Case reports: Four concomitant non-fatal intoxications with AB-FUBINACA and MDMA

SummaryWe report four cases of non-lethal intoxication with a mix of synthetic cannabinoid (AB-FUBINACA) and ecstasy. Four young (19- to 24-year-old) men were simultaneously admitted to the emergency department after sniffing an unknown white powder in addition of ecstasy consumption. One of them stayed in deep coma for one day, while the three others exhibited tachycardia, hallucinations and dizziness. Toxicological investigations (using immunochemical, LC-DAD, LC-MS/MS and GC-MS methods) revealed the presence of MDMA, MDA and amphetamine in urine and plasma samples collected on admission. A peak related to AB-FUBINACA (ABF) was detected by GC-MS screening and subsequently confirmed by LC-HRMS analysis. Plasma and urine ABF concentrations (determined using LC-SM/SM method) ranged from 1.6 to 44.3 μg/L and from 0.7 to 3.9 μg/L, respectively. Three ABF metabolites were identified using LC-HRMS in plasma and/or urine: an ABF carboxylic acid, a hydroxy-ABF and a hydroxy-desalkyl-ABF. This report emphasizes the need to investigate synthetic cannabinoids in intoxication cases of young patients.