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.”
Reference
- 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
