Acute skin and hair symptoms followed by severe, delayed eye complications in subjects using the synthetic opioid MT‐45

• Published in: British journal of dermatology (1951) Vol. 176; no. 4; pp. 1021 - 1027
• Main Authors: Helander, A., Bradley, M., Hasselblad, A., Norlén, L., Vassilaki, I., Bäckberg, M., Lapins, J.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.04.2017
• Subjects: Acute Disease; Adult; Alopecia - chemically induced; Analgesics, Opioid - adverse effects; Cataracts; Dermatitis; Drug Eruptions - etiology; Enzymes; Exanthema - chemically induced; Eye; Eye Diseases - chemically induced; Fatalities; Folliculitis; Hair; Humans; Internet; Keratinization; Liver; Male; Medical personnel; Medicin och hälsovetenskap; Nails (Anatomy); Narcotics; Opioids; Overdose; Pigmentation Disorders - chemically induced; Piperazines - adverse effects; Psychotropic Drugs - adverse effects; Skin; Street Drugs - adverse effects; Surgery; Young Adult
• ISSN: 0007-0963; 1365-2133; 1365-2133
• DOI: 10.1111/bjd.15174

Summary Background The introduction of unclassified new psychoactive substances (NPS) on the recreational drugs market through open online sale (‘legal highs’ or ‘Internet drugs’) continues unabated and represents a growing health hazard. The use of NPS has resulted in numerous, severe, adverse events and fatalities, due to unintended overdose or unknown toxic side‐effects. Objectives To try to find a possible common underlying cause for the skin–hair–eye symptoms complex observed in three men. Methods From late 2013 to mid‐2014, three Swedish men aged 23–34 years with a history of recreational drug use independently presented with similar and very remarkable clinical signs, requiring extensive examination and prolonged treatment. Results Common clinical signs included hair depigmentation, hair loss, widespread folliculitis and dermatitis, painful intertriginous dermatitis, dry eyes, and elevated liver enzymes. Two of them also showed transverse white Mees’ lines (leukonychia striata) on the fingernails and toenails, suggesting a temporary, drug‐induced, disorganized keratinization. The clinical signs gradually disappeared over time. However, later on, two developed severe bilateral secondary cataracts requiring surgery. Because drug tests within the Swedish STRIDA project had demonstrated intake of the NPS opioid MT‐45 in all patients, this was suspected to be the common causative agent. Conclusions These cases highlight the importance for physicians and health professionals to consider the increasing number of novel, untested recreational drugs, as a potential cause of unusual and otherwise unrecognized clinical signs and symptoms. What's already known about this topic? The use of new psychoactive substances (NPS) distributed through open online sale, also referred to as ‘legal highs’ or ‘Internet drugs’, has increased much in recent years. Intake of NPS has been reported to result in numerous severe adverse events and fatalities, due to unintended overdose or unknown toxic side‐effects. What does this study add? This study describes a new complex adverse drug reaction with symptoms involving the hair, skin, nails and eyes, seemingly linked to the intake of the NPS opioid MT‐45. The study expands the understanding of health hazards associated with the use of novel, untested recreational drugs. This paper further highlights the importance for health professionals to consider NPS as a potential cause of unusual and otherwise unrecognized clinical signs and symptoms.