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Shopan N, Scolnik D, Hassoun E, Firsow A, Volkov I, Glatstein M. Acute intoxication caused by three common synthetic cannabinoids: The experience of a large, urban, tertiary care hospital. Am J Emerg Med 2023; 73:7-10. [PMID: 37572408 DOI: 10.1016/j.ajem.2023.08.007] [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: 06/23/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Synthetic cannabinoids (SC) are chemical substances, which activate cannabinoid receptors in a similar fashion to tetrahydrocannabinol, but with increased efficacy, and are used as illicit recreational drugs. OBJECTIVE Our objective was to characterize the clinical manifestations and management of three specific, common SC exposures in a cohort of patients presenting to the emergency department of our institution. METHODS Retrospective case series of patients admitted to an urban tertiary care center between August 1, 2018 and December 31, 2021, with confirmed SC use and positive urinary immunoassay testing for AB-FUBINACA, 4F-MDMB-BUTINACA and ACHMINACA. RESULTS 58 patients met inclusion criteria during the 3-year study period; median age was 35 years, 60% were male, 31% patients were exposed to >1 substance, and 31% needed hospital addition. The most common physical signs were cardiovascular (54%) and neuropsychiatric (45%). Severe outcomes included coma and seizures, necessitating intubation in 4 patients, and acute renal injury in 7 patients. CONCLUSION SC are potentially harmful drugs of abuse which can lead to life-threatening complications. Acute care personnel should be aware of the broad range of signs and symptoms of SC use. Testing with short turn around times is available to assess SC use.
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Affiliation(s)
- Noah Shopan
- Department of Emergency Medicine, Tel Aviv Medical Center, Faculty of Medicine, Tel Aviv University, Israel
| | - Dennis Scolnik
- Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Eyal Hassoun
- Clinical Biochemistry and Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv University, Israel
| | - Anastasia Firsow
- Clinical Biochemistry and Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv University, Israel
| | - Ilan Volkov
- General Psychiatry & Addiction Medicine, Dr. Tal Center for Psychiatry and Mental Health Services, Tel Aviv, Israel
| | - Miguel Glatstein
- Division of Pediatric Emergency Medicine Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel; Division of Clinical Toxicology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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Ciucă Anghel DM, Nițescu GV, Tiron AT, Guțu CM, Baconi DL. Understanding the Mechanisms of Action and Effects of Drugs of Abuse. Molecules 2023; 28:4969. [PMID: 37446631 DOI: 10.3390/molecules28134969] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/18/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
AIM Drug abuse and addiction are major public health concerns, with millions of people worldwide affected by the negative consequences of drug use. To better understand this complex issue, a review was conducted to examine the mechanisms of action and effects of drugs of abuse, including their acute and chronic effects, the symptoms of abstinence syndrome, as well as their cardiovascular impacts. METHODS The analyzed data were obtained after surveying an electronic database, namely PubMed, with no time limit, grey literature sources, and reference lists of relevant articles. RESULTS The review highlights the different categories of drugs of abuse, such as opioids, stimulants, depressants, hallucinogens, and cannabis, and discusses the specific ways that each drug affects the brain and body. Additionally, the review explores the short-term and long-term effects of drug abuse on the body and mind, including changes in brain structure and function, physical health problems, and mental health issues, such as depression and anxiety. In addition, the review explores the effects of drug abuse on cardiovascular health, focusing on electrocardiogram changes. Moreover, the analysis of relevant literature also highlighted possible genetic susceptibility in various addictions. Furthermore, the review delves into the withdrawal symptoms that occur when someone stops using drugs of abuse after a period of chronic use. CONCLUSION Overall, this review provides a comprehensive overview of the current state of knowledge on drug abuse and addiction. The findings of this review can inform the development of evidence-based prevention and intervention strategies to address this critical public health issue.
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Affiliation(s)
| | - Gabriela Viorela Nițescu
- Ward ATI-Toxicology, Paediatric Clinic 2, "Grigore Alexandrescu" Emergency Clinical Hospital for Children, 011732 Bucharest, Romania
| | - Andreea-Taisia Tiron
- Department of Medical Semiology, Sf. Ioan Emergency Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 20021 Bucharest, Romania
| | - Claudia Maria Guțu
- Department of Toxicology, Carol Davila University of Medicine and Pharmacy, 20021 Bucharest, Romania
| | - Daniela Luiza Baconi
- Department of Toxicology, Carol Davila University of Medicine and Pharmacy, 20021 Bucharest, Romania
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Hindson SA, Andrews RC, Danson MJ, van der Kamp MW, Manley AE, Sutcliffe OB, Haines TSF, Freeman TP, Scott J, Husbands SM, Blagbrough IS, Anderson JLR, Carbery DR, Pudney CR. Synthetic cannabinoid receptor agonists are monoamine oxidase-A selective inhibitors. FEBS J 2023; 290:3243-3257. [PMID: 36708234 PMCID: PMC10952593 DOI: 10.1111/febs.16741] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 01/13/2023] [Accepted: 01/27/2023] [Indexed: 01/29/2023]
Abstract
Synthetic cannabinoid receptor agonists (SCRAs) are one of the fastest growing classes of recreational drugs. Despite their growth in use, their vast chemical diversity and rapidly changing landscape of structures make understanding their effects challenging. In particular, the side effects for SCRA use are extremely diverse, but notably include severe outcomes such as cardiac arrest. These side effects appear at odds with the main putative mode of action, as full agonists of cannabinoid receptors. We have hypothesized that SCRAs may act as MAO inhibitors, owing to their structural similarity to known monoamine oxidase inhibitors (MAOI's) as well as matching clinical outcomes (hypertensive crisis) of 'monoaminergic toxicity' for users of MAOIs and some SCRA use. We have studied the potential for SCRA-mediated inhibition of MAO-A and MAO-B via a range of SCRAs used commonly in the UK, as well as structural analogues to prove the atomistic determinants of inhibition. By combining in silico and experimental kinetic studies we demonstrate that SCRAs are MAO-A-specific inhibitors and their affinity can vary significantly between SCRAs, most notably affected by the nature of the SCRA 'head' group. Our data allow us to posit a putative mechanism of inhibition. Crucially our data demonstrate that SCRA activity is not limited to just cannabinoid receptor agonism and that alternative interactions might account for some of the diversity of the observed side effects and that these effects can be SCRA-specific.
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Affiliation(s)
- Sarah A. Hindson
- Department of Biology and BiochemistryUniversity of BathBA2 7AYBathUK
| | - Rachael C. Andrews
- Department of ChemistryUniversity of BathBA2 7AYBathUK
- Centre for Sustainable and Circular TechnologiesUniversity of BathBA2 7AYBathUK
| | - Michael J. Danson
- Department of Biology and BiochemistryUniversity of BathBA2 7AYBathUK
| | | | - Amy E. Manley
- Faculty of Health SciencesUniversity of BristolBS8 1THBristolUK
| | - Oliver B. Sutcliffe
- MANchester DRug Analysis & Knowledge Exchange (MANDRAKE), Department of Natural SciencesManchester Metropolitan UniversityM15 5GDManchesterUK
| | | | | | - Jennifer Scott
- Faculty of Health SciencesUniversity of BristolBS8 1THBristolUK
| | | | - Ian S. Blagbrough
- Department of Pharmacy and PharmacologyUniversity of BathBA2 7AYBathUK
| | | | - David R. Carbery
- Department of ChemistryUniversity of BathBA2 7AYBathUK
- Centre for Sustainable and Circular TechnologiesUniversity of BathBA2 7AYBathUK
| | - Christopher R. Pudney
- Department of Biology and BiochemistryUniversity of BathBA2 7AYBathUK
- Centre for Sustainable and Circular TechnologiesUniversity of BathBA2 7AYBathUK
- Centre for Therapeutic InnovationUniversity of BathBA2 7AYBathUK
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Celeste-Villalvir A, Crouch C, Witte L, Heads AM, Weaver M, Schmitz JM, Isbell F, Schick V. Assessing Stage of Change and Harm Reduction Strategies for Synthetic Cannabinoid Use Among Individuals Experiencing Homelessness in Houston, Texas. JOURNAL OF DRUG ISSUES 2023. [DOI: 10.1177/00220426231161284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Synthetic cannabinoids (SCs) are low-cost substances that have been associated with adverse health outcomes and an increase in emergency department visits over recent years, particularly among people experiencing homelessness. This mixed methods study explored the connection between homelessness, SC use, and readiness to quit in order to inform the development of harm reduction strategies. Individuals (18+) residing in homeless encampments in Houston, TX with experiences of SC use were eligible to participate. Participants ( N = 65) completed an interviewer-administered survey about their SC use. Most participants were Black/African American (65.7%), male (82.9%), and most (75.4%) reported using SCs to avoid positive drug tests. Many wanted to quit using SCs (69.2%) and already employed harm reduction strategies while using SCs. Organizations supporting individuals experiencing homelessness who use SCs should focus on reducing barriers to stopping SC use and increasing the availability of housing and supportive services.
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Affiliation(s)
- Alane Celeste-Villalvir
- Department of Management, Policy & Community Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Laura Witte
- Department of Management, Policy & Community Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Angela M. Heads
- Department of Psychiatry and Behavioral Health, University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - Michael Weaver
- Department of Psychiatry and Behavioral Health, University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
- Center for Neurobehavioral Research on Addiction, Houston, TX, USA
| | - Joy M. Schmitz
- Department of Psychiatry and Behavioral Health, University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
- Center for Neurobehavioral Research on Addiction, Houston, TX, USA
| | | | - Vanessa Schick
- Department of Management, Policy & Community Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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5
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Al-Eitan L, Alkhawaldeh M. MDMB-FUBINACA Influences Brain Angiogenesis and the Expression of VEGF, ANG-1, and ANG-2. Curr Vasc Pharmacol 2023; 21:356-365. [PMID: 37711102 DOI: 10.2174/1570161121666230913093441] [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: 02/14/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/16/2023]
Abstract
AIM This study aims to explore the impact of the synthetic cannabinoid methyl 2-(1-(4- fluorobenzyl)-1H-indazole-3-carboxamido)-3,3-dimethylbutanoate (MDMB-FUBINACA) on the angiogenesis process in human brain microvascular endothelial cells. BACKGROUND Synthetic cannabinoids (SCs) are substances that mimic the natural components found in the cannabis plant. SCs are considered prohibited substances that have a clear impact on the central nervous system (CNS). OBJECTIVES The purpose of this study is to explore how MDMB-FUBINACA influences angiogenesis in human brain microvascular endothelial cells and to clarify the pathways related to the cannabinoid receptors. METHODS Human brain microvascular endothelial cells (hBMECs) were grown in the medium containing Dulbecco Modified Eagle Medium (DMEM/F12) using an endothelial cell growth kit. Endothelial cell viability was evaluated using the MTT test. Migration ability was measured using the Wound healing test. The angiogenic capability was measured using a Tube Formation assay. Real-time polymerase chain reaction (RT-PCR) was utilized to explore the mRNA concentrations following MDMBFUBINACA treatment. ELISA and Western blotting were also employed to measure the protein levels. RESULTS MDMB-FUBINACA greatly increases tube formation, endothelial cell proliferation, and migration. Pro-angiogenic factors such as angiopoietins 1 and 2 (ANG-1 and 2) and vascular endothelial growth factor (VEGF) were shown to be increased at both the RNA and protein levels. CONCLUSION MDMB-FUBINACA induces the progression of the angiogenesis process by inducing the expression of pro-angiogenic factors. These findings aim toward developing novel treatments for angiogenesis- related disorders.
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Affiliation(s)
- Laith Al-Eitan
- Biotechnology and Genetic Engineering Department, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Mishael Alkhawaldeh
- Biotechnology and Genetic Engineering Department, Jordan University of Science and Technology, Irbid, 22110, Jordan
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6
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Klein TA, Dilley JA, Graves JM, Liebelt EL. Synthetic cannabinoid poisonings and access to the legal cannabis market: findings from US national poison centre data 2016-2019. Clin Toxicol (Phila) 2022; 60:1024-1028. [PMID: 35942512 DOI: 10.1080/15563650.2022.2099887] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To investigate trends in synthetic cannabinoid exposures reported to United States (US) poison control centres, and their association with status of state cannabis legalisation. METHODS A retrospective study of National Poison Data System (NPDS) data from 2016 to 2019 identified and associated synthetic poisoning reports with annual state cannabis law and market status. State status was categorised as restrictive (cannabis illegal or limited medical legalisation), medical (allowing THC-containing medical cannabis use) and permissive (allowing non-medical use of THC-containing cannabis by adults). We categorised a subset of states with permissive policies by their implementation of legal adult possession/use and opening retail markets, on a quarterly basis. Mixed-effects Poisson regression models assessed synthetic exposures associated with legal status, first among all states using annual counts, and then among states that implemented permissive law alone using quarterly counts. RESULTS A total of 7600 exposures were reported during the study period. Overall, reported synthetic exposures declined over time. Most reported exposures (64.8%) required medical attention, and 61 deaths were documented. State implementation of medical cannabis law was associated with 13% fewer reported annual exposures. Adoption of permissive state cannabis policy was independently and significantly associated with 37% lower reported annual synthetic exposures, relative to restrictive policies (IRR: 0.63, 95% CI: 0.50-0.79). Among states with permissive law during the period, implementation of legal adult possession/use was associated with 22% fewer reported quarterly exposures. Opening of retail markets was associated with 36% fewer reported exposures, relative to states with medical cannabis only. CONCLUSIONS Adoption of permissive cannabis law was associated with significant reductions in reported synthetic cannabinoid exposures. More permissive cannabis law may have the unintended benefit of reducing both motivation and harms associated with use of synthetic cannabis products.
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Affiliation(s)
- Tracy A Klein
- College of Nursing, Washington State University, Vancouver, WA, USA
| | - Julia A Dilley
- Multnomah County Health Department, Oregon Health Authority, Portland, OR, USA
| | - Janessa M Graves
- College of Nursing, Washington State University, Spokane, WA, USA
| | - Erica L Liebelt
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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7
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Garus-Pakowska A, Kolmaga A, Gaszyńska E, Ulrichs M. The Scale of Intoxications with New Psychoactive Substances over the Period 2014-2020-Characteristics of the Trends and Impacts of the COVID-19 Pandemic on the Example of Łódź Province, Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4427. [PMID: 35457295 PMCID: PMC9031094 DOI: 10.3390/ijerph19084427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 12/04/2022]
Abstract
Legal highs are new psychoactive substances (NPSs) which pose a high risk for human health, and the spread of the SARS-CoV-2 pandemic has changed peoples’ behaviours, including the demand for NPS. The aim of the study was to assess both the frequency of intoxication with NPS in Łódź province over the period 2014−2020, and the impact of the COVID-19 pandemic on developing this trend. An analysis was carried out of data on intoxications in Łódź province in the years 2014−2020 reported by hospitals. The medical interventions rate (MI) per 100,000 people in the population was calculated. The frequency of intoxications was compared taking sociodemographic variables into account, and the effect of seasonal influence on intoxications was calculated using the Holt−Winter multiplicative seasonal method. In the period considered, there were 7175 acute NPS poisonings in the Łódź province and 25,495 in Poland. The averaged MI rate between 2014−2020 was 9.45 for Poland and 38.53 for the Łódź province, and the lowest value was found during the COVID pandemic in the year 2020 (respectively, 2.1 vs. 16.94). NPS users were mainly young men of 19−24 years old from a big city. Most cases were registered at weekends and in summer months. The majority of intoxications were caused by unidentified psychoactive substances of legal highs (chi2 = 513.98, p < 0.05). The actual number of NPS-related poisonings in the Łódź province in 2020 was lower than the value extrapolated from trend analysis of data between 2014−2019. NPS use in Poland decreased during the pandemic. It should be noted that a decrease in the number of drug-related incidents can have more than one reason, e.g., preventive programs, increased awareness, or changes in the law. This paper advocates that, in addition to monitoring NPS-related intoxications, there is further investigation into the social, cultural, and behavioural determinants of NPS to facilitate targeted prevention programmes and the development of new medical treatments.
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Affiliation(s)
- Anna Garus-Pakowska
- Department of Nutrition and Epidemiology, Medical University of Lodz, 90-752 Lodz, Poland; (A.K.); (E.G.)
| | - Agnieszka Kolmaga
- Department of Nutrition and Epidemiology, Medical University of Lodz, 90-752 Lodz, Poland; (A.K.); (E.G.)
| | - Ewelina Gaszyńska
- Department of Nutrition and Epidemiology, Medical University of Lodz, 90-752 Lodz, Poland; (A.K.); (E.G.)
| | - Magdalena Ulrichs
- Department of Econometrics, Faculty of Economics and Sociology, University of Lodz, 90-255 Lodz, Poland;
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Correia B, Fernandes J, Botica MJ, Ferreira C, Quintas A. Novel Psychoactive Substances: The Razor's Edge between Therapeutical Potential and Psychoactive Recreational Misuse. MEDICINES (BASEL, SWITZERLAND) 2022; 9:medicines9030019. [PMID: 35323718 PMCID: PMC8950629 DOI: 10.3390/medicines9030019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Novel psychoactive substances (NPS) are compounds of natural and synthetic origin, similar to traditional drugs of abuse. NPS are involved in a contemporary trend whose origin lies in a thinner balance between legitimate therapeutic drug research and legislative control. The contemporary NPS trend resulted from the replacement of MDMA by synthetic cathinones in 'ecstasy' during the 2000s. The most common NPS are synthetic cannabinoids and synthetic cathinones. Interestingly, during the last 50 years, these two classes of NPS have been the object of scientific research for a set of health conditions. METHODS Searches were conducted in the online database PubMed using boolean equations. RESULTS Synthetic cannabinoids displayed protective and therapeutic effects for inflammatory, neurodegenerative and oncologic pathologies, activating the immune system and reducing inflammation. Synthetic cathinones act similarly to amphetamine-type stimulants and can be used for depression and chronic fatigue. CONCLUSIONS Despite the scientific advances in this field of research, pharmacological application of NPS is being jeopardized by fatalities associated with their recreational use. This review addresses the scientific achievements of these two classes of NPS and the toxicological data, ending with a reflection on Illicit and NPS control frames.
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Affiliation(s)
- Beatriz Correia
- Laboratório de Ciências Forenses e Psicológicas Egas Moniz, Campus Universitário—Quinta da Granja, Monte de Caparica, 2825-084 Caparica, Portugal; (B.C.); (J.F.); (C.F.)
| | - Joana Fernandes
- Laboratório de Ciências Forenses e Psicológicas Egas Moniz, Campus Universitário—Quinta da Granja, Monte de Caparica, 2825-084 Caparica, Portugal; (B.C.); (J.F.); (C.F.)
| | - Maria João Botica
- Instituto Português de Oncologia de Lisboa Francisco Gentil (IPO), Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal;
| | - Carla Ferreira
- Laboratório de Ciências Forenses e Psicológicas Egas Moniz, Campus Universitário—Quinta da Granja, Monte de Caparica, 2825-084 Caparica, Portugal; (B.C.); (J.F.); (C.F.)
- Molecular Pathology and Forensic Biochemistry Laboratory, Centro de Investigação Interdisciplinar Egas Moniz, 2825-084 Caparica, Portugal
- Faculty of Medicine of Porto University, Rua Professor Lima Basto, 1099-023 Lisboa, Portugal
| | - Alexandre Quintas
- Laboratório de Ciências Forenses e Psicológicas Egas Moniz, Campus Universitário—Quinta da Granja, Monte de Caparica, 2825-084 Caparica, Portugal; (B.C.); (J.F.); (C.F.)
- Molecular Pathology and Forensic Biochemistry Laboratory, Centro de Investigação Interdisciplinar Egas Moniz, 2825-084 Caparica, Portugal
- Correspondence:
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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.
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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
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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.
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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
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11
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Cannabinoid Receptor Type 1 Regulates Drug Reward Behavior via Glutamate Decarboxylase 67 Transcription. Int J Mol Sci 2021; 22:ijms221910486. [PMID: 34638827 PMCID: PMC8508987 DOI: 10.3390/ijms221910486] [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: 07/21/2021] [Revised: 09/19/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
Interaction of cannabinoid receptor type 1 (CB1) and GABAergic neuronal activity is involved in drug abuse-related behavior. However, its role in drug-dependent Pavlovian conditioning is not well understood. In this study, we aimed to evaluate the effects of a CB1 agonist, JWH-210, on the development of conditioned place preference (CPP)-induced by methamphetamine (METH). Pretreatment with a synthetic cannabinoid, JWH-210 (CB1 agonist), increased METH-induced CPP score and METH-induced dopamine release in acute striatal slices. Interestingly, CB1 was expressed in glutamate decarboxylase 67 (GAD67) positive cells, and overexpression of CB1 increased GAD67 expression, while CB1 knockdown reduced GAD67 expression in vivo and in vitro. GAD67 is known as an enzyme involved in the synthesis of GABA. CB1 knockdown in the mice striatum increased METH-induced CPP. When GAD67 decreased in the mice striatum, mRNA level of CB1 did not change, suggesting that CB1 can regulate GAD67 expression. GAD67 knockdown in the mouse striatum augmented apomorphine (dopamine receptor D2 agonist)–induced climbing behavior and METH-induced CPP score. Moreover, in the human brain, mRNA level of GAD67 was found to be decreased in drug users. Therefore, we suggest that CB1 potentiates METH-induced CPP through inhibitory GABAergic regulation of dopaminergic neuronal activity.
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'Synthetic cannabis': A dangerous misnomer. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 98:103396. [PMID: 34343944 DOI: 10.1016/j.drugpo.2021.103396] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/23/2022]
Abstract
The term 'synthetic cannabis' has been widely used in public discourse to refer to a group of cannabinoid receptor agonists. In this paper we detail the characteristics of these drugs, and present the case that the term is a misnomer. We describe the pharmacodynamics of these drugs, their epidemiology, mechanisms of action, physiological effects and how these differ substantially from delta-9-tetrahydrocannabinol (THC). We argue that not only is the term a misnomer, but it is one with negative clinical and public health implications. Rather, the substances referred to as 'synthetic cannabis' in public discourse should instead be referred to consistently as synthetic cannabinoid receptor agonists (SCRAs), a drug class distinct from plant-derived cannabinoids. SCRAs have greater potency and efficacy, and psychostimulant-like properties. While such terminology may be used in the scientific community, it is not widely used amongst the media, general public, people who use these drugs or may potentially do so. A new terminology has the potential to reduce the confusion and harms that result from the misnomer 'synthetic cannabis'. The constant evolution of this distinct drug class necessitates a range of distinct policy responses relating to terminology, harm reduction, epidemiology, treatment, and legal status.
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Moustafa B, Testai FD. Cerebrovascular Complications Associated with Marijuana Use. Curr Neurol Neurosci Rep 2021; 21:25. [PMID: 33825077 DOI: 10.1007/s11910-021-01113-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW In the last few years, the attitude toward marijuana in many parts of the world has shifted from illicit to legalized for medical use and to decriminalized. In parallel, there has been a gradual increase in the consumption of this product in the general population, particularly among adolescents and young adults. Marijuana is generally perceived as a harmless drug. However, data obtained in observational studies and preclinical models have established associations between cannabis use and cardiovascular events. In addition, there is emerging evidence linking marijuana use to cerebrovascular complications. Here we provide a critical review of the literature with special emphasis on the association of cannabinoids with stroke and the possible pathogenic mechanisms involved. RECENT FINDINGS Ischemic and hemorrhagic stroke have been described in association with cannabis use, particularly in young individuals. Cerebral infarction remains the most commonly reported stroke subtype seen in marijuana users. Several pathogenic mechanisms have been proposed to explain this association, including multifocal intracranial stenosis, reversible cerebral vasoconstriction syndrome, and coexisting vascular risk factors. Cannabis use is increasingly recognized in young individuals presenting with acute stroke. Our understanding of the pathogenic mechanisms associated with cannabis use and stroke is limited but rapidly evolving. Healthcare providers should educate patients about the potential cardiovascular and cerebrovascular complications related to marijuana or cannabinoids use.
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Affiliation(s)
- Bayan Moustafa
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, College of Medicine, 912 S Wood St, Chicago, IL, USA.
| | - Fernando D Testai
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, College of Medicine, 912 S Wood St, Chicago, IL, USA
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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.
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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
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Overview of the major classes of new psychoactive substances, psychoactive effects, analytical determination and conformational analysis of selected illegal drugs. OPEN CHEM 2021. [DOI: 10.1515/chem-2021-0196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Abstract
The misuse of psychoactive substances is attracting a great deal of attention from the general public. An increase use of psychoactive substances is observed among young people who do not have enough awareness of the harmful effects of these substances. Easy access to illicit drugs at low cost and lack of effective means of routine screening for new psychoactive substances (NPS) have contributed to the rapid increase in their use. New research and evidence suggest that drug use can cause a variety of adverse psychological and physiological effects on human health (anxiety, panic, paranoia, psychosis, and seizures). We describe different classes of these NPS drugs with emphasis on the methods used to identify them and the identification of their metabolites in biological specimens. This is the first review that thoroughly gives the literature on both natural and synthetic illegal drugs with old known data and very hot new topics and investigations, which enables the researcher to use it as a starting point in the literature exploration and planning of the own research. For the first time, the conformational analysis was done for selected illegal drugs, giving rise to the search of the biologically active conformations both theoretically and using lab experiments.
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Schifano F, Napoletano F, Chiappini S, Guirguis A, Corkery JM, Bonaccorso S, Ricciardi A, Scherbaum N, Vento A. New/emerging psychoactive substances and associated psychopathological consequences. Psychol Med 2021; 51:30-42. [PMID: 31327332 DOI: 10.1017/s0033291719001727] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The present paper provides an updated review of both the large number of new/novel/emerging psychoactive substances (NPS) and their associated psychopathological consequences. Focus was here given on identification of those NPS being commented in specialised online sources and the related short-/long-term psychopathological and medical ill-health effects. METHODS NPS have been identified through an innovative crawling/navigating software, called the 'NPS.Finder®', created in order to facilitate the process of early recognition of NPS online. A range of information regarding NPS, including chemical and street names; chemical formula; three-dimensional image and anecdotally reported clinical/psychoactive effects, were here made available. RESULTS Using the 'NPS.Finder®' approach, a few thousand NPS were here preliminarily identified, a number which is about 4-fold higher than those figures suggested by European and international drug agencies. NPS most commonly associated with the onset of psychopathological consequences included here synthetic cannabinoids/cannabimimetics; new synthetic opioids; ketamine-like dissociatives; novel stimulants; novel psychedelics and several prescription and over-the-counter medicines. CONCLUSIONS The ever-increasing changes in terms of recreational psychotropics' availability represent a relatively new challenge for psychiatry, as the pharmacodynamics and pharmacokinetics of many NPS have not been thoroughly understood. Health/mental health professionals should be informed about the range of NPS; their intake modalities; their psychoactive sought-after effects; the idiosyncratic psychotropics' combinations and finally, their medical and psychopathological risks.
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Affiliation(s)
- F Schifano
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | | | - S Chiappini
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - A Guirguis
- Swansea University Medical School, Institute of Life Sciences 2, Swansea University, Singleton Park, Swansea, Wales
| | - J M Corkery
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - S Bonaccorso
- Camden and Islington NHS Mental Health Foundation Trust, London, UK
| | - A Ricciardi
- Camden and Islington NHS Mental Health Foundation Trust, London, UK
- Department of Mental Health, ASL Roma 1, Rome, Italy
| | - N Scherbaum
- LVR-Klinikum Essen, Klinik für Psychiatrie und Psychotherapie, University of Duisburg-Essen, Essen, Germany
| | - A Vento
- Addictions' Observatory (ODDPSS), Rome, Italy
- 'Guglielmo Marconi' University, Rome, Italy
- Department of Mental Health, ASL Roma 2, Rome, Italy
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Feeney W, Moorthy AS, Sisco E. Spectral trends in GC-EI-MS data obtained from the SWGDRUG mass spectral library and literature: A resource for the identification of unknown compounds. Forensic Chem 2020; 31:10.1016/j.forc.2022.100459. [PMID: 36578315 PMCID: PMC9793444 DOI: 10.1016/j.forc.2022.100459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Rapid identification of new or emerging psychoactive substances remains a critical challenge in forensic drug chemistry laboratories. Current analytical protocols are well-designed for confirmation of known substances yet struggle when new compounds are encountered. Many laboratories initially attempt to classify new compounds using gas chromatography-electron ionization-mass spectrometry (GC-EI-MS). Though there is a large body of research focused on the analysis of illicit substances with GC-EI-MS, there is little high-level discussion of mass spectral trends for different classes of drugs. This manuscript compiles literature information and performs simple exploratory analyses on evaluated GC-EI-MS data to investigate mass spectral trends for illicit substance classes. Additionally, this work offers other important aspects: brief discussions of how each class of drugs is used; illustrations of EI mass spectra with proposed structures of commonly observed ions; and summaries of mass spectral trends that can help an analyst classify new illicit compounds.
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Affiliation(s)
- William Feeney
- Corresponding author at: Surface and Trace Chemical Analysis Group, Material Measurement Laboratory, 100 Bureau Drive, Gaithersburg, MD 20899, USA. (W. Feeney)
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Lal S, Shekher A, Puneet, Narula AS, Abrahamse H, Gupta SC. Cannabis and its constituents for cancer: History, biogenesis, chemistry and pharmacological activities. Pharmacol Res 2020; 163:105302. [PMID: 33246167 DOI: 10.1016/j.phrs.2020.105302] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/03/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022]
Abstract
Cannabis has long been used for healing and recreation in several regions of the world. Over 400 bioactive constituents, including more than 100 phytocannabinoids, have been isolated from this plant. The non-psychoactive cannabidiol (CBD) and the psychoactive Δ9-tetrahydrocannabinol (Δ9-THC) are the major and widely studied constituents from this plant. Cannabinoids exert their effects through the endocannabinoid system (ECS) that comprises cannabinoid receptors (CB1, CB2), endogenous ligands, and metabolizing enzymes. Several preclinical studies have demonstrated the potential of cannabinoids against leukemia, lymphoma, glioblastoma, and cancers of the breast, colorectum, pancreas, cervix and prostate. Cannabis and its constituents can modulate multiple cancer related pathways such as PKB, AMPK, CAMKK-β, mTOR, PDHK, HIF-1α, and PPAR-γ. Cannabinoids can block cell growth, progression of cell cycle and induce apoptosis selectively in tumour cells. Cannabinoids can also enhance the efficacy of cancer therapeutics. These compounds have been used for the management of anorexia, queasiness, and pain in cancer patients. Cannabinoid based products such as dronabinol, nabilone, nabiximols, and epidyolex are now approved for medical use in cancer patients. Cannabinoids are reported to produce a favourable safety profile. However, psychoactive properties and poor bioavailability limit the use of some cannabinoids. The Academic Institutions across the globe are offering training courses on cannabis. How cannabis and its constituents exert anticancer activities is discussed in this article. We also discuss areas that require attention and more extensive research.
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Affiliation(s)
- Samridhi Lal
- Amity Institute of Pharmacy, Amity University, Gurgaon, Haryana, 122413, India
| | - Anusmita Shekher
- Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi, 221 005, India
| | - Puneet
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221 005, India
| | | | - Heidi Abrahamse
- Laser Research Centre, University of Johannesburg, Doornfontein, 2028, South Africa
| | - Subash C Gupta
- Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi, 221 005, India.
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Sezer Y, Jannuzzi AT, Huestis MA, Alpertunga B. In vitro assessment of the cytotoxic, genotoxic and oxidative stress effects of the synthetic cannabinoid JWH-018 in human SH-SY5Y neuronal cells. Toxicol Res (Camb) 2020; 9:734-740. [PMID: 33447358 DOI: 10.1093/toxres/tfaa078] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/14/2020] [Accepted: 09/22/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND JWH-018 was the first synthetic cannabinoid introduced as a legal high and the first of the new generation of novel psychoactive substances that flooded worldwide drug markets. JWH-018 was marketed as "spice," "herbal incense," or "herbal blend," as a popular and legal (at the time) alternative to cannabis (marijuana). JWH-018 is a potent synthetic cannabinoid with considerable toxicity associated with its use. JWH-018 has qualitatively similar but quantitatively greater pharmacological effects than cannabis, leading to intoxications and even deaths. The mechanisms of action of the drug's toxicity require research, and thus, the aim of the present study was to investigate the toxicological profile of JWH-018 in human SH-SY5Y neuronal cells. METHODS SH-SY5Y neuronal cells were exposed to increasing concentrations from 5 to 150 μM JWH-018 over 24 h. Cytotoxicity, DNA damage, the apoptotic/necrotic rate, and oxidative stress were assessed following SH-SY5Y exposure. RESULTS JWH-018 did not produce a significant decrease in SH-SY5Y cell viability, did not alter apoptotic/necrotic rate, and did not cause genotoxicity in SH-SY5Y cells with 24-h exposure. Glutathione reductase and catalase activities were significantly reduced; however, there was no significant change in glutathione peroxidase activity. Also, JWH-018 treatment significantly decreased glutathione concentrations, significantly increased protein carbonylation, and significantly increased malondialdehyde (MDA) concentrations. For significance, all P < 0.05. DISCUSSION/CONCLUSION JWH-018 produced oxidative stress in SH-SY5Y cells that could be an underlying mechanism of JWH-018 neurotoxicity. Additional in vivo animal and human-based studies are needed to confirm our findings.
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Affiliation(s)
- Yigit Sezer
- Council of Forensic Medicine, Ministry of Justice, Istanbul 34197, Turkey
| | - Ayse Tarbin Jannuzzi
- Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Istanbul University, Istanbul 34126, Turkey
| | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Buket Alpertunga
- Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Istanbul University, Istanbul 34126, Turkey
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Lodygin AN, Rakhmanova EA, Popova EA, Batotsyrenov BV, Popov AA, Bolshakova MA, Rakhmanov RM. [Optimization of treatment of acute poisoning with severe psychodisleptics]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:60-65. [PMID: 33081448 DOI: 10.17116/jnevro202012009160] [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: 11/17/2022]
Abstract
OBJECTIVE To increase the efficacy of acute poisoning with severe psychodisleptics. MATERIAL AND METHODS Fifty-two patients with acute psychoactive substance poisoning were studied. Patients of the main group (n=27) received cytoflavin infusion in combination with inhaled sedation with sevoflurane in addition to conventional therapy. The comparison group consisted of 25 patients who received conventional therapy. RESULTS AND CONCLUSION Augmentation of conventional therapy with cytoflavin in combination with inhaled sedation with sevoflurane, affecting various links in the pathogenesis of acute severe poisoning with psychodisleptics, made it possible to cope in a shorter time.
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Affiliation(s)
- A N Lodygin
- Dzhanelidze St. Petersburg research Institute of emergency medicine, St-Petersburg, Russia
| | - E A Rakhmanova
- Karpovich Krasnoyarsk Interdistrict clinical hospital of emergency medical care, Krasnoyarsk, Russia.,Voino-Yasenetsky Krasnoyarsk state medical University, Krasnoyarsk, Russia
| | - E A Popova
- Karpovich Krasnoyarsk Interdistrict clinical hospital of emergency medical care, Krasnoyarsk, Russia.,Voino-Yasenetsky Krasnoyarsk state medical University, Krasnoyarsk, Russia
| | - B V Batotsyrenov
- Dzhanelidze St. Petersburg research Institute of emergency medicine, St-Petersburg, Russia
| | - A A Popov
- Karpovich Krasnoyarsk Interdistrict clinical hospital of emergency medical care, Krasnoyarsk, Russia.,Voino-Yasenetsky Krasnoyarsk state medical University, Krasnoyarsk, Russia
| | - M A Bolshakova
- Karpovich Krasnoyarsk Interdistrict clinical hospital of emergency medical care, Krasnoyarsk, Russia.,Voino-Yasenetsky Krasnoyarsk state medical University, Krasnoyarsk, Russia
| | - R M Rakhmanov
- Karpovich Krasnoyarsk Interdistrict clinical hospital of emergency medical care, Krasnoyarsk, Russia.,Voino-Yasenetsky Krasnoyarsk state medical University, Krasnoyarsk, Russia
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Δ 9-tetrahydrocannabinol: Drug discrimination abuse liability testing in female Lister Hooded rats: Trials, tribulations and triumphs. J Pharmacol Toxicol Methods 2020; 106:106937. [PMID: 33096236 DOI: 10.1016/j.vascn.2020.106937] [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: 11/20/2019] [Revised: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The assessment of the abuse potential of CNS-active drugs is a regulatory requirement. Drug discrimination is one of the nonclinical tests that contribute to this assessment by providing information on a drug's potential to induce a discriminative stimulus comparable to that of a known drug of abuse. AIM The objective was to validate drug discrimination in the rat for the purpose of supporting regulatory submissions for novel drugs with potential cannabinoid-like activity. METHODS Ten female Lister hooded rats were trained to discriminate no-drug from Δ9-THC (1.5 mg/kg, IP) under a FR10 schedule of reinforcement. Once trained, a Δ9-THC dose-response curve was obtained using doses of 0.25, 0.75, 1.5, and 3 mg/kg, IP. This was followed by evaluation of amphetamine (0.3 mg/kg, SC); morphine (3 mg/kg, IP); midazolam (2.5 mg/kg, PO); and the synthetic cannabinoids WIN55,212-2 (0.75 to 2 mg/kg, IP), CP-47,497 (0.5 to 2 mg/kg, IP), and JWH-018 (1 mg/kg, IP) for their discriminative stimulus similarity to Δ9-THC. RESULTS Pharmacological specificity was demonstrated by achieving the anticipated dose-response curve for Δ9-THC, and a vehicle-like response for the non-cannabinoid drugs. Although full generalisation was obtained for JWH-018, in contrast to published literature, WIN55,212-2 and CP-47,497 failed to generalise to Δ9-THC. DISCUSSION Based on the literature review performed in light of the results obtained, contrasting and unpredictable behavioural responses produced by cannabinoids in animals and humans raises the question of the reliability and relevance of including drug discrimination and self-administration studies within an abuse potential assessment for novel cannabinoid-like drugs.
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Parajuli P, Regmi MR, Lara-Garcia OE, Abu Limon I, Deckard A. Man vs. man-made marijuana: A case of drug-induced posterior reversible encephalopathy syndrome (PRES) due to K2, a ynthetic cannabinoid (SCB). J Community Hosp Intern Med Perspect 2020; 10:361-364. [PMID: 32850099 PMCID: PMC7427457 DOI: 10.1080/20009666.2020.1781349] [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] [Indexed: 02/08/2023] Open
Abstract
Synthetic Cannabinoids (SCB) are engineered chemical compounds that share a similar chemical structure with the active ingredient of marijuana, delta-9-tetrahydrocanabinol. Although the FDA has not approved the use of SCB without a prescription from a licensed health-care provider, the cost effectiveness and availability of SCB has made it a popular choice among recreational drug users. Manufacture of SCB as a street drug is not regulated. These SCB are highly potent chemicals that cause various severe toxicities. In this case report, we describe an adult who suffered from PRES after consuming K2, a synthetic cannabinoid.
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Affiliation(s)
- Priyanka Parajuli
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Manjari Rani Regmi
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA
| | | | - Ismael Abu Limon
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Alan Deckard
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA
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Bulbena-Cabre A, DiGenova P, Sigel P, Dunn NR, Swift RG. Synthetic Cannabinoid Intoxication Presenting as Malignant Catatonia: a Case Report. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-018-9954-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Gamage TF, Barrus DG, Kevin RC, Finlay DB, Lefever TW, Patel PR, Grabenauer MA, Glass M, McGregor IS, Wiley JL, Thomas BF. In vitro and in vivo pharmacological evaluation of the synthetic cannabinoid receptor agonist EG-018. Pharmacol Biochem Behav 2020; 193:172918. [PMID: 32247816 DOI: 10.1016/j.pbb.2020.172918] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/26/2020] [Indexed: 01/08/2023]
Abstract
Synthetic cannabinoid receptor agonists (SCRAs) possess high abuse liability and complex toxicological profiles, making them serious threats to public health. EG-018 is a SCRA that has been detected in both illicit products and human samples, but it has received little attention to date. The current studies investigated EG-018 at human CB1 and CB2 receptors expressed in HEK293 cells in [3H]CP55,940 competition binding, [35S]GTPγS binding and forskolin-stimulated cAMP production. EG-018 was also tested in vivo for its ability to produce cannabimimetic and abuse-related effects in the cannabinoid tetrad and THC drug discrimination, respectively. EG-018 exhibited high affinity at CB1 (21 nM) and at CB2 (7 nM), but in contrast to typical SCRAs, behaved as a weak partial agonist in [35S]GTPγS binding, exhibiting lower efficacy but greater potency, than that of THC at CB1 and similar potency and efficacy at CB2. EG-018 inhibited forskolin-stimulated cAMP with similar efficacy but lower potency, compared to THC, which was likely due to high receptor density facilitating saturation of this signaling pathway. In mice, EG-018 (100 mg/kg, 30 min) administered intraperitoneally (i.p.) did not produce effects in the tetrad or drug discrimination nor did it shift THC's ED50 value in drug discrimination when administered before THC, suggesting EG-018 has negligible occupancy of brain CB1 receptors following i.p. administration. Following intravenous (i.v.) administration, EG-018 (56 mg/kg) produced hypomotility, catalepsy, and hypothermia, but only catalepsy was blocked by the selective CB1 antagonist rimonabant (3 mg/kg, i.v.). Additional studies of EG-018 and its structural analogues could provide further insight into how cannabinoids exert efficacy through the cannabinoid receptors.
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Affiliation(s)
- Thomas F Gamage
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Daniel G Barrus
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Richard C Kevin
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia; Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia
| | - David B Finlay
- Department of Pharmacology and Toxicology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Timothy W Lefever
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Purvi R Patel
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Megan A Grabenauer
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Michelle Glass
- Department of Pharmacology and Toxicology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Iain S McGregor
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia; Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia
| | - Jenny L Wiley
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA.
| | - Brian F Thomas
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
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Meader N, Mdege N, McCambridge J. The public health evidence-base on novel psychoactive substance use: scoping review with narrative synthesis of selected bodies of evidence. J Public Health (Oxf) 2019; 40:e303-e319. [PMID: 29409048 DOI: 10.1093/pubmed/fdy016] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Indexed: 12/17/2022] Open
Abstract
Background This review aimed to address what was known about the public health burden associated with novel psychoactive substances (NPS) use, and the effectiveness of responses targeting NPS use and/or associated problems. Methods Relevant literature was identified through a range of searches covering the period from January 2006 to June 2016. Data synthesis was undertaken in three stages. Firstly we mapped the evidence available in order to characterize the literature according to a set of analytic categories developed a priori. Secondly, we identified evidence gaps from a set of a priori research questions. Finally, we then undertook a narrative synthesis of selected bodies of evidence, interpreting data using a conceptual framework specifically designed for use in this review. Results A total of 995 articles were included in the scoping review with the majority being case reports/series on individual level adverse effects due to NPS use. We synthesized UK data from 29 surveys and 7 qualitative studies, and international data in 10 systematic reviews on harms associated with NPS use, and 17 evaluations of policy responses. We found little data on risk factors, harms associated with long-term NPS use, and interventions. Conclusion In all cases we found the available evidence to be at an early stage of development.
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Affiliation(s)
- Nick Meader
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Noreen Mdege
- Department of Health Sciences, University of York, York, UK
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Higgins K, O’Neill N, O’Hara L, Jordan JA, McCann M, O’Neill T, Clarke M, O’Neill T, Campbell A. Evidence for public health on novel psychoactive substance use: a mixed-methods study. PUBLIC HEALTH RESEARCH 2019. [DOI: 10.3310/phr07140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background
Novel psychoactive substances (NPSs) contribute to the public health impact of substance misuse. This report provides research evidence addressing 11 research questions related to NPSs, covering types, patterns and settings of use; supply sources; and implications for policy and practice.
Methods
The study used a conceptually linked three-phase mixed-methods design with a shared conceptual framework based on multiple-context risk and protective factors. Phase 1 was a quantitative phase involving secondary data analysis of the longitudinal Belfast Youth Development Study (BYDS), a latent class analysis using the 2039 BYDS participants. Phase 2 was an extensive qualitative analysis via narrative interviews with participants, sampled from BYDS, drug/alcohol services and prisons, to explore NPS use trajectories. Phase 3 was the final quantitative phase; generalisability of the shared risk factor part of the model was tested using the manual three-step approach to examine risk factors associated with latent class membership. The quantitative and qualitative analyses were integrated, thus allowing emerging findings to be further explored.
Results
The data suggest that NPSs have a place within a range of polydrug use trajectories. Models showed no distinctive NPS class, with no clear evidence of differential risks for NPS use compared with the use of other substances. From the qualitative analysis, a taxonomy of groups was derived that explored how and where NPSs featured in a range of trajectories. This taxonomy was used to structure the analysis of factors linked to use within a risk and protective framework. Drivers for use were considered alongside knowledge, perceptions and experience of harms. Suggestions about how interventions could best respond to the various patterns of use – with special consideration of synthetic cannabinoids (SCs), including how they relate to the use of heroin and the potential for NPSs to operate as a ‘snare’ to more problem use – were also presented.
Limitations
The study was conducted during 2016/17; generalisability beyond this sample and time point is limited. The level of missing data for some of the BYDS analysis was a limitation, as was the fact that the BYDS data were collected in 2011, so in a different context from the data collected during the narrative interviews. The Psychoactive Substances Act 2016 (Great Britain. Psychoactive Substances Act 2016. London: The Stationery Office; 2016) came into force during qualitative fieldwork and, although not particularly influential in this study, may be influential in future work. It is acknowledged that many of the data related to SCs and mephedrone. Although drug use was measured by self-report, the strength of rapport within interviews, reflective diaries and methodological acceptability checks helped to mitigate self-report bias.
Conclusions
NPSs continue to present significant challenges for legislation and monitoring, researching and developing interventions. Understanding of usage patterns remains poor, with most information based on populations and settings where problems have already occurred. This research contributes to the evidence base by providing much needed further empirical data on the lived experiences of NPS users across a range of settings. In the light of these data, implications for policy and practice are discussed.
Future work
Future research must generate improved epidemiological data on the extent, patterns and motivations for use longitudinally. The uniqueness of the information concerning SC use points to a specific set of findings not evidenced in other literature (e.g. intensity of SC withdrawal). Future research should focus on the symbiotic link between SC and heroin use.
Funding
The National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Kathryn Higgins
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, UK
- School of Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, UK
| | - Nina O’Neill
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, UK
- School of Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, UK
| | - Leeanne O’Hara
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, UK
- School of Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, UK
| | - Julie-Ann Jordan
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, UK
- School of Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, UK
| | - Mark McCann
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Tara O’Neill
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, UK
- School of Psychology, Queen’s University Belfast, Belfast, UK
| | - Mike Clarke
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Tony O’Neill
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, UK
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Anne Campbell
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, UK
- School of Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, UK
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Raghunathan R, Liu CH, Kouka A, Singh M, Miranda RC, Larin KV. Assessing the acute effects of prenatal synthetic cannabinoid exposure on murine fetal brain vasculature using optical coherence tomography. JOURNAL OF BIOPHOTONICS 2019; 12:e201900050. [PMID: 30887665 PMCID: PMC10039318 DOI: 10.1002/jbio.201900050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/15/2019] [Accepted: 03/17/2019] [Indexed: 05/02/2023]
Abstract
Marijuana is one of the most commonly abused substances during pregnancy. Synthetic cannabinoids (SCBs) are a group of heterogeneous compounds that are 40- to 600-fold more potent than Δ9 -tetrahydrocannabinol, the major psychoactive component of marijuana. With SCBs being legally available for purchase and the prevalence of unplanned pregnancies, the possibility of prenatal exposure to SCBs is high. However, the effects of prenatal SCB exposure on embryonic brain development are not well understood. In this study, we use complex correlation mapping optical coherence angiography to evaluate changes in murine fetal brain vasculature in utero, minutes after maternal exposure to an SCB, CP-55940. Results showed a significant decrease (P < 0.05) in fetal brain vessel diameter, length fraction and area density when compared to the sham group. This preliminary study shows that acute prenatal exposure to an SCB resulted in significant fetal brain vasoconstriction during the peak period for brain development.
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Affiliation(s)
- Raksha Raghunathan
- Department of Biomedical Engineering, University of Houston, Houston, Texas
| | - Chih-Hao Liu
- Department of Biomedical Engineering, University of Houston, Houston, Texas
| | - Amur Kouka
- Department of Biomedical Engineering, University of Houston, Houston, Texas
| | - Manmohan Singh
- Department of Biomedical Engineering, University of Houston, Houston, Texas
| | - Rajesh C. Miranda
- Department of Neuroscience and Experimental Therapeutics, TAMHSC College of Medicine, Bryan, Texas
| | - Kirill V. Larin
- Department of Biomedical Engineering, University of Houston, Houston, Texas
- Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas
- Correspondence: Kirill V. Larin, Department of Biomedical Engineering, University of Houston, 3517 Cullen Blvd., Houston, TX 77204.
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28
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Gamage TF, Farquhar CE, McKinnie RJ, Kevin RC, McGregor IS, Trudell ML, Wiley JL, Thomas BF. Synthetic Cannabinoid Hydroxypentyl Metabolites Retain Efficacy at Human Cannabinoid Receptors. J Pharmacol Exp Ther 2019; 368:414-422. [PMID: 30552295 PMCID: PMC6374541 DOI: 10.1124/jpet.118.254425] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/12/2018] [Indexed: 01/26/2023] Open
Abstract
Synthetic cannabinoids (SCs) are novel psychoactive substances that are easily acquired, widely abused as a substitute for cannabis, and associated with cardiotoxicity and seizures. Although the structural bases of these compounds are scaffolds with known affinity and efficacy at the human cannabinoid type-1 receptor (hCB1), upon ingestion or inhalation they can be metabolized to multiple chemical entities of unknown pharmacological activity. A large proportion of these metabolites are hydroxylated on the pentyl chain, a key substituent that determines receptor affinity and selectivity. Thus, the pharmacology of SC metabolites may be an important component in understanding the in vivo effects of SCs. We examined nine SCs (AB-PINACA, 5F-AB-PINACA, ADB/MDMB-PINACA, 5F-ADB, 5F-CUMYL-PINACA, AMB-PINACA, 5F-AMB, APINACA, and 5F-APINACA) and their hydroxypentyl (either 4-OH or 5-OH) metabolites in [3H]CP55,940 receptor binding and the [35S]GTPγS functional assay to determine the extent to which these metabolites retain activity at cannabinoid receptors. All of the SCs tested exhibited high affinity (<10 nM) and efficacy for hCB1 and hCB2 The majority of the hydroxypentyl metabolites retained full efficacy at hCB1 and hCB2, albeit with reduced affinity and potency, and exhibited greater binding selectivity for hCB2 These data suggest that phase I metabolites may be contributing to the in vivo pharmacology and toxicology of abused SCs. Considering this and previous reports demonstrating that metabolites retain efficacy at the hCB1 receptor, the full pharmacokinetic profiles of the parent compounds and their metabolites need to be considered in terms of the pharmacological effects and time course associated with these drugs.
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Affiliation(s)
- Thomas F Gamage
- RTI International, Research Triangle Park, North Carolina (T.F.G., C.E.F., J.L.W., B.F.T.); Department of Chemistry, University of New Orleans, New Orleans, Louisiana (R.J.M., M.L.T.); and School of Psychology, University of Sydney, Sydney, New South Wales, Australia (R.C.K., I.S.M.)
| | - Charlotte E Farquhar
- RTI International, Research Triangle Park, North Carolina (T.F.G., C.E.F., J.L.W., B.F.T.); Department of Chemistry, University of New Orleans, New Orleans, Louisiana (R.J.M., M.L.T.); and School of Psychology, University of Sydney, Sydney, New South Wales, Australia (R.C.K., I.S.M.)
| | - Ryan J McKinnie
- RTI International, Research Triangle Park, North Carolina (T.F.G., C.E.F., J.L.W., B.F.T.); Department of Chemistry, University of New Orleans, New Orleans, Louisiana (R.J.M., M.L.T.); and School of Psychology, University of Sydney, Sydney, New South Wales, Australia (R.C.K., I.S.M.)
| | - Richard C Kevin
- RTI International, Research Triangle Park, North Carolina (T.F.G., C.E.F., J.L.W., B.F.T.); Department of Chemistry, University of New Orleans, New Orleans, Louisiana (R.J.M., M.L.T.); and School of Psychology, University of Sydney, Sydney, New South Wales, Australia (R.C.K., I.S.M.)
| | - Iain S McGregor
- RTI International, Research Triangle Park, North Carolina (T.F.G., C.E.F., J.L.W., B.F.T.); Department of Chemistry, University of New Orleans, New Orleans, Louisiana (R.J.M., M.L.T.); and School of Psychology, University of Sydney, Sydney, New South Wales, Australia (R.C.K., I.S.M.)
| | - Mark L Trudell
- RTI International, Research Triangle Park, North Carolina (T.F.G., C.E.F., J.L.W., B.F.T.); Department of Chemistry, University of New Orleans, New Orleans, Louisiana (R.J.M., M.L.T.); and School of Psychology, University of Sydney, Sydney, New South Wales, Australia (R.C.K., I.S.M.)
| | - Jenny L Wiley
- RTI International, Research Triangle Park, North Carolina (T.F.G., C.E.F., J.L.W., B.F.T.); Department of Chemistry, University of New Orleans, New Orleans, Louisiana (R.J.M., M.L.T.); and School of Psychology, University of Sydney, Sydney, New South Wales, Australia (R.C.K., I.S.M.)
| | - Brian F Thomas
- RTI International, Research Triangle Park, North Carolina (T.F.G., C.E.F., J.L.W., B.F.T.); Department of Chemistry, University of New Orleans, New Orleans, Louisiana (R.J.M., M.L.T.); and School of Psychology, University of Sydney, Sydney, New South Wales, Australia (R.C.K., I.S.M.)
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29
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Hobbs M, Kalk NJ, Morrison PD, Stone JM. Spicing it up - synthetic cannabinoid receptor agonists and psychosis - a systematic review. Eur Neuropsychopharmacol 2018; 28:1289-1304. [PMID: 30454908 DOI: 10.1016/j.euroneuro.2018.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 09/13/2018] [Accepted: 10/23/2018] [Indexed: 01/04/2023]
Abstract
Synthetic cannabinoid receptor agonists (SCRAs) are suggested to have increased potential to induce psychosis compared to natural cannabis (NC). In this review we synthesise current knowledge about the association of SCRA use with psychotic symptoms. Following a literature search we identified 2 toxicology reports, 4 case-control studies, 3 cross-sectional studies and 15 case reports. In each of the case reports, we identified the presence or absence of symptoms based on the items of the Postitive and Negative Syndrome Scele (PANSS). The toxicology reports highlighted the main presenting features as being toxic psychosis and delirium (40%), agitation (10%) and hallucinations (4-7%). The median age was 25 years, and around 80% cases were male. Cross-sectional studies reported that SCRA use was present in approximately 10-13% patients presenting to acute psychiatric services, and was often the cause of their presentation, and that psychotic symptoms were present in 15% patients attending emergency departments following SCRA use. Case-control studies reported that SCRA use was significantly associated with psychotic symptoms and that SCRA users had higher levels of positive psychotic symptoms than NC users. The case reports supported the association of SCRA use with a wide range of positive and negative psychotic symptoms as well as with self-harm, agitation and aggressive behaviour. SCRA use is relatively prevalent in patients with psychosis and may lead to psychotic symptoms in individuals with no past psychiatric history. Further work is required to understand the long term risks of SCRA use and optimal management strategies.
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Affiliation(s)
- Melissa Hobbs
- King's College London Institute of Psychiatry, Psychology and Neuroscience, United Kingdom
| | - Nicola J Kalk
- King's College London Institute of Psychiatry, Psychology and Neuroscience, United Kingdom
| | - Paul D Morrison
- King's College London Institute of Psychiatry, Psychology and Neuroscience, United Kingdom
| | - James M Stone
- King's College London Institute of Psychiatry, Psychology and Neuroscience, United Kingdom.
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30
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Smith KE, Staton M. Synthetic cannabinoid use among a sample of individuals enrolled in community-based recovery programs: Are synthetic cannabinoids actually preferred to other drugs? Subst Abus 2018; 40:160-169. [PMID: 30457960 DOI: 10.1080/08897077.2018.1528495] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Over the past decade, availability and use of novel psychoactive substances such as synthetic cannabinoid receptor agonists (SCRA) have proliferated globally. However, the prevalence of SCRAs use remains uncertain, as does the degree to which individuals reporting SCRA use prefer SCRA to other drugs. Methods: In April 2017, a total of 500 anonymous surveys were completed by clients enrolled in a residential drug recovery program. Chi-square and t tests were used to examine significant differences between those who had ever used SCRA and those who had not. Logistic regression analysis was conducted in order to determine which other substances used within the past 12 months were significantly associated with past-12-month SCRA use. Results: About 69% (68.4%) of clients reported lifetime SCRA use. Those reporting SCRA use were predominantly younger ( x¯ = 32.5 vs. 40.7, P < .001), single (60.3% vs. 48.1%, P = .011), and white (87.1% vs. 77.7%, P = .008) and were more likely to have experienced past-12-month homelessness (6.5% vs. 3.2%, P = .004). This group had higher rates of probation/parole involvement (79.2% vs. 61.8%, P < .001) and incarceration (91.8% vs. 79.6%, P < .001). Individuals reporting SCRA use also showed extensive substance use histories and favored heroin, opioids, and amphetamines compared with SCRA. Only 5.2% of the SCRA-using group stated that SCRA was a preferred substance, and only 11.8% reported that they would try SCRA again. E-cigarettes (adjusted odds ratio [AOR] = 1.88), traditional cannabis (AOR = 3.87), amphetamines (AOR = 2.20), and synthetic cathinones (AOR = 3.51) were significantly associated with past-12-month SCRA use. Motivations for use included circumnavigating drug screens and peer influence. Approximately half of those who tried SCRA reported adverse effects associated with use. Conclusions: Prevalence of SCRA use among individuals with a history of substance misuse and criminal justice system involvement is high; however, SCRA are not indicated as a preferred drug.
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Affiliation(s)
- Kirsten Elin Smith
- Kent School of Social Work, University of Louisville , Louisville , Kentucky , USA.,Center on Drug and Alcohol and Research, University of Kentucky , Lexington , Kentucky , USA
| | - Michele Staton
- Department of Behavioral Science, University of Kentucky , Lexington , Kentucky , USA.,Center on Drug and Alcohol and Research, University of Kentucky , Lexington , Kentucky , USA
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31
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Kaló Z, Kassai S, Rácz J, Van Hout MC. Synthetic Cannabinoids (SCs) in Metaphors: a Metaphorical Analysis of User Experiences of Synthetic Cannabinoids in Two Countries. Int J Ment Health Addict 2018. [DOI: 10.1007/s11469-018-9970-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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32
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Yücens B, Kotan VO, Okay İT, Göka E. The severity of dissociative symptoms among patients with cannabis and synthetic cannabinoid use disorder: association with substance use characteristics and suicide. PSYCHIAT CLIN PSYCH 2018. [DOI: 10.1080/24750573.2018.1505451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Bengü Yücens
- Department of Psychiatry, Afyon Kocatepe University Medical Faculty, Afyonkarahisar, Turkey
| | - Vahap Ozan Kotan
- Department of Psychiatry, Başkent University Medical Faculty, Ankara, Turkey
| | - İhsan Tuncer Okay
- Department of Psychiatry, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Erol Göka
- Department of Psychiatry, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Abstract
Several novel psychoactive substances have emerged in recent years. Users are typically young men who use other substances. In the category of stimulants, cathinones ("bath salts") have predominated and can lead to agitation, psychosis, hyperthermia, and death. Synthetic cannabinoids ("spice") are more potent than marijuana and can lead to agitation, psychosis, seizures, and death. There are no rapid tests to identify these substances and general treatment includes benzodiazepines for agitation and supportive therapy. Many Synthetic opioids are potent analogues of fentanyl and carry a high risk of overdose. In addition, there are several designer benzodiazepines that have emerged.
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Affiliation(s)
- Ryan Graddy
- Division of Chemical Dependence, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite D5W, Baltimore, MD 21224, USA
| | - Megan E Buresh
- Division of Chemical Dependence, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite D5W, Baltimore, MD 21224, USA
| | - Darius A Rastegar
- Division of Chemical Dependence, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite D5W, Baltimore, MD 21224, USA.
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Cengel HY, Bozkurt M, Evren C, Umut G, Keskinkilic C, Agachanli R. Evaluation of cognitive functions in individuals with synthetic cannabinoid use disorder and comparison to individuals with cannabis use disorder. Psychiatry Res 2018; 262:46-54. [PMID: 29407568 DOI: 10.1016/j.psychres.2018.01.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 11/26/2017] [Accepted: 01/24/2018] [Indexed: 02/05/2023]
Abstract
The use of synthetic cannabinoid has been increasing throughout the world and has become a major public health problem. The present study aims to investigate the attention, memory, visuospatial and executive functions in individuals with synthetic cannabinoid use disorder and compare the results with findings obtained from individuals with cannabis use disorder and healthy volunteers with no substance use. Fifty-two patients with synthetic cannabinoid use disorder, 45 patients with cannabis use disorder and 48 healthy control group males were included in the study. The neuropsychological test battery was designed to involve ten studies evaluating a large series of cognitive functions. Impairments in attention, memory, executive and visuospatial functions were identified in individuals with synthetic cannabinoid use disorder and these impairments were found to be significantly greater than in individuals with cannabis use disorder and healthy controls. In line with the data obtained from this study; the evaluation of each cognitive function with more comprehensive test batteries and supporting these evaluations with sensitive brain imaging studies are important topics for future research.
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Affiliation(s)
- Hanife Yilmaz Cengel
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey.
| | - Muge Bozkurt
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Cuneyt Evren
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Gokhan Umut
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Cahit Keskinkilic
- Department of Neuropsychology, Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Ruken Agachanli
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
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35
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Gamage TF, Farquhar CE, Lefever TW, Marusich JA, Kevin RC, McGregor IS, Wiley JL, Thomas BF. Molecular and Behavioral Pharmacological Characterization of Abused Synthetic Cannabinoids MMB- and MDMB-FUBINACA, MN-18, NNEI, CUMYL-PICA, and 5-Fluoro-CUMYL-PICA. J Pharmacol Exp Ther 2018; 365:437-446. [PMID: 29549157 DOI: 10.1124/jpet.117.246983] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/06/2018] [Indexed: 12/29/2022] Open
Abstract
Synthetic cannabinoids are a class of novel psychoactive substances that exhibit high affinity at the cannabinoid type-1 (CB1) receptor and produce effects similar to those of Δ-9-tetrahydrocannabinol (THC), the primary psychoactive constituent of cannabis. Illicit drug manufacturers are continually circumventing laws banning the sale of synthetic cannabinoids by synthesizing novel structures and doing so with little regard for the potential impact on pharmacological and toxicological effects. Synthetic cannabinoids produce a wide range of effects that include cardiotoxicity, seizure activity, and kidney damage, and they can cause death. Six synthetic cannabinoids, recently detected in illicit preparations, MMB-FUBINACA, MDMB-FUBINACA, CUMYL-PICA, 5F-CUMYL-PICA, NNEI, and MN-18 were assessed for: 1) receptor binding affinity at the human CB1 and human CB2 receptors, 2) function in [35S]GTPγS and cAMP signaling, and 3) THC-like effects in a mouse drug discrimination assay. All six synthetic cannabinoids exhibited high affinity for human cannabinoid receptors type-1 and type-2 and produced greater maximal effects than THC in [35S]GTPγS and cAMP signaling. Additionally, all six synthetic cannabinoids substituted for THC in drug discrimination, suggesting they probably possess subjective effects similar to those of cannabis. Notably, MDMB-FUBINACA, a methylated analog of MMB-FUBINACA, had higher affinity for CB1 than the parent, showing that minor structural modifications being introduced can have a large impact on the pharmacological properties of these drugs. This study demonstrates that novel structures being sold and used illicitly as substitutes for cannabis are retaining high affinity at the CB1 receptor, exhibiting greater efficacy than THC, and producing THC-like effects in models relevant to subjective effects in humans.
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Affiliation(s)
| | | | | | | | | | | | - Jenny L Wiley
- RTI International, Research Triangle Park, North Carolina
| | - Brian F Thomas
- RTI International, Research Triangle Park, North Carolina;
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36
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Sherif MA, Cortes-Briones JA, Ranganathan M, Skosnik PD. Cannabinoid-glutamate interactions and neural oscillations: implications for psychosis. Eur J Neurosci 2018; 48:2890-2902. [PMID: 29247465 DOI: 10.1111/ejn.13800] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 12/06/2017] [Accepted: 12/07/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Mohamed A. Sherif
- Department of Psychiatry; Yale University School of Medicine; VA Connecticut Healthcare System Building 5, Suite C-214 950 Campbell Avenue West Haven CT 06516 USA
| | - Jose A. Cortes-Briones
- Department of Psychiatry; Yale University School of Medicine; VA Connecticut Healthcare System Building 5, Suite C-214 950 Campbell Avenue West Haven CT 06516 USA
| | - Mohini Ranganathan
- Department of Psychiatry; Yale University School of Medicine; VA Connecticut Healthcare System Building 5, Suite C-214 950 Campbell Avenue West Haven CT 06516 USA
| | - Patrick D. Skosnik
- Department of Psychiatry; Yale University School of Medicine; VA Connecticut Healthcare System Building 5, Suite C-214 950 Campbell Avenue West Haven CT 06516 USA
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37
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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.
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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
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Health and Social Problems Associated with Recent Novel Psychoactive Substance (NPS) Use Amongst Marginalised, Nightlife and Online Users in Six European Countries. Int J Ment Health Addict 2017; 16:480-495. [PMID: 29674947 PMCID: PMC5897487 DOI: 10.1007/s11469-017-9824-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Continued diversification and use of new psychoactive substances (NPS) across Europe remains a public health challenge. The study describes health and social consequences of recent NPS use as reported in a survey of marginalised, nightlife and online NPS users in the Netherlands, Hungary, Portugal, Ireland, Germany and Poland (n = 3023). Some respondents were unable to categorise NPS they had used. Use of ‘herbal blends’ and ‘synthetic cannabinoids obtained pure’ was most reported in Germany, Poland and Hungary, and use of ‘branded stimulants’ and ‘stimulants/empathogens/nootropics obtained pure’ was most reported in the Netherlands. Increased heart rate and palpitation, dizziness, anxiety, horror trips and headaches were most commonly reported acute side effects. Marginalised users reported substantially more acute side effects, more mid- and long-term mental and physical problems, and more social problems. Development of country-specific NPS awareness raising initiatives, health and social service needs assessments, and targeted responses are warranted.
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Babi MA, Robinson CP, Maciel CB. A spicy status: Synthetic cannabinoid (spice) use and new-onset refractory status epilepticus-A case report and review of the literature. SAGE Open Med Case Rep 2017; 5:2050313X17745206. [PMID: 29238581 PMCID: PMC5721953 DOI: 10.1177/2050313x17745206] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/07/2017] [Indexed: 02/02/2023] Open
Abstract
Synthetic cannabinoids refer to a wide variety of chemicals engineered to bind cannabinoid receptors (CB1 and CB2) and mimic the effects of delta-9-tetrahydrocanabinol. The potential for severe toxicity and limited in vivo data make synthetic cannabinoid intake an important public health and safety concern. Neurologic toxidromes associated with their use include mental status changes, panic attacks, memory distortions, acute psychosis (e.g. paranoia, delusional thoughts), disorganized behavior, and suicidal and homicidal thoughts. Systemic complications include vomiting, sinus tachycardia, myocardial infarction, and acute kidney injury. Seizures are common; however, status epilepticus is not widely reported. In this case report, we describe a patient who developed acute psychosis and new-onset refractory status epilepticus necessitating emergent neurological life-support and prolonged admission to an intensive care unit following abuse of synthetic cannabinoids. We include a brief review of the literature to prepare the treating clinician for the broad clinical spectrum of this increasingly common intoxication.
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Affiliation(s)
- Marc-Alain Babi
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | | | - Carolina B Maciel
- Department of Neurology, University of Florida, Gainesville, FL, USA
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Marusich JA, Wiley JL, Lefever TW, Patel PR, Thomas BF. Finding order in chemical chaos - Continuing characterization of synthetic cannabinoid receptor agonists. Neuropharmacology 2017; 134:73-81. [PMID: 29113898 DOI: 10.1016/j.neuropharm.2017.10.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 10/11/2017] [Accepted: 10/31/2017] [Indexed: 01/01/2023]
Abstract
Diversion of synthetic cannabinoids from the lab to drugs of abuse has become increasingly prevalent in recent years. Moreover, as earlier synthetic cannabinoids were banned, manufacturers introduced a new supply of novel compounds to serve as replacements. Hence, the chemical diversity of synthetic cannabinoid analogs has also rapidly increased. The present study examined 8 new synthetic cannabinoids: AM-1220, AM-2232, AM-2233, AM-679, EAM-2201, JWH-210, JHW-251, and MAM-2201. Each compound was assessed for binding affinity and functional activation of CB1 and CB2 receptors, and pharmacological equivalence with Δ9-tetrahydrocannabinol (THC) in THC drug discrimination. All compounds bound to and activated CB1 and CB2 receptors, although efficacy at the CB2 receptor was reduced compared to that for the CB1 receptor. Similarly, all compounds stimulated [35S]GTPγS binding through the CB1 receptor, and all compounds except AM-1220 and AM-2233 stimulated [35S]GTPγS binding through the CB2 receptor. Furthermore, these compounds, along with CP55,940, substituted for THC in THC drug discrimination. Rank order of potency in drug discrimination was correlated with CB1 receptor binding affinity. Together, these results suggest that all test compounds share the THC-like subjective effects of marijuana. Interestingly, the most potent compounds in CB1 binding in the present study were also the compounds that have been found recently in the U.S., MAM-2201, EAM-2201, JWH-210, AM-2233, and AM-1220. These results indicate that the evolution of the synthetic cannabinoid drug market may be focused toward compounds with increased potency. This article is part of the Special Issue entitled 'Designer Drugs and Legal Highs.'
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Affiliation(s)
- Julie A Marusich
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, United States
| | - Jenny L Wiley
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, United States
| | - Timothy W Lefever
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, United States
| | - Purvi R Patel
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, United States
| | - Brian F Thomas
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, United States.
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Abstract
PURPOSE OF REVIEW Physicians of all disciplines must rapidly adjust their clinical practices following the expansion of marijuana legalization across the country. Organ transplantation teams are uniquely struggling in this gray zone with eight states having passed laws explicitly banning the denial of transplant listing based on a patient's use of medical marijuana. In this review, we examine the clinical evidence of marijuana use in transplant patients to enable psychiatric providers to meaningfully contribute to the relevant medical and psychiatric aspects of this issue in a unique patient population. RECENT FINDINGS There is no consensus among experts regarding marijuana use in transplantation patients. There are extant case reports of post-transplant complications attributed to marijuana use including membranous glomerulonephritis, ventricular tachycardia, and tacrolimus toxicity. However, recent studies suggest that the overall survival rates in kidney, liver, lung, and heart transplant patients using marijuana are equivalent to non-users. Transplant teams should not de facto exclude marijuana users from transplant listing but instead holistically evaluate a patient's candidacy, integrating meaningful medical, psychiatric, and social variables into the complex decision-making process. Psychiatric providers can play a key role in this process. Appropriate stewardship over donor organs, a limited and precious resource, will require a balance of high-clinical standards with inclusive efforts to treat as many patients as possible.
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Affiliation(s)
- Harinder Singh Rai
- University of Michigan Department of Psychiatry, 9D 9816 University Hospital, 1500 E. Medical Center Dr. SPC 5118, Ann Arbor, MI, 48109-5118, USA
| | - Gerald Scott Winder
- University of Michigan Department of Psychiatry, 9D 9816 University Hospital, 1500 E. Medical Center Dr. SPC 5118, Ann Arbor, MI, 48109-5118, USA.
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Smith KE, Bunting AM, Staton M, Walker R, Shalash S, Winston E, Pangburn K. Examination of Synthetic Cannabinoid and Cathinone Use among a Drug-Using Offender Sample, 2013-2015. J Psychoactive Drugs 2017; 49:436-445. [PMID: 28813207 DOI: 10.1080/02791072.2017.1361560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Use of novel psychoactive substances (NPS) such as synthetic cannabinoids (e.g., "Spice," "Serenity") and cathinones (e.g., "bath salts") has proliferated in recent years; however, there is a gap in research examining prevalence among offender samples. This study examined demographics, drug use, mental health characteristics, and criminal histories of NPS users compared to non-NPS users within an offender sample entering drug treatment. Using logistic regression analysis, combined 2013-2015 assessment data were examined (N = 8,791). NPS users offended more often (x̄ = 10.3), were more likely to have experienced homelessness (12.2%), and to have lived in a metro area (59.0%). NPS users reported significantly more past-year drug use, including substances not readily detected by standard urine analysis (e.g., hallucinogens, alcohol, and inhalants). Individuals with higher anxiety symptom counts (OR = 1.07; p < .001) and those who reported drinking to intoxication (OR = 1.30; p < .001) had an increased likelihood of NPS use. Older individuals (OR = 0.95; p < .001) and those who began using drugs at an older age (OR = 0.95; p < .001) were less likely to report NPS use. NPS use may be a marker of more severe using patterns in an offender sample. Future investigation should focus on NPS use as a possible method for bypassing drug testing measures.
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Affiliation(s)
- Kirsten Elin Smith
- a Former Senior Data Coordinator, Center on Drug and Alcohol Research , University of Kentucky , Lexington , KY , USA.,b Doctoral Student and Research Assistant, Kent School of Social Work , University of Louisville , Louisville , KY , USA
| | - Amanda M Bunting
- c Research Assistant, Center on Drug and Alcohol Research , University of Kentucky , Lexington , KY , USA.,d Doctoral Candidate, Department of Sociology , University of Kentucky , Lexington , KY , USA
| | - Michele Staton
- e Associate Professor, Center on Drug and Alcohol Research , University of Kentucky , Lexington , KY , USA.,f Associate Professor, College of Medicine, Department of Behavioral Science , University of Kentucky , Lexington , KY , USA
| | - Robert Walker
- g Assistant Professor, College of Medicine, Department of Behavioral Science , University of Kentucky , Lexington , KY , USA
| | - Sara Shalash
- h Senior Data Coordinator, Center on Drug and Alcohol Research , University of Kentucky , Lexington , KY , USA
| | - Erin Winston
- i Study Director, Center of Drug and Alcohol Research , University of Kentucky , Lexington , KY , USA
| | - Kevin Pangburn
- j Director of Substance Abuse Division, Kentucky Department of Corrections , Lexington , KY , USA
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Abstract
The term "new psychoactive substances" (NPS) can be defined as individual drugs in pure form or in complex preparations that are not scheduled under the Single Convention on Narcotic Drugs (1961) or the Convention on Psychotropic Substances (1971). NPS may be categorized by chemical structure, by psychoactive properties, by biological targets, or by source (plant, synthetic, or combined). The emergence of hundreds of NPS in the past decade is challenging for public health and drug policies globally. The novelty of NPS, their ambiguous legal status, ability to evade toxicological tests, swift adaptation to legal restrictions, global Internet marketing, and scant public knowledge of their adverse effects are among the key drivers of this twenty-first century phenomenon. Multi-disciplinary research in areas of biology, epidemiology, prevention, and web analytics are needed to develop effective responses in a domain capable of overwhelming current international conventions and national drug control policies. Ultimately, research-guided prevention education will fortify societies against this tidal wave.
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Affiliation(s)
- Bertha K Madras
- Harvard Medical School, Department of Psychiatry, Boston, MA, USA.
- Division of Alcohol and Drug Abuse, McLean Hospital, Oaks Building, Room 342, 115 Mill Street, Belmont, MA, 02478, USA.
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Fischer B, Russell C, Sabioni P, van den Brink W, Le Foll B, Hall W, Rehm J, Room R. Lower-Risk Cannabis Use Guidelines: A Comprehensive Update of Evidence and Recommendations. Am J Public Health 2017. [PMID: 28644037 DOI: 10.2105/ajph.2017.303818] [Citation(s) in RCA: 253] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cannabis use is common in North America, especially among young people, and is associated with a risk of various acute and chronic adverse health outcomes. Cannabis control regimes are evolving, for example toward a national legalization policy in Canada, with the aim to improve public health, and thus require evidence-based interventions. As cannabis-related health outcomes may be influenced by behaviors that are modifiable by the user, evidence-based Lower-Risk Cannabis Use Guidelines (LRCUG)-akin to similar guidelines in other health fields-offer a valuable, targeted prevention tool to improve public health outcomes. OBJECTIVES To systematically review, update, and quality-grade evidence on behavioral factors determining adverse health outcomes from cannabis that may be modifiable by the user, and translate this evidence into revised LRCUG as a public health intervention tool based on an expert consensus process. SEARCH METHODS We used pertinent medical search terms and structured search strategies, to search MEDLINE, EMBASE, PsycINFO, Cochrane Library databases, and reference lists primarily for systematic reviews and meta-analyses, and additional evidence on modifiable risk factors for adverse health outcomes from cannabis use. SELECTION CRITERIA We included studies if they focused on potentially modifiable behavior-based factors for risks or harms for health from cannabis use, and excluded studies if cannabis use was assessed for therapeutic purposes. DATA COLLECTION AND ANALYSIS We screened the titles and abstracts of all studies identified by the search strategy and assessed the full texts of all potentially eligible studies for inclusion; 2 of the authors independently extracted the data of all studies included in this review. We created Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow-charts for each of the topical searches. Subsequently, we summarized the evidence by behavioral factor topic, quality-graded it by following standard (Grading of Recommendations Assessment, Development, and Evaluation; GRADE) criteria, and translated it into the LRCUG recommendations by the author expert collective on the basis of an iterative consensus process. MAIN RESULTS For most recommendations, there was at least "substantial" (i.e., good-quality) evidence. We developed 10 major recommendations for lower-risk use: (1) the most effective way to avoid cannabis use-related health risks is abstinence, (2) avoid early age initiation of cannabis use (i.e., definitively before the age of 16 years), (3) choose low-potency tetrahydrocannabinol (THC) or balanced THC-to-cannabidiol (CBD)-ratio cannabis products, (4) abstain from using synthetic cannabinoids, (5) avoid combusted cannabis inhalation and give preference to nonsmoking use methods, (6) avoid deep or other risky inhalation practices, (7) avoid high-frequency (e.g., daily or near-daily) cannabis use, (8) abstain from cannabis-impaired driving, (9) populations at higher risk for cannabis use-related health problems should avoid use altogether, and (10) avoid combining previously mentioned risk behaviors (e.g., early initiation and high-frequency use). AUTHORS' CONCLUSIONS Evidence indicates that a substantial extent of the risk of adverse health outcomes from cannabis use may be reduced by informed behavioral choices among users. The evidence-based LRCUG serve as a population-level education and intervention tool to inform such user choices toward improved public health outcomes. However, the LRCUG ought to be systematically communicated and supported by key regulation measures (e.g., cannabis product labeling, content regulation) to be effective. All of these measures are concretely possible under emerging legalization regimes, and should be actively implemented by regulatory authorities. The population-level impact of the LRCUG toward reducing cannabis use-related health risks should be evaluated. Public health implications. Cannabis control regimes are evolving, including legalization in North America, with uncertain impacts on public health. Evidence-based LRCUG offer a potentially valuable population-level tool to reduce the risk of adverse health outcomes from cannabis use among (especially young) users in legalization contexts, and hence to contribute to improved public health outcomes.
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Affiliation(s)
- Benedikt Fischer
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Cayley Russell
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Pamela Sabioni
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Wim van den Brink
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Bernard Le Foll
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Wayne Hall
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Jürgen Rehm
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Robin Room
- Benedikt Fischer, Cayley Russell, Pamela Sabioni, and Jürgen Rehm are with the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario. Wim van den Brink is with the Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Bernard Le Foll is with the Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto. Wayne Hall is with the Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. Robin Room is with the Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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Mdege ND, Meader N, Lloyd C, Parrott S, McCambridge J. The Novel Psychoactive Substances in the UK Project: empirical and conceptual review work to produce research recommendations. PUBLIC HEALTH RESEARCH 2017. [DOI: 10.3310/phr05040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BackgroundAlthough illegal drug use has largely been declining in the UK over the past decade, this period has witnessed the emergence of a range of novel psychoactive substances (NPS) (‘legal highs’). These are new, mostly synthetic, substances that mimic the effects of existing drugs). Despite there being many causes for concern in relation to NPS, there has been little prior study of the burden associated with their use in public health terms. Clarity is lacking on research priorities in this rapidly developing literature.ObjectivesTo inform the development of public health intervention research on NPS by reviewing existing data on their use, associated problems and potential responses to such problems.DesignA scoping review and narrative synthesis of selected bodies of evidence was undertaken to summarise and evaluate what is known about NPS use and the related harms of, and responses to, such use. Relevant literature was identified from electronic databases (covering January 2006 to June 2016 inclusive), Google (Google Inc., Mountain View, CA, USA), relevant websites and online drug forums and by contacting experts. Articles were included if they were primary studies, secondary studies involving the analysis and interpretation of primary research or discussion papers. A conceptual framework postulating an evidence-informed public health approach to NPS use in the UK was developed through a pragmatic literature review, the iterative development of concepts and finalisation in light of the results from the empirical review work. The process also involved feedback from various stakeholders. Research recommendations were developed from both strands of work.ResultsA total of 995 articles were included in the scoping review, the majority of which related to individual-level health-related adverse effects attributable to NPS use. The prevalence of lifetime NPS use varied widely between (e.g. with higher prevalence in young males) and within population subgroups. The most commonly reported adverse effects were psychiatric/other neurological, cardiovascular, renal and gastrointestinal manifestations, and there is limited evidence available on responses. In these and other respects, available evidence is at an early stage of development. Initial evidence challenges the view that NPS should be treated differently from other illicit drugs. The conceptual framework indicated that much of the evidence that would be useful to inform public health responses does not yet exist. We propose a systems-based prevention approach that develops existing responses, is multilevel and life course informed in character, and emphasises commonalities between NPS and other legal and illegal drug use. We make 20 recommendations for research, including nine key recommendations.LimitationsScoping reviews do not interrogate evidence in depth, and the disjunction between the scoping review and the conceptual framework findings is worthy of careful attention.ConclusionsKey research recommendations build on those that have previously been made and offer more evidence-based justification and detail, as previous recommendations have not yet been acted on. The case for decision-making on commissioning new research based on these recommendations is both strong and urgent.Future workThe validity of recommendations generated through this project could be enhanced via further work with research commissioners, policy-makers, researchers and the public.Study registrationThe systematic review element of this study is registered as PROSPERO CRD42016026415.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Noreen D Mdege
- Department of Health Sciences, University of York, York, UK
| | - Nick Meader
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Charlie Lloyd
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
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Kaneko S. Motor vehicle collisions caused by the 'super-strength' synthetic cannabinoids, MAM-2201, 5F-PB-22, 5F-AB-PINACA, 5F-AMB and 5F-ADB in Japan experienced from 2012 to 2014. Forensic Toxicol 2017; 35:244-251. [PMID: 28706566 PMCID: PMC5486620 DOI: 10.1007/s11419-017-0369-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 01/30/2023]
Abstract
From 2012 to 2014 in Japan, 214 cases of motor vehicle collisions were attributed to the use of illegal drugs. In 93 out of 96 investigated cases, the causative agents were a variety of synthetic cannabinoids (SCs). These SCs can be classified into three groups according to the lineage of the chemical structures: (1) naphthoyl indoles, such as MAM-2201, (2) quinolinyl ester indoles, such as 5F-PB-22, and (3) indazole carboxamides, such as 5F-AB-PINACA, 5F-AMB, and 5F-ADB. These SCs became available sequentially with increasing cannabinoid CB1 agonist potencies and reached a nationwide outbreak in the summer of 2014. They caused acute intoxication with impaired consciousness, anterograde amnesia (impaired memory), catalepsy with muscle rigidity, tachycardia, and vomiting or drooling soon after smoking. Drivers who had abused one of these SCs might unexpectedly experience the acute intoxication that caused uncontrolled driving. These SCs were generally difficult to detect from body fluid samples. It is thought that the highly lipophilic SCs disappear from the blood via rapid degradation by liver enzymes and selective accumulation into adipose tissues. Thus, much effort should be directed to the development of fast and sensitive chemical detection of the drug usage.
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Affiliation(s)
- Shuji Kaneko
- Department of Molecular Pharmacology, Graduate School of Pharmaceutical Sciences, Kyoto University, Yoshida-Shimoadachi-cho 46-29, Sakyo-ku, Kyoto, 606-8501 Japan
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Niaz K, Khan F, Maqbool F, Momtaz S, Ismail Hassan F, Nobakht-Haghighi N, Rahimifard M, Abdollahi M. Endo-cannabinoids system and the toxicity of cannabinoids with a biotechnological approach. EXCLI JOURNAL 2017; 16:688-711. [PMID: 28827985 PMCID: PMC5547394 DOI: 10.17179/excli2017-257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 04/29/2017] [Indexed: 01/06/2023]
Abstract
Cannabinoids have shown diverse and critical effects on the body systems, which alter the physiological functions. Synthetic cannabinoids are comparatively innovative misuse drugs with respect to their nature of synthesis. Synthetic cannabinoids therapy in healthy, chain smokers, and alcoholic individuals cause damage to the immune and nervous system, eventually leading to intoxication throughout the body. Relevant studies were retrieved using major electronic databases such as PubMed, EMBASE, Medline, Scopus, and Google Scholar. The extensive use of Cannabis Sativa L. (C. Sativa) and its derivatives/analogues such as the nonpsychoactive dimethyl heptyl homolog (CBG-DMH), and tetrahydrocannabivarin (THCV) amongst juveniles and adults have been enhanced in recent years. Cannabinoids play a crucial role in the induction of respiratory, reproductive, immune and carcinogenic effects; however, potential data about mutagenic and developmental effects are still insufficient. The possible toxicity associated with the prolong use of cannabinoids acts as a tumor promoter in animal models and humans. Particular synthetic cannabinoids and analogues have low affinity for CB1 or CB2 receptors, while some synthetic members like Δ9-THC have high affinity towards these receptors. Cannabinoids and their derivatives have a direct or indirect association with acute and long-term toxicity. To reduce/attenuate cannabinoids toxicity, pharmaceutical biotechnology and cloning methods have opened a new window to develop cannabinoids encoding the gene tetrahydrocannabinolic acid (THCA) synthase. Plant revolution and regeneration hindered genetic engineering in C. Sativa. The genetic culture suspension of C. Sativa can be transmuted by the use of Agrobacterium tumefaciens to overcome its toxicity. The main aim of the present review was to collect evidence of the endo-cannabinoid system (ECS), cannabinoids toxicity, and the potential biotechnological approach of cannabinoids synthesis.
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Affiliation(s)
- Kamal Niaz
- International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran.,Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Fazlullah Khan
- International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran.,Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Faheem Maqbool
- International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran.,Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeideh Momtaz
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Karaj, Iran
| | - Fatima Ismail Hassan
- International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran.,Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Navid Nobakht-Haghighi
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Faculty of Pharmacy, Eastern Mediterranean University, Famagusta, North Cyprus Mersin 10, Turkey
| | - Mahban Rahimifard
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Abdollahi
- International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran.,Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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49
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Abstract
Synthetic cannabinoids are becoming a public health concern. No data are apparently available concerning use of synthetic cannabinoids in the elderly. We report two cases of elderly individuals who used synthetic cannabinoids and were admitted to a psychiatric hospital.
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Warren KE, Tay S, Wen LS. The Role of Public Health in Combatting Synthetic Cannabinoid Use in Adolescents. J Adolesc Health 2017; 60:483-486. [PMID: 28433118 DOI: 10.1016/j.jadohealth.2017.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 02/18/2017] [Accepted: 02/23/2017] [Indexed: 10/19/2022]
Abstract
As the country struggles to address an epidemic of alcohol and drug overdose, a wide-ranging category of chemical substances known as synthetic drugs have provoked a new sense of public urgency over the past decade. Synthetic cannabinoids, a heterogeneous and evolving set of synthetic compounds that act on endogenous cannabinoid receptors, have become particularly popular among adolescents due to their relative ease of access and reputation as a "legal high." The Baltimore City Health Department has worked to combat the recent surge in synthetic drug use through a major public awareness campaign, legislative reform, and retailer engagement and compliance initiative. In doing so, the city has built a coalition of clinicians, advocates, retailers, educators, legislators, and community members to fight synthetic cannabinoid use in Baltimore City. In this commentary piece, we offer strategies from our work and from that of our colleagues across the country for clinicians and communities fighting to stem the tide of recreational synthetic cannabinoid use.
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Affiliation(s)
| | - Shirli Tay
- Baltimore City Health Department, Baltimore, Maryland
| | - Leana S Wen
- Baltimore City Health Department, Baltimore, Maryland.
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