Prevalence of 3,4-Methylenedioxy-α-Pyrrolidinohexanophenone (3,4-MDPHP) in 465 Suspected Intoxication Cases and Cross-Reactivity Evaluation in an Ecstasy Immunoassay.

BACKGROUND

The rise of synthetic cathinones (SC), and in particular 3,4-MDPHP (3,4-methylenedioxy-α-pyrrolidinohexanophenone), is a concerning health threat. This paper represents the most extensive case series on 3,4-MDPHP suspected intoxications to date, offering a detailed analysis of its impact.

METHODS

This study presents the analytical findings for 108 hospitalized patients who tested positive for 3,4-MDPHP, out of a total of 465 subjects admitted for suspected new psychoactive substances (NPS) intoxication. Analyses were performed by GC-MS and LC-MS/MS. The potential cross-reactivity of 3,4-MDPHP with the Syva EMIT II Plus urine ecstasy immunoassay is also investigated.

RESULTS

3,4-MDPHP was detected in 56% of NPS positive cases. A wide range of 3,4-MDPHP concentrations was observed in both blood (1-257 ng/mL) and urine (2-32 250 ng/mL). 3,4-MDPHP was the sole detected substance in 73.1% of cases, while 26.9% involved co-consumption with other drugs of abuse, primarily cocaine. Investigations about 3,4-MDPHP cross-reactivity with Syva EMIT II Plus urine ecstasy demonstrated that unmodified 3,4-MDPHP does not trigger a positive result, but its metabolites seem to be involved in a positive cross-reaction.

CONCLUSION

This study confirms the high prevalence (108/465) of 3,4-MDPHP in NPS related intoxication cases in our cohort. It is essential for clinical laboratories and emergency departments to be aware of the potential cross-reactivity in ecstasy immunoassay, as this may lead to significant diagnostic errors and misinterpretation of results.