Case ReportThree fatalities associated with the synthetic cannabinoids 5F-ADB, 5F-PB-22, and AB-CHMINACA
Graphical abstract
Introduction
For more than ten years the drug scene in the Dresden region in Saxony, Germany, has been dominated by methamphetamine (‘crystal meth’) [1]. With the exception of cannabis, no other illicit drugs, including new psychoactive substances (NPS), played a significant role in this region for many years. Moreover, in contrast to other parts of Germany [2], [3], [4] data on the consumption as well as the forensic relevance of NPS in the Dresden region is scarce. Given this background, it was surprising that the police investigators found herbal blends containing synthetic cannabinoids at the scenes where three young men were found dead.
The recreational use of synthetic cannabinoids has been very popular in Europe since 2008 [5], [6], [7], [8], [9]. Mainly purchased via the Internet synthetic cannabinoids have become an established alternative for cannabis, in particular because of the easy and ‘legal’ availability of these substances and their relatively low prices. The non-detectability of these substances with standard drug tests most probably also plays a role in certain populations [3], [6], [7], [8]. From 2009 on, many countries placed the identified compounds under legal control and chemically similar substances were quickly introduced into the market, a process that is still continuing [4], [6]. Synthetic cannabinoid receptor agonists interact with the cannabinoid receptors CB1 and/or CB2, and severely toxic effects were described after ingestion of these compounds [9], [10]. For the toxicological analysis of synthetic cannabinoids powerful targeted screening methods employing HPLC-MS/MS were established [2], [11], [12].
Here we report on three death cases associated with the novel synthetic cannabinoids 5F-ADB, 5F-PB-22, and AB-CHMINACA, respectively. The involved SCs will shortly be described:
5F-PB-22 (quinolin-8-yl 1-(5-fluoropentyl)-1H-indole-3-carboxylate (Fig. 1)), is a full agonist at the CB1 and the CB2 receptor producing central depressant effects lasting for 120–150 min in mice [13]. Banister et al. reported a higher potency for 5F-PB-22 than for AM-2201, APICA, STS-135, XLR-11, and UR-144, based on magnitude and duration of hypothermia in rats [14].
5F-ADB (methyl N-{[1-(5-fluoropentyl)-1H-indazol-3-yl]carbonyl}-3-methylvalinate (Fig. 1)), also sold under the name 5F-MDMB-PINACA, first appeared in Europe in January 2015 in Hungary [15]. It shows agonistic activity at CB1 and CB2 receptors with a greater potency than most other derivatives of the valine and tert-leucine type of synthetic cannabinoids as shown in a fluorometric assay of membrane potential [16]. In this assay only 5F-MDMB-PICA showed a higher potency.
AB-CHMINACA (N-(1-amino-3-methyl-1-oxobutan-2-yl)-1-(cyclohexylmethyl)-1H-indazole-3-carboxamide (Fig. 1)) first appeared in August 2014 in Germany. Acute AB-CHMINACA poisoning can be accompanied by delirium and seizures as well as tachycardia, hypertension, altered mental status, and hallucinations [17]. Slurred speech, confusion, lack of coordination/dexterity and lethargy were commonly observed in cases of impaired driving [18].
Section snippets
Case 1
A 25-year-old male Caucasian with a history of alcohol and illicit drug use was found dead in his apartment by neighbors in October 2014. The decedent lay on his stomach on his bed. The face was directed to the mattress and looked blueish. It was reported by witnesses that the decedent had drunk a lot of alcohol on the evening before his death.
Packages of products named ‘F1’, ‘Hammer Head’ (Fig. 2) and ‘Magic Gold’ were found at the scene.
Case 2
In January 2015, a 28-year-old male Caucasian was found
Material and methods
In all three cases medical examiners collected femoral blood, urine and gastric content at autopsy.
Systematic toxicological analysis was performed at the Institute of Legal Medicine in Dresden, Germany. Ethanol was determined by headspace GC-FID (Clarus 500, PerkinElmer, Rodgau, Germany) in femoral blood and urine. The analysis of classical drugs of abuse in femoral blood was performed by GC–MS (GC 6890N, MSD 5973, Agilent Technologies, Waldbronn, Germany) after solid-phase extraction and
Case 1
Signs of an acute oxygen deficiency according to suffocation after obstruction of the respiratory tract were obtained at forensic autopsy. Besides cerebral edema, pulmonary edema and acute blood congestion of the internal organs, petechial hemorrhages were identified in the eyelids, on the facial skin and on the lungs. Neither specific anatomic changes nor signs of violence could be observed at the autopsy.
General toxicological screening produced a blood alcohol concentration (BAC) of 2.60 g/kg
Conclusions
Due to their availability via the Internet synthetic cannabinoids are becoming more important also in regions where classical drugs of abuse like methamphetamine have been dominating the market for many years.
The three cases presented here describe fatalities in which the synthetic cannabinoids 5F-ADB, 5F-PB-22 as well as AB-CHMINACA were detected by HPLC-MS/MS besides remarkable amounts of ethanol in two cases. Neither injuries nor a serious disease could be discovered at autopsy.
Due to
Conflict of interest
The authors declare that they have no conflicts of interest.
Acknowledgement
This publication has been produced with the financial support of the ‘Prevention of and Fight against Crime (ISEC)’ program of the European Commission (JUST/2013/ISEC/DRUGS/AG/6421).
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