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Amanollahi A, Babeveynezhad T, Sedighi M, Shadnia S, Akbari S, Taheri M, Besharatpour M, Jorjani G, Salehian E, Etemad K, Mehrabi Y. Incidence of rhabdomyolysis occurrence in psychoactive substances intoxication: a systematic review and meta-analysis. Sci Rep 2023; 13:17693. [PMID: 37848606 PMCID: PMC10582156 DOI: 10.1038/s41598-023-45031-4] [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: 10/17/2022] [Accepted: 10/14/2023] [Indexed: 10/19/2023] Open
Abstract
Rhabdomyolysis is a potentially life-threatening condition induced by diverse mechanisms including drugs and toxins. We aimed to investigate the incidence of rhabdomyolysis occurrence in intoxicated patients with psychoactive substances. In this review, three databases (PubMed, Scopus, Web of Science) and search engine (Google Scholar) were searched by various keywords. After the screening of retrieved documents, related data of included studies were extracted and analyzed with weighted mean difference (WMD) in random effect model. The highest incidence of rhabdomyolysis was observed in intoxication with heroin (57.2 [95% CI 22.6-91.8]), amphetamines (30.5 [95% CI 22.6-38.5]), and cocaine (26.6 [95% CI 11.1-42.1]). The pooled effect size for blood urea nitrogen (WMD = 8.78, p = 0.002), creatinine (WMD = 0.44, p < 0.001), and creatinine phosphokinase (WMD = 2590.9, p < 0.001) was high in patients with rhabdomyolysis compared to patients without rhabdomyolysis. Our results showed a high incidence of rhabdomyolysis induced by psychoactive substance intoxication in ICU patients when compared to total wards. Also, the incidence of rhabdomyolysis occurrence was high in ICU patients with heroin and amphetamine intoxication. Therefore, clinicians should anticipate this complication, monitor for rhabdomyolysis, and institute appropriate treatment protocols early in the patient's clinical course.
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Affiliation(s)
- Alireza Amanollahi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohsen Sedighi
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shahin Shadnia
- Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sadaf Akbari
- Department of Internal Medicine, Division of Nephrology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Mahbobeh Taheri
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Besharatpour
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Goljamal Jorjani
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Salehian
- Resources Development Deputy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Koorosh Etemad
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Yadollah Mehrabi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Sommer MJ, Halter S, Angerer V, Auwärter V, Eyer F, Liebetrau G, Ebbecke M, Hermanns-Clausen M. Effect of new legislation in Germany on prevalence and harm of synthetic cannabinoids. Clin Toxicol (Phila) 2022; 60:1130-1138. [PMID: 36074033 DOI: 10.1080/15563650.2022.2095282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
CONTEXT New psychoactive substances (NPS) have become an ongoing threat to public health. To prevent the emergence and spread of NPS, a new German law, the 'NpSG' took effect in November 2016. This study presents an overview of analytically confirmed synthetic cannabinoid (SC) intoxications from January 2015 to December 2018. In order to demonstrate effects of the NpSG, the results of 23 month before and 25 month after the introduction of the law were compared. METHODS Within the scope of a prospective observational study blood and urine samples were collected from emergency patients with suspected NPS intoxication. Comprehensive drug analyses were performed by LC-MS/MS analysis. RESULTS In the period considered, 138 patients were included. Within these, SC intake was verified in 65 patients (73%) in the period before the law change, and in 30 patients (61%) after. The median age increased significantly from 19.5 to 26 years. Seizures and admission to the ICU were reported significantly less frequently (seizures 29% versus 6.7%, p = 0.0283; ICU admission 42% versus 13%, p = 0.0089). 34 different SCs were detected, including four SCs (Cumyl-PEGACLONE, 5 F-MDMB-P7AICA, EG-018, 5 F-Cumyl-P7AICA) not covered by the NpSG at the time of detection. In the first period the most prevalent SC was MDMB-CHMICA (n = 24). 5 F-ADB was the most prevalent SC overall, detected in 7 patients (11%) in the first, and in 24 patients (80%) in the second period. CONCLUSION The number of SC intoxications decreased overall after the implementation of the NpSG. The shift in the detected SCs can be considered a direct effect of the NpSG but unfortunately the market supply does not appear to have been reduced. Although changes in the age distribution and in the severity of intoxications may be seen as secondary effects of the law, the main objectives of the new law to prevent the emergence and spread of further chemical variations of known scheduled drugs, have apparently not been achieved from the perspective of this study.
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Affiliation(s)
- Michaela J Sommer
- Forensic Toxicology, Institute of Forensic Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Poisons Information Center, Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Mecine, University of Freiburg, Freiburg, Germany.,Hermann Staudinger Graduate School, University of Freiburg, Freiburg, Germany
| | - Sebastian Halter
- Forensic Toxicology, Institute of Forensic Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Mecine, University of Freiburg, Freiburg, Germany
| | - Verena Angerer
- Forensic Toxicology, Institute of Forensic Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Mecine, University of Freiburg, Freiburg, Germany
| | - Volker Auwärter
- Forensic Toxicology, Institute of Forensic Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Mecine, University of Freiburg, Freiburg, Germany
| | - Florian Eyer
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Martin Ebbecke
- GIZ-Nord Poisons Centre, University Medical Centre Göttingen, Göttingen, Germany
| | - Maren Hermanns-Clausen
- Poisons Information Center, Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Mecine, University of Freiburg, Freiburg, Germany
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Weiss ST, Veach LJ, McGill W, Brent J. Rates and types of urine drug screen false negative results compared with confirmatory toxicology testing in major trauma patients. Clin Toxicol (Phila) 2022; 60:1122-1129. [PMID: 36069771 DOI: 10.1080/15563650.2022.2117052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Trauma centers are required to screen patients for alcohol use, and if necessary, intervene and refer to treatment (SBIRT). Similar screening for illicit drug use is recommended but not required. Urine drug screening (UDS) underestimates problematic substance use. This study aimed to estimate the types and rates of UDS false negatives (FN) compared to comprehensive testing by liquid chromatography-mass spectrometry (LC-MS) in trauma patients. METHODS We performed a prospective cohort study of deidentified urine samples from adult trauma and burn activation patients. Both UDS and LC-MS comprehensive testing of >200 analytes were performed by a reference laboratory on all samples. Iatrogenic medications were excluded from the FN count. Crosstab analyses were conducted for UDS versus LC-MS outcomes to establish FN types and rates. We dichotomized the results by creating an "intentionality" variable (intentional injuries by self/others versus accidental injuries). A series of crosstabs with odds ratios considered intentionality by substance class and demographics. Statistically significant variables by Chi-Square were assessed by logistic regression. RESULTS Psychoactive FN were detected in 56/100 urine samples analyzed; the most frequent included anticonvulsants (primarily gabapentin, N = 13), opioid agonists (N = 12), antihistamines (primarily diphenhydramine, N = 10), and phenethylamines (primarily bupropion, N = 5). Nonpsychoactive FN were detected in 70/100 samples; the most common were nicotine (N = 33), caffeine (N = 23), acetaminophen (N = 22), and antidepressants (N = 12). Of substance classes included in the UDS and also tested by LC-MS, FN occurred for opiates (3%), amphetamines (5%) and opioids (25%). Polypharmacy was associated with fall injuries in elderly patients. Cocaine (p = 0.015) and cannabinoids (p = 0.002) were significantly associated with intentionality. CONCLUSIONS Our results indicate that FN for potentially important psychoactive and nonpsychoactive substances are common when toxicologic testing is limited to routine UDS in trauma patients. We recommend expanding SBIRT in this patient population to include misuse of tobacco products, prescription analgesics, and over-the-counter antihistamines.
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Affiliation(s)
- Stephanie T Weiss
- Addiction Medicine Research Fellowship Program, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Translational Addiction Medicine Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Laura J Veach
- Addiction Medicine Research Fellowship Program, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Jeffrey Brent
- Departments of Medicine and Emergency Medicine, School of Medicine, University of Colorado, Aurora, CO, USA.,Toxicology Associates, Littleton, CO, USA
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Hakimian D, Benson AA, Khoury T, Massarwa M, Israel S, Salameh S, Gershinsky Y, Shapira B, Muszkat M. Gastrointestinal manifestations of synthetic cannabinoids: a retrospective cohort study. BMC Gastroenterol 2021; 21:274. [PMID: 34229620 PMCID: PMC8259032 DOI: 10.1186/s12876-021-01847-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 04/19/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Synthetic cannabinoids (SC) are chemical substances which activate cannabinoid receptors similarly to tetrahydrocannabinol, but with a higher efficacy. These substances are used as illicit recreational drugs, often smoked as herbal mixtures. The continuing availability and rapid evolution of SC is an ongoing health risk. The adverse effects of SC are wide ranging, and span from mild behavioral changes to death. Knowledge regarding gastrointestinal (GI) manifestations of SC use is sparse. METHODS Single tertiary-care referral medical center retrospective study. RESULTS The medical records of patients presented to hospital emergency care due to SC use between January 2014 and February 2018 were retrieved from Hadassah Mount Scopus Hospital's computerized database. The records were reviewed for clinical outcomes and laboratory tests. Fifty-five (55) patients were identified with a hospital presentation due to SC use. Twenty-one (21) out of 55 patients (38%) reported gastrointestinal complaints. The most common complaints were abdominal pain and vomiting. Of those, 28% had recurrent emergency department presentations due to abdominal pain and 66% presented with leukocytosis. Serum lactate was elevated in 66% of patients with GI manifestations. One patient had an abnormal computerized tomography (CT) abdominal angiography scan, which was compatible with intestinal ischemia. CONCLUSIONS The clinical spectrum of gastrointestinal manifestations in SC intoxication ranges from mild symptoms, such as abdominal pain and vomiting, to even more severe symptoms suggestive of intestinal ischemia. Clinicians should be aware that abdominal pain and other gastrointestinal complaints can be associated with SC use.
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Affiliation(s)
- David Hakimian
- Institute of Gastroenterology and Liver Diseases, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, 91240, Ein Kerem, Jerusalem, Israel.
| | - Ariel A Benson
- Institute of Gastroenterology and Liver Diseases, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, 91240, Ein Kerem, Jerusalem, Israel
| | - Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Bar-Ilan Faculty of Medicine, Safed, Israel
| | - Muhammad Massarwa
- Institute of Gastroenterology and Liver Diseases, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, 91240, Ein Kerem, Jerusalem, Israel
| | - Sarah Israel
- Department of Internal Medicine, Hadassah Medical Center Mt Scopus and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shaden Salameh
- Department of Emergency Medicine, Mt Scopus and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yonatan Gershinsky
- Department of Emergency Medicine, Mt Scopus and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Barak Shapira
- Braun School of Public Health and Community Medicine, Hebrew University Ein Kerem Medical Campus, Jerusalem, Israel
- Division of Enforcement and Inspection, Israel Ministry of Health, Jerusalem, Israel
| | - Mordechai Muszkat
- Department of Internal Medicine, Hadassah Medical Center Mt Scopus and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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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.
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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
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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.
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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
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