Methoxetamine: a novel ketamine analog and growing health-care concern

Clinical Toxicology (2011), Early Online, 1-2
Copyright (c) 2011 Informa Healthcare USA, Inc.
1 ISSN: 1556-3650 print / 1556-9519 online
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2 DOI: 10.3109/15563650.2011.617310
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4 LETTER TO THE EDITOR
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Methoxetamine: a novel ketamine analog and

dopamine reuptake inhibition, although formal pharmacol-
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growing health-care concern
ogy has not yet been determined.
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Oral, insuffl ation, intramuscular, rectal, and intravenous
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have been described as potential routes of methoxetamine
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To the Editor:
administration. 3 Methoxetamine is also easily accessible to
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the public via the Internet. 4,5 We made two attempts to pur-
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Methoxetamine (MXE) is a ketamine congener that is avail-
chase the drug. The fi rst attempt by a leading researcher in
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able from online vendors. We discuss what we believe to be
emerging drugs of abuse failed. The second attempt, made
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the fi rst report of the abuse of this substance in a health-care
by a toxicology fellow with little presence on the Internet,
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setting. We also present the successful analysis of methoxet-
secured the drug from an Internet website. Within 2 weeks,
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amine which can be easily purchased over the Internet.
500 mg methoxetamine arrived via registered mail with
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A 32 year old male with a history of hallucinogenic drug
postmarks indicating the United Kingdom as the source of
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use, presented following methoxetamine injection. Paramed-
distribution. The methoxetamine itself was stored in a 2X2
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ics and police found the patient agitated. The patient admitted
cm silver packing material within the larger envelope. The
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to using methoxetamine, but was unable to provide the dos-
methoxetamine was an odorless, white powder. There was
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age or frequency of administration. He was able to state that
no additional paperwork with the methoxetamine, including
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it was administered intramuscularly prior to his arrival. He
quality assurances, instruction uses, or contact information.
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denied any co-ingestions. On arrival to the ED (Emergency
The total cost was $ 62.00.
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department) his temperature was 37.2 celsius, heart rate 105,

Gas chromatography-mass spectrometry (GC-MS) of the
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blood pressure 140/95, respiration rate 16, oxygen saturation
purchased substance was identifi ed as 2-(3-methoxyphenyl)-
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98% room air. His capillary blood glucose measurement was
2-(ethylamino) cyclohexanone, or methoxetamine. 6 A stan-
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122 mg/dL. He was oriented to name and location only. He
dard institutional alkaline extraction protocol was employed
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would appropriately respond to questions for a brief period,
to determine the GC-MS profi le (The University of Massa-
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but then would appear in a dissociative state. His pupils
chusetts Clinical Toxicology Laboratory; Agilent Technolo-
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were 6 mm and reactive with rotatory nystagmus bilaterally.
gies 5973).
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He was tachycardic with clear lungs sounds bilaterally. His

There are currently no legal restrictions within the United
For personal use only.
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abdomen was soft and non-tender with normal bowel sounds.
States (U.S) prohibiting the purchase or use of methoxet-
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His skin was warm and dry with no rashes. His neurologic
amine (U.S. Drug Enforcement Agency, personal commu-
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exam was normal, including no signs of clonus or rigidity.
nication). Early reports from September 2010 are available
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The complete blood count, basic metabolic panel were all
on bluelight.ru. Used for the dissociative and hallucinogenic
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normal. The salicylate concentration was less than 4 mg/dL
properties, users claim feelings of euphoria and enlighten-
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and acetaminophen concentration was less than 10 mcg/ml.
ment while under the infl uence of methoxetamine: 3
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Serum ethanol level was less than 10 mg/dL. After an 8 h

Although Internet vendors state that methoxetamine is
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observation period, the patient had returned to his baseline
not for human consumption, the drug is clearly used for
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mental status. He stated he purchased the methoxetamine
illicit purposes. 3,7 Methoxetamine, in addition to being eas-
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over the Internet and that this was his fi rst time using this
ily accessible, is also relatively inexpensive, with prices
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substance. He stated he easily ordered the methoxetamine
ranges from $ 7 to $ 270 US dollars for 50 mg to 10 g, respec-
Clinical Toxicology Downloaded from informahealthcare.com by University of Maastricht on 11/09/11
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over the Internet and it was then delivered without incident
tively. 4,5 Methoxetamine is also purported to protect against
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to his home.
urologic pathology, since ketamine has been demonstrated
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Methoxetamine, or 2-(3-methoxyphenyl)-2-(ethylamino)
as a cause of papillary necrosis, although this still requires
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cyclohexanone, is an arylcyclohexylamine congener of ket-
verifi cation. 3 Similar to other substances popularized online
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amine and phencyclidine, or PCP. 1 Thought to be initially
(i.e. K2, bath salts, and benzofury), the ease of methoxet-
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synthesized by an underground chemist to treat chronic pain,
amine accessibility via the Internet and the dissemination
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methoxetamine is likely manufactured in China before ship-
of information with regards to use are located on numer-
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ment to the UK for general distribution. 2 The mechanism
ous websites. 3,7 This provides the framework for continued
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of action likely involves NMDA receptor blockade and
nationwide abuse potential of this novel xenobiotic.
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Received 15 August 2011 ; accepted 21 August 2011
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Address correspondence to Dr. Jeanine Ward MD PhD, University of
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Massachusetts Medical School, Emergency Department, 55 Lake Ave
58 North, Worcester, 01655 United States. E-mail: jward4654@gmail.com
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1

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2 Letter to the Editor
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We are concerned that this novel medication and its ease

Sean Rhyee, Jason Plansky, Edward Boyer 59
2 of accessibility to the public presents a new healthcare threat.

University of Massachusetts Medical School, Emergency 60
3 These issues range from increased risk taking behavior of
Medicine, 55 Lake Avenue North, Worcester, United States 61
4 individuals under the infl uence of hallucinogens and disso-
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5 ciatives, as well as the increased risk of intravenous drug use
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6 infections, namely HIV. Of note, methoxetamine is a medi-
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References
7 cation with no current CSA number or publications listed in
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8 PubMed or Ovid. We are in support of legislation prohibiting
1. Linders J, Furlano DC, Mattson MV, Jacobsen AE, Rice KC. Synthesis 66
9
and preliminary biochemical evaluation of novel derivatives of PCP.
the future importation and use of methoxetamine into the U.S.
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Letters in Drug Design and Discovery 2010; 7:79 - 87.
10 We hope this report will serve to provide information pertain-
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2. Morris H (11-February-2011); Interview with a Ketamine Chemist: or
11 ing to a novel xenobiotic threat to our healthcare colleagues.
to be more precise, an arylcyclohexylamine chemist. Vice Magazine. 69
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Retrieved 2011-5-01.
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13
Jeanine Ward
3. http://www.bluelight.ru.
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4. http://www.nercs.com/methoxetamine.html).

University of Massachusetts Medical School,
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5. http://mxeking.co.uk/shop/catalog/browse?shop_param.
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Emergency Department, 55 Lake Ave North,
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6. http://ewsd.wiv-isp.be/_layouts/viewlsts.aspx.
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Worcester, 01655 United States.
7. http://www.erowid.org/experiences/subs/exp_Methoxetamine_html.
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For personal use only.
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Clinical Toxicology, Early Online, 2011

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