NBOMes

"Derived from, and thus similar to, the 2C class of amphetamines made popular by the late self-experimenting chemist Alexander Shulgin, NBOMes are now used recreationally by adolescents and young adults for their sympathomimetic and serotonergic effects. Often sold in microgram doses on blotter paper and marketed as “legal” or “natural LSD,” NBOMes are also available as liquid, powder, capsules, tablets, or sprays [2]. They can be administered sublingually, buccally, or by insufflation; due to low oral bioavailability, they are only rarely ingested. NBOMes are most commonly synthesized outside of the USA but, due to the high potency, are easily smuggled across borders in small batches.

"Although marketed as an alternative to LSD, a psychoactive drug well studied and known to have few adverse effects, few studies assess the pharmacologic and safety profiles of NBOMes in either animals or humans. Clinical manifestations, as described in previous case reports and this case series, reflect both sympathomimetic effects (hypertension, tachycardia, diaphoresis, psychomotor agitation, altered mental status, hyperthermia, and/or seizures) and serotonergic toxicity (altered mental status, hallucinations, tremulousness, muscle rigidity, rhabdomyolysis and subsequent renal failure, seizure, hyperthermia, and death).

"Without published human safety data describing differences in the potency and toxicity attributable to each NBOMe, we cannot say that one variant is more dangerous or more likely to produce serotonin toxicity than another. Indeed, with a lack of quality controls in illicit drug synthesis, the actual chemical purity, composition, and concentration can vary substantially, even from one dose to the next. Laboratory confirmation helps to identify the presence of undisclosed NBOMe variants, contributing to the limited epidemiologic data of these highly potent new LSD substitutes."