A case of synthetic cannabinoid poisoning in Croatia


The number of new psychoactive substances (NPS), synthetic cannabinoids (SCs) in particular, is growing constantly. Because of the insufficiently explored effects on consumer health, they have become a major problem in the emergency departments. They are difficult to identify, and there are no antidotes that could reverse their detrimental effects. We report a case of poisoning of a young man who used SCs. The patient was admitted to the emergency department of the Clinical Hospital Merkur, Zagreb (Croatia) after sniffing and smoking a herbal product bought on the street. He presented with severe cognitive difficulties and visible eye redness. Other symptoms included somnolence, disorientation, loss of coordination, unsteady gait, hyporeflexia, stiffness, cramps and cold limbs, blurred vision, teeth grinding, dry mouth, tinnitus, fear, suicidal thoughts, impaired focus, memory, and speech, sedation, fatigue, depression, thought blocking, and autistic behaviour. His skin was dry, and his mucosa dry and irritated. Herbal products “Rainbow Special” and “Luminated Aroma” used by the patient were qualitatively analysed with gas chromatography / mass spectrometry (GC/MS) after direct extraction with an organic solvent. Solid-phase extraction method was used to analyse serum and urine samples. Despite the negative findings of biological samples, mostly due to the limitations of GC/MS, the clinical picture infallibly pointed to the poisoning with SCs. This was confirmed by the findings of 5-fluoro AMB (methyl 2-(1-(5-fluoropentyl)-1H-indazole-3-carboxamido)-3-methylbutanoate) in the herbal products.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and Europol. EU Drug Markets Report: Strategic Overview. Luxembourg: EMCDDA, Europol; 2016. doi: 10.2810/216248

  • 2. Vlada Republike Hrvatske. Protokol o nacionalnom informacijskom sustavu za droge u Republici Hrvatskoj [Croatian Protocol on the National Information Drugs System, in Croatian]. Zagreb: Ured za suzbijanje zlouporabe opojnih droga, Nacionalna informacijska jedinica za opojne droge; 2007.

  • 3. United Nations Office on Drugs and Crime. The challenge of new Psychoactive substances, Global SMART Programme, 2013 [displayed 14 May 2018]. Available at https://www.unodc.org/documents/scientific/NPS_Report.pdf

  • 4. Centers for Disease Control and Prevention. Opioids drive continued increase in drug overdose deaths [displayed 20 February, 2013]. Available at http://www.cdc.gov/media/

  • 5. Pinnamanemi K, Sievers RE, Sharma R, Selchau A M, Gutierrez G, Nordsieck EJ, Su R, An S, Chen Q, Wang X, Derakhshandeh R, Aschbacher K, Heiss C, Glantz SA, Schick SF, Springer ML. Brief exposure to secondhand smoke reversibly impairs endothelial vasodilatory function. Nicotine Tob Res 2014;16:584-90. doi: 10.1093/ntr/ntt189

  • 6. ACMD. Consideration of the major cannabinoid agonists, 2009 [displayed 14 May 2018]. Available at http://www.namsdl.org/library/E2E91AB8-1372-636C-DDFC2BA64093B64C/

  • 7. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and Europol. EU Drug Markets Report: In-Depth Analysis. Lisbon: EMCDDA, Europol; 2016.

  • 8. Dargan PI, Wood DM, editors. Novel Psychoactive Substances: Classification, Pharmacology and Toxicology. London: Academic Press/Elsevier; 2013. doi: 10.1016/C2011-0-04205-9

  • 9. Baumeister D, Tojo LM, Tracy DK. Legal highs: staying on top of the flood of novel psychoactive substances. Ther Adv Psychopharmacol 2015;5:97-132. doi: 10.1177/2045125314559539

  • 10. Katselou M, Papoutsis I, Nikolaou PD, Spiliopoulou C, Athanaselis S. α-PVP (“flakka”): a new synthetic cathinone invades the drug arena. Forensic Toxicol 2016;34:41-50. doi: 10.1007/s11419-015-0298-1

  • 11. Rojek S, Klys M, Maciow-Glab, Kula K, Strona M. Cathinones derivatives-related deaths as exemplified by two fatal cases involving matcathinone with 4-methylmatcathinone and 4-methylethcathinone. Drug Test Anal 2014;6:770-7. doi: 10.1002/dta.1615

  • 12. Rösner P, Junge T, Westphal F, Fritschi G. Mass Spectra of Designer Drugs 2015. Weinheim: Wiley; 2015.

  • 13. Scientific Working Group for the Analysis of Seized Drugs (SWGDRUG). Mass Spectral Library [displayed 23 May 2018]. Available at http://www.swgdrug.org/ms.htm

  • 14. Vaiano F, Busardò FP, Palumbo D, Kyriakou C, Fioravanti A, Catalani V, Mari F, Bertol E. A novel screening method for 64 new psychoactive substances and 5 amphetamines in blood by LC–MS/MS and application to real cases. J Pharmaceut Biomed 2016;129: 441-9. doi: 10.1016/j.jpba.2016.07.009

  • 15. European Monitoring Centre for Drugs and Drugs Addiction (EMCDDA). European information system and database on new drugs [displayed 23 May 2018]. Available at https://ednd-cma.emcdda.europa.eu/

  • 16. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). European Drug Report: Trends and Developments 2014. Lisbon: EMCDDA; 2014. doi: 10.2810/32306

  • 17. Hasegawa K, Wurita A, Minakata K, Gonmori K, Nozawa H, Yamagishi I, Watanabe K, Suzuki O. Postmortem distribution of AB-CHMINACA, 5-fluoro-AMB, and diphenidine in body fluids and solid tissues in a fatal poisoning case: usefulness of adipose tissue for detection of the drugs in unchanged forms. Forensic Toxicol 2015;33:45-53. doi: 10.1007/s11419-014-0245-6

  • 18. Hess C, Stockhausen S, Kernbach-Wighton G, Madea B. Death due to diabetic ketoacidosis: Induction by the consumption of synthetic cannabinoids? Forensic Sci Int 2015;257:e6-11. doi: 10.1016/j.forsciint.2015.08.012

  • 19. Andersson M, Diao X, Wohlfarth A, Scheidweiler KB, Huestis MA. Metabolic profiling of new synthetic cannabinoids AMB and 5F-AMB by human hepatocyte and liver microsome incubations and high-resolution mass spectrometry. Rapid Commun Mass Sp 2016;30:1067-78. doi: 10.1002/rcm.7538


Journal + Issues