title: Analytically Confirmed Intoxications Involving MDMB-CHMICA from the STRIDA Project.
abstract: About a decade ago, synthetic cannabinoids (SC) started to appear as recreational drugs on the new psychoactive substance (NPS) market. This report from the STRIDA project describes analytically confirmed intoxications involving MDMB-CHMICA (methyl-2-(1-(cyclohexylmethyl)-1H-indol-3-ylcarbonylamino)-3,3-dimethylbutanoate), a SC that was first detected in 2014.
  
  
  
  This is an observational case series of patients from Sweden with suspected NPS exposure presenting in emergency departments and intensive care units. The results of retrospective serum and urine toxicological analysis were compared with clinical signs reported during consultation with the Poisons Information Centre and retrieved from medical records.
  
  
  
  Clinical and bioanalytical data in nine acute intoxications associated with MDMB-CHMICA during 2014-2015 are presented. The patients were aged 23-62 (median 34) years, and eight were men. MDMB-CHMICA (parent compound) was analytically confirmed in serum samples, using a liquid chromatography-high-resolution mass spectrometry multi-component method.
  
  
  
  Of the nine MDMB-CHMICA-positive patients, eight had a Poisoning Severity Score (PSS) of 2 or 3, and five were monitored in the intensive care unit and all patients survived. Development of seizures and deep unconsciousness were common features. All cases except one also tested positive for other NPS and/or classical psychoactive compounds, hampering the possibility to establish a causal relationship between drug and toxic symptoms. MDMB-CHMICA was also identified in seven drug materials donated by the patients.
  
  
  
  The association with severe adverse reactions in nine acute analytically confirmed intoxication cases involving MDMB-CHMICA is consistent with other reports of serious toxicity linked to this substance, suggesting that MDMB-CHMICA might be a particularly harmful SC.
authors.affiliation: Swedish Poisons Information Centre, SE-171 76, Stockholm, Sweden. matilda.backberg@gic.se.
authors.forename: Matilda
authors.initials: M
authors.lastname: Bäckberg
authors.affiliation: Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Luiza
authors.initials: L
authors.lastname: Tworek
authors.affiliation: Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.|Karolinska University Laboratory, Clinical Pharmacology, Stockholm, Sweden.
authors.forename: Olof
authors.initials: O
authors.lastname: Beck
authors.affiliation: Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.|Karolinska University Laboratory, Clinical Pharmacology, Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Helander
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D002851:Chromatography, High Pressure Liquid; D003422:Critical Care / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D013287:Illicit Drugs / Q000097:blood / Q000506:poisoning* / Q000652:urine; D007211:Indoles / Q000097:blood / Q000506:poisoning* / Q000652:urine; D008297:Male; D013058:Mass Spectrometry; D008875:Middle Aged; D011041:Poisoning / Q000453:epidemiology; D012640:Seizures / Q000139:chemically induced / Q000188:drug therapy; D013548:Sweden; D053719:Tandem Mass Spectrometry; D014474:Unconsciousness / Q000139:chemically induced / Q000628:therapy; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D013287:Illicit Drugs; D007211:Indoles; C000610109:methyl 2-(1-(cyclohexylmethyl)-1H-indole-3-carboxamido)-3,3-dimethylbutanoate
keywords: Drug exposure; New psychoactive substances; Spice; Synthetic cannabinoid receptor agonists; Synthetic cannabinoids