potent pharmacological effects. The substances abused frequently change in response to legislative controls and market demands. It is important for health care providers to remain up-to-date on the toxicological effects of these emerging agents.