Is the 5-iodo-2-aminoindan (5-IAI) the New MDMA?

Council Decision 2005/387/JHA defines a new psychoactive substance as ‘a new narcotic drug or a new psychotropic drug in pure form or in a preparation, that has not been scheduled under the 1961 United Nations Single Convention on Narcotic Drugs, and that may pose a threat to public health comparable to the substances listed in Schedule I, II or IV (new narcotic drug) or under the 1971 United Nations Convention on Psychotropic Substances, and that may pose a threat to public health comparable to the substances listed in Schedule I, II, III or IV (new psychotropic drug)’. A preparation is defined as ‘a mixture containing a new psychoactive substance’ (Article 3) [1]. In the last years, the spread of new psychoactive drugs sold as legal substances producing the same effects of traditional and illicit drugs, has been continually on the rise. Between 1997 and 2011, more than 200 new substances have been officially notified in European Union (EU) via the Early Warning System (EWS) with the largest number of compounds ever reported in a single year in 2011 (49 substances) [2]. These compounds are frequently classified as research chemicals and labelled as “not for human consumption”. As demonstrated by several evidences, research chemicals are generally sold via webshops or in specialized street shops known as “smart or head shops”. In particular, online market is able to respond rapidly to changes in the legal status of the psychoactive drugs offering for sale new legal alternatives [1-4]. In 2010, an internet snapshot, a multilingual internet monitoring used by the European Monitoring Centre for Drugs and Drug Abuse (EMCDDA) for rapid assessments of the online availability of psychoactive substances undertaken during a limited time window, anticipated the presence of 5-iodo-2-aminoindan (5IAI) (Figure 1) within the recreational drug market [5]. In 2011, this compound, a psychoactive analog of p-iodoamphetamine (PIA) (Figure 2), was identified in United Kingdom (UK) [1]. To date, there is very little information about the pharmacological and toxicological properties of this substance. Furthermore, there are no data on acute and chronic effects of 5-IAI in humans. As suggested by users, 5-IAI can produce 3,4-methylenedioxymethamphetamine (MDMA)-like effects, and is used as a club drug in substitution of other amphetamine and methamphetamine derivatives [6-8]. The legal status of this compound meets the growing demand for legal amphetamines and is a risk factor for the spread of this MDMA-like compound among young people [9,10]. The use of amphetamine and methamphetamine derivatives is a public health concern in many countries [11,12]. It is estimated that around 12 million European adults aged 15-64 have tried amphetamines at last once in their lives [11]. Prevalence levels of more than 3% have been reported by the Czech Republic and Denmark while UK, Estonia and Bulgaria have reported a prevalence of more than 2% [11]. United Office on Drugs and Crime has estimated that in 2010, the number of MDMA-group users ranges between 10.5 and 25.8 million people worldwide (people aged 15-64) [13]. Overall, these substances are considered club drugs and are used by young people in so called “rave or party scenes”. Furthermore, their use is also high among person infected with human immunodeficiency virus (HIV) [12]. The aim of this paper is to summarize the clinical, pharmacological and toxicological information currently available about this new potential MDMA substitute.