DESIGNER DRUGS AS A CAUSE OF HOMICIDE

A 22-year-old man with no prior mental illness committed a homicide during a severe psychotic state induced by the designer drugs 5-MeO-DIPT and 5-MeO-MIPT, which he purchased online. He ingested unknown quantities of 'Wild Game' and 'Mipty' to enhance sexual pleasure, but within 1.5 hours experienced palpitations, nausea, delusions, visual distortions, and loss of consciousness. Police found him naked and confused 3 hours later; his girlfriend had been killed with a kitchen knife. Laboratory tests confirmed the tryptamine derivatives in his urine and her body; no other substances were detected. Clinical recovery occurred after 17 hours, with amnesia for the event. This is the first reported homicide linked to these drugs, and the authors suggest that simultaneous intake of both analogues may prolong serotoninergic overactivation, causing severe psychosis.

Study at a glance

Abstract

'Foxy' is a widely used street name for a hallucinogenic drug containing the tryptamine derivative 5-methoxy-N,N-diisopropyltryptamine (5-MeO-DIPT). The US Drug Enforcement Administration classified 5-MeO-DIPT as a Schedule I substance in 2004 [1]; the Japanese Ministry of Health, Labour and Welfare has also restricted this substance since April 2005, according to the Narcotics and Psychotropics Control Law. However, drug dealers continue to sell 5-MeO-DIPT using names other than Foxy, and also sell chemically analogous substances. Traffic in such designer drugs—produced as an analogue to escape legal restriction, or simply sold under a name differing from the popular street name—has spread among youth via internet websites. We recently encountered a tragic occurrence of acute intoxication by loophole drugs in a forensic setting. A 22-year-old man with no previous history of mental disorder or criminal charges was arrested on suspicion of homicide. He had previously taken a mushroom hallucinogen and marijuana without experiencing a 'bad trip' or psychotic episodes. The most recent use of these drugs was 4 months before the arrest. More recently, he had purchased the three designer drugs, named 'Foxy', 'Wild Game' and 'Mipty', through an internet website. Two weeks before the arrest he had ingested only one of these, 'Foxy'. He had heard that this was a psychedelic agent, although when he took it he had experienced neither euphoria nor distress. According to his statements in the interview we conducted for psychiatric evaluation, he simultaneously ingested unknown quantities of the other two drugs purchased on the internet, 'Wild Game' and 'Mipty', in his apartment on the evening of the arrest. His stated aim was to enhance sexual pleasure with his girlfriend who, like him, apparently did not know the chemical content of these two drug preparations. Immediately he experienced palpitations and nausea and feared a 'bad trip', although he still could recognize his girlfriend. Approximately 1.5 hours after drug intake, he perceived his surroundings delusionally as conveying ominous warnings, spiritual meanings and important revelations. Sensory distortion, visual illusion and intermittent loss of consciousness soon followed. He was markedly confused and incoherent when police officers found him naked and bloody, arresting him at midnight in a suburb near his apartment 3 hours after drug intake. According to police investigators, he had killed his girlfriend in his apartment with a kitchen knife a few minutes before the arrest. In a container found in his room labelled 'Mipty', 5-MeO-DIPT and 5-methoxy-N-methyl-N-isopropyltryptamine (5-MeO-MIPT) were detected by gas chromatography with mass spectrometry; 5-MeO-DIPT was detected in the container labelled 'Wild Game'. These substances also were present in his urine and in the body of his girlfriend. No other psychoactive substances, including alcohol or methamphetamine, were detected. At 17 hours following drug ingestion clinical recovery was apparent, with no neurological deficits apart from amnesia for certain intervals during the night, including the homicide and walking about naked. To our knowledge, this is the first clinical report of a homicide apparently committed during a severe psychotic state induced by tryptamine derivatives; it also may be the first report of a case involving disturbance of consciousness by 5-MeO-DIPT. Three clinical case reports [2-4] and one experimental study [5] have concerned 5-MeO-DIPT intoxication. Meatherall & Sharma [3] reported that 5-MeO-DIPT may cause mild hallucinations and motor disturbances lasting for 3.5 hours, while Wilson et al. [4] reported transient tactile hallucinations resolving after 4 hours of observation in an emergency ward. Shulgin & Carter [5] further demonstrated that experimental administration of 5-MeO-DIPT produced effects lasting up to 6.5 hours. Taken together, these reports appeared to suggest that psychotic symptoms induced by 5-MeO-DIPT may be relatively transient, or lasting several hours at the most. However, Ikeda et al. [2] have described auditory hypersensitivity and persistent visual distortions. No reports, however, mentioned severely disordered conduct or disturbances of consciousness induced by 5-MeO-DIPT. Why the man reported here showed severe psychosis with disturbance of consciousness for a period as long as 17 hours remains unclear. We speculate that pharmacological effects of 5-MeO-DIPT, which have been demonstrated to cause serotoninergic activation [1], may bereinforced and prolonged by simultaneous intake of 5-MeO-MIPT. Although no cases of 5-MeO-MIPT intoxication have been reported, one might suspect pharmacological effects similar to 5-MeO-DIPT because it is also a tryptamine derivative largely analogous in structure [1]. Some previous case reports [6, 7] have suggested that serotoninergic overactivation by combined intake of selective serotonin reuptake inhibitor, lithium carbonate and other psychotropic agents could cause delirium. Similarly, simultaneous intake of 5-MeO-DIPT and 5-MeO-MIPT might overactivate serotoninergic function in the central nervous system to cause severe, long-lasting psychosis with disturbance of consciousness. While accumulation of additional cases should provide more information, prompt action by several government entities—including the those of Japan and the United States—is needed to restrict internet trafficking in analogues not yet addressed officially, such as 5-MeO-MIPT. The danger of designer drugs should be publicized, with the aims of preventing tragedies such as in the one currently reported.