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Toxicological results from postmortem matrices with special focus on synthetic cannabinoids are discussed in terms of their relevance to the death.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>The samples were analyzed by toxicological screening procedures involving immunoassays and gas chromatography\u2013mass spectrometry (GC\u2013MS) as well as quantitative analyses by means of GC\u2013MS and high-performance liquid chromatography\u2013tandem mass spectrometry (LC\u2013MS\/MS).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>At the autopsy, coronary artery disease and signs of liver congestion were noted, in the absence of acute myocardial ischemic changes. Femoral blood concentrations of fentanyl and pregabalin were 14\u00a0ng\/mL and 3,200\u00a0ng\/mL, respectively. In addition, 2.7\u00a0ng\/mL 5F-ADB and 13\u00a0ng\/mL 5F-MDMB-P7AICA were detected together with relatively low amounts of 5 other synthetic cannabinoids in cardiac blood. A total number of up to 17 synthetic cannabinoids were detected in kidney, liver, urine and hair. Fentanyl and 5F-ADB were also detected in the water of the bucket bong.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The cause of death could be attributed to an acute mixed intoxication by fentanyl and 5F-ADB (both Toxicological Significance Score (TSS)\u2009=\u20093) with a contribution of pregabalin and 5F-MDMB-P7AICA (TSS\u2009=\u20092), in a subject suffering from pre-existing heart damage. The most plausible mechanism of death consists in a respiratory depression. This case report demonstrates that use of opioids in combination with synthetic cannabinoids might be particularly dangerous.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s11419-023-00666-w","type":"journal-article","created":{"date-parts":[[2023,6,10]],"date-time":"2023-06-10T05:01:37Z","timestamp":1686373297000},"page":"82-92","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Death after smoking of fentanyl, 5F-ADB, 5F-MDMB-P7AICA and other synthetic cannabinoids with a bucket bong"],"prefix":"10.1007","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3826-2327","authenticated-orcid":false,"given":"Merja A.","family":"Neukamm","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Halter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Auw\u00e4rter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Schmitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianna","family":"Giorgetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Bartel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,6,10]]},"reference":[{"key":"666_CR1","first-page":"495","volume-title":"New psychoactive substances pharmacology, clinical, forensic and analytical toxicology. 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