Journal of Medical Toxicology

, Volume 12, Issue 4, pp 396–401 | Cite as

Acute Toxicity Associated with Use of 5F-Derivations of Synthetic Cannabinoid Receptor Agonists with Analytical Confirmation

  • Rachelle AbouchedidEmail author
  • James H. Ho
  • Simon Hudson
  • Alison Dines
  • John R. H. Archer
  • David M. Wood
  • Paul I. Dargan
Toxicology Observation



Synthetic Cannabinoid Receptor Agonists (SCRAs) are the largest group of new psychoactive substances reported to the European Warning System and the United Nations Office on Drugs and Crime to date. The heterogeneous nature and speed of diversification of these compounds make it challenging to accurately characterise and predict harms of these compounds in pre-clinical studies, ahead of their appearance.

Case Report

We report the case of a 19-year-old female who purchased three products from a headshop: two new psychoactive substances (sachets of “cannabis tea” and “mushroom tea”) as well as two LSD blotters. After the “cannabis tea” was smoked and the two LSD blotters and “mushroom tea” were ingested, the patient became tachycardic (HR 128), developed seizures, agitation, visual hallucinations as well as suspected serotonergic toxicity (sustained ankle clonus 20–30 beats) 1–2 hours after use. She was treated with 1 mg of intravenous midazolam. Symptoms/signs resolved within 13 hours. No further supportive care was required. Plasma, blood, and urine samples confirmed the presence of two SCRAs: 5FAKB-48 and 5F-PB-22. The patient also reported therapeutic use of both fluoxetine and citalopram for depression.


To the best of our knowledge, this is the first case report of non-fatal intoxication with 5F-AKB-48 with analytical confirmation and exposure times. It also highlights the difficulties in understanding the pattern of toxicity of certain SCRAs in the context of psychotropic medications/co-morbid mental illness.


Synthetic cannabinoid receptor agonist 5F-AKB-48 5F-PB-22 Novel psychoactive substances Recreational drug toxicity 


Compliance with Ethical Standards

Conflict of Interest

Authors Rachelle Abouchedid, James H. Ho, Simon Hudson, Alison Dines, John RH. Archer, David M. Wood and Paul I. Dargan declare that they have no conflict of interest.

Professor Dargan reports that he is a member of the UK Advisory Council on the Misuse of Drugs and the Scientific Committee of the European Monitoring Centre for Drugs and Drug Addiction.

Sources of Funding


Informed Consent

Consent for publication of this case was obtained and provided to the journal in accordance with JMT policy.


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Copyright information

© American College of Medical Toxicology 2016

Authors and Affiliations

  • Rachelle Abouchedid
    • 1
    • 2
    Email author
  • James H. Ho
    • 1
    • 2
  • Simon Hudson
    • 3
  • Alison Dines
    • 1
  • John R. H. Archer
    • 1
    • 4
  • David M. Wood
    • 1
    • 4
  • Paul I. Dargan
    • 1
    • 4
  1. 1.Department of Clinical ToxicologyGuy’s and St Thomas’ NHS Foundation Trust and King’s Health PartnersLondonUK
  2. 2.Emergency DepartmentGuy’s and St Thomas’ NHS Foundation Trust and King’s Health PartnersLondonUK
  3. 3.LGC LtdFordhamUK
  4. 4.Faculty of Life Sciences and MedicineKing’s College LondonLondonUK

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