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Publication Type: Safety Notice
Single or Multiple Incident: Multiple
Date: 7/2/2021 12:00:00 AM
Country: Australia
This alert addresses the use of an illicit substance thought to be 3,4-Methylenedioxymethamphetamine (MDMA), also known as Ecstasy or Molly, but which actually contained a hallucinogenic and stimulant drug, 25C-NBOMe or phenyethylamine. The latter can produce mild to severe toxicity including multiorgan failure. The alert provides clinical manifestations of NBOMe use and case management guidelines for identifying and treating NBOMe toxicity following MDMA use.

Additional Details

Medication/Gas/Fluid:
illicit drugs, 3,4-Methyl​enedioxy​methamphetamine, Ecstasy, Molly, E, NBOMes, phenethylamine, stimulant, amphetamine, 4-fluoroamphetamine, hallucinogenic, sedative, benzodiazepine

Rules / Policies / Procedures
  1. Have a high index of suspicion for NBOMes in patients who develop hallucinations, mydriasis and severe agitation following MDMA use.
  2. The mainstay of management includes supportive care to prevent multiorgan dysfunction, and control of behavioural disturbance to prevent physical injury.
  3. Use benzodiazepine for agitation, hypertension and seizures. Patients may require high doses for sedation in severe toxicity.
  4. Manage patients with acute severe behavioural disturbance in accordance with local guidelines or NSW Health GL2015_007. (https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2015_007.pdf)
  5. Control hyperthermia by adequate sedation and appropriate external cooling techniques.
Training
  1. Contact the Poisons Information Centre (PIC) on 13 11 26 or local toxicology service for advice on management of severe toxicity, such as hyperthermia or serotonin syndrome (agitation, tachycardia, hyperthermia, tremor, sustained clonus).
  2. Be aware that most Urine Drug Screens do not detect novel hallucinogens such as NBOMes, or 4-fluoroamphetamine.

25C-NBOMe toxicity in patients who used powder thought to be MDMA