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Suicide by vaping the synthetic cannabinoid 4F-MDMB-BINACA: cannabinoid receptors and fluoride at the crossroads of toxicity?

Forensic Science, Medicine and Pathology volume 17, pages 684–688 (2021)Cite this article

Abstract

A 22-year-old man was hospitalized after stating he would ‘commit suicide in a non-detectable way’. He was admitted with a severe necrotizing pancreatitis and acute kidney injury, evolving to multiple organ failure. His condition rapidly deteriorated, and he died 11 days after hospital admission. Postmortem histopathology confirmed fulminant necrotizing pancreatitis, acute tubular necrosis, cerebral edema, pericentral/midzonal hepatocellular necrosis and acute respiratory distress syndrome. Metabolites of 4F-MDMB-BINACA, a synthetic cannabinoid, were detected in urine and serum collected at hospital admission. The same drug was found in a vapor fluid found in the man’s apartment. As cannabis use has been etiologically linked to acute pancreatitis, we hypothesize that the more afferent and potent 4F-MDMB-BINACA could induce acute pancreatitis via stimulation of cannabinoid (CB)1-receptors. Alternatively, terminal fluorination could have induced a dose-dependent toxic effect on a wide range of cellular processes, leading to cell dysfunction and death. This is the first clinicopathological description of a lethal intoxication with 4F-MDMB-BINACA, following extensive vaping. Toxic effects could either relate to CB-receptor binding or to direct fluoride toxicity.

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Acknowledgements

The authors would like to thank Christophe Stove (Ghent University), Philippe Vervliet (University of Antwerp) and Volker Auwarter (University of Freiburg) for their valuable input.

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Authors and Affiliations

  1. Department of Forensic Medicine and Pathology, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 655, B-2650, Edegem, Belgium

    Babette Van Rafelghem & Werner Jacobs

  2. Toxicological Center, University of Antwerp, Antwerp, Belgium

    Adrian Covaci, Alexander L. N. van Nuijs & Hugo Neels

  3. Department of Emergency Medicine, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium

    Kurt Anseeuw

  4. Department of Laboratory Medicine, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium

    Boris Mahieu

  5. Military Hospital Queen Astrid, Crisis Unit, Brussels, Belgium

    Werner Jacobs

Authors
  1. Babette Van Rafelghem
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  2. Adrian Covaci
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  3. Kurt Anseeuw
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  4. Alexander L. N. van Nuijs
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  5. Hugo Neels
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  6. Boris Mahieu
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  7. Werner Jacobs
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Contributions

BVR—drafted the manuscript, performed forensic autopsy. AC—revised the manuscript extensively, performed toxicological analyses. KA—drafted the manuscript, provided clinical data. AVN, HN, BM—revised the manuscript, performed toxicological analyses. WJ—revised the manuscript, performed forensic autopsy.

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Correspondence to Babette Van Rafelghem.

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The current report was written in accordance with the ethical standard guidelines of the University of Antwerp.

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Van Rafelghem, B., Covaci, A., Anseeuw, K. et al. Suicide by vaping the synthetic cannabinoid 4F-MDMB-BINACA: cannabinoid receptors and fluoride at the crossroads of toxicity?. Forensic Sci Med Pathol 17, 684–688 (2021). https://doi.org/10.1007/s12024-021-00424-7

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  • DOI: https://doi.org/10.1007/s12024-021-00424-7

Keywords

  • 4F-MDMB-BINACA
  • Vaping
  • Acute pancreatitis
  • Acute kidney injury
  • Fluoride