New psychoactive substance α-PVP in a traffic accident case

Forensic Toxicol DOI 10.1007/s11419-016-0309-x CASE REPORT New psychoactive substance a-PVP in a traffic accident case Sebastian Rojek1 • Karol Kula1 • Martyna Maciów-Gła˛b1 • Małgorzata Kłys1 Received: 22 November 2015 / Accepted: 18 February 2016  The Author(s) 2016. This article is published with open access at Springerlink.com Abstract The problems of new psychoactive substances (NPSs), especially related to drivers, constitute an open research area. In this case report, we present a traffic accident case, in which two passengers of five individuals died instantly, while the other three persons survived the accident with minor injuries only. From the blood samples of the driver and the passengers, a-pyrrolidinovalerophenone (a-PVP), an NPS belonging to the category of cathinone derivatives, was disclosed. Therefore, we established a detailed procedure for analysis of a-PVP in blood samples by liquid chromatography–tandem mass spectrometry. After careful validation tests of this method, a-PVP concentration in blood samples from the surviving driver and passengers, and from the two deceased, were measured. The concentrations varied from 20 to 650 ng/ mL. Access to detailed information originating from the court files and from explanations provided by the driver and eye witnesses revealed extremely valuable illustrative details addressing the symptoms and pharmacological effects of a-PVP on the human organism, thus contributing to enriching the body of knowledge of a-PVP abuse. Keywords Traffic accident  New psychoactive substances (NPSs)  a-pyrrolidinovalerophenone (a-PVP)  Psychological symptoms  DRUID & Małgorzata Kłys 1 Department of Forensic Medicine, Jagiellonian University Medical College, Grzegórzecka 16 Str, 31-531 Kraków, Poland Introduction The issues associated with driving under the influence of alcohol and narcotic substances are subject to continuous interest not only for legal practitioners, but also for the police, prosecution, and medico-legal teams. Among initiatives implemented in this field, there is the European Union DRUID program carried out by 19 EU countries in the years 2006–2011, aiming at evaluating the phenomena. The final report claimed that although the gravest danger in traffic in EU member countries was posed by alcohol consumption, especially when combined with medications, considerable problems also arose by other psychoactive substances, such as amphetamines and cannabis that are the most popular [1]. Practice shows that preliminary testing of a driver by police road patrol to detect the presence of alcohol and classic narcotic substances often yields a negative result; the driver may be under the influence of other psychoactive agent(s), the presence of which is not detected by most of testers. This may cause the driver to develop a sense of impunity and thus leads to increased chance of traffic accidents. Inasmuch as the issue of alcohol and classic narcotic substances in relation to traffic has been legally regulated in keeping with legislative directives of particular European countries, the problem of new psychoactive substances (NPSs) as related to drivers constitutes an open research area. Although research papers addressing this subject have been published [2–6], the problem continues to be poorly investigated. In this case report, we present a traffic accident case in which two passengers were killed, and the driver and two passengers survived; from the blood samples of all individuals, variable concentrations of a-pyrrolidinovalerophenone (a-PVP), an NPS belonging to the category 123 Forensic Toxicol of cathinone derivatives, were detected. Access to detailed information originating from the court files and derived from explanations provided by the driver and the eye witnesses revealed extremely valuable illustrative material addressing the effect of a-PVP on the human organism, thus contributing to enriching the body of knowledge of the NPS. Case history According to the court files, in a small town in Poland, a group of young people was driving home from a nearby discotheque in early morning hours. Approximately at 6 a.m. the driver, exercising no special caution, drove onto the curb of a safety island, lost control of the car, and drove into a ditch, where the car overturned and hit a tree. In consequence of the accident, two passengers, a 17-year-old female and a 28-year-old male, were killed instantly; one of the remaining passengers, a 19-year-old female, suffered a minor spine injury, while another passenger, a 36-year-old male, and the 21-year-old driver succumbed to minor injuries. Immediately upon arrival of the police, the surviving individuals involved in the accident, the driver and the passenger sitting in front were tested for state of intoxication by means of breath analyzers. The wounded female passenger was tested upon arrival at a hospital *1 h later, while the deceased individuals were tested by means of postmortem blood analysis. After the accident, blood samples were collected and analyzed for psychoactive substances, with the exception of the injured 19-year-old female, whose blood was tested for ethyl alcohol upon admission. As follows from the court files, all people involved in the accident except the driver were under the influence of alcohol, which was later confirmed by tests. The sensations felt by the driver following his taking the narcotic substance were described on his allegation. The psychoactive substance was insufflated through the nose by him and his friends. They had a form of crystals called FETA, KATAR, or KRYSTYNA. The persons attending the party had taken the first fix of the psychoactive substance *6 h prior to the accident. The driver informed that the fix of the substance in an amount of *0.4 g ‘‘was good’’ for about 6 h. One person had prepared the so-called toot, which was then divided and insufflated through the nose. The doses were not calculated, but rather applied using a ‘‘hit-and-miss’’ method. Having insufflated the first fix of the substance, the driver felt agitated, started to sweat profusely, and experienced palpitations. He exploded with energy in spite of the fact that he was tired, having previously performed physical labor in the forest. He had not 123 taken any alcohol. Together with his friends, he took another fix 4 h later, i.e., *2 h prior to the accident. Afterwards, he was agitated, no longer sleepy, and did not experience palpitations or sweating; he was only thirsty, but generally felt well and full of inner energy. Immediately before the accident, however, he recounted: ‘‘…suddenly I saw spots before my eyes…for a moment I felt as if I had lost consciousness, when I snapped out, there was a safety island in front of me…then I jerked the steering wheel to the right and to the left…. I put the car in neutral…I pressed the gas and clutch…I did not use brakes…I could not control the car…’’. Then everything went very fast. The car (...truncated)