4,4’-dimethylaminorex (‘4,4’-DMAR’; ‘Serotoni’) misuse; a web-based study

Background: 4,4′-DMAR (4,4’-dimethylaminorex; ‘Serotoni’) is a potent stimulant drug which has recently been associated with a number of fatalities in Europe. Over the last few years, online communities have emerged as important resources for disseminating levels of technical knowledge on novel psychoactive substances/NPS. Objective: Analysing the information provided by the fora communities on 4,4’-DMAR use, additionally critical reviewing the available evidence-based literature on this topic. Methods: Different website drug fora were identified. A critical review of the existing evidence-based literature was undertaken. Individuation and analysis of qualitative data from the identified website fora were performed. Results: The combined search results identified six website fora from which a range of qualitative data on recurring themes was collected. These themes included: routes of administration and doses; desired effects; adverse effects; comparison with other drugs; association with other drugs; medications self administered to reverse 4,4’-DMAR action; overall impression; provision of harm reduction advice. Conclusions: Although being characterized by a number of methodological limitations, the social networks’ web monitoring approach (netnography) may be helpful to better understand some of the clinical and psychopharmacological issues pertaining to a range of NPS, including 4,4’-DMAR, for which only extremely little, if any, scientific knowledge is available