Positivity of New Synthetic Cannabinoid 4F-MDMB-BICA Increasing in U.S. as Prevalence of 5F-MDMB-PICA Wanes

4F-MDMB-BICA was first identified in the United States (U.S.) in plant-like material seized by law enforcement in May 2020 and soon after in toxicology casework in July 2020, with concurrent emergence in European countries. 4F-MDMB-BICA is structurally similar to the synthetic cannabinoid 4F-MDMB-BINACA, differing by an indole vs. indazole core, respectively. 4F-MDMB-BICA is an activator of the cannabinoid receptor system and its toxicity can be demonstrated through medicolegal death investigations paired with comprehensive toxicology findings. In the U.S., 4F-MDMB-BICA has been identified in at least 26 toxicology cases associated with postmortem (PM) and driving under the influence of drugs (DUID) investigations. In Europe, 4F-MDMB-BICA has been identified in several countries, including Hungary, the United Kingdom, Belgium, and Slovenia. Eleven deaths were attributed to the use of 4F-MDMB-BICA in Hungary between May and August 2020.
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