A synthetic cannabinoid with strong depressant effects accounted for the “zombie-like” behavior reported in a mass intoxication in New York City in July, researchers reported in the New England Journal of Medicine.

The synthetic cannabinoid methyl 2-(1-(4-fluorobenzyl)-1H-indazole-3-carboxamido)-3-methylbutanoate, otherwise known as AMB-FUBINACA, was identified as “AK-47 24 Karat Gold” due to a mass intoxication of 33 persons on July 12, 2016, in New York City. The press described this as a “zombie” outbreak because of the appearance of the intoxicated persons; 18 patients were transported to 2 local medical centers.

The clinical features in this outbreak were identified by the index patient, a 28-year-old man who was described by EMS providers as having a “blank stare.” The patient had a heart rate of 88 beats per minute, blood pressure 101/61 mm Hg, respiratory rate 21 breaths per minute, body temperature 36.7°C (98°F) orally, and oxygen saturation 95% while he was breathing ambient air. The patient was sweating, however, and had intermittent periods of zombie-like groaning and slow, mechanical movements of the arms and legs.

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Lab results, which included screenings for amphetamines, cocaine, opiates, THC, methadone, and tricyclic antidepressants, revealed no abnormalities. The DEA obtained biologic samples from 8 of the 18 patients in the outbreak who were transported for medical care and sent the samples for comprehensive drug analysis with the use of high-resolution mass spectrometry. A sample of the product that had been smoked by a patient was brought to the hospital to be analyzed as well.

Several aliquots of AK-47 24 Karat Gold, blood, and urine samples were sent to the Clinical Toxicology and Environmental Biomonitoring Laboratory at the University of California in San Francisco. Analysis of the product revealed a unique signal at a concentration of 1mg per millimeter, which corresponded to AMB-FUBINACA.

The potency of AMB-FUBINACA is consistent with strong depressant effects that account for the zombie-like behavior reported in this mass intoxication. According to Axel J. Adams, BS, and colleagues, “AMB-FUBINACA is an example of the emerging class of ‘ultrapotent’ synthetic cannabinoids and poses a public health concern. As the number and complexity of new psychoactive substances increases, this type of coordination among multiple agencies is important for the timely resolution of future outbreaks.”


  1. Adams AJ, Banister SD, Irizarry L, et al. “Zombie” outbreak caused by the synthetic cannabinoid AMB-FUBINACA in New York. N Engl J Med. 2016 Dec 14. DOI: 10.1056/NEJMoa1610300