“We are still one step behind the people who produce these [synthetic] drugs,” Blokhuis said in November 2020. He is currently working with the Department of Justice to create a comprehensive law – one that would ban hundreds of raw materials used to make many different types of substances and place them in the same legal class as drugs like cocaine and speed. “We can assume that synthetic drugs based on [these hard drugs] can also cause significant health problems,” Blokhuis and Justice and Security Minister Ferd Grapperhaus say in the bill. They see prohibition as the only answer. In a short time, several reports have been published detailing how young lives have been “destroyed” by this new horror drug. Parents desperately sounded the alarm about the potentially deadly substance, while various Dutch mayors were driven “to despair” because 3-MMC was “so addictive and terrible.” The mayors joined forces to write a letter to the head of the Dutch Ministry of Justice, drawing attention to the fact that 3-MMC was still legally available. 3-MMC and 3-CMC would be sold as legal substitutes for the closely related substances mephedrone and 4-chloromethane (4-CMC), which were controlled internationally in 2015 and 2020, respectively. Most cathinone use appears to be recreational use and involves sniffing or swallowing, but injection is also reported in high-risk situations such as chemsex parts (5). 3-Methylmethcathinone (3-MMC or metaphedrone) is a synthetic cathinone recently introduced to the market for new psychoactive substances (NPS), initially as a substitute for mephedrone (4-methylmethcathinone or 4-MMC) and is spreading rapidly among drug users. 3-Methylmethcathinone is controlled by law in many countries, but is still readily available on websites and is often found in recreational facilities. Most of the toxicological data on this drug comes from reports of human cases of poisoning. Therefore, further study of their pharmacological and toxicological properties is needed to assess their potential adverse effects. This work provides an overview of the available data on the legal status of 3-MMC, chemistry, patterns of use, prevalence, biological effects, toxicokinetics, toxicity and factors influencing stimulant/toxicological effects.
3-Methylmethcathinone, also known as 3-MMC and metaphedrone, is a synthetic drug of the substituted cathinone family. The structure of 3-MMC is closely related to mephedrone (4-MMC), a more well-known illicit drug, and is also illegal in most countries that have banned mephedrone, as 3-MMC is a structural isomer of 4-MMC. However, 3-MMC has always appeared on the recreational drug market as an alternative to mephedrone and was first sold in Sweden in 2012.  Unlike other legal highs, 3-MMC has been tested and characterized in large mammals, and has provided much more knowledge about it than is known about other synthetic cathinones. 3-MMC is a monoamine transporter substrate that strongly inhibits the absorption of norepinephrine and has a more pronounced dopaminergic activity than serotonergic.  Health Minister Paul Blokhuis has decided to severely restrict legal access to the synthetic drug 3-MMC by adding it to List II of substances prohibited under the Opium Act. The decision was made out of fears that the drug, which is associated with many health risks, would become increasingly popular among young people in the Netherlands. Since the spread of its story, the Dutch media has been obsessed with 3-MMC, also known as metahedrone – a synthetic drug from the Cathinone family that is very similar to 4-MMC or mephedrone. Most countries that have banned 4-MMC have also banned 3-MMC due to its similar structure, but in the Netherlands it can still be purchased legally. According to the Coordination Unit for the Evaluation and Monitoring of New Drugs (CAM), the number of health emergencies increased after the use of 3-MMC. In addition, the drug was lightweight and widely used due to its current legal status.
Meanwhile, Dr Zee says the Dutch government`s plan to ban its creation is “clearly a mistake that will be corrected very soon”. It defends its right to exist legally, although it recognizes the risks of overuse. “You can`t blame drugs for that,” he says. “It`s about how you treat the substance yourself.” Synthetic cathinones are a group of stimulant substances chemically related to cathinone, the main psychoactive substance in the khat plant (Catha edulis). Cathinone itself is chemically similar to amphetamine and is part of Annex I of the 1971 United Nations Convention on Psychotropic Substances. At the end of 2021, the EMCDDA monitored 162 synthetic cathinones, making it the second largest category of NPS (after synthetic cannabinoids) observed. Cathinones are marketed as a “legal” substitute for controlled stimulants such as amphetamine, MDMA and cocaine. 3-MMC or metahedrone is a synthetic cathinone that first appeared on the “high legal” market. Let`s take a closer look.
The European Commission today adopted measures to tackle two harmful new psychoactive substances (NPS) across the EU (1). The substances in question — 3-methylmethcathinone (3-MMC) and 3-chlorometcathinone (3-CMC) — are both synthetic cathinones of concern in Europe. The delegated act follows risk assessments carried out by the EU Medicines Agency (EMCDDA) in November 2021 (2) as part of a three-stage legal procedure to respond to potentially threatening new medicines available on the market (3). Dutch Health Secretary Paul Blokhuis wants to criminalize drugs because they are very similar to illegal substances such as amphetamine and MDMA. But Kaj Hollemans, who is very familiar with Dutch drug policy, says it`s not the solution. “The ban will actually create more problems,” he says. “It`s not that substances disappear once you make them illegal.” Hollemans believes there is simply a high demand for recreational drugs. “What`s missing is a conversation about reducing the risks associated with these substances,” he says. The ban on 3-MMC is expected to come into effect in the fall of 2021. Drugs are already illegal in most countries.
The restriction of access is intended to raise awareness that the use of 3-MMC can lead to serious health risks. Cardiac arrhythmias, increased blood pressure or elevated body temperature are some of the health problems associated with the use of the drug. “The legal status gives this drug a false and innocent image, we must get rid of it as soon as possible. These are dangerous things that we need to protect ourselves from by warning our young people about it,” Blokhuis said. From 28 October 2021, 3-MMC is planned under the Dutch Opium Act and therefore illegal in the Netherlands.  Kaj Hollemans, who specializes in legal advice used to inform national policies regarding drugs, alcohol and gambling, believes that media reports have not only exaggerated the topic of 3-MMC, but have likely fueled it as well. “If the [Dutch] media is to be believed, it`s Sodom and Gomorrah,” he said over the phone. “But a few years ago, the 3-MMC was hardly used by anyone.” Tolerance to many effects of 3-MMC develops with prolonged and repeated use.
As a result, users must administer ever larger doses to achieve the same effects. After that, it takes about 3-7 days for the tolerance to be halved and 1-2 weeks to return to the baseline (in the absence of additional consumption). 3-MMC has cross-tolerance with all dopaminergic stimulants, which means that after consuming 3-MMC, all stimulants have a reduced effect. The number of 3 MMC poisonings reported to the DPIC has increased over time. Most 3-MMC poisonings resulted in moderate toxicity and sympathomimetic effects, while severe effects were observed in 5 cases. As such, it is still a work in progress and may contain incomplete or incorrect information. If you think someone is suffering from a medical emergency, call 111 immediately and ask for an ambulance. Always tell emergency responders what someone has taken – you won`t get into trouble and it could save a life. The risk assessments on 3-MMC and 3-CMC, carried out by an enlarged EMCDDA Scientific Committee (4), examined the health and social risks of the substances, their availability and use in Europe, international trade and the involvement of organised crime. At the time of these assessments, Member States had reported 27 and 10 deaths with confirmed exposure to 3-MMC and 3-CMC respectively through the EU Early Warning System (EMS).
Please see page 204 for the summary of the capsule from the editor of this article. Today`s adoption of a delegated act builds on recent legislation to enable a stronger and faster response to NPS in Europe (6). The European Parliament and the Council have two months to examine the act before its entry into force, after which Member States have six months to introduce the relevant national legislation. There are no simple transformations into controlled substances.  A podcast on this article is available on www.annemergmed.com. Combining 3-MMC with certain substances such as alcohol or stimulants also increases the risks, while taking it with serotonin-releasing agents such as MDMA or antidepressants can lead to dangerously high serotonin levels. 3-MMC affects people differently depending on a number of factors such as dosage, age, health and whether other substances were taken at the same time. WARNING: Always start with lower doses due to differences in individual body weight, tolerance, metabolism, and personal sensitivity. See Responsible Use.
Risk assessments have recently shown a significant increase in the supply of cathinone powders in Europe. In 2020, a total of 3,300 kg of these powders were seized (750 kg in 2019), with 3-CMC representing 880 kg and 3-MMC 750 kg. After the controls of these substances in China, they now appear to have been manufactured in India and imported into Europe “on an industrial scale”.