By Kevin Shanks, D-ABFT-FT

In October, I traveled to the Society of Forensic Toxicologists (SOFT) annual meeting in Denver, CO and was able to present information about the newly emerged substituted cathinone, alpha-PiHP, and its detection in postmortem toxicology cases in Florida. Any applicable details of these postmortem cases were provided by the following offices and we thank them for their contributions to this presentation.

1. District 2 Medical Examiner’s Office, Tallahassee, Florida; Dr. Lisa Flanagan and Dr. Jon Throgmartin

2. District 14 Medical Examiner’s Office, Panama City, Florida; Dr. Jay Radtke

3. District 15 Medical Examiner’s Office, West Palm Beach, Florida; Dr. Catherine Miller and Dr. Heidi Reinhard

We have previously discussed alpha-PiHP on this blog but I’d like to summarize the poster presentation here.

Substituted cathinones, derivatives of the naturally occurring cathinone, are a class of novel psychoactive substances (NPS) that have emerged across the world since the early 2000s and have been implicated in morbidity and mortality.

Alpha-PiHP is a substituted cathinone that is an isomer of the prescription medication pyrovalerone, which is a norepinephrine-dopamine reuptake inhibiting drug that is used as an appetite suppressant and for the treatment of chronic fatigue. Alpha-PiHP was first reported as being a drug sold in Slovenia in 2016 and in the USA in 2018. This compound acts similarly to other classical stimulants such as methamphetamine with pharmacological activity involving the neurotransmitters serotonin, norepinephrine, and dopamine. Reported effects after use of substances such as these include increased alertness, increased energy, euphoria, feelings of well-being, restlessness, and hallucination. Other physiological effects are hyperthermia, tachycardia, hypertension, mydriasis, diaphoresis, dehydration, and hyponatremia.

Due to reports of the recent increase of alpha-PiHP in the US, in December 2022, we added the substance to our scope of comprehensive testing in postmortem blood samples. Qualitative identification of alpha-PiHP was undertaken by a protein precipitation extraction with acetonitrile followed by liquid chromatography with quadrupole time of flight mass spectrometry (LC-QToF-MS) detection. The limit of detection for alpha-PiHP was 5 ng/mL.

For the first five months (01/01/2023 – 06/01/2023), we identified the presence of alpha-PiHP in seven different postmortem blood samples in Florida. It was detected as the sole substance in two cases and was detected alongside fentanyl in three cases and dimethylpentylone/pentylone in two cases. Details were not able to be acquired or published for all cases, but in the three cases where cause of death certification was available, alpha-PiHP was implicated in all three as the drug of toxicological interest.

As with any NPS, it is important that a toxicology laboratory assesses regional and temporal drug trends and prevalence for the locations which submit work to them and adapt their scopes of testing. If a laboratory is not screening for alpha-PiHP, it is possible to miss potentially positive casework.

Please reach out to us if you have any questions regarding this poster, substituted cathinones, alpha-PiHP, or interpretation of results for a case involving alpha-PiHP. We can be reached at 317-759-4869 option 3 or [email protected]. A copy of the poster is available as a PDF file upon request. If you’d like to collaborate on a future presentation or publication, please do not hesitate to reach out to us. We’d love to work with you!