Background: Synthetic cannabinoid receptor agonists (SCRAs) have become the largest group of new psychoactive substances monitored by the European Union Early Warning System. Despite the wide diffusion on the market, data regarding effects, toxicities, and mechanisms as well as toxic/lethal doses are still scarce. Methods: A comprehensive literature search for articles published up to January 2019 was performed in multiple electronic databases. Only cases of death in which toxicological analyses revealed the presence of SCRAs in blood or urine and at least an external examination was performed, including those occurred in emergency departments, were included. Results: Of 380 studies identified, 354 were excluded, while 8 additional manuscripts were included through the screening of relevant references cited in the selected articles. A total number of 34 manuscripts (8 case series and 26 case reports) were included. Conclusions: Typical toxic ranges for SCRAs have not been so far identified, and the results of toxicological analyses should be interpreted with caution. In death cases involving SCRAs, a thorough post-mortem examination is a prerequisite to assess the role of the substance use in the deceased and to identify a probable mechanism of death. Even after a comprehensive analysis of clinical, circumstantial, toxicological, and autoptic data, the cause and manner of death remain unclear in some cases.

The internet and social networking sites play a significant role in the marketing, sale and the distribution of drugs. The internet is being used both as a source of information and communication but also as a tool to disseminate drug-related websites and sell controlled substances without prescriptions. Our review aims to obtain knowledge concerning the profile of the online drug consumer and the determinants of internet preference. PubMed, Google Scholar and Scopus databases were searched without any language limitations by using a set of keywords. For each set of keywords we evaluated all articles providing socio-demographic characteristics of online drug consumers; reasons for purchasing online drugs; risks related to the online shopping of medicaments and features of illicit/legitimate commercial sites. All data has been analysed and compared for these specified clusters. Results report a majority of Caucasian males in their twenties, both in internet users and drug user/abusers. Several studies reported that the men usually perceive less risks, are more likely to turn to the internet as a source of prescription drugs and, subsequently, more likely to buy drugs and illegal substances online. On the other hand, women were noted as more likely to search for health information. The protection of identity by screen pseudonyms, variety and quality of product listings, selection of vendors based on review feedbacks, reduced personal risks, forum activity and the availability of a service for prescriptiononly drugs stimulate the growth and development of both OPs and drug marketplaces.

Synthetic cannabinoids (SCs) remain one of the largest groups of new psychoactive substances (NPS) on the European drug market. Although the number of new derivatives occurring on the market has dropped in the last two years, newly emerging NPS still represent a challenge for laboratories performing forensic drug analysis in biological matrices. The newly emerged SC 4F‐MDMB‐BINACA has been reported by several law enforcement agencies in Europe and the USA since November 2018. This work aimed at revealing urinary markers to prove uptake of 4F‐MDMB‐BINACA and differentiate from the use of structurally similar SCs. Phase‐I metabolites detected in human urine specimens were confirmed by phase‐I metabolites generated in vitro using a pooled human liver microsomes (pHLM) assay. Seized materials and test‐purchased “legal high” products were analyzed by gas chromatography–mass spectrometry (GC–MS) and liquid chromatography−quadrupole‐time‐of‐flight−mass spectrometry (LC−qToF−MS). Human urine specimens and pHLM assay extracts were measured with liquid chromatography−electrospray ionization−tandem mass spectrometry (LC−ESI−MS/MS) and confirmed by LC−qToF−MS. In January 2019, the Institute of Legal Medicine in Erlangen (Germany) identified 4F‐MDMB‐BINACA in three herbal blends. During the same time period, the described SC was identified in a research chemical purchased online. Investigation of phase‐I metabolism led to the metabolites M10 (ester hydrolysis) and M11 (ester hydrolysis and dehydrogenation) as reliable urinary markers. Widespread distribution on the German drug market was proven by analysis of urine samples from abstinence control programs and by frequent detection of 4F‐MDMB‐BINACA in “herbal blends” and “‘research chemicals” purchased via the Internet.