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The powder was identified as very potent synthetic cannabinoid ADB-BUTINACA\/ADB-BINACA with a high purity (&gt;\u200998%). This case highlights the risks associated with mislabeled novel psychoactive substances (NPS), particularly those purchased online.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The powder was analyzed using liquid chromatography-high resolution mass spectrometry (LC-HRMS), liquid chromatography-tandem mass spectrometry (LC-MS\/MS), and nuclear magnetic resonance (NMR) spectroscopy. Comprehensive toxicological screening, including NPS, was performed in urine and blood. ADB-BUTINACA was quantified using a standard addition method on various post-mortem matrices: femoral and heart blood, urine, stomach content, bile fluid and liver tissue. Scalp hair was analyzed via external calibration to assess potential long-term exposure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>ADB-BUTINACA concentrations were 34.5 ng\/mL in femoral blood, 101 ng\/mL in heart blood and 3.1 ng\/mL in urine. Traces of MDMB-BUTINACA were found in the powder and hair, but not in other biological matrices. ADB-BUTINACA metabolites were detected in all biological matrices. MDPHP was found at low concentrations (&lt;\u20092 ng\/mL) in blood and urine but not in the powder, indicating prior cathinone use. A toxicological significance score (TSS) of 3 was assigned for this monointoxication with ADB-BUTINACA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case demonstrates fatal poisoning due to extremely high ADB-BUTINACA concentrations in post-mortem blood samples, emphasizing the severe risks associated with mislabeled substances. It underscores the importance of drug checking services to prevent poisonings and overdoses caused by highly potent NPS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11419-025-00746-z","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T09:12:35Z","timestamp":1764234755000},"page":"257-270","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Deadly confusion of novel psychoactive substances: fatal outcome of ADB-BUTINACA mislabeled as 3\u2019,4\u2019-methylenedioxy-\u03b1-pyrrolidinohexiophenone"],"prefix":"10.1007","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9017-0111","authenticated-orcid":false,"given":"Annette","family":"Zschiesche","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6028-8382","authenticated-orcid":false,"given":"Nadine","family":"Theofel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Braukm\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin","family":"Ehrlich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Jasyk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3872-8622","authenticated-orcid":false,"given":"Maximilian","family":"Methling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Tsokos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Scholtis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4190-5469","authenticated-orcid":false,"given":"Laura M.","family":"Huppertz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1883-2804","authenticated-orcid":false,"given":"Volker","family":"Auw\u00e4rter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,27]]},"reference":[{"key":"746_CR1","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/j.lfs.2013.09.017","volume":"97","author":"WE Fantegrossi","year":"2014","unstructured":"Fantegrossi WE, Moran JH, Radominska-Pandya A, Prather PL (2014) Distinct Pharmacology and metabolism of K2 synthetic cannabinoids compared to \u22069-THC: mechanism underlying greater toxicity? 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