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Overview
3,4-Methylenedioxypyrovalerone (MDPV), known by various street names such as "Bath Salts" and "Monkey Dust," is a potent stimulant belonging to the cathinone and pyrrolidine classes. It is renowned for its robust stimulating properties, and its mechanism of action primarily involves inhibiting the reuptake of norepinephrine and dopamine (NDRI).

History

MDPV was initially synthesized in the 1960s by researchers at Boehringer Ingelheim. Although it showed potential as an alternative to racemic amphetamine and boasted a reduced toxicity profile, it was not further developed for medicinal use. MDPV remained obscure until approximately 2004 when it emerged as a designer drug, being marketed as "bath salts" in gas stations and convenience stores in the United States.

Subjective Effects

MDPV elicits a range of subjective effects, including stimulation, disinhibition, increased libido, appetite suppression, and profound euphoria. However, its use has been associated with numerous incidents of psychological and physical harm, including a relatively high number of fatalities reported by European countries between September 2009 and August 2013.

Chemistry

MDPV, chemically known as 3,4-Methylenedioxypyrovalerone, falls into the synthetic stimulant category of cathinone and pyrrolidine derivatives. It represents the 3,4-methylenedioxy ring-substituted analog of a-PVP. Notably, its effects differ significantly from other methylenedioxy phenylalkylamine derivatives like MDMA, primarily manifesting as classical stimulant effects with only mild entactogenic properties.

Pharmacology

MDPV primarily functions as a potent norepinephrine-dopamine reuptake inhibitor. This action reduces the reuptake of norepinephrine and dopamine, resulting in elevated concentrations of these catecholamine neurotransmitters within the synaptic cleft. While serotonin plays a role, its impact is considerably less. This sudden increase in neurotransmitter levels in the brain contributes to the pleasurable high associated with MDPV.

Effects

Physical Effects

MDPV use yields several physical effects, including stimulation, increased stamina, irregular heartbeat, heightened heart rate, muscle contractions, muscle spasms, appetite suppression, headaches, gustatory hallucinations, diarrhea (albeit relatively rare), nausea (also relatively uncommon), and restless leg syndrome.

Auditory Effects

Users may experience auditory distortion and auditory hallucinations when under the influence of MDPV.

After Effects

The offset of an MDPV experience, commonly referred to as the "comedown," is characterized by negative and uncomfortable effects due to neurotransmitter depletion. These effects include anxiety, cognitive fatigue, depression, irritability, motivation suppression, thought deceleration, and heightened wakefulness. Notably, the after-effects are often more unpleasant if users compulsively redose.

Cognitive Effects

MDPV's cognitive effects are similar to typical stimulants. At common dosages, it induces euphoria and mild empathogenic feelings, increasing motivation, sociability, sexual desire, and concentration. Higher doses may intensify negative effects, such as anxiety, disorganized thoughts, delusions, and even psychosis. It may also lead to time distortion, thought acceleration, thought organization (mainly observed at low to common doses), thought disorganization (more prominent at high doses), and prolonged wakefulness.

Toxicity and Harm Potential

MDPV, while having limited historical human use records before 2004, was once considered a potential low-toxicity alternative to existing stimulants. However, clinical research on human MDPV administration has been sparse for decades. Recent studies on persisting psychosis from chronic MDPV use have shown recovery rates with specific antipsychotics and antihistamines. There is currently no conclusive data on MDPV's neurotoxicity in the human brain.

Anecdotal accounts suggest no major health effects when used sparingly at low doses. However, no guarantees can be made regarding its safety.

In-vitro and in-vivo studies reveal MDPV shares properties with methamphetamine and cocaine, often exceeding their potency. Excessive dopamine and noradrenaline stimulation, coupled with MDPV's potential to hinder serotonergic activity, can lead to aggressive and psychotic reactions, as seen in emergency situations and reported in the media.

Lethal Dosage

The exact lethal dosage of MDPV remains unknown, with no human studies conducted. A report mentioned a lethal dose of 0.4 micrograms per milliliter in a post-mortem case, but this data is too individualistic and variable to provide meaningful information. Gas chromatography-mass spectrometry or liquid chromatography-mass spectrometry can detect MDPV in blood, plasma, or urine, aiding diagnosis in poisoning cases or medicolegal investigations. Expected MDPV concentrations range from 10–50 μg/L in recreational users, over 50 μg/L in intoxicated patients, to over 300 μg/L in acute overdose cases.

Harm reduction practices are strongly advised when using this substance.

Dependence and Abuse Potential

MDPV, more so than other stimulants, can be highly addictive, leading to psychological dependence and compulsive redosing. Users who become addicted may experience cravings and withdrawal symptoms when discontinuing use, making it a significant risk.

Psychosis

Reports suggest that chronic MDPV abuse or single-exposure overdose can more readily lead to psychosis compared to most stimulants. Psychotic symptoms include auditory hallucinations, visual disturbances, self-harming urges, severe anxiety, mania, grandiosity, paranoid delusions, confusion, heightened aggression, and irritability.