Dangers of Mephedrone Use

Mephedrone (4-methylmethcathinone or 4-methylephedrone) is a drug that is similar in its chemical composition to cathinones, particularly khat, a stimulant substance that is found in the leaves and shoots of the plant Cathulla edullisin Africa. Mephedrone is typically taken orally in the form of tablets, or snorted or injected as a powder. It produces effects that are similar to those produced by stimulants, such as amphetamines, cocaine, and MDMA (ecstasy). In addition to stimulant effects, the drug has been labeled an entactogenic stimulant that produces feelings of enhanced sociability, empathy, and gregariousness. Mephedrone should not be confused with methadone, which is a drug in the class of opiate drugs and an entirely different substance.

Street names for mephedrone include MCAT, meow-meow, M-smack, meph, drone, and bubbles. The substance is categorized as a Schedule I controlled substance by the DEA, designating that it has no accepted medicinal uses in the US and is a significant drug of abuse, which can result in the development of physical dependence.

The substance was first synthesized in 1929, but did not become widely used until the early 2000s (most likely around 2003). Around 2007, it had become available for sale on the Internet, and law enforcement agencies had become aware of its presence.

The drug is often categorized with several other drugs that are collectively known as bath salts. The National Institute on Drug Abuse(NIDA) reports that these are designer drugs that can be synthetically produced in private laboratories. Bath salts may be found under the street names flakka, vanilla sky, white dove, white lightning, and many others. These substances are generally produced overseas in India and China, and there is no regulation regarding their manufacture, making them very dangerous to use.

Who Uses Mephedrone?

According to the DEA, mephedrone is most popular with young male individuals who live in urban environments; however, it is abused by women and older adults as well.

The amount of the drug used by these individuals varies depending on the mode of administration. Individuals who snort the drug typically use 25-75 mg of the drug per dose, but those who take it orally typically use doses ranging from 150 mg to 250 mg. The desired effects of the drug typically occur 15-45 minutes after it has been taken.

The Effects of Mephedrone

There are several research sources that document the effects of using mephedrone and similar substances. The effects include:

• Feelings of euphoria, most likely associated with the substance’s ability to produce the release of the neurotransmitters dopamine and serotonin
• Rapid thoughts or thought acceleration
• Increased feelings of empathy, sociability, and affection (observable effects, but not as powerful as the same effects that are produced by ecstasy)
• Altered sensations of time, such that time seems to be accelerated
• A relaxation of judgment and a loss of inhibitions
• Inflated sense of self and, in some cases, dissociative effects
• Anxiety
• Increased energy levels
• Increased tactile sensations or even spontaneous tactile sensations, such as tingling
• Vibrating vision that occurs when the individual may develop nystagmus-like issues as a result of using the drug
• Teeth clenching, dehydration, and overheating
• Cardiovascular effects that include irregular or rapid heartbeat, vasoconstriction (which can result in high blood pressure), and cardiovascular damage associated with long-term use
• Appetite loss
• Dilated pupils
• Insomnia
• Increased potential for seizure or stroke
• The development of psychological issues, such as depression or psychotic behaviors (e.g., hallucinations and/or delusions)
• Delirium
• Suicidal issues
• Respiratory distress

Long-term use of mephedrone may be associated with an increased potential to develop severe cardiovascular issues, such as stroke or heart attack, or severe neurological issues, such as seizures or swelling in the brain. Individuals may also develop significant cognitive issues that reflect neurological damage, such as issues with attention, memory, and problem-solving.

The use of mephedrone may often occur in context with the use of other drugs, such as alcohol, other stimulants, cannabis productions, and central nervous system depressants. When these drugs are combined, the potential for serious drug interactions becomes a very real danger. There are numerous references in research literature to fatalities associated with mephedrone use or overdose.

Mephedrone and Physical Dependence

There are numerous animal studies that indicate that animals self-administer synthetic cathinones like mephedrone similar to the manner in which they administer highly addictive drug like heroin and cocaine. This indicates that animals most likely develop significant cravings for these drugs once they have been using them. Observational research also indicates that the use of mephedrone is associated with the development of cravings in individuals who take the drug.

Cravings are an important aspect of the development of abuse and substance use disorders. They are associated with anxiety, negative feelings, and satisfaction when an individual gives into them. Cravings help to develop the occasional use of the drug into a formal substance use disorder as a result of both positive and negative reinforcement. Positive reinforcement occurs when repeating a behavior produces desirable effects (e.g., euphoria, feelings of sociability, etc.); negative reinforcement occurs when repeating a behavior alleviates undesirable affects (e.g., stress reduction, anxiety reduction, discomfort, etc.). When a specific drug can activate both of these mechanisms, it can become a significant drug of abuse.

Case study research has indicated that individuals likely develop physical dependence on mephedrone, although there is likely to be quite a bit of individual variability in the withdrawal syndrome associated with the drug. According to the available research, individuals do develop tolerance to the drug. Withdrawal symptoms typically include:

• Severe cravings
• Insomnia
• Irritability, jitteriness, and anxiety
• Potential issues with depression
• Tremors
• Weight loss and reduced appetite
• Cognitive problems that include issues with attention, memory, and judgment
• Psychotic behaviors

In case studies, it appears that the length of the withdrawal process is 1-4 weeks. It is unclear if the withdrawal syndrome associated with mephedrone alone can produce seizures because many individuals who abuse this drug abuse it in conjunction with other drugs, such as alcohol, that are associated with withdrawal symptoms that can produce seizures. Most likely, individuals who develop seizures as a result of the withdrawal syndrome associated with mephedrone abuse engaged in some form of poly-substance abuse.

Treatment for Abuse

There are no medications specifically approved for the treatment of withdrawal from mephedrone. The treatment approach for withdrawal from the drug as well as for treating a substance use disorder associated with mephedrone abuse would follow standard treatment protocols for substance use disorders and would be adjusted based on the needs of the individual. The approach would include:

• Assessment: An initial physical, psychological, and cognitive assessment of the individual should be conducted. This would identify all potential issues that need to be addressed during the individual’s recovery.
• Medical detox: Because discontinuation of the drug is associated with the development of withdrawal symptoms, individuals in recovery would be expected to participate in a physician-assisted withdrawal management program, or medical detox. Individuals experiencing issues with hallucinations would most likely benefit from antipsychotic medications, and most individuals undergoing withdrawal could most likely benefit from benzodiazepines and/or antidepressant medications. Other potential medications could be used to address specific issues. Benzodiazepines would also address any potential issues with seizures that might develop.
• Therapy: Individuals in recovery for any substance abuse issues should become involved in substance use disorder therapy. Most often, the therapy of choice is some form of Cognitive Behavioral Therapy, although other forms of psychotherapy can be used. The individual can participate in group therapy sessions, individual therapy sessions, or a combination of both. Substance use disorder therapy includes elements of psycho-education regarding addictive behaviors, uncovering issues that fueled the substance use/abuse, addressing irrational beliefs, instituting a program of relapse prevention (e.g., dealing with cravings, changing behaviors, etc.), and the development of strategies for continued abstinence and success.
• Social support: In addition to therapy, individuals in recovery require strong social support systems. Getting family members or friends involved in one’s recovery is often essential to overall success. Participation in social support groups, such as 12-Step groups, is often an invaluable component to a successful recovery program.
• Care for co-occurring disorders: Individuals should be treated for any co-occurring psychiatric/psychological issues and serious medical issues that were identified in the assessment.
• Complementary treatments: Any other interventions that would benefit the individual should also be implemented. These interventions would be relevant to the specifics of the individual’s needs and the personal issues involved in the case. They may include physical or occupational therapy, speech therapy, occupational training, tutoring for school, assistance in finding suitable living quarters, case management, etc.

Because successful recovery from a substance use disorder is associated with the length of treatment, individuals would be expected to maintain involvement in some form of treatment-related activity for many months and even years following discontinuation of mephedrone. Often, this involves continued participation in social support groups and periodic checkups with substance use disorder therapists to keep one focused on recovery. Simply discontinuing the drug of choice and completing medical detox is not sufficient to ensure successful recovery.