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      Accidental Ingestion of a Novel Psychoactive Substance: A Case Report

      case-report
      Author(s): 1 , , 2 , 2
      Editor(s): ,
      Publication date (Electronic, pub):
      Publication date (Electronic, collection):
      Journal: Cureus
      Publisher: Cureus
      Keywords: novel psychoactive substances, 5-fluoro-mdmb-pica, synthetic cannabinoids, seizure, singapore

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          Abstract

          Novel psychoactive substances (NPSs) are a new generation of designer drugs that are quickly replacing the traditionally abused street drugs. Since their development, the number of molecules in NPSs and their variants have expanded exponentially. Little is known locally about the toxic effects of the exposure of these NPSs. We report two cases of accidental ingestion of methyl (2S)-2-{[1-(5-fluoropentyl)-1H-indole-3-arbonyl]amino}-3,3-dimethylbutanoate (5-fluoro-MDMB-PICA), a recent NPS. They were drinking the liquid in a winter melon tea bottle, and one patient had a seizure episode directly after ingestion. Both patients were managed supportively and discharged after a brief hospitalization period. Presentation to the emergency departments (EDs) following exposure to NPSs may become more common. Knowledge about the impact of NPS exposure and their clinical effects is lacking amongst emergency physicians in Singapore, and this case report serves as a potential resource for physicians.

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          Next generation of novel psychoactive substances on the horizon - A complex problem to face.

          Jolanta Zawilska, Dariusz Andrzejczak (2015)
          The last decade has seen a rapid and continuous growth in the availability and use of novel psychoactive substances (NPS) across the world. Although various products are labeled with warnings "not for human consumption", they are intended to mimic psychoactive effects of illicit drugs of abuse. Once some compounds become regulated, new analogues appear in order to satisfy consumers' demands and at the same time to avoid criminalization. This review presents updated information on the second generation of NPS, introduced as replacements of the already banned substances from this class, focusing on their pharmacological properties and metabolism, routes of administration, and effects in humans.
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            Cannabinoid-like effects of five novel carboxamide synthetic cannabinoids

            Michael B Gatch, Michael Forster (2019)
            A new generation of novel cannabinoid compounds have been developed as marijuana substitutes to avoid drug control laws and cannabinoid blood tests. 5F-MDMB-PINACA (also known as 5F-ADB, 5F-ADB-PINACA), MDMB-CHIMICA, MDMB-FUBINACA, ADB-FUBINACA, and AMB-FUBINACA (also known as FUB-AMB, MMB-FUBINACA) were tested for in vivo cannabinoid-like effects to assess their abuse liability. Locomotor activity in mice was tested to screen for locomotor depressant effects and to identify behaviorally-active dose ranges and times of peak effect. Discriminative stimulus effects were tested in rats trained to discriminate Δ 9 -tetrahydrocannabinol (3 mg/kg, 30-min pretreatment). 5F-MDMB-PINACA (ED 50 =1.1 mg/kg) and MDMB-CHIMICA (ED 50 =0.024 mg/kg) produced short-acting (30 min) depression of locomotor activity. ADB-FUBINACA (ED 50 =0.19 mg/kg), and AMB-FUBINACA (ED 50 =0.19 mg/kg) depressed locomotor activity for 60–90 min; whereas MDMB-FUBINACA (ED 50 =0.04 mg/kg) depressed locomotor activity for 150 min. AMB-FUBINACA produced tremors at the highest dose tested. 5F-MDMB-PINACA (ED 50 =0.07), MDMB-CHIMICA (ED 50 =0.01 mg/kg), MDMB-FUBINACA (ED 50 =0.051 mg/kg), ADB-FUBINACA (ED 50 =0.075 mg/kg) and AMB-FUBINACA (ED 50 =0.029) fully substituted for the discriminative stimulus effects of Δ 9 -THC following 15-min pretreatment. All 5 compounds decreased locomotor activity and produced discriminative stimulus effects similar to those of Δ 9 -THC, which suggests they may have abuse liability similar to that of Δ 9 -THC. AMB-FUBINACA may have an increased risk of toxicities in recreational users.
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              The synthetic cannabinoid 5F-MDMB-PICA: A case series.

              J Kleis, T Germerott, S. Halter … (2020)
              5F-MDMB-PICA has been detected in products sold on the internet as well as in biological samples since 2016. It is associated with serious adverse health and behavioral effects and even death. Herein we report on twelve cases with proven 5F-MDMB-PICA consumption, including three fatalities, four cases of driving under the influence of drugs and five other criminal acts. In these cases, 5F-MDMB-PICA was detected in postmortem blood or serum. Concentrations ranged from 0.1-16ng/mL. In some blood (serum) and urine samples, the hydrolysis metabolite of 5F-MDMB-PICA (M12) could also be detected. In this case series, co-consumption with other drugs occurred in 9 of 12 cases, most commonly alcohol, cannabis and other contemporary SCs. In five cases, 4F-MDMB-BINACA was also detected. The described cases demonstrate various adverse effects that might be associated with 5F-MDMB-PICA. Observed physical adverse effects were mainly balance deficiencies and ocular effects such as reddened conjunctivae, glassy eyes and delayed or unresponsive pupil light reactions. Observed mental and behavioral effects were mainly changing moods, aggression, confusion, erratic behavior, mental leaps, disorientation, slowed reaction, logorrhea and slurred speech. Due to the fast changing market of synthetic cannabinoids, data on such new appearing substances are basically scarce. Because of the limited number of studies on pharmacological properties of synthetic cannabinoids, reports of findings in human samples along with corresponding case history descriptions can be valuable for the interpretation of upcoming routine cases.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 26 October 2020
                Publication date (Electronic, collection): October 2020
                Volume: 12
                Issue: 10
                Electronic Location Identifier: e11185
                Affiliations
                [1 ] Emergency Medicine, Changi General Hospital/Singhealth, Singapore, SGP
                [2 ] Accident and Emergency, Changi General Hospital/Singhealth, Singapore, SGP
                Author notes
                Article
                DOI: 10.7759/cureus.11185
                PMC ID: 7703709
                PubMed ID: 33269117
                SO-VID: 6d011580-fcff-4c17-bdd2-c219b8ab3e4f
                Copyright © Copyright © 2020, Kant et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date accepted : 26 October 2020
                Categories
                Subject: Emergency Medicine
                Subject: Internal Medicine
                Subject: Public Health

                Keywords: novel psychoactive substances,5-fluoro-mdmb-pica,synthetic cannabinoids,seizure,singapore
                Data availability:
                Keywords: novel psychoactive substances, 5-fluoro-mdmb-pica, synthetic cannabinoids, seizure, singapore

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