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When clinical presentation and/or initial DOA testing results are inconclusive, additional testing with LC-QTOF-MS can be valuable and is recommended. SCRAs and other NPS may not be detected by point-of-care DOA tests. In this case, the point-of-care DOA urine screening was not able to detect the synthetic cannabinoid ADB-BUTINAC


Tremors were observed in mice 30 minutes following 1 mg/kg AMB-FUBINACA in the present study. 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. Average potency of the discriminative stimulus effects of early compounds was 0.81±0.17 mg/kg (Gatch et al., 2014), whereas the potency of a recent set was 0.09±0.03 mg/kg (Gatch et al., 2018), and the potency of the current set is 0.05±0.01 mg/kg. Short-onset, short-acting compounds have a greater abuse liability, and long-acting compounds pose problems of long-acting adverse effects and interactions with other drugs. The duration of action of the synthetic cannabinoids tested using the 8-h protocol have varied widely, with some producing a duration of action no longer than 1 h, others producing a duration of action between 1–2 h, and others lasting more than 2 h. There seems to be a trend of newer synthetic cannabinoids being more potent than earlier compound

The % peak area abundance ratio of metabolites detected in the urine samples are often affected by numerous factors such as drug intake behaviour (intake route, amount of drug and intake frequency), time from last drug intake and metabolic stabilit


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 patient.
Data availabili

The chemical structures of the recent synthetic cannabinoids are unlike that of Δ9-THC, but are largely based on the structure of older synthetic cannabinoids that are known to have substantial abuse liability (Fig. 1


All of the compounds tested in the present study depressed locomotor activity as is typical for other synthetic cannabinoids (see review by Wiley et al., 2017). Average horizontal activity counts/10 min as a function of time (10 min bins) and dose. Depressant effects of 1.33 mg/kg were observed within 10 min following administration and peak depressant effects were 4F ADB observed between 0–30 min. Duration of the locomotor depression increased over dose from 30 min following 0.1 mg/kg to 2.5 h following 1 mg/k

Furthermore, users of these vapes and alerting authorities may not notice the addition of recreational drugs to the e-liquid as the smell of recreational drugs is lost during vaping due to the specific smell of added flavours

Legal status
Briefly, the FOB test was comprised of several behavioral changes including catalepsy, traction, tremor, convulsion, exopthalmos, piloerection, salivation, lacrimation, diarrhea, skin coloration, pinna reflex, righting reflex, and death. The FOB test was performed using published procedures (Moser et al., 1989) with some modifications. However, because of their subjective properties, it is necessary to set up a more objective automated measurement to determine their neurotoxicity. However, there are only a couple of anecdotal reports suspecting the possibility of their neurotoxicity with no scientific evidence (Cohen et al., 2012; McGuinness and Newell, 2012; Harris and Brown, 2013; Hermanns et al., 2013


The current study indicates that the test compounds produce locomotor depression similar to that of Δ9-THC, and fully substitute for the discriminative stimulus effects of Δ9-THC. In summary, these 5F-MDMB-PINACA, MDMB-CHIMICA, MDMB-FUBINACA, ADB-FUBINACA, and AMB-FUBINACA have similar abuse liability as Δ9-tetrahydrocannabinol and should be controlled in a similar fashion. Much of the in vivo 4F ADB testing of the synthetic cannabinoid compounds have been pre-clinical studies focused on their cannabinoid-like effects or like the present study, focused on their abuse liability. There is indication that at least some of the first-generation synthetic cannabinoids act at receptors other than cannabinoid CB1 and CB2 (Wiley et al., 2016), and a compound from the present study, 5F-MDMB-PINACA, was found to activate midbrain dopamine neurons, but not serotonin neurons (Asaoka et al., 2016
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