title: MDMB-CHMICA: Availability, Patterns of Use, and Toxicity Associated With This Novel Psychoactive Substance.
abstract: MDMB-CHMICA (methyl 2-[[1-(cyclohexylmethyl)indole-3-carbonyl]amino]-3,3-dimethylbutanoate) is a synthetic cannabinoid receptor agonist that has been detected in several recreational drug products in Europe since August 2014.
  
  
  
  This article aims to describe the prevalence of use, availability, and desired and adverse effects of MDMB-CHMICA.
  
  
  
  Data were collated from published scientific literature, and systematic searches were conducted of publically available Internet sources (the "gray literature"), including websites offering to sell MDMB-CHMICA and Internet discussion forums featuring user reports.
  
  
  
  There are two case reports of fatalities in the published literature and one series of analytically confirmed cases of intoxication with MDMB-CHMICA. Seventy-eight websites offered to sell MDMB-CHMICA and a range of quantities were available with discounts for purchase of larger quantities (from 0.25 g at $27.95/g to 100 kg at $1.28/g). We identified 36 reports from MDMB-CHMICA users on Internet discussion forums dated October 2014 onwards. The most common positive effect reported by users was euphoria (11; 30.6%) and almost all reports (33; 91.7%) described one or more adverse effects, most commonly palpitations (11; 30.6%), vomiting (9; 25.0%), loss of consciousness (6; 16.7%), visual hallucinations (6; 16.7%), chest pain (5; 13.9%), and anxiety (5; 13.9%).
  
  
  
  This systematic review of qualitative and scientific data relating to MDMB-CHMICA shows that it is widely available from Internet-based suppliers. Users describe a spectrum of effects that are consistent with other synthetic cannabinoids, but there was a high prevalence of adverse effects, and both users and suppliers warn of its high potency.
authors.affiliation: a Emergency Department , St Thomas Hospital , London , UK.|b Department of Clinical Toxicology , St. Thomas Hospital , London , UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Haden
authors.affiliation: b Department of Clinical Toxicology , St. Thomas Hospital , London , UK.|c Faculty of Life Sciences and Medicine , King's College London , London , UK.
authors.forename: John R H
authors.initials: JR
authors.lastname: Archer
authors.affiliation: b Department of Clinical Toxicology , St. Thomas Hospital , London , UK.|c Faculty of Life Sciences and Medicine , King's College London , London , UK.
authors.forename: Paul I
authors.initials: PI
authors.lastname: Dargan
authors.affiliation: b Department of Clinical Toxicology , St. Thomas Hospital , London , UK.|c Faculty of Life Sciences and Medicine , King's College London , London , UK.
authors.forename: David M
authors.initials: DM
authors.lastname: Wood
mesh_terms: D006801:Humans; D013287:Illicit Drugs / Q000633:toxicity*; D007211:Indoles / Q000633:toxicity*; D015995:Prevalence; D019966:Substance-Related Disorders / Q000453:epidemiology*
chemical_list: D013287:Illicit Drugs; D007211:Indoles; C000610109:methyl 2-(1-(cyclohexylmethyl)-1H-indole-3-carboxamido)-3,3-dimethylbutanoate
keywords: MDMB-CHMICA; NPS; recreational drugs; synthetic cannabinoid; toxicity