Findings of synthetic cathinones in post-mortem toxicology

Synthetic cathinones (SCs) are a group of new psychoactive substances with amphetamine-like effects but generally higher potency. The aim of this study was to assess the incidence and significance of SCs in post-mortem (PM) investigations in Finland, focusing on the three most prevalent substances: α-PVP, α-PHP, and α-PiHP. All PM cases positive for SCs during 2018–2023 were investigated with respect to cause and manner of death, PM blood and urine concentrations, and concomitant use of other drugs of abuse. There were 136 findings of α-PVP, α-PHP, or α-PiHP in 118 death cases, in which the median age at death was 35 years and 82 % were males. Concomitant opioids, stimulants, or sedatives were found in 69–92 % of cases, and cannabis in 39–47 %. In two cases (1.7 %), SCs were the only findings of abused drugs. Thirty-four fatal poisonings (29 %) were identified in which at least one of the three SCs was implicated in the cause of death. The median (range) femoral blood concentrations of α-PVP, α-PHP, and α-PiHP in these poisoning cases were 0.18 (0.03–2.6) mg/L, 0.16 (0.02–0.58) mg/L, and 0.14 (0.03–2.1) mg/L, respectively. α-PVP, α-PHP and α-PiHP were found in 4.0 % of all drug abuse cases and in 2.7 % of all fatal poisonings related to drug abuse, while for amphetamine/methamphetamine, these figures were 44 % and 21 %, respectively. Despite their lower prevalence in PM cases, SCs appear to have similar abuse liability and similar drug use patterns to amphetamine.