A case series of symptomatic patients, including one fatality, following 2-CE exposure [abstract] Abstract uri icon
  • Background: Designer drug use has increased during the last decade. 2C-E is a phenethylamine commonly referred to as Europa that is readily available on the Internet. It is known to produce strong visual hallucinations and has been described as a unique marriage between ecstasy and LSD. We report the first case series of symptomatic patients, including one fatality, after 2C-E use.
    Case Report: Ten symptomatic patients were evaluated and treated in local Emergency Departments after the recreational use of 2C-E. The drug, advertised online as 2C-I, was purchased and then distributed at a party. The patients ranged in age from 16 to 23. The majority of those affected snorted lines but some also ingested the powder; one patient ingested the drug in toilet paper to create a sustained release phenomenon. A 19 year-old male developed significant agitation one hour after snorting the drug and suffered a fatal cardiac arrest. The remaining nine patients were symptomatic. Seven were tachycardic with heart rates ranging from the low 100s to the 170s. Two patients were markedly hypertensive with systolic blood pressures measured in the 220s. All nine demonstrated neurologic symptomatology; one reported experiencing eupohoria while the remaining eight were agitated, delirious, and hallucinating. Five patients required sedation with haloperidol, benzodiazepines, or both; one patient required intubation and sedation with propofol due to agitation.
    Discussion: This is the first reported series of symptomatic patients after 2C-E use. The confiscated drug was confirmed 2C-E by the Bureau of Criminal Apprehension. 2C-E is a member of the 2C family of phenylethylamine compounds of which at least nine are known; they are all characterized by a hydrophobic side chain. These compounds have a reported affinity for 5-HT2 and alpha-adrenergic receptors, and their clinical effects may include agitation, psychosis, tachycardia, hypertension, mydriasis, hyperthermia, rhabdomyolysis, and cardiac arrest. Peak symptoms are typically observed within 60 minutes of use and effects may persist for 6-12 hours. The cornerstone of treatment remains supportive care including fluid resuscitation and liberal administration of benzodiazepines.
    Conclusion: 2C-E, an emerging designer drug, may result in significant morbidity and mortality. Healthcare providers should be aware of this drug and its potential clinical effects so that appropriate and timely management can be provided.

  • publication date
  • 2011
  • Research
  • Drugs and Drug Therapy
  • Emergency Medicine
  • Poisoning
  • Substance Abuse
  • Additional Document Info
  • 49
  • issue
  • 6