Evidence map›Paper›PMID 41307856›Full record

ArticleForensic toxicology2026

Deadly confusion of novel psychoactive substances: fatal outcome of ADB-BUTINACA mislabeled as 3',4'-methylenedioxy-α-pyrrolidinohexiophenone.

Annette Zschiesche, Nadine Theofel, Stefan Braukmüller, Edwin Ehrlich, Martin Jasyk, Maximilian Methling, Michael Tsokos, Stefan Scholtis, Laura M Huppertz, Volker Auwärter

Abstract readCase Reports
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In one paragraph

Article in Forensic toxicology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Annette ZschiescheInstitute of Forensic Medicine, Forensic Toxicology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Albertstr. 9, 79104, Freiburg, Germany.ORCID 0009-0005-9017-0111
Nadine TheofelDepartment of Forensic Toxicology, Governmental Institute of Legal Medicine and Forensic Sciences, Turmstraße 21, Berlin, Germany.ORCID 0000-0001-6028-8382
Stefan BraukmüllerInstitute of Organic Chemistry, University of Freiburg, 79104, Freiburg, Germany.
Edwin EhrlichDepartment of Forensic Toxicology, Governmental Institute of Legal Medicine and Forensic Sciences, Turmstraße 21, Berlin, Germany.
Martin JasykDepartment of Forensic Toxicology, Governmental Institute of Legal Medicine and Forensic Sciences, Turmstraße 21, Berlin, Germany.
Maximilian MethlingDepartment of Forensic Toxicology, Governmental Institute of Legal Medicine and Forensic Sciences, Turmstraße 21, Berlin, Germany.ORCID 0000-0003-3872-8622
Michael TsokosDepartment of Forensic Toxicology, Governmental Institute of Legal Medicine and Forensic Sciences, Turmstraße 21, Berlin, Germany.
Stefan ScholtisDepartment of Forensic Toxicology, Governmental Institute of Legal Medicine and Forensic Sciences, Turmstraße 21, Berlin, Germany.
Laura M HuppertzInstitute of Forensic Medicine, Forensic Toxicology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Albertstr. 9, 79104, Freiburg, Germany.ORCID 0000-0002-4190-5469
Volker AuwärterInstitute of Forensic Medicine, Forensic Toxicology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Albertstr. 9, 79104, Freiburg, Germany. volker.auwaerter@uniklinik-freiburg.de.ORCID 0000-0002-1883-2804

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeA powder found at a fatality scene, labeled as the synthetic cathinone 3',4'-methylenedioxy-α-pyrrolidinohexiophenone (MDPHP) and most likely smoked using a crack pipe, was analyzed. The powder was identified as very potent synthetic cannabinoid ADB-BUTINACA/ADB-BINACA with a high purity (> 98%). This case highlights the risks associated with mislabeled novel psychoactive substances (NPS), particularly those purchased online.

methodsThe powder was analyzed using liquid chromatography-high resolution mass spectrometry (LC-HRMS), liquid chromatography-tandem mass spectrometry (LC-MS/MS), and nuclear magnetic resonance (NMR) spectroscopy. Comprehensive toxicological screening, including NPS, was performed in urine and blood. ADB-BUTINACA was quantified using a standard addition method on various post-mortem matrices: femoral and heart blood, urine, stomach content, bile fluid and liver tissue. Scalp hair was analyzed via external calibration to assess potential long-term exposure.

resultsADB-BUTINACA concentrations were 34.5 ng/mL in femoral blood, 101 ng/mL in heart blood and 3.1 ng/mL in urine. Traces of MDMB-BUTINACA were found in the powder and hair, but not in other biological matrices. ADB-BUTINACA metabolites were detected in all biological matrices. MDPHP was found at low concentrations (< 2 ng/mL) in blood and urine but not in the powder, indicating prior cathinone use. A toxicological significance score (TSS) of 3 was assigned for this monointoxication with ADB-BUTINACA.

conclusionsThis case demonstrates fatal poisoning due to extremely high ADB-BUTINACA concentrations in post-mortem blood samples, emphasizing the severe risks associated with mislabeled substances. It underscores the importance of drug checking services to prevent poisonings and overdoses caused by highly potent NPS.

Indexed as

CannabinoidsDesigner DrugsPsychotropic DrugsPyrrolidinesAdultBileChromatography, LiquidFatal OutcomeForensic ToxicologyGastrointestinal ContentsHairHumansMalePowdersSubstance Abuse DetectionTandem Mass SpectrometryCannabinoidsDesigner DrugsPowdersPsychotropic DrugsPyrrolidinesDesigner stimulantDrug-checkingFatal intoxicationMislabelingNPSSynthetic cannabinoid receptor agonist

Identifiers

PMID41307856
PMCPMC12858572

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.