Year(s) and type of review / ECDD meetings
Drug Class

Recommendation (from TRS)

Substance identification
ADB-FUBINACA (N-[(2S)-1-amino-3,3-dimethyl-1-oxobutan-2-yl]-1-[(4- fluorophenyl)methyl]-1H-indazole-3-carboxamide) is available as a powder, in solution or is sprayed on plant material that mimics the appearance of cannabis. It is sold as herbal incense or branded products under a variety of different names.

WHO review history
ADB-FUBINACA has not been previously pre-reviewed or critically reviewed by the WHO ECDD. A critical review was proposed based on information brought to WHO’s attention that ADB-FUBINACA poses a serious risk to public health and has no recognized therapeutic use.

Similarity to known substances and effects on the central nervous system
ADB-FUBINACA is similar to other synthetic cannabinoid receptor agonists that are currently scheduled under the Convention on Psychotropic Substances of 1971. It binds to both the CB1 and CB2 cannabinoid receptors with full agonist activity as demonstrated by in vitro studies. The efficacy and potency of ADB- FUBINACA is substantially greater than that of Δ9-tetrahydrocannabinol (Δ9- THC). Reported clinical features of intoxication include confusion, agitation, somnolence, hypertension and tachycardia, similar to intoxication with other synthetic cannabinoid receptor agonists.

Dependence potential
No controlled experimental studies examining the dependence potential of ADB-FUBINACA in humans or animals were available. However, based on its central nervous system action as a full CB1 agonist, ADB-FUBINACA would be expected to produce dependence in a manner similar to or more pronounced than cannabis.

Actual abuse and/or evidence of likelihood of abuse
ADB-FUBINACA is sold and used as a substitute for cannabis. It is smoked (as preparations of drug components introduced onto plant material) or vaped (i.e. using an e-cigarette). Owing to the nature of synthetic cannabinoid products, users cannot tell which synthetic cannabinoid is contained in such products. Evidence from case reports in which ADB-FUBINACA has been detected in biological samples has demonstrated that use of this substance has contributed to severe adverse reactions in humans, including death. However, in most cases it was noted that other substances, including other synthetic cannabinoids, were also present in the urine or blood samples taken following non-fatal and fatal intoxication and/or in the product used. Evidence of use has been reported from Asia, Europe and the United States. In recognition of its potential for abuse and associated harm, ADB-FUBINACA has been placed under national control in a number of countries in several different regions.

Therapeutic usefulness
ADB-FUBINACA is not known to have any therapeutic use.

ADB-FUBINACA is a synthetic cannabinoid receptor agonist that is administered by smoking plant material sprayed with the substance or inhaling vapour after heating. Its mode of action suggests the potential for dependence and the likelihood of abuse. Its use has been associated with a range of severe adverse effects, including death. These effects are similar to those produced by other synthetic cannabinoids that have the same mechanism of action as ADB-FUBINACA and which are placed in Schedule II of the Convention on Psychotropic Substances of 1971. ADB-FUBINACA has no therapeutic use.

■■ Recommendation: The Committee recommended that ADB-FU- BINACA (N-[(2S)-1-amino-3,3-dimethyl-1-oxobutan-2-yl]-1-[(4- fluorophenyl)methyl]-1H-indazole-3-carboxamide) be added to Schedule II of the Convention on Psychotropic Substances of 1971.

ECDD Recommendation

Inclusion in Schedule II of the 1971 Convention on Psychotropic Substances