Dear Editor:

Mephedrone (4-Methylmethcathinone) appears to be the new drug of concern, especially in Europe. Its use has also been reported in some states in the United States, but usage is probably more prevalent than reported. It is known by several street names, namely miaow miaow, meow meow, bounce, bath salts, mad cow, and bubbles.[1,5]

It is a drug that was reportedly manufactured in China and is a derivative of cathinone compounds found in khat plants in East Africa. It was first synthesized in 1929, but its popularity started in 2003, and by 2007, mephedrone was available for sale on the internet. By 2010, mephedrone became a very common drug in Europe, especially in the United Kingdom. It has been labeled an illegal drug in most European countries, and in Australia, New Zealand, Canada, and the United States, it is also illegal.[1]

In the United Kingdom, it is the most popular drug behind cannabis, cocaine, and 3-4-methylenedioxymethamphetamine (MDMA, “ecstasy”). It was classified as an illegal drug in the United Kingdom this year.[2,4]

Mephedrone is believed to act by stimulating the release of monoamine neurotransmitters and inhibit their reuptake.[1,3] The drug causes euphoria, sexual stimulation, stimulus-enhanced appreciation for music, and similar effects to cocaine, amphetamines, and MDMA. It also causes hallucinations, anxiety, paranoia and other delusions, seizures, poor concentration, poor short-term memory, teeth grinding, raised blood pressure, dilated pupils, and seizures.[4,2] It can be taken orally, snorted, or intravenously administered. Several deaths from effects of the drug have been reported in Europe, and there has been one confirmed death in the United States.5 It is available in the form of tablets, capsules, or white powder. Snorting is the most common route of drug use, and the intravenous the least used.[3]

The presence of the drug has been detected in Oregon, Illinois, Alabama, and North Dakota. North Dakota recently banned mephedrone.[5,6]

A major concern is that despite its significant prevalence in Europe, shortage of data on the use and patterns of the drug makes health and social interventions in these communities difficult. The other major concern is that more synthetic analogs of cathinone compounds are likely to be synthesized, keeping illegal manufacturing of these drugs a step ahead of government monitoring agencies. Other public health concerns are its increased use among school and college students and its easy accessibility over internet sale sites. It cannot be overstated that interest in research of this drug and its analogs is needed.

1. Wikipedia entry for mephedrone. Accessed December 20, 2010.
2. European Monitoring Centre for Drugs and Drug Addiction and EUROPOL. (2010) Europol–EMCDDA joint report on a new psychoactive substance: 4-methylmethcathinone (mephedrone). European Monitoring Centre for Drugs and Drug Addiction and EUROPOL, Lisbon. http://www.drugsandalcohol.
ie/13130/. Accessed December 20, 2010.
3. Winstock AR, Marsden J, Mitcheson L. BMJ. 2010; 340:c1605.
4. Mephedrone addiction treatment. Private Healthcare UK.
articles/may-2010/mephedrone-addiction-treatment/. Accessed December 20, 2010.
5. 4-methylmethcathinone [Mephedrone, 4-MMC, meow meow, m-CAT, bounce, bubbles, mad cow]. US Department of Justice Drug Enforcement Administration, Office of Diversion Control. http://www.deadiversion.usdoj
.gov/drugs_concern/mephedrone.htm. Accessed December 20, 2010.
6. Snyder B. Mephedrone: The New Ecstasy? Hartford Advocate. June 15, 2010.

With regards,

Adegboyega Oyemade, MD
Board Certified Addiction Psychiatrist, Southern Illinois Healthcare Foundation, Belleville, Illinois