Emergence of Cumyl-PEGACLONE-related fatalities in the Northern Territory of Australia
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ORIGINAL ARTICLE
Emergence of Cumyl‑PEGACLONE‑related fatalities in the Northern Territory of Australia Marianne Tiemensma1,2 · John David Rutherford1 · Timothy Scott3,4 · Steven Karch5 Accepted: 19 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Suspected unnatural or unexpected deaths in the Northern Territory of Australia are reportable to the coroner, and investigation of such cases typically includes a post-mortem examination with comprehensive toxicological screening. An autopsy case series of five Cumyl-PEGACLONE-related fatalities over a recent eighteen-month period is presented. Databases of the Northern Territory coroner’s office and the Royal Darwin Hospital Forensic Pathology Unit were searched to identify deaths related to synthetic cannabis use between July 1, 2018 and December 31, 2020. Toxicological analysis was performed at Forensic Science South Australia using a combination of liquid chromatography, gas chromatography and mass spectrometry. Cumyl-PEGACLONE, a synthetic cannabinoid receptor agonist (SCRA) with a gamma-carbolinone core, was detected in five cases (range in post-mortem blood 0.73—3.0 μg/L). Concurrent alcohol use and underlying cardiovascular disease were considered relevant factors in most cases. Toxicological Significance Scoring was carefully considered in all five cases, and in four cases, the presence of Cumyl-PEGACLONE was considered to be highly significant (TSS = 3). Synthetic cannabis use has not previously been identified in Northern Territory drug trends, and only one fatality related to the use of gamma-carbolines was identified in a recent Australia-wide study on synthetic cannabinoid-related fatalities. Deaths related to Cumyl-PEGACLONE use are emerging in the Northern Territory of Australia; this has public health implications. Although the exact mechanism(s) of death related to Cumyl-PEGACLONE are not fully established, this additional descriptive case series reaffirm an association with underlying cardiovascular disease, and suggest that concurrent use with alcohol may be relevant. Keywords New psychoactive substances · Synthetic cannabinoid(s) · Cumyl-PEGACLONE
Introduction The Northern Territory (NT) is a federal territory in the central and northern regions of Australia. It is a sparsely populated region with a population of approximately 250,000, which is less than 1% of Australia’s population * Marianne Tiemensma [email protected] 1
Forensic Pathology Unit, Royal Darwin Hospital, Darwin, Australia
2
College of Medicine and Public Health, Flinders University, Adelaide, Australia
3
Forensic Science South Australia, Adelaide, Australia
4
College of Science and Engineering, Flinders University, Adelaide, Australia
5
San Francisco, USA
[1]. Suspected unnatural or unexpected deaths are reportable to the coroner, and medico-legal investigation of such cases typically includes a post-mortem examination with comprehensive toxicological screening. An autopsy case series of five Cumyl-PEGACLONE
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