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Clinical features associated with ADB-BUTINACA exposure in patients attending emergency departments in England
4. Drugs
Short-onset, short-acting compounds have a greater abuse liability, and long-acting compounds pose problems of long-acting adverse effects and interactions with other drugs. The duration of action of the synthetic cannabinoids tested using the 8-h protocol have varied widely, with some producing a duration of action no longer than 1 h, others producing a duration of action between 1–2 h, and others lasting more than 2 h. There seems to be a trend of newer synthetic cannabinoids being more potent than earlier compounds. All of the compounds tested in the present study depressed locomotor activity as is typical for other synthetic cannabinoids (see review by Wiley et al., 2017). Average horizontal activity counts/10 min as a function of time (10 min bins) and dose. Depressant effects of 1.33 mg/kg were observed within 10 min following administration and peak depressant effects were observed between 0–30 min.
Michael B Gat
Locomotor activity in mice was tested to screen for locomotor depressant effects and to identify behaviorally-active dose ranges and times of peak effect. Previous studies have demonstrated that these compounds have chemical structures similar to synthetic cannabinoids known to have substantial abuse liability and act at the CB1 receptor. Tremors were not observed following AMB-FUBINACA during the drug discrimination study, but the maximum dose tested was only 0.1 mg/kg, which is 10-fold lower than the dose that produced tremors in the mice. AMB-FUBINACA has been implicated in severe adverse effects in recreational users (Adams et al., 2017; Hamilton et al., 2017), which suggests that the range between behaviorally active and toxic doses of AMB-FUBINACA is narrow. Following that line of reasoning, it should also be noted that some of the more recent compounds produced non-linear dose-effect curves and one compound produced an inverted U-shaped dose-effect, such that intermediate dose fully substituted, but higher doses did not (Gatch and Forster, 2018). All of the compounds identified as available on the recreational market and submitted to our laboratory by the US Drug Enforcement Agency for testing have fully substituted at some dose (Gatch and Forster 2014, 2015, 2016, 2018); however; it is important to note that not all structural congeners are active (Wiley et al., 2012
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
While the patient's symptoms strongly suggest the inhalation of ADB-BUTINACA, it is worth considering that these symptoms could also be attributed to nicotine exposure, as the symptoms partially overlap with known nicotine effect
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All of the compounds tested in the present study depressed locomotor activity as is typical for other synthetic cannabinoids (see review by Wiley et al., 2017). Average horizontal activity counts/10 min as a function of time (10 min bins) and dose. Depressant effects of 1.33 mg/kg were observed within 10 min following administration and peak depressant effects were 5CL ADBA powder observed between 0–30 min. Duration of the locomotor depression increased over dose from 30 min following 0.1 mg/kg to 2.5 h following 1 mg/k
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
Moreover, a study conducted in the United Kingdom investigated components of e-liquids in 112 samples originating from prisoners, teenagers and test purchases of commercially available e-cigarettes taken between 2014 and 2021 . This is the first case report that describes the toxicological symptoms of vaping ADB-BUTINACA. Results of the DOA test (including testing for amphetamines, methamphetamines, barbiturates, benzodiazepines, cocaine, methadone, opioids, cannabis, tricyclic antidepressants) were available within 30 minutes and were all negative. We report a case of an involuntary intoxication of the SCRA ADB-BUTINACA after vaping. There are several pitfalls in the detection of SCRA in samples taken from the patien
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