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 4F ADB 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

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

Tremors were observed in mice 30 minutes following 1 mg/kg AMB-FUBINACA in the present study. Pretreatment times and dose ranges for the drug discrimination assay were selected based on the time of peak depression in the locomotor activity assay in mice. Average potency of the discriminative stimulus effects of early compounds was 0.81±0.17 mg/kg (Gatch et al., 2014), whereas the potency of a recent set was 0.09±0.03 mg/kg (Gatch et al., 2018), and the potency of the current set is 0.05±0.01 mg/kg. Short-onset, short-acting compounds have a greater abuse liability, and long-acting compounds pose problems of long-acting adverse effects and interactions with other drugs. The duration of action of the synthetic cannabinoids tested using the 8-h protocol have varied widely, with some producing a duration of action no longer than 1 h, others producing a duration of action between 1–2 h, and others lasting more than 2 h. There seems to be a trend of newer synthetic cannabinoids being more potent than earlier compound

LC separates the urine or blood sample and QTOF-MS provides high-resolution and accurate mass measurements for precise identification and structural elucidation of compounds. The LC-QTOF-MS method offers a more comprehensive and sensitive approach for drug detection, covering hundreds of recreational drugs, including NPS. Besides increasing the temperature to enlarge the drug aerolisation and bioavailability, one can elevate the flow rate of air through the e-cigarette and/or add a diluent . Of all e-cigarette users registered at this forum, 7.8 % vaped SCRAs . About 15 % of individuals registered at forums for drug users such as erowid.org who vaped cannabis have also vaped SRCAs. SCRAs belong, together with synthetic opioids, cathinones, amphetamines and hallucinogens to the new psychoactive substances (NPS) that are currently developed at high speed.
Data availabili

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

Although there were reports on the metabolism of 4F-MDMB-BINACA using in-vivo and various in-vitro models, studies were either conducted using small in-vivo sample size such as 1 to 4 samples [5, 29] or in closed environments such as forensic psychiatric wards and prisons . The hepatic cell line HepG2 is often used as an initial screen as it is known to produce high reproducibility results with relatively stable enzyme concentration, although they are limited by the low-level expression of several metabolizing enzymes, including the cytochrome P450 (CYP) class of proteins [17, 18]. In-vitro metabolism studies are generally used to complement these data using perfused organs, tissue or cell cultures and microsomal preparations amongst which pooled human liver microsomes (HLM) have been frequently used to elucidate metabolism of SCBs [12,13,14,15,16]. Since most SCBs are found extensively in metabolized forms in urine, the identification of metabolites is of vital importance for forensic and clinical toxicologists. Identifying SCB intake and its correlating specific adverse effects require rapid elucidation of these SCBs. The proliferation of SCBs has become a global challenge as new compounds are rapidly introduced into the illegal drug market to evade existing drug laws.
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