A limitation of this case report is that we did not have a urine sample available for additional NPS testing. Point-of-care DOA tests using urine to screen for misuse of multiple substances, regularly include cannabis, amphetamines, cocaine, opioids, benzodiazepines and methadone. THC, methamphetamine, SRCA, lysergic acid diethylamide (LSD), gamma-hydroxybutyrate (GHB) and ketamine are likely to become volatile under the temperature of current e-cigarettes, while crack cocaine is hard to vaporise. A systematic review including data of 114 patients of which the majority was intoxicated due to SCRA smoking revealed that 45 % of the patients who present at the ER after an intoxication due to SCRA smoking recovered within 24 hours .
Data availability
Moreover, a study conducted in the United Kingdom investigated components of e-liquids in 112 samples originating from prisoners, teenagers and test purchases of commercially available e-cigarettes taken between 2014 and 2021 . This is the first case report that describes the toxicological symptoms of vaping ADB-BUTINACA. Results of the DOA test (including testing for amphetamines, methamphetamines, barbiturates, benzodiazepines, cocaine, methadone, opioids, cannabis, tricyclic antidepressants) were available within 30 minutes and were all negative. We report a case of an involuntary intoxication of the SCRA ADB-BUTINACA after vaping. There are several pitfalls in the detection of SCRA in samples taken from the patien
These synthetic cannabinoids act 4F ADB directly at cannabinoid CB1 and CB2 receptors as does Δ9-tetrahydrocannabinol (Δ9-THC) found in marijuana, but have different chemical structures unrelated to Δ9-THC, different metabolism, and often greater toxicity (Fantegrossi et al., 2014). Discriminative stimulus effects were tested in rats trained to discriminate Δ9-tetrahydrocannabinol (3 mg/kg, 30-min pretreatment). 5F-MDMB-PINACA (also known as 5F-ADB, 5F-ADB-PINACA), MDMB-CHIMICA, MDMB-FUBINACA, ADB-FUBINACA, and AMB-FUBINACA (also known as FUB-AMB, MMB-FUBINACA) were tested for in vivo cannabinoid-like effects to assess their abuse liabilit
In general, the locomotor depressant and discriminative stimulus effects 4F ADB have been observed at doses that do not produce adverse effects, although tremors were observed upon handling in mice that received JWH-210 (Gatch et al., 2016), and 5F-AMB produced sustained vocalization and convulsions in rats (Gatch et al., 2018). All of the synthetic cannabinoids tested in the present study fully substituted for the discriminative stimulus effects of Δ9-THC. Subsequently, a one-way analysis of variance was conducted on horizontal activity counts for the 30-min period of maximal effect, and planned comparisons were conducted for each dose against the vehicle control using single degree-of-freedom F tests. A two-way analysis of variance, with dose as a between groups factor and time as a within subject factor, was conducted on horizontal activity counts/10 min interval.
Michael B Gatch
These findings are in agreement with earlier studies showing the synthetic cannabinoids substitute for the discriminative stimulus effects of Δ9-THC (see review by Wiley et al., 2017). Pretreatment times and dose ranges for the drug discrimination assay were selected based on the time of peak depression in the locomotor activity assay in mice. As mentioned previously, short-onset compounds have a greater abuse liability; further, compounds that have fewer adverse effects while they are active are likely to be preferred. All five of the compounds in the present study fully substituted with a pretreatment time of 15 min, suggesting a rapid onset of the discriminative stimulus effects. All of the cathinones fully substituted for the discriminative stimulus effects of Δ9-tetrahydrocannabinol (≥80% drug-appropriate responding). Because response suppression may compromise stimulus control, rats failing to complete at least ten responses during the test session were excluded from the analysis of the discriminative stimulus effects of that dose of test compoun
Due to the unknown toxicity of newly emerging SCRAs, forensic assessments of cases involving these substances are challenging. According to the reported cases and reviews of the scientific literature, concurrent ethanol consumption should amplify the toxicity of SCRAs. The concentration of 4F-MDMB-BINACA in the postmortem blood was 2.50 and 2.34 ng/mL, and blood alcohol concentration was 2.11 and 2.49 g/L, respectively. Two fatal cases are reported caused by simultaneous consumption of 4F-MDMB-BINACA and ethanol.
Fig. 2.
The precursor ion m/z 396 (B10, B12/B15) was 32 Da higher than the parent drug, 4F-MDMB-BINACA, suggesting the addition of two hydroxy groups. All the below explanations for transformations into metabolites are based on the data shown in Fig. Metabolites were identified according to their precursor ions, product ions, and fragmentation patterns (Fig. 1). Traditional in-vivo metabolism studies to generate human metabolites of drugs relied heavily on the use of whole animal model systems, which are expensive, limited by drug administration amount, influenced by species variation and faced by many ethical issues. Eight in-vivo metabolites tentatively identified were mainly products of ester hydrolysis with or without additional dehydrogenation, N-dealkylation, monohydroxylation and oxidative defluorination with further oxidation to butanoic acid.
Fig. 1.
Monitoring metabolism of synthetic cannabinoid 4F-MDMB-BINACA via high-resolution mass spectrometry assessed in cultured hepatoma cell line, fungus, 4F ADB liver microsomes and confirmed using urine samples The threshold for fatal overdose of combined use of SCRAs and ethanol can be estimated as a little ng/mL (0.37–4.1 ng/mL according to the reported cases) of SCRA and 1.5–2.5 g/L of ethanol. The reported cases and reviews of the scientific literature suggest a possible synergistic effect between SCRAs and ethanol, because their combined use clearly increases their toxicity. The victim died due to severe necrotizing pancreatitis and acute kidney injury evolving into multi-organ failure 11 days after hospital admission . Studies have found no unequivocal synergistic effect between THC and ethanol at low or moderate ethanol doses [29, 30], but no data on high doses of ethanol are available. Given that THC and ethanol act on the same receptors, data on their simultaneous use may yield important insights in this regard.
Fungus C. elegans
Methyl (2S)-2-([1-(4-fluorobutyl)-1H-indazole-3-carbonyl]amino)-3,3-dimethylbutanoate (4F-MDMB-BINACA, 4F-MDMB-BUTINACA or 4F-ADB), found in numerous SCB product seizures, has been reported by various law enforcement since 2018 . However, most of the SCBs are full agonists at CB1 and CB2 receptors, having a higher risk of undesirable side effects when compared to THC which is a partial agonist . Synthetic cannabinoids (SCBs) are agonists at cannabinoid receptor type 1 (CB1) and type 2 (CB2), where they elicit their main effect
Data availability
Moreover, a study conducted in the United Kingdom investigated components of e-liquids in 112 samples originating from prisoners, teenagers and test purchases of commercially available e-cigarettes taken between 2014 and 2021 . This is the first case report that describes the toxicological symptoms of vaping ADB-BUTINACA. Results of the DOA test (including testing for amphetamines, methamphetamines, barbiturates, benzodiazepines, cocaine, methadone, opioids, cannabis, tricyclic antidepressants) were available within 30 minutes and were all negative. We report a case of an involuntary intoxication of the SCRA ADB-BUTINACA after vaping. There are several pitfalls in the detection of SCRA in samples taken from the patien
These synthetic cannabinoids act 4F ADB directly at cannabinoid CB1 and CB2 receptors as does Δ9-tetrahydrocannabinol (Δ9-THC) found in marijuana, but have different chemical structures unrelated to Δ9-THC, different metabolism, and often greater toxicity (Fantegrossi et al., 2014). Discriminative stimulus effects were tested in rats trained to discriminate Δ9-tetrahydrocannabinol (3 mg/kg, 30-min pretreatment). 5F-MDMB-PINACA (also known as 5F-ADB, 5F-ADB-PINACA), MDMB-CHIMICA, MDMB-FUBINACA, ADB-FUBINACA, and AMB-FUBINACA (also known as FUB-AMB, MMB-FUBINACA) were tested for in vivo cannabinoid-like effects to assess their abuse liabilit
In general, the locomotor depressant and discriminative stimulus effects 4F ADB have been observed at doses that do not produce adverse effects, although tremors were observed upon handling in mice that received JWH-210 (Gatch et al., 2016), and 5F-AMB produced sustained vocalization and convulsions in rats (Gatch et al., 2018). All of the synthetic cannabinoids tested in the present study fully substituted for the discriminative stimulus effects of Δ9-THC. Subsequently, a one-way analysis of variance was conducted on horizontal activity counts for the 30-min period of maximal effect, and planned comparisons were conducted for each dose against the vehicle control using single degree-of-freedom F tests. A two-way analysis of variance, with dose as a between groups factor and time as a within subject factor, was conducted on horizontal activity counts/10 min interval.
Michael B Gatch
These findings are in agreement with earlier studies showing the synthetic cannabinoids substitute for the discriminative stimulus effects of Δ9-THC (see review by Wiley et al., 2017). Pretreatment times and dose ranges for the drug discrimination assay were selected based on the time of peak depression in the locomotor activity assay in mice. As mentioned previously, short-onset compounds have a greater abuse liability; further, compounds that have fewer adverse effects while they are active are likely to be preferred. All five of the compounds in the present study fully substituted with a pretreatment time of 15 min, suggesting a rapid onset of the discriminative stimulus effects. All of the cathinones fully substituted for the discriminative stimulus effects of Δ9-tetrahydrocannabinol (≥80% drug-appropriate responding). Because response suppression may compromise stimulus control, rats failing to complete at least ten responses during the test session were excluded from the analysis of the discriminative stimulus effects of that dose of test compoun
Due to the unknown toxicity of newly emerging SCRAs, forensic assessments of cases involving these substances are challenging. According to the reported cases and reviews of the scientific literature, concurrent ethanol consumption should amplify the toxicity of SCRAs. The concentration of 4F-MDMB-BINACA in the postmortem blood was 2.50 and 2.34 ng/mL, and blood alcohol concentration was 2.11 and 2.49 g/L, respectively. Two fatal cases are reported caused by simultaneous consumption of 4F-MDMB-BINACA and ethanol.
Fig. 2.
The precursor ion m/z 396 (B10, B12/B15) was 32 Da higher than the parent drug, 4F-MDMB-BINACA, suggesting the addition of two hydroxy groups. All the below explanations for transformations into metabolites are based on the data shown in Fig. Metabolites were identified according to their precursor ions, product ions, and fragmentation patterns (Fig. 1). Traditional in-vivo metabolism studies to generate human metabolites of drugs relied heavily on the use of whole animal model systems, which are expensive, limited by drug administration amount, influenced by species variation and faced by many ethical issues. Eight in-vivo metabolites tentatively identified were mainly products of ester hydrolysis with or without additional dehydrogenation, N-dealkylation, monohydroxylation and oxidative defluorination with further oxidation to butanoic acid.
Fig. 1.
Monitoring metabolism of synthetic cannabinoid 4F-MDMB-BINACA via high-resolution mass spectrometry assessed in cultured hepatoma cell line, fungus, 4F ADB liver microsomes and confirmed using urine samples The threshold for fatal overdose of combined use of SCRAs and ethanol can be estimated as a little ng/mL (0.37–4.1 ng/mL according to the reported cases) of SCRA and 1.5–2.5 g/L of ethanol. The reported cases and reviews of the scientific literature suggest a possible synergistic effect between SCRAs and ethanol, because their combined use clearly increases their toxicity. The victim died due to severe necrotizing pancreatitis and acute kidney injury evolving into multi-organ failure 11 days after hospital admission . Studies have found no unequivocal synergistic effect between THC and ethanol at low or moderate ethanol doses [29, 30], but no data on high doses of ethanol are available. Given that THC and ethanol act on the same receptors, data on their simultaneous use may yield important insights in this regard.
Fungus C. elegans
Methyl (2S)-2-([1-(4-fluorobutyl)-1H-indazole-3-carbonyl]amino)-3,3-dimethylbutanoate (4F-MDMB-BINACA, 4F-MDMB-BUTINACA or 4F-ADB), found in numerous SCB product seizures, has been reported by various law enforcement since 2018 . However, most of the SCBs are full agonists at CB1 and CB2 receptors, having a higher risk of undesirable side effects when compared to THC which is a partial agonist . Synthetic cannabinoids (SCBs) are agonists at cannabinoid receptor type 1 (CB1) and type 2 (CB2), where they elicit their main effect