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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


To evaluate whether the changes of coordinative functions by CNS damages were due to test substances, rota-rod test was performed using Rota-rod apparatus (Daejong, Seoul, Korea). The test apparatus for the locomotor activity test was designed to measure locomotor activity automatically using UV system (AM 1051, Benwick Electronics, Benwick, UK) when experimental animals moved in the chamber. In both tests, a group of mice were treated with negative control (vehicle, 1 mg/kg, i.p.), positive control (methamphetamine, 1 mg/kg, i.p.), or one of the three doses of test substances (0.1, 1, 5 mg/kg, i.p.) once every other day for 10 day


As synthetic cannabinoid receptor agonists (SCRA) are gaining popularity globally, clinicians have to understand that intoxication caused by vaping SCRA is not detected by commonly available tests. He confirmed that he had been vaping an electronic cigarette (e-cigarette) earlier that day just before the onset of his symptoms. Metabolic acidosis (1/3, 0/7) and respiratory acidosis (1/3, 0/7), All 10 patients recovered with supportive care, including intubation and ventilation for one case. In 3 cases ADB-BUTINACA was the only substance detected, while in seven other substances of misuse were also detected including other SCRA, opioids, benzodiazepines cocaine and pregabali


Acute kidney damage and even kidney failure have been reported following use of synthetic cannabinoids (Davidson, et al., 2017). One recent study has looked at other mechanisms of action in some of the older synthetic cannabinoids and reported that some produced varying amounts of activity at sites which are related to cardiotoxicity and heart disease (Wiley et al., 2016). It is not known whether the increased toxicity is due only to activation of CB1 cannabinoid receptors more strongly than Δ9-THC or whether these "super-strength" cannabinoids produce effects at other receptors. A major cause of concern is that some of the more recently seen synthetic cannabinoids are more likely to produce extremely toxic effects than the older synthetics (Tai and Fantegrossi, 2017


Test 2 was performed everyday for 5 days after consecutive administration of the substances, including negative (vehicle) and positive (methamphetamine) controls. After the last administration, the first trial was performed. Morris water maze test was performed to evaluate the changes of learning and memory function through administration of the test substances. Generally, neurotoxicity of a substance is evaluated by animal behavioral aspects, i.e. functional observation battery (FOB) tests (O’Callaghan et al., 2014). Our results suggest that JWH-081 and JWH-210 may 5CLADBA be neurotoxic substances through changing neuronal cell damages, especially in the core shell part of nucleus accumbens.
About Powder JWH-2


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 5CLADBA 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


LC-QTOF-MS represents a significant advancement in the field of drug detection, offering higher sensitivity, specificity, and a broader spectrum of detectable substances. Despite all negative results in the point-of-care test for recreational drugs, the liquid chromatography-quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) analysis showed that the liquid of the e-cigarette contained ADB-BUTINACA, a synthetic cannabinoid. We report a 27-year-old man who was admitted to the emergency room because of sudden 5CLADBA headache, nausea, vertigo, red eyes and palpitations. Synthetic cannabinoids are gaining popularity globally and detection is not commonly available.
Data availability
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
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