Axel J Adams1, Samuel D Banister1, Lisandro Irizarry1, Jordan Trecki1, Michael Schwartz1, Roy Gerona1. 1. From the Clinical Toxicology and Environmental Biomonitoring Laboratory (A.J.A., R.G.) and School of Medicine (A.J.A.), University of California, San Francisco, San Francisco, and the Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto (S.D.B.) - both in California; the Department of Emergency Medicine, Wyckoff Heights Medical Center, New York (L.I.); the Office of Diversion Control, Drug and Chemical Evaluation Section, Drug Enforcement Administration, Springfield, VA (J.T.); and the Chemical Defense Program, Office of Health Affairs, Department of Homeland Security, Washington, DC (M.S.).
Abstract
BACKGROUND: New psychoactive substances constitute a growing and dynamic class of abused drugs in the United States. On July 12, 2016, a synthetic cannabinoid caused mass intoxication of 33 persons in one New York City neighborhood, in an event described in the popular press as a "zombie" outbreak because of the appearance of the intoxicated persons. METHODS: We obtained and tested serum, whole blood, and urine samples from 8 patients among the 18 who were transported to local hospitals; we also tested a sample of the herbal "incense" product "AK-47 24 Karat Gold," which was implicated in the outbreak. Samples were analyzed by means of liquid chromatography-quadrupole time-of-flight mass spectrometry. RESULTS: The synthetic cannabinoid methyl 2-(1-(4-fluorobenzyl)-1H-indazole-3-carboxamido)-3-methylbutanoate (AMB-FUBINACA, also known as MMB-FUBINACA or FUB-AMB) was identified in AK-47 24 Karat Gold at a mean (±SD) concentration of 16.0±3.9 mg per gram. The de-esterified acid metabolite was found in the serum or whole blood of all eight patients, with concentrations ranging from 77 to 636 ng per milliliter. CONCLUSIONS: The potency of the synthetic cannabinoid identified in these analyses is consistent with strong depressant effects that account for the "zombielike" behavior reported in this mass intoxication. AMB-FUBINACA is an example of the emerging class of "ultrapotent" synthetic cannabinoids and poses a public health concern. Collaboration among clinical laboratory staff, health professionals, and law enforcement agencies facilitated the timely identification of the compound and allowed health authorities to take appropriate action.
BACKGROUND: New psychoactive substances constitute a growing and dynamic class of abused drugs in the United States. On July 12, 2016, a synthetic cannabinoid caused mass intoxication of 33 persons in one New York City neighborhood, in an event described in the popular press as a "zombie" outbreak because of the appearance of the intoxicated persons. METHODS: We obtained and tested serum, whole blood, and urine samples from 8 patients among the 18 who were transported to local hospitals; we also tested a sample of the herbal "incense" product "AK-47 24 Karat Gold," which was implicated in the outbreak. Samples were analyzed by means of liquid chromatography-quadrupole time-of-flight mass spectrometry. RESULTS: The synthetic cannabinoid methyl 2-(1-(4-fluorobenzyl)-1H-indazole-3-carboxamido)-3-methylbutanoate (AMB-FUBINACA, also known as MMB-FUBINACA or FUB-AMB) was identified in AK-47 24 Karat Gold at a mean (±SD) concentration of 16.0±3.9 mg per gram. The de-esterified acid metabolite was found in the serum or whole blood of all eight patients, with concentrations ranging from 77 to 636 ng per milliliter. CONCLUSIONS: The potency of the synthetic cannabinoid identified in these analyses is consistent with strong depressant effects that account for the "zombielike" behavior reported in this mass intoxication. AMB-FUBINACA is an example of the emerging class of "ultrapotent" synthetic cannabinoids and poses a public health concern. Collaboration among clinical laboratory staff, health professionals, and law enforcement agencies facilitated the timely identification of the compound and allowed health authorities to take appropriate action.
Authors: Andrew A Monte; Andrew Hopkinson; Jessica Saben; Shelby K Shelton; Stephen Thornton; Aaron Schneir; Adam Pomerleau; Robert G Hendrickson; Ann M Arens; Jon B Cole; James Chenoweth; Spencer Martin; Axel Adams; Samuel D Banister; Roy R Gerona Journal: Addiction Date: 2019-11-25 Impact factor: 6.526
Authors: Nicklaus Brandehoff; Axel Adams; Kyle McDaniel; Samuel D Banister; Roy Gerona; Andrew A Monte Journal: Clin Toxicol (Phila) Date: 2017-09-01 Impact factor: 4.467
Authors: Thomas F Gamage; Charlotte E Farquhar; Timothy W Lefever; Julie A Marusich; Richard C Kevin; Iain S McGregor; Jenny L Wiley; Brian F Thomas Journal: J Pharmacol Exp Ther Date: 2018-03-16 Impact factor: 4.030