An Impaired Driver Found to be Under the Influence of Methoxetamine.

The popularity of designer drugs has increased over the past few years as users seek new, cheap and sometimes "legal" ways to get high. This case report focuses on a case that happened in the City of Henderson, Nevada, which involved the designer drug methoxetamine. Methoxetamine is a psychoactive compound that is structurally related to ketamine and reported to have similar effects. These effects include analgesia, cardiovascular and respiratory stimulation, and enhanced skeletal muscle tone. Presented here is a case of a 33-year-old female who was pulled over after almost colliding with a marked police motorcycle, causing the police officer to avoid the collision by running onto a pedestrian sidewalk. Upon stopping the vehicle and questioning the passengers, the officer learned that the driver of the vehicle had ingested methoxetamine earlier in the day. After the driver was taken into custody, a blood sample was drawn and sent to the laboratory for analysis. Initial screening of the blood sample showed presumptive positive results for the amphetamine enzyme-linked immunosorbent assay. The next day, a full scan screen of the blood sample was performed using the gas chromatography-mass spectrometry (GC/MS) and methoxetamine and dextromethorphan were detected. Since the laboratory did not have the ability to confirm methoxetamine, the sample was sent to NMS Labs for analysis. The results from NMS Labs showed a methoxetamine concentration of 160 ng/mL. To date, this is the first DUI case in the state of Nevada where methoxetamine was detected and confirmed. A short time after the NMS results were received, a full SWGTOX validation was performed on a new GC/MS method to confirm methoxetamine along with five synthetic cathinone analytes. After the GC/MS analysis validation was complete, the sample was subsequently reanalyzed for methoxetamine in the toxicology laboratory at the Henderson Police Department Forensic Science Laboratory and the result that attained was 151 ng/mL, which was in line with the result from NMS Labs.

Clinicopathologic features of agranulocytosis in the setting of levamisole-tainted cocaine.

Levamisole is a known contaminant of cocaine and, via this route, has been associated with otherwise unexplained agranulocytosis. Levamisole is currently present in the majority of cocaine samples seized by the US Drug Enforcement Agency. We identified 20 cases of unexplained agranulocytosis in our practice locations of Albuquerque, NM, and Vancouver, Canada. Epidemiologic investigation revealed recent or ongoing cocaine use in 14 cases (70%). Certain morphologic features, including circulating plasmacytoid lymphocytes, increased bone marrow plasma cells, and mild megakaryocytic hyperplasia, were associated with the cocaine-exposed group. Of 5 patients tested, 3 (60%) were HLA-B27+ and showed antineutrophil antibodies, consistent with known associations of levamisole-induced agranulocytosis. One patient, who was positive for cocaine and levamisole by toxicology testing, died of infectious complications. Inadvertent consumption of levamisole via cocaine is a severely under-appreciated risk factor for agranulocytosis, and specific laboratory features are suggestive of this etiology.