New synthetic cannabinoid ADB-BUTINACA emerged in UK emergency departments with concerning features | Research

The takeaway

ADB-BUTINACA was detected in 10 patients presenting to UK emergency departments since February 2021, with reduced consciousness in all cases, including two who unknowingly consumed it in edible "cannabis" gummies.

Emergency physicians, harm reduction workers, drug checking services, and cannabis consumers concerned about product safety.

All 10 patients had reduced consciousness; 2 consumed contaminated edibles

What the researchers found

ADB-BUTINACA was found in 10 of 1,279 patients in the IONA study, all since February 2021, suggesting recent emergence. Reduced consciousness occurred in all 10 patients. Two had ingested edible "cannabis" gummies unknowingly contaminated with the synthetic cannabinoid. In 7 cases, other drugs were co-detected. All patients recovered with supportive care.

Why it matters

ADB-BUTINACA is entering the drug supply disguised as natural cannabis, including in edible products. Users who think they are consuming cannabis may unknowingly be exposed to a far more potent and dangerous synthetic cannabinoid.

The numbers in context

10 patients from 1,279 total IONA participants. All 10 since February 2021. 9 male, median age 45. All 10 had reduced consciousness. 2 consumed edible "cannabis" gummies. 3 had ADB-BUTINACA only; 7 had co-detected substances. Median hospital stay: 19 hours.

How the study worked

Prospective surveillance from the IONA study enrolling adults presenting to UK emergency departments with toxicity after suspected drug misuse since March 2015. Blood and/or urine analyzed by LC-MS.

What this study cannot tell us

Small case series (10 patients). Single country surveillance. Co-detection of other substances in 7 cases complicates attribution. Cannot determine population-level prevalence.

How to read the evidence

Case series from a large prospective surveillance study, but only 10 patients identified.

When this study was published

Published in 2022.

The bigger picture

The contamination of edible cannabis products with synthetic cannabinoids represents an escalating harm reduction concern, especially as more consumers shift toward edibles.

Questions still open

How widespread is synthetic cannabinoid contamination of edible cannabis products? Would legal cannabis markets eliminate this risk?

Common questions

Can edible cannabis products contain synthetic cannabinoids?

Yes. In this UK study, two patients unknowingly consumed ADB-BUTINACA after eating "cannabis" gummy edibles that were actually contaminated with the synthetic cannabinoid.

What happens when someone takes ADB-BUTINACA?

All 10 patients in this study had reduced consciousness, with some also experiencing agitation, tachycardia, seizures, and hallucinations. All recovered with supportive care.

Read the original research

Clinical features associated with ADB-BUTINACA exposure in patients attending emergency departments in England.

Clinical toxicology (Philadelphia, Pa.), 60(10), 1094-1098

View on PubMed ↗Publisher’s paper ↗

Citation

King, A; Hill, S L; Pucci, M; Bailey, G; Keating, L; Macfarlane, R; Cantle, F; Hudson, S; Thomas, S H L. (2022). Clinical features associated with ADB-BUTINACA exposure in patients attending emergency departments in England.. Clinical toxicology (Philadelphia, Pa.), 60(10), 1094-1098. https://doi.org/10.1080/15563650.2022.2101469