Return of the Quaaludes? Prolonged agitated delirium after intentional ingestion of the methaqualone analog SL-164 – a case report. Issue 4 (October 2021)

• Record Type: Journal Article
• Authors: Romanek, Katrin; Fels, Helena; Dame, Torsten; Skopp, Gisela; Musshoff, Frank; Eiglmeier, Hans; Eyer, Florian
• Is Part Of: Substance abuse. Volume 42:Issue 4(2021)
• Page Start: 503
• Page End: 505
• Publication Date: 2021-10
• Subjects: SL-164 -- methaqualone -- new psychoactive substance -- agitated delirium -- myoclonic convulsions -- tachycardia; Substance abuse -- Periodicals; Medical education -- Periodicals; Education, Medical -- periodicals; Substance Abuse -- periodicals; 362.29
• DOI: 10.1080/08897077.2021.1903648
• Languages: English
• ISSNs: 0889-7077

Abstract

Background: A 22-year-old male with a known history of drug abuse presented to our department with prolonged agitated delirium, myocloni, tachycardia and subfebrile temperature after the deliberate ingestion of opium poppy tea ( Papaver somniferum L.) together with the methaqualone analog SL-164 (5-chloro-3-(4-chloro-2-methylphenyl)-2-methyl-4( 3H )-quinazolinone) which is sold online as a designer drug. Methods: SL-164 and its hydroxy metabolites were detected in serum and urine via liquid chromatography-quadrupole-time-of-flight mass spectrometry (LC-QTOF-MS). Results: The pronounced delirium was treated with benzodiazepines and neuroleptics; temporary medical restraint had to be applied. Symptoms completely resolved over the next 72 h and the patient was discharged on day three able to give consent. Conclusions: Although methaqualone was a popular and widespread sedative in the 1950s and 60 s before its discontinuation in the USA in 1985, derivatives of the methaqualone class have not previously played a large role as drugs of abuse in the rapidly growing market of new psychoactive substances. To our knowledge, this is the first case of agitated delirium with detection of SL-164 and hydroxylated metabolites in a patient's serum and urine.