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Clinical Features Associated With ADB-BUTINACA Exposure In Patients Attending Emergency Departments In England: Difference between revisions

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High resolution mass spectrometry such as LC-QTOF-MS allows the detection and identification of a broad spectrum of recreational drugs, including new psychoactive substances. A point-of-care drugs of abuse (DOA) test was initially performed on the urine of the patient. He confirmed drinking 750 ml energy drink without any further consumption of food and using an e-cigarette from Gaziantep, Turkey 10 seconds before the onset of his first symptoms. He usually smokes a pack of cigarettes a day and sometimes smokes e-cigarettes. Combined with non-specific, transient symptoms, clinical recognition of SCRA intoxication is challenging .<br>Data availability <br>The intensity is plotted against the retention time for both chromatograms, demonstrating the [https://cannabinoidsrc4f-adb.com/ https://cannabinoidsrc4f-adb.com/] presence and elution profiles of nicotine and ADB-BUTINACA in the analysed vape liquid sample. LC-QTOF-MS Chromatograms of Nicotine (Top) and ADB-BUTINACA (Bottom) in the Vape Liquid used by the patient. The LC-QTOF-MS analysis showed that the e-liquid contained nicotine and ADB-BUTINACA (Fig. 1). Because the point-of-care DOA test is generally not able to detect synthetic recreational drug substances, the liquid of the e-cigarette was thereafter screened using liquid chromatography-quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) on the Waters™ Xevo G3 QTOF MS system. After eating a light meal and drinking caffeinated sports drinks at the ER, the nausea complaints of the patient were reduced and the patient was discharged hom<br><br><br>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 https://cannabinoidsrc4f-adb.com/ headache, nausea, vertigo, red eyes and palpitations. Synthetic cannabinoids are gaining popularity globally and detection is not commonly availabl<br><br>Male ND4 Swiss–Webster mice were obtained from Envigo (Houston, TX) at approximately 8 weeks of age and maintained in the University of North Texas Health Science Center (UNTHSC) animal facility for two weeks prior to testin<br><br><br>Demographic and clinical features are recorded and blood and/or urine samples analysed using high-resolution accurate mass liquid chromatography-mass spectrometry. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Second, we could not https://cannabinoidsrc4f-adb.com/ retrieve further detailed information about the e-cigarette that was used by the patient such as the label or the region of origin. Whether a recreational drug can be administered via vaping, depends on whether the drug becomes volatile under the evaporation temperature of the e-cigarette. Of these samples, 22 contained one or more SCRAs, THC was only detected in 11 samples, only one contained cannabidiol and 6 contained a mixture of THC and cannabidiol. There is difficulty in finding the right information about the NPS, defining their potency and confirmation of their existence in e-liquids or urine samples.<br>Data availabili<br><br>4. Drugs <br>The purpose of the present study was to assess the abuse liability of 5F-MDMB-PINACA, MDMB-CHIMICA, MDMB-FUBINACA, ADB-FUBINACA, and AMB-FUBINACA. The findings produce an apparent paradox, since CPP and self-administration predict with high reliability the likelihood that a compound will be abused by humans, and cannabinoids are well-known to produce active drug-seeking in humans. Drug discrimination is a well-known animal model of the subjective effects of drugs and correlates well with abuse liability (Young 2009; Horton et al. 2013). Assessment of abuse liability is based on several factors, including chemical structure, pharmacological mechanism of action, and finally, subjective and reinforcing behavioral effects (FDA, 2010; Swedberg, 2013).<br>Michael B Gat<br><br>Synthetic cannabinoids have consistently been shown to produce discriminative stimulus effects similar to those of Δ9-THC (Bannister and Connor, 2018), and MDMB-FUBINACA fully substituted for Δ9-THC (Gamage et al., 2018<br><br>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<br><br><br>These synthetic cannabinoids act https://cannabinoidsrc4f-adb.com/ directly at cannabinoid CB1 and CB2 receptors as does Δ9-tetrahydrocannabinol (Δ9-THC) found in marijuana, but have different chemical structures unrelated to Δ9-THC, different metabolism, and often greater toxicity (Fantegrossi et al., 2014). Discriminative stimulus effects were tested in rats trained to discriminate Δ9-tetrahydrocannabinol (3 mg/kg, 30-min pretreatment). 5F-MDMB-PINACA (also known as 5F-ADB, 5F-ADB-PINACA), MDMB-CHIMICA, MDMB-FUBINACA, ADB-FUBINACA, and AMB-FUBINACA (also known as FUB-AMB, MMB-FUBINACA) were tested for in vivo cannabinoid-like effects to assess their abuse liabilit
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 [https://cannabinoidsrc4f-adb.com/ homesite] headache, nausea, vertigo, red eyes and palpitations. Synthetic cannabinoids are gaining popularity globally and detection is not commonly available.<br>Data availability <br>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<br><br>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<br><br><br>Taken together these data further confirmed the structure elucidation of B16. The precursor ion m/z 276 (B1) detected, which was 74 Da lower than that for the 4F-MDMB-BINACA ester hydrolysis metabolite (B22), indicated N-dealkylation of B22. The precursor ion m/z 348 and product ion detected at m/z 217 (B2) identified was 2 Da less than the 4F-MDMB-BINACA ester hydrolysis metabolite (B22), indicating oxidative defluorination (loss of fluorine with addition of hydroxy homesite group<br><br><br>Although there were reports on the metabolism of 4F-MDMB-BINACA using in-vivo and various in-vitro models, studies were either conducted using small in-vivo sample size such as 1 to 4 samples [5, 29] or in closed environments such as forensic psychiatric wards and prisons . The hepatic cell line HepG2 is often used as an initial screen as it is known to produce high reproducibility results with relatively stable enzyme concentration, although they are limited by the low-level expression of several metabolizing enzymes, including the cytochrome P450 (CYP) class of proteins [17, 18]. In-vitro metabolism studies are generally used to complement these data using perfused organs, tissue or cell cultures and microsomal preparations amongst which pooled human liver microsomes (HLM) have been frequently used to elucidate metabolism of SCBs [12,13,14,15,16]. Since most SCBs are found extensively in metabolized forms in urine, the identification of metabolites is of vital importance for forensic and clinical toxicologists. Identifying SCB intake and its correlating specific adverse effects require rapid elucidation of these SCBs. The proliferation of SCBs has become a global challenge as new compounds are rapidly introduced into the illegal drug market to evade existing drug law<br><br><br>§ (3) of the Hungarian act of Forensic Experts (2016.XXIX), the data of the reported case can be utilized freely for scientific and educational purposes without special ethical permission. These results indicate that the simultaneous intoxication of SCRA and ethanol directly and exclusively caused the death of the two victims. The victims did not have any significant diseases that could have contributed to the outcome. Very limited data are available in the scientific literature about the possible effects of the combined consumption of SCRAs and ethanol. Several case reports describe that the presence of a little ng/mL (0.37–4.1) of SCRAs and a high—but not lethal—concentration of ethanol (1.45–2.7 g/L) directly and exclusively contributed to the death of the victim [24–27] (Table 2). The fact that 4F-MDMB-BINACA was not detected in postmortem urine samples is partly explained by the high rate of hepatic metabolism of SCRAs [11, 14, 22], but also suggests that the victims consumed 4F-MDMB-BINACA shortly before their death<br><br><br>Due to the unknown toxicity of newly emerging SCRAs, forensic assessments of cases involving these substances are challenging. According to the reported cases and reviews of the scientific literature, concurrent ethanol consumption should amplify the toxicity of SCRAs. The concentration of 4F-MDMB-BINACA in the postmortem blood was 2.50 and 2.34 ng/mL, and blood alcohol concentration was 2.11 and 2.49 g/L, respectively. Two fatal cases are reported caused by simultaneous consumption of 4F-MDMB-BINACA and ethanol.<br>Fig. 2. <br>The precursor ion m/z 396 (B10, B12/B15) was 32 Da higher than the parent drug, 4F-MDMB-BINACA, suggesting the addition of two hydroxy groups. All the below explanations for transformations into metabolites are based on the data shown in Fig. Metabolites were identified according to their precursor ions, product ions, and fragmentation patterns (Fig. 1). Traditional in-vivo metabolism studies to generate human metabolites of drugs relied heavily on the use of whole animal model systems, which are expensive, limited by drug administration amount, influenced by species variation and faced by many ethical issues. Eight in-vivo metabolites tentatively identified were mainly products of ester hydrolysis with or without additional dehydrogenation, N-dealkylation, monohydroxylation and oxidative defluorination with further oxidation to butanoic acid.<br>Fig. 1. <br>This outcome was anticipated since CES-mediated hydrolysis is commonly homesite reported as the major metabolic pathway among the SCBs impacting the terminal ester group . Glucosides and sulfate metabolites have been reported with other SCBs where C. From these three samples, sample 2 contained only an ester hydrolysis metabolite (m/z 350). Both ester hydrolysis followed by oxidative defluorination to butanoic acid (B4, m/z 362) and monohydroxylation at tert-leucine moiety (B8, m/z 366) metabolites were found in 16/20 urine samples (Table 2). A In-vitro metabolites observed in common among respective seven most abundant metabolites in b C. The product ion detected at m/z 235, indicating loss of sulfate, confirmed the identity of the sulfation metabolite.<br>Fungus C. elegans <br>Methyl (2S)-2-([1-(4-fluorobutyl)-1H-indazole-3-carbonyl]amino)-3,3-dimethylbutanoate (4F-MDMB-BINACA, 4F-MDMB-BUTINACA or 4F-ADB), found in numerous SCB product seizures, has been reported by various law enforcement since 2018 . However, most of the SCBs are full agonists at CB1 and CB2 receptors, having a higher risk of undesirable side effects when compared to THC which is a partial agonist . Synthetic cannabinoids (SCBs) are agonists at cannabinoid receptor type 1 (CB1) and type 2 (CB2), where they elicit their main effect

Latest revision as of 09:49, 24 May 2026

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 homesite 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

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


Taken together these data further confirmed the structure elucidation of B16. The precursor ion m/z 276 (B1) detected, which was 74 Da lower than that for the 4F-MDMB-BINACA ester hydrolysis metabolite (B22), indicated N-dealkylation of B22. The precursor ion m/z 348 and product ion detected at m/z 217 (B2) identified was 2 Da less than the 4F-MDMB-BINACA ester hydrolysis metabolite (B22), indicating oxidative defluorination (loss of fluorine with addition of hydroxy homesite group


Although there were reports on the metabolism of 4F-MDMB-BINACA using in-vivo and various in-vitro models, studies were either conducted using small in-vivo sample size such as 1 to 4 samples [5, 29] or in closed environments such as forensic psychiatric wards and prisons . The hepatic cell line HepG2 is often used as an initial screen as it is known to produce high reproducibility results with relatively stable enzyme concentration, although they are limited by the low-level expression of several metabolizing enzymes, including the cytochrome P450 (CYP) class of proteins [17, 18]. In-vitro metabolism studies are generally used to complement these data using perfused organs, tissue or cell cultures and microsomal preparations amongst which pooled human liver microsomes (HLM) have been frequently used to elucidate metabolism of SCBs [12,13,14,15,16]. Since most SCBs are found extensively in metabolized forms in urine, the identification of metabolites is of vital importance for forensic and clinical toxicologists. Identifying SCB intake and its correlating specific adverse effects require rapid elucidation of these SCBs. The proliferation of SCBs has become a global challenge as new compounds are rapidly introduced into the illegal drug market to evade existing drug law


§ (3) of the Hungarian act of Forensic Experts (2016.XXIX), the data of the reported case can be utilized freely for scientific and educational purposes without special ethical permission. These results indicate that the simultaneous intoxication of SCRA and ethanol directly and exclusively caused the death of the two victims. The victims did not have any significant diseases that could have contributed to the outcome. Very limited data are available in the scientific literature about the possible effects of the combined consumption of SCRAs and ethanol. Several case reports describe that the presence of a little ng/mL (0.37–4.1) of SCRAs and a high—but not lethal—concentration of ethanol (1.45–2.7 g/L) directly and exclusively contributed to the death of the victim [24–27] (Table 2). The fact that 4F-MDMB-BINACA was not detected in postmortem urine samples is partly explained by the high rate of hepatic metabolism of SCRAs [11, 14, 22], but also suggests that the victims consumed 4F-MDMB-BINACA shortly before their death


Due to the unknown toxicity of newly emerging SCRAs, forensic assessments of cases involving these substances are challenging. According to the reported cases and reviews of the scientific literature, concurrent ethanol consumption should amplify the toxicity of SCRAs. The concentration of 4F-MDMB-BINACA in the postmortem blood was 2.50 and 2.34 ng/mL, and blood alcohol concentration was 2.11 and 2.49 g/L, respectively. Two fatal cases are reported caused by simultaneous consumption of 4F-MDMB-BINACA and ethanol.
Fig. 2.
The precursor ion m/z 396 (B10, B12/B15) was 32 Da higher than the parent drug, 4F-MDMB-BINACA, suggesting the addition of two hydroxy groups. All the below explanations for transformations into metabolites are based on the data shown in Fig. Metabolites were identified according to their precursor ions, product ions, and fragmentation patterns (Fig. 1). Traditional in-vivo metabolism studies to generate human metabolites of drugs relied heavily on the use of whole animal model systems, which are expensive, limited by drug administration amount, influenced by species variation and faced by many ethical issues. Eight in-vivo metabolites tentatively identified were mainly products of ester hydrolysis with or without additional dehydrogenation, N-dealkylation, monohydroxylation and oxidative defluorination with further oxidation to butanoic acid.
Fig. 1.
This outcome was anticipated since CES-mediated hydrolysis is commonly homesite reported as the major metabolic pathway among the SCBs impacting the terminal ester group . Glucosides and sulfate metabolites have been reported with other SCBs where C. From these three samples, sample 2 contained only an ester hydrolysis metabolite (m/z 350). Both ester hydrolysis followed by oxidative defluorination to butanoic acid (B4, m/z 362) and monohydroxylation at tert-leucine moiety (B8, m/z 366) metabolites were found in 16/20 urine samples (Table 2). A In-vitro metabolites observed in common among respective seven most abundant metabolites in b C. The product ion detected at m/z 235, indicating loss of sulfate, confirmed the identity of the sulfation metabolite.
Fungus C. elegans
Methyl (2S)-2-([1-(4-fluorobutyl)-1H-indazole-3-carbonyl]amino)-3,3-dimethylbutanoate (4F-MDMB-BINACA, 4F-MDMB-BUTINACA or 4F-ADB), found in numerous SCB product seizures, has been reported by various law enforcement since 2018 . However, most of the SCBs are full agonists at CB1 and CB2 receptors, having a higher risk of undesirable side effects when compared to THC which is a partial agonist . Synthetic cannabinoids (SCBs) are agonists at cannabinoid receptor type 1 (CB1) and type 2 (CB2), where they elicit their main effect