Abstract
The detection of synthetic cannabinoid (SC) intoxication cases is challenging, even more when the involved SC identification is requested in a forensic context. This situation can be complicated by new modes of SC consumption, non-specific symptomatology, and analytical pitfalls. To illustrate these issues, we report the case of a 16-year-old man who presented symptoms evocating of a seizure disorder in the minutes following the use of a friend’s e-cigarette. At admission in the emergency department, his electroencephalogram was interpreted as coherent with a recent seizure episode. 5F-ADB, a third generation SC, was detected in the e-liquid and in an early collected (H2 after the e-cigarette use) serum sample (0.50 µg/L), but not in urine samples (H18 and H38). One 5F-ADB metabolite, O-desmethyl-5F-ADB (M5), was detectable in urine up to at least 38 h after intoxication. Neither 5F-ADB nor its metabolites could be detected in victim’s hair sampled 3 months after the intoxication. Although leading to a non-specific symptomatology, acute SC intoxication should be considered when the case history is related to e-cigarette or e-liquid use. Early biological samples are recommended, even if analytical screening can be positive for SC metabolites in urine sampled until 2 days after exposure. Accordingly, data from the literature and the present case underscore the relevance of adding both main 5F-ADB metabolites (M5 and 5-OH-pentyl-ADB) to mass spectrum databases used for toxicological screening in order to reduce the risk of false-negative results in intoxication cases involving 5F-ADB.
References
Le Boisselier R, Alexandre J, Lelong-Boulouard V, Debruyne D (2017) Focus on cannabinoids and synthetic cannabinoids. Clin Pharmacol Ther 101(2):220–229. https://doi.org/10.1002/cpt.563
Trecki J, Gerona RR, Schwartz MD (2015) Synthetic cannabinoid-related illnesses and deaths. N Engl J Med 373(2):103–107. https://doi.org/10.1056/NEJMp1505328
Lam RPK, Tang MHY, Leung SC, Chong YK, Tsui MSH, Mak TWL (2017) Supraventricular tachycardia and acute confusion following ingestion of e-cigarette fluid containing AB-FUBINACA and ADB-FUBINACA: a case report with quantitative analysis of serum drug concentrations. Clin Toxicol (Phila) 55(7):662–667. https://doi.org/10.1080/15563650.2017.1307385
Gaulier JM, Richeval C, Phanithavong M, Brault S, Allorge D, Dumestre-Toulet V (2019) A case report of carfentanil-related fatality in France. Toxicol Anal Clin 31(4):323–331. https://doi.org/10.1016/j.toxac.2019.01.002
Presley BC, Castaneto MS, Logan BK, Jansen-Varnum SA (2020) Metabolic profiling of synthetic cannabinoid 5F-ADB and identification of metabolites in authentic human blood samples via human liver microsome incubation and ultra-high-performance liquid chromatography/high-resolution mass spectrometry. Rapid Commun Mass Spectrom 34(22):e8908. https://doi.org/10.1002/rcm.8908
Usui K, Fujita Y, Kamijo Y, Kokaji T, Funayama M (2018) Identification of 5-Fluoro ADB in Human Whole Blood in Four Death Cases. J Anal Toxicol 42(2):e21–e25. https://doi.org/10.1093/jat/bkx088
Angerer V, Jacobi S, Franz F, Auwärter V, Pietsch J (2017) Three fatalities associated with the synthetic cannabinoids 5F-ADB, 5F-PB-22, and AB-CHMINACA. Forensic Sci Int 281:e9–e15. https://doi.org/10.1016/j.forsciint.2017.10.042
McCain KR, Jones JO, Chilbert KT, Patton AL, James LP, Moran JH (2018) Impaired driving associated with the synthetic cannabinoid 5F-ADB. J Forensic Sci Criminol 6(1):https://doi.org/10.15744/2348-9804.6.105.
Barceló B, Pichini S, López-Corominas V, Gomila I, Yates C, Busardò FP, Pellegrini M (2017) Acute intoxication caused by synthetic cannabinoids 5F-ADB and MMB-2201: a case series. Forensic Sci Int 273:e10–e14. https://doi.org/10.1016/j.forsciint.2017.01.020
Kraemer M, Fels H, Dame T, Musshoff F, Halter S, Mogler L, Hess C, Madea B, Maas A (2019) Mono-/polyintoxication with 5F-ADB: a case series. Forensic Sci Int 301:e29–e37. https://doi.org/10.1016/j.forsciint.2019.05.017
Yeter O, Ozturk YE (2019) Metabolic profiling of synthetic cannabinoid 5F-ADB by human liver microsome incubations and urine samples using high-resolution mass spectrometry. Drug Test Anal 11(6):847–858. https://doi.org/10.1002/dta.2566
United Nations Office on Drugs and Crime (2020) Current NPS Threats Volume II. https://www.unodc.org/documents/scientific/Current_NPS_Threats_Volume_II_Web.pdf. Accessed 18 Nov 2020
Elamin M, Dunn M, Dargan PI, Wood DM, Tucker S, Hill SL, Thomas SHL (2017) Clinical features following analytically confirmed use of 5F-ADB, a synthetic cannabinoid receptor agonist. A report from the UK IONA study. Clinical Toxicology 37th International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) 16–19 May 2017, Basel, Switzerland (poster#163):73–74. https://doi.org/10.1080/15563650.2017.1309792.
Banister SD, Longworth M, Kevin R, Sachdev S, Santiago M, Stuart J, Mack JB, Glass M, McGregor IS, Connor M, Kassiou M (2016) Pharmacology of valinate and tert-leucinate synthetic cannabinoids 5F-AMBICA, 5F-AMB, 5F-ADB, AMB-FUBINACA, MDMB-FUBINACA, MDMB-CHMICA, and their analogues. ACS Chem Neurosci 7(9):1241–1254. https://doi.org/10.1021/acschemneuro.6b00137
Franz F, Jechle H, Angerer V, Pegoro M, Auwärter V, Neukamm MA (2018) Synthetic cannabinoids in hair - pragmatic approach for method updates, compound prevalences and concentration ranges in authentic hair samples. Anal Chim Acta 1006:61–73. https://doi.org/10.1016/j.aca.2017.12.029
Lagoutte-Renosi J, Richeval C, Phanithavong M, Wiart JF, Castex E, Vanhoy X, Hakim F, Deheul S, Tournebize J, Allorge D, Gaulier JM (2020) Hair analysis can support the follow-up addiction care after acute new psychoactive substances intoxication: illustration by two cases. Drug Test Anal. https://doi.org/10.1002/dta.2936
Franz F, Angerer V, Hermanns-Clausen M, Auwärter V, Moosmann B (2016) Metabolites of synthetic cannabinoids in hair–proof of consumption or false friends for interpretation? Anal Bioanal Chem 408(13):3445–3452. https://doi.org/10.1007/s00216-016-9422-2
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Salle, S., Sevestre, C., Richeval, C. et al. Involuntary 5F-ADB-related intoxication following e-cigarette use. Int J Legal Med 135, 1467–1470 (2021). https://doi.org/10.1007/s00414-021-02561-8
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DOI: https://doi.org/10.1007/s00414-021-02561-8