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

A limitation of this case report is that we did not have a urine sample available for additional NPS testing. Point-of-care DOA tests using urine to screen for misuse of multiple substances, regularly include cannabis, amphetamines, cocaine, opioids, benzodiazepines and methadone. THC, methamphetamine, SRCA, lysergic acid diethylamide (LSD), gamma-hydroxybutyrate (GHB) and ketamine are likely to become volatile under the temperature of current e-cigarettes, while crack cocaine is hard to vaporise. A systematic review including data of 114 patients of which the majority was intoxicated due to SCRA smoking revealed that 45 % of the patients who present at the ER after an intoxication due to SCRA smoking recovered within 24 hours .
Data availability
Moreover, a study conducted in the United Kingdom investigated components of e-liquids in 112 samples originating from prisoners, teenagers and test purchases of commercially available e-cigarettes taken between 2014 and 2021 . This is the first case report that describes the toxicological symptoms of vaping ADB-BUTINACA. Results of the DOA test (including testing for amphetamines, methamphetamines, barbiturates, benzodiazepines, cocaine, methadone, opioids, cannabis, tricyclic antidepressants) were available within 30 minutes and were all negative. We report a case of an involuntary intoxication of the SCRA ADB-BUTINACA after vaping. There are several pitfalls in the detection of SCRA in samples taken from the patient.
Data availabili

As previously mentioned, all of the compounds tested in the present study (MDMB-PINACA, MDMB-CHMICA, MDMB-FUBINACA, ADB-FUBINACA, and AMB-FUBINACA) act as agonists at CB1 receptors (Banister et al., 2015, 2016; Gamage et al., 2018), which suggests these compounds will produce Δ9-THC-like effects, including abuse liabilit

Separation of compounds was performed on a 2.1 mm×100 mm, 1.7 5CL ADBA powder μm particle size ACQUITY Torus™ DIOL analytical column (Waters) with guard cartridge. Measurements were performed by an ACQUITY UPC2 supercritical fluid chromatography system (Waters) coupled with a Xevo TQ-S Triple Quadrupole Mass Spectrometer (Waters). During the death scene examination, multiple cigarette butts without filters were found in an ashtray; also found were alcohol bottles, an unopened box of nebivolol-containing drug, and 18 g of unrecognizable herbal residue in a cigarette box.
Data concerning the combined effects of SCRAs and other substances are highly limited, which renders forensic evaluation of possible overdose cases difficult . The threshold SCRA concentration for fatal overdose can be estimated ng/mL level (0.37–4.1 ng/mL according to the reported cases) in cases in which 1.5–2.5 g/L of ethanol is present in the blood. The victims were brothers who were both found deceased after consuming 4F-MDMB-BINACA and ethanol. These confusing shorter names were not scientifically adopted but were used by websites selling the drugs to the public. Monitoring metabolism of synthetic cannabinoid 4F-MDMB-BINACA via high-resolution mass spectrometry assessed in cultured hepatoma cell line, fungus, liver microsomes and confirmed using urine samples. This article does not contain any studies with human participants or animals performed by any of the author

§ (3) of the Hungarian act of Forensic Experts (2016.XXIX), the data of the reported case can be utilized freely for scientific and educational purposes without special ethical permission. These results indicate that the simultaneous intoxication of SCRA and ethanol directly and exclusively caused the death of the two victims. The victims did not have any significant diseases that could have contributed to the outcome. Very limited data are available in the scientific literature about the possible effects of the combined consumption of SCRAs and ethanol. Several case reports describe that the presence of a little ng/mL (0.37–4.1) of SCRAs and a high—but not lethal—concentration of ethanol (1.45–2.7 g/L) directly and exclusively contributed to the death of the victim [24–27] (Table 2). The fact that 4F-MDMB-BINACA was not detected in postmortem urine samples is partly explained by the high rate of hepatic metabolism of SCRAs [11, 14, 22], but also suggests that the victims consumed 4F-MDMB-BINACA shortly before their death

Demographic and clinical features are recorded and blood and/or urine samples analysed using high-resolution accurate mass liquid chromatography-mass spectrometry. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Second, we could not 5CL ADBA powder retrieve further detailed information about the e-cigarette that was used by the patient such as the label or the region of origin. Whether a recreational drug can be administered via vaping, depends on whether the drug becomes volatile under the evaporation temperature of the e-cigarette. Of these samples, 22 contained one or more SCRAs, THC was only detected in 11 samples, only one contained cannabidiol and 6 contained a mixture of THC and cannabidiol. There is difficulty in finding the right information about the NPS, defining their potency and confirmation of their existence in e-liquids or urine samples.
Data availabili