In October 2025, toxicologist Kevin Shanks made presentations at both the National Association of Medical Examiners 2025 Conference in Louisville, Kentucky, and at the Society of Forensic Toxicologists 2025 Conference in Portland, Oregon.
NAME 2025 Recap: MDMB-4en-PINACA
At this year’s NAME meeting, Kevin Shanks presented a poster about the prevalence of the synthetic cannabinoid, MDMB-4en-PINACA, and its detection via the butanoic acid metabolite in postmortem toxicology cases. Axis has previously discussed synthetic cannabinoids on this blog, but briefly, synthetic cannabinoids are synthetically derived substances designed to simulate the effects of delta-9-tetrahydrocannabinol (THC). Unlike natural cannabinoids found in the cannabis plant, synthetic cannabinoids are often created in clandestine laboratories and sold as herbal incense, powders, or vape liquids. These compounds are full agonists of the cannabinoid receptors 1 and 2 (CB1 and CB2) and produce effects more intense than cannabis, which can include anxiety, agitation, tachycardia, hypertension, paranoia, hallucinations, seizure, and death.
MDMB-4en-PINACA is an older synthetic cannabinoid compound and was first detected in the USA in 2019. Even though it was federally scheduled in 2023, it has remained as one of the top two most prevalent synthetic cannabinoids in the USA. Because MDMB-4en-PINACA is subject to rapid enzymatic degradation in blood, Axis analyzes for the compound via its 3,3-dimethylbutanoic acid metabolite. Axis’ analytical methods screen for MDMB-4en-PINACA butanoic acid metabolite by liquid chromatography with quadrupole time of flight mass spectrometry (LC-qToF-MS) and confirm by liquid chromatography with tandem mass spectrometry (LC-MS/MS). Results are reported qualitatively and the limit of detection is 2 ng/mL.
From 1/1/2024 to 3/31/2025, the lab reported 126 detections of MDMB-4en-PINACA butanoic acid metabolite in postmortem casework. The substance was detected in 10 states (Indiana, Florida, Kentucky, Kansas, Michigan, Missouri, Illinois, Nebraska, Ohio, and Louisiana) with the vast majority of positive results from Indiana (64 cases). The substance was the sole compound of toxicological relevance in 29 cases. In the other 97 cases, the most prevalent compounds detected alongside the synthetic cannabinoid were fentanyl (32 cases), methamphetamine (32 cases), cocaine/benzoylecgonine (15 cases), and ethanol (14 cases).
While MDMB-4en-PINACA is several years old, it is still prevalent in postmortem toxicology casework and its popularity has not been affected by governmental scheduling. It is important to remember that some older novel psychoactive substances may stick around much longer than is normal and it is prudent to be aware of those substances and how they may play a role in a medical-legal death investigation. To discuss the potential impact of synthetic cannabinoids in your casework or for more information about the presentation, please contact [email protected]
SOFT 2025 Recap: Phencyclidine (PCP)
At this year’s SOFT meeting, Kevin Shanks presented a poster about the detection and prevalence of phencyclidine (PCP) in postmortem toxicology casework.
PCP was first synthesized in 1926 and its use as an anesthetic was discovered in 1956. Shortly thereafter, PCP was allowed as a medication as a short-acting anesthetic in humans, but quickly was removed from the market after adverse effects were observed. PCP appeared on the illicit drug market in the USA in 1967 and became a drug of abuse throughout the 1970s-1980s. It is typically used orally, insufflated, smoked, or injected intravenously. Pharmacologically, PCP is an N-methyl-D-aspartate (NMDA) receptor antagonist and it has cholinergic, adrenergic, and dopaminergic effects. Physiological effects include hypertension, hyperthermia, perspiration, hyper salivation, repetitive motor movements, muscle rigidity, arrhythmia, and seizure. Psychological effects include agitation, anxiety, dissociation, insomnia, rage, amnesia, and catatonia.
Axis’ analytical methods screen for PCP by liquid chromatography with quadrupole time of flight mass spectrometry (LC-qToF-MS) and confirm by gas chromatography with mass spectrometry (GC-MS). Results are reported quantitatively and the reporting limit is 50 ng/mL. From 1/1/2023 to 5/1/2025, Axis detected PCP in 83 postmortem blood toxicology cases. The substance was detected across 8 states (Arizona, Indiana, Kansas, Missouri, Nebraska, New York, Ohio, and Texas) with the majority of detections being from Missouri (73.4%). PCP was the sole substance of toxicological interest in 16 cases; PCP blood concentrations averaged 313 ng/mL in these cases. The most common substances detected alongside PCP were cocaine, ethanol, fentanyl, methamphetamine, and THC; and in those cases, PCP blood concentrations were generally lower than those cases where PCP was detected alone.
While most of the focus in postmortem toxicology presently is centered on fentanyl and novel psychoactive substances, it is important to remember that older, more classical drugs of abuse still exist. It is prudent that the postmortem toxicology laboratory include them in every comprehensive toxicology analysis. If you have a PCP-related question or more information about the presentation, please do not hesitate to reach out to our subject matter experts at [email protected].