A case of 5F-ADB / FUB-AMB abuse: Drug-induced or drug-related death?

Ivanov, Ivo; Stoykova, Silviya; Ivanova, Elka; Vlahova, Aleksandrina; Burdzhiev, Nikola; Pantcheva, Ivayla; Atanasov, Vasil

doi:10.1016/j.forsciint.2019.02.005

Cited by 26 publications

(19 citation statements)

References 26 publications

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“…Several death cases involving SCs, e.g. [11,[22][23][24][25]. The wide range of postmortem concentrations, overlapping those of non-fatal intoxications, strongly limits the possibility of identifying so-called "toxic ranges" [25,26].…”

Section: Discussionmentioning

confidence: 99%

Four cases of death involving the novel synthetic cannabinoid 5F-Cumyl-PEGACLONE

et al. 2019

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Purpose Cumyl-PEGACLONE was the first synthetic cannabinoid (SC) with a γ-carbolinone core structure detected in forensic casework and, since then, it has dominated the German SC-market. Here the first four cases of death involving its fluorinated analog, 5F-Cumyl-PEGACLONE, a recently emerged γ-carbolinone derived SC, are reported. Methods Complete postmortem examinations were performed. Postmortem samples were screened by immunoassay, gas chromatography mass spectrometry (GC-MS) or liquid chromatography tandem mass spectrometry. For quantification of SCs, the standard addition method was employed. Herbal blends were analyzed by GC-MS. In each case of death, the Toxicological Significance Score (TSS) was assigned to the compound. Results 5F-Cumyl-PEGACLONE was identified at concentrations ranging 0.09-0.45 ng/mL in postmortem femoral blood. In case 1, signs of hypothermia and kidney bleedings were noted. Despite a possible tolerance due to long term SC use, a TSS of 3 was assigned. In case 2, an acute heroin intoxication occurred and a contributory role (TSS = 1) of 5F-Cumyl-PEGACLONE was suggested. In case 3, a prisoner was found dead. GC-MS analysis of herbal blends, retrieved in his cell together with paraphernalia, confirmed the presence of 5F-Cumyl-PEGACLONE and a causative role was deemed probable (TSS = 2). In case 4, the aspiration of gastric content due to a SC-induced coma was observed (TSS = 3). Conclusions 5F-Cumyl-PEGACLONE is an emerging and extremely potent SC which raises serious public health concerns. A comprehensive analysis of circumstantial, clinical, and postmortem findings, as well as an in-depth toxicological analysis is necessary for a valid interpretation and for the assessment of the toxicological significance.

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Section: Discussionmentioning

confidence: 99%

Four cases of death involving the novel synthetic cannabinoid 5F-Cumyl-PEGACLONE

et al. 2019

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“…AMB-FUBINACA was cited in one instance [16] . Although outbreaks of bizarre behaviour and stupor resulting in increased visits to emergency rooms are well known with AMB-FUBINACA [ 23 , 24 ], we are aware of only two recent case reports of fatalities associated with AMB-FUBINACA, each combined with another synthetic cannabinoid (EMB-FUBINACA and 5F-ADB, respectively) [ 13 , 14 ]. We believe that this series represents the first description of an outbreak of multiple deaths associated with AMB-FUBINACA.…”

Section: Discussionmentioning

confidence: 99%

“…In a survey of American medical examiner/coroner offices between 2010 and 2014, 25 deaths were reported in which synthetic cannabinoids were toxicologically confirmed and may have contributed to death [4] . Since 2014 an increasing number of deaths associated with a variety of synthetic cannabinoids has been reported [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] . A recent review of Australian coronial deaths between 2000 and 2017 revealed 55 cases in which synthetic cannabinoid use was considered a contributory mechanism to death [16] .…”

Section: Introductionmentioning

confidence: 99%

“…AMB-FUBINACA is a synthetic cannabinoid that has caused outbreaks of poisonings in New York [3] and Connecticut [17] , USA, in July 2016 and Aug 2018, respectively. Although no deaths were reported in these outbreaks, AMB-FUBINACA in combination with other synthetic cannabinoids (EMB-FUBINACA and 5F-ADB) has been implicated in at least two fatalities [ 13 , 14 ]. In late May, June and July 2017, 17 deaths associated with AMB-FUBINACA were observed in Auckland, New Zealand [18] .…”

Section: Introductionmentioning

confidence: 99%

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An outbreak of deaths associated with AMB-FUBINACA in Auckland NZ

et al. 2020

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Background AMB-FUBINACA is a synthetic cannabinoid that has been associated with periodic outbreaks of acute poisonings, but few fatalities. In late May, June and July 2017 Auckland, New Zealand, experienced an outbreak of deaths associated with AMB-FUBINACA that continued at a rate of about 2–3 per month through February 2019. The aim of this study was to define the demographic, circumstantial, pathological and toxicological characteristics of this outbreak. Methods All records of the Northern Forensic Pathology Service, Auckland Hospital, were reviewed in which the word “AMB-FUBINACA” was referenced, including initial police reports, autopsy reports and toxicology reports. Recorded data included age, sex, race/ethnicity, times and locations, cause of death, autopsy and toxicology findings, and a brief summary of the circumstances of death. Descriptive statistics were performed using IBM® SPSS® Statistics Version 24 and Microsoft® Excel® Version 14.7.2. Findings Sixty-four cases were identified. One sudden infant death and five cases where cause of death was due to trauma were excluded. Of the remaining 58 cases, 88% were male. Mean age was 42 years. In 95% of the deaths, AMB-FUBINACA alone or in combination with alcohol or another drug was listed as the primary or contributory cause of death. In 41 cases postmortem blood concentrations of AMB-FUBINACA acid were available, ranging from <45 ng/mL to >1000 ng/mL, mean 229 ng/mL, median 140 ng/mL. Comorbidities identified included mixed intoxications (29%), heart disease (47%) and obesity (16%). A mental health diagnosis was reported in 50%, and 40% were on antipsychotic medications. Interpretation This study presents characteristics, comorbidities and toxicological findings in a unique outbreak of deaths associated with the synthetic cannabinoid AMB-FUBINACA in Auckland, NZ. Funding All work was funded as part of the usual employment of the authors in their respective institutions. No special funding sources are reported.

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“…SCs severe and fatal poisonings in young people are also frequent [29]: the number of deaths reported in the medical literature appears to be increasing and mostly related to the use of the most recent and powerful SCs, such as 5F-ADB/ FUB-AMB, 5F-PB-22, and AB-CHMINACA [19,37,38].…”

Section: Epidemiologymentioning

confidence: 99%

New Drugs of Abuse and Cardiovascular Function

Locatelli¹,

Lonati²,

Petrolini³

2020

Brain and Heart Dynamics

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Over the past decade, several new chemical compounds (the so-called NPS, new or novel psychoactive substances) have been synthesized and placed on the abuse market. About a thousand agents are known and monitored by supranational and national agencies because they cause new intoxication, prolonged health adverse effects, and addiction. Synthetic cannabinoids, cathinones, ketamines, new phenethylamines, and other molecules are today readily available at low cost. The high potency of these compounds, the important effects on the cardiovascular and central nervous systems, the still little knowledge about the prolonged health consequences, together with the hope to identify contrastable mechanisms of toxicity, have conquered

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A case of 5F-ADB / FUB-AMB abuse: Drug-induced or drug-related death?

Cited by 26 publications

References 26 publications

Four cases of death involving the novel synthetic cannabinoid 5F-Cumyl-PEGACLONE

Four cases of death involving the novel synthetic cannabinoid 5F-Cumyl-PEGACLONE

An outbreak of deaths associated with AMB-FUBINACA in Auckland NZ

New Drugs of Abuse and Cardiovascular Function

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