Cannabis adulterated with the synthetic cannabinoid receptor agonist MDMB-4en-PINACA and the role of European drug checking services

The Trans European Drug Information (TEDI) network is used by European drug checking services to exchange information on drug trends, as well as coordination of responses. From Spring 2020 onwards, multiple services detected the synthetic cannabinoid receptor agonist (SCRA) MDMB-4en-PINACA as an adulterant in low-tetrahydrocannabinol (THC) cannabis products that were sold as regular cannabis. Low-THC cannabis products are derivatives of industrial hemp, and their sale is generally not prohibited by drug laws if the levels of THC are sufficiently low (usually ≤0.2%). Consumption of these products adulterated with MDMB-4en-PINACA has led people to experience serious negative effects.

Data was collected between April 2020 and April 2021. Cannabis products suspected of adulteration were analyzed for the presence of MDMB-4en-PINACA by 9 services in 8 countries within the TEDI network. A sample was suspected of adulteration if the experienced effects deviated from the expected effects, as reported by service users. If available, phytocannabinoid analysis was also performed, and information on medical incidents involving MDMB-4en-PINACA-adulterated cannabis was collected.

1142 samples sold as cannabis in herbal, resin and e-liquid form were analyzed, of which 270 (23.6%) were found to contain MDMB-4en-PINACA. Most MDMB-4en-PINACA-positive samples were sold as herbal cannabis. If analyzed, all adulterated cannabis samples were found to contain ≥4% cannabidiol (CBD) and low THC (<1%), except the e-liquids which contained no phytocannabinoids. Users reported adverse effects including nausea, vomiting, tremors, paralysis, paresthesia, headaches, paranoia, anxiety, insomnia, hallucinations, aggressiveness, heart palpitations and loss of consciousness. In Germany, three serious health incidents requiring hospitalization after use of an adulterated cannabis sample were reported.

Adulteration of cannabis with SCRAs is a new phenomenon that carries risk for people who use it. Given that cannabis consumers are not a usual target group for drug checking services, services and associated harm reduction interventions could be reconfigured to include them.