Identification of Novel Psychoactive Substances Seized, Consumed, and Associated with Deaths in Kuwait During 2018 and 2019 Using GC-MS and LC-MS-Ms

Al-Matrouk¹, M. Alqallaf², A. AlShemmeri¹, D. AlShemmeri¹, H. BoJbarah¹. ¹Narcotic and Psychotropic Laboratory, Department of Criminal Evidence, Ministry of Interior, Kuwait; ²Toxicology Laboratory, Department of Criminal Evidence, Ministry of Interior, Kuwait

Novel Psychoactive Substances (NPS, “legal highs”) are compounds designed to mimic existing established recreational drugs. They are becoming very popular worldwide, and consequently, the death rate associated with their use is increasing. Despite of the increased concerns about the adverse effects of using these substances, there is no published data on the subject in the Gulf region, in general, and more specifically, in Kuwait. Thus, our study investigates the diversity of Novel Psychoactive in Kuwait in 2018 and 2019. This is by reviewing of the databases of the Kuwait Narcotics and Psychotropic Laboratory, Toxicology Laboratory and Forensic Medicine Department. A total of 1039 cases from the Narcotics and Psychotropic Laboratory, 297 cases from the Toxicology Laboratory, and six cases from the Forensic Medicine Department were reviewed and analyzed. Numerous different types of Novel Psychoactive Substances were identified using the GC-MS and LC-MS-MS. Families of synthetic cannabinoids and their identified members include indazole-3-carboxamides (5F-ADB, FUB-AMB, ADB-FUBINACA, AB-FUBINACA, 5F-ADB-PINACA, 5F-AB-PINACA, 4-cyano-CUMYL-BUTINACA, 4F-MDMB-BUTINACA, 5F-AB-PINACA, FAB-144, and 5F-AKB-48), indole-3-carboxymides (MDMB-CHMICA, 5F-MDMB-PICA, ADB-BICA, 5F-ADBICA, and MMB-CHMICA), indole-3-carboxylates (CBL2201 and 5F-PB-22), cyclopropyl-indoles (UR-144 and XLR-11), naphthoyl-indoles (AM-2201), and benzoyl-indoles (RCS-4). Members of synthetic cathinones identified in Kuwait include N- Ethylhexedrone, Dibutylone, MDPPP, and 4-Cl-ɑPPP. The most common synthetic cannabinoids were 5F-ADB, 5F-MDMB-PICA, FUB-AMB, and 5Cl-AKB-48. Different combinations of two, three, and four types of synthetic cannabinoids were identified, and combinations of synthetic cannabinoids with other illicit drugs were revealed. FUB-AMB and 5F-ADB were found to be combined either with each other or with methamphetamine, tramadol, heroin, ∆9THC, or ketamine. Most importantly, our results show the types of synthetic cannabinoids associated with six cases of death.