Methoxetamine (MXE) is a dissociative hallucinogen that has been sold as a designer drug. It differs from many dissociatives such as ketamine and phencyclidine (PCP) that were developed as pharmaceutical drugs for use as general anesthetics in that it was designed specifically to increase the antidepressant effects of ketamine. MXE is an arylcyclohexylamine. It acts mainly as an NMDA receptor antagonist, similarly to other arylcyclohexylamines like ketamine and PCP.
Recreational use
Effects
MXE is reported to have a similar effect to ketamine. It was often believed to possess opioid properties due to its structural similarity to 3-HO-PCP, but this assumption is not supported by data, which shows insignificant affinity for the μ-opioid receptor by the compound. Recreational use of MXE has been associated with hospitalizations from high and/or combined consumption in the US and UK. Acute reversible cerebellar toxicity has been documented in three cases of hospital admission due to MXE overdose, lasting for between one and four days after exposure. MXE was designed in part in an attempt to avoid the urotoxicity associated with ketamine abuse; it was thought the compound's increased potency and reduced dose would limit the accumulation of urotoxic metabolites in the bladder. Like ketamine, MXE has been found to produce bladder inflammation and fibrosis after high dose chronic administration in mice, although the dosages used were quite large. Reports of urotoxicity in humans have yet to appear in the medical literature.
Pharmacology
Pharmacodynamics
MXE acts mainly as a selective and high-affinity NMDA receptor antagonist, specifically of the dizocilpine (MK-801) site (Ki = 257 nM). It produces ketamine-like effects. In addition to antagonism of the NMDA receptor, MXE has been found to act as a serotonin reuptake inhibitor (Ki = 479 nM; IC50 = 2,400 nM). Conversely, it shows little or no effect on the reuptake of dopamine and norepinephrine (Ki and IC50 > 10,000 nM). Nonetheless, MXE has been found to activate dopaminergic neurotransmission, including in the mesolimbic reward pathway. This is a characteristic that it shares with other NMDA receptor antagonists, including ketamine, PCP, and dizocilpine (MK-801). Animal studies suggest MXE may have rapidly-acting antidepressant effects similar to those of ketamine. A study that assessed binding of MXE at 56 sites including neurotransmitter receptors and transporters found that MXE had Ki values of >10,000 nM for all sites except the dizocilpine site of the NMDA receptor and the serotonin transporter (SERT).
Pharmacokinetics MXE has a longer duration of action than that of ketamine.
Chemistry
MXE is an arylcyclohexylamine and a derivative of eticyclidine (PCE). It can also be thought of as the β-Keto-derivative of 3-methoxyeticyclidine (3-MeO-PCE), or the N-ethyl homologue of methoxmetamine (MXM) and methoxpropamine (MXPr). It is closely related structurally to ketamine, and more distantly to PCP. MXE hydrochloride is soluble in ethanol up to 10 mg/ml at 25 °C.
Detection in body fluids A forensic standard of MXE is available, and the compound has been posted on the Forendex website of potential drugs of abuse.
History The qualitative effects of MXE were first described online in May 2010 and the compound became commercially available on a small scale in September 2010. By November the use and sale of the MXE had increased enough for it to be formally identified by the European Monitoring Centre for Drugs and Drug Addiction. By July 2011, the EMCDDA had identified 58 websites selling the compound at a cost of 145–195 euros for 10 grams.
Society and culture
Media coverage Mixmag reported in January 2012, that people in the dance music and clubbing community have given MXE the slang name 'roflcoptr'. Vice commented that it was likely that the phrase will only be used by "the same politicians, parents and journalists" who called mephedrone 'meow meow'. After being called mexxy in UK Home Office press releases, the media adopted the name. A literature review was published in March 2012 which looked at scientific literature and information on the web. It concluded that "the online availability of information on novel psychoactive drugs, such as MXE, may constitute a pressing public health challenge. Better international collaboration levels and novel forms of intervention are necessary to tackle this fast-growing phenomenon."
Legal status
Brazil MXE became classified as a narcotic in Brazil in February 2014.
Canada As of January 2011 MXE is a controlled substance in Canada.
China As of October 2015 MXE is a controlled substance in China.
European Union On 16 June 2014, the European Commission proposed that MXE be banned across the European Union, subjecting those in violation to criminal sanctions. This is following the procedure for risk-assessment and control of new psychoactive substances set up by the council: Decision 2005/387/JHA.
Finland Scheduled in the "government decree on narcotic substances, preparations and plants" and is hence illegal.
Israel MXE became classified as an illegal narcotic in Israel in May 2012.
Japan MXE became a controlled substance in Japan from 1 July 2012, by amendment to the Pharmaceutical Affairs Law.
Poland MXE is a controlled substance (group II-P) making it illegal to produce, sell or possess in The Republic of Poland as of 1 July 2015.
Russia MXE has been a controlled substance in Russia since October 2011.
Sweden MXE became classified as a narcotic in Sweden in late February 2012.
Switzerland MXE has been illegal in Switzerland since December 2011.
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