Back to basics – a case of multidrug intoxication involving 6-APB, known on the black market as benzofury

Introduction The misuse of new psychoactive substances poses a threat to public health. Although new compounds are constantly emerging, substances that have been known for years should not be overlooked in routine toxicological analyses, as users often return to using them. Benzofurans, known as benzofury, are synthetic phenethylamines that exhibit structural and functional similarities to MDMA and MDA. Concurrent use of benzofury with, among others, synthetic cathinones may trigger a sympathomimetic syndrome characterized by serious and severe somatic and CNS symptoms. The first benzofurans to appear on the drug market were 5-APB and 6-APB. The authors present a case of a fatal multi-substance overdose involving 6-APB in a young man.

Methods Post-mortem biological matrices were subjected to analysis using a LC-MS/MS and HS-GC-FID/FID. This comprehensive approach covered a broad spectrum of substances, encompassing drugs, illicit substances, NPS, volatile compounds. Information pertaining to the circumstances of death was obtained from prosecutor.

Results The authors analyze this case of death in terms of the composition, mechanism of action, toxicity, and concentrations of substances identified in samples collected during the autopsy. The materials confirmed the presence of 6-APB, 6-APDB, MDMA, amphetamine, methamphetamine were detected. No ethyl alcohol was detected. The results obtained may indicate poisoning by multiple substances. These results correlate with information regarding the symptoms the man exhibited prior to death, which may suggest the occurrence of a sympathomimetic syndrome.

Conclusions In cases of suspected death following simultaneous ingestion of multiple xenobiotics, the authors recommend conducting extensive toxicological analyses using various analytical techniques. Detection of a toxic substance in biological material, combined with a detailed history of poisoning symptoms and an investigation into the circumstances of the incident, is helpful in compiling a report on the investigation, including an interpretation of the toxicological analysis results.