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

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.

Automated summary

A 22-year-old male with a history of drug abuse presented prolonged agitated delirium after ingesting opium poppy tea and the designer drug SL-164. Treatment with benzodiazepines and neuroleptics led to complete resolution of symptoms within 72 hours, allowing the patient to be discharged on day three. This case represents a unique occurrence of agitated delirium with detection of SL-164 and its metabolites in a patient's serum and urine.