First death involving 4-Fluoroethylphenidate (4F-EPH): case-report, user experiences, and review of the related literature

Background: 4-Fluoroethylphenidate (4F-EPH) is a psychoactive substance, sold primarily over the Internet as a ‘research chemical’. Recreational and ‘functional’ use of this drug has been reported by online user fora. Scientifically-based data on the pharmacological, physiological, psychopharmacological, toxicological, and epidemiological characteristics of this molecule is non-existent. The aim of this paper is to remedy this situation. Methods: Recent literature (including ‘grey’) was searched to update what is known about 4F-EPH, especially its toxicity. This was supplemented by netnographic examinations of internet sites. Results: The resultant information is presented, including details of the first reported death involving 4F-EPH use in 2016. There are no international controls imposed on 4F-EPH. However, it has been made a controlled drug in several European countries, including the United Kingdom since 31 May 2017, as well as Canada. Conclusions: It is vital that any other cases, including non-fatal overdoses, are documented so that a firmer scientific evidence-base can be established for this molecule. This will then help inform clinical practice.