Acute Intoxications Involving α-Pyrrolidinobutiophenone (α-PBP): Results from the Swedish STRIDA Project

Many new psychoactive substances (NPS) introduced as recreational drugs have been associated with severe intoxication and death. Blood and/or urine samples were collected from intoxicated patients treated at Swedish hospitals that participated in the STRIDA project, a nationawide effort to address the growing problem of NPS. In patients undergoing evaluation for drug overdose, alpha-PBP was identified using liquid chromatography-mass spectrometry. Demographic and clinical data were collected during Poisons Information Centre consultations and retrieved from medical records. From April 2013 to November 2015, 43 patients tested positive for alpha-PBP. However, alpha-PBP was never specifically mentioned during consultation but only confirmed analytically. The alpha-PBP concentrations ranged 2.0-13,200 ng/mL in urine and 2.0-440 ng/mL in serum. The patients were aged 19-57 (mean 34) years, 81% were men, and 73% were known drug addicts. All cases except 1 also involved other NPS and/or classical drugs. MDPV, alpha-PVP, and other pyrovalerone analogues were the most common other NPS (31 cases; 72%). CNS depressants were detected in 28 cases (65%), with benzodiazepines (16 cases) being most frequent. Main clinical characteristics were agitation/anxiety (59%), tachycardia (54%), and hypertension (37%), and 14 patients (33%) required monitoring in the intensive care unit of which 8 were graded as severe intoxications. No fatalities were reported. Patients with intoxication from alpha-PBP resembled those by NPS cathinones MDPV and alpha-PVP. As patients never specifically declared alpha-PBP intake and poly-drug intoxication was common, they may have been unaware of the actual substance taken.