U.S. Department of Justice

Drug Enforcement Administration

Background, Data and Analysis 

of Synthetic Cathinones: 

Mephedrone (4-MMC), Methylone (MDMC) and 3,4-Methylenedioxypyrovalerone 

(MDPV)

Prepared by 

Office of Diversion Control, Drug and Chemical Evaluation Section

Washington, D.C. 20537

August 2011

Background

The Comprehensive Crime Control Act of 1984 (Pub. L. 98-473), which was signed into 

law on October 12, 1984, amended section 201 of the Controlled Substances Act (CSA) (21 

U.S.C. 811) to give the Attorney General the authority to temporarily place a substance into 

Schedule I of the CSA for one year without regard to the requirements of 21 U.S.C. 811(b) if he 

finds that such action is necessary to avoid imminent hazard to the public safety. 21 U.S.C. 

811(h); 21 CFR 1308.49. If proceedings to control a substance are initiated under 21 U.S.C. 

811(a)(1), the Attorney General may extend the temporary scheduling up to six months. 21 

U.S.C. 811(h)(2). Where the necessary findings are made, a substance may be temporarily 

scheduled if it is not listed in any other schedule under section 202 of the CSA (21 U.S.C. 812) 

or if there is no exemption or approval in effect under section 505 of the Federal Food, Drug, and 

Cosmetic Act (21 U.S.C. 355) for the substance. 21 U.S.C. 811(h)(1). The Attorney General has 

delegated his authority under 21 U.S.C. 811 to the Administrator of the Drug Enforcement 

Administration (DEA). 28 CFR 0.100.

Section 201(h)(4) of the CSA (21 U.S.C. 811(h)(4)) requires the Administrator to notify 

the Secretary of Health and Human Services of her intention to temporarily place a substance 

into Schedule I of the CSA.1 The Administrator has transmitted notice of her intent to place 4-

methyl-N-methylcathinone (mephedrone), 3,4-methylenedioxy-N-methylcathinone (methylone) 

 

1 The Secretary of Health and Human Services has delegated to the Assistant Secretary for Health of the 

Department of Health and Human Services the authority to make domestic drug scheduling 

recommendations.
2

and 3,4-methylenedioxypyrovalerone (MDPV) in Schedule I on a temporary basis to the 

Assistant Secretary by letter dated June 15, 2011. The Assistant Secretary responded to this 

notice by letter dated July 25, 2011, and advised that based on review by the Food and Drug 

Administration (FDA) there are currently no investigational new drug applications (INDs) or 

approved new drug applications (NDAs) for MDPV, mephedrone, or methylone. The Assistant 

Secretary also stated that the Department of Health and Human Services has no objection to the 

temporary placement of MDPV, mephedrone, and methylone into Schedule I of the CSA. DEA 

has taken into consideration the Assistant Secretary‟s comments. As MDPV, mephedrone, and 

methylone are not currently listed in any schedule under the CSA, and as no exemptions or 

approvals are in effect for MDPV, mephedrone, and methylone under section 505 of the Federal 

Food, Drug, and Cosmetic Act (21 U.S.C. 355), DEA believes that the conditions of 21 U.S.C. 

811(h)(1) have been satisfied. Any additional comments submitted by the Assistant Secretary in 

response to this notice, including whether any exemptions or approvals come into effect for the 

substances in question under the Federal Food, Drug, and Cosmetic Act, shall also be taken into 

consideration before a final order is published. 21 U.S.C. 811(h)(4).

To make a finding that placing a substance temporarily into Schedule I of the CSA is 

necessary to avoid an imminent hazard to the public safety, the Administrator is required to 

consider three of the eight factors set forth in section 201(c) of the CSA (21 U.S.C. 811(c)). 

These factors are as follows: the substance‟s history and current pattern of abuse; the scope, 

duration and significance of abuse; and what, if any, risk there is to the public health. 21 U.S.C. 

811(c)(4)-(6). Consideration of these factors includes actual abuse, diversion from legitimate 

channels, and clandestine importation, manufacture, or distribution. 21 U.S.C. 811(h)(3).

A substance meeting the statutory requirements for temporary scheduling (21 U.S.C. 

811(h)(1)) may only be placed in Schedule I. Substances in Schedule I are those that have a high 

potential for abuse, no currently accepted medical use in treatment in the United States, and lack 

accepted safety for use under medical supervision. Available data and information for 

mephedrone, methylone, and MDPV indicate that these three synthetic cathinones have a high 

potential for abuse, no currently accepted medical use in treatment in the United States, and lack 

accepted safety for use under medical supervision.

This review document provides an evaluation of the criteria for this determination for the 

synthetic cathinones mephedrone, methylone, and MDPV, as of August 2011.

Introduction

Mephedrone, methylone, and MDPV are synthetic cathinones (also commonly referred to 

as substituted cathinones or cathinone derivatives) that share many similarities with the Schedule

I stimulants cathinone and methcathinone. Evidence indicates that these synthetic cathinones are 

being abused for their psychoactive properties. These substances are falsely marketed as 

“research chemicals,” “plant food,” or “bath salts.” They are sold at smoke shops, head shops, 

convenience stores, adult book stores, and gas stations and can also be purchased on the Internet. 

The packages of these commercial products usually contain the warning “not for human 

consumption” most likely in an effort to circumvent statutory restrictions for these substances.

Evidence from law enforcement and poison control centers indicates that the abuse of synthetic 
3

cathinones appears to be widespread and is growing. The American Association of Poison 

Control Centers (AAPCC)2reported that, as of July 31, 2011, poison control centers have 

received 4,137 calls relating to human exposures to “bath salts” for this year (AAPCC, 2011). 

These calls were received in poison centers in at least 47 states and the District of Columbia. In 

2009, the National Forensic Laboratory Information System (NFLIS) registered 15 reports from 

8 states containing these three synthetic cathinones.3 However, in 2010, there were 560 reports 

from 29 states related to these substances registered in NFLIS, and from January to March 2011 

there were 391 reports. An additional 435 reports to NFLIS were captured from April to June 

2011 for a total of 826 reports from January to June 2011.4

Mephedrone, methylone, and MDPV have no known medical use in the United States 

and evidence demonstrates that these substances are being abused by individuals as there have 

been reports of emergency room admissions and deaths associated with the abuse of these 

substances. These substances have become a serious drug abuse threat. In light of the above 

information and to protect the public health and safety, DEA is proposing and intends to 

temporarily place these synthetic cathinones in Schedule I of the CSA. Under the CSA, before 

DEA can temporarily schedule a substance, the Administrator must notify the Assistant 

Secretary for Health, delegate of the Secretary of Health and Human Services (HHS), of her 

intentions. In accordance with Section 201(h)(4) of the CSA, the Assistant Secretary for Health 

was notified on June 15, 2011.

To make a finding that placing a substance temporarily into Schedule I of the CSA is 

necessary to avoid an imminent hazard to the public safety, the Administrator is required to 

consider three of the eight factors set forth in section 201(c) of the CSA (21 U.S.C. 811(c)). 

These factors are as follows: the substance‟s history and current pattern of abuse; the scope, 

duration and significance of abuse; and what, if any, risk there is to the public health. Pursuant 

to this action, DEA has reviewed the three factors under the CSA (21 U.S.C. 811(c)(4)-(6))

required for temporary scheduling of mephedrone, methylone, and MDPV.

Synthetic cathinones

Synthetic cathinones are a class of β-ketone amphetamines. Synthetic cathinones include 

but are not limited to mephedrone, methylone, MDPV, butylone, 4-fluoromethcathinone (4-

FMC), 3-fluoromethcathinone (3-FMC), 4-methoxymethcathinone (methedrone), 4-methyl-Nethylcathinone (4-MEC), ethylone, buphedrone, dimethylcathinone, diethylcathinone, and 3,4-

methylenedioxy- -pyrrolidinopentiophenone (MDPBP). Synthetic cathinones, like cathinone, 

methcathinone, and amphetamine, are central nervous system stimulants and have been reported 

to induce subjective effects similar to those induced by Schedule I and II stimulants. 

Consequently, synthetic cathinones are being abused for their stimulant effects. Synthetic 

cathinones are also reported to be abused for their hallucinogenic effects. Like Schedule I and II

 

2 AAPCC is a non-profit, national organization that represents the poison control centers of the United 

States.

3 NFLIS is a DEA sponsored database for seized items analyzed by federal, state, and local forensic 

laboratories.

4 Analyzed on August 24, 2011.
4

stimulants, synthetic cathinones effect monoamine transmission. Synthetic cathinones have been 

shown to bind to monoamine transporters for dopamine, serotonin, and noradrenaline in the brain 

and promote release of these monoamines (Cozzi et al., 1998; Cozzi et al., 1999; Fuwa et al., 

2007; Nagai et al., 2007; Kehr et al., 2011; Sogawa et al., 2011). Increased monoamine 

concentration in the central nervous system is thought to be involved in the stimulant and 

hallucinogenic effects of the phenethylamine class of drugs (Dal Cason et al., 1997).

 

Mephedrone, methylone, and MDPV are the most commonly encountered synthetic 

cathinones. These three substances represent more than 98% (1,401 of 1,429) of the synthetic 

cathinones that have been encountered by law enforcement, as reported to NFLIS. Of all the 

reports (1,429) of synthetic cathinones recorded by NFLIS from January 2009 to June 2011, 55%

(791) were MDPV, 23% (331) were mephedrone, and 20% (279) were methylone.

These three substances have also been identified during screening of individual urine 

samples. Redwood Toxicology Laboratory screened over 2000 urine samples for the following 

14 designer stimulants: amphetamines [3,4-methylenedioxyamphetamine (MDA), MDMA, 3,4-

methylenedioxymethamphetamine (MDEA), methylbenzyldioxolylbutanamine (MBDB)], 

cathinones [(methylone, ethylone, butylone, cathinone, methcathinone, MDPV, mephedrone)]

and designer piperazines [N,N-benzylpiperazine (BZP), 1-(3-trifluoromethylphenyl)-piperazine 

(TFMPP) and 1-(3-chlorophenyl)piperazine (mCPP)] (Rana et al., 2011). Six of these 14 

designer stimulants were detected of which MDPV (88% or 1,760) and methylone (21% or 420) 

were the most common substances detected. The other substances detected were mephedrone, 

butylone, TFMPP, and BZP. A similar study that screened urine samples (209) from attendees 

of a Methadone maintenance program in the Republic of Ireland found that 13.9% (29) of 

samples were positive for mephedrone and 3.3% (7) were positive for methylone (European 

Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 2011; McNamara et al., 2010).

Drug courts have also detected these three synthetic cathinones during mandatory 

periodic drug screens. Drug courts were developed to achieve a reduction in recidivism and 

substance abuse among nonviolent, substance abusing offenders by increasing their likelihood 

for successful rehabilitation through early, continuous, and intense judicially supervised 

treatment, mandatory periodic drug testing, and the use of appropriate sanctions and other 

rehabilitation services. Drug courts analyze specimens from participants for new and existing 

drugs of abuse. Drug courts submitted to DEA 18 reports from the analysis of biological 

specimens which contained synthetic cathinones. Mephedrone was mentioned in 10 of these 

reports, methylone in 5, and MDPV in 7.5 Other substances detected included butylone,

lidocaine, benzocaine, and MDMA. It is possible that drug court participants use synthetic 

cathinones because they believe that these substances are legal and, thus, they can avoid being 

charged with violating their parole by using synthetic cathinones.

At a single United States port of entry, the U.S. Customs and Border Protection (CBP)

has encountered several shipments of products containing mephedrone, methylone, MDPV, or 

other synthetic cathinones, thus indicating the popularity of these three substances. Of 96

synthetic cathinone shipments encountered as of July 2011, 14 contained mephedrone, 42

 

5

Some specimens contain more than one cathinone.
5

contained methylone, 17 contained MDPV, and 10 contained 4-MEC. Other synthetic 

cathinones encountered by CBP were butylone, fluoromethcathinone, and dimethylcathinone. 

Most of the shipments of these synthetic cathinones originated in China or India and were 

destined for delivery throughout the United States such as Arizona, Alaska, Hawaii, Kansas, 

Louisiana, Oklahoma, Oregon, Pennsylvania, Missouri, Virginia, Washington, and West 

Virginia. These encounters of synthetic cathinones through drug screenings and law 

enforcement encounters are indications of the popularity of these substances.

Mephedrone

Mephedrone, also known as m-cat, Meow, and mad cow, is a psychoactive chemical that 

is structurally and pharmacologically similar to the Schedule I and II stimulants cathinone,

methcathinone, MDMA, and methamphetamine. There is no evidence that mephedrone has a

legitimate non-research use and according to HHS there are no approved drug products or new 

drug applications that contain mephedrone. Mephedrone is reported to cause both stimulant and 

hallucinogenic effects. Mephedrone, like Schedule I and II stimulants, increased extracellular 

serotonin and dopamine in rat brain (Bauman et al., 2011; Kehr et al., 2011). Increased 

monoamine concentration in the central nervous system is thought to be involved in stimulant 

and hallucinogenic effects (Dal Cason et al., 1997). Mephedrone, like amphetamine, is a 

locomotor stimulant (Bauman et al., 2011; Kehr et al., 2011). In rats, mephedrone increased 

locomotor activity but the effects were weaker and shorter than that induced by amphetamine.

Because the effects of mephedrone in rats are like that of Schedule I and II stimulants, it is 

expected that mephedrone will have pharmacological effects in humans similar to those of 

Schedule I and II stimulants. Accordingly, the effects of mephedrone have been reported to be 

similar to that of cocaine and amphetamine.

Methylone

Research in anti-depressant and anti-parkinson agents resulted in the development and 

patenting of methylone in 1996 (Jacob and Shulgin, 1996). However, there is no evidence that 

methylone has a legitimate non-research use and according to HHS there are no approved drug 

products or new drug applications that contain methylone. Methylone has been demonstrated to 

increase serotonin release and to inhibit serotonin and dopamine reuptake in rat brain 

synaptosomes and in cells expressing the dopamine transporter (DAT), norepinephrine 

transporter (NET), and the serotonin transporter (SERT) (Cozzi et al., 1998; Cozzi et al., 1999; 

Nagai et al., 2007; Sogawa et al., 2011). Like methamphetamine and MDMA, methylone 

elicited the release of dopamine, norepinephrine and serotonin from cells expressing the DAT, 

NET, and SERT (Sogawa et al., 2011). Methylone, similar to MDMA, also increased 

extracellular serotonin and dopamine in rat brain (Bauman et al., 2011). Increased monoamine 

concentration in the central nervous system is thought to be involved in stimulant and 

hallucinogenic effects of the phenethylamine class of drugs (Dal Cason et al., 1997). In drug 

discrimination assays, methylone substituted for MDMA and amphetamine, which suggests that 

methylone will likely produce subjective effects in humans similar to these substances and have 

a similar pattern of abuse (Dal Cason et al., 1997; Balster and Bigelow, 2003). Studies also 

showed methylone to be a weak locomotor stimulant (Bauman et al., 2011).
6

Little is known about the mechanism of methylone-induced toxicity, but studies show

that methylone can be cytotoxic with liver cells as possible targets of the methylone-induced 

cytotoxicity. Incubation of hepatocytes (liver cells) with methylone or MDMA caused cell death 

(Nakagawa et al., 2009). In addition, high concentrations of methylone induced the release of 

lactate dehydrogenase (LDH), an indication of decreased cell viability (Sogawa et al., 2011). 

Although methylone was not toxic to cells at concentrations that were cytotoxic by 

methamphetamine, methylone in combination with methamphetamine had a synergistic cytotoxic 

effect on cells. This is important because users have been reported to use synthetic cathinones in 

combination with other drugs of abuse. These data suggest that using methylone alone and in 

combination with other psychoactive substances may cause damage to liver cells. A case of liver 

toxicity was reported in the scientific literature. Boulanger-Gobeil et al. (2011) described a 22-

year-old female who developed rhabdomyolysis (a symptom of liver failure) after ingesting a 

product called “legal ecstasy” which was analyzed to be a mixture of methylone and 

ethcathinone.

MDPV

MDPV is closely related in structure to phenethylamines such as the Schedule I and II 

stimulants methamphetamine, cathinone, and methcathinone. MDPV is also structurally related 

to pyrovalerone, which is a psychoactive drug that was used to treat chronic lethargy and fatigue. 

There is no evidence that MDPV has a legitimate non-research use and according to HHS there 

are no approved drug products or new drug applications that contain MDPV. MDPV and other 

cathinone derivatives (including those which bear ring-group substituents) have been reported to 

induce subjective effects similar to those induced by stimulant drugs of abuse such as cocaine, 

amphetamine, MDMA, and methcathinone. Like other stimulants, MDPV has affinity at the 

dopamine, noradrenaline, and serotonin transporters (Kelly, 2011). Also like methamphetamine 

and MDMA, MDPV increased extracellular levels of dopamine in mice brain, although with less 

potency than these Schedule I and II substances (Fuwa et al., 2007). Increased monoamine 

concentration in the central nervous system is thought to be involved in stimulant and 

hallucinogenic effects of the phenethylamine class of drugs (Dal Cason et al., 1997). 
7

FACTOR 4. ITS HISTORY AND CURRENT PATTERN OF ABUSE

The synthetic cathinones mephedrone, methylone, and MDPV have recently emerged on 

the United States‟ illicit drug market and are being perceived as being „legal‟ alternatives to 

cocaine, methamphetamine, and MDMA. Although synthetic cathinones are new to the United 

States‟ illicit drug market, they have been popular as drugs of abuse in Europe since 2007. 

These substances are falsely marketed as “research chemicals,” “plant food,” or “bath salts.” 

They are sold at smoke shops, head shops, convenience stores, adult book stores, and gas stations 

and can also be purchased on the Internet. These substances are encountered in the form of 

capsules, tablets, and powders. The packages of these commercial products usually contain the 

warning “not for human consumption,” most likely in an effort to circumvent statutory 

restrictions for these substances. Some of the products found to contain synthetic cathinones 

include, but are not limited to: Ivory Wave, Vanilla Sky, Energy 1, Explosion, Tranquility, 

White Rush, Starry Nights, and others.

Drug survey reports suggest that the main users of these and other synthetic cathinones 

are young male adults (Karila et al., 2010; Winstock et al., 2011b; Vardakou et al., 2011). These 

substances are popular with youths in urban environments with males appearing to abuse 

synthetic cathinones more than females. Data also suggest that these substances are used by 

several population groups, such as young adults, mid-to-late adolescents, and older adults 

(Newcombe, 2009; EMCDDA, 2011).

The most common routes of administration of mephedrone, methylone, and MDPV are 

nasal insufflation by snorting the powder and ingestion by swallowing capsules or tablets

(Psychonaut, 2010a, c; Winstock et al., 2011a; EMCDDA, 2011; Kelly, 2011; Vardakou et al., 

2011). The powder can also be injected or swallowed (Schifano et al., 2011; Wood et al., 2009; 

Wood et al., 2010a; EMCDDA et al., 2011). Other methods of intake include rectal 

administration, ingestion by “bombing” (wrapping a dose of powder in a paper wrap and 

swallowing) and intramuscular injection (Newcombe, 2009; Schifano et al., 2011; Psychonaut,

2010a, c; Wood et al., 2010a). Users have reported switching from snorting to swallowing 

because of its painful effects on the nasal membranes (Newcombe, 2009; McElrath and O‟Neill, 

2011). Abusers report that the effects occur a few minutes to 15 minutes after administration, 

depending on the synthetic cathinones and the route of administration, and the effects can last up 

to three hours. Following nasal insufflations of MDPV, onset is reported to be within a few 

minutes with effects lasting for two to three hours (Psychonaut, 2010b; EMCDDA, 2011). 

Following oral or nasal ingestions of mephedrone, users report that desired effects occur 15 to 45 

minutes after administration (Karila et al., 2010; Psychonaut, 2010b; EMCDDA, 2011). 

Following intravenous injections (typical dose reported to be 1⁄2 to 1⁄3 an oral dose) of MDPV, 

effects are reported to last 1 to 15 minutes with an overall duration of approximately 30 minutes 

(EMCDDA, 2011).
8

Users from drug surveys reported that mephedrone, methylone, MDPV, and other 

synthetic cathinones have an effect profile similar to known drugs of abuse like cocaine and 

MDMA. The desired psychoactive effects reported by users include euphoria, general 

stimulation, empathy, enhanced music appreciation, hallucinations, increased insight, elevated 

mood, decreased hostility, improved mental function, and mild sexual stimulation (Psychonaut, 

2010a, b, c; Winstock, 2011b; Measham, 2010; EMCDDA, 2011). If mephedrone is compared 

to cocaine, participants in a survey of readers of a popular UK dance music magazine reported 

that mephedrone gave a better high than cocaine (Winstock, 2011b; EMCDDA, 2011). Another 

survey that was advertised on websites frequented by drug users found that users considered the 

effects of mephedrone to be similar to those of MDMA (Carhart-Harris et al., 2011). This is 

consistent with studies in animals that demonstrated that methylone resembles MDMA in its 

behavioral profile (Dal Cason et al., 1997; Bossong et al., 2005). In rats trained to discriminate 

MDMA from saline, methylone substitutes for MDMA.

Like Schedule I stimulants, mephedrone, methylone, and MDPV cause common 

stimulant-like effects. Stimulant related psychological effects reported by users included 

headache, nausea, palpitation, increased sex drive, excessive sweating, and cold blue fingers 

(Dargan et al., 2010; Winstock et al., 2011a, b). Other adverse effects reported by users include 

bruxism (teeth grinding), paranoia, sore nasal passages, hot flashes, sore mouth/throat, nose 

bleed, suppressed appetite, blurred vision, insomnia, hallucinations, addiction/dependence, 

nausea/vomiting, burns, and blue/cold extremities (Newcombe, 2009; Psychonaut, 2010a, b, c; 

Bajaj et al., 2010; Brunt et al., 2010; Dargan et al., 2010; Wood et al., 2009, 2010a, 2010b, 

EMCDDA, 2011; Regan et al., 2010; Winstock et al., 2011a).

The reported average amount of use of mephedrone, methylone, or MDPV ranged 

extensively (from approximately 25 milligrams – 5 grams) depending on the substance, duration 

of intake, and route of administration. The average amount used for mephedrone ranged from 

0.5 to 4 grams depending on the route of administration and the number of doses taken 

(Newcombe, 2009; James et al., 2010; Schifano et al., 2011; Winstock et al., 2011b). According 

to self-reported drug users, the amounts for snorting mephedrone ranged from 25 – 75 

milligrams whereas for oral administration it ranged from 150 to 250 milligrams (Schifano et al. 

2011). The typical oral dose reported for methylone ranged from 100 – 250 mg (Kelly, 2010). 

The dosage for snorting MDPV ranges from as little as 25 milligrams to as high as 5 grams 

(ACMD, 2010; Psychonaut, 2010b, c; Durham, 2011).
9

A number of users of mephedrone, methylone, MDPV, and other synthetic cathinones 

report using these substances monthly or less often. In a 2009 survey of approximately 947 

mephedrone users, the majority (69.7%) of users reported consuming mephedrone monthly or 

less often (Winstock et al., 2011b). Some users (15.1%) reported weekly or more frequent 

consumption of mephedrone and 15.2% reported use every two weeks. In another survey,

regular users of drugs including mephedrone reported initially using mephedrone occasionally, 

but the participants in the study reported quickly progressing to weekend use (Newcombe, 2009). 

There is some evidence of daily use of synthetic cathinones (Dargan et al., 2010; EMCDDA, 

2011). In a survey of 1,006 school and college students in Scotland, over 20% (205) reported 

using mephedrone weekly whereas 4.4% (44) reported using mephedrone on a daily basis 

(Dargan et al., 2010). Synthetic cathinones have also been reported to be used in binges 

(Newcombe, 2009; Bajaj et al., 2010; EMCDDA, 2011; Schifano et al., 2011). A young 

professional male who needed inpatient treatment reported binging twice-weekly on 4 to 5 grams

of mephedrone orally (Bajaj et al., 2010). Re-dosing (up to 200 milligrams for MDPV and 4 

grams for mephedrone) has been reported by users of MDPV and mephedrone (Psychonaut 

2010a; Psychonaut 2010c). Abusers also reported that typical sessions using mephedrone lasted

approximately 10.4 hours with some individuals administering several times throughout a 

session (Winstock et al., 2011b). Because of the short duration of action of synthetic cathinones 

like mephedrone, one possible reason for binging may be to prolong the duration of effects

(ACMD, 2010; Schifano et al., 2011). Accordingly, readers of a popular UK dance music 

magazine who used drugs including mephedrone reported in a survey that mephedrone had a

short duration of action and an urge to use that was similar to that of cocaine (Winstock, 2011b).

Mephedrone, methylone, and MDPV are often co-ingested with other substances 

(Newcombe, 2009; Debruyne et al., 2010; EMCDDA, 2011; Kriikku et al., 2011; Vardakou et 

al., 2011). Some co-ingested drugs are used to either heighten the effects or ameliorate the 

come-down effects of the synthetic cathinones (Newcombe, 2009; Vardakou et al., 2011). Coingestions can be from the ingestion of multiple products separately or a single product that is 

composed of multiple substances (e.g., one tablet containing both MDPV and BZP). Substances 

reported to have been used in combination with mephedrone, methylone, or MDPV are: other 

synthetic cathinones (e.g., mephedrone, butylone, fluoromethcathinone, MDPV, etc.), 

pharmaceutical agents (e.g., lidocaine, caffeine, benzocaine, clonazepam, etc.), or other 

recreational substances (e.g., amphetamine, MDMA, cocaine, gamma-butyrolactone (GBL), 

kratom, BZP, and TFMPP) (Newcombe, 2009; EMCDDA, 2011; Vardakou et al., 2011). 

Multiple drug use is confirmed by 1) investigative toxicology reports of drugs screens of drug 

users in which more than one substance was detected and 2) seized and purchased synthetic 

cathinone products in which analyzed data revealed that some products contained multiple

substances.
10

FACTOR 5. THE SCOPE, DURATION, AND SIGNIFICANCE OF ABUSE

The popularity of mephedrone, methylone, MDPV, and other synthetic cathinones as 

recreational drugs has increased since they first appeared on the United States‟ illicit drug 

market. These substances are becoming increasingly prevalent and abused throughout the 

United States. Consequently, there is increasing evidence of their abuse and availability in the 

United States. Possible reasons for the increased abuse of mephedrone, methylone, and MDPV

and other synthetic cathinones may be attributed to their ease of access, price, and legal status. 

An additional explanation that has been provided in response to findings in the European 

designer drug market is that some cathinones are being sold as ecstasy/MDMA (Brunt et al., 

2010; EMCDDA, 2011; Griffiths et al., 2010). Griffiths and colleagues (2010) further stated that 

cathinones are growing in importance as „legal‟ alternatives and end-users are seeking out 

specific substances due to a growing awareness. These substances are readily available from the 

Internet, retail suppliers (e.g., head shops, tobacco shops, convenience stores, adult book stores, 

and gas stations) or street dealers. Law enforcement data indicate that products that contain 

these substances are generally sold in 50 - 500 milligram packets with prices ranging from $25-

$70 per packet and $60-$70 per gram (PACIC, 2011). These substances can also be bought in 

bulk quantities (e.g., 100 g to over 5 kg). Companies located in China and India are primarily 

responsible for the export of these substances. The perceived noncontrolled status of these 

substances may give synthetic cathinones an added appeal (Measham et al., 2010). A web-based 

survey of individuals who visit drug websites found that mephedrone‟s popularity was related to 

its legality (Carhart-Harris et al., 2011).

Surveys suggest a high prevalence of use of mephedrone, methylone, MDPV, and other 

synthetic cathinones. In a 2009 survey of 2,295 clubbers in the United Kingdom, 41.3% (947) of

those surveyed reported ever having used mephedrone, 38.7% (890) reported use of mephedrone 

within the last year and 33.6% (762) reported within the last month (Winstock, 2011b). This is 

comparable with other psychoactive substances ever used by these respondents such as 

amphetamine (51.3% or 1,174) and methamphetamine (5.6% or 129). By comparison, a total of 

10.8% (248) and 1.9% (44) reported ever having used methylone and MDPV, respectively. In a 

2010 survey of 1,006 school and college students in Scotland, 20.3% (205) of those surveyed had 

used mephedrone on at least one occasion (Dargan et al., 2010). In specimens collected for drug 

screens, MDPV and methylone were detected in 88% (1,760) and 21% (420), respectively, of 

urine samples that were analyzed for designer drugs (Rana et al., 2011).

Evidence of the abuse of mephedrone, methylone, and MDPV is confirmed by drug 

courts. Drug court reports have identified these and other synthetic cathinones in specimens 

submitted for testing by drug court participants confirming the use of these substances by 

supposedly former recovering drug users. Drug court reports have identified mephedrone, 

methylone, MDPV, and butylone in specimens submitted for testing by drug court participants.
11

Studies suggest that mephedrone, methylone, MDPV, and other synthetic cathinones may 

be used as an alternative to illicit substances like MDMA and cocaine (EMCDDA, 2011). A 

study analyzing the urine of opioid-dependent patients undergoing opioid substitution treatment 

found nine of thirty-four patients tested positive for MDPV (Ojanperä et al., 2011). In addition, 

surveys found that participants who reported ever having used cocaine, also used mephedrone 

(Carhart-Harris et al., 2011; Winstock, 2011a). Debruyne et al. (2010) described two individuals 

who used mephedrone in place of cocaine. ACMD reported that mephedrone and “Toot” (most 

commonly identified as a mixture of butylone and methylone) were popular among users of 

heroin (ACMD, 2010). In fact, 36% of a survey of mephedrone users (United Kingdom

magazine readers) reported that they now took less cocaine and 63% reported that they took less 

ecstasy since they began using mephedrone (EMCDDA, 2011). Moreover, 46% reported they 

would choose mephedrone over cocaine, and only 26% reported they would take mephedrone 

over ecstasy.

Evidence from law enforcement and poison control centers indicates that the abuse of 

mephedrone, methylone, MDPV, and other substances is widespread and growing. In 2009, 

NFLIS received 15 reports of analyzed seizures from 8 states related to mephedrone, methylone, 

and MDPV. However, in 2010, there were 560 reports of analyzed seizures from 29 states 

related to these substances reported to NFLIS and in the first half of 2011 (January to June 2011) 

there were 826. The Texas Poison Center Network reported an increase in the number of calls 

regarding mephedrone and MDPV since the beginning of 2010 (Forrester, 2011). In January 

2010, there were no calls regarding these substances and only 20 total calls for the entire year of 

2010. However, from January to July 2011, they received 237 calls. The callers ranged in age 

from 15 to 57 and 75.9% (195) of all the callers from January 2010 to April 2011 were male. 

The New Jersey Division of Consumer Affairs reported an increase in the number of cases 

involving “bath salts” (New Jersey Poison Information and Education System (NJPIES), 2011). 

Prior to January 2011, NJPIES received no reports of the use of designer drugs labeled as “bath 

salts.” However, from January 2011 to April 2011, NJPIES received 23 cases of “bath salt” 

exposures. AAPCC reported that, in 2010, poison control centers took 303 calls about synthetic 

cathinones (AAPCC, 2011). As of July 31, 2011, poison control centers have received 4,137

calls relating to these products for this year. These calls were received in poison control centers 

representing at least 47 states and the District of Columbia.

Concerns over the abuse of mephedrone, methylone, MDPV, and other synthetic 

cathinones have prompted many states to control these substances. As of July 15, 2011, thirtythree states have emergency scheduled or enacted legislation placing regulatory controls on some 

or many of the synthetic cathinones. These states include Alabama, Arkansas, Florida, Georgia, 

Hawaii, Idaho, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, 

Mississippi, Missouri, New Jersey, New Mexico, New York, North Carolina, North Dakota, 

Ohio, Oklahoma, Oregon, Pennsylvania, Texas, Tennessee, Utah, Virginia, Washington, West 

Virginia, Wisconsin and Wyoming. In addition, the use of synthetic cathinones by members of 

the U.S. Armed Forces is prohibited.

Abuse of these substances is not limited to the United States. Internationally, several

member countries of the European Union have enacted laws placing controls on the possession 

and/or sale of one or more of these substances (Winstock et al., 2010; EMCDDA, 2011).
12

FACTOR 6. WHAT, IF ANY, RISK THERE IS TO THE PUBLIC HEALTH

Law enforcement, forensic laboratories, and public health officials have reported 

exposure incidents demonstrating the public health risks associated with these synthetic 

cathinones to both individual abusers and the public.

These synthetic cathinones have been reported to cause a number of stimulant-like

adverse effects (ACMD, 2010; Psychonaut, 2010a; Psychonaut, 2010c; EMCDDA, 2011). The 

clinical presentation of intoxication from synthetic cathinones shares some features seen with 

MDMA and stimulants like cocaine. Clinical case reports indicate that these synthetic 

cathinones produce a number of stimulant-like adverse effects such as palpitation, seizure, 

vomiting, sweating, headache, discoloration of the skin, hypertension, tachycardia and hyperreflexia (Wood et al., 2009; Durham, 2011; Frohlich et al, 2011; Vardakou et al., 2011). A 

survey of readers of a popular drug-related magazine on the use, effect profile and abuse liability 

associated with the use of mephedrone reported that the physical effect profile of mephedrone is 

very typical of stimulants (EMCDDA, 2011). Adverse effects associated with consumption of 

these drugs as reported by users include nose-bleeds, bruxism (teeth grinding), paranoia, hot 

flashes, blurred vision, dry mouth/thirst, fast erratic heart-beats, muscular tension in the jaw and 

limbs, headache, agitation, anxiety, tremor, fever and sweating (Newcombe, 2009; Dargan et al., 

2010; Winstock et al, 2011a, b; EMCDDA, 2011; Vardakou et al., 2011). Hyperthermia, a 

serious adverse effect, can lead to metabolic acidosis, rhadomyolysis, renal failure, disseminated 

intravascular coagulation, coma and death. Thus, these serious adverse effects may require visits

to the emergency department (ED).

Consequently, numerous individuals have presented at emergency departments in 

response to exposure incidents. Several cases of acute toxicity have been reported for the 

ingestion of mephedrone or MDPV. Debruyne et al. (2010) reported seven cases in France that 

were related to the abuse of mephedrone and were reported to the Center of Evaluation and 

Information on the Pharmacodependence (Addictovigilance). Wood et al. (2009) reported a case 

of acute toxicity in the United Kingdom after the abuse of mephedrone. A 22-year-old male 

presented to the emergency room with sympathomimetic toxicity after ingesting 200 milligrams

of mephedrone. He developed palpitation, blurred vision, mydriasis, agitation, tachycardia, and 

an elevated body temperature. His symptoms resolved after treatment. Mephedrone was the 

only substance detected in his serum. Nicholson et al. (2010) described the case of a 19-year-old 

Irish male who presented to the emergency room with central crushing chest pain. Clinical tests 

showed myocardial inflammation. He admitted to ingesting plant food that contained

mephedrone. Toxicology screening of biological samples confirmed the presence of 

mephedrone and no other neurostimulant drugs. He was successfully treated and discharged to 

go home five days after his admission. The website for the New Jersey Consumer Affairs, 

www.njconsumeraffairs.gov (2011), reported several cases of emergency room incidents 

involving patients who abused “bath salts.” The Michigan Department of Community Health

reported 25 cases of severe illness and one fatality caused by drugs marketed as “bath salts” 

(MMWR, 2011). Frohlich et al. (2011) described a case of acute liver failure after the ingestion 

of synthetic cathinones. A 28-year-old male suffering from bipolar affective disorder (but 

otherwise healthy) ingested 12 stimulant tablets. Following ingesting he suffered a seizure. He 
13

was transported to the emergency department suffering tachycardia, hypertension, hyperpyrexia, 

and profuse sweating. Rhabdomyolysis, a symptom of liver failure, developed two days after 

ingestion. The liver failure eventually resolved following treatment and the patient was 

discharged into psychiatric care. The pills that the patient had ingested were analyzed and found 

to be MDPV and butylone. In a similar case, a 22-year-old female developed rhabdomyolysis 

after ingesting “legal ecstasy” which was analyzed to be a mixture of methylone and 

ethcathinone (Boulanger-Gobeil et al., 2011). She also suffered from recurrent seizures, severe 

hyponatremia (abnormally high concentration of sodium in the blood), nystagmus (involuntary 

rapid eye movement), hyperreflexia, and bruxism. All her symptoms resolved after treatment 

that required hospitalization. Penders and Gestring (2011) reported three cases of paranoid 

psychotic delirium (presenting as paranoid hallucinatory psychosis) following the alleged abuse 

of “bath salts” containing MDPV. Interestingly, in these three cases of delirium, some memory 

loss was reported during the time of abuse of the “bath salts.” Cases of acute toxicity were also

reported for the ingestion of methylone. Katagi et al. (2010) reported two cases of acute toxicity 

from the confirmed ingestion of methylone. A 19-year-old male was taken to the emergency 

department suffering from dementia after ingesting an unknown amount of methylone powder. 

In the second case, a 29-year-old male was taken to the emergency department suffering from 

acute toxicity after taking an unknown amount of a mixture of methylone and a hallucinogen.

Abusers suspected of driving under the influence of intoxicating substances have been 

found to have positive test results for a synthetic cathinone. Kriikku et al. (2011) reported on the 

prevalence of MDPV use among individuals suspected of driving while under the influence of 

drugs (DUIDs) in Finland. Blood samples from individuals suspected of DUIDs from August 

2009 to August 2010 were screened for the presence of MDPV. Of 3000 samples tested, 259 

were found to be positive for MDPV. Although other drugs were detected in some case samples, 

the authors concluded that MDPV use was a significant problem in DUID cases in Finland. 

DUIDs have also been reported in Ohio. Urine samples from drivers in Ohio suspected of 

driving under the influence of drugs have tested positive for MDPV. In one of the DUID cases

in Ohio reported to DEA, a 31-year-old female hit three parked cars in different locations and 

was unaware that she hit anything. MDPV was confirmed in blood specimen from this driver; 

benzoylecmethylecgonine (a metabolite of cocaine) and fluoxetine were also detected. In 

another incident, a 37-year-old male died when he collided head on with a passenger van. 

Samples from the decedent tested positive for tetrahydrocannabinol (THC), MDPV, and 

methylone. Toxicology screens of drivers suspected of driving under the influence in Maine also 

identified individuals who tested positive for synthetic cathinones. MDPV was confirmed in 

samples from some of these drivers. DUID cases have been reported for mephedrone, 

methylone, and MDPV.

Individuals under the influence of these synthetic cathinones have acted violently and 

unpredictably causing harm, or even death, to themselves or others, including children. In one 

incident, a man shot and killed himself and his wife; police had tried to pull him over for 

speeding but he fled and a police chase ensued. Soon after, the couple‟s 5-year-old son was 

discovered dead at home. “Bath salts” packaging was found on the male decedent and at the 

residence of the decedent. Specimens from the decedents confirmed the presence of MDPV and 

lidocaine. In another incident, officers responded to a domestic disturbance call at a hotel. At 

the hotel, a male and his wife appeared to be in a state of paranoia and the male admitted to the 
14

officers that he and his wife had been snorting “bath salts” which was confirmed to be MDPV by 

laboratory analysis. Officers found several children including a 9-year-old and 3-month-old at 

the site. One of the children appeared to be under the influence of drugs and was transported to 

the emergency department. The parents were issued summons including one for child 

endangering. Rohrig (2011) described the case of a 21-year-old who was struck and killed by a 

van after he ran into oncoming traffic. A witness reported that the decedent was let out on the 

side of a local interstate after he acted wildly and belligerently after ingesting “bath salts” and 

smoking “K2” (a synthetic cannabinoid). MDPV was detected in serum samples from the 

decedent. In another incident, a 26-year-old male shot and killed a deputy who was responding 

to a domestic violence call. Toxicological testing confirmed the presence of MDPV and 

synthetic cannabinoids in specimens from the suspect. Maskell et al. (2011) reported a case of a

17-year-old male who died from injuries sustained in a vehicular collision. While driving on the 

wrong side of the road, he collided head-on with an oncoming car. Mephedrone was detected in 

blood samples from this individual and is suspected to have affected the ability of this person to 

drive. Lusthof et al. (2011) reported a case of extreme agitation and death after the ingestion of 

mephedrone. A 36-year-old man died from substantial blood loss that may have led to 

aggravated heart and blood pressure problems after he was arrested by police for extreme 

agitation. An autopsy revealed high concentrations of mephedrone in the decedent‟s blood and 

urine. Other substances including oxazepam, MDMA, and alcohol were also detected but in 

smaller concentrations. A 21-year-old male committed suicide after snorting “bath salts” 

marketed under the name “Cloud 9.” Family members described the decedent as paranoid before 

he shot and killed himself. A toxicology laboratory report confirmed the presence of MDPV and 

citalopram in specimens from the decedent.

There are at least three reported deaths in which mephedrone, methylone, or MDPV was ruled as 

the cause of death by the medical examiner or after an autopsy. Maskell et al. (2011) described a

death in the United Kingdom that was attributable to mephedrone abuse. A 19-year-old male 

died after taking an unknown amount of mephedrone along with alcohol and MDMA at a party. 

Others at the party described the 19-year-old as being sweaty and acting strangely. Subsequently 

he collapsed. Emergency services were called and he was taken to the hospital but efforts to 

resuscitate him were unsuccessful. Toxicology screens confirmed the presence of mephedrone 

in urine and blood samples from this individual. Mephedrone was considered to be the principal 

cause of death. A medical examiner‟s report described the death of a 23-year-old male from

methylone intoxication. The decedent was walking in and out of traffic and acting belligerently. 

The decedent was detained by law enforcement and transported to the emergency department. 

The decedent had a high temperature and subsequently went into respiratory failure. After 

several attempts to stabilize the decedent, he died. The medical examiner listed the cause of 

death as intoxication by methylone. Wyman et al. (2011) reported the death of a 39-year-old 

male. Family members indicated that the male, who had a history of schizophrenia, depression, 

and drug abuse, had been snorting “bath salts.” The decedent was found dead in his bed. Empty 

jars of “bath salts” (TranQuility and Infinity) and synthetic cannabinoids (Demon and Flame) 

were found in the trash next to the decedent. A toxicological screen detected MDPV distributed 

among multiple tissues, urine and blood samples from the decedent. Other substances detected 

were nicotine, cotinine, pseudoephedrine, m-chlorophenylpiperazine and methylone. The cause 

of death was ruled acute MDPV intoxication.
15

Mephedrone, methylone, and MDPV have also been implicated in drug induced overdose 

deaths. Maskell et al. (2011) reported two deaths that were linked to mephedrone. In the first 

death, a 55-year-old female was found dead in her bed. Multiple drug toxicity (mephedrone and 

methadone) were considered to be the cause of death, because her death was attributed to the 

combined effects of mephedrone and methadone. In the second death, a 49-year-old female died 

after snorting approximately 0.5 grams of mephedrone that she purchased from the Internet. She 

also consumed alcohol and smoked marijuana. A few hours after consuming mephedrone, she 

complained of a sore chest, she vomited, and then she collapsed. She was transported to the 

hospital by emergency services but died despite efforts to resuscitate her. Her death was 

attributed to the adverse effects of mephedrone. A police report described the death of a 29-

year-old female. Emergency personnel responded to a call from the decedent‟s mother that the 

subject was experiencing seizures after taking an unknown substance. The decedent complained 

of hearing things and was acting differently. The decedent was transported to the hospital where 

she later died. A previously described case of a 39-year-old male with psychiatric complications 

where the cause of death was ruled acute MDPV intoxication also had in his system methylone, 

nicotine, cotinine, pseudoephedrine, and m-chlorophenylpiperazine. MDPV and 

diphenhydramine were detected in blood samples taken from the decedent. In another incident, 

the death of a 19-year-old was ruled a complication of acute oxymorphone toxicity with 

alprazolam, ethanol, and mephedrone use as likely contributing factors. The decedent was found 

dead on the fire escape of an apartment building, partially leaning on and over a railing, along 

with another individual who was also deceased.

There are reports that synthetic cathinones are highly addictive (Psychonaut, 2010a). 

Studies show that the abuse of synthetic cathinones can lead to psychological dependence like 

that reported for other stimulant drugs. For example, a young professional male claimed he 

could not stop using mephedrone (Bajaj et al., 2010). He presented to the hospital with transient 

psychosis, hallucination, hypomania and mood disturbances. His symptoms resolved after 

treatment. Additionally, users report a “craving” for some synthetic cathinones, like MDPV and 

mephedrone, leading to high/frequent abuse of these substances (Psychonaut, 2010a, b, c; 

EMCDDA, 2011). A survey of mephedrone users found that for 30% (29 of 100) of users, there 

was evidence of a strong compulsion to use the drug (Winstock et al., 2011a). These individuals 

met the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV dependence criteria. 

Dargan et al. (2010) also reported that one of six users (17.6%) surveyed (college and university

students) reported a strong urge to re-dose.

The manufacturers and retailers who make and sell these products do not fully disclose 

the product ingredients including the active ingredients or the health risks and potential hazards

associated with these products. This lack of information poses significant risk to users who may 

not know what they are purchasing or the risk associated with the abuse of those products. Thus, 

individuals who purchase these products likely have insufficient knowledge of the exact product 

contents. In addition, products may not contain the expected active ingredients. In a study that 

analyzed products offered for sale, there was significant variation in the content of the cathinones 

in one quarter (5 of 20) of the products they purchased and tested (Davies et al., 2010). Another 

study showed that there was poor quality of product information (Schmidt et al., 2010). Of 1,308 

products evaluated, 40% (524) did not list ingredients, 92% (1,202) failed to list any side effects, 

and 86% (1,129) failed to list any warnings about potential interactions with other substances or 
16

medications. Products marketed to contain a specific legal substance may in fact contain a 

different substance. A study by Brandt et al. (2010) showed that 70% of the products analyzed

contained an illicit substance. Since abusers obtain these drugs through unknown sources, the 

purity of these drugs is uncertain, thus presenting another level of risk to users (EMCDDA, 

2011). Thus, the limited knowledge about product content, purity and lack of information about 

product effects pose significant risks to the user.

Available evidence on the overall health and social risks of these synthetic cathinones

indicates that these substances can cause acute health problems, can potentially lead to 

dependency, or can cause death. Acute effects include those typical of a sympathomimetic agent 

including tachycardia, headache, palpitations, agitation, anxiety, mydriasis, tremor, fever or 

sweating and hypertension (Brunt et al., 2010; Wood et al., 2009; James et al., 2010; Wood et al., 

2010b; Wood et al., 2010c; EMCDDA, 2011; Winstock et al., 2011a, b).

Conclusion Regarding 3-Factor Analysis

After a careful review of the scientific literature, Factors 4, 5, and 6, NFLIS, law 

enforcement data and other sources of information, it is evident that mephedrone, methylone, and

MDPV are trafficked and abused and pose a significant public health risk. These drugs have 

become popular among drug abusers for their stimulant and hallucinogenic effects.

DEA has considered the three criteria for placing a substance into Schedule I of the CSA 

(21 U.S.C. 812). The data available and reviewed for 4-methyl-N-methylcathinone 

(mephedrone), 3,4-methylenedioxy-N-methylcathinone (methylone), and 3,4-

methylenedioxypyrovalerone (MDPV) indicate that these substances pose an imminent hazard to 

public safety and health, have no currently accepted medical use in treatment in the United 

States, and are not safe for use under medical supervision.
17

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ReDNet Research Groups. 2011. Mephedrone (4-methylmethcathinone; 'meow meow'): 

chemical, pharmacological and clinical issues. Psychopharmacology (Berl), 214: 593-602.

Shimizu E, Watanabe H, Kojima T, Hagiwara H, Fujisake M, Miyatake R, Hashimoto K, Iyo M. 

2007. Combined intoxication with methylone and 5-MeO-DIPT. Progress in NeuroPsychopharmacology & Biological Psychiatry. 31: 571 – 573.

Schmidt MM, Sharm A, Schifano F, Feinmann C. 2010. “Legal highs” on the net-Evaluation of 

UK-based Websites, products and product information. Forensic Science International, 206: 92-

97.

Sogawa C, Sogawa N, Ohyama K, Kikura-Hanajiri R, Goda Y, Sora I, Kitayama. 2011. 

Methylone and monoamine transporters: Correlation with toxicity. Current Neuropharmacology,

9: 58-62.

Torrance H, Cooper G. 2010. The detection of mephedrone (4-methylmethcathinone) in 4 

fatalities in Scotland. Forensic Science International. 202: e62-e63.

Vardakou I, Pistos C, Spiliopolou. 2011. Drugs for youth via Internet and the example of 

mephedrone. Toxicology Letters, 201: 191-195.

Winstock A, Mitcheson L, Marsden. 2010. Mephedrone: still available and twice the price. The 

Lancet, 376: 1537.

Winstock A, Mitcheson L, Ramsey J, Marsden J. 2011a. Mephedrone: use, subjective effects and 

health risks. Addiction, doi: 10.1111/j.1360-0443.2011.03502.x. 

Winstock AR, Mitcheson LR, Deluca P, Davey Z, Corazza O, Schifano F. 2011b. Mephedrone, 

new kid for the chop? Addiction, 106: 154-161.

Wood DM, Davies S, Puchnarewicz M, Button J, Archer R, Ramsey J, Lee T, Holt DW, Dargan 

PL. 2009. Recreational Use of 4-methylmethcathinone (4-MMC) presenting with 

sympathomimetic toxicity and confirmed by toxicological screening. Clinical Toxicology, 47:

733.

Wood DM, Davies S, Puchnarewicz M, Button J, Archer R, Ovaska H, Ramsey J, Lee T, Holt 

DW, Dargan PL. 2010a. Recreational use of (4-methylmethcathinone, 4-MMC) with associated

sympathomimetic toxicity. Journal of Medical Toxicology, 6: 327–330.
21

Wood DM, Greene SL, Dargan PI. 2010b. Clinical pattern of toxicity associated with the novel 

synthetic cathinones mephedrone. Emergency Medicine Journal, 28: 280-282.

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Forensic Toxicologist (TIAFT). In press
22

Appendix 1

Reports from the Scientific Literature

Case Reports of Fatalities Involving Synthetic Cathinones

1. Torrance and Cooper (2010) reported the death of four Scottish individuals whose blood 

samples tested positive for mephedrone. These fatalities were not attributed to the sole 

use of mephedrone but they can be considered to be evidence of the misuse of 

mephedrone and the subsequent harm they may cause to the user or general public. 

2. Maskell et al. (2011) reported four deaths in the United Kingdom related to mephedrone 

abuse. (1) A 49-year-old female died after snorting approximately 0.5 grams

mephedrone that she purchased from the Internet. She also consumed alcohol and 

smoked marijuana. A few hours after taking mephedrone, she complained of a sore 

chest, vomited, and then collapsed. She was transported to the hospital by emergency 

services but died despite efforts to resuscitate her. Her death was attributed to the 

adverse effects of mephedrone. (2) A 19-year-old male died after taking an unknown 

amount of mephedrone along with alcohol and MDMA at a party. Others at the party 

described the 19-year-old as being sweaty and acting strangely, and subsequently he 

collapsed. Emergency services were called and he was taken to the hospital but efforts to 

resuscitate him were unsuccessful. Toxicology reports confirmed the presence of 

mephedrone in urine and blood samples from this individual. Mephedrone toxicity was 

considered to be the principal cause of death. (3) A 55-year-old female was found dead 

in bed, her death attributed to the combined effects of mephedrone and methadone. 

Multiple drug toxicity (mephedrone and methadone) was considered to be the cause of 

death. (4) A 17-year-old male died from injuries sustained in a vehicular collision. 

While driving on the wrong side of the road he collided head-on with an oncoming car. 

Mephedrone was detected in his blood and is suspected to have affected his ability to 

drive.

3. Dickson et al. (2010) described the case of a 22-year-old male who was found 

unresponsive at his home in Maryland. He was transported to the hospital where he died, 

and a subsequent autopsy revealed heroin and high concentrations of mephedrone. The 

medical examiner reported multiple drug toxicity associated with mephedrone and heroin 

use as the cause of death.

4. Lusthof et al. (2011) described the death of a 36-year-old man from substantial blood loss 

that may have led to aggravated heart and blood pressure problems after he was arrested 

by police for extreme agitation. An autopsy revealed a high concentration of mephedrone 

in the decedent‟s blood and urine. Other substances including oxazepam, MDMA, and

alcohol were also detected but in smaller concentrations. 

Emergency Department Incidents/Visits Involving Synthetic Cathinones

5. Shimizu et al. (2007) reported a case of acute drug intoxication from the ingestion of a 

mixture of methylone and 5-methoxy-N-methyl-N-isopropyltryptamine (5-MeO-MIPT) 

powder. A 27-year-old Japanese male presented to the emergency room after taking 

approximately 200 milligrams of methylone and 5-MeO-MIPT powder by oral ingestion 
23

that he purchased over the Internet. According to the report, the subject was transported 

to the hospital after reportedly acting strangely. At the hospital, the subject had an 

elevated heart rate and blood pressure, while exhibiting dilated pupils and sweating. The 

patient‟s symptoms resolved after five hours of treatment.

6. Debruyne et al. (2010) reported that seven cases in France related to the use of 

mephedrone were reported to the Center of Evaluation and Information on 

Pharmacodependence (Addictovigilance). In one case, a young man was involved in a 

vehicular accident after snorting mephedrone. His blood tested positive for mephedrone. 

In another case, an individual used mephedrone in place of cocaine. 

7. Wood et al. (2009 and 2010a) described a case of toxicity in the United Kingdom. 

Mephedrone was reported to produce sympathomimetic effects in a 22-year-old male

who used it for recreational purposes.

8. Wood et al. (2010b) described 15 patients who presented to the emergency department in 

the United Kingdom following self-reported mephedrone use. These patients presented 

with agitation (53.3%), tachycardia (40%), hypertension (20%) and seizures (20%).

9. Wood et al. (2010c) described reports of acute toxicity associated with seven confirmed 

cases of mephedrone use. The most common symptoms reported in these patients were 

agitation, palpitations, and chest pain. All patients had an elevated heart rate (mean rate 

was 109.1 beats per minute) and blood pressure (mean systolic blood pressure was 153 

mmHg). One patient, a 29-year-old male, died. The coroner determined that the cause of 

death was hypoxic brain injury due to cerebral oedema following ingestion of a 

psychoactive substance. Although no other drugs were detected in specimens from the 

patient, the coroner ruled that it was possible that other drugs may have been used which 

were not detectable at the time the biological specimens were collected. 

10. Nicholson et al. (2010) described a case involving a 19-year-old Irish male who presented 

to the emergency room with central crushing chest pain. Clinical tests showed 

myocardial inflammation. He admitted to ingesting plant food that contained

mephedrone. Toxicology screening of biological samples confirmed the presence of 

mephedrone and no other neurostimulant drugs. He was successfully treated and 

discharged home five days after his admission.

11. New Jersey Consumer Affairs, www.njconsumeraffairs.gov (2011), published a report 

online that described several cases of emergency room incidents involving patients who 

abused designer drugs. Prior to January 2011, no reports regarding the use of designer 

drugs had been received by New Jersey Poison Information and Education System. Since 

January 2011, 23 cases have been reported (NJPIES, 2011). 

12. The Centers for Disease Control and Prevention published a report that describes 25 

cases in Michigan of severe illness and one fatality caused by drugs marketed as “bath 

salts” (MMWR, 2011).

Physiological or Psychological Dependence of Synthetic Cathinones

13. Bajaj et al. (2010) reported a case regarding a young man from the United Kingdom who 

was admitted for treatment after a diagnosis of dependence on stimulants (namely 

mephedrone) with psychosis. The patient stated that he had used mephedrone 

recreationally (~4 - 5 grams) by insufflation or rectal administration for over one year. 
24

After a few months, he suffered from difficulty sleeping, poor appetite, weight loss, and 

auditory and visual hallucinations. He reported that his tolerance to mephedrone 

increased and he needed more to achieve similar effects. He had tried to stop using 

mephedrone but could only manage abstinence for a few weeks. He was treated and 

discharged after four weeks. 

Reports Documenting that Individuals are Using Synthetic Cathinones in Environments 

that Cause Harm to the User or Public

14. Kriikku et al. (2011) described cases involving individuals suspected of DUIDs in 

Finland. Blood samples from individuals suspected of DUIDs from August 2009 to 

August 2010 were screened for the presence of MDPV. Of 3000 samples tested, 259 

were found to be positive for MDPV. The concentration of MDPV ranged from 0.020 –

8.4 mg/L (limit of detection is 0.003 mg/L). Although other drugs may have been 

detected, the authors concluded that MDPV is a significant problem in DUID cases in 

Finland.

Studies on the Use, Effect Profile or Abuse Liability Associated with the Use of Synthetic 

Cathinones

15. Carhart-Harris et al., 2011. Drug and Alcohol Dependence, 

doi:10.1016/j.drugalcdep.2011.02.011.

16. Dargan et al., 2010. QJM: An International Journal of Medicine, 103: 875-879.

17. EMCDDA, 2011. Luxembourg: Publications Office of the European Union, doi: 

10.2810/40800.

18. James et al., 2010. Emerging Medicine Journal, 28: 686-689.

19. McNamara et al., 2010. Irish Medical Journal, 103: 134-137.

20. Measham et al., 2010. Drugs and Alcohol Today. 10:14-21.

21. Newcombe. 2009. Lifeline Publications and Research, Manchester.

22. Regan et al., 2010. Emerging Medicine Journal, 2010 Dec 23. doi: 

10.1136/emj.2010.103093. 

23. Vardakou et al., 2011. Toxicology Letters, 201: 191-195.

24. Winstock et al., 2010. Lancet, 376: 1537.

25. Winstock et al., 2011. Addiction, 106: 154-161.

Scientific Literature Detailing Synthetic Cathinone Analyses or Metabolism

26. Jankovics et al., 2011. Forensic Science International, doi: 10.1013/j.forsciint. 

2011.03.019.

27. Maheux et al., 2010. Microgram Journal, 7: 42-49.

28. Camilleri et al., 2010. Forensic Science International, 1997: 59-66.

29. Meyer et al., 2010a. TIAFT Bulletin, 40: 36-37.

30. Meyer et al., 2010b. Analytical and Bioanalytical Chemistry, 397: 1225-1233.
25

31. Awad et al., 2006. Journal of Chromatographic Science, 44: 155-161.

32. Combs, 2010. Journal of the Clandestine Laboratory Investigating Chemists Association, 

20: 2-4.

33. Gibbons and Zloh, 2010. Bioorganic & Medicinal Chemistry Letters, 20: 4135-4139.

34. Meyer and Maurer, 2010. Current Drug Metabolism, 11: 468-482.

35. Ojanpera et al., 2011. Therapeutic Drug Monitor, 33: 257-263.

36. Strano-Rossi et al., 2010. Rapid Communication in Mass Spectrometry, 24: 2706-2714.

37. Yohannan and Bozenko, 2010. Microgram Journal, 7: 12-15.

38. Westphal et al., 2009. Forensic Science International, 190: 1-8.

39. Uchiyama et al., 2008. Yakugaka Zasshi, 128: 1499-1505.

40. Brandt et al., 2010. Drug Testing Analysis, doi: 10.1002/dta.155.

41. Meyer et al, 2010c. TIAFT Bulletin, 40: 38-39.

42. Katagi et al., 2010. TIAFT Bulletin, 40: 30-35.

43. Dal Cason, 1997. Forensic Science International, 87: 9-53.

44. Kamata et al., 2006. Xenobiotica, 36: 709-723.

45. Santali et al., 2011. Journal of Pharmaceutical & Biomedical Analysis, 56: 246-255.

46. Maurer, 2010. Therapeutic Drug Monitoring, 32: 544-549.

Reports from Exposure Incidents

Law Enforcement Reports

1. A police report described the death of a 29-year-old female. Emergency personnel 

responded to a call from the decedent‟s mother that the subject was experiencing seizures 

after taking an unknown substance. The decedent complained to the mother of hearing 

things and was described by the mother as acting different. The decedent was transported 

to the hospital where she later died. MDPV and diphenhydramine were detected in blood 

samples taken from the decedent.

2. The U.S. Customs and Border Protection (CBP) encountered shipments of products 

containing mephedrone, methylone, MDPV, and other synthetic cathinones. Of 96

shipments encountered, 14 were mephedrone, 42 contained methylone, 17 contained

MDPV, and 10 contained 4-MEC. Some of the other synthetic cathinones encountered 

by CBP were butylone, fluoromethcathinone, and dimethylcathinone. Most of these 

shipments originated in China or India and had destinations throughout the United States

such as Arizona, Alaska, Hawaii, Kansas, Louisiana, Oklahoma, Oregon, Pennsylvania, 

Missouri, Virginia, Washington, and West Virginia. A few shipments were destined for 

Great Britain, The Netherlands, and Germany. 

3. The DEA North Central Laboratory received submissions of tablets (66 blue tablets, 37 

purple tablets, and 37 yellow tablets) that were confirmed to contain MDPV and caffeine. 
26

(DEA, 2010, Ecstasy mimic tablets (actually containing 3,4-Methylenedioxypyrovalerone 

(MDPV) and caffeine). Microgram. 43:124)

4. An Ohio police office has submitted 13 cases since January 2011, some describing child 

endangerment, where the presence of MDPV was confirmed by laboratory analysis and 

13 cases where “bath salts” were suspected.

5. The DEA New York Field Division arrested two individuals who sold 35 kilograms of 

MDPV to undercover agents.

6. The Harris County Institute of Forensic Sciences Drug Chemistry Section (Texas)

received submissions of tablets confirmed to contain MDPV, TFMPP, and caffeine. A 

syringe containing MDPV, oxymorphone, methylone, and lidocaine was also seized.

(DEA, 2011, 3,4-Methylenedioxypyrovalerone (MDPV) tablets seized in Houston, 

Texas. Microgram. 44:41)

7. A patrol officer from in Wisconsin described a case involving MDPV: a 22-year-old 

male was arrested for possession of drug paraphernalia and a white powder (suspected to 

be heroin by the arresting patrol officer) that was located in the suspect‟s car. The 

suspect stated that the powder was mephedrone and that he had been “shooting up” 

mephedrone like heroin. The suspect also stated that he paid $40 for one gram and that 

he purchased it from a distributer who bought the product online in large quantities from 

China. Laboratory analysis identified the powder as mephedrone.

8. The DEA South Central Laboratory received a submission of a black zip lock plastic bag 

containing a teal-colored clumpy powder. The substance was identified to be

mephedrone. (DEA, 2011, 4-methylmethcathinone seized in Baton Rouge, Louisiana. 

Microgram. 44:43)

9. The Oregon State Police Bend Forensic Laboratory received submissions of white 

powder referred to as “sunshine” by users. The substance was identified to be 

mephedrone. (DEA, 2009, 4-methylmethcathinone in Oregon. Microgram. 42:62.)

10. The Northeastern Illinois Regional Crime Laboratory received several submissions of 

white powder. The powder in all the submissions was identified to be mephedrone.

(DEA, 2010, 4-methylmethcathinone seized in Mundelein, Illinois. Microgram. 43:31.)

11. The Food and Drug Administration‟s Forensic Chemistry Center received several 

submissions of white powder. The powder in all the submissions was identified to be 

mephedrone. (DEA, 2010, 4-methylmethcathinone (mephedrone) seized in 

Northumberland County, Virginia. Microgram. 43:51.)

12. The State of Michigan Department of State Police submitted a case report of an 

individual arrested for possessing mephedrone as identified by laboratory analysis

(originally suspected to be amphetamine or MDMA). The individual was arrested at his 

residence after a search warrant yielded a white powdery substance and drug related 

paraphernalia. 

13. The Las Vegas Metropolitan Police Department received submissions of 44 illicitly 

manufactured tablets (10 peach and round and imprinted with a trefoil radiation symbol, 

34 red and round and imprinted with the Motorola logo). Laboratory analysis of the 10 

peach tablets identified methamphetamine, methylone, and caffeine. The red tablets were 
27

identified to be methylone and caffeine. (DEA, 2011, Ecstasy mimic tablets (actually 

containing methamphetamine, 3,4-methylenedioxypyrovalerone (MDPV) and caffeine 

seized in Las Vegas, Nevada. Microgram. 44:21)

14. A police report from Minnesota reported two individuals who were arrested for the 

possession of mephedrone (powder and capsule) and a prescription drug. A complaint 

from a mother that her son was selling drugs in the garage was received, and upon 

arriving at the residence officers found two males parked in the driveway of the residence 

where the complaint had originated. When questioned, the two individuals were evasive 

in their answers and gave slightly different versions of their reason for their presence at 

the residence. The individuals were arrested when the officer noticed a small plastic bag 

with a white powdery substance with a sticker that read “White Gold Plant Food 1⁄2 gram”

and 22 clear capsule pills. A field kit test of the powder inside the capsule tested positive 

for the presence of methamphetamine or MDMA. In the course of the arrest, the 

arresting officer noticed that one of the suspects was acting erratic and unable to sit still. 

The suspect also complained that his mouth was dry and asked for water. The officer 

noted that the suspect appeared to be under the influence of a controlled substance.

Product Identification Reports

15. A drug testing laboratory submitted laboratory analysis of the “bath salt” product called 

“Ivory Wave” that was purchased. The product was mixed with a pre-collected sample 

of urine to aid in the analysis of product. Laboratory results identified MDPV in the 

sample. 

16. A manufacturing laboratory analyzed the “bath salt” product called “White Rush.” 

Laboratory analysis by GC/MS detected MDPV and inositol in the product.

Poison Control Centers; Press Releases

17. The Texas Poison Center Network reported that no calls were received in January 2010. 

However, in August 2011, the Texas Poison Center Network received 53 calls. Overall, 

257 calls were received from January 2010 to August 2, 2011 (Forrester, 2011). 

18. The New Jersey Poison Information and Education System received no reports prior to 

January 2011. From January 2011 to April 2011, NJPIES received 23 cases of “bath 

salt” exposures (NJPIES, 2011). 

19. The American Association of Poison Control Centers reported that in 2010, poison 

control centers took 303 calls about synthetic cathinones. As of July 31, 2011, poison 

control centers have received 4,137 calls relating to these products for this year. These 

calls were received in poison control centers representing at least 47 states and the 

District of Columbia (AAPCC, 2011). 

Reports from Medical Examiners or Autopsy Reports

20. The death of a 19-year-old was ruled a result of complications of acute oxymorphone 

toxicity with alprazolam, ethanol, and mephedrone use as likely contributing factors. The 

decedent was found dead on the fire escape of an apartment building, partially leaning 

on/over a railing, along with another individual who was also deceased. 

21. A death of a 39-year-old male was reported by Wyman et al. (2011). Family members 

indicated that the male, who had a history of schizophrenia, depression, and drug abuse, 
28

had been snorting “bath salts.” The subject was found dead in his bed. Empty jars of 

“bath salts” (TranQuility and Infinity) and synthetic cannabinoids (Demon and Flame) 

were found in the trash. A toxicological screen detected MDPV distributed among 

multiple tissues, urine and blood samples from the decedent. Other substances detected 

were nicotine, cotinine, pseudoephedrine, m-chlorophenylpiperazine and methylone. The 

cause of death was ruled acute MDPV intoxication.

22. A 21-year-old male committed suicide after snorting “Cloud 9” bath salts. Family 

members described the decedent as paranoid before he shot and killed himself. A 

toxicology laboratory report confirmed the presence of MDPV and citalopram in 

specimens from the decedent. 

23. The Michigan Department of Community Health reported the death of an individual from 

MDPV. Marijuana and other prescriptions drugs (venlafaxine and desmethylvenlafaxine) 

were also detected. Autopsy results revealed MDPV toxicity to be the primary factor 

contributing to death (MMWR, 2011).

24. A police report described the death of a 23-year-old male suspected of using methylone. 

The decedent was walking in and out of traffic and acting belligerently. The decedent 

was detained by law enforcement and transported to the hospital. The decedent had a 

high temperature and subsequently went into respiratory failure. After several attempts 

by medical personnel to stabilize the decedent, he died. The medical examiner listed the 

cause of death as intoxication by methylone.

Drug Screens

25. Redwood Toxicology Laboratory screened over 2,000 urine samples for 14 designer 

stimulants: amphetamines (MDA, MDMA, MDEA, MBDB), cathinones (methylone, 

ethylone, butylone, cathinone, methcathinone, MDPV, mephedrone) and designer 

piperazines (BZP, TFMPP and mCPP). They detected 6 out of 14 designer stimulants in 

these samples. MDPV (88%) and methylone (21%) were the most common substances 

detected. The other substances detected were mephedrone, butylone, TFMPP, and BZP

(Rana et al., 2011).

26. Drug courts analyze specimens from participants for new and existing drugs of abuse. 

Drug court reports have identified synthetic cathinones in specimens submitted for testing 

by drug court participants. Drug Court reports have identified mephedrone, methylone,

MDPV and butylone in specimens submitted for testing by drug court participants. Of 

the 18 drug court reports received, mephedrone was the most common substance detected 

and MDPV was the second most common substance detected.

Driving while Under the Influence of Drugs (DUIDs)

27. Urine samples from drivers in Ohio suspected of DUIDs have tested positive for MDPV. 

In one DUID case, a 31-year-old female hit three parked cars in different locations and 

was unaware that she hit anything. MDPV was confirmed in blood specimen; 

benzoylecmethylecgonine (a metabolite of cocaine) and fluoxetine were also detected. In 

another case, a 37-year-old male died when he collided head on with a passenger van. 

Samples from the decedent tested positive for THC, MDPV, and methylone.

28. Urine samples from drivers in Maine suspected of DUIDs have tested positive for 

MDPV. MDPV was confirmed in the urine of five individuals suspected of DUIDs. 
29

Other substances detected in some specimens were THC, buprenorphine, cocaine, 

tramadol, mirtazepine, gabapentine, and lorazepam.