title: Clinical toxicity following analytically confirmed use of the synthetic cannabinoid receptor agonist MDMB-CHMICA. A report from the Identification Of Novel psychoActive substances (IONA) study.
abstract: BACKGROUND
  Recreational use of Synthetic Cannabinoid Receptors Agonists (SCRAs) has become increasingly common in many countries and may cause severe toxic effects.
  
  
  OBJECTIVE
  To describe the clinical features of toxicity in seven men after analytically confirmed exposure to MDMB-CHMICA, a recently described indole-based SCRA.
  
  
  METHODS
  Clinical information and biological samples (blood, urine) were collected from patients with severe toxicity after suspected use of novel psychoactive substances. Samples were analyzed by data-independent liquid chromatography-tandem mass spectrometry (LC-MS/MS).
  
  
  METHODS
  All seven cases were men who presented to hospitals in England between July and October 2015; six reported smoking "legal high" products. In all cases, MDMB-CHMICA was identified in blood samples taken on admission to hospital. Other substances were identified in four cases (methadone 1, methiopropamine 1, other SCRAs 2). Clinical features in all seven cases and in the three exposed to MDMB-CHIMICA alone included acidosis (7/7 and 3/3) which was respiratory (3/7 and 3/3), metabolic (3/7 and 0/3) or mixed (1/7, 0/3), reduced level of consciousness (6/7 and 3/3), mydriasis (5/7 and 3/3), tachycardia (5/7 and 2/3), bradycardia (2/7 and 1/3), tonic-clonic convulsions (2/7 and 1/3) and agitation (3/7 and 1/3). Recovery occurred within 24 h in all cases except one male also exposed to methiopropamine.
  
  
  CONCLUSIONS
  Analytically confirmed exposure to MDMB-CHMICA was associated with acidosis (often of respiratory origin), reduced level of consciousness, mydriasis, heart rate disturbances and convulsions.
authors.affiliation: a National Institute for Health Research Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Medical Toxicology Centre, Newcastle University , Newcastle , UK ;|b Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary , Newcastle , UK ;
authors.forename: Simon L
authors.initials: SL
authors.lastname: Hill
authors.affiliation: b Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary , Newcastle , UK ;
authors.forename: Javad
authors.initials: J
authors.lastname: Najafi
authors.affiliation: a National Institute for Health Research Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Medical Toxicology Centre, Newcastle University , Newcastle , UK ;
authors.forename: Michael
authors.initials: M
authors.lastname: Dunn
authors.affiliation: c Royal Liverpool University Hospital , Liverpool , UK ;
authors.forename: Paul
authors.initials: P
authors.lastname: Acheampong
authors.affiliation: d Acute Medical Unit , North Manchester General Hospital , Manchester , UK ;
authors.forename: Ashraf
authors.initials: A
authors.lastname: Kamour
authors.affiliation: e Emergency Department , Royal London Hospital , London , UK.
authors.forename: Johann
authors.initials: J
authors.lastname: Grundlingh
authors.affiliation: a National Institute for Health Research Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Medical Toxicology Centre, Newcastle University , Newcastle , UK ;|b Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary , Newcastle , UK ;
authors.forename: Peter G
authors.initials: PG
authors.lastname: Blain
authors.affiliation: a National Institute for Health Research Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Medical Toxicology Centre, Newcastle University , Newcastle , UK ;|b Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary , Newcastle , UK ;
authors.forename: Simon H L
authors.initials: SH
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D063386:Cannabinoid Receptor Agonists / Q000097:blood / Q000633:toxicity* / Q000652:urine; D002853:Chromatography, Liquid; D006801:Humans; D013287:Illicit Drugs / Q000097:blood / Q000633:toxicity* / Q000652:urine; D007211:Indoles / Q000097:blood / Q000633:toxicity* / Q000652:urine; D008297:Male; D008875:Middle Aged; D011619:Psychotropic Drugs / Q000097:blood / Q000633:toxicity* / Q000652:urine; D015813:Substance Abuse Detection; D019966:Substance-Related Disorders / Q000097:blood / Q000209:etiology / Q000523:psychology* / Q000652:urine; D053719:Tandem Mass Spectrometry; D006113:United Kingdom; D055815:Young Adult
chemical_list: D063386:Cannabinoid Receptor Agonists; D013287:Illicit Drugs; D007211:Indoles; D011619:Psychotropic Drugs; C000610109:methyl 2-(1-(cyclohexylmethyl)-1H-indole-3-carboxamido)-3,3-dimethylbutanoate
keywords: MDMB-CHMICA; methiopropamine; synthetic cannabinoid receptor agonist; toxicity