Emergence of 2-MMC in the French Alps: description of 13 clinical and forensic toxicology cases.

Synthetic cathinones are becoming increasingly significant in the European stimulant market. Since 2023, there has been a notable emergence of 2-methylmethcathinone (2-MMC). This paper aims to document 2-MMC exposures and its concentrations in various biological matrices. For this study, analyses of 2-MMC were carried out using Ultrahigh Performance Liquid Chromatography (UPLC) coupled with tandem Mass Spectrometry (MS/MS) and positive electrospray ionization (ESI). Quantitative analysis was performed using LC-MS/MS, while qualitative metabolite exploration was conducted with LC-HRMS (High-Resolution Mass Spectrometry) and in silico metabolic profiling on Compound Discoverer. This paper reports on 13 cases involving 13 men, aged 19 to 63 (with a median age of 38). These cases included five deceased and eight living individuals from diverse contexts, such as drug-facilitated crime, driving under the influence of drugs, chemsex, and suicide. The blood concentration range in post-mortem cases was 4.7-3,030 ng/mL, and the plasma concentration range in clinical/other cases was 106–218 ng/mL. Several Phase I metabolites previously described for 3-MMC were also confirmed: a hydroxylated derivative, an N-desmethyl derivative, and a keto-reduced derivative. The observed increase in 2-MMC-related cases suggests a potential resurgence of 2-MMC, which may be replacing other previously prevalent synthetic cathinones like 3-MMC and 3-CMC. This study provides valuable insights for interpreting future 2-MMC cases.