Critical Review Report:

MDMB-4en-PINACA

Expert Committee on Drug Dependence

Forty-third Meeting
Geneva, 12–20 October 2020

This report contains the views of an international group of experts, and does not necessarily represent the decisions or
the stated policy of the World Health Organization.
43rd ECDD (2020): MDMB-4en-PINACA

© World Health Organization 2020

All rights reserved.

This is an advance copy distributed to the participants of the 43rd Expert Committee on Drug Dependence,
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Table of Contents
Executive summary ............................................................................................................................ 5
1. Substance identification.............................................................................................................................. 6
A. International Nonproprietary Name (INN) ............................................................................................................... 6
B. Chemical Abstract Service (CAS) Registry Number ................................................................................................ 6
C. Other chemical names ...................................................................................................................................................... 6
D. Trade names ......................................................................................................................................................................... 6
E. Street names......................................................................................................................................................................... 6
F. Physical appearance .......................................................................................................................................................... 6
G. WHO review history ........................................................................................................................................................... 6
2. Chemistry...................................................................................................................................................... 6
A. Chemical name .................................................................................................................................................................... 6
B. Chemical structure ............................................................................................................................................................. 7
C. Stereoisomers....................................................................................................................................................................... 7
D. Methods and ease of illicit manufacturing ............................................................................................................... 7
E. Chemical properties ........................................................................................................................................................... 7
F. Identification and analysis .............................................................................................................................................. 7
3. Ease of convertibility into controlled substances...................................................................................... 8

4. General pharmacology................................................................................................................................ 8
A. Routes of administration and dosage......................................................................................................................... 8
B. Pharmacokinetics ............................................................................................................................................................... 8
C. Pharmacodynamics ........................................................................................................................................................... 8
5. Toxicology..................................................................................................................................................... 9

6. Adverse reactions in humans...................................................................................................................... 9

7. Dependence potential ................................................................................................................................. 9

A. Animal studies ...................................................................................................................................................................... 9
B. Human studies ..................................................................................................................................................................... 9
8. Abuse potential ............................................................................................................................................ 9
A. Animal studies ...................................................................................................................................................................... 9
B. Human studies .................................................................................................................................................................. 10
9. Therapeutic applications and extent of therapeutic use and epidemiology of medical use .............. 10

10. Listing on the WHO Model List of Essential Medicines .......................................................................... 10

11. Marketing authorizations (as a medicinal product) ............................................................................... 10

12. Industrial use .............................................................................................................................................. 10

13. Nonmedical use, abuse and dependence ................................................................................................ 10

14. Nature and magnitude of public health problems related to misuse, abuse and dependence.......... 10

15. Licit production, consumption and international trade ......................................................................... 10

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16. Illicit manufacture and traffic and related information ......................................................................... 10

17. Current international controls and their impact..................................................................................... 11

18. Current and past national controls .......................................................................................................... 11

19. Other medical and scientific matters relevant for a recommendation on the scheduling of the
substance ................................................................................................................................................... 11

References ....................................................................................................................................... 12
Annex 1. Report on WHO Questionnaires for Review of Psychoactive Substances for the 43rd ECDD:
evaluation of MDMB-4en-PINACA ......................................................... Error! Bookmark not defined.

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Executive summary
MDMB-4en-PINACA (CAS: not available), methyl (S)-3,3-dimethyl-2-(1-(pent-4-en-1-yl)-1H-
indazole-3-carboxamido)butanoate, is a synthetic cannabinoid with an indazole core and a
terminal alkene on the side-chain. It is structurally similar to 5F-MDMB-PINACA (5F-ADB). MDMB-
4en-PINACA has a chiral centre. The enantiomers have not been separated experimentally, but the
S-enantiomer has been identified in samples. The compound is not readily converted into other
controlled substances and has not been previously reviewed by the WHO Expert Committee on
Drug Dependence.
The most likely routes of administration for MDMB-4en-PINACA in humans are inhalation via
smoking the chemical after it has been sprayed onto plant material or vaping it after formulation
in liquid. It has been identified in seized material formulated for smoking. The dosage required to
elicit pharmacological effects in humans is unknown. With the exception of two studies, scientific
investigation of MDMB-4en-PINACA has been sparse. These two studies focused on identification
of biomarker(s) that could serve in forensic investigations as indicators of use. Like many other
synthetic cannabinoids, MDMB-4en-PINACA is extensively metabolized. However, unlike many
other synthetic cannabinoids, the parent product has been identified in authentic urine samples.
Analysis of human liver microsomes, hepatocytes and authentic urine samples showed that M3
(C19H27N3O5) was the most abundant metabolite.
MDMB-4en-PINACA binds to human cannabinoid type 1 (hCB 1) receptors with a Ki of 3.26 nM.
Further, it is a full and potent agonist, decreasing forskolin-stimulated accumulation of cyclic
adenosine monophosphate (cAMP) (half maximal effective concentration (EC 50) = 0.33 nM). No
reports of in vivo pharmacological or toxicological effects of MDMB-4en-PINACA have been
published. Unpublished data suggest that MDMB-4en-PINACA produces substantial lethargy and
hypothermia at higher doses (1–10 mg/kg). No studies demonstrating its abuse or dependence
potential were identified.
In humans, MDMB-4en-PINACA has been detected in postmortem femoral vein blood samples
taken following two deaths; however, the degree to which the drug contributed to the deaths
could not be determined. MDMB-4en-PINACA has also been detected in products marketed as
heroin and cannabis in the United States of America and in Wales.
MDMB-4en-PINACA was first identified in Europe in 2017. Since then, prevalence has increased
dramatically, with the largest number of seizures reported in 2019, and a recent seizure in
February 2020. Further, MDMB-4en-PINACA has been detected in Asia (3 countries), the European
Union (17 countries), New Zealand, the Russian Federation and the United States of America.
Currently, MDMB-4en-PINACA is not subject to international control under the 1971 United
Nations Convention on Psychotropic Substances. It is under national control in Canada, Germany,
Sweden and the United Kingdom.

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1. Substance identification
A. International Nonproprietary Name (INN)
NA
B. Chemical Abstract Service (CAS) Registry Number
None available
C. Other chemical names
MDMB-PENINACA
MDMB-PINACA N1-pentyl-4-en isomer
5-CL-ADB-A
ADB-PINACA-A
D. Trade names
NA
E. Street names
Reported in product labelled “Heavy Weight” (unpublished certificate of analysis from
Commonwealth of Massachusetts, Department of State Police, February 2020). This
product also contained other substances, including fentanyl.
F. Physical appearance
MDMB-4en-PINACA is described as a powder (1) white powder (2, 3) ; yellow/brown
powder (3); tan powder (unpublished certificate of analysis from Commonwealth of
Massachusetts, Department of State Police, February 2020).
G. WHO review history
MDMB-4en-PINACA has not previously been reviewed by the WHO Expert Committee on
Drug Dependence (ECDD). It is classified as a high priority submission for the forty-third
annual meeting of the ECDD.
2. Chemistry
A. Chemical name
IUPAC name: methyl (S)-3,3-dimethyl-2-(1-(pent-4-en-1-yl)-1H-indazole-3-
carboxamido)butanoate
CA Index name: NA

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B. Chemical structure

Molecular formula: C20H27N3O3

Molecular weight: 357.5 g/mol

C. Stereoisomers
MDMB-4en-PINACA has one chiral centre, with two enantiomers (S and R). The S-
enantiomer has been synthesized as an in-house standard for forensic analysis (4);
however, it was unclear whether the samples analysed contained only this enantiomer or
the racemate.
D. Methods and ease of illicit manufacturing
No information is available on methods for synthesis or ease of illicit manufacturing.
E. Chemical properties
Melting point
No data
Boiling point
No data
Solubility
Soluble in CH2Cl2, MeOH and H2O.(1)
F. Identification and analysis
Various methods have been used to identify and/or analyse MDMB-4en-PINACA. They include gas
chromatography-mass spectrometry (GC-MS) (1, 4), high-performance liquid chromatography-
time of flight (HPLC-TOF) (1), ultra-high-pressure liquid chromatography with photodiode array
and quadrupole time of flight mass spectrometry (UPLC-PDA-QToF-MS) (4), nuclear magnetic
resonance (NMR) spectroscopy (4), liquid chromatography and quadrupole time of flight mass
spectrometry (LC-QTOF-MS) (2), and liquid chromatography-high-resolution mass spectrometry
(LC–HRMS) (5).

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3. Ease of convertibility into controlled substances

Convertibility into a controlled, but non-cannabinoid substance, is unlikely.
4. General pharmacology
A. Routes of administration and dosage
MDMB-4en-PINACA has been identified in herbal material obtained for research from
online purchases or law enforcement seizures (5). Most users who have posted on the
effects of MDMB-4en-PINACA in online forums report that they smoked or vaped the
product containing the compound and one reported sublingual administration (6).
Recently, Norman et al. (4) reported analysis and identification of MDMB-4en-PINACA
infused onto paper that was mailed to inmates in Scottish prisons. Since the ban on
smoking in prisons, inmates had been inserting small pieces of paper infused with MDMB-
4en-PINACA and other synthetic cannabinoids into their e-cigarette devices for subsequent
vaping. Concentration of MDMB-4en-PINACA on a single card ranged from <0.07–0.58
mg/cm2. The dosage of MDMB-4en-PINACA required to elicit pharmacological effects in
humans is unknown.
B. Pharmacokinetics
No information on the absorption and distribution of MDMB-4en-PINACA is available. Two
studies have examined its metabolism, with an emphasis on the identification of
biomarker(s) that could serve during forensic investigations as indicators of use. Like many
other synthetic cannabinoids, MDMB-4en-PINACA is extensively metabolized. However,
unlike many other synthetic cannabinoids, the parent product has also been detected in
authentic urine samples (2, 5). Analysis of human liver microsomes revealed 14–31 phase I
metabolites resulting from various chemical reactions, including ester hydrolysis, double-
bond oxidation and hydroxylation (2, 5). Follow-up analysis of authentic human urine
samples showed that M3 (C19H27N3O5) was the most abundant metabolite (5).
C. Pharmacodynamics
MDMB-4en-PINACA binds to human cannabinoid type 1 (hCB 1) cannabinoid receptors
(expressed in human embryo kidney cells), with Ki (CB1) = 3.26 ± 0.81 nM (7). When
evaluated for functional activation of the CB 1 receptor, MDMB-4en-PINACA was shown to
be a full and potent agonist, decreasing forskolin-stimulated accumulation of cyclic
adenosine monophosphate (cAMP): half maximal effective concentration (EC 50) = 0.33 ±
0.11 nM; Emax = 112.7 ± 5.5% (7).
To date, no reports on the in vivo effects of MDMB-4en-PINACA have been published;
however, an unpublished preclinical study tested the compound in male ICR mice (n = 6)
(Wiley JL and Marusich JA. RTI International, Durham, NC, USA, unpublished data). In this
experiment, MDMB-4en-PINACA (0.1, 1 or 10 mg/kg) was injected intraperitoneally. Rectal
temperature was measured at 30, 45 and 60 minutes post-injection and overt behaviour
was observed over the same period. Whereas the dose of 0.1 mg/kg did not reduce
temperature at any time point, 1 and 10 mg/kg decreased temperature, with maximal
decreases of −4.6 ± 0.62 oC and −8.15 ± 0.41 oC, respectively. In addition, some mice that
received either 1 or 10 mg/kg were lethargic and exhibited seizures upon handling. At
1 mg/kg, cage behaviour normalized within 2 hours; however, at 10 mg/kg, mice were still

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lethargic at 5 hours post-injection. The 10 mg/kg dose also led to gasping and aggression in
some mice. These effects had worn off by 3 hours post-injection.
5. Toxicology
No preclinical toxicology studies on MDMB-4en-PINACA have been conducted.
6. Adverse reactions in humans
Although adverse reactions to MDMB-4en-PINACA have not been widely reported, some
information was available. For example, analysis of postmortem femoral vein blood
samples by the Center for Forensic Science Research and Education (Willow Grove, PA; 12
September 2019) following two deaths, revealed the presence of MDMB-4en-PINACA.
However, the degree to which the drug contributed to the deaths could not be confirmed,
as circumstances related to the deaths were not reported. Bizarre and impulsive behaviour
following consumption of heroin that had been cut with MDMB-4en-PINACA was reported
by Massachusetts Police in Holyoke (8). Although the United Nations Office on Drugs and
Crime (UNODC) Tox-Portal was searched, no cases related to MDMB-4en-PINACA were
identified.
Of the user forums searched, Reddit (sub-reddit r/noids) contained the most information
about user-reported effects (6). Users reported cannabis-like euphoria at moderate levels
of intake, with dissociation occurring at higher concentrations. Some users reported
sedation whereas others reported stimulation. Memory loss, confusion and agitation have
also been reported by some users (9).
7. Dependence potential
A. Animal studies
No in vivo animal studies to evaluate the dependence potential of MDMB-4en-PINACA
have been conducted.
B. Human studies
No human studies to evaluate the dependence potential of MDMB-4en-PINACA have been
conducted.
8. Abuse potential
A. Animal studies
No animal studies on the abuse potential of MDMB-4en-PINACA have been published.
However, unpublished drug discrimination data (Wiley JL and Marusich JA, RTI
International, Durham, NC, USA, unpublished data) show that intraperitoneal MDMB-4en-
PINACA substituted for 9-tetrahydrocannabinol (THC) in male (n = 8) and female (n = 2)
C57/Bl6 mice trained to discriminate 5.6 mg/kg THC (intraperitoneal) from vehicle in a two
nose-poke drug discrimination procedure. Substitution was dose-dependent, with maximal
substitution (97% THC-aperture responding) occurring at 0.1 mg/kg and was not
accompanied by effects on response rates. The ED 50 for THC-like discriminative stimulus
effects for MDMB-4en-PINACA was 0.071 µmol/kg.

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B. Human studies
No human studies to evaluate the dependence potential of MDMB-4en-PINACA have been
conducted.
9. Therapeutic applications and extent of therapeutic use and epidemiology of
medical use
NA
10. Listing on the WHO Model List of Essential Medicines
MDMB-4en-PINACA is not listed on the WHO Model List of Essential Medicines.
11. Marketing authorizations (as a medicinal product)
MDMB-4en-PINACA has no marketing authorizations as a medicinal product.
12. Industrial use
NA
13. Nonmedical use, abuse and dependence
MDMB-4en-PINACA was first identified in Europe in 2017 (10). Since then, prevalence has
increased dramatically, with the largest number of seizures (143 cases (89%)) reported in
2019 and a recent seizure in February 2020 (10). As of August 2020, more than 70 product
samples had been submitted and found to contain MDMB-4en-PINACA by the Welsh
Emerging Drugs and Identification of Novel Substances Project (Wedinos.org) (9). Whereas
most samples contained only MDMB-4en-PINACA, a few samples contained additional
substances, including nicotine, 5F-MDMB-BINACA, flubromazolam or pregabalin. Other
specific information on MDMB-4en-PINACA use/abuse was not found.
The prevalence of chronic use and dependence on MDMB-4en-PINACA has not been
reported.
14. Nature and magnitude of public health problems related to misuse, abuse and
dependence
Specific information on the nature and magnitude of public health problems associated
with use of MDMB-4en-PINACA is not available. Adverse effects reported by individual
users have been described in section 6 of this document.
15. Licit production, consumption and international trade
NA
16. Illicit manufacture and traffic and related information
MDMB-4en-PINACA has been detected in 17 countries in the European Union: Austria,
Belgium, Bulgaria, Cyprus, France, Germany, Hungary, Latvia, Lithuania, the Republic of
Moldova, Poland, Romania, Slovakia, Slovenia, Spain, Sweden, Turkey and the United
Kingdom (10, 11). Of these countries, 12 (70%) reported the identification of the substance
for the first time in 2019 (10). Identification of MDMB-4en-PINACA has also been reported

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in Asia (China, Kyrgyzstan and Singapore) (11), the Russian Federation (11), (11)New
Zealand (3) and the United States (11).
Information provided by the WHO ECDD confirmed traffic to the United States. For
example, a situation report from the United States District of Columbia Department of
Forensic Science (dated 16 December 2019) stated that MDMB-4en-PINACA had been
identified for the first time in Washington, DC. Similarly, a report from the Center for
Forensic Science Research and Education (Willow Grove, PA; 12 September 2019) analysed
postmortem biological fluid taken in July 2019 from two individuals in Indiana and reported
the presence of MDMB-4en-PINACA.
17. Current international controls and their impact
MDMB-4en-PINACA is not currently under international control.
18. Current and past national controls
Sweden entered MDMB-4en-PINACA into its list of controlled substances in 2018. It is also
controlled in Canada, Germany and the United Kingdom.
19. Other medical and scientific matters relevant for a recommendation on the
scheduling of the substance
MDMB-4en-PINACA has been detected as an adulterant in substances marketed as heroin
or cannabis/THC (8, 9, 12).

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References
1. European Project Response 2. Analytical report: Mdmb-pinaca n1-pentyl-4-en isomer Ljubljana,
Slovenia: National Forensic Laboratory, 2018.
2. Watanabe S, Vikingsson S, Åstrand A, Gréen H, Kronstrand R. Biotransformation of the new
synthetic cannabinoid with an alkene, mdmb-4en-pinaca, by human hepatocytes, human liver
microsomes, and human urine and blood. AAPS Journal. 2019;22:13. Epub 2019/12/19.
3. High Alert. Synthetic cannabinoid mdmb-4en-pinaca detected. New Zealand; 2020
(https://www.highalert.org.nz/alerts-and-notifications/synthetic-cannabinoid-mdmb-4en-pinaca-
detected, accessed 29 July 2020).
4. Norman C, Walker G, McKirdy B, McDonald C, Fletcher D, Antonides LH, et al. Detection and
quantitation of synthetic cannabinoid receptor agonists in infused papers from prisons in a
constantly evolving illicit market. Drug Testing Anal. 2020;12:538–54. Epub 2020/01/17.
5. Yeter EO, Yeter O. In vitro phase i metabolism of the recently emerged synthetic mdmb-4en-
pinaca and its detection in human urine samples. J Anal Toxicol. 2020. Epub 2020/02/25.
6. Reddit. Mdmb-4en-pinaca. User reports available at:
https://www.reddit.com/r/noids/comments/etrro7/best_cannabinoid_out_of_these_4fadb_5fmd
mb2201/;
https://www.reddit.com/r/researchchemicals/comments/h16ya4/mdmb4enpinaca_5cladba_reall
y_pleasant_high/;
https://www.reddit.com/r/researchchemicals/comments/elsw68/5cladba_mdmb4enpinaca/;
https://www.reddit.com/r/researchchemicals/comments/d106p1/5cladba_aka_mdmb4enpinaca_
review/; https://www.reddit.com/r/noids/comments/hzbiqw/mdmb4enpinaca_5cladba/; 2020
(cited 19 August 2020).
7. Janowsky A. Mdmb-4en-pinaca. Portland, OR: Oregon Health & Science University, 2020.
8. Taylor M. Police warn of heroin cut with research-only cannabinoid. Forensic [Internet]. 2020
(https://www.forensicmag.com/561307-Police-Warn-of-Heroin-Cut-with-Research-only-
Cannabinoid/, accessed 29 July 2020).
9. Wedinos. Mdmb-4en-pinaca (https://www.wedinos.org/db/samples/search/page:1; 2020
accessed 20 August 2020.
10. EMCDDA. EU early warning system situation report: Situation report 1 — June 2020. Lisbon:
European Monitoring Centre for Drugs and Drug Addiction; 2020.
11. United Nations Office on Drugs and Crime. Early warning advisory on new psychoactive substances
(data) (https://www.unodc.org/LSS/Home/NPS2020, accessed on 24 July 2020).
12. DrugData.Org. Mdmb-4en-pinaca.
(https://www.drugsdata.org/search.php?substance1=24722020, accessed on 29 July 2020).

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Annex 1. Report on WHO Questionnaires for Review of Psychoactive

Substances for the 43rd ECDD: evaluation of MDMB-4en-PINACA
Data were obtained from 105 Member States (19 African Region, 13 Eastern Mediterranean
Region, 40 European Region, 16 Region of the Americas, seven South-East Asia Region and 10
Western Pacific Region) for the WHO Questionnaires for the Review of Psychoactive Substances.
The total number of countries opting out of participation in the questionnaire is 13 (three African
Region, two Eastern Mediterranean Region, two European Region, three Region of the Americas,
one South-East Asia Region and two Western Pacific Region), leaving 92 active countries. Of these,
35 countries had information on the substance (Table 1).

Table 1. Numbers of countries providing information on MDMB-4en-PINACA

Region Number of countries without Number of countries with
information information on substance
African Region 15 1
Eastern Mediterranean 6 5
Region
European Region 18 20
Region of the Americas 10 3
South-East Asia Region 4 2
Western Pacific Region 4 4
Total 92 57 35

LEGITIMATE USE
No countries reported approved human medical products or veterinary products containing
MDMB-4en-PINACA.

One country (Region of the Americas) reported MDMB-4en-PINACA being currently used in
medical or scientific research (excluding use as an analytical standard), specifically in cell line
studies (binding/functional assays) and animal studies.

Two countries (one European Region, one Western Pacific Region) reported MDMB-4en-PINACA
being used in industrial or other non-medical or non-scientific use.

No countries reported approved therapeutic indications for MDMB-4en-PINACA.

EPIDEMIOLOGY OF NON-MEDICAL/NON-SCIENTIFIC USE – USE FOR PSYCHOACTIVE PURPOSES OR

RECREATIONAL DRUG USE
Sixteen countries reported that MDMB-4en-PINACA is being misused or abused for its
psychoactive properties/recreational use.

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The most common known route of administration reported was smoking (Table 2).

Table 2. Common routes of administration

Route of administration Number of countries

Oral 1
Injection 0
Inhalation 2
Sniffing 0
Smoking 14
Don’t know 18

The most common known formulation of MDMB-4en-PINACA reported was powder (Table 3).

Table 3. Common formulations reported by countries

Formulation Number of countries

Powder 9
Tablets 0
Liquid for oral use 2
Solution for injection 0
Don’t know 16

To the above, countries added:

 herbal material/paper
 plant mixture sprayed with active substance
 solution for smoking – e-liquid
 blotters.

Eleven countries reported the level of negative health impact due to MDMB-4en-PINACA’s non-
medical consumption as “serious” or “substantial” (Table 4).

Table 4. Numbers of countries reporting levels of negative health impact of MDMB-4en-PINACA

Serious Substantial Negligible Don’t know
7 4 8 16

One country (Western Pacific Region) stated, “The social harm caused by MDMB-4en-PINACA is
substantial”. Another country (European Region) reported “use by minors (15 years for the
youngest) with electronic cigarettes (e-liquid)”. Another country (European Region) was
concerned that “… there may be unknown cases of negative health impacts because … there is no
reporting obligation by hospitals, poison centers, etc.”. One country (European Region) reported,
“Recent increase in use, reflected in increase in emergency room visits and increase in seizures.

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Mainly used by the population of 'high-risk' and homeless drug users in combination with other
substances”. One country (Region of the Americas) stated, “MDMB-4en-PINACA has been
identified in seized drug evidence both alone and mixed with fentanyl and/or heroin. It has also
been associated with overdoses.”

Five countries (four European Region, one Region of the Americas) reported emergency room
admissions related to the non-medical use of MDMB-4en-PINACA.

Several countries reported specific adverse effects. One country (European Region) listed the
adverse effects as “drowsiness, dizziness, nausea, pallor, derealization, euphoria, visual
disturbances (‘zoom’)”. However, they also noted the difficulty specifying the adverse effects
associated with MDMB-4en-PINACA because of multiple drug use. Another country (European
Region) reported “agitation, anxiety, hallucination, convulsions, tachycardia and large pupils”. A
third country (Region of the Americas) noted “body/muscle spasms similar to seizure, violence
towards EMS personnel, tachycardia, PCP-like adverse effects, hypertension, erratic behavior”.

No countries reported users of MDMB-4en-PINACA presenting for drug dependence treatment.

Regarding mortality, only two countries (two European Region) reported deaths involving MDMB-
4en-PINACA:
 one fatal case where other substances were also involved (2019)
 one fatal case where this substance was the only substance involved (2019).

STATUS OF NATIONAL CONTROL AND POTENTIAL IMPACT OF INTERNATIONAL CONTROL

Nineteen countries responded that MDMB-4en-PINACA is currently controlled under national
legislation to regulate its availability.

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Table 5 shows the main reported activities involving MDMB-4en-PINACA.

Table 5. Reported illicit activities involving MDMB-4en-PINACA
Activities Number of
countries
Smuggling from other countries 8
Manufacture of substance by chemical synthesis 1
Manufacture of substance by extraction from other products 0
Production of consumer products containing the substance 2
Trafficking 5
Diversion from legal supply chain 0
Internet sales – seller or website located in country 2
Internet sales – from abroad to buyers in country 2
Internet sales – other, or location of sellers and website unknown 4
Direct sales to people who use the substance 3
Don’t know 20

In addition to the above, countries added:

 trafficking through postal services
 seizures in prisons.

Fifteen countries reported seizures (Table 6).

Table 6. Reported seizures of MDMB-4en-PINACA

Year Seizures
2020 554
2019 1321
2018 13
Total 1888

Twenty-eight countries have the forensic laboratory capacity to analyse MDMB-4en-PINACA.

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