1
|
Taflaj B, La Maida N, Tittarelli R, Di Trana A, D'Acquarica I. New Psychoactive Substances Toxicity: A Systematic Review of Acute and Chronic Psychiatric Effects. Int J Mol Sci 2024; 25:9484. [PMID: 39273431 PMCID: PMC11395625 DOI: 10.3390/ijms25179484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/15/2024] Open
Abstract
New psychoactive substances (NPSs) are a heterogenous group of psychotropic molecules and diverted pharmaceutical drugs sold worldwide as legal substitutes for controlled drugs. The psychiatric consequences of NPS use are relatively unknown, although evidence of related psychotic symptoms has been described in the literature. We sought to summarize the available evidence on NPS-related psychiatric disorders, to facilitate the interpretation of the molecular mechanism underlying their specific pathologies. A literature search of Scopus, PubMed and Google Scholar was conducted including studies published between 2013 and 2024, in which a correlation between NPS consumption and psychiatric symptoms was reported. Furthermore, the short- and long-term psychopathological effects were included. The literature search resulted in 109 NPS-related intoxication cases in which acute or chronic psychiatric symptoms were reported, mostly related to synthetic cannabinoids, followed by synthetic cathinones, hallucinogens, natural NPSs and stimulants. The most common acute symptoms were hallucinations, aggressiveness, and psychotic and bizarre behavior, related to the molecular disbalance of neurotransmitters in the central nervous systems, with different mechanisms. The lack of clear diagnostic criteria and toxicological analyses has resulted in crucial complications in psychiatric diagnoses related to NPS intoxication. Hence, the implementation of toxicological screening procedures in emergency rooms, including the main NPS classes, should support the diagnosis of acute intoxication and its proper therapeutic treatment. Finally, proper follow-up should be implemented to assess the chronic sequelae.
Collapse
Affiliation(s)
- Beldisa Taflaj
- Azienda Ospedaliera San Giovanni Addolorata, Via dell'Amba Aradam 8, 00184 Rome, Italy
| | - Nunzia La Maida
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Roberta Tittarelli
- Laboratory of Forensic Toxicology, Section of Legal and Forensic Medicine, Social Security and Forensic Toxicology, Department of Biomedicine and Prevention, Faculty of Medicine and Surgery, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Annagiulia Di Trana
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Ilaria D'Acquarica
- Dipartimento di Chimica e Tecnologie del Farmaco, Sapienza Università di Roma, Piazzale A. Moro 5, 00185 Rome, Italy
| |
Collapse
|
2
|
Eski MT, Teberik K, Taha S, Büken B, Turan Sönmez F. Compare of optic coherence tomography parameters in recreational synthetic tetrahydrocannabinol use and healthy control. Cutan Ocul Toxicol 2023; 42:179-183. [PMID: 37417942 DOI: 10.1080/15569527.2023.2234042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/16/2023] [Accepted: 07/01/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE To evaluate retinal thickness (RT), retinal nerve fiber layer thickness (RNFLT), and choroidal thickness (CT) changes in synthetic cannabinoid (SC) users. METHODS This prospective study evaluated the RT, RNFLT, and CT values of 56 SC users and 58 healthy controls. The individuals using SCs were referred to us by our hospital's forensic medicine department. Retinal and choroidal images were obtained using spectral-domain optical coherence tomography (OCT). Measurements (one subfoveal, three temporals, three nasal) were taken at 500 μm intervals up to 1500 μm using the caliper system. Only the right eye was used for subsequent analysis. RESULTS Mean ages were 27.7 ± 5.7 years in the SC-user group and 25.4 ± 6.7 in the control group. Subfoveal Global RNFLT was in the SCs group 102.3 ± 10.5 μm and 105.6 ± 20.2 μm in the control group (p = 0.271). Subfoveal CT was in the SC group mean of 316.1 ± 100.2 μm and in the control group mean 346.4 ± 81.8 μm (p = 0.065). RT, T500 (283.3 ± 36.7 μm, 296.6 ± 20.5 μm, p = 0.011) and N1500 (355.1 ± 14.3 μm, 349.3 ± 18.1 μm, p = 0.049) were significantly higher in the SC group than in the control group, respectively. CONCLUSION Analysis of OCT findings of individuals who had been using SC for more than one year revealed no statistically significant difference between RNFLT and CT, although N1500 was significantly higher in RT. Further studies in the field of OCT are important to explore the pathology of SC.
Collapse
Affiliation(s)
- Mehmet Tahir Eski
- Department of Ophthalmology, Erzincan Private Neon Hospital, Erzincan, Turkey
| | - Kuddusi Teberik
- Department of Ophthalmology, Duzce University School of Medicine, Duzce, Turkey
| | - Sezer Taha
- Department of Ophthalmology, Duzce University School of Medicine, Duzce, Turkey
| | - Bora Büken
- Department of Forensic Medicine, Duzce University
| | | |
Collapse
|
3
|
Leczycki M, Zaki P, Espiridion ED. Moon Rock Cannabis-Induced Psychosis and New-Onset Seizures in a 20-Year-Old Male. Cureus 2023; 15:e42752. [PMID: 37654922 PMCID: PMC10468007 DOI: 10.7759/cureus.42752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
"Moon rock" cannabis is a type of new and highly potent preparation of cannabis, which is made of a strain of cannabis dipped in hash oil and sprinkled with kief crystals, effectively increasing the concentration of δ-9-tetrahydrocannabinol (THC), the main psychoactive compound in cannabis, well beyond what is naturally found in the cannabis plant. The use of increasingly potent forms of cannabis has far-reaching health implications, including psychiatric and neurologic effects, which are not yet fully understood. This case report summarizes existing knowledge of the association of cannabis use with psychosis and seizures and describes a novel case of "moon rock" cannabis-induced psychosis and new-onset seizures.
Collapse
Affiliation(s)
- Martin Leczycki
- Psychiatry, Reading Hospital - Tower Health, West Reading, USA
| | - Peter Zaki
- Neurosurgery, Drexel University College of Medicine, Philadelphia, USA
| | - Eduardo D Espiridion
- Psychiatry, Reading Hospital - Tower Health, West Reading, USA
- Psychiatry, Drexel University College of Medicine, Philadelphia, USA
| |
Collapse
|
4
|
Rodrigues CHP, Mariotto LS, Castro JS, Peruquetti PH, Silva-Junior NC, Bruni AT. Acute, chronic, and post-mortem toxicity: a review focused on three different classes of new psychoactive substances. Forensic Toxicol 2023; 41:187-212. [PMID: 36604359 DOI: 10.1007/s11419-022-00657-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/22/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE New psychoactive substances (NPS) are not controlled under the Single Convention on Narcotic Drugs of 1961 or the 1971 Convention, but they may pose a public health threat. Knowledge of the main properties and toxicological effects of these substances is lacking. According to the current Drugs Law (Law n. 11.343/2006), the Brazilian Surveillance Agency issues directives for forbidden substances in Brazil, and structural classes of synthetic cannabinoids, cathinones, and phenylethylamines are considered illicit drugs. Considering that data on these controlled substances are scattered, the main objective of this work was to collect and organize data to generate relevant information on the toxicological properties of NPS. METHODS We carried out a literature review collecting information on the acute, chronic, and post-mortem toxicity of these classes of NSP. We searched info in five scientific databases considering works from 2017 to 2021 and performed a statistical evaluation of the data. RESULTS Results have shown a general lack of studies in this field given that many NPS have not had their toxicity evaluated. We observed a significant difference in the volume of data concerning acute and chronic/post-mortem toxicity. Moreover, studies on the adverse effects of polydrug use are scarce. CONCLUSIONS More in-depth information about the main threats involving NPS use are needed.
Collapse
Affiliation(s)
- Caio H P Rodrigues
- Department of Chemistry, Faculty of Philosophy, Science and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-901, Brazil
- INCT Forense - Department of Chemistry, Faculty of Philosophy, Science and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-901, Brazil
| | - Lívia S Mariotto
- Department of Chemistry, Faculty of Philosophy, Science and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-901, Brazil
- INCT Forense - Department of Chemistry, Faculty of Philosophy, Science and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-901, Brazil
| | - Jade S Castro
- Department of Chemistry, Faculty of Philosophy, Science and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-901, Brazil
- INCT Forense - Department of Chemistry, Faculty of Philosophy, Science and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-901, Brazil
| | - Paulo H Peruquetti
- Department of Chemistry, Faculty of Philosophy, Science and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-901, Brazil
| | - Newton C Silva-Junior
- Department of Chemistry, Faculty of Philosophy, Science and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-901, Brazil
- INCT Forense - Department of Chemistry, Faculty of Philosophy, Science and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-901, Brazil
| | - Aline T Bruni
- Department of Chemistry, Faculty of Philosophy, Science and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-901, Brazil.
- INCT Forense - Department of Chemistry, Faculty of Philosophy, Science and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-901, Brazil.
| |
Collapse
|
5
|
Marchetti B, Bilel S, Tirri M, Corli G, Roda E, Locatelli CA, Cavarretta E, De-Giorgio F, Marti M. Acute Cardiovascular and Cardiorespiratory Effects of JWH-018 in Awake and Freely Moving Mice: Mechanism of Action and Possible Antidotal Interventions? Int J Mol Sci 2023; 24:7515. [PMID: 37108687 PMCID: PMC10142259 DOI: 10.3390/ijms24087515] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
JWH-018 is the most known compound among synthetic cannabinoids (SCs) used for their psychoactive effects. SCs-based products are responsible for several intoxications in humans. Cardiac toxicity is among the main side effects observed in emergency departments: SCs intake induces harmful effects such as hypertension, tachycardia, chest pain, arrhythmias, myocardial infarction, breathing impairment, and dyspnea. This study aims to investigate how cardio-respiratory and vascular JWH-018 (6 mg/kg) responses can be modulated by antidotes already in clinical use. The tested antidotes are amiodarone (5 mg/kg), atropine (5 mg/kg), nifedipine (1 mg/kg), and propranolol (2 mg/kg). The detection of heart rate, breath rate, arterial oxygen saturation (SpO2), and pulse distention are provided by a non-invasive apparatus (Mouse Ox Plus) in awake and freely moving CD-1 male mice. Tachyarrhythmia events are also evaluated. Results show that while all tested antidotes reduce tachycardia and tachyarrhythmic events and improve breathing functions, only atropine completely reverts the heart rate and pulse distension. These data may suggest that cardiorespiratory mechanisms of JWH-018-induced tachyarrhythmia involve sympathetic, cholinergic, and ion channel modulation. Current findings also provide valuable impetus to identify potential antidotal intervention to support physicians in the treatment of intoxicated patients in emergency clinical settings.
Collapse
Affiliation(s)
- Beatrice Marchetti
- Department of Translational Medicine, Section of Legal Medicine and LTTA Center, University of Ferrara, 44121 Ferrara, Italy; (B.M.); (S.B.); (M.T.); (G.C.)
| | - Sabrine Bilel
- Department of Translational Medicine, Section of Legal Medicine and LTTA Center, University of Ferrara, 44121 Ferrara, Italy; (B.M.); (S.B.); (M.T.); (G.C.)
| | - Micaela Tirri
- Department of Translational Medicine, Section of Legal Medicine and LTTA Center, University of Ferrara, 44121 Ferrara, Italy; (B.M.); (S.B.); (M.T.); (G.C.)
| | - Giorgia Corli
- Department of Translational Medicine, Section of Legal Medicine and LTTA Center, University of Ferrara, 44121 Ferrara, Italy; (B.M.); (S.B.); (M.T.); (G.C.)
| | - Elisa Roda
- Laboratory of Clinical & Experimental Toxicology, Pavia Poison Centre, National Toxicology Information Centre, Toxicology Unit, Istituti Clinici Scientifici Maugeri IRCCS Pavia, 27100 Pavia, Italy; (E.R.); (C.A.L.)
| | - Carlo Alessandro Locatelli
- Laboratory of Clinical & Experimental Toxicology, Pavia Poison Centre, National Toxicology Information Centre, Toxicology Unit, Istituti Clinici Scientifici Maugeri IRCCS Pavia, 27100 Pavia, Italy; (E.R.); (C.A.L.)
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 00185 Roma, Italy;
- Mediterrranea Cardiocentro, 80122 Napoli, Italy
| | - Fabio De-Giorgio
- Section of Legal Medicine, Department of Health Care Surveillance and Bioetics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Matteo Marti
- Department of Translational Medicine, Section of Legal Medicine and LTTA Center, University of Ferrara, 44121 Ferrara, Italy; (B.M.); (S.B.); (M.T.); (G.C.)
- Collaborative Center for the Italian National Early Warning System, Department of Anti-Drug Policies, 00186 Rome, Italy
| |
Collapse
|
6
|
Hur KH, Lee Y, Donio AL, Lee JG, Lee BR, Kim SK, Yoon S, Lee YS, Kim HC, Lee SY, Jang CG. Mepirapim, a novel synthetic cannabinoid, induces Parkinson's disease-related behaviors by causing maladaptation of the dopamine system in the brain. Arch Toxicol 2023; 97:581-591. [PMID: 36355181 DOI: 10.1007/s00204-022-03414-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022]
Abstract
Mepirapim is a novel synthetic cannabinoid that first appeared on the illicit drug market in 2013. In recent years, recreational abuse of Mepirapim has caused serious emergencies, posing a threat to public health. However, there are no legal regulations to prohibit the use of Mepirapim, as there is no scientific evidence for the dangerous pharmacological effects of the drug. In the present study, we investigated the dangerous neurotoxic effects of Mepirapim through behavioral and molecular experiments in mice (ICR/CD1, male, 25-30 g). In particular, based on a previous study that Mepirapim activates the dopamine system, we evaluated whether high-dose Mepirapim [single (15, 30, or 60 mg·kg-1, i.p.) or multiple (8, 15, or 30 mg·kg-1, i.p. × 4 at 2 h intervals)] treatment causes Parkinson's disease-related symptoms through damage to the dopamine system. In the result, we found that Mepirapim treatment caused comprehensive Parkinson's disease-related symptoms, including motor impairment, cognitive deficits and mood disorders. Furthermore, we confirmed the maladaptation in dopamine-related neurochemicals, including decreased dopamine levels, decreased tyrosine hydroxylase expression, and increased α-synuclein expression, in the brains of mice treated with Mepirapim. Taken together, these results indicate that Mepirapim has dangerous neurotoxic effects that induces Parkinson's disease-related behaviors by causing maladaptation of the dopamine system in the brain. Based on these findings, we propose the strict regulation of recreational abuse and therapeutic misuse of Mepirapim.
Collapse
Affiliation(s)
- Kwang-Hyun Hur
- Department of Pharmacology, School of Pharmacy, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Youyoung Lee
- Department of Pharmacology, School of Pharmacy, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Audrey Lynn Donio
- Department of Pharmacology, School of Pharmacy, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Jae-Gyeong Lee
- Department of Pharmacology, School of Pharmacy, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Bo-Ram Lee
- Department of Pharmacology, School of Pharmacy, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Seon-Kyung Kim
- Department of Pharmacology, School of Pharmacy, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Seolmin Yoon
- Department of Fundamental Pharmaceutical Sciences, School of Pharmacy, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Yong-Sup Lee
- Department of Pharmacy, School of Pharmacy, Kyung Hee University, Seoul, 02447, Republic of Korea.,Department of Life and Nanopharmaceutical Sciences, School of Pharmacy, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Hyoung-Chun Kim
- Neuropsychopharmacology and Toxicology Program, School of Pharmacy, Kangwon National University, Chuncheon, 24341, Republic of Korea
| | - Seok-Yong Lee
- Department of Pharmacology, School of Pharmacy, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Choon-Gon Jang
- Department of Pharmacology, School of Pharmacy, Sungkyunkwan University, Suwon, 16419, Republic of Korea.
| |
Collapse
|
7
|
Boronat Ena MDM, Cowan DA, Abbate V. Ambient ionization mass spectrometry applied to new psychoactive substance analysis. MASS SPECTROMETRY REVIEWS 2023; 42:3-34. [PMID: 34036620 DOI: 10.1002/mas.21695] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 04/09/2021] [Accepted: 04/17/2021] [Indexed: 06/12/2023]
Abstract
In the past decade a plethora of drugs with similar effects to controlled psychoactive drugs, like cannabis, amfetamine (amphetamine), or lysergic acid diethylamide, have been synthesized. These drugs can collectively be classified under the term new psychoactive substances (NPS) and are used for recreational purposes. The novelty of the substances, alongside the rapid rate of emergence and structural variability, makes their detection as well as their legal control highly challenging, increasing the demand for rapid and easy-to-use analytical techniques for their detection and identification. Therefore, interest in ambient ionization mass spectrometry applied to NPS has grown in recent years, which is largely because it is relatively fast and simple to use and has a low operating cost. This review aims to provide a critique of the suitability of current ambient ionization techniques for the analysis of NPS in the forensic and clinical toxicology fields. Consideration is given to analytical performance and ease of implementation, including ionization efficiency, selectivity, sensitivity, quantification, analyte chemistry, molecular coverage, validation, and practicality.
Collapse
Affiliation(s)
- Maria Del Mar Boronat Ena
- Department of Analytical, Environmental and Forensic Sciences, King's College London, Faculty of Life Sciences & Medicine, London, UK
| | - David A Cowan
- Department of Analytical, Environmental and Forensic Sciences, King's College London, Faculty of Life Sciences & Medicine, London, UK
| | - Vincenzo Abbate
- Department of Analytical, Environmental and Forensic Sciences, King's College London, Faculty of Life Sciences & Medicine, London, UK
| |
Collapse
|
8
|
Methyl (S)-2-(1-7 (5-fluoropentyl)-1H-indole-3-carboxamido)-3,3-dimethylbutanoate (5F-MDMB-PICA) intoxication in a child with identification of two new metabolites (ultra-high-performance liquid chromatography-tandem mass spectrometry). Forensic Toxicol 2023; 41:47-58. [PMID: 36652054 DOI: 10.1007/s11419-022-00629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/12/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Methyl (S)-2-(1-7 (5-fluoropentyl)-1H-indole-3-carboxamido)-3,3-dimethylbutanoate (5F-MDMA-PICA) intoxication in 1.5-year-old child was presented, together with diagnostic parameters discussion and 5F-MDMB-PICA determination in biological material. Furthermore, 5F-MDMB-PICA metabolites were identified in a urine sample as markers of exposure in situation when a parent compound is not present in specimens. METHODS Drugs and metabolites were extracted from serum and urine with ethyl acetate both under alkaline (pH 9) and acidic (pH 3) conditions. Hair, after decontamination and pulverization, were incubated with methanol (16 h, 60 °C). The analysis was carried out using ultra-high-performance liquid chromatography-tandem mass spectrometry. For the identification of 5F-MDMB-PICA metabolites, an urine sample was precipitated with cold acetonitrile. Analysis was performed using ultra-high-performance liquid chromatograph with quadrupole time-of-flight mass spectrometer. RESULTS 5F-MDMB-PICA was determined only in serum sample at concentration of 298 ng/mL. After 1 year, when analysis was repeated, concentration of synthetic cannabinoid in the same sample was only 17.6 ng/mL which revealed high instability of 5F-MDMB-PICA in serum sample. Eight 5F-MDMB-PICA metabolites were identified in urine sample, including two potentially new ones with m/z 391.18964 and m/z 275.14016. CONCLUSIONS Toxicological analysis confirmed a 1.5-year-old boy intoxication with 5F-MDMB-PICA. Besides the parent drug, metabolites of 5F-MDMB-PICA were identified, including two potentially new ones, together with possible metabolic reactions which they resulted from. Metabolites determination could serve as a marker of 5F-MDMB-PICA exposure when no parent drug is present in biological material.
Collapse
|
9
|
Mepirapim, a Novel Synthetic Cannabinoid, Induces Addiction-Related Behaviors through Neurochemical Maladaptation in the Brain of Rodents. Pharmaceuticals (Basel) 2022; 15:ph15060710. [PMID: 35745629 PMCID: PMC9229951 DOI: 10.3390/ph15060710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 01/27/2023] Open
Abstract
Mepirapim is a synthetic cannabinoid that has recently been abused for recreational purposes. Although serious side effects have been reported from users, the dangerous pharmacological effects of Mepirapim have not been scientifically demonstrated. In this study, we investigated the addictive potential of Mepirapim through an intravenous self-administration test and a conditioned place preference test in rodents. Moreover, to determine whether the pharmacological effects of Mepirapim are mediated by cannabinoid receptors, we investigated whether Mepirapim treatment induces cannabinoid tetrad symptoms in mice. Lastly, to identify Mepirapim induced neurochemical maladaptation in the brains of mice, we performed microdialysis, western blots and neurotransmitter enzyme-linked immunosorbent assays. In the results, Mepirapim supported the maintenance of intravenous self-administration and the development of conditioned place preference. As a molecular mechanism of Mepirapim addiction, we identified a decrease in GABAeric signalling and an increase in dopaminergic signalling in the brain reward circuit. Finally, by confirming the Mepirapim-induced expression of cannabinoid tetrad symptoms, we confirmed that Mepirapim acts pharmacologically through cannabinoid receptor one. Taken together, we found that Mepirapim induces addiction-related behaviours through neurochemical maladaptation in the brain. On the basis of these findings, we propose the strict regulation of recreational abuse of Mepirapim.
Collapse
|
10
|
Sparkes E, Cairns EA, Kevin RC, Lai F, Grafinger KE, Chen S, Deventer MH, Ellison R, Boyd R, Martin LJ, McGregor IS, Gerona RR, Hibbs DE, Auwärter V, Glass M, Stove C, Banister SD. Structure-activity relationships of valine, tert-leucine, and phenylalanine amino acid-derived synthetic cannabinoid receptor agonists related to ADB-BUTINACA, APP-BUTINACA, and ADB-P7AICA. RSC Med Chem 2022; 13:156-174. [PMID: 35308023 PMCID: PMC8864554 DOI: 10.1039/d1md00242b] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/14/2021] [Indexed: 11/01/2023] Open
Abstract
Synthetic cannabinoid receptor agonists (SCRAs) remain one the most prevalent classes of new psychoactive substances (NPS) worldwide, and examples are generally poorly characterised at the time of first detection. We have synthesised a systematic library of amino acid-derived indole-, indazole-, and 7-azaindole-3-carboxamides related to recently detected drugs ADB-BUTINACA, APP-BUTINACA and ADB-P7AICA, and characterised these ligands for in vitro binding and agonist activity at cannabinoid receptor subtypes 1 and 2 (CB1 and CB2), and in vivo cannabimimetic activity. All compounds showed high affinity for CB1 (K i 0.299-538 nM) and most at CB2 (K i = 0.912-2190 nM), and most functioned as high efficacy agonists of CB1 and CB2 in a fluorescence-based membrane potential assay and a βarr2 recruitment assay (NanoBiT®), with some compounds being partial agonists in the NanoBiT® assay. Key structure-activity relationships (SARs) were identified for CB1/CB2 binding and CB1/CB2 functional activities; (1) for a given core, affinities and potencies for tert-leucinamides (ADB-) > valinamides (AB-) ≫ phenylalaninamides (APP-); (2) for a given amino acid side-chain, affinities and potencies for indazoles > indoles ≫ 7-azaindoles. Radiobiotelemetric evaluation of ADB-BUTINACA, APP-BUTINACA and ADB-P7AICA in mice demonstrated that ADB-BUTINACA and ADB-P7AICA were cannabimimetic at 0.1 mg kg-1 and 10 mg kg-1 doses, respectively, as measured by pronounced decreases in core body temperature. APP-BUTINACA failed to elicit any hypothermic response up to the maximally tested 10 mg kg-1 dose, yielding an in vivo potency ranking of ADB-BUTINACA > ADB-P7AICA > APP-BUTINACA.
Collapse
Affiliation(s)
- Eric Sparkes
- School of Chemistry, The University of Sydney NSW 2006 Australia
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney NSW 2050 Australia
| | - Elizabeth A Cairns
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney NSW 2050 Australia
- School of Psychology, The University of Sydney NSW 2050 Australia
| | - Richard C Kevin
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney NSW 2050 Australia
- School of Psychology, The University of Sydney NSW 2050 Australia
| | - Felcia Lai
- School of Pharmacy, The University of Sydney NSW 2006 Australia
| | - Katharina Elisabeth Grafinger
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg 79104 Freiburg Germany
| | - Shuli Chen
- Department of Pharmacology and Toxicology, University of Otago Dunedin 9016 New Zealand
| | - Marie H Deventer
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University Ottergemsesteenweg 460 9000 Ghent Belgium
| | - Ross Ellison
- Clinical Toxicology and Environmental Biomonitoring Laboratory, University of California San Francisco CA 94143 USA
| | - Rochelle Boyd
- School of Chemistry, The University of Sydney NSW 2006 Australia
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney NSW 2050 Australia
| | - Lewis J Martin
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney NSW 2050 Australia
- School of Psychology, The University of Sydney NSW 2050 Australia
| | - Iain S McGregor
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney NSW 2050 Australia
- School of Psychology, The University of Sydney NSW 2050 Australia
| | - Roy R Gerona
- Clinical Toxicology and Environmental Biomonitoring Laboratory, University of California San Francisco CA 94143 USA
| | - David E Hibbs
- School of Pharmacy, The University of Sydney NSW 2006 Australia
| | - Volker Auwärter
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg 79104 Freiburg Germany
| | - Michelle Glass
- Department of Pharmacology and Toxicology, University of Otago Dunedin 9016 New Zealand
| | - Christophe Stove
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University Ottergemsesteenweg 460 9000 Ghent Belgium
| | - Samuel D Banister
- School of Chemistry, The University of Sydney NSW 2006 Australia
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney NSW 2050 Australia
| |
Collapse
|
11
|
Dal Farra D, Valdesalici A, Zecchinato G, De Sandre A, Saccon D, Simonato P, Corazza O, Martinotti G, Smith AL, Solmi M. Knowledge and Use of Novel Psychoactive Substances in an Italian Sample with Substance Use Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:915. [PMID: 35055743 PMCID: PMC8776073 DOI: 10.3390/ijerph19020915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/30/2021] [Accepted: 01/10/2022] [Indexed: 01/27/2023]
Abstract
This study aims to determine prevalence and frequency of use of novel psychoactive substances (NPS) and to identify the factors associated with NPS use in an Italian sample of patients diagnosed with substance use disorder (SUD). Prevalence and correlates of NPS knowledge and use were assessed in 185 patients with SUD in three addiction services (Padova, Belluno, Feltre) in the Veneto region with an ad-hoc designed survey. Two thirds of the samples reported knowing NPS and one third reported using them. NPS were considered by them less dangerous than "regular" substances of abuse (t = 6.06 mean 0.78, p < 0.001). Factors associated with NPS use were youth (OR = 4.81; p < 0.001), studentship (OR = 4.99; p = 0.004), subsequent mental disorders diagnosis (OR = 2.49; p = 0.027), suicide attempt history (OR = 11.67; p < 0.001), home detention (OR = 2.30; p = 0.040), residential care (OR = 5.66; p = 0.002), and polysubstance abuse (t = 8.99 mean 2.65 p < 0.001). NPS use in patients with SUD is highly prevalent, particularly in the youngest age group, and associated with psychiatric comorbidity and worse prognosis. It is crucial to systematically assess NPS use and inform addiction service users with SUD of the toxic and potentially lethal side effects. Mental healthcare professionals working in addiction services should receive education and training. Cohort and longitudinal studies are needed.
Collapse
Affiliation(s)
- Deborah Dal Farra
- Department of General Psychology, University of Padua, 35122 Padova, Italy; (D.D.F.); (A.V.)
| | - Alice Valdesalici
- Department of General Psychology, University of Padua, 35122 Padova, Italy; (D.D.F.); (A.V.)
| | | | - Alfio De Sandre
- Addiction Department, AULSS 1 Dolomiti, 32021 Agordo, Italy;
| | - Diego Saccon
- Addiction Department, AULSS 4 Veneto Orientale, 30027 San Donà di Piave, Italy;
| | | | - Ornella Corazza
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (O.C.); (G.M.)
| | - Giovanni Martinotti
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (O.C.); (G.M.)
- Department of Neuroscience, Imaging, Clinical Sciences, University “G.d’Annunzio”, 66100 Chieti-Pescara, Italy
| | - Andrew L. Smith
- Department of Psychiatry, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, ON K1N 6N5, Canada
| |
Collapse
|
12
|
Gaunitz F, Andresen-Streichert H. Analytical findings in a non-fatal intoxication with the synthetic cannabinoid 5F-ADB (5F-MDMB-PINACA): a case report. Int J Legal Med 2021; 136:577-589. [PMID: 34921326 PMCID: PMC8847293 DOI: 10.1007/s00414-021-02717-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/27/2021] [Indexed: 11/23/2022]
Abstract
The case report centres on analytical findings from a spice sample (mixed with tobacco (as a cigarette) for consumption), and its corresponding plasma sample, smoked by a 31-year-old man who was attended by emergency services following collapse. The man was fully conscious and cooperative during initial medical treatment. Suddenly, he suffered a complete loss of self-control, whereupon the police was notified. The man encountered the police officers when exiting the apartment, at which point he threatened them with clenched fists and reached for a plant bucket in order to strike out in the direction of the officers. At the trial, he described himself as confused and as being completely overwhelmed, having lost self-control, suffered a panic attack and “just wanted to get out the situation”. Furthermore, he stated that he had no recollection of the incident. He feared death due to palpitations, heart pain, dizziness and repetitive anxiety states. Routine systematic as well as extended toxicological analysis of the plasma sample, taken approximately 2 h after the incident, confirmed the use of cannabis and spice. Plasma concentrations of THC, OH-THC and THC-COOH were 8.0 μg/L, 4.0 μg/L and 147 μg/L, respectively. Furthermore, analysis confirmed uptake of 5F-ADB (5F-MDMB-PINACA) via detection of both 5F-ADB and the 5F-ADB N-(5-OH-pentyl) metabolite. The spice sample additionally contained 5F-MDMB-PICA, which was not detected in the plasma sample. A differentiation between a possible co-use and a recent use of cannabis was not possible. In summary, this case once more underlines the health risks of spice use.
Collapse
Affiliation(s)
- Franziska Gaunitz
- Institute of Legal Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany.
| | - Hilke Andresen-Streichert
- Institute of Legal Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| |
Collapse
|
13
|
Yeniocak S, Kalkan A, Yamanoğlu A, Öztürk S, Söğüt Ö, Metiner M. The effects of synthetic cannabinoids on the cardiovascular system: A case-control study. Turk J Emerg Med 2021; 21:198-204. [PMID: 34849432 PMCID: PMC8593429 DOI: 10.4103/2452-2473.329634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES: Limited clinical studies have investigated the effects of synthetic cannabinoids (SCs) on the cardiovascular system (CVS). The aim of this study was to evaluate the effects of SCs on the CVS. METHODS: The patient group of this single-center, prospective, case–control study consisted of adult patients presenting to the emergency department (ED) with symptoms of SC use. Vital signs and electrocardiogram (ECG) after use of SC of patients were followed. A control group with a similar number of patients and patient demographics were formed following the patient admission process. Pulse rate, arterial blood pressure (ABP), and ECG of patient and control groups were compared using Mann–Whitney U and Chi-squared tests. RESULTS: A total of 148 people were included in the study, 74 in the patient group and 74 in the control group. Systolic and diastolic ABPs of patient group were statistically significantly lower than those of the control group (P < 0.001). P-wave width and amplitude in the patient group were significantly higher compared to the control group (P: 0.027 and P: 0.004, respectively). QRS width on patient group ECGs was significantly higher than in the control group, while T-wave amplitude was significantly lower (P: 0.045 and P < 0.001, respectively). ST elevation was seen in 12 (16.2%) subjects in the patient group, while no ST elevation was seen in the control group (P < 0.001). CONCLUSION: SCs can reduce systemic tension and SCs may cause changes in ECG, especially P wave, ST segment, T wave, and QRS. Further large-scale studies are needed to show whether these changes are associated with fatal arrhythmias or myocardial infarction.
Collapse
Affiliation(s)
- Selman Yeniocak
- Department of Emergency Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Asım Kalkan
- Department of Emergency Medicine, Okmeydanı Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Adnan Yamanoğlu
- Department of Emergency Medicine, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Semi Öztürk
- Department of Cardiology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Özgür Söğüt
- Department of Emergency Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Merve Metiner
- Department of Emergency Medicine, Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
14
|
Ivanov ID, Stoykova SS, Burdzhiev NT, Pantcheva IN, Atanasov VN. Synthetic Cannabinoids 5F-QUPIC and MDMB-CHMICA in Plant Material – Identification and Quantification by Gas Chromatography – Mass Spectrometry (GC-MS), Nuclear Magnetic Resonance (NMR), and High-Performance Liquid Chromatography with Diode Array Detection (HPLC-DAD). ANAL LETT 2021. [DOI: 10.1080/00032719.2021.1879109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ivo D. Ivanov
- Faculty of Chemistry and Pharmacy, Department of Analytical Chemistry, Sofia University “St. Kl. Ohridski”, Sofia, Bulgaria
- Department of Toxicology, Military Medical Academy, Sofia, Bulgaria
| | - Silviya S. Stoykova
- Faculty of Chemistry and Pharmacy, Department of Analytical Chemistry, Sofia University “St. Kl. Ohridski”, Sofia, Bulgaria
- Department of Toxicology, Military Medical Academy, Sofia, Bulgaria
| | - Nikola T. Burdzhiev
- Faculty of Chemistry and Pharmacy, Department of Organic Chemistry and Pharmacognosy, Sofia University “St. Kl. Ohridski”, Sofia, Bulgaria
| | - Ivayla N. Pantcheva
- Faculty of Chemistry and Pharmacy, Department of Analytical Chemistry, Sofia University “St. Kl. Ohridski”, Sofia, Bulgaria
| | - Vasil N. Atanasov
- Faculty of Chemistry and Pharmacy, Department of Analytical Chemistry, Sofia University “St. Kl. Ohridski”, Sofia, Bulgaria
- Department of Toxicology, Military Medical Academy, Sofia, Bulgaria
| |
Collapse
|
15
|
Lattanzi S, Leitinger M, Rocchi C, Salvemini S, Matricardi S, Brigo F, Meletti S, Trinka E. Unraveling the enigma of new-onset refractory status epilepticus: a systematic review of aetiologies. Eur J Neurol 2021; 29:626-647. [PMID: 34661330 PMCID: PMC9298123 DOI: 10.1111/ene.15149] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/10/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE New-onset refractory status epilepticus (NORSE) is a clinical presentation, neither a specific diagnosis nor a clinical entity. It refers to a patient without active epilepsy or other pre-existing relevant neurological disorder, with a NORSE without a clear acute or active structural, toxic or metabolic cause. This study reviews the currently available evidence about the aetiology of patients presenting with NORSE and NORSE-related conditions. METHODS A systematic search was carried out for clinical trials, observational studies, case series and case reports including patients who presented with NORSE, febrile-infection-related epilepsy syndrome or the infantile hemiconvulsion-hemiplegia and epilepsy syndrome. RESULTS Four hundred and fifty records were initially identified, of which 197 were included in the review. The selected studies were retrospective case-control (n = 11), case series (n = 83) and case reports (n = 103) and overall described 1334 patients both of paediatric and adult age. Aetiology remains unexplained in about half of the cases, representing the so-called 'cryptogenic NORSE'. Amongst adult patients without cryptogenic NORSE, the most often identified cause is autoimmune encephalitis, either non-paraneoplastic or paraneoplastic. Infections are the prevalent aetiology of paediatric non-cryptogenic NORSE. Genetic and congenital disorders can have a causative role in NORSE, and toxic, vascular and degenerative conditions have also been described. CONCLUSIONS Far from being a unitary condition, NORSE is a heterogeneous and clinically challenging presentation. The development and dissemination of protocols and guidelines to standardize diagnostic work-up and guide therapeutic approaches should be implemented. Global cooperation and multicentre research represent priorities to improve the understanding of NORSE.
Collapse
Affiliation(s)
- Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Markus Leitinger
- Department of Neurology, Christian Doppler University Hospital, Center for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria.,Neuroscience Institute, Christian Doppler University Hospital, Center for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
| | - Chiara Rocchi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Sergio Salvemini
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Sara Matricardi
- Department of Child Neuropsychiatry, Children's Hospital 'G. Salesi', Ancona, Italy
| | - Francesco Brigo
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy.,Division of Neurology, 'Franz Tappeiner' Hospital, Merano, BZ, Italy
| | - Stefano Meletti
- Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy.,Department of Biomedical, Metabolic and Neural Science, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Center for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria.,Neuroscience Institute, Christian Doppler University Hospital, Center for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria.,Public Health, Health Services Research and HTA, Medical Informatics and Technology, University for Health Sciences, Hall i.T, Austria
| |
Collapse
|
16
|
Bukke VN, Archana M, Villani R, Serviddio G, Cassano T. Pharmacological and Toxicological Effects of Phytocannabinoids and Recreational Synthetic Cannabinoids: Increasing Risk of Public Health. Pharmaceuticals (Basel) 2021; 14:ph14100965. [PMID: 34681189 PMCID: PMC8541640 DOI: 10.3390/ph14100965] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 01/01/2023] Open
Abstract
Synthetic Cannabinoids (CBs) are a novel class of psychoactive substances that have rapidly evolved around the world with the addition of diverse structural modifications to existing molecules which produce new structural analogues that can be associated with serious adverse health effects. Synthetic CBs represent the largest class of drugs detected by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) with a total of 207 substances identified from 2008 to October 2020, and 9 compounds being reported for the first time. Synthetic CBs are sprayed on natural harmless herbs with an aim to mimic the euphoric effect of Cannabis. They are sold under different brand names including Black mamba, spice, K2, Bombay Blue, etc. As these synthetic CBs act as full agonists at the CB receptors, they are much more potent than natural Cannabis and have been increasingly associated with acute to chronic intoxications and death. Due to their potential toxicity and abuse, the US government has listed some synthetic CBs under schedule 1 classification. The present review aims to provide a focused overview of the literature concerning the development of synthetic CBs, their abuse, and potential toxicological effects including renal toxicity, respiratory depression, hyperemesis syndrome, cardiovascular effects, and a range of effects on brain function.
Collapse
|
17
|
Ordak M, Nasierowski T, Muszynska E, Bujalska-Zadrozny M. Psychoactive Substances Taken with Mephedrone and HCV Infection. J Clin Med 2021; 10:jcm10153218. [PMID: 34362002 PMCID: PMC8348849 DOI: 10.3390/jcm10153218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background: In recent years, the observed frequency of hospitalization of patients taking mephedrone with other psychoactive substances has increased. There are no data in the literature on the effect of mephedrone use on liver function in patients, including the frequency of HCV infection. We have analysed the impact of taking mephedrone together with other psychoactive substances on the incidence of HCV infection. We have also analysed the effect of taking mephedrone with heroin, alcohol, and benzodiazepines on liver enzyme levels. Methods: The study included patients taking mephedrone with: alcohol (n = 115), heroin (n = 85) and benzodiazepines (n = 130) hospitalized in 2010–2018. The control group consisted of patients addicted to alcohol (n = 180), heroin (n = 221) and benzodiazepines (n = 152). Clinical data and laboratory findings were collected from medical records. Results: Taking mephedrone together with benzodiazepines is a statistically significant predictor of HCV infection in this group of patients, OR (8.44); 95% CI 5.63–12.64; p < 0.001). A statistically significant interaction of the group with HCV infection was observed, i.e., for the level of alanine transaminase (p < 0.001) and aspartate transaminase (p < 0.001). Increased levels of liver enzymes in each of the studied groups was characteristic in patients with HCV infection (p < 0.001). Taking additional mephedrone by this group of patients did not increase the level of liver enzymes. Conclusion: HCV infection is a statistically significant factor affecting the increase in liver enzymes levels in the group of patients taking mephedrone.
Collapse
Affiliation(s)
- Michal Ordak
- Department of Pharmacodynamics, Centre for Preclinical, Research and Technology (CePT), Medical University of Warsaw, 02-091 Warsaw, Poland;
- Correspondence:
| | - Tadeusz Nasierowski
- Department of Psychiatry, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Elzbieta Muszynska
- Department of Medical Biology, Medical University of Bialystok, 15-089 Bialystok, Poland;
| | - Magdalena Bujalska-Zadrozny
- Department of Pharmacodynamics, Centre for Preclinical, Research and Technology (CePT), Medical University of Warsaw, 02-091 Warsaw, Poland;
| |
Collapse
|
18
|
Monti MC, Scheurer E, Mercer-Chalmers-Bender K. Phase I In Vitro Metabolic Profiling of the Synthetic Cannabinoid Receptor Agonists CUMYL-THPINACA and ADAMANTYL-THPINACA. Metabolites 2021; 11:470. [PMID: 34436411 PMCID: PMC8398790 DOI: 10.3390/metabo11080470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/16/2021] [Accepted: 07/16/2021] [Indexed: 11/16/2022] Open
Abstract
Synthetic cannabinoid receptor agonists (SCRAs) remain popular drugs of abuse. As many SCRAs are known to be mostly metabolized, in vitro phase I metabolic profiling was conducted of the two indazole-3-carboxamide SCRAs: CUMYL-THPINACA and ADAMANTYL-THPINACA. Both compounds were incubated using pooled human liver microsomes. The sample clean-up consisted of solid phase extraction, followed by analysis using liquid chromatography coupled to a high resolution mass spectrometer. In silico-assisted metabolite identification and structure elucidation with the data-mining software Compound Discoverer was applied. Overall, 28 metabolites were detected for CUMYL-THPINACA and 13 metabolites for ADAMATYL-THPINACA. Various mono-, di-, and tri-hydroxylated metabolites were detected. For each SCRA, an abundant and characteristic di-hydroxylated metabolite was identified as a possible in vivo biomarker for screening methods. Metabolizing cytochrome P450 isoenzymes were investigated via incubation of relevant recombinant liver enzymes. The involvement of mainly CYP3A4 and CYP3A5 in the metabolism of both substances were noted, and for CUMYL-THPINACA the additional involvement (to a lesser extent) of CYP2C8, CYP2C9, and CYP2C19 was observed. The results suggest that ADAMANTYL-THPINACA might be more prone to metabolic drug-drug interactions than CUMYL-THPINACA, when co-administrated with strong CYP3A4 inhibitors.
Collapse
Affiliation(s)
| | | | - Katja Mercer-Chalmers-Bender
- Institute of Forensic Medicine, Department of Biomedical Engineering, University of Basel, 4056 Basel, Switzerland; (M.C.M.); (E.S.)
| |
Collapse
|
19
|
Kim NS, Lim NY, Choi HS, Lee JH, Kim H, Baek SY. Application of a simultaneous screening method for the detection of new psychoactive substances in various matrix samples using liquid chromatography/electrospray ionization tandem mass spectrometry and liquid chromatography/quadrupole time-of-flight mass spectrometry. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2021; 35:e9067. [PMID: 33656207 DOI: 10.1002/rcm.9067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/01/2021] [Accepted: 02/06/2021] [Indexed: 06/12/2023]
Abstract
RATIONALE Recently, new psychoactive substances (NPS) have emerged as a public health risk. Particularly, their chemical structures are modified to avoid detection. Synthetic NPS with effects similar to those of illegal drugs have been recently detected and synthesized worldwide, including MDMB-FUBINACA and APINAC, making it essential to rapidly and accurately detect NPS. METHODS Fourteen NPS with similar structures were selected and their structures identified using 1 H and 13 C NMR spectroscopy. Additionally, we proposed the fragmentation pattern of each compound using liquid chromatography/quadrupole time-of-flight mass spectrometry (LC/QTOF-MS). A simultaneous analytical method using liquid chromatography/electrospray ionization tandem mass spectrometry (LC/ESI-MS/MS) was also developed and applied to real samples to detect the 14 NPS. The method was validated based on the specificity, linearity, limit of detection (LOD), limit of quantification (LOQ), precision, accuracy, matrix effect, and stability according to international validation guidelines. RESULTS The established method was used to screen 65 different matrix samples using LC/ESI-MS/MS. By comparing the calculated product ion ratios with those of standards, 2C-B in one of the real samples and 5F-MDMB-PICA in 20 samples were identified. For re-confirmation of detected compounds, the fragmentation pattern of each compound was compared with that of each standard using LC/QTOF-MS. CONCLUSIONS In this study, LC/QTOF-MS data were used to elucidate the structures and fragmentation patterns of 14 NPS. A simultaneous method was developed using LC/ESI-MS/MS, which was applied to 65 real samples. The presented method and results can assist in ensuring the safety of public health from illegal adulteration.
Collapse
Affiliation(s)
- Nam Sook Kim
- Center for Advanced Analysis, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Osong Health Technology Administration Complex, 187 Osongsaengmyeong2-ro, Osongeup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do, 363-700, Republic of Korea
| | - Na Young Lim
- Center for Advanced Analysis, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Osong Health Technology Administration Complex, 187 Osongsaengmyeong2-ro, Osongeup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do, 363-700, Republic of Korea
| | - Hwan Seong Choi
- Center for Advanced Analysis, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Osong Health Technology Administration Complex, 187 Osongsaengmyeong2-ro, Osongeup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do, 363-700, Republic of Korea
| | - Ji Hyun Lee
- Center for Advanced Analysis, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Osong Health Technology Administration Complex, 187 Osongsaengmyeong2-ro, Osongeup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do, 363-700, Republic of Korea
| | - Hyungil Kim
- Center for Advanced Analysis, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Osong Health Technology Administration Complex, 187 Osongsaengmyeong2-ro, Osongeup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do, 363-700, Republic of Korea
| | - Sun Young Baek
- Center for Advanced Analysis, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Osong Health Technology Administration Complex, 187 Osongsaengmyeong2-ro, Osongeup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do, 363-700, Republic of Korea
| |
Collapse
|
20
|
Abstract
Synthetic marijuana use has increased significantly since 2008 among young adults in the United States, as have adverse reactions to it, leading to a dramatic increase in emergency department visits. However, much of the research conducted on it has been case studies, which report detrimental symptoms on an individual basis. Only a limited number of studies aim to better understand the larger parameters of this epidemic to assist health care providers and policy makers, including early detection, intervention, and adequate treatment. In addition, there has been limited critical review of this substance to help health care professionals educate the public about the negative health effects of using this drug. This article explores the critical reviews of synthetic marijuana, also commonly known as "K2" and "Spice," synthesizing information from literature reviews, case studies, media information, and government websites. Findings were organized by synthetic marijuana's history, description, adverse reactions including withdrawal symptoms and death incidents, detection screening, treatment, and legislative issues. Health care providers need to understand the detrimental effects of this illicit and harmful substance to both the body and mind and sometimes irreversible damage caused to individuals who consume it. Policy makers, the public, and affected individuals and their family members need to be educated as well.
Collapse
|
21
|
Forsythe ML, Boileau AJ. Use of cannabinoids for the treatment of patients with post-traumatic stress disorder. J Basic Clin Physiol Pharmacol 2021; 33:121-132. [PMID: 33662194 DOI: 10.1515/jbcpp-2020-0279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/18/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Post-traumatic Stress Disorder (PTSD) is a diagnosis of extreme anxiety caused by a traumatic event. Less than 10% of individuals who have experienced severe trauma will develop this disorder. Treatment options include various psychotherapies, but not all patients respond to them. Different pharmacological approaches have been explored as potential adjuvants, including using cannabinoids to target the endocannabinoid system to reduce the symptoms and enhance extinction training over the associated fear memories. This review was aimed to determine the effects of using cannabinoids for treatment of PTSD. CONTENT For this review, four cohort studies, four randomized clinical trials, one case report, and one case series were obtained from PubMed within the last 10 years. Cannabis extracts, tetrahydrocannabinol (THC) and cannabidiol (CBD), and synthetic cannabinoids were used in the studies to target the cannabinoid receptors 1 and 2. Cannabinoids were shown to improve overall PTSD symptoms, including sleep quality and quantity, hyperarousal, and treatment-resistant nightmares. When participants were undergoing extinction training, cannabinoids given within the same time interval enhanced consolidation and retention. SUMMARY AND OUTLOOK Cannabinoids have been shown to be an effective treatment option for patients with PTSD. Besides aiding to relieve the symptoms and enhance extinction training, they also are relatively well tolerated. Common adverse effects included light-headedness, forgetfulness, dizziness, and headaches.
Collapse
Affiliation(s)
- Marika L Forsythe
- Department of Anatomy, Saba University School of Medicine, The Bottom, Saba, Caribbean Netherlands
| | - Andrew J Boileau
- Department of Anatomy, Saba University School of Medicine, The Bottom, Saba, Caribbean Netherlands
| |
Collapse
|
22
|
Lie W, Cheong EJY, Goh EML, Moy HY, Cannaert A, Stove CP, Chan ECY. Diagnosing intake and rationalizing toxicities associated with 5F-MDMB-PINACA and 4F-MDMB-BINACA abuse. Arch Toxicol 2020; 95:489-508. [PMID: 33236189 DOI: 10.1007/s00204-020-02948-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/05/2020] [Indexed: 11/25/2022]
Abstract
5F-MDMB-PINACA and 4F-MDMB-BINACA are synthetic cannabinoids (SCs) that elicit cannabinoid psychoactive effects. Defining pharmacokinetic-pharmacodynamic (PK-PD) relationships governing SCs and their metabolites are paramount to investigating their in vivo toxicological outcomes. However, the disposition kinetics and cannabinoid receptor (CB) activities of the primary metabolites of SCs are largely unknown. Additionally, reasons underlying the selection of ester hydrolysis metabolites (EHMs) as urinary biomarkers are often unclear. Here, metabolic reaction phenotyping was performed to identify key metabolizing enzymes of the parent SCs. Hepatic clearances of parent SCs and their EHMs were estimated from microsomal metabolic stability studies. Renal clearances were simulated using a mechanistic kidney model incorporating in vitro permeability and organic anionic transporter 3 (OAT3)-mediated uptake data. Overall clearances were considered in tandem with estimated volumes of distribution for in vivo biological half-lives (t1/2) predictions. Interactions of the compounds with CB1 and CB2 were investigated using a G-protein coupled receptor activation assay. We demonstrated that similar enzymatic isoforms were implicated in the metabolism of 5F-MDMB-PINACA and 4F-MDMB-BINACA. Our in vivo t1/2 determinations verified the rapid elimination of parent SCs and suggest prolonged circulation of their EHMs. The pronounced attenuation of the potencies and efficacies of the metabolites against CB1 and CB2 further suggests how toxic manifestations of SC abuse are likely precipitated by augmented exposure to parent SCs. Notably, basolateral OAT3-mediated uptake of the EHMs substantiates their higher urinary abundance. These novel insights underscore the importance of mechanistic, quantitative and systematic characterization of PK-PD relationships in rationalizing the toxicities of SCs.
Collapse
Affiliation(s)
- Wen Lie
- Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Eleanor Jing Yi Cheong
- Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Evelyn Mei Ling Goh
- Analytical Toxicology Laboratory, Applied Sciences Group, Health Sciences Authority, 11 Outram Road, Singapore, 169078, Singapore
| | - Hooi Yan Moy
- Analytical Toxicology Laboratory, Applied Sciences Group, Health Sciences Authority, 11 Outram Road, Singapore, 169078, Singapore
| | - Annelies Cannaert
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium
| | - Christophe P Stove
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium
| | - Eric Chun Yong Chan
- Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Singapore.
| |
Collapse
|
23
|
Krotulski AJ, Cannaert A, Stove C, Logan BK. The next generation of synthetic cannabinoids: Detection, activity, and potential toxicity of pent-4en and but-3en analogues including MDMB-4en-PINACA. Drug Test Anal 2020; 13:427-438. [PMID: 32997377 DOI: 10.1002/dta.2935] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 11/12/2022]
Abstract
A new class of synthetic cannabinoids has emerged as new psychoactive substances (NPS). Similar in structure to JWH-022, these substances contain alkene modifications to the tail region of the synthetic cannabinoid core structure, and nomenclature denotes these new analogues as pent-4en or but-3en species. Internationally, two analogues from this new series recently emerged: MDMB-4en-PINACA and MMB-4en-PICA. Previously, data regarding activity and potential toxicity were not available. In vitro assessment of cannabinoid receptor 1 (CB1) activation via the β-arrestin 2 recruitment was studied for three (3) pent-4en analogues, one (1) but-3en analogue, and one (1) principal metabolite. MDMB-4en-PINACA (2.47 nM, 239%), MDMB-4en-PICA (11.5 nM, 302%), and MDMB-3en-BINACA (14.3 nM, 286%) were highly potent and efficacious (comparison: JWH-018, 25.3 nM, 100%), while the potencies of MMB-4en-PICA and MDMB-4en-PINACA 3,3-dimethylbutanoic acid were markedly lower. Modifications to core and tail structural features (i.e., indole vs. indazole) led to relatively small differences in potency, while changes among the head region led to larger differences. Sample-mining and data-mining conducted on toxicology samples led to the identification of MDMB-4en-PINACA in 25 forensic toxicology cases, including postmortem and impaired driving investigations, with case details and limited histories described herein. Moderate geographical distribution of MDMB-4en-PINACA was noted in the United States with emergence in the Northeast, Midwest, South, and West regions. Results from toxicology testing paired with case history show the potential for MDMB-4en-PINACA to cause or contribute to impairment or death. Forensic scientists, public health and public safety officials, law enforcement, clinicians, medical examiners, and coroners should consider involvement of emergent synthetic cannabinoids in their work and that new analogues containing an alkene tail can retain similar or increased potency and toxicity.
Collapse
Affiliation(s)
- Alex J Krotulski
- Center for Forensic Science Research and Education, Fredric Rieders Family Foundation, Willow Grove, PA, USA
| | - Annelies Cannaert
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Christophe Stove
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Barry K Logan
- Center for Forensic Science Research and Education, Fredric Rieders Family Foundation, Willow Grove, PA, USA.,Toxicology Department, NMS Labs, Horsham, PA, USA
| |
Collapse
|
24
|
Stellpflug SJ, Cole JB, Greller HA. Urine Drug Screens in the Emergency Department: The Best Test May Be No Test at All. J Emerg Nurs 2020; 46:923-931. [PMID: 32843202 DOI: 10.1016/j.jen.2020.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/11/2020] [Accepted: 06/03/2020] [Indexed: 11/27/2022]
Abstract
The manuscript purpose is to provide a resource for clinicians on the functionality and pitfalls of the rapid urine drug screen for clinical decision making. Many providers remain under-informed about the inherent inaccuracies. The rapid urine drug screen is the first, and often only, step of drug testing. In the majority of emergency departments the urine drug screen is a collection of immunoassays reliant on an interaction between the structure of a particular drug or metabolite and an antibody. Drugs in separate pharmacologic classes often have enough structural similarity to cause false positives. Conversely, drugs within the same pharmacologic class often have different enough structures that they may result in inappropriate negatives. This lack of sensitivity and specificity significantly reduces the test utility, and may cause decision-making confusion. The timing of the drug screen relative to the drug exposure also limits accuracy, as does detection threshold. Confirmatory steps following the initial immunoassay include chromatography and/or mass spectrometry. These are unavailable at many institutions and results rarely return while the patient is in the emergency department. In addition, institutional capabilities vary, even with confirmatory testing. Confirmation accuracy depends on a number of factors, including the extent of the catalog of drugs/metabolites that the facility is calibrated to detect and report. In summary, the standard emergency department urine drug screen is a test with extremely limited clinical utility with multiple properties contributing to poor sensitivity, specificity, and accuracy. The test should be used rarely, if ever, for clinical decision making.
Collapse
|
25
|
Unintentional Exposure of an Infant to Synthetic Cannabinoid (Bonzai) Related to the Parent's Use. Pediatr Emerg Care 2020; 36:e355-e357. [PMID: 29698342 DOI: 10.1097/pec.0000000000001492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The increase of available synthetic cannabinoids poses an emerging public health threat worldwide. Synthetic cannabinoid use has been mainly reported in adolescent cases in pediatric practices; there are few reported cases involving infants affected by unintentional use. In this case report, we present the youngest age of synthetic cannabinoid bonzai exposure in the literature, discussing a 3-month-old child affected by exposure to the parents' use of bonzai in the home environment. Because unintentional exposure to synthetic cannabinoids like bonzai might be encountered, pediatric emergency teams should be aware of this condition and child protection teams should be informed of suspicions of child negligence and abuse as a part of the medical approach.
Collapse
|
26
|
Luethi D, Liechti ME. Designer drugs: mechanism of action and adverse effects. Arch Toxicol 2020; 94:1085-1133. [PMID: 32249347 PMCID: PMC7225206 DOI: 10.1007/s00204-020-02693-7] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/25/2020] [Indexed: 12/18/2022]
Abstract
Psychoactive substances with chemical structures or pharmacological profiles that are similar to traditional drugs of abuse continue to emerge on the recreational drug market. Internet vendors may at least temporarily sell these so-called designer drugs without adhering to legal statutes or facing legal consequences. Overall, the mechanism of action and adverse effects of designer drugs are similar to traditional drugs of abuse. Stimulants, such as amphetamines and cathinones, primarily interact with monoamine transporters and mostly induce sympathomimetic adverse effects. Agonism at μ-opioid receptors and γ-aminobutyric acid-A (GABAA) or GABAB receptors mediates the pharmacological effects of sedatives, which may induce cardiorespiratory depression. Dissociative designer drugs primarily act as N-methyl-D-aspartate receptor antagonists and pose similar health risks as the medically approved dissociative anesthetic ketamine. The cannabinoid type 1 (CB1) receptor is thought to drive the psychoactive effects of synthetic cannabinoids, which are associated with a less desirable effect profile and more severe adverse effects compared with cannabis. Serotonergic 5-hydroxytryptamine-2A (5-HT2A) receptors mediate alterations of perception and cognition that are induced by serotonergic psychedelics. Because of their novelty, designer drugs may remain undetected by routine drug screening, thus hampering evaluations of adverse effects. Intoxication reports suggest that several designer drugs are used concurrently, posing a high risk for severe adverse effects and even death.
Collapse
Affiliation(s)
- Dino Luethi
- Center for Physiology and Pharmacology, Institute of Pharmacology, Medical University of Vienna, Währinger Strasse 13a, 1090, Vienna, Austria.
- Institute of Applied Physics, Vienna University of Technology, Getreidemarkt 9, 1060, Vienna, Austria.
- Division of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland.
| | - Matthias E Liechti
- Division of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland.
| |
Collapse
|
27
|
Ellsworth JT. Spice, vulnerability, and victimization: Synthetic cannabinoids and interpersonal crime victimization among homeless adults. Subst Abus 2019; 43:32-38. [PMID: 31697191 DOI: 10.1080/08897077.2019.1686725] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Although the physiologic and psychological harms associated with the use of synthetic cannabinoids, such as spice, are well-described, researchers have yet to examine how spice abuse affects exposure to crime. This paper describes the dangerous social environment where spice is used and delineates how synthetic cannabinoid abuse increases the risk of victimization. Methods: This qualitative study used semi-structured interviews to examine crime- and victimization-related experiences of 22 homeless adults. Transcripts were analyzed for emergent themes using a two-tiered qualitative coding process. Results: Those experiencing homelessness describe synthetic cannabinoids as powerful intoxicants. Substances such as spice are sought for their ability to detach those under the drug's influence from reality. Participants illustrated their understanding of how synthetic cannabinoids affect the health and safety of unsheltered persons. Spice use frequently results in rapid intoxication; individuals under the influence of spice are thereby physically vulnerable to crime, particularly theft and robbery. Conclusion: Findings add to previous research on the harms of synthetic cannabinoid abuse. This study suggests a victimization process common among homeless persons who use spice: Incapacitation often rapidly follows use, which in turn precipitates victimization.
Collapse
Affiliation(s)
- Joshua T Ellsworth
- Department of Criminal Justice, Indiana University, Bloomington, Indiana, USA
| |
Collapse
|
28
|
Yalçın M, Tunalı N, Yıldız H, Oğuz A, Gültekin BK. Sociodemographic and clinical characteristics of synthetic cannabinoid users in a large psychiatric emergency department in Turkey. J Addict Dis 2019; 37:259-267. [PMID: 31581902 DOI: 10.1080/10550887.2019.1671146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Synthetic cannabinoid (SC) use is a global concern and is creating new challenges for treatment services. Although some studies have been reported, there is a need for further research regarding the sociodemographic and clinical characteristics of SC users so that general and psychiatric emergency departments can provide more effective treatments. We aimed to investigate the sociodemographic and clinical characteristics in a cohort of patients using SC who presented to the psychiatric emergency department of the University of Health Sciences, Istanbul Erenköy Training and Research Hospital for Psychiatry and Neurology (ERSHEAH) in Istanbul, Turkey. This cross-sectional and retrospective medical record review examined 340 SC users who presented to the emergency department of ERSHEAH in a 3-month period. The mean age of the SC users was 26.8 ± 7.5 years and 92.6% were men. Psychotic symptoms were present in 247 SC users (78.8%). Severe intoxication was diagnosed in 26 SC users (7.6%), although SC was detectable in the samples of only 6 patients (13.6%). Impaired consciousness (42.3%) was the most common reason for referral to the general hospital and increased liver enzyme levels (15.9%) were the most common indication in the laboratory findings. We observed that the SC users in our sample presenting as psychiatric emergencies were mostly young men experiencing psychotic symptoms. Determining the sociodemographic and clinical properties of SC users may provide an important contribution to fast recognition and more effective management of acute symptoms of SC users in emergency departments.
Collapse
Affiliation(s)
- Murat Yalçın
- Erenköy Training and Research Hospital for Psychiatry and Neurology, Psychiatry Department, University of Health Sciences, Istanbul, Turkey
| | - Nazlı Tunalı
- Erenköy Training and Research Hospital for Psychiatry and Neurology, Psychiatry Department, University of Health Sciences, Istanbul, Turkey
| | - Handan Yıldız
- Erenköy Training and Research Hospital for Psychiatry and Neurology, Psychiatry Department, University of Health Sciences, Istanbul, Turkey
| | - Ayşenur Oğuz
- Fatih Sultan Mehmet Training and Research Hospital, Psychiatry Department, University of Health Sciences, Istanbul, Turkey
| | - Bülent Kadri Gültekin
- Erenköy Training and Research Hospital for Psychiatry and Neurology, Psychiatry Department, University of Health Sciences, Istanbul, Turkey
| |
Collapse
|
29
|
Orsolini L, Chiappini S, Corkery JM, Guirguis A, Papanti D, Schifano F. The use of new psychoactive substances (NPS) in young people and their role in mental health care: a systematic review. Expert Rev Neurother 2019; 19:1253-1264. [PMID: 31503507 DOI: 10.1080/14737175.2019.1666712] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Introduction: Over the past 10 years, a large number of New Psychoactive Substances (NPS) have entered the recreational drug scenario. NPS intake has been associated with health-related risks, and especially so for vulnerable populations such as the youngsters. Currently, most knowledge on the NPS health effects is learnt from both a range of users' reports, made available through the psychonauts' web fora, and from the few published, related toxicity, clinical observations.Areas covered: This paper aims at providing an overview of NPS effects on youngsters' mental health, whilst performing a systematic review of the current related knowledge.Expert opinion: NPS consumption poses serious health risks, due to both a range of unpredictable clinical pharmacological properties and the typical concomitant use of other psychoactive molecules; overall, this can lead to near misses and fatalities. In comparison with adults, the central nervous system of children/adolescents may be more vulnerable to the activity of these molecules, hence raising even further the levels of health-related concerns. More research is needed to provide evidence of both short- and long-term effects of NPS, related health risks, and their addiction potential.
Collapse
Affiliation(s)
- Laura Orsolini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Neomesia Mental Health, Villa Jolanda Hospital, Jesi, Italy.,Polyedra, Teramo, Italy
| | - Stefania Chiappini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - John M Corkery
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Amira Guirguis
- Swansea University Medical School, Institute of Life Sciences 2, Swansea University, Singleton Park, Swansea, Wales
| | - Duccio Papanti
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| |
Collapse
|
30
|
Bianchi F, Agazzi S, Riboni N, Erdal N, Hakkarainen M, Ilag LL, Anzillotti L, Andreoli R, Marezza F, Moroni F, Cecchi R, Careri M. Novel sample-substrates for the determination of new psychoactive substances in oral fluid by desorption electrospray ionization-high resolution mass spectrometry. Talanta 2019; 202:136-144. [DOI: 10.1016/j.talanta.2019.04.057] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/18/2019] [Accepted: 04/22/2019] [Indexed: 11/28/2022]
|
31
|
Anderson SAR, Oprescu AM, Calello D, Monte A, Dayan PS, Hurd YL, Manini AF. Neuropsychiatric Sequelae in Adolescents With Acute Synthetic Cannabinoid Toxicity. Pediatrics 2019; 144:e20182690. [PMID: 31285395 PMCID: PMC6697124 DOI: 10.1542/peds.2018-2690] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Adolescents represent the largest age group that presents to emergency departments (ED) for synthetic cannabinoid (SC) toxicity; however, the neurotoxic effects of acute SC exposures in this group are understudied. Our aim was to characterize the neuropsychiatric presentation of adolescents with SC-related exposure in the ED compared with those with traditional cannabis exposure. METHODS A multicenter registry of clinical information prospectively collected by medical toxicologists (Toxicology Investigators Consortium Case Registry) was reviewed for adolescents presenting to the ED after SC or cannabis exposure from 2010 through 2018. Associations were measured between drug exposures and neuropsychiatric symptoms and/or signs. Exposures were classified into 4 groups: SC-only exposure, SC-polydrug exposures, cannabis-only exposure, and cannabis-polydrug exposures. RESULTS Adolescents presenting to the ED with SC-only exposure (n = 107) had higher odds of coma and/or central nervous system depression (odds ratio [OR] 3.42; 95% confidence interval [CI] 1.51-7.75) and seizures (OR 3.89; 95% CI 1.39-10.94) than those with cannabis-only exposure (n = 86). SC-only drug exposure was associated with lower odds of agitation than cannabis-only exposure (OR 0.18; 95% CI 0.10-0.34). In contrast, the group with SC-polydrug exposures (n = 38) had higher odds of agitation (OR 3.11; 95% CI 1.56-7.44) and seizures (OR 4.8; 95% CI 1.80-12.74) than the cannabis-polydrug exposures group (n = 117). CONCLUSIONS In this multisite cohort of US adolescents assessed in the ED, SC exposure was associated with higher odds of neuropsychiatric morbidity than cannabis exposure providing a distinct neurospychiatric profile of acute SC toxicity in adolescents.
Collapse
Affiliation(s)
| | - Anna M Oprescu
- Departments of Psychiatry, Neuroscience, and Pharmacological Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Diane Calello
- Department of Emergency Medicine, New Jersey Medical School, Rutgers University, Newark, New Jersey; and
| | - Andrew Monte
- Departments of Emergency Medicine and Pharmaceutical Sciences, School of Medicine, University of Colorado, Aurora, Colorado
| | - Peter S Dayan
- Departments of Pediatrics and
- Emergency Medicine, Columbia University Herbert and Florence Irving Medical Center, New York, New York
| | - Yasmin L Hurd
- Departments of Psychiatry, Neuroscience, and Pharmacological Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alex F Manini
- Division of Medical Toxicology, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai and Elmhurst Hospital Center, New York, New York
| |
Collapse
|
32
|
Fabregat-Safont D, Mardal M, Noble C, Cannaert A, Stove CP, Sancho JV, Linnet K, Hernández F, Ibáñez M. Comprehensive investigation on synthetic cannabinoids: Metabolic behavior and potency testing, using 5F-APP-PICA and AMB-FUBINACA as model compounds. Drug Test Anal 2019; 11:1358-1368. [PMID: 31192526 DOI: 10.1002/dta.2659] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 12/30/2022]
Abstract
Synthetic cannabinoids (SCs) represented 45% of new psychoactive substances seizures in Europe (data from 2016). The consumption of SCs is an issue of concern due to their still unknown toxicity and effects on human health, the great variety of compounds synthetized, and the continuous modifications being made to their chemical structure to avoid regulatory issues. These compounds are extensively metabolized in the organism and often cannot be detected as the intact molecule in human urine. The monitoring of SCs in forensic samples must be performed by the analysis of their metabolites. In this work, a workflow for the comprehensive study of SC consumption is proposed and applied to 5F-APP-PICA (also known as PX 1 or SRF-30) and AMB-FUBINACA (also known as FUB-AMB or MMB-FUBINACA), based not only on the elucidation of their metabolites but also including functional data using the NanoLuc approach, previously published. Both cannabinoids were completely metabolized by human hepatocytes (12 and 8 metabolites were elucidated by high resolution mass spectrometry for 5F-APP-PICA and AMB-FUBINACA, respectively) and therefore suitable consumption markers are proposed. The bioassays revealed that 5F-APP-PICA presented lower activity than AMB-FUBINACA at CB1 and CB2 receptors, based on the half maximal effective concentration (EC50 ) and the maximum response (Emax ). These results are in agreement with the different intoxication cases found in the literature for AMB-FUBINACA.
Collapse
Affiliation(s)
| | - Marie Mardal
- Department of Forensic Medicine, Section of Forensic Chemistry, Faculty of Health and Medicinal Sciences, University of Copenhagen, Denmark
| | - Carolina Noble
- Department of Forensic Medicine, Section of Forensic Chemistry, Faculty of Health and Medicinal Sciences, University of Copenhagen, Denmark
| | - Annelies Cannaert
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Christophe P Stove
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Juan V Sancho
- Research Institute for Pesticides and Water, University Jaume I, Castellón, Spain
| | - Kristian Linnet
- Department of Forensic Medicine, Section of Forensic Chemistry, Faculty of Health and Medicinal Sciences, University of Copenhagen, Denmark
| | - Félix Hernández
- Research Institute for Pesticides and Water, University Jaume I, Castellón, Spain
| | - María Ibáñez
- Research Institute for Pesticides and Water, University Jaume I, Castellón, Spain
| |
Collapse
|
33
|
Nayak BP, Khajuria H. Synthetic marijuana is no more marijuana. Asian J Psychiatr 2019; 43:211-212. [PMID: 29146044 DOI: 10.1016/j.ajp.2017.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 11/06/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Biswa Prakash Nayak
- Amity Institute of Forensic Sciences, Amity University, Sec 125, Noida 201313, U.P., India.
| | - Himanshu Khajuria
- Amity Institute of Forensic Sciences, Amity University, Sec 125, Noida 201313, U.P., India.
| |
Collapse
|
34
|
Keskin G, Urganci N. Cannabinoid-induced toxic hepatitis. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2019. [DOI: 10.23736/s0393-3660.18.03786-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
35
|
Ivanov ID, Stoykova S, Ivanova E, Vlahova A, Burdzhiev N, Pantcheva I, Atanasov VN. A case of 5F-ADB / FUB-AMB abuse: Drug-induced or drug-related death? Forensic Sci Int 2019; 297:372-377. [DOI: 10.1016/j.forsciint.2019.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 12/28/2022]
|
36
|
Theunissen EL, Hutten NR, Mason NL, Toennes SW, Kuypers KP, Ramaekers JG. Neurocognition and Subjective Experience Following Acute Doses of the Synthetic Cannabinoid JWH-018: Responders Versus Nonresponders. Cannabis Cannabinoid Res 2019; 4:51-61. [PMID: 31363493 PMCID: PMC6661919 DOI: 10.1089/can.2018.0047] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Synthetic cannabinoid mixtures have been easily accessible for years, leading to the belief that these products were natural and harmless, which contributed to their popularity. Nevertheless, there are many reports of users ending up in hospital due to severe side effects such as tachycardia, aggression, and psychosis. Controlled studies on the effects of synthetic cannabinoids on human performance are lacking. In the present study, we assessed the safety pharmacology of the synthetic cannabinoid JWH-018 after acute administration. Methods: Seventeen healthy cannabis-experienced participants took part in this placebo-controlled, crossover study. Participants inhaled the vapor of JWH-018 (doses ranged between 2 and 6.2 mg) and were subsequently monitored for 12 h, during which vital signs, cognitive performance, and subjective experience were measured. Subjective high scores showed that there is a large variability in the subjective experience of participants. Therefore, a mixed analysis of variance, with "Responder" (i.e., subjective high score >2) as a between-subjects factor and "Drug" as a within-subjects factor (placebo and JWH-018), was used. Results: Serum concentrations of JWH-018 were significantly higher in the responders. Overall, JWH-018 increased heart rate within the first hour and significantly impaired critical tracking and memory performance. Responders to JWH-018 performed more poorly in tests measuring reaction time and showed increased levels of confusion, amnesia, dissociation, derealization, and depersonalization and increased drug liking after JWH-018. Conclusion: JWH-018 administration produced large variability in drug concentrations and subjective experience. Fluctuations in drug delivery probably contributed to the variation in response. JWH-018's impairing effects on cognition and subjective measures were mainly demonstrated in participants who experienced a subjective intoxication of the drug. Lack of control over drug delivery may increase the risk of overdosing in synthetic cannabinoid users.
Collapse
Affiliation(s)
- Eef L. Theunissen
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Nadia R.P.W. Hutten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Natasha L. Mason
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Stefan W. Toennes
- Department of Forensic Toxicology, Institute of Legal Medicine, Goethe University of Frankfurt, Frankfurt, Germany
| | - Kim P.C. Kuypers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Johannes G. Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
37
|
Abstract
INTRODUCTION The addictive disorder is a multifactorial pathology variable in its manifestations, environmental, developmental, inheritable, neurobiological, and behavioral. METHODS Synthesis of recent data from the literature. RESULTS/DISCUSSION Addiction is a pathology affecting decision-making, the emotional balance, the voluntary control of behaviour, not only in cases of psychoactive products use but also in behavioural dependencies. The social environment, developmental stages, and genetic factors are closely related to the vulnerability to addiction. In this article, after reviewing risk factors and neurobiology data, we will use cannabis, synthetic cannabinoids and cocaine as an example of substance use disorder.
Collapse
|
38
|
Amar JY, Ruta J, Rahimian D, Dillinger RL, Katz P. Toxic leukoencephalopathy with extrapyramidal dysfunction due to synthetic cannabinoids. J Clin Neurosci 2018; 58:213-214. [PMID: 30327216 DOI: 10.1016/j.jocn.2018.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/05/2018] [Indexed: 10/28/2022]
Abstract
Neurologic sequelae of synthetic cannabinoids are not well understood. We report a case of a woman who developed hyperreflexia, paratonia and cogwheel rigidity after consumption of synthetic cannabinoids. MR imaging demonstrated T2/FLAIR signal enhancement in the supratentorial white matter and globus pallidus internus.
Collapse
Affiliation(s)
- Jordan Yardain Amar
- Department of Neurology, Washington University School of Medicine, 1 Brookings Road, Campus Box 8121, St. Louis, MO 63110, United States.
| | - Jeffrey Ruta
- Department of Neurology, Lewis Katz School of Medicine at Temple University, 3401 North Broad Street, Philadelphia, PA 19140, United States
| | - David Rahimian
- Department of Neurology, Lewis Katz School of Medicine at Temple University, 3401 North Broad Street, Philadelphia, PA 19140, United States
| | - Rachel Leah Dillinger
- Department of Psychiatry, University of Maryland School of Medicine, 110 South Paca Street, Baltimore, MD 21201, United States
| | - Paul Katz
- Department of Neurology, Lewis Katz School of Medicine at Temple University, 3401 North Broad Street, Philadelphia, PA 19140, United States; Temple Neurosciences Center, 3509 N. Broad Street, Philadelphia, PA 19140, United States
| |
Collapse
|
39
|
Jambo H, Dispas A, Avohou HT, André S, Hubert C, Lebrun P, Ziemons É, Hubert P. Implementation of a generic SFC-MS method for the quality control of potentially counterfeited medicinal cannabis with synthetic cannabinoids. J Chromatogr B Analyt Technol Biomed Life Sci 2018; 1092:332-342. [DOI: 10.1016/j.jchromb.2018.05.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 11/29/2022]
|
40
|
Synthetic cannabinoids are substrates and inhibitors of multiple drug-metabolizing enzymes. Arch Pharm Res 2018; 41:691-710. [PMID: 30039377 DOI: 10.1007/s12272-018-1055-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 07/11/2018] [Indexed: 01/06/2023]
Abstract
Synthetic cannabinoids, a new class of psychoactive substances, are potent agonists of cannabinoid receptors, which mimic the psychoactive effects of the principal psychoactive component of cannabis, ∆9-tetrahydrocannabinol. Despite governmental scheduling as illicit drugs, new synthetic cannabinoids are being produced. The abuse of synthetic cannabinoids with several drugs containing different chemical groups has resulted in large numbers of poisonings. This has increased the urgency for forensic and public health laboratories to identify the metabolites of synthetic cannabinoids and apply this knowledge to the development of analytical methods and for toxicity prediction. It is necessary to determine whether synthetic cannabinoids are involved in drug-metabolizing enzyme-mediated drug-drug interactions. This review describes the metabolic pathways of 13 prevalent synthetic cannabinoids and various drug-metabolizing enzymes responsible for their metabolism, including cytochrome P450 (CYP), UDP-glucuronosyltransferases (UGTs), and carboxylesterases. The inhibitory effects of synthetic cannabinoids on CYP and UGT activities are also reviewed to predict the potential of synthetic cannabinoids for drug-drug interactions. The drug-metabolizing enzymes responsible for metabolism of synthetic cannabinoids should be characterized and the effects of synthetic cannabinoids on CYP and UGT activities should be determined to predict the pharmacokinetics of synthetic cannabinoids and synthetic cannabinoid-induced drug-drug interactions in the clinic.
Collapse
|
41
|
Bonsai intoxication at emergency service: A review of 61 cases. JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.422416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
42
|
Exploration of the Use of New Psychoactive Substances by Individuals in Treatment for Substance Misuse in the UK. Brain Sci 2018; 8:brainsci8040058. [PMID: 29601550 PMCID: PMC5924394 DOI: 10.3390/brainsci8040058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 11/23/2022] Open
Abstract
Substance misuse services need to meet the growing demand and needs of individuals using new psychoactive substances (NPS). A review of the literature identified a paucity of research regarding NPS use by these individuals and UK guidelines outline the need for locally tailored strategies. The purpose of this qualitative study was to identify and explore key themes in relation to the use of NPS by individuals receiving community treatment for their substance use. Electronic records identified demographics and semi-structured interviews were undertaken. A thematic analysis of transcripts identified a variety of substance use histories; 50% were prescribed opiate substitutes and 25% used NPS as a primary substance. All were males, age range 26–59 years (SD = 9), who predominantly smoked cannabinoids and snorted/injected stimulant NPS. The type of NPS used was determined by affordability, availability, side-effect profile and desired effects (physical and psychological: 25% reported weight loss as motivation for their use). Poly-pharmacy, supplementation and displacement of other drugs were prevalent. In conclusion, NPS use and associated experiences vary widely among people receiving substance use treatment. Development of effective recovery pathways should be tailored to individuals, and include harm reduction strategies, psychosocial interventions, and effective signposting. Services should be vigilant for NPS use, “on top” use and diversion of prescriptions.
Collapse
|
43
|
Sengel TY, Celik EG, Aydogan C, Gumus ZP, Ilktac R, Aydindogan E, Ciftci M, Aldemir E, Coskunol H, Timur S, Yagci Y. A Functional Platform for the Detection of JWH-073 as a Model for Synthetic Cannabinoids. ChemElectroChem 2018. [DOI: 10.1002/celc.201800015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Tulay Yilmaz Sengel
- Department of Biochemistry, Faculty of Science; Ege University; 35100 Bornova, Izmir Turkey
| | - Emine Guler Celik
- Department of Biochemistry, Faculty of Science; Ege University; 35100 Bornova, Izmir Turkey
| | - Cansu Aydogan
- Department of Chemistry, Faculty of Science and Letters; Istanbul Technical University; 34469, Maslak Istanbul Turkey
| | - Zinar Pinar Gumus
- Institute of Drug Abuse, Toxicology & Pharmaceutical Sciences; Ege University; 35100 Bornova, Izmir Turkey
- Central Research Testing and Analysis Laboratory Research and Application Center; Ege University; 35100 Bornova, Izmir Turkey
| | - Raif Ilktac
- Central Research Testing and Analysis Laboratory Research and Application Center; Ege University; 35100 Bornova, Izmir Turkey
| | - Eda Aydindogan
- Department of Biochemistry, Faculty of Science; Ege University; 35100 Bornova, Izmir Turkey
| | - Mustafa Ciftci
- Department of Chemistry, Faculty of Science and Letters; Istanbul Technical University; 34469, Maslak Istanbul Turkey
| | - Ebru Aldemir
- Institute of Drug Abuse, Toxicology & Pharmaceutical Sciences; Ege University; 35100 Bornova, Izmir Turkey
| | - Hakan Coskunol
- Ege University, Faculty of Medicine, Addiction Treatment Center; 35100 Bornova, Izmir/ Turkey
| | - Suna Timur
- Department of Biochemistry, Faculty of Science; Ege University; 35100 Bornova, Izmir Turkey
- Central Research Testing and Analysis Laboratory Research and Application Center; Ege University; 35100 Bornova, Izmir Turkey
| | - Yusuf Yagci
- Department of Chemistry, Faculty of Science and Letters; Istanbul Technical University; 34469, Maslak Istanbul Turkey
- King Abdulaziz University, Faculty of Science, Chemistry Department; Jeddah/ Saudi Arabia
| |
Collapse
|
44
|
Burns NK, Ashton TD, Stevenson PG, Pearson JR, Fox IL, Pfeffer FM, Francis PS, Smith ZM, Barnett NW, Chen L, White JM, Conlan XA. Extraction, identification and detection of synthetic cannabinoids found pre-ban in herbal products in Victoria, Australia. Forensic Chem 2018. [DOI: 10.1016/j.forc.2017.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
45
|
Barrett FS, Schlienz NJ, Lembeck N, Waqas M, Vandrey R. "Hallucinations" Following Acute Cannabis Dosing: A Case Report and Comparison to Other Hallucinogenic Drugs. Cannabis Cannabinoid Res 2018; 3:85-93. [PMID: 29682608 PMCID: PMC5908416 DOI: 10.1089/can.2017.0052] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction: Cannabis has been historically classified as a hallucinogen. However, subjective cannabis effects do not typically include hallucinogen-like effects. Empirical reports of hallucinogen-like effects produced by cannabis in controlled settings, particularly among healthy research volunteers, are rare and have mostly occurred after administration of purified Δ-9 tetrahydrocannabinol (THC) rather than whole plant cannabis. Methods: The case of a healthy 30-year-old male who experienced auditory and visual hallucinations in a controlled laboratory study after inhaling vaporized cannabis that contained 25 mg THC (case dose) is presented. Ratings on the Hallucinogen Rating Scale (HRS) following the case dose are compared with HRS ratings obtained from the participant after other doses of cannabis and with archival HRS data from laboratory studies involving acute doses of cannabis, psilocybin, dextromethorphan (DXM), and salvinorin A. Results: Scores on the Volition subscale of the HRS were greater for the case dose than for the maximum dose administered in any other comparison study. Scores on the Intensity and Perception subscales were greater for the case dose than for the maximum dose of cannabis, psilocybin, or salvinorin A. Scores on the Somaesthesia subscale were greater for the case dose than for the maximum dose of DXM, salvinorin A, or cannabis. Scores on the Affect and Cognition subscales for the case dose were significantly lower than for the maximum doses of psilocybin and DXM. Conclusion: Acute cannabis exposure in a healthy adult male resulted in self-reported hallucinations that rated high in magnitude on several subscales of the HRS. However, the hallucinatory experience in this case was qualitatively different than that typically experienced by participants receiving classic and atypical hallucinogens, suggesting that the hallucinatory effects of cannabis may have a unique pharmacological mechanism of action. This type of adverse event needs to be considered in the clinical use of cannabis.
Collapse
Affiliation(s)
- Frederick S Barrett
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nicolas J Schlienz
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Natalie Lembeck
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Muhammad Waqas
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ryan Vandrey
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
46
|
Avvisati R, Meringolo M, Stendardo E, Malavasi E, Marinelli S, Badiani A. Intravenous self-administration of benzydamine, a non-steroidal anti-inflammatory drug with a central cannabinoidergic mechanism of action. Addict Biol 2018; 23:610-619. [PMID: 28429885 DOI: 10.1111/adb.12516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 03/21/2017] [Accepted: 03/21/2017] [Indexed: 11/27/2022]
Abstract
Benzydamine (BZY) is a non-steroidal anti-inflammatory drug used for the topical treatment of inflammations of the oral and vaginal mucosae. Virtually nothing is known about the central pharmacological actions of BZY. Yet there are reports of voluntary systemic overdosage of BZY in drug addicts, resulting in a euphoric, hallucinatory state. In the present study, we investigated the reinforcing properties of BZY in a rat self-administration paradigm. We found that BZY has a powerful reinforcing effect and that this effect is greatly facilitated in animals that already had substance experience, having previously self-administered heroin and cocaine, indicating cross sensitization between BZY and other common drugs of abuse. We then assessed the effect of BZY on prelimbic cortex-to-nucleus accumbens glutamatergic transmission, using field recordings in rat parasagittal brain slices. BZY dose-dependently reduced both field excitatory post synaptic potential amplitude and paired pulse ratio, suggesting a presynaptic mechanism of action. Similarly to the in vivo paradigm, also the electrophysiological effects of BZY were potentiated in slices from animals that had undergone cocaine and heroin self-administration. Furthermore, BZY-induced Long Term Depression (LTD)-like responses in the prelimbic cortex-to-nucleus accumbens circuitry were significantly reduced in the presence of the CB1 receptor antagonist AM251. These findings provide firm evidence of the abuse liability of BZY and suggest a possible cannabinoidergic mechanism of action. Further research is needed in order to give insights into the molecular mechanism underlying BZY psychoactive and reinforcing effects, to better understand its abuse potential.
Collapse
Affiliation(s)
- Riccardo Avvisati
- Department of Physiology and Pharmacology; Sapienza University of Rome; Italy
- Sussex Addiction Research and Intervention Centre (SARIC), School of Psychology; University of Sussex; UK
| | - Maria Meringolo
- Department of Physiology and Pharmacology; Sapienza University of Rome; Italy
| | - Emiliana Stendardo
- Department of Physiology and Pharmacology; Sapienza University of Rome; Italy
| | - Elisa Malavasi
- Department of Physiology and Pharmacology; Sapienza University of Rome; Italy
| | | | - Aldo Badiani
- Department of Physiology and Pharmacology; Sapienza University of Rome; Italy
- Sussex Addiction Research and Intervention Centre (SARIC), School of Psychology; University of Sussex; UK
| |
Collapse
|
47
|
Coopman V, Cordonnier J. ‘Spice-like’ herbal incense laced with the synthetic opioid U-47700. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2018. [DOI: 10.1016/j.toxac.2017.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
48
|
Aydin S, Yuksel O, Aydin AE, Kizilkilic O, Celik SE. Intracerebral Hemorrhage with Multiple Intracranial Arterial Stenoses in a Synthetic Cannabinoid "Spice" User. Asian J Neurosurg 2018; 13:522-524. [PMID: 29682077 PMCID: PMC5898148 DOI: 10.4103/ajns.ajns_48_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Synthetic cannabinoids (spice), which are used frequently worldwide, are more potent than herbal compounds and also have more side effects in comparison. A 23-year-old male was admitted to the emergency unit with altered consciousness. There was no sign of trauma, and his medical history did not reveal any chronic illness. Computed tomography revealed a large frontal hematoma extending to the ventricular system. The outcomes of cerebral angiography were consistent with multiple intracranial arterial stenoses (MIAS) which can also be seen after cannabis usage. The patient made a good recovery with treatment, and during the follow-up, his medical condition was stable. In addition to the psychological symptoms, encephalopathy, ischemia, and seizures have also been described as side effects of synthetic cannabinoids. This paper reports an intracerebral hematoma due to synthetic cannabinoids and its association with MIAS.
Collapse
Affiliation(s)
- Seckin Aydin
- Department of Neurosurgery, Okmeydani Education and Research Hospital, Istanbul, Turkey
| | - Odhan Yuksel
- Department of Neurosurgery, Siverek State Hospital, Sanliurfa, Turkey
| | - Aysegul Esen Aydin
- Department of Neurosurgery, Okmeydani Education and Research Hospital, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Neuroradiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Suat Erol Celik
- Department of Neurosurgery, Okmeydani Education and Research Hospital, Istanbul, Turkey
| |
Collapse
|
49
|
Ralphs R, Gray P. New psychoactive substances: new service provider challenges. DRUGS-EDUCATION PREVENTION AND POLICY 2017. [DOI: 10.1080/09687637.2017.1417352] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Rob Ralphs
- Department of Sociology, Manchester Metropolitan University, Manchester, UK
| | - Paul Gray
- Department of Sociology, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
50
|
Fojtíková L, Šuláková A, Blažková M, Holubová B, Kuchař M, Mikšátková P, Lapčík O, Fukal L. Lateral flow immunoassay and enzyme linked immunosorbent assay as effective immunomethods for the detection of synthetic cannabinoid JWH-200 based on the newly synthesized hapten. Toxicol Rep 2017; 5:65-75. [PMID: 29276691 PMCID: PMC5738196 DOI: 10.1016/j.toxrep.2017.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 11/23/2017] [Accepted: 12/04/2017] [Indexed: 11/27/2022] Open
Abstract
In recent years, the use of synthetic cannabinoids (SCs) as drugs of abuse has greatly increased. SCs are associated with a risk of severe poisoning or even death. Therefore, more rapid, cost effective and reliable methods are needed, especially for the screening of drivers after traffic accidents and for detailed toxicological analysis in forensic laboratories. In this study, we developed a lateral flow immunoassay (LFIA) and an enzyme linked immunosorbent assay (ELISA) for the detection of JWH-200 in oral fluids. For this purpose a new hapten was prepared using a ten-step synthetic route. The developed immuno methods are based on antibodies obtained from rabbit immunized with synthesized hapten conjugated to carrier protein. The proposed methods are highly sensitive (LODLFIA = 0.08 ± 0.04 ng mL-1; LODELISA = 0.04 ± 0.02 ng mL-1). They were applied to the quantification of JHW-200 in spiked oral fluids. The recoveries ranged from 82 to 134% for both methods. The results correlated excellently with results obtained using UHPLC-MS/MS (R2LFIA = 0.99; R2ELISA = 0.99). Our developed methods could be an important tool for analyses of JWH-200 in human oral fluids. The one-step LFIA is particularly suitable for roadside and on-site monitoring due to the rapid qualitative results it delivers, while the ELISA is especially useful for laboratory quantitative analyses of positive samples captured by LFIA.
Collapse
Key Words
- BSA, bovine serum albumin
- DCC, N,N’-dicyclohexylcarbodiimide
- DIBAH, diisobutylaluminium hydride
- DMF, N,N-dimethylformamide
- ELISA
- ELISA, enzyme-linked immunosorbent assay
- GAR, goat anti-rabbit antibody
- GAR-Po, peroxidase labelled goat anti-rabbit antibody
- Hapten synthesis
- Immunomethods
- JWH-200
- LFIA
- LFIA, lateral flow immunoassay
- LOD, limit of detection
- NBS, N-bromosuccinimide
- NHS, N-hydroxysuccinimide
- NPS, new psychoactive substances
- PEG, polyethylene glycol
- RSA, rabbit serum albumin
- RSD, relative standard deviation
- SCs, synthetic cannabinoids
- Synthetic cannabinoid
- THC, thin layer chromatography
Collapse
Affiliation(s)
- Lucie Fojtíková
- Department of Biochemistry and Microbiology, Faculty of Food and Biochemical Technology, University of Chemistry and Technology Prague, Technická 3, 166 28 Prague, Czech Republic
| | - Anna Šuláková
- Department of Chemistry of Natural Compounds, Faculty of Food and Biochemical Technology, University of Chemistry and Technology Prague, Technická 3, 166 28 Prague, Czech Republic
| | - Martina Blažková
- Department of Biochemistry and Microbiology, Faculty of Food and Biochemical Technology, University of Chemistry and Technology Prague, Technická 3, 166 28 Prague, Czech Republic
| | - Barbora Holubová
- Department of Biochemistry and Microbiology, Faculty of Food and Biochemical Technology, University of Chemistry and Technology Prague, Technická 3, 166 28 Prague, Czech Republic
| | - Martin Kuchař
- Department of Chemistry of Natural Compounds, Faculty of Food and Biochemical Technology, University of Chemistry and Technology Prague, Technická 3, 166 28 Prague, Czech Republic
| | - Petra Mikšátková
- Department of Chemistry of Natural Compounds, Faculty of Food and Biochemical Technology, University of Chemistry and Technology Prague, Technická 3, 166 28 Prague, Czech Republic
| | - Oldřich Lapčík
- Department of Chemistry of Natural Compounds, Faculty of Food and Biochemical Technology, University of Chemistry and Technology Prague, Technická 3, 166 28 Prague, Czech Republic
| | - Ladislav Fukal
- Department of Biochemistry and Microbiology, Faculty of Food and Biochemical Technology, University of Chemistry and Technology Prague, Technická 3, 166 28 Prague, Czech Republic
| |
Collapse
|