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§ (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


Some mice showed abnormal behaviors (catalepsy, loss of traction, convulsion) right after the administration of the tested substances. The locomotor activity of the mice was measured 30 min and 2 hrs after the last substance administration. We also examined their neurotoxicity using brain samples through histopathological diagnose, especially in the nucleus accumbens core region. In histopathological analysis, neural cells of the animals treated with the high dose (5 mg/kg) of JWH-081 or JWH-210 showed distorted nuclei and nucleus membranes in the core shell of nucleus accumbens, suggesting neurotoxicity.
Table of Conten


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 redirected here 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


To evaluate whether the changes of coordinative functions by CNS damages were due to test substances, rota-rod test was performed using Rota-rod apparatus (Daejong, Seoul, Korea). The test apparatus for the locomotor activity test was designed to measure locomotor activity automatically using UV system (AM 1051, Benwick Electronics, Benwick, UK) when experimental animals moved in the chamber. In both tests, a group of mice were treated with negative control (vehicle, 1 mg/kg, i.p.), positive control (methamphetamine, 1 mg/kg, i.p.), or one of the three doses of test substances (0.1, 1, 5 mg/kg, i.p.) once every other day for 10 day

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


After the incubation, mixture was centrifuged (18,000 x g, 20 °C) for 5 min and 0.5 μL of the supernatant was directly injected to the chromatographic system. In the next step, ammonium formate as salting agent was added to the mixture and incubated in a thermomixer (20 °C, 1200 rpm) for 15 min. After vortex-mixing, the mixture was allowed to stand redirected here at room temperature for 5 min. MS/MS experiments were performed in MRM (multiple reaction monitoring) mode with an isolation window of 0.4 m/z. The MS measurement was performed in positive ion mode (except for some acidic compounds such as barbiturates


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