Fatal intoxication with 3-methyl-N-methylcathinone (3-MMC) and 5-(2-aminopropyl)benzofuran (5-APB)

• We report a fatal case of 3-MMC and 5-APB poisoning in combination with alcohol.
• The clinical manifestations included agitation, seizures, hypertension, tachycardia, hyperthermia and bradycardia.
• Results of toxicological analysis were as follows: 1.6 μg/mL for 3-MMC, 5.6 μg/mL for 5-APB and 1.4 g/L for alcohol.
• Developed methods allow distinguishing between 3-MMC and 4-MMC as well as 5-APB and 6-ABP.

The emergence of a large number of new psychoactive substances (NPSs) in recent years poses a serious problem to clinical and forensic toxicologists. Here we report a patient who administrated ca. 500 mg of 3-MMC (3-methyl-N-methylcathinone) and 400 mg of 5-APB (5-(2-aminopropyl)benzofuran) in combination with 80 g of ethyl alcohol. The clinical manifestations included agitation, seizures, hypertension, tachycardia, hyperthermia and bradycardia. The patient did not recover and died around 4 h after the use of drugs. The cause of death was acute cardiovascular collapse that occurred following mixed intoxication with NPSs and alcohol. Toxicological analysis of post-mortem blood revealed 3-MMC and 5-APB in concentrations of 1.6 μg/mL and 5.6 μg/mL, respectively. Moreover, the serum alcohol concentration was 1.4 g/L in ante-mortem sample collected 1 h after admission to the hospital. This is the first report on blood concentration of 3-MMC and 5-APB in fatal intoxication.