Involuntary intoxication caused by vaping the synthetic cannabinoid ADB-BUTINACA: A case report

Abstract

Synthetic cannabinoids are gaining popularity globally and detection is not commonly available. We report a 27-year-old man who was admitted to the emergency room because of sudden headache, nausea, vertigo, red eyes and palpitations. He confirmed that he had been vaping an electronic cigarette (e-cigarette) earlier that day just before the onset of his symptoms. 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. LC-QTOF-MS represents a significant advancement in the field of drug detection, offering higher sensitivity, specificity, and a broader spectrum of detectable substances. Clinicians should be aware that besides the harmful effects of nicotine and toxic metals in e-cigarettes, e-cigarettes may also contain synthetic cannabinoids or other recreational drugs including new psychoactive substances (NPS), which can cause involuntary intoxication with potentially severe adverse effects. When clinical presentation and/or initial recreational drugs testing results are inconclusive, additional testing with LC-QTOF-MS can be valuable.

Keywords: ADB-BUTINACA; E-cigarette; Synthetic cannabinoid; Vaping.

Fig. 1

LC-QTOF-MS Chromatograms of Nicotine (Top) and ADB-BUTINACA (Bottom) in the Vape Liquid used by the patient. The smaller peaks may represent other compounds or impurities in the sample. The intensity is plotted against the retention time for both chromatograms, demonstrating the presence and elution profiles of nicotine and ADB-BUTINACA in the analysed vape liquid sample.