{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T22:43:20Z","timestamp":1780958600008,"version":"3.54.1"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2022,11,1]],"date-time":"2022-11-01T00:00:00Z","timestamp":1667260800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Toxicologists are often confronted with the abuse of multiple drugs and are obliged to decide which compound may have been the cause of death. We report on a 21-year-old man (182\u2009cm, 84\u2009kg), who was found unconscious in his bed. Beside him, the police found several controlled substances, among them were dried opium poppy pods containing thebaine, codeine and morphine, a clear liquid with the designer benzodiazepines flualprazolam and clonazolam and a white powder with the imprint SGT-25, instead of SGT-78 (CUMYL-4CN-BINACA). These compounds were also found in the urine sample following a non-targeted gas chromatography\u2013mass spectrometry and a targeted liquid chromatography\u2013tandem mass spectrometry (LC\u2013MS-MS) screening approach. Subsequently, these compounds were quantified in whole femoral blood and scalp hair. Based on the concentrations measured in femoral blood in particular, we assume that the deceased had taken a lethal dose of the designer benzodiazepines\u2014flualprazolam (0.74\u2009mg\/L) and clonazolam (2.08\u2009mg\/L), an extremely high dose of the opiates\u2014thebaine (0.81\u2009mg\/L), codeine (0.23\u2009mg\/L) and morphine (0.13 mg\/L\u2009) and a high dose of the synthetic cannabinoid\u2014CUMYL-4CN-BINACA (0.01\u2009mg\/L). Besides postmortem concentrations, we also present electron impact and electrospray ionization mass spectra of compounds found in the vicinity of the decedent, namely the tryptamines\u20144-hydroxy-N-isopropyl-N-methyltryptamine (4-HO-MIPT), 4-hydroxy-N-ethyl-N-methyltryptamine (4-HO-MET) and 4-acetoxy-N,N-diethyltryptamine (4-ACO-DET), the amphetamines\u20143-fluoroethamphetamine (3-FEA) and 2-fluoromethamphetamine (2-FMA) and the arylcyclohexylamines\u2014N-ethyldeschloroketamine (O-PCE), 3-methoxyphencyclidine (3-MeO-PCP) and 3-methoxyeticyclidine (3-MeO-PCE).<\/jats:p>","DOI":"10.1093\/jat\/bkac098","type":"journal-article","created":{"date-parts":[[2022,12,14]],"date-time":"2022-12-14T18:42:55Z","timestamp":1671043375000},"page":"e285-e290","source":"Crossref","is-referenced-by-count":9,"title":["A Fatal Case Report Resulting from the Abuse of the Designer Benzodiazepines Clonazolam and Flualprazolam in Conjunction with Dried Opium Poppy Pods"],"prefix":"10.1093","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6028-8382","authenticated-orcid":false,"given":"Nadine","family":"Theofel","sequence":"first","affiliation":[{"name":"Department of Forensic Toxicology, Governmental Institute of Legal Medicine and Forensic Sciences , Turmstra\u00dfe 21, Berlin D-10559, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"M\u00f6ller","sequence":"additional","affiliation":[{"name":"Department of Forensic Toxicology, Governmental Institute of Legal Medicine and Forensic Sciences , Turmstra\u00dfe 21, Berlin D-10559, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elke","family":"Vejmelka","sequence":"additional","affiliation":[{"name":"Department of Forensic Toxicology, Governmental Institute of Legal Medicine and Forensic Sciences , Turmstra\u00dfe 21, Berlin D-10559, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus","family":"Kramer","sequence":"additional","affiliation":[{"name":"Department of Forensic Toxicology, Governmental Institute of Legal Medicine and Forensic Sciences , Turmstra\u00dfe 21, Berlin D-10559, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Tsokos","sequence":"additional","affiliation":[{"name":"Department of Forensic Toxicology, Governmental Institute of Legal Medicine and Forensic Sciences , Turmstra\u00dfe 21, Berlin D-10559, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Scholtis","sequence":"additional","affiliation":[{"name":"Department of Forensic Toxicology, Governmental Institute of Legal Medicine and Forensic Sciences , Turmstra\u00dfe 21, Berlin D-10559, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,12,14]]},"reference":[{"key":"2023012411404569400_R1","doi-asserted-by":"crossref","first-page":"4628","DOI":"10.1021\/jo200567n","article-title":"Synthesis of buprenorphine from oripavine via N-demethylation of oripavine quaternary salts","volume":"76","author":"Werner","year":"2011","journal-title":"The Journal of Organic Chemistry"},{"key":"2023012411404569400_R2","doi-asserted-by":"crossref","first-page":"17","DOI":"10.3109\/00498257409052087","article-title":"Pharmacokinetics and metabolism of [3H] thebaine","volume":"4","author":"Misra","year":"1974","journal-title":"Xenobiotica"},{"key":"2023012411404569400_R3","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1093\/jat\/21.5.376","article-title":"The analysis of thebaine in urine for the detection of poppy seed consumption","volume":"21","author":"Cassella","year":"1997","journal-title":"Journal of Analytical Toxicology"},{"key":"2023012411404569400_R4","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1002\/dta.1590","article-title":"The poppy seed defense: a novel solution","volume":"6","author":"Chen","year":"2014","journal-title":"Drug Testing and Analysis"},{"key":"2023012411404569400_R5","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1093\/jat\/34.8.527","article-title":"Fatality involving the ingestion of phenazepam and poppy seed tea","volume":"34","author":"Kristen","year":"2010","journal-title":"Journal of Analytical Toxicology"},{"key":"2023012411404569400_R6","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.forsciint.2015.12.013","article-title":"Death in a legal poppy field in Spain","volume":"265","author":"Martinez","year":"2016","journal-title":"Forensic Science International"},{"key":"2023012411404569400_R7","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1093\/jat\/bkaa070","article-title":"Flualprazolam blood concentrations in 197 forensic investigation cases","volume":"45","author":"Papsun","year":"2021","journal-title":"Journal of Analytical Toxicology"},{"key":"2023012411404569400_R8","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.forsciint.2016.09.006","article-title":"Blood concentrations of new designer benzodiazepines in forensic cases","volume":"268","author":"H\u00f8iseth","year":"2016","journal-title":"Forensic Science International"},{"key":"2023012411404569400_R9","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1093\/jat\/bkaa043","article-title":"Blood concentrations of designer benzodiazepines: relation to impairment and findings in forensic cases","volume":"44","author":"Heide","year":"2020","journal-title":"Journal of Analytical Toxicology"},{"key":"2023012411404569400_R10","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1093\/jat\/bkz063","article-title":"Validation of an LC\u2013MS-MS method for the quantification of 13 designer benzodiazepines in blood","volume":"43","author":"Mei","year":"2019","journal-title":"Journal of Analytical Toxicology"},{"key":"2023012411404569400_R11","doi-asserted-by":"crossref","DOI":"10.1016\/j.forsciint.2019.110101","article-title":"Femoral blood concentrations of flualprazolam in 33 postmortem cases","volume":"307","author":"Kriikku","year":"2020","journal-title":"Forensic Science International"},{"key":"2023012411404569400_R12","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1093\/jat\/bkx061","article-title":"Identification of the synthetic cannabinoid 1-(4-cyanobutyl)-N-(2-phenylpropan-2-yl)-1Hindazole-3-car-boxamide (CUMYL-4CN-BINACA) in plant material and quantification in postmortem blood samples","volume":"41","author":"Yeter","year":"2017","journal-title":"Journal of Analytical Toxicology"},{"key":"2023012411404569400_R13","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1002\/dta.2298","article-title":"In vitro metabolism of the synthetic cannabinoids CUMYL-PINACA, 5F-CUMYL-PINACA, CUMYL-4CNBINACA, 5F-CUMYL-P7AICA and CUMYL-4CN-B7AICA","volume":"10","author":"Staeheli","year":"2018","journal-title":"Drug Testing and Analysis"},{"key":"2023012411404569400_R14","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1002\/dta.2248","article-title":"Detection of metabolites of the new synthetic cannabinoid CUMYL-4CN-BINACA in authentic urine samples and human liver microsomes using high-resolution mass spectrometry","volume":"10","author":"Oeztuerk","year":"2018","journal-title":"Drug Testing and Analysis"},{"key":"2023012411404569400_R15","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1002\/dta.2373","article-title":"Metabolism study for CUMYL-4CN-BINACA in human hepatocytes and authentic urine specimens: free cyanide is formed during the main metabolic pathway","volume":"10","author":"Aastrand","year":"2018","journal-title":"Drug Testing and Analysis"},{"key":"2023012411404569400_R16","doi-asserted-by":"crossref","first-page":"e2","DOI":"10.1093\/jat\/bky063","article-title":"A fatal case involving N-ethyldeschloroketamine (2-Oxo-PCE) and venlafaxine","volume":"43","author":"Theofel","year":"2019","journal-title":"Journal of Analytical Toxicology"},{"key":"2023012411404569400_R17","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1186\/s13054-020-02915-5","article-title":"Therapeutic and toxic blood concentrations of more than 1100 drugs and other xenobiotics","volume":"24","author":"Schulz","year":"2020","journal-title":"Critical Care"},{"key":"2023012411404569400_R18","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1093\/jat\/bkaa093","article-title":"Death from poppy tea consumption","volume":"44","author":"Bishop-Freeman","year":"2020","journal-title":"Journal of Analytical Toxicology"},{"key":"2023012411404569400_R19","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1007\/s00414-020-02259-3","article-title":"Concentration distribution of more than 100 drugs and metabolites in forensic hair samples","volume":"134","author":"Musshoff","year":"2020","journal-title":"International Journal of Legal Medicine"}],"container-title":["Journal of Analytical Toxicology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jat\/advance-article-pdf\/doi\/10.1093\/jat\/bkac098\/48479343\/bkac098.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jat\/article-pdf\/46\/9\/e285\/48844662\/bkac098.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jat\/article-pdf\/46\/9\/e285\/48844662\/bkac098.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,24]],"date-time":"2023-01-24T11:43:26Z","timestamp":1674560606000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jat\/article\/46\/9\/e285\/6901908"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,1]]},"references-count":19,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,12,14]]},"published-print":{"date-parts":[[2023,1,24]]}},"URL":"https:\/\/doi.org\/10.1093\/jat\/bkac098","relation":{},"ISSN":["0146-4760","1945-2403"],"issn-type":[{"value":"0146-4760","type":"print"},{"value":"1945-2403","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,11,1]]},"published":{"date-parts":[[2022,11,1]]}}}