A case series of individuals with analytically confirmed acute diphenyl-2-pyrrolidinemethanol (D2PM) toxicity.

Purpose: There is increasing interest in the use of pipradrol and pipradrol derivatives, such as diphenylproplinol [diphenyl-2-pyrrolidinemethanol (D2PM)] and desoxypipradrol [2-diphenylmethylpiperidine (2-DPMP)], as recreational drugs. There is limited information on the acute toxicity related to both D2PM and 2-DPMP. We report here a case series of five individuals with acute toxicity related to the use of D2PM.
Case Series: Five patients aged between 21 and 33 years old presented to the Emergency Department (ED) on unrelated occasions having used a range of different novel psychoactive substances; none had actually purchased D2PM. They presented with ongoing prolonged neuropsychiatric symptoms of agitation, anxiety and insomnia lasting 24-96 h post-ingestion. None had evidence of sympathomimetic toxicity on presentation to the ED. All were reassured and discharged home after review. TOXICOLOGICAL SCREENING: Urine collection at the time of presentation to the ED was subsequently analysed by gas chromatography-mass spectrometry (GC-MS). All of the urine samples tested positive for D2PM and benzophenone. Additional screening by liquid chromatography tandem mass-spectrometry (LC-MS-MS) demonstrated that the benzophenone detected was an analytical artefact due to the high-injection temperature of the GC-MS analysis.
Conclusions: This descriptive case series provides more detailed information on the acute toxicity related to the use of D2PM. This information is useful for clinical pharmacologists and clinicians managing these individuals to be able to provide more appropriate advice on the acute toxicity associated with the use of D2PM, particularly in relation to the prolonged neuropsychiatric symptoms seen.