Involuntary MDMB-4en-PINACA intoxications following cannabis consumption: clinical and analytical findings

Goncalves, Ruben; Labadie, Magali; Chouraqui, Simon; Peyré, Alexandre; Castaing, Nadège; Daveluy, Amélie; Molimard, Mathiéu

doi:10.1080/15563650.2021.1994144

Cited by 6 publications

(5 citation statements)

References 26 publications

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“…There are now (July 2023) 44 scientific articles in all (40 entries in Pubmed, 41 in Scopus, and 37 in Web of Science), but none of these describe a fatal case in detail, and only one describes the symptoms linked with its usage. Goncalves et al reported eight cases of MDMB-4en-PINACA associated hospitalization with the most common symptoms of paranoia and/or hallucinations (four cases), nausea and/or vomiting (three cases), altered or loss of consciousness (three cases), psychomotor agitation and/or aggressiveness (three cases), headaches (three cases), persistent tiredness (three cases), mydriasis (three cases), seizure (two cases), amnesia (two cases), and dizziness (two cases) [ 29 ]. Seizures after consumption of MDMB-4-en-PINACA were also reported [ 30 ].…”

Section: Resultsmentioning

confidence: 99%

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Fatal Overdose with the Cannabinoid Receptor Agonists MDMB-4en-PINACA and 4F-ABUTINACA: A Case Report and Review of the Literature

Simon

Kuźma

Mayer

et al. 2023

Toxics

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A case of a 26-year-old male who died from consuming synthetic cannabinoid receptor agonists MDMB-4en-PINACA and 4F-ABUTINACA is reported. MDMB-4en-PINACA and 4F-ABUTINACA are potent synthetic cannabinoid receptor agonists (SCRAs). This is the first detailed reporting of MDMB-4-en-PINACA and 4F-ABUTINACA associated fatality, which can help the routine forensic work. The scientific literature on the symptoms associated with these substances are evaluated, along with the pharmacological properties and possible mechanism of death. A forensic autopsy was performed according to Recommendation No. R (99)3 of the Council of Europe on medico-legal autopsies. Histological samples were stained with hematoxylin and eosin (HE). Complement component C9 immunohistochemistry was applied to all heart samples. Toxicological analyses were carried out by supercritical fluid chromatography coupled with tandem mass spectrometry (SFC-MS/MS) and headspace gas chromatography with a flame ionization detector (HS-GC-FID). The literature was reviewed to identify reported cases of MDMB-4en-PINACA and 4F-ABUTINACA use. Autopsy findings included brain edema, internal congestion, petechial bleeding, pleural ecchymoses, and blood fluidity. Toxicological analyses determined 7.2 ng/mL of MDMB-4en-PINACA and 9.1 ng/mL of 4F-ABUTINACA in the peripheral blood. MDMB-4en-PINACA and 4F-ABUTINACA are strong, potentially lethal SCRA, and their exact effects and outcome are unpredictable.

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Section: Resultsmentioning

confidence: 99%

“…Xiang et al also identified further ketone metabolites and special phase II metabolites [ 28 ]. Various clinical symptoms were reported after using MDMB-4en-PINACA, such as headaches, seizures, paranoia, anxiety, hallucinations, amnesia, mydriasis, nausea, and vomiting [ 29 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

Fatal Overdose with the Cannabinoid Receptor Agonists MDMB-4en-PINACA and 4F-ABUTINACA: A Case Report and Review of the Literature

Simon

Kuźma

Mayer

et al. 2023

Toxics

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“…3,15,16 Among the drug class, MDMB-4en-PINACA is a newer generation compound that has recently emerged, probably with a toxicity profile like the drug class in general. 17,18 Although other toxic effects such as seizures, psychiatric symptoms, and gastrointestinal symptoms have been described with synthetic cannabinoid use, the most significant and potentially lethal toxicities are cardiovascular in nature, particularly arrhythmias, cardiac arrest, and myocardial ischemia. These effects are thought to be mediated by the highly potent activation of cannabinoid receptor 1 by synthetic cannabinoids in comparison with the only partial agonist effects on this receptor by tetrahydrocannabinol found in marijuana, although downstream details of this activation are not well understood.…”

Section: Discussionmentioning

confidence: 99%

“…This is in part due to their potentially lethal toxic adverse effects, as well as their frequently evolving chemical makeup, which renders their toxicologic identification and monitoring more difficult 3,15,16 . Among the drug class, MDMB-4en-PINACA is a newer generation compound that has recently emerged, probably with a toxicity profile like the drug class in general 17,18 . Although other toxic effects such as seizures, psychiatric symptoms, and gastrointestinal symptoms have been described with synthetic cannabinoid use, the most significant and potentially lethal toxicities are cardiovascular in nature, particularly arrhythmias, cardiac arrest, and myocardial ischemia.…”

Section: Discussionmentioning

confidence: 99%

Fatal Thyroid Storm in the Setting of Untreated Graves Disease and Use of the Synthetic Cannabinoid MDMB-4en-PINACA

Ricciardo

Hastings

2023

Am J Forensic Med Pathol

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Thyroid storm, or thyrotoxic crisis, is a rare but well-described and potentially lethal exacerbation of thyrotoxicosis, characterized by multisystem effects due to failure of the hypothalamic-pituitary-thyroid axis. Thyroid storm is seen most frequently in the setting of inadequately treated Graves disease; however, it may also be triggered or exacerbated by infection, trauma, childbirth, radioiodine treatment, and pharmacologic agents. While there are rare reports of cases in which illicit drug use may have triggered or exacerbated thyroid storm, none specifically involving synthetic cannabinoids have been previously described. We present the case of a 25-year-old man who presented with thyroid storm in the setting of poorly controlled Graves disease and synthetic cannabinoid use.

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“…With a positivity rate of 3.6%, synthetic cannabinoids appear not to be 'niche drugs' anymore. Furthermore, there is a growing concern that traditional consumers of cannabis may be at risk of inadvertent exposure to synthetic cannabinoids [54][55][56][57].…”

Section: Europementioning

confidence: 99%

Detecting novel psychoactive substances around the world

Salomone,

Vincenti

2024

Current Opinion in Psychiatry

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Purpose of review The worldwide spread of novel psychoactive substances (NPS) in the illicit drug market and their continuous increase in number and type, for the purpose of bypassing controlled substance legislation, represents a continuing challenge for forensic scientists, clinicians and enforcement authorities. We aim to provide information regarding the most urgent harms related to NPS consumption in different world regions and the current state of the art for NPS analysis. Recent findings Unfortunately, the identification of NPS in biological samples is controversial, especially when samples are limited, or the drug is promptly and extensively metabolized. This causes a lack of information on their real diffusion in different parts of the world and in different populations. New technologies and instrumental detection of NPS in alternative samples are offering comprehensive information about NPS use. Summary The lack of detection and underreporting of NPS in biological samples makes it difficult to obtain complete qualitative and quantitative information about NPS prevalence. The most innovative strategies that have been proposed in the last 2 years to assist NPS analysis and possibly facilitate the understanding of the NPS diffusion around the world are presented.

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Involuntary MDMB-4en-PINACA intoxications following cannabis consumption: clinical and analytical findings

Cited by 6 publications

References 26 publications

Fatal Overdose with the Cannabinoid Receptor Agonists MDMB-4en-PINACA and 4F-ABUTINACA: A Case Report and Review of the Literature

Fatal Overdose with the Cannabinoid Receptor Agonists MDMB-4en-PINACA and 4F-ABUTINACA: A Case Report and Review of the Literature

Fatal Thyroid Storm in the Setting of Untreated Graves Disease and Use of the Synthetic Cannabinoid MDMB-4en-PINACA

Detecting novel psychoactive substances around the world

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