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The Analytical Zen Podcast
Biography and Research: See Orcid.org/0000-0001-8344-6582 (presenting 100+ academic works)
Dr. Geraldine M. Dowling PFHEA, SFHEA has over 20 years of experience in forensic lab work, forensic/clinical and analytical toxicology, food safety and drug residue testing, method validation and ISO 17025 laboratory accreditation. She also has more than 10 years in academia as a university educator. She was past elected member of Academic Council at Atlantic Technological University and member of the Universal Design for Learning (UDL) Working Group. Her research spans forensic and clinical toxicology, with a focus on forensic science, medicine, clinical practice, metabolomics, lipidomics, drug testing, drug harm reduction, laboratory accreditation and additionally teaching education pedagogies (universal design for learning and community based learning).
Dr. Dowling is an internationally recognized researcher and gives international lectures. She is a Senior Fellow of the Higher Education Academy (SFHEA), awarded for her excellence in teaching, research and leadership. She is the creator and host of The Analytical Zen Podcast, designed to make complex scientific concepts accessible to students and the public (available on platforms like Spotify, Apple Podcasts).
She serves as Vice Chair of the United Kingdom and Ireland Association of Forensic Toxicologists (professional body), representing forensic practitioners across England, Ireland, Wales, Northern Ireland, Scotland and the Channel Islands. She is also the elected regional representative for Ireland with the International Association of Forensic Toxicologists, a member of the Society of Forensic Toxicologists (USA) and an elected member of the London Toxicology Group Committee.
Dr. Dowling has trained professional staff and students in ISO 17025-accredited national government laboratories in Ireland and abroad, including The State Laboratory, Teagasc and the Marine Institute. She is a Principal Investigator, supervising postgraduate students (PhD/MSc).
Dr. Dowling was an invited contributor to the Irish Government's "Emerging Drug Trends and Drug Checking Working Group", which aims to introduce safer harm-reduction strategies.
She is a contributing author, reviewer and editor for international journals, including Drug Testing and Analysis, Journal of Analytical Toxicology and Forensic Science Review. She has written, edited and co-authored four books.
Dr. Dowling is the current Editor-in-Chief of the IACFT Journal [ISSN 3088-6600] and Outgoing Editor-in-Chief (2026) of the Science Undergraduate Research Experience Journal [ISSN 2990-8167].
She is a Visiting Professor of Toxicology and Forensic Science at Kingston University, holds a Visiting Senior Lecturer appointment (2024) at King’s College London, UK and holds a Honorary Senior Lecturer appointment (2023) at Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK. She previously held an Adjunct Assistant Professor appointment (2020) at Trinity College Dublin.
Dr. Dowling’s work has had a lasting impact, with Ireland’s Marine Institute applying her methods in aquaculture monitoring since 2006 and the U.S. Food and Drug Administration (FDA) adopting her research for drug monitoring since 2011. Her work as Principal Investigator, along with that of the students she supervises, has resulted in multiple validated methods being accredited on several occasions by the Irish National Accreditation Board (INAB) and used nationally. In addition, selected work she developed has been used in international proficiency testing schemes.
The Analytical Zen Podcast
The Chemsex Conversation: Sex, Society and New Psychoactive Substances
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In this thought-provoking episode, Dr. Luis Manuel Menéndez Quintanal joins us to explore the complex intersections between sexual health, substance use and forensic toxicology.
From the science of new psychoactive substances (NPS) to the social and health implications of chemsex, this conversation sheds light on an urgent and often misunderstood topic - blending scientific insight with compassionate harm reduction perspectives.
🔬 Listen now and join the conversation on how science and society can better understand and respond to emerging drug trends.
#Chemsex #NewPsychoactiveSubstances #DrugAwareness #SubstanceUse #SexualHealth #SocietyAndScience #HarmReduction #ForensicScience #Medicine #ForensicToxicology
Setting The Stage: Toxicology Meets Mind-Body
Speaker 1Where we delve into the mind space and explore forensic toxicology, medicine, and health in terms of mind, body, and spirit. I'm your host, Jurgen and Downey. What did you expect in the Analytical Zen podcast? Where we'll dive into cutting-edge research and topics that inspire curiosity, related to forensic and clinical toxicology pursuits, and engage in conversations and perspectives from disciplines outside of these fields.
Guest Intro: Dr. Menéndez Quintanal
Speaker 1We're thrilled to have Dr. Luis Manuel Menendez Quentinal as our guest on the Analytical Zen podcast. Luis earned his degree in chemistry from the University of Oviedo, Spain, when he specialized in organic chemistry between 1998 and 2002. He completed his PhD in chemistry at the Complutense University of Madrid in 2008. Carrying out his doctoral research at the Spanish National Research Council from 2003 to 2008. His research focuses on organic synthesis, particularly radical organic chemistry, where he gained in-depth expertise in chromatographic separation techniques such as gas and liquid chromatography, as well as structural elucidation methods, including mass spectrometry and nuclear magnetic resonance. From 2009 to 2011, Dr. Luz worked as a mass spectrometry specialist at the Institute of Chemical Research in Seville. In 2012, he joined the Laboratory of Chemistry and Drugs at the Canary Islands Department of the Spanish National Institute of Toxicology and Forensic Sciences, where he currently serves as a forensic toxicologist. In this role, he prepares expert reports for judicial proceedings across all the Canary Islands. Dr. Lewis is actively involved in the development of mass spectrometry-based strategies for the detection of new psychoactive substances and their metabolites in biological fluids, particularly in post-mortem investigations and drug facilitated crimes, as he reflected in his recent publications. He's a member of the Spanish Society of Toxicology, the Society of Hair Testing, and the International Association of Forensic Toxicologists. He recently wrote an article in the International Alliance of Clinical and Forensic Toxicologists Gazette entitled New Psychoactive Substances and Chemsex, a European and Spanish Overview with Clinical and Forensic Case Studies from the Canary Islands, and is here to talk to us about it today. Welcome, Lewis.
LuisI have been at pressure to write a paper for the International Alliance of Clinical and Forensic Toxicology, Gazette, and it is an honor as well to have been invited to the TikTok to talk about chemsex and MPS. I think you are doing a great job, pretty knowledge and keeping the clinical and forensic toxicology community up to date on such a wide variety of topics. Before starting, I would like to clarify that I'm speaking today on my own and the opinions I express do not represent the official views or policies of the Spanish National Institute of Toxicology and Forensic Science.
Speaker 1Lewis, thank you for your kind words. For those who may not be familiar with the term chemsex, could you explain what it refers to?
Defining Chemsex: Origins And Scope
LuisFirst of all, a bit of history is needed. In the late 1990s, the term chemsex began to be used among gay men in London to refer to drug use in sexual contests. Groups such as the Chem Sex Club emerged, and the term chemsex gained popularity with the launch of platforms like gaydag.com in 1999. Over time, it spread into healthcare, scientific literature, and the media. Although there is no official definition, we could say that chemsex refers to the intentional use of psychoactive substances during sexual activity, often to increase pleasure, reduce inhibition, or prolonged experience. This practice is mainly reported among men who have sex with men and it carries significant health and social risk, including in the increased vulnerability to sexually transmitted infection, mental health issues, and drug dependency. I would like to highlight that if we are talking about drug use between the heterosexual couples or in another context, then we wouldn't be referring to chem sex. Chem sex specifically refers to the sexualized use of drugs among men who have sex with men. This phenomenon is global and is also known as party and play in the USA and as an intensive sex party in Australia. For example, in Asia, common alternative terms include high fan or chem fam, and the term high and horny is also used globally on mobile dating apps to convey the meaning of chem sex. For example, in Spain we call it a chill, to have a chill. Chemsex session can involve one-on-one interaction with casual or steady partners, threesomes or group sex. It is also important to know that some individuals engage in chem sex while watching pornographic material or interacting with others via webcam. Typically, chem sex sessions take place take place in private homes, but they can also occur in other places such as sauna, sex clubs, hotels, festivals, and christen spots. I hope this has answered your question to have a first idea about chemsex.
Speaker 1Lewis, why is the phenomenon on the rise and why should public health services be concerned about it?
LuisWell, experts believe the rising chemsex is largely driven by digital technologies with the increased use of dating apps and social media platforms, making it easier for people to connect and organize chemsex parties and meetups. Platforms designed for casual sex provide immediately access to partners and often include filters for location, preference, and drug use. These create rapid pathways to chemsense encounters, so we can't talk about certain normalization in media and apps. Chemsex is widely recognized as a high-risk activity due to the involvement of substances that can impair judgment
Digital Platforms And Rising Risk
Luisand reduce inhibition during sexual encounters. Although these effects may enhance pleasure for some, communication can compromise sexual boundaries and consent, increasing the risk of actions that participants may later regret, and it is crucial to recognize the potential of chem sex for chemically facilitated sexual assaults, which can occur either proactively or opportunistically. Another risky problem is the practice now as slamming or slam sex where drugs are injected intravenously during chem sex. This behavior heightens the risk of HIV, monog, hepatitis C, transmission, especially if needles or injection equipment are shared. Although chemsex is associated with pleasure and a sense of freedom, it can mass underlying substance dependency, which may develop into addiction and lead to significant health and social issues. Individuals under the influence of these substances are also more prone to engage in condolent sex, thereby increasing the risk of contracting sexually transmitted infection, including HIV. People often stay because of pressure from others, fear of being excluded, or because they have developed a habit.
Speaker 1Luz, how widespread is this phenomenon in Europe and particularly in Spain?
LuisWell, from a European perspective, the 2024 European Men Who Have Sex With Men Internet Survey gathered responses from over 50,330 participants across 50 European countries and asked participants whether they had engaged in chemsex during the previous four weeks. Prevalence was highest in the Netherlands and Spain, 12% each country, followed by Belgium, 10%, and other European countries such as Portugal, France, Ireland, the UK, Denmark, Iceland, Germany, Latvia, Poland, Austria, Switzerland, and several Balkan countries reported rates between 5 and 10%. Overall, these numbers exceed those reported in a 2070 European survey. It is important to highlight that chemsex was more prevalent among respondents diagnosed with HIV 50% and among those using presposure prophylaxis 12%, compared to those not using antiretroviral medication. Spain is a leading destination for LGTBA tourists where sexual activity is a major motivation for some travelers. According to the 2010 European Internet Survey, Spain ranked first in this regard. The chem sex phenomenon is particularly extended in major cities like Madrid and Barcelona, but it is also present in smaller locations such as Ibiza in the Balearic Island, Sites in Barcelona, in the south Torremolinos, Malaga, and Maspalomas in the Canary Island.
Speaker 1And in your opinion, why should clinical and forensic toxicologists be concerned about this phenomenon?
LuisWell, in chemsex, people often use several drugs at the same time, what we call polydrug use. The most common ones are crystal meth, that's to say methamphetamine, methedron, and GHV or GBL. These substances are used to increase sexual arrosal, lower inhibition, and prolong sexual activity. Other drugs are also common, like MDMA, or ecstasy, poppers, alkinitries, and ketamine. These are often mixed with medication like Viagra or other erectile dysfunction drugs to improve performance. Many chemsex participants are also on antiretrovirals. These include people living with HIV as well as those taking pre-exposure or post-exposure prophylaxis to prevent infection. Because so many drugs are used together, there's a high risk of dangerous interactions, some combinations can be unpredictable or even life-threatening. One of the biggest challenges in chemces is the use of MPS. These are newer synthetic drugs like synthetic cathinons, similar to mephedron, or alerthiclocillamine related to ketamine. There are two major problems with MPS. First, many labs struggle to detect them. And second one, even if we do detect them, it's hard to say what the levels mean, how toxic they are or how they may interact with other drugs. In short, the mix of traditional drugs, MPS, and medication makes chemces a complex and risky situation for both users and health professionals.
Speaker 1Lewis, regarding substance combinations, which ones are you referring to that may pose a serious health risk?
LuisWell, let's look at some dangerous drug combinations that are often
Europe And Spain: Prevalence Snapshot
Luisseen in chem sex and can seriously affect health. The first combination is cocaine and alcohol. When these two are taken together, the liver produces a substance called cocathylene. It makes the high last longer, but it is also more toxic than cocaine alone. It can increase the risk of sudden death by up to 25 times. Another combination is alcohol, DHV, GBL, benzodiazepines, and antidepressants. All of these depress the central nervous system, and when mixed together, they can cause low blood pressure, loss of conscience, slow breathing, or even heart failure. Poppers and erectile dysfunction drugs, what are called PD5 inhibitors, this mix causes strong blood vessel dilatation and it can lead to dangerously low blood pressure, heart attacks or stroke. Erectile dysfunction drugs in combination with cathinomins or amphetamines. This combination affects blood pressure and heart function. Together they can lead to rapid heartbeat, low blood pressure and serious heart problems, even death. Cocaine with cathinums or amphetamines or those last two combined. This will overstimulate the nervous system. The effects can include high blood pressure, overheating, the heat, and high risk of complication. Now we talk about interaction with antiretroviral drugs. Things get even more complicated. Drugs like darunavir, ropinavir, skinavir, and dolutegrave, often taken with retonavir or covicystat, can block enzymes in the liver. These enzymes normally help break down drugs like methamphetamine, memetamine, benzodecipis, and erectile dysfunction medication. And when the enzymes are blocked, these drugs stay in the body longer, increasing the risk of overdose and toxicity. On the other side, we have some antiretrovirals like favidens, travirine, and nevirapine that can increase the activity of TYP3A4. This speeds up the formation of norcocaine, a handful by product of cocaine, which raises the risk of toxicity. All this combination of classic drugs and PS medication create a highly dangerous cocktail with health consequences that are difficult to predict.
Speaker 1Luz, what about the prevalence
Why Toxicologists Should Care
Speaker 1of consumption of all these substances in Kensex in Europe and in Spain? Is there any difference between the profiles of the consumptions?
LuisLet me share with you some data from the European 2070 survey which looked at substance use among men who have sex with men across all Europe. First of all, alcohol was by far the most commonly used substances. And other frequently reported substances included poppers, used by just over 50%, cannabis, 39%, MDMA, about 30%, PD5 inhibitors, used by nearly 29%. Some other drugs had lower but still notable rates, such as cocaine around 20%, amphetamine 14%, ketamine 8%, methedron and other synthetic stimulants, 8%, LSD 7%, methamphetamine 6.5%, synthetic cannabinoids just under 5%, and heroin had the lowest rate at 2%. It is important that there were no major differences between between the European data overall and the numbers specific to Spain. Now keep in mind this data is from 2017. A new version of the European survey was conducted across Europe in 2024, but those results haven't been published yet. We also have more recent data from Spain. For example, a 2021 survey revealed that the use of methadrons, synthetic cathinons and GHB GVL has increased since 2070. In fact, synthetic cathinons and GHV GBL are now the third and fourth most commonly used substances with usage rates of 67 and 66% respectively, just behind alcohol and poppers. A pilot study from the clinic hospital in Barcelona focused on people using pressposual prophylaxis, the most frequent drug combination included cocaine with PD5 inhibitors, ketamine with synthetic acinons and GHB EVL, GHB EVL with methamphetamines and PD five inhibitors, and popper with PD5 inhibitors and cannabis. So recent data suggests both a shift in drug preference and increase in high risk combination, especially among certain groups. So we will be keeping
Deadly Drug Combinations Explained
Luisan eye on the results of the European Survey 2024 over the coming months to see the new trends in substance use.
Speaker 1Luz talking about MPS, what is the relationship between chemsex and MPS?
LuisMPS in chemsex for the same reason they use traditional drugs to feel less inhibited, get a stronger high, and make sexual desire last longer. Now let's look at how changes in the market are affecting chemsex and rigs involved. One big challenge for sex users today is that they often do not know exactly what they are taking. This is especially true with drugs like ketamine, methedron, or methamphetamine. Because of international regulation, these drugs are being replaced on the black market by similar but a slightly altered version now that's structural analogs, that's to say MPS. The problem is these substitutes can have a now or even higher toxicity which has serious health risks. According to data from the European Union Drug Agency, while the number of new synthetic MPS reported is going down, the total amount being seized hasn't dropped. In fact, in 2023, authorities cited 41 tons of MPS across Europe. The two most common substances seized were synthetic cathinons, particularly three chlorometcatinone, which made up 46% of the total, and two methylmetcatinone, which made up 26% of this total. Other substances were Nethylpenthedron, ketamine, and alpha PHIP. When we look at forensic K report, cathinons are often among the most frequently detected substances in KemSis cases. Here, for example, are a few examples of publication from recent years. In 2070, Simon Alar reported four cases of Kensex involving four-methylet catenone, often mixed with cocaine, MDMA, alcohol, and erectile dysfunction drugs. One of these cases resulted in death. In 2019, Alisa Melin reported a fatal chemsease case involving 3-methyl metcatenone and 4-methylhet catenone. In 2020, Lucan Silotti documented a case of acute methadron toxicity in Parma, in Italy. At the same year in France, Nicolas Cartisier reported a fatal overdose involving 4-methylpentadron along with cocaine, sildenaphyll, benzodiazepine, and HIV medication. In 2021, Guillaume Drevin reported the case of the intoxication of a 31-year-old male involving 3-methyl metcatinone and GHV during a slam sex session. In 2022, Rubén Goncalves identified metoxiphenidine in a chemces-related case using hair analysis. And finally, in 2024, Romain Pelletier reported some Eutilon biomarkers of consumption related to chemces cases. Lastly, it's important to point out that GHV
Use Patterns And Shifts Since 2017
Luiscontinues to be one of the most common substances involved in chemces-related death. Because of this, it remains a key focus in toxicology testing for these types of cases.
Speaker 1Lewis, what about your own professional experience? Have you come across any chem sex related cases in your laboratory work within your area of expertise in the Canary Islands? Given that, as you mentioned earlier, Mascolomas is one of the leading gay destinations in Europe. It would be interesting to know whether this has influenced the local prevalence or types of substances detected.
LuisYes. Between 2021 and 2024, we investigated several chemsex related cases, a total of nine, of which seven were postmortem cases, and two involve living individuals treated in collaboration with regional hospital. Among the postmortem cases, we highlight the following. Case number one, a 25-year-old male, was found deceased in a creasing area among the Maspalomas dune in Gran Canaria. At the scene, a bottle of whiskey, a plastic container with a transparent liquid and several empty bottles, were discovered nerve. The autopsy revealed phone and the mouth, phone com, acute pulmonary edema and cerebral hemorrhage. Biological samples, including blood, hearing, vitreous humor, stomach contents, and drug paraphernalia, were collected for toxicological analysis. The transparent liquid in the container was identified as DHV, which guided subsequent testing. Toxicological findings revealed a blood alcohol concentration of 1.67 grams per liter and a DHV level of 412 mg per liter. Urine analysis confirmed the presence of DHV, methedron, ketamine, and or ketamine, while both DHV and methedron were also detected in the stomach content. The elevated concentration of DHV indicated a fatal intoxication, and the cause of death was determined to be respiratory depression, most likely due to the combined depressive effect of alcohol, DHV, and ketamine. In case number two, a 60-year-old man died during a chemsex session after injecting a substance identified as 3-methyl metcatinone. Despite effort to perform CPR technique, he couldn't be revived. GCMS and high-resolution mass spectrometry identified the white powder as a methyl metcatinone, which was further confirmed as 3-methyl metcatinone using a nuclear magnetic resonance experiment. Toxicological findings revealed the presence of 3-methyl metcatinone at a level of 50 nanogram per milliliter along with metoprolol, cidenaphyll and antiretroviral drugs nevirapin and entricitabin in his blood. Although the detective concentration of 3MMC is lower than that reported in other cases, it's important to consider the disease age and the presence of cardiovascular issues, as evidenced by the concomitant
Chemsex And NPS: Market Dynamics
Luispresence of metoprolol. The cause of death was established to be an acute myocardial infarctation due to the toxicity of 3MMC. In case number three, a 59-year-old man was found deceased in his bed and a white powder was discovered on the bedside table. The following day, an optosy was conducted and peripheral blood samples were sent to our lab. The powder was identified as chloromethcatenone using GCMS and hard resolution mass spectrometry. With nuclear magnetic resonance experiments, we confirmed it as 3-chloromethcatinone. Antopsicological analysis revealed 3-chloromethcatinone at a level of 2 nanogram per milliliters and its metabolite dehedro 3 methyl chlorocatenone. And the antidepressive antidepressant cytalopran at 18 nanogram per milliliters and NS methyl cithaloprin at 15 nanogram per milliliters. The low levels of 3 CMC detected were of concern due to the now instability of halogenetic cationons in biological samples, and the cause of death was probably a vasovagal reaction caused by the injection of toxic substances. In case number four, a 63-year-old man died after using poppers and ejecting a substance as reported by his partner. Two serines at a metal pipe were discovered in the trash. The disease had a history of HIV. An optosy conduced the next day revealed anatomical findings of a thermatose plaque in the circumflex coronary artery, 50% of occlusion, an almost complete occlusion of the right coronary artery, and samples of blood, vitreous humor, and urine were collected for toxicological analysis. A liquid chromatographic method using a biphenyl column was employed to separate several cathinone radioisomers. The toxicological results indicated the presence again of 3 chlorometcatinone, amiodarone, and atropine, the later two as a result of resuscitation attempts. These substances were also detected in the vitrous humor and urine. Additionally, metabolites of 3CMC were detected in urine, and the cause of death was determined to be an acute heart failure. In case number 5, a 48-year-old man lost consciousness and died after being found near a Christian area. Despite medical intervention, including the fibrillation, he went into a systole accounts revived. Toxicological analysis detected metabolites of 3CMC, again, specifically dehedro 3CMC, NOR3CMC, and dehedron 3CMC in blood, urine, and vitreo humor, while 3CMC itself was only found in the stomach. This case highlights the importance of targeting metabolites in toxicological investigation, particularly within stable substances like calocathinons, which may degrade and become undetectable. Case number six, a 44-year-old man with a history of polydrug abuse, was found dead in a recruitment sexual setting after using paupers. Toxicological analysis of blood revealed traces of isopropyl alcohol and acetone,
Canary Islands Case Series: Postmortem
Luislikely from popper exposure, as well as amphetamine, methamphetamine, sildenaphyll, and 11-carboxy THC. It should be noted that alkinitrice can interact with PD5 inhibitors, leading to dangerously low blood pressure, while amphetamine derivatives rise it. This can lead to cardiovascular collapse, arrhythmias, and heart failure. This risk is heightened by Hukovic stat inhibition of ison responsible for metabolizing sildenafhyll. And finally, the last postmortem case, case number 7, a 45-year-old man was found deceased in a hotel room during a chemsex session involving stimulant drug use. Biological samples, blood and urine, and drug paraffernalia were collected for toxicological analysis. GCMS and high-resolution mass spectrometry testing of the paraffernalia identify several substances: GVL in droppers, 2 methyl metcatinone, 2 fluorodeschloroketamine, 2FDC key deschloroketamine DC key and ketamine in another container, amyl and pentinitrites, and a commercial erectile dysfunction preparation containing papaverine and fentananamyl that is called scatherapy. While quantification of 2FDC key and DC keys is still pending due to the lack of reference materials, routine to psychological analysis reveals the following concentration in blood: GHV at a level of 22 mg per liter, 2 methyl metinone at a level of 57 nanogram per milliliters, methamphetamine 42 nanogram per milliliters, amphetamine 7 nanogram per milliliter, storketamine 5 nanogram per milliliters. 2FDC key is a ketamine analog with greater lipophilicity due to fluorine substitution in the molecule. It reported by user to have dissociative and anesthetic effects similar to ketamine, but its toxicological profile is not well established. A 2F DC key related poison outbreak in Hong Kong highlighted its potential to cause serious neurological symptoms such as agitation, delirium, seizures, and cardiovascular effects such as hypertension and tachycardia. Despite awaiting quantification for 2FDC key and DC key, the combining presence of multiple central nervous system, depressant, and stimulant strongly suggests that an acute cardia given due to drug interaction led to the individual's death. And we have the living individuals, case number eight. A patient was hospitalized due to severely impaired consciousness, with his partner stating that he had consumed GHV the previous day during sexual activity. The psychological analysis of blood revealed a GHV concentration of 326 mg per liter, along with the diazepan, or diazepan, osacepan, themazepan, and cydenaphyll at various levels. In urine, GHV was found at a much higher concentration, along with again over all 3 chloromethcodinone dehydro 3 CMC an or 3CMC and the rest of substances. And finally, case number 9, a patient was found semiconscious in a dark room of a nightclub suspected of participating in a chemist session involving GHV and POPERS. He was hospitalized. Results revealed the presence of Nethyldeschloroketamine and its metabolites in blood and urine. Also detected were anti-retroviral medication and sedative agents, and urine also showed the presence of two methyl metcatinon and its metabolized dehedro 2 MMC and R2 MMMC. In this case, notably GHV was absent in all samples despite initial clinical suspicion. 2-oxopith, also called N ethyl sclerocetamine, is acid is a dissociative anesthetic drug related to ketamine, but differs by lacking a chlorine atom and having an ethyl group on the amine. Clinically, it can cause confusion, reduce consciousness, erratic behavior, hypertension, tachycardia and seizures. Evidence suggests it is more potent and potentially more toxic than ketamine itself, especially when combined with substances like cathinone or certified. I hope these cases have illustrated the complexities of BS in chemces context, especially when clinical signs and non-specific and standard drug screen fail to detect newer compounds. These highlight the need to detect metabolites using software techniques such as molecular network, as well as specific analytical method and advanced structural elucidation techniques such as nuclear magnetic resonance.
Speaker 1Luz, is it possible then to identify any correlation between the substances found in your case studies and the trends observed in the European market for NPS?
LuisWell, the most frequently detected substances across all presented cases were cationons, specifically 3-chloromethcatinone, 3-methylmetcatinone, and more recently 2 methylmetcatinone. These findings aligned with the 2023 report by the European Drug Agency, which identified 3-chlorometcatinone and 2 methylmetcatinone as the most commonly seized substances. In chemsex sessions, the substances used often vary according to their availability and legal status, reflecting broader trends in the MPS market. For instance, between 2007 and 2009, methedron for methylmetcatinone became popular in Europe due to its MDMA-like effect and as easy online access as a so-called legal high. After widespread use, it was classified as a controlless substance and banned in Spain in 2011. No less methedron remained prevalent in chemsex setting, although not all products marketed as methedron are actually for methylmetcatenone. Following the ban, 3MMC, a positional isomer of 4MC, gained popularity. The European Drug Agency closely monitored 3MMC, which was later internationally regulated and vanished in Spain in 2023. As a result, in the Kemps cases recorded in 2024, substances labeled as methedron are no longer 4-methyl meth metinol or 3-methyl metcatinone, but rather 2-methyl metcatinone, the only remaining regisomer that has not been yet regulated. A similar trend is observed. With chlorinitic cation for C ban in 2021, following by 3 CMC in 2023. It is expected that 2 CMC, which is still unregulated, will begin to emerge in the market. For example, our colleagues in Barcelona have actually started to see an increase in the use of alpha catenons, such as alpha PVP, alpha PHP, and alpha PHIP, in cases across the whole of the Mediterranean area. Ketamine and G and GHB are banned in Spain, but that hasn't stopped them from showing up in the illegal drug market. Ketamine is often diverted from its legitimate use in surgery or veterinary medicine and then sold illegally. More recently, several synthetic versions of ketamine, known as sarylcyclosylamine, like two fluorodescloroketamine, dloroketamine, and two oxopcl or NAFIL deschloroquetamine are being sold as ketamine. This is risky because users may anomally take these substances which can be more dangerous or even lethal. As for DHB, it is usually consumed in the form of GVL. Once GVL enters in the blood, it is quickly converted into GHV. While GHV is banned, GVL is still relatively easy to find on the black market, which makes it use even harder to control. So, as a conclusion to your question, the current trends in the MPS market are observed in our chemces casualty.
Speaker 1Luz, what are your recommendations for addressing chemsex cases from the perspective of a clinical and forensic toxicology laboratory?
LuisWell, from an analytical perspective, chemces cases often involve the use of MPS, making it crucial for labs to maintain up-to-date detection capabilities. As a first step, any paraffarnalia associated with the case should be analyzed promptly, as it can provide valuable orientation for the analysis of biological samples. Investigating powders or liquids found near the body allows for the use of advanced structural elucidation techniques such as nuclear magnetic resonance to accurately determine the composition of the substance involved. Particularly necessary is the case of in the case of alkinitriats, since due to the short half-life in the blood, they quickly disappear after inhalation. Therefore, the volatile alcohol resulting from the degradation such as isopropyl alcohol,
Living Cases And Diagnostic Challenges
Luisisobutyl alcohol, butyl alcohol, and isoamyl alcohol should be sought in the blood. On the other hand, since they cause methymoglobinemia, the percentage of methymoglobin should be measured, although in postmortem cases it's true that this analysis may be affected by postmortem artifact. Certain MPS are known to be unstable in biological matrices and can be degraded or even disappear quickly. Therefore, it is advised to keep samples frozen until analysis to prevent in vitro degradation. In the case of cathinos, it is strongly recommended to include dehedrometabolites in routine analysis as they exhibit greater stability than the parent drug. GHB or GBL analysis is not routinely included in the standard toxicological screening of many labs. However, in cases related to PEMSEX, it is recommended to include their detection due to the high prevalence of these substances among individuals involved in such practices. As an important aspect to consider is the ability of the analytical method to effectively separate positional isomers of MPS, which is especially relevant in the case of synthetic catenons. For instance, while 4-methyl metcatinone and 3-methyl metcatinol are controlless substances, two methyl metcatenol remains unregulated. A similar regulatory pattern is observed with allogenetic catenons such as 4-chlorometcatinone and 3-chlorometcatinone in contrast to 2-chloromethcatinone. Employing a biphenyl colume during liquid chromatographic separation in combination with an optimized grading can facilitate the separation of these isomers. This type of column exploits PP interaction and offers distinct selectivity, making it well suited for differentiating closely related structural analogs such as positional isomers. Analytical methods should incorporate comprehensive and regulatory update spectral libraries that reflect the substances currently circulating in the market. High resolution mass spectrometry using data-dependent acquisition DDA or data-independent acquisition DIA technique enables the application of diagnostic framenion strategies to identify structural motifs characteristic of specific MPS families. Additionally, molecular network proves to be an valuable tool for detecting metabolites, and when combined with neutral loss analysis, it can assist in reconstructing the structure of the parent compound. Overall, the analytical approach should prioritize not only the detection of emerging MPS but also the interabolite. So these are all my recommendations for addressing this type of case from the laboratory perspective.
Speaker 1Thank you, Lewis. And finally, based on your experience, what harm reduction strategies should be prioritized in chemsex-related cases, and what policy measures could be considered to support their implementation?
LuisWell, uh substance use in chem sex has a serious impact on physical, mental, and sexual health. Because of this, we need a comprehensive multidisciplinary approach to care. This should include psychiatric and psychological support, medical care, sexual health services, and even therapeutic leisure activities. There are some warning
Aligning Cases With EU NPS Trends
Luissigns that might show a person needs help. These include things like agitation, psychosis, true breathing, repeated sexual transmitted infection, new diagnosis of HIV or hepatitis C, monkeypox, or mentioning drug use during a consultation. To respond to these issues, public health strategies should take a holistic approach, bringing together professionals from mental health, medicine, addiction services, and sexology. Certain life factors like being diagnosed with HIV, being a migrant, experiencing trauma or loneliness, or having untreated health conditions can make someone more vulnerable to chem sex. Recognizing this risk factor helps in designing more personalized and effective interventions. The types of support available can vary. They may include addiction treatment centers, non-governmental organizations, and specialized service in medicine, psychology, sexology, and social work. For example, in Spain, the NGO Energy Control offers harm reduction services like drug testing and psychosocial support at events. Public health care systems are also work with community-based organizations to provide multidisciplinary treatment, but there are still challenges, like, for example, a lack of professional training and limited access to reliable information. To help prevent harm, targeted programs share pro-educational materials and preventive items in places like sauna, sex clubs, and community centers, and campaigns also reach people through websites, social media, dating apps, and even public spaces on gay, bisexual, and other men who have sex with men. Preventive information is often shared during rapid HIV or sexual transmitted infection testing, whether at clinics, mobile units, or sexual health centers. Some of these have become specialized chem sex reference centers. And finally, we also learn a lot from data from postmortem cases, drug seizures, toxicology reports, police investigation, and the European Union Drug Agency. This information helps track which substances are in circulation in public health decisions and issue alerts as alerts about risky pattern of use. In Spain, for example, all these findings are included in the National Plan on Drugs Annual Reports.
Speaker 1Lewis, as a conclusion to the podcast, considering everything you've shared with us and the cases you see daily in your lab, what do you think we can expect in the coming years regarding NPS and their use in the context of chemsex?
LuisHonestly, uh Geraldine, it's a tough
Lab Playbook: Methods And Metabolites
Luisquestion to answer. However, I believe that despite increasing awareness about the risks of chemsex and drug use, we'll probably see a rise in the use of NPS in this setting. This is largely driven by the partial media, data maps, and the availability of unregulated MPS online. We are already seeing this trend not just in chemsex. For example, there's currently a trend around so called pink cocaine. Many users think they are taking 2CB, but what we are actually finding is that this pink cocaine is often a mix of MDMA and ketamine. And in many cases, that combination is even more dangerous than 2CB itself. We are also starting to see the appearance of MPS in cases related to spiritual retreats where traditional hallucinogenic substances are used, such as scopolamine, bufotenin, psillosine, and dimethyltritamine. In some of these cases, we have detected substances like 1 cyctopil LSD, 5 metoxidimethyltritamine, and 2CB. We have also seen MPS showing up in the context of body enhancement or fitness culture, for example, in seizures of anabolic androgeneteroid substances like Nethyldoscleroketamine, four fluoromethylphenidate, and dipentylone have also been found, although it is still unclear how exactly they are being used in that context. So it is likely that we will continue to see more frequent appearance of MPS in chem sex as well. And that's why I want to emphasize how important it is for forensic and clinical toxicology labs to be ready for the challenge, both in terms of detecting these substances, being able to interpret the results accurately. We toxicologists certainly will be bored in the coming years.
Speaker 1Outside of our fields, Lewis, people don't really know anything about it, really. Lewis, have a fantastic day. Thank you so much for giving up your time. And um we will be chatting very soon.
LuisThank you.
Speaker 1And to our listeners, thank you for joining us on another episode of the Analytical Zen Podcast. Be sure to join us next time and stay curious.