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2C-E and its Effects

Though some have been in use since the 1970s, a seemingly ever-growing number of designer drugs, synthetic drugs, and “research chemicals” have been identified in the United States since that time.1 One of these drugs, 2C-E (4-ethyl-2,5-dimethoxy-4-phenethylamine), is considered a designer hallucinogenic drug with a psychoactive effects profile that intersects with that of classical hallucinogens like LSD or psilocybin. At relatively low doses 2C-E may act as a central nervous system stimulant, while at higher doses, it has more pronounced psychoactive and hallucinogenic effects that may last 4-8 hours.2

 

First identified in the 1970s by Alexander Shulgin, an American chemist and, 2C-E has since that time gained some popularity for recreational use. However, in the grand scheme of abused substances, 2C-E remains relatively uncommon.

With reported street names including EuropaTootsie, and Aquarust, 2C-E has, in the past, been bought online and shipped into the United States from countries such as China, ABC News reports.3 The drug may elicit its hallucinogenic effects through its interaction with a certain type of serotonin receptor (5-HT2c) in the brain.2

Designer drugs may be difficult to identify through standard toxicology screening and laboratory testing.1 Additionally, due to their illicit nature, it is hard to identify exactly what is in the drug being taken, making these drugs incredibly hazardous and increasing the potential for an adverse reaction or deadly overdose. In 2011, the drug 2C-E was identified as the cause of a mass overdose that left 10 people hospitalized and one 19-year-old man dead in Minnesota.3

Though reports of intoxication with substances such as 2C-E generally involve a younger demographic, another relatively recently reported 2C-E related mass poisoning involved 29 individuals ranging in age from 24-56.4 Because it is relatively difficult to detect, the numbers of 2C-E related emergencies may be underestimated across the country.

The drug may be used via oral or insufflated (inhaled) routes.2 The DEA considers 2C-E a Schedule I controlled substance in the United States, meaning that it is illegal with no accepted medicinal uses and has a high potential for abuse.

Side Effects of 2C-E Abuse

The 2C family of drugs elicit a combination of hallucinogenic and stimulant effects. Given these stimulant effects, 2C-E may lead to increased body temperature, heart rate, and blood pressure when taken.5 The drug may not affect everyone in exactly the same way, however, making it unpredictable and difficult to know how someone will react to 2C-E. Alexander Shulgin, the chemist who first synthesized the drug, described his experience with the substance—complete with negative auditory hallucinations—as a “toxic psychosis”.5

There are several variations of drugs in the 2C family. In 2013, the Journal of Medical Toxicology published that at least five deaths could be attributed to 2C drug intoxication. Someone taking a 2C drug may become violent, aggressive, or agitated; experience hallucinations or be delirious; and suffer from hypertension, tachycardia, hyperthermia, trouble breathing, chest pains, or seizures while intoxicated. 5

2C-E intoxication and the dangers associated with it may be complicated by the presence of another drug or alcohol, as often occurs in social/recreational drug use settings.

Recognizing Synthetic Drug Abuse and Getting Help

Being able to spot 2C-E abuse, or any type of problematic drug or alochol use, can help family members and loved ones open the door to a discussion about substance abuse and may be the first step toward getting help. Some general signs of certain types of substance abuse, that could be present in someone using 2C-E, could include:

  • Packages coming in the mail from out of the country; labels without listed ingredients (for drugs obtained through disreputable online sources, etc.).
  • Changes in behavior.
  • Increased secrecy and time spent online.
  • Social withdrawal and lack of interest in activities that were previously important.
  • Drop in grades at school or performance at work.
  • Sleeping more or less than usual and at odd times.
  • Changes in weight or eating habits.
  • Increased risk-taking behaviors or engaging in potentially dangerous behaviors.
  • Possible financial trouble or legal difficulties related to consistent or compulsive substance use.

While hallucinogenic drugs like 2C-E may differ from substances more commonly thought of as addictive (e.g., heroin, cocaine), their use (either alone or in conjunction with other substances) may become problematic enough in a person’s life that an individual using such substances would benefit from substance abuse treatment.

Abusing drugs before the brain has fully developed may be a particularly troubling phenomenon, as the parts of the brain that help someone to make good decisions, control impulses, and regulate emotions may not be completely mature until around the mid-20s, the National Institute on Drug Abuse (NIDA) reports; this could make someone both vulnerable to drug abuse and open the door for possible future problems, should early drug use take place.6

Getting help for substance often starts with detox that, in some cases, may be medically managed in a specialized facility. Medical detox includes 24-hour monitoring and supervision to ensure safety and as much comfort as possible. Many synthetic “designer” hallucinogens are not associated with a pronounced withdrawal syndrome;7 as such, medications may not necessarily be required during detox for safe withdrawal management. Though treatment will mainly be supportive, any adverse developments, such as anxiety and agitation may be managed pharmacologically with benzodiazepines or antipsychotics.8

Beyond detox, therapy and counseling may be helpful in determining any underlying reasons for turning to substance use. Sometimes, drug abuse is a coping mechanism to minimize emotional pain or mental illness symptoms, or to escape stress or memories of trauma. Behavioral therapies, in both group and individual settings, can get to the root causes of an individual’s substance abuse, and teach new and healthier ways to manage stress and deal with potential triggers. Support groups exist for both families and those battling substance abuse, and they may be beneficial during recovery.

Both outpatient care, where the individual returns home at night, and residential treatment, where the person stays onsite in a specialized facility for period of time, can promote long-term recovery from drug abuse. Highly trained professionals can help determine the appropriate level of care through a confidential assessment and evaluation in order to promote complete recovery.

References

  1. Stellpflug, S. J., Kealey, S. E., Hegarty, C. B., & Janis, G. C. (2014). 2-(4-Iodo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine (25I-NBOMe): clinical case with unique confirmatory testingJournal of medical toxicology : official journal of the American College of Medical Toxicology10(1), 45–50.
  2. Van Vrancken, M. J., Benavides, R., & Wians, F. H., Jr (2013). Identification of designer drug 2C-E (4-ethyl-2, 5-dimethoxy-phenethylamine) in urine following a drug overdoseProceedings (Baylor University. Medical Center)26(1), 58–61.
  3. Pham, Sherisse. (2011). Man Arrested in Mass Drug Overdose That Killed 1 Teen and Left 10 People Hospitalized.
  4. Iwersen-Bergmann S., et al. (2019). Mass poisoning with NPS: 2C-E and Bromo-DragonFly. International Journal of Legal Medicine. 133(1):123-129.
  5. Dean, B. V., Stellpflug, S. J., Burnett, A. M., & Engebretsen, K. M. (2013). 2C or not 2C: phenethylamine designer drug reviewJournal of medical toxicology : official journal of the American College of Medical Toxicology9(2), 172–178.
  6. National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide.
  7. Eshleman, A. J., Forster, M. J., Wolfrum, K. M., Johnson, R. A., Janowsky, A., & Gatch, M. B. (2014). Behavioral and neurochemical pharmacology of six psychoactive substituted phenethylamines: mouse locomotion, rat drug discrimination and in vitro receptor and transporter binding and functionPsychopharmacology231(5), 875–888.
  8. Weaver, M. F., Hopper, J. A., & Gunderson, E. W. (2015). Designer drugs 2015: assessment and managementAddiction science & clinical practice10(1), 8.
About The Contributor
Scot Thomas, M.D.
Senior Medical Editor, American Addiction Centers
Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating... Read More