Clinical and Toxicological Profile of NBOMes : A Systematic Review, Nino Cesar Marchi et al., 2019

Clinical and Toxicological Profile of NBOMes : A Systematic Review

Nino Cesar Marchi, Juliana Nichterwitz Scherer, Letícia Schwanck Fara, Lysa Remy, Rafaela Ornel, Monique Reis, Amanda Zamboni, Mariana Paim, Taís Regina Fiorentin, Carlos Alberto Yasin Wayhs,
Lisia Von Diemen, Flavio Pechansky, Felix Henrique Paim Kessler, Renata Pereira Limberger

Psychosomatics, 2019 Mar – Apr, 60, (2), 129-138.

doi : 10.1016/j.psym.2018.11.002


Background : NBOMes are a new class of potent hallucinogens widely present in illicit drugs. Little is known about this class of drugs, regarding its detection and clinical manifestations of intoxication.

Objective : This study aims to enhance care involving NBOMes by reviewing the literature on their clinical manifestations and laboratory detection.

Methods : A systematic review was performed on the clinical manifestations and laboratory tests of NBOMEs ingestion. Embase, Pubmed, PsycINFO, and Cochrane databases were employed in this analysis.

Results : Forty-five articles met the inclusion criteria out of the 2814 nonduplicated studies on the theme. Seventy case reports of intoxication were found in the analyzed articles (64.3% were men and 11.4% were women, mean age of 22.5). The technique most employed for NBOMes identification was chromatography of blood, urine, and oral fluids. Moreover, the studies identified 13 chemical structures different from the NBOMes on their toxicological analyses. According to these studies, most of these drugs were ingested orally—nasal use was the second preferred administration route, followed by intravenous administration.

Conclusion : Better identification of the clinical manifestations and laboratory profile of NBOMes is crucial to the recognition of intoxication as well as to its effective treatment.

Key words : designer drugs, NBOMes, hallucinogens, clinical and laboratorial.



New psychoactive substances have arrived in the last few years, creating public health challenges for regulatory agencies.1 In 2012, more than 250 new drugs were developed, and in 2015 this number doubled, which makes management of intoxication, challenging.2 Among the new psychoactive substances, is N-benzylmethoxy, better known as NBOMes.3

he ingestion of these substances has most often been reported in young male adults, these drugs can be easily bought online.4,5 NBOMes are derived from the 2C-X family of hallucinogenic phenethylamines and they are sold under different names as “designer drugs,” “herbal highs,” “synthetic drugs,” “research chemicals,” “legal highs,” “smile,” “synthetic lysergic acid,” “Nbomb,” “Acid,” “25B,” and “25C.”

They can be administered sublingually, buccally, or by insufflation4,6,7. As the NBOMes are often falsely sold as lysergic acid, users are mostly not aware of which substance is being ingested.8

Some studies describe psychiatric manifestations of intoxication by NBOMes (e.g., euphoria, panic attacks).913 Its consumption can also increase risky behaviors (e.g., suicide attempts, unprotected sex with multiple partners).14,15

The toxicological profile involves the detection, identification, and quantification of the substance which allows for the establishment of a cause and effect relationship, thus helping the health professionals to choose the best clinical management for it.1619

Because there are no experimental studies or quantitative studies of NBOMes, the potential harm and effects of these drugs remain unknown. The recent rise of this new class of drugs, its selling as lysergic acid, and its a online purchasing increases public health concerns. Thus, this study aims to review the literature on NBOMes, as well as the identification of their clinical manifestations.