As most of the urine samples obtained in this study were found to contain other SCBs’ metabolites and other drugs, the urinary profile of the three individual urine samples that encompass 4F-MDMB-BINACA metabolites exclusively (Table 3) is worth considering when selecting a suitable urinary marke

LC-QTOF-MS represents a significant advancement in the field of drug detection, offering higher sensitivity, specificity, and a broader spectrum of detectable substances. Despite all negative results in the point-of-care test for recreational drugs, the liquid chromatography-quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) analysis showed that the liquid of the e-cigarette contained ADB-BUTINACA, a synthetic cannabinoid. We report a 27-year-old man who was admitted to the emergency room because of sudden adb butinaca headache, nausea, vertigo, red eyes and palpitations. Synthetic cannabinoids are gaining popularity globally and detection is not commonly available.
Data availability
When clinical presentation and/or initial DOA testing results are inconclusive, additional testing with LC-QTOF-MS can be valuable and is recommended. SCRAs and other NPS may not be detected by point-of-care DOA tests. In this case, the point-of-care DOA urine screening was not able to detect the synthetic cannabinoid ADB-BUTINAC

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Product ions detected at m/z 302, 217, and 145 (B2) confirmed that tert-leucine and indazole moieties remained unchanged, leading to the structure elucidation of a hydroxy-functional group at the 4-position of the butyl side chain by oxidative defluorination. The product ion m/z 336 (loss of methyl ester moiety) further confirmed the presence of dihydroxylated metabolites. The precursor ion, m/z 364 (B14, B5/B6) had a loss of 2 Da from m/z 366 indicated further dehydrogenation of the ester hydrolysis plus monohydroxylated metabolites. The presence of the product ion m/z 320, likely formed from a loss of carbon dioxide, indicated monohydroxylation at the tert-leucine in B8 (m/z 219), butyl side chain in B9 (m/z 145) and indazole moiety in B13 (m/z 161). The precursor ion, m/z 350 showed a loss of 14 Da explaining the hydrolysis of methyl ester from 4F-MDMB-BINACA.
Fig. 2.
4F-MDMB-BINACA was hydrolysed via ester hydrolysis forming the 4F-MDMB-BINACA ester hydrolysis metabolite (B22). Data obtained from the twenty urine samples were retrospectively analysed and processed using TraceFinder software based on the identification criteria of mass errors less than ± 5 ppm for full MS peaks and MS/MS peaks from the theoretical mass and matching of MS/MS spectra. The mixture was vortex-mixed and 500 µL of this mixture and 500 µL of methanol were loaded onto the Clean Screen FASt® tube. After incubation, the mixture was cooled at room temperature, and 150 µL of purified water was added. High-resolution QTOF-MS data were acquired on an Agilent 6510 Accurate Mass QTOF mass spectrometer (Agilent Technologies) equipped with dual electrospray ionization (ESI) source operated in both positive and negative ion modes, to determine accurate masses of the metabolites. Chromatographic separation was performed on an Agilent 1290 LC system with a Poroshell 120 EC-C18 analytical column (2.7 μm, 75 × 2.1 mm; Agilent Technologies, Santa Clara, CA, USA).
Fig. 1.
Monitoring metabolism of synthetic cannabinoid 4F-MDMB-BINACA via high-resolution mass spectrometry assessed in cultured hepatoma cell line, fungus, adb butinaca liver microsomes and confirmed using urine samples The threshold for fatal overdose of combined use of SCRAs and ethanol can be estimated as a little ng/mL (0.37–4.1 ng/mL according to the reported cases) of SCRA and 1.5–2.5 g/L of ethanol. The reported cases and reviews of the scientific literature suggest a possible synergistic effect between SCRAs and ethanol, because their combined use clearly increases their toxicity. The victim died due to severe necrotizing pancreatitis and acute kidney injury evolving into multi-organ failure 11 days after hospital admission . Studies have found no unequivocal synergistic effect between THC and ethanol at low or moderate ethanol doses [29, 30], but no data on high doses of ethanol are available. Given that THC and ethanol act on the same receptors, data on their simultaneous use may yield important insights in this regard.
Fungus C. elegans
Methyl (2S)-2-([1-(4-fluorobutyl)-1H-indazole-3-carbonyl]amino)-3,3-dimethylbutanoate (4F-MDMB-BINACA, 4F-MDMB-BUTINACA or 4F-ADB), found in numerous SCB product seizures, has been reported by various law enforcement since 2018 . However, most of the SCBs are full agonists at CB1 and CB2 receptors, having a higher risk of undesirable side effects when compared to THC which is a partial agonist . Synthetic cannabinoids (SCBs) are agonists at cannabinoid receptor type 1 (CB1) and type 2 (CB2), where they elicit their main effect