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What is 4FAMB
Certainly, 4FAMB is Synthetic cannabinoids or synthetic marijuana  belonging to a large family of chemically unrelated structures that are created and marketed to mimic the action of  (THC), the primary psychoactive constituent of marijuana. Marijuana is  a Schedule I controlled substances in New York State.  Other examples of Schedule I controlled substances include heroin and LSD. Synthetic cannabinoids  mimic the effects of marijuana.

What are the signs and symptoms of 4FAMB use?
Without a doubt, increased heart rate and blood pressure is a common adverse effects. Nonetheless, paranoid behavior, agitation, irritability, nausea and vomiting, confusion, drowsiness, headache, electrolyte abnormalities and seizures are common. Severe side effects may include acute renal failure and significant negative effects to the cardiovascular and central nervous systems.

Adverse reactions in humans
Sweden, UK, Norway and USA  have 6 non-fatal intoxications and 16 deaths  associated with 4FAMB.

Abuse potential
There have been few studies regarding the dependence/abuse potential with no specific studies in humans. Brittany etal however assessed the dependence liability of its use in rats and rhesus monkeys. Equally, Naloxone-treatment of rats that had received repeated doses of 4FAMB (5 to 20 mg/kg orally, three times a day for five days). This showed ‘abstinence syndrome’ similar to that observable for morphine using a similar dose schedule. Likewise, nalorphine, also an opioid receptor antagonist, evoked withdrawal symptoms in rhesus monkeys that had received repeated doses of 4FAMB. Furthermore, single doses of 4FAMB  (5–10 mg/kg s.c.) completely alleviated the abstinence syndrome in morphine-dependent rhesus monkeys. The study concluded that the drug “would be classified as a narcotic analgesic having high addictive liability”.

Nature and magnitude of public health problems related to misuse, abuse and dependence
As a matter of fact, misuse of this drug is individual not the general population. The mode of use may involve the combinational use (intentionally or unintentionally) of other drugs. However, in the fatalities in particular, due to the opioid nature of 4FAMB. 4FAMB is a contributory cause of death in cases of other drugs use.