"Smoking" guns: Answers

Toxicology studies identified AB-FUBINACA, a fifth generation synthetic cannabinoid (SC), in the urine (450 ng/mL) and serum (52 ng/mL). Acute kidney injury (AKI) secondary to SCs was brought to international attention in a report from the U.S. Centers for Disease Control and Prevention in February 2013 [1] which detailed 16 cases of AKI after SC use in six states. A case series of four patients from Alabama, all from the same county, also implicated SCs as a cause of AKI [2]. An additional case has since been reported [3]. This is the first report of a fifth generation SC associated with AKI. SCs, commonly referred to as “Spice,” are designed to bind to the same cannabinoid receptors (designated CB1 and CB2) as the active compound in marijuana, delta-9 tetrahydrocannabinol (THC). Many SCs demonstrate a high affinity for CB1 and CB2 despite having markedly different chemical structures from THC; consequently, these compounds are also referred to as “synthetic marijuana” or cannabimimetics. SCs are designed and synthesized in clandestine laboratories. Plant material/inactive vegetable matter is soaked in solvent containing the dissolved SC or the SC is sprayed directly onto the matter [1, 4]. This material is then dried and smoked. The U.S Drug Enforcement Administration (DEA) has placed multiple SCs into Schedule I of the Controlled Substance Act (CSA), including AB-FUBINACA [5–7]. However, illicit use continues as new drugs are constantly being designed, and many of the older compounds remain commercially available under the guise of herbal incense, bath additives, or air fresheners with the label “not for human consumption.” The illegal use is further encouraged by affordability, expectation of an intense high, and avoidance of detection by commonly used urine drug tests. The synthetic drug industry is a growing market. In the high school age group, 8–11 % of seniors have reported use [8]. There are countless street and commercial names for SCcontaining products (Table 1)—with these names having no correlation with the presence of a particular SC. These drugs are made in laboratories with no quality or safety controls, and thus there is great variability amongst these products in terms of ingredients, potentially toxic preservatives, adulterants, and concentration of active SC [4]. There is no assurance that This article refers to the article that can be found at http://dx.doi.org/10. 1007/s00467-014-2978-1.