Emerging Drugs of Abuse: Synthetic Cannabinoids, Phenylethylamines (2C Drugs), and Synthetic Cathinones

Emerging drugs of abuse include psychostimulants marketed as household products but containing novel psychoactive substances. These products are easily purchased and frequently change composition in response to regulatory pressure. The synthetic cannabinoids, 2C phenylethylamines, and synthetic cathinones are 3 novel psychoactive substance classes that have recently experienced significant growth and market penetration. Synthetic cannabinoids are potent activators of cannabinoid receptors, often sold as “incense”; have evolved from early compounds to the ultrapotent indazole class; and have been associated with many negative health outcomes and deaths. The 2C drugs are highly serotonergic, hallucinogenic phenylethylamines frequently marketed as “LSD”. The “NBOMe” class of 2C drugs has been associated with several case clusters and deaths. The synthetic cathinones possess stimulant and hallucinogenic properties and include the “bath salts” as well as the recent emergence of “flakka,” containing α-pyrrolidinovalerophenone. The cathinones can cause severe agitation and aggression. Although specific assays for these agents exist, they are usually not immediately available to clinicians. Fortunately, toxicity from all of the drugs discussed in this article can be treated by controlling agitation and monitoring for and aggressively treating hyperthermia and end-organ damage.