Clinical features and sociodemographic characteristics associated with analytically confirmed exposure to MDMB-4en-PINACA
Starbrook, Lauren
Starbrook, Lauren
Abstract
Introduction: MDMB-4en-PINACA is a synthetic cannabinoid receptor agonist which has been present in the recreational drug market since 2017. Its use appears to be more common within vulnerable and deprived communities. Methods: This was a retrospective observational case series of patients attending emergency departments with acute drug toxicity in Birmingham, United Kingdom, between November 2020 and December 2024, who were found on routine toxicological screening to have been exposed to MDMB-4en-PINACA. Results: There were 202 hospital presentations involving 163 patients with acute drug toxicity and exposure to MDMB-4en-PINACA during the study period. The majority of patients were male (82.6%); median age was 39 years (range 14-78); 32.2% were homeless. The most common clinical features were reduced level of consciousness (n = 164, 81.2%), agitation (n = 99, 49%), seizures (n = 61, 30.2%), hypotension (n = 45, 22.3%), increased blood lactate concentration (n = 95, 47%) and increased creatine kinase activity (n = 77, 38.1%). There were four deaths. In the majority of cases (n = 178, 88.1%), more than one recreational substance was detected. In 15 cases, MDMB-4en-PINACA was analytically confirmed as the only substance taken. Discussion: The clinical features observed following exposure to MDMB-4en-PINACA are similar to those documented following exposure to other potent synthetic cannabinoids. Polydrug use limits the interpretation of clinical features in the majority of cases. However, the predominant clinical features in the 15 patients with no other substances detected were consistent with the overall cohort. It is likely that synthetic cannabinoid receptor agonists have become popular among those experiencing homelessness due to their low cost and high potency. Conclusions: Use of synthetic cannabinoid receptor agonist MDMB-4en-PINACA is common within the male homeless population in Birmingham, United Kingdom, and remained prevalent over the 4-year study period.
MIDER Authors
Affiliations
Sandwell and West Birmingham NHS Trust
Date
2026-02-02
Type
Article
Subject
Collections
Citation
Moyns EJ, Starbrook L, Pucci M. Clinical features and sociodemographic characteristics associated with analytically confirmed exposure to MDMB-4en-PINACA. Clin Toxicol (Phila). 2026 Apr;64(4):274-281. doi: 10.1080/15563650.2025.2608229. Epub 2026 Feb 2