4-Bromomethcathinone (4-BMC) Revisited: The First Reported Fatal Case and Toxicological Insights

Background: 4-bromomethcathinone (4-BMC) has been present on the illicit drug market since 2011. Recent EUDA data indicate renewed availability of 4-BMC in Europe, including substantial seizures reported in 2024. Despite numerous seizures of this compound across Europe during its fourteen-year presence, no fatal intoxication involving 4-BMC has been reported so far. This paper presents the first documented fatal intoxication involving 4-BMC reported worldwide. Methods: Quantitative determination of 4-BMC in post-mortem blood and urine was performed using the Ultra-High Performance Liquid Chromatography coupled with Triple Quadrupole Mass Spectrometry (UHPLC-QqQ-MS/MS) method, together with complementary toxicological analyses. Results: The 4-BMC concentrations were 16,601 ng/mL in blood and over 50,000 ng/mL in urine. Both matrices also contained 3-chloromethcathinone at 1.7 ng/mL in blood and 122.2 ng/mL in urine. No other drugs, medications, or new psychoactive substances were detected apart from bromomethcathinone and chloromethcathinone metabolites. Conclusions: This first fatal case associated with 4-BMC underscores the necessity for enhanced monitoring of this compound by both forensic and clinical toxicologists. The re-emergence of 4-BMC after more than a decade demonstrates that previously known xenobiotics may reappear and again pose a serious threat to human health.