A case of 5F-ADB / FUB-AMB abuse: Drug-induced or drug-related death?

•Identification of 5F-ADB and FUB-AMB in herbal mixture.•Identification of 5F-ADB and FUB-AMB in postmortem blood and urine samples.•Quantification of 5F-ADB by LLE in postmortem blood.•Histological analysis of tissue samples.•The first established death case in Bulgaria due to intoxication with synthetic cannabinoids. Synthetic cannabinoids (SCs) belong to the group of new psychoactive substances (NPS) which appear sprayed on herbal mixtures on the “street” drug market and are intended for smoking like marijuana. In the present report we discuss a fatal case of 18-years-old boy, who had smoked SCs since several months and an overuse of SCs during last 48 h of his life has been apprised. The autopsy findings revealed acute respiratory distress syndrome (ARDS). Both toxicological analysis of deceased blood and urine samples and chemical analysis of the herbal mixture seized revealed presence of two SCs - 5F-ADB and FUB-AMB. The amount of 5F-ADB in blood was found to be 3.7 ng/mL by standard addition method. Severe and irreversible morphology changes in lung specimen, leading to ischemic damage of all internal organs and tissues, were observed during histological examination. The present case can be discussed as an example of both drug-induced and drug-related death resulting from acute intoxication with 5F-ADB and FUB-AMB as well as from systematic use of both synthetic cannabinoids.