Return of the Quaaludes? Prolonged agitated delirium after intentional ingestion of the methaqualone analog SL-164 – a case report

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.

Keywords:

• SL-164
• methaqualone
• new psychoactive substance
• agitated delirium
• myoclonic convulsions
• tachycardia

Ethical approval

Written informed consent for this case report to be published was obtained from the patient and is available on demand. Given the retrospective nature of this case report, I hereby confirm that this case report is exempt from the assessment by the institutional ethics committee and that publication of the case in anonymous form is permitted without the approval of an ethics committee.

The sampling of patient material and the information given to the patient have been performed in accordance with the current laws of Germany about biomedical research in particular regarding ethics and data protection.

Acknowledgment

No funding was received for this case report.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

K.R., H.E. and F.E. were responsible for research conception and design of this case study. K.R. and F.E. performed the patient’s clinical evaluation and collection of data.

H.F., T.D., G.S. and F.M. were responsible for the drug analysis and interpretation of results.

K.R., H.F. and F.E. were responsible for writing and revision of this case study.