Sudden Cardiac Death Following Use of the Synthetic Cannabinoid MDMB-CHMICA

Synthetic cannabinoids first appeared in Europe in 2008, and by 2014 a total of 134 different compounds belonging to this class of drugs had been described (1). Their pharmacological effects are highly unpredictable and range from a mild cannabis-like ‘high’ to death (2). We report our first case of a fatal intoxication by a drug which has allegedly been implicated in an increasing but hitherto not comprehensively reported number of cases of deaths and intoxications (3); the indole-based synthetic cannabinoid MDMB-CHMICA (methyl-(S)-2-(1-(cyclohexylmethyl)-1H-indole-3-carboxamido)-3,3-dimethylbutanoate) (Figure 1). ... A 22-year-old male with an unremarkable medical history was found lifeless by friends after being alone for ∼15 min after smoking a brown organic powder alleged to be a synthetic cannabinoid. Upon arrival of ambulance personnel, he was found to have asystole. He received emergency treatment on site, spontaneous circulation was reestablished and he was subsequently transferred by helicopter to an intensive care unit at the St. Olav University Hospital. The following day the patient was declared dead due to brain hypoxia. He underwent organ donation and medico-legal autopsy, where changes commensurate with anoxic brain damage and pneumonia were present. No signs of injury or illness that could explain the circulatory collapse or brain damage were present.