Fatal Intoxications from a Combination of 4-Fluoroamphetamine and 25C-NBOMe

Area of Science:

• Forensic Toxicology
• Clinical Toxicology
• Pharmacology

Background:

• Emergence of novel psychoactive substances (NPSs) poses challenges to public health and forensic investigations.
• Specific NPS combinations, like 4-fluoroamphetamine (4FA) and 25C-NBOMe, have been implicated in fatalities.
• Understanding the toxicological profiles and clinical effects of NPSs is crucial for accurate cause-of-death determination.

Purpose of the Study:

• To report on six fatalities associated with the combined ingestion of 4-fluoroamphetamine (4FA) and 25C-NBOMe.
• To analyze postmortem blood concentrations of 4FA and 25C-NBOMe in fatal cases.
• To discuss the potential role of these NPSs in sudden death and the challenges in their detection.

Main Methods:

• Retrospective analysis of six fatality cases over a 9-month period.
• Full postmortem examinations including femoral blood collection.
• Toxicological analysis for 4-fluoroamphetamine (4FA) and 25C-NBOMe using postmortem blood concentrations.

Main Results:

• Six fatalities were linked to 4FA and 25C-NBOMe, with four from direct drug effects and two from indirect causes (fall, restraint).
• Postmortem blood concentrations for drug-caused fatalities ranged from 330-682 ng/L for 4FA and 1.4-12 ng/mL for 25C-NBOMe.
• Detected concentrations did not suggest high recreational use; other drugs were present in most cases, but 4FA and 25C-NBOMe were considered primary triggers.

Conclusions:

• The combination of 4FA and 25C-NBOMe may increase the risk of sudden death, potentially through serotonin elevation and stimulant effects.
• Fatalities can occur at concentrations not indicative of high recreational doses.
• Detection of NPSs can be challenging without prior suspicion, highlighting the need for comprehensive toxicological screening.