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Stogner J, Baldwin JM, Wiercioch A. 'Spice' Use Motivations, Experiences, and Repercussions among Veterans of the United States Armed Forces. Subst Use Misuse 2024; 59:1182-1189. [PMID: 38548662 DOI: 10.1080/10826084.2024.2330900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND OBJECTIVES The potential for synthetic cannabinoids (SCs) to function as an alternative to marijuana without the same risk of a positive urinalyses led to claims of pervasive military SC use. Case studies confirm use among veterans, but no study has adequately explored SC use in the military using detailed interview data. METHODS Interviews (1-2 h) were conducted with 318 justice-involved veterans. Recruitment was attempted with all participants in eight veterans treatment courts in three U.S. states (54.9% of 579 eligible veterans). Interviews were transcribed and thematic analyses completed. RESULTS SC use was reported by 65 participants (21.3%). Major emergent themes indicated SCs were perceived as unpleasant, overly powerful, and a poor substitute for marijuana. Further, habitual use was rare as many chose not to reuse after initial negative experiences. Few indicated that the perception that SCs would not appear on routine military urinalyses enabled their use. Veterans were aware of the changing drug composition and feared "bad batches." CONCLUSIONS SCs were explicitly disliked both independently and relative to marijuana. Nine discussed avoiding positive military drug screens as a consideration, but negative initial experiences generally prevented progression to habitual use. Veterans did not view SCs as a suitable marijuana replacement. Fears that SCs are being used as a marijuana alternative among veterans subject to frequent drug testing appear unfounded. These interviews suggest that routine military drug testing did not motivate individuals to use SCs habitually as a marijuana replacement; however, veterans' negative interpretation of SC effects contributed to this outcome.
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Affiliation(s)
- John Stogner
- Department of Criminal Justice and Criminology, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, North Carolina
| | - Julie Marie Baldwin
- Department of Justice, Law & Criminology, American University, Washington, DC
| | - Amelia Wiercioch
- Department of Criminal Justice, University of Central Florida, 12494 University Blvd, Orlando, FL
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Alzu'bi A, Almahasneh F, Khasawneh R, Abu-El-Rub E, Baker WB, Al-Zoubi RM. The synthetic cannabinoids menace: a review of health risks and toxicity. Eur J Med Res 2024; 29:49. [PMID: 38216984 PMCID: PMC10785485 DOI: 10.1186/s40001-023-01443-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/10/2023] [Indexed: 01/14/2024] Open
Abstract
Synthetic cannabinoids (SCs) are chemically classified as psychoactive substances that target the endocannabinoid system in many body organs. SCs can initiate pathophysiological changes in many tissues which can be severe enough to damage the normal functionality of our body systems. The majority of SCs-related side effects are mediated by activating Cannabinoid Receptor 1 (CB1R) and Cannabinoid Receptor 2 (CB2R). The activation of these receptors can enkindle many downstream signalling pathways, including oxidative stress, inflammation, and apoptosis that ultimately can produce deleterious changes in many organs. Besides activating the cannabinoid receptors, SCs can act on non-cannabinoid targets, such as the orphan G protein receptors GPR55 and GPR18, the Peroxisome Proliferator-activated Receptors (PPARs), and the Transient receptor potential vanilloid 1 (TRPV1), which are broadly expressed in the brain and the heart and their activation mediates many pharmacological effects of SCs. In this review, we shed light on the multisystem complications found in SCs abusers, particularly discussing their neurologic, cardiovascular, renal, and hepatic effects, as well as highlighting the mechanisms that intermediate SCs-related pharmacological and toxicological consequences to provide comprehensive understanding of their short and long-term systemic effects.
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Affiliation(s)
- Ayman Alzu'bi
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, 211-63, Jordan.
| | - Fatimah Almahasneh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, 211-63, Jordan
| | - Ramada Khasawneh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, 211-63, Jordan
| | - Ejlal Abu-El-Rub
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, 211-63, Jordan
| | - Worood Bani Baker
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, 211-63, Jordan
| | - Raed M Al-Zoubi
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation & Men'S Health, Doha, Qatar.
- Department of Biomedical Sciences, QU-Health, College of Health Sciences, Qatar University, Doha, 2713, Qatar.
- Department of Chemistry, Jordan University of Science and Technology, P.O.Box 3030, Irbid, 22110, Jordan.
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Neukamm MA, Halter S, Auwärter V, Schmitt G, Giorgetti A, Bartel M. Death after smoking of fentanyl, 5F-ADB, 5F-MDMB-P7AICA and other synthetic cannabinoids with a bucket bong. Forensic Toxicol 2024; 42:82-92. [PMID: 37300633 PMCID: PMC10808286 DOI: 10.1007/s11419-023-00666-w] [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: 02/09/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE We report a case of a polydrug user who consumed various synthetic cannabinoids and fentanyl from a transdermal patch via a bucket bong. Toxicological results from postmortem matrices with special focus on synthetic cannabinoids are discussed in terms of their relevance to the death. METHODS The samples were analyzed by toxicological screening procedures involving immunoassays and gas chromatography-mass spectrometry (GC-MS) as well as quantitative analyses by means of GC-MS and high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS). RESULTS At the autopsy, coronary artery disease and signs of liver congestion were noted, in the absence of acute myocardial ischemic changes. Femoral blood concentrations of fentanyl and pregabalin were 14 ng/mL and 3,200 ng/mL, respectively. In addition, 2.7 ng/mL 5F-ADB and 13 ng/mL 5F-MDMB-P7AICA were detected together with relatively low amounts of 5 other synthetic cannabinoids in cardiac blood. A total number of up to 17 synthetic cannabinoids were detected in kidney, liver, urine and hair. Fentanyl and 5F-ADB were also detected in the water of the bucket bong. CONCLUSIONS The cause of death could be attributed to an acute mixed intoxication by fentanyl and 5F-ADB (both Toxicological Significance Score (TSS) = 3) with a contribution of pregabalin and 5F-MDMB-P7AICA (TSS = 2), in a subject suffering from pre-existing heart damage. The most plausible mechanism of death consists in a respiratory depression. This case report demonstrates that use of opioids in combination with synthetic cannabinoids might be particularly dangerous.
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Affiliation(s)
- Merja A Neukamm
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Albertstrasse 9, 79104, Freiburg, Germany.
| | - Sebastian Halter
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Albertstrasse 9, 79104, Freiburg, Germany
| | - Volker Auwärter
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Albertstrasse 9, 79104, Freiburg, Germany
| | - Georg Schmitt
- Institute of Forensic and Traffic Medicine, University Hospital, Voßstrasse 2, 69115, Heidelberg, Germany
| | - Arianna Giorgetti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy
| | - Marc Bartel
- Institute of Forensic and Traffic Medicine, University Hospital, Voßstrasse 2, 69115, Heidelberg, Germany
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Hancox JC, Copeland CS, Harmer SC, Henderson G. New synthetic cannabinoids and the potential for cardiac arrhythmia risk. JOURNAL OF MOLECULAR AND CELLULAR CARDIOLOGY PLUS 2023; 6:100049. [PMID: 38143960 PMCID: PMC10739592 DOI: 10.1016/j.jmccpl.2023.100049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 12/26/2023]
Abstract
Synthetic cannabinoid receptor agonists (SCRAs) have been associated with QT interval prolongation. Limited preclinical information on SCRA effects on cardiac electrogenesis results from the rapid emergence of new compounds and restricted research availability. We used two machine-learning-based tools to evaluate seven novel SCRAs' interaction potential with the hERG potassium channel, an important drug antitarget. Five SCRAs were predicted to have the ability to block the hERG channel by both prediction tools; ADB-FUBIATA was predicted to be a strong hERG blocker. ADB-5Br-INACA and ADB-4en-PINACA showed varied predictions. These findings highlight potentially proarrhythmic hERG block by novel SCRAs, necessitating detailed safety evaluations.
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Affiliation(s)
- Jules C. Hancox
- School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences Building, University Walk, Bristol BS8 1TD, UK
| | - Caroline S. Copeland
- Institute of Pharmaceutical Science, King's College London, UK
- Centre for Pharmaceutical Medicine Research, King's College London, UK
| | - Stephen C. Harmer
- School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences Building, University Walk, Bristol BS8 1TD, UK
| | - Graeme Henderson
- School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences Building, University Walk, Bristol BS8 1TD, UK
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Hasan MR, Tabassum T, Tabassum T, Tanbir MA, Abdelsalam M, Nambiar R. Synthetic Cannabinoids-Related Cardiovascular Emergencies: A Review of the Literature. Cureus 2023; 15:e41929. [PMID: 37583720 PMCID: PMC10424760 DOI: 10.7759/cureus.41929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2023] [Indexed: 08/17/2023] Open
Abstract
Synthetic cannabinoids (SCBs) are a group of psychoactive compounds, known to cause a range of multisystem adverse events, including the cardiovascular system. The aim of this review is to provide an overview of the literature on cardiovascular emergencies associated with SCBs. A systematic search of electronic databases was conducted to identify relevant studies published between January 2010 and September 2022. Inclusion criteria were studies reporting on cardiovascular emergencies in individuals with SCB abuse. The search yielded a total of 43 studies, including case reports, case series, and meta-analyses. This review indicates that SCB abuse can lead to a range of cardiovascular emergencies, including acute coronary syndrome, arrhythmias, and hypertension. The onset of these emergencies is often sudden and may occur in previously healthy individuals. The severity of these complications can vary widely, with some cases resulting in cardiac arrest or death. Management strategies for SCB-related cardiovascular emergencies include supportive care, pharmacological interventions, and, sometimes, invasive procedures. There is no specific antidote against SCB to date. In conclusion, SCB abuse is associated with various cardiovascular emergencies, which can be life-threatening in some cases. Early recognition and management of these emergencies are critical for improving outcomes. Further research is needed to better understand the underlying mechanisms of SCB-related cardiovascular complications and to develop effective prevention and management strategies.
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Affiliation(s)
- Md Rockyb Hasan
- Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Tanzin Tabassum
- General Surgery, West Suffolk Hospital, Bury St. Edmunds, GBR
| | - Tahsin Tabassum
- Public Health, School of Community Health and Policy, Morgan State University, Baltimore, USA
| | - Mohammed A Tanbir
- Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Mohammed Abdelsalam
- Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Rajesh Nambiar
- Cardiology, Texas Tech University Health Sciences Center, Amarillo, USA
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Jafry AH, LaGrow A, Akhtar KH, Hacker E, Russell S, Kliewer B, Asad ZUA. Synthetic cannabinoids and ST elevation myocardial infarction. Am J Med Sci 2022; 364:481-491. [PMID: 35545143 DOI: 10.1016/j.amjms.2022.05.001] [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: 10/07/2021] [Revised: 03/16/2022] [Accepted: 05/02/2022] [Indexed: 01/25/2023]
Abstract
Synthetic cannabinoids cannot be detected on a standard urine drug screen (UDS), making them a convenient drug of abuse. We report the first case of ST elevation myocardial infarction (STEMI) in a young patient due to coronary artery thrombosis secondary to synthetic cannabinoid use and concurrent COVID-19 infection. A 38-year-old previously healthy male developed severe chest pain and was found to have anterior STEMI and COVID-19 infection. Coronary angiography showed acute thrombotic occlusion of the mid-left anterior descending artery that was managed with thrombectomy and stent placement. He only required supportive care for COVID-19. A comprehensive literature search revealed 34 additional cases of STEMI with synthetic cannabinoid use; majority were males (97%) with mean age of 29 years. 29 patients (85.3%) underwent coronary angiography and majority had left anterior descending artery (LAD) involvement (55%), with 13 (44.8%) undergoing stent placement. We highlight STEMI as a potentially lethal complication of synthetic cannabinoids; prompt angiography may be lifesaving.
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Affiliation(s)
- Ali Haider Jafry
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.
| | - Austin LaGrow
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Khawaja Hassan Akhtar
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Ethan Hacker
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Sage Russell
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Brian Kliewer
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
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Santangelo O, Baldwin JM, Stogner J. Does cannabis testing in the military drive synthetic cannabinoid use? Self-reported use motivations among justice-involved veterans. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103756. [PMID: 35738030 DOI: 10.1016/j.drugpo.2022.103756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Though synthetic cannabinoid receptor agonists (SCRAs) were controlled after being introduced as a 'legal high,' SCRAs likely remain appealing to individuals subject to routine drug screens as not all testing programs consistently include SCRAs. Military populations have been linked to SCRAs due to the unconfirmed supposition that testing protocols led many to substitute SCRAs for cannabis. This study aimed to explore SCRA use prevalence, correlates, and use motivations among veterans, with a particular focus on whether United States military personnel substituted SCRAs for cannabis to subvert testing protocols. METHODS All veterans appearing in one of eight civilian criminal courts in three U.S. states were invited to answer questionnaire items related to military service, court functionality, and substance use. Of the 579 veterans eligible, 54.9% chose to participate, yielding a cross-sectional sample of 318 veterans charged with a criminal offense by civilian authorities. RESULTS Sixty-five (21.3%) justice-involved veterans reported lifetime SCRA use. Use while within the military was reported by 15.0% of veterans enlisting after 2008. Only eight (12.3%) reported SCRAs were used as a substitute for cannabis. Boredom (36.9%), experimentation (27.7%), and social aspects of SCRA use (32.3%) were more commonly reported motives. Logistic regression models indicated that use of cannabis (aPR=2.06, p<.05), hallucinogens (aPR=2.50, p<.01), and SCRAs (aPR=2.49, p<.05) while in the military were risk factors for SCRA use after leaving the military, whereas older age at time of military exist was a protective factor (aPR=.87, p<.01) CONCLUSIONS: Drug testing programs within the military do not appear to have the unintended consequence of routing individuals to more risky drugs; however, SCRAs appear to have been an underappreciated problem within the military. Further, use extends beyond the military with many only initiating use after discharge, suggesting SCRA use may jeopardize the health of veterans post-service.
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Affiliation(s)
- Orion Santangelo
- Department of Criminal Justice and Criminology, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC 28223-0001, United States; Loss Prevention Research Council, 747 SW 2nd Ave, Gainesville, FL 32601, United States
| | - Julie Marie Baldwin
- Department of Justice, Law & Criminology, American University, 4400 Massachusetts Avenue NW, Washington, DC 20016-8043, United States
| | - John Stogner
- Department of Criminal Justice and Criminology, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC 28223-0001, United States.
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Hussien R, El-Setouhy M, Shinawi ME, El-Hariri HM, Hirshon JM. Acute Toxic Effects of the New Psychoactive Substance "Voodoo" among Patients presented to the Poison Control Center of Ain Shams University Hospitals (PCC-ASUH), Egypt, during 2017. Subst Abuse Treat Prev Policy 2021; 16:71. [PMID: 34544462 PMCID: PMC8454133 DOI: 10.1186/s13011-021-00408-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Voodoo is a heterogeneous mixture of psychoactive substances that has recently grown in popularity among youth in Egypt. Patients can present with a variety of manifestations that may lead to death in some cases. This study assessed the acute toxic effects of voodoo among patients presented to the Poison Control Center of Ain Shams University Hospitals (PCC-ASUH) during a one year period. METHODS This is a retrospective study of all patients presented with voodoo intoxication at the PCC-ASUH from 1 January 2017 to 31 December 2017. Clinical data, routine laboratory findings, and ECG results as well as duration of hospitalization and outcome were compiled from hospital records. RESULTS Seventy-one voodoo intoxication cases meeting the inclusion criteria were analyzed (mean age: 25.19 ± 9.54 years, range: 15-50 years, 97.2 % male). Pulse, blood pressure, and respiratory rate were normal in more than half of all patients. Neurological abnormalities including agitation, hallucinations, disturbance of consciousness were the most frequent manifestations. Respiratory acidosis was the most common laboratory finding (54.9 %), followed by increased serum urea (43.6 %), hypokalemia (33.8 %), hyperglycemia (28.1 %), and leukocytosis (26.7 %). The most common ECG finding was sinus tachycardia (31 %), followed by QT prolongation (15.4 %). More than half of the studied patients (53.5 %) co-administered other illicit substances, most frequently cannabis and tramadol. Most patients recovered fully and were discharged, but death occurred in two cases. CONCLUSIONS Voodoo toxicity can manifest with many presentations, hampering timely diagnosis. Clinicians should consider possible voodoo poisoning in patients presenting with a history of drug use with neurological symptoms, and they should conduct follow-up arterial blood gases, electrolytes and ECG as voodoo may contain potentially fatal psychoactive substances.
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Affiliation(s)
- Rania Hussien
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Maged El-Setouhy
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mohamed El Shinawi
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Jon Mark Hirshon
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Chetty K, Lavoie A, Deghani P. A Literature Review of Cannabis and Myocardial Infarction-What Clinicians May Not Be Aware Of. CJC Open 2021; 3:12-21. [PMID: 33458628 PMCID: PMC7801213 DOI: 10.1016/j.cjco.2020.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/01/2020] [Indexed: 12/11/2022] Open
Abstract
Increasing legalization and expanding medicinal use have led to a significant rise in global cannabis consumption. With this development, we have seen a growing number of case reports describing adverse cardiovascular events, specifically, cannabis-induced myocardial infarction (MI). However, there are considerable knowledge gaps on this topic among health care providers. This review aims to provide an up-to-date review of the current literature, as well as practical recommendations for clinicians. We also focus on proposed mechanisms implicating cannabis as a risk factor for MI. We performed a comprehensive literature search using the MEDLINE, Cochrane, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Turning Research into Practice (TRIP) PRO databases for articles published between 2000 and 2018. A total of 92 articles were included. We found a significant number of reports describing cannabis-induced MI. This was especially prevalent among young healthy patients, presenting shortly after use. The most commonly proposed mechanisms included increased autonomic stimulation, altered platelet function, vasospasm, and direct toxic effects of smoke constituents. However, it is likely that the true pathogenesis is multifactorial. We should increase our pretest probability for MI in young patients presenting with chest pain. We also recommend against cannabis use in patients with known coronary artery disease, especially if they have stable angina. Finally, if patients are adamant about using cannabis, health care providers should recommend against smoking cannabis, avoidance of concomitant tobacco use, and use of the lowest delta-9-tetrahydrocannabinol dose possible. Data quality is limited to that of observational studies and case report data. Therefore, more clinical trials are needed to determine a definitive cause-and-effect relationship.
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Affiliation(s)
| | - Andrea Lavoie
- Department of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Payam Deghani
- Department of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Stogner J, Miller BL. Exploring the Relationships between Sexual Orientation and Gender Identity and Youth Synthetic Cannabinoid Use. Subst Use Misuse 2021; 56:327-332. [PMID: 33353471 DOI: 10.1080/10826084.2020.1858105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Purpose: Existing studies have identified sexual minorities as being at enhanced risk for reporting synthetic cannabinoid (SC) use. It is unclear whether this association is the result of those that identify as a minority due to sexual orientation being more likely to use SCs, due to those that identify as transgender using SCs more, or both. Deconstructing this relationship will allow for targeted clinical advice and public health campaigns. Methods: Data from the 2015 and 2017 Youth Risk Behavior Study are utilized. In total, 31,279 youth were asked about their gender identity, sexual orientation, and SC use history. Bivariate analyses and logistic regression models were completed to explore relevant associations. Results: Identifying as lesbian, gay, bisexual, or questioning was linked to SC use and continuing SC use. Similarly, identifying as transgender was linked to SC use and continuing use. Regression analyses showed no significant interactive effect; identifying as both LGBQ and transgender does not have a compounding effect on use likelihood. Conclusions: Both sexual orientation and gender identity contribute to the relationship between sexual minority status and SC use noted in extant literature. This relationship is hypothesized to be tied to increased exposure to discrimination, victimization, and social isolation. Thus, efforts to directly counsel LGBTQ patients about the dangers associated with SC use are warranted as well as social policy reforms to better protect and support members of the LGBTQ community.
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Affiliation(s)
- John Stogner
- Criminal Justice and Criminology, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
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An Investigation of the COMT Gene Val158Met Polymorphism in Patients Admitted to the Emergency Department Because of Synthetic Cannabinoid Use. Balkan J Med Genet 2020; 23:63-68. [PMID: 32953411 PMCID: PMC7474226 DOI: 10.2478/bjmg-2020-0010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Catechol-O-methyl transferase (COMT) enzyme has a role in the inactivation of catecholamine neurotransmitters. Functional polymorphism in the COMT gene has been reported to play an important role in schizophrenia, bipolar affective disorder, aggressive and antisocial behavior, suicide attempts and the pathogenesis of Parkinson's disease. In this study, we aimed to investigate the effect of the Vall58Met polymorphism of the COMT gene on substance use, and treatment history in patients with synthetic cannabinoid (SC) intoxication. The COMT enzyme Val158Met polymorphisms from DNA of 49 patients who were evaluated in the Emergency Department after SC use and 50 healthy control groups aged 18-45 years, were identified by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analyses as reported in the literature. Information regarding recurrent intake or hospitalization due to substance use was obtained from hospital records. Wild-type (WT) genotypes in 14 (28.6%) patients, heterozygous genotypes in 25 (51.0%) and homozygous genotypes in 10 (20.4%) patients were detected. Wild-type genotypes The homozygous genotype was found to be significantly higher in patients hospitalized due to drug addiction and substance use (p 0.008). The Vall58 Met polymorphism of the COMT gene was not found to be significant in the first use after substance intake, while a significant relationship was found in terms of this polymorphism in patients with substance addiction diagnosis and treatment history.
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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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13
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Efe SC, Oz A, Guven S, Kambur I, Topacoglu H, Karabag T. Evaluation of index of cardiac-electrophysiological balance as arrhythmia predictor in bonsai users. Minerva Cardioangiol 2020; 68:559-566. [PMID: 32472984 DOI: 10.23736/s0026-4725.20.05124-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Synthetic cannabinoids are part of a group of drugs called new psychoactive substances. The increase in substance use among young adults is becoming a major problem in the world. In this study we aimed to investigate the effects of synthetic cannabinoid drugs such as bonsai to electrocardiographic (ECG) parameters, in patients who were admitted to emergency service with self-reported usage of bonsai. METHODS Seventy-two patients (68 males; mean age 33.8±11.8) with self-reported use of bonsai and 27 (22 males; mean age 37.1±8.7) age and sex-matched healthy control group enrolled the study. ECG parameters and rhythm holter were measurements calculated in both groups. RESULTS Groups were age and sex matched. Glucose, potassium, white blood cell count, heart rate end smoking status was significantly different in patients compared to control group. P wave max time, P wave min. time, P wave dispersion, QT max. time QT dispersion, QT corrected time and index of cardiac-electrophysiological balance measurements (iCEB) were significantly different in groups of patients. A multivariate logistic regression analysis was used to determine independent predictors of ≥30 Ventricular premature beat (VPB)/h using parameters found to be associated with ≥30 VPB/h in a univariate analysis (potassium, QT<inf>max</inf> time, QTc, QRS time, iCEB).In a multivariate analysis, independent predictors of ≥30 VPB/h were potassium (Odds ratio [OR]: 0.107, 95% CI: 0.024-0.481;P=0.004) and iCEB (OR: 4.474, 95% CI: 1.752-11.429;P=0.002). In generalize linear model β-coefficient value of interaction terms between K*iCEB has no important effect on ventricular premature beats. CONCLUSIONS If the results are confirmed in further studies, iCEB seems to be a simple, easily measurable and non-invasive marker to predict cannabinoid-induced ventricular arrhythmias.
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Affiliation(s)
- Süleyman C Efe
- Department of Cardiology, Istanbul Education and Research Hospital, Istanbul, Turkey -
| | - Ahmet Oz
- Department of Cardiology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Saadet Guven
- Department of Cardiology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Incifer Kambur
- Department of Emergency Medicine, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Hakan Topacoglu
- Department of Emergency Medicine, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Turgut Karabag
- Department of Cardiology, Istanbul Education and Research Hospital, Istanbul, Turkey
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Abstract
Psychoactive substances with chemical structures or pharmacological profiles that are similar to traditional drugs of abuse continue to emerge on the recreational drug market. Internet vendors may at least temporarily sell these so-called designer drugs without adhering to legal statutes or facing legal consequences. Overall, the mechanism of action and adverse effects of designer drugs are similar to traditional drugs of abuse. Stimulants, such as amphetamines and cathinones, primarily interact with monoamine transporters and mostly induce sympathomimetic adverse effects. Agonism at μ-opioid receptors and γ-aminobutyric acid-A (GABAA) or GABAB receptors mediates the pharmacological effects of sedatives, which may induce cardiorespiratory depression. Dissociative designer drugs primarily act as N-methyl-d-aspartate receptor antagonists and pose similar health risks as the medically approved dissociative anesthetic ketamine. The cannabinoid type 1 (CB1) receptor is thought to drive the psychoactive effects of synthetic cannabinoids, which are associated with a less desirable effect profile and more severe adverse effects compared with cannabis. Serotonergic 5-hydroxytryptamine-2A (5-HT2A) receptors mediate alterations of perception and cognition that are induced by serotonergic psychedelics. Because of their novelty, designer drugs may remain undetected by routine drug screening, thus hampering evaluations of adverse effects. Intoxication reports suggest that several designer drugs are used concurrently, posing a high risk for severe adverse effects and even death.
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15
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Hancox JC, Kalk NJ, Henderson G. Synthetic cannabinoids and potential cardiac arrhythmia risk: an important message for drug users. Ther Adv Drug Saf 2020; 11:2042098620913416. [PMID: 32269749 PMCID: PMC7093686 DOI: 10.1177/2042098620913416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Jules C Hancox
- The School of Physiology, Pharmacology and Neuroscience, University of Bristol, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, UK
| | - Nicola J Kalk
- National Addictions Centre, Kings College London, UK
| | - Graeme Henderson
- The School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
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16
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Ahmed T, Khan A, See VY, Robinson S. Cardiac arrest associated with synthetic cannabinoid use and acquired prolonged QTc interval: A case report and review of literature. HeartRhythm Case Rep 2020; 6:283-286. [PMID: 32461896 PMCID: PMC7244635 DOI: 10.1016/j.hrcr.2020.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Talha Ahmed
- University of Maryland Midtown Campus, Baltimore, Maryland
| | - Ahmed Khan
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Vincent Y See
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Shawn Robinson
- University of Maryland School of Medicine, Baltimore, Maryland
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17
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Ozturk HM, Yetkin E, Ozturk S. Synthetic Cannabinoids and Cardiac Arrhythmia Risk: Review of the Literature. Cardiovasc Toxicol 2020; 19:191-197. [PMID: 31030341 DOI: 10.1007/s12012-019-09522-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Synthetic cannabinoids (SCBs) are widely used recreational substances especially among adults. Although they have been considered as safe during the marketing process, our knowledge about their adverse effects has evolved since years. SCBs are associated with various cardiac events including acute myocardial infarction and sudden cardiac death. There is also growing evidence that SCBs are associated with cardiac arrhythmia development both in acute and chronic exposure. SCBs have been shown to be associated with both supraventricular and ventricular arrhythmias. However, the exact mechanism of the SCB related arrhythmia remains unknown. Understanding the exact association and possible mechanisms may help us to identify high risk patients at an early stage and to develop treatment modalities to prevent or reverse the arrhythmic effects of SCBs.
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Affiliation(s)
| | - Ertan Yetkin
- Department of Cardiology, Istinye University Liv Hospital, Istanbul, Turkey
| | - Selcuk Ozturk
- Cardiology Clinic, Ankara Education and Research Hospital, Ankara, Turkey.
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18
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Giorgetti A, Busardò FP, Tittarelli R, Auwärter V, Giorgetti R. Post-Mortem Toxicology: A Systematic Review of Death Cases Involving Synthetic Cannabinoid Receptor Agonists. Front Psychiatry 2020; 11:464. [PMID: 32523555 PMCID: PMC7261860 DOI: 10.3389/fpsyt.2020.00464] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/06/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Synthetic cannabinoid receptor agonists (SCRAs) have become the largest group of new psychoactive substances monitored by the European Union Early Warning System. Despite the wide diffusion on the market, data regarding effects, toxicities, and mechanisms as well as toxic/lethal doses are still scarce. METHODS A comprehensive literature search for articles published up to January 2019 was performed in multiple electronic databases. Only cases of death in which toxicological analyses revealed the presence of SCRAs in blood or urine and at least an external examination was performed, including those occurred in emergency departments, were included. RESULTS Of 380 studies identified, 354 were excluded, while 8 additional manuscripts were included through the screening of relevant references cited in the selected articles. A total number of 34 manuscripts (8 case series and 26 case reports) were included. CONCLUSIONS Typical toxic ranges for SCRAs have not been so far identified, and the results of toxicological analyses should be interpreted with caution. In death cases involving SCRAs, a thorough post-mortem examination is a prerequisite to assess the role of the substance use in the deceased and to identify a probable mechanism of death. Even after a comprehensive analysis of clinical, circumstantial, toxicological, and autoptic data, the cause and manner of death remain unclear in some cases.
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Affiliation(s)
- Arianna Giorgetti
- Legal Medicine and Toxicology, University-Hospital of Padova, Padova, Italy.,Institute of Forensic Medicine, Forensic Toxicology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Francesco Paolo Busardò
- Section of Legal Medicine, Department of Excellence SBSP, University Politecnica delle Marche of Ancona, Ancona, Italy
| | - Roberta Tittarelli
- Unit of Forensic Toxicology, SAIMLAL Department, Sapienza University of Rome, Rome, Italy
| | - Volker Auwärter
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Raffaele Giorgetti
- Section of Legal Medicine, Department of Excellence SBSP, University Politecnica delle Marche of Ancona, Ancona, Italy
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19
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Bilel S, Tirri M, Arfè R, Stopponi S, Soverchia L, Ciccocioppo R, Frisoni P, Strano-Rossi S, Miliano C, De-Giorgio F, Serpelloni G, Fantinati A, De Luca MA, Neri M, Marti M. Pharmacological and Behavioral Effects of the Synthetic Cannabinoid AKB48 in Rats. Front Neurosci 2019; 13:1163. [PMID: 31736697 PMCID: PMC6831561 DOI: 10.3389/fnins.2019.01163] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/14/2019] [Indexed: 12/12/2022] Open
Abstract
AKB48 is a designer drug belonging to the indazole synthetic cannabinoids class, illegally sold as herbal blend, incense, or research chemicals for their psychoactive cannabis-like effects. In the present study, we investigated the in vivo pharmacological and behavioral effects of AKB48 in male rats and measured the pharmacodynamic effects of AKB48 and simultaneously determined its plasma pharmacokinetic. AKB48 at low doses preferentially stimulated dopamine release in the nucleus accumbens shell (0.25 mg/kg) and impaired visual sensorimotor responses (0.3 mg/kg) without affecting acoustic and tactile reflexes, which are reduced only to the highest dose tested (3 mg/kg). Increasing doses (0.5 mg/kg) of AKB48 impaired place preference and induced hypolocomotion in rats. At the highest dose (3 mg/kg), AKB48 induced hypothermia, analgesia, and catalepsy; inhibited the startle/pre-pulse inhibition test; and caused cardiorespiratory changes characterized by bradycardia and mild bradipnea and SpO2 reduction. All behavioral and neurochemical effects were fully prevented by the selective CB1 receptor antagonist/inverse agonist AM251. AKB48 plasma concentrations rose linearly with increasing dose and were correlated with changes in the somatosensory, hypothermic, analgesic, and cataleptic responses in rats. For the first time, this study shows the pharmacological and behavioral effects of AKB48 in rats, correlating them to the plasma levels of the synthetic cannabinoid. Chemical Compound Studied in This Article: AKB48 (PubChem CID: 57404063); AM251 (PubChem CID: 2125).
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Affiliation(s)
- Sabrine Bilel
- Department of Morphology, Experimental Medicine and Surgery, Section of Legal Medicine and Laboratory for Technologies of Advanced Therapies (LTTA) Centre, University of Ferrara, Ferrara, Italy
| | - Micaela Tirri
- Department of Morphology, Experimental Medicine and Surgery, Section of Legal Medicine and Laboratory for Technologies of Advanced Therapies (LTTA) Centre, University of Ferrara, Ferrara, Italy
| | - Raffaella Arfè
- Department of Morphology, Experimental Medicine and Surgery, Section of Legal Medicine and Laboratory for Technologies of Advanced Therapies (LTTA) Centre, University of Ferrara, Ferrara, Italy.,Section of Legal Medicine, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Serena Stopponi
- Pharmacology Unit, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Laura Soverchia
- Pharmacology Unit, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Roberto Ciccocioppo
- Pharmacology Unit, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Paolo Frisoni
- Department of Morphology, Experimental Medicine and Surgery, Section of Legal Medicine and Laboratory for Technologies of Advanced Therapies (LTTA) Centre, University of Ferrara, Ferrara, Italy
| | - Sabina Strano-Rossi
- Section of Legal Medicine, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina Miliano
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Fabio De-Giorgio
- Section of Legal Medicine, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Serpelloni
- Department of Psychiatry in the College of Medicine, Drug Policy Institute, University of Florida, Gainesville, FL, United States
| | - Anna Fantinati
- Department of Chemistry and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Margherita Neri
- Department of Morphology, Experimental Medicine and Surgery, Section of Legal Medicine and Laboratory for Technologies of Advanced Therapies (LTTA) Centre, University of Ferrara, Ferrara, Italy
| | - Matteo Marti
- Department of Morphology, Experimental Medicine and Surgery, Section of Legal Medicine and Laboratory for Technologies of Advanced Therapies (LTTA) Centre, University of Ferrara, Ferrara, Italy.,Department of Anti-Drug Policies, Presidency of the Council of Ministers, Collaborative Center for the Italian National Early Warning System, Ferrara, Italy
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20
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Anzillotti L, Marezza F, Calò L, Banchini A, Cecchi R. A case report positive for synthetic cannabinoids: are cardiovascular effects related to their protracted use? Leg Med (Tokyo) 2019; 41:101637. [PMID: 31683096 DOI: 10.1016/j.legalmed.2019.101637] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/05/2019] [Accepted: 09/21/2019] [Indexed: 12/15/2022]
Abstract
The use of synthetic cannabinoids is being increasingly recognised worldwide, but the chemical compositions and physiological effects of these drugs are poorly characterised and are continually changing. New substances are constantly being added to the content of synthetic cannabinoids and they are rarely identified on toxicological screening tests. Due to their structures synthetic cannabinoids and their effects have been compared to the psychoactive compound, Δ-9-tetrahydrocannabinol (THC), found in marijuana. On the molecular level, they are potent cannabinoid receptor agonists that also may have affinity for other types of receptors such as those on platelets. Reported symptoms of toxicity include anxiety, agitation, paranoia, hallucinations, tachycardia, hypertension, excessive sweating, nausea, and vomiting. They can also be linked to serious adverse cardiovascular events and can affect the cardiovascular system causing hypotension and bradycardia, myocardial infarction, atrial fibrillation, prolonged QTc, and Mobitz type II atrioventricular block, as well as interfere with the aggregation of platelets. We present a case report of a cardiac tamponade with toxicological findings positive for synthetic cannabinoids. This case highlights the importance of testing routinely for novel psychoactive compounds, and recognising their potential to cause life-threatening conditions.
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Affiliation(s)
- Luca Anzillotti
- Department of Medicine and Surgery, Unit of Legal Medicine, University of Parma, Via A. Gramsci 14, 43126 Parma, Italy.
| | - Francesca Marezza
- Department of Medicine and Surgery, Unit of Legal Medicine, University of Parma, Via A. Gramsci 14, 43126 Parma, Italy.
| | - Luca Calò
- Department of Medicine and Surgery, Unit of Legal Medicine, University of Parma, Via A. Gramsci 14, 43126 Parma, Italy.
| | - Antonio Banchini
- Department of Medicine and Surgery, Unit of Legal Medicine, University of Parma, Via A. Gramsci 14, 43126 Parma, Italy.
| | - Rossana Cecchi
- Department of Medicine and Surgery, Unit of Legal Medicine, University of Parma, Via A. Gramsci 14, 43126 Parma, Italy.
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21
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Speckle-tracking strain assessment of left ventricular dysfunction in synthetic cannabinoid and heroin users. Anatol J Cardiol 2018; 19:388-393. [PMID: 29848923 PMCID: PMC5998859 DOI: 10.14744/anatoljcardiol.2018.76429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective There is growing evidence regarding the numerous adverse effects of synthetic cannabinoids (SCBs) on the cardiovascular system; however, no studies have shown the cardiovascular effects of opioids using strain echocardiography. This study examines the cardiac structure and function using echocardiographic strain imaging in heroin and synthetic cannabinoid users. Methods This double-blind study included patients who were admitted or referred to a rehabilitation center for heroin (n=31) and synthetic cannabinoid users (n=30). Heroin users and synthetic cannabinoid users were compared with healthy volunteers (n=32) using two-dimensional (2D) speckle-tracking (ST) echocardiography. Results No differences were found in the baseline characteristics and 2D echocardiography values. The mean global longitudinal strain value was −20.5%±2.4% for SCB users, −22.3%±2.4% for opioid users, and −22.5%±2.2% for healthy volunteers (p=0.024). The mean apical 2-chamber (AP2C) L-strain values were −20.1%±3.1%, −22.4%±3.0%, and −22.3%±2.8% for SCB users, opioid users, and healthy volunteers, respectively (p=0.032). The mean apical 4-chamber (AP4C) L-strain values were −20.7%±2.5% for SCB users, −23.2%±3.2% for opioid users, and −23.8%±3.1% for healthy volunteers (p<0.001). Conclusion SCBs are potential causes of subclinical left ventricular dysfunction.
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22
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Schindler CW, Gramling BR, Justinova Z, Thorndike EB, Baumann MH. Synthetic cannabinoids found in "spice" products alter body temperature and cardiovascular parameters in conscious male rats. Drug Alcohol Depend 2017; 179:387-394. [PMID: 28846955 PMCID: PMC5599362 DOI: 10.1016/j.drugalcdep.2017.07.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/16/2017] [Accepted: 07/25/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND The misuse of synthetic cannabinoids is a persistent public health concern. Because these drugs target the same cannabinoid receptors as the active ingredient of marijuana, Δ9-tetrahydrocannabinol (THC), we compared the effects of synthetic cannabinoids and THC on body temperature and cardiovascular parameters. METHODS Biotelemetry transmitters for the measurement of body temperature or blood pressure (BP) were surgically implanted into separate groups of male rats. THC and the synthetic cannabinoids CP55,940, JWH-018, AM2201 and XLR-11 were injected s.c., and rats were placed into isolation cubicles for 3h. RESULTS THC and synthetic cannabinoids produced dose-related decreases in body temperature that were most prominent in the final 2h of the session. The rank order of potency was CP55,940>AM2201=JWH-018>THC=XLR-11. The cannabinoid inverse agonist rimonabant antagonized the hypothermic effect of all compounds. Synthetic cannabinoids elevated BP in comparison to vehicle treatment during the first h of the session, while heart rate was unaffected. The rank order of potency for BP increases was similar to that seen for hypothermia. Hypertensive effects of CP55,940 and JWH-018 were not antagonized by rimonabant or the neutral antagonist AM4113. However, the BP responses to both drugs were antagonized by pretreatment with either the ganglionic blocker hexamethonium or the α1 adrenergic antagonist prazosin. CONCLUSIONS Our results show that synthetic cannabinoids produce hypothermia in rats by a mechanism involving cannabinoid receptors, while they increase BP by a mechanism independent of these sites. The hypertensive effect appears to involve central sympathetic outflow.
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Affiliation(s)
- Charles W. Schindler
- Designer Drug Research Unit, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD,Preclinical Pharmacology Section, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD
| | - Benjamin R. Gramling
- Designer Drug Research Unit, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD
| | - Zuzana Justinova
- Preclinical Pharmacology Section, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD
| | - Eric B. Thorndike
- Preclinical Pharmacology Section, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD
| | - Michael H. Baumann
- Designer Drug Research Unit, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD
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23
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Jouanjus E, Raymond V, Lapeyre-Mestre M, Wolff V. What is the Current Knowledge About the Cardiovascular Risk for Users of Cannabis-Based Products? A Systematic Review. Curr Atheroscler Rep 2017; 19:26. [DOI: 10.1007/s11883-017-0663-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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24
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Davidson C, Opacka-Juffry J, Arevalo-Martin A, Garcia-Ovejero D, Molina-Holgado E, Molina-Holgado F. Spicing Up Pharmacology: A Review of Synthetic Cannabinoids From Structure to Adverse Events. CANNABINOID PHARMACOLOGY 2017; 80:135-168. [DOI: 10.1016/bs.apha.2017.05.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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25
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Weinstein AM, Rosca P, Fattore L, London ED. Synthetic Cathinone and Cannabinoid Designer Drugs Pose a Major Risk for Public Health. Front Psychiatry 2017; 8:156. [PMID: 28878698 PMCID: PMC5572353 DOI: 10.3389/fpsyt.2017.00156] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 08/08/2017] [Indexed: 12/16/2022] Open
Abstract
As part of an increasing worldwide use of designer drugs, recent use of compounds containing cathinones and synthetic cannabinoids is especially prevalent. Here, we reviewed current literature on the prevalence, epidemiology, bio-behavioral effects, and detection of these compounds. Gender differences and clinical effects will also be examined. Chronic use of synthetic cathinone compounds can have major effects on the central nervous system and can induce acute psychosis, hypomania, paranoid ideation, and delusions, similar to the effects of other better-known amphetamine-type stimulants. Synthetic cannabinoid products have effects that are somewhat similar to those of natural cannabis but more potent and long-lasting than THC. Some of these compounds are potent and dangerous, having been linked to psychosis, mania, and suicidal ideation. Novel compounds are developed rapidly and new screening techniques are needed to detect them as well as a rigorous regulation and legislation reinforcement to prevent their distribution and use. Given the rapid increase in the use of synthetic cathinones and cannabinoid designer drugs, their potential for dependence and abuse, and harmful medical and psychiatric effects, there is a need for research and education in the areas of prevention and treatment.
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Affiliation(s)
- Aviv M Weinstein
- Department of Behavioral Science, Ariel University, Ariel, Israel
| | - Paola Rosca
- Department for the Treatment of Substance Abuse, Ministry of Health, Jerusalem, Israel
| | - Liana Fattore
- Institute of Neuroscience-Cagliari, National Research Council of Italy, Cagliari, Italy
| | - Edythe D London
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States.,Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, CA, United States.,Brain Research Institute, University of California Los Angeles, Los Angeles, CA, United States
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26
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Affiliation(s)
- Juliana Tournebize
- CEIP-Addictovigilance, Nancy University Medical Center, Nancy, France
- French Addictovigilance Network (FAN), Nancy, France
| | - Valérie Gibaja
- CEIP-Addictovigilance, Nancy University Medical Center, Nancy, France
- French Addictovigilance Network (FAN), Nancy, France
| | - Jean-Pierre Kahn
- CEIP-Addictovigilance, Nancy University Medical Center, Nancy, France
- French Addictovigilance Network (FAN), Nancy, France
- Department of Psychiatry and Clinical Psychology, Centre Psychothérapique de Nancy, Nancy, France
- Université de Lorraine, Nancy, France
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27
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Yılmaz S, Ünal S, Kuyumcu MS, Balcı KG, Balcı MM. Acute anterior myocardial infarction after "Bonzai" use. Anatol J Cardiol 2016; 15:265-6. [PMID: 25880186 PMCID: PMC5337075 DOI: 10.5152/akd.2015.5994] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Samet Yılmaz
- Clinic of Cardiology, Türkiye Yüksek İhtisas Education and Research Hospital; Ankara-Turkey.
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28
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Can your heart handle the spice: A case of acute myocardial infarction and left ventricular apical thrombus. Int J Cardiol 2016; 215:129-31. [DOI: 10.1016/j.ijcard.2016.04.055] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 04/10/2016] [Indexed: 11/20/2022]
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29
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Clinical Effects of Synthetic Cannabinoid Receptor Agonists Compared with Marijuana in Emergency Department Patients with Acute Drug Overdose. J Med Toxicol 2016; 12:335-340. [PMID: 27255136 DOI: 10.1007/s13181-016-0558-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/07/2016] [Accepted: 05/14/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Synthetic cannabinoid receptor agonists (SCRAs) are heterogeneous compounds originally intended as probes of the endogenous cannabinoid system or as potential therapeutic agents. We assessed the clinical toxicity associated with recent SCRA use in a large cohort of drug overdose patients. METHODS This subgroup analysis of a large (n = 3739) drug overdose cohort study involved consecutive ED patients at two urban teaching hospitals collected between 2009 and 2013. Clinical characteristics of patients with the exposure to SCRAs (SRCA subgroup) were compared with those from patients who smoked traditional cannabinoids (marijuana subgroup). Data included demographics, exposure details, vital signs, mental status, and basic chemistries gathered as part of routine clinical care. Study outcomes included altered mental status and cardiotoxicity. RESULTS Eighty-seven patients reported exposure to any cannabinoid, of whom 17 reported SCRAs (17 cases, 70 controls, mean age 38.9 years, 77 % males, 31 % Hispanic). There were no significant differences between SRCA and marijuana with respect to demographics (age, gender, and race/ethnicity), exposure history (suicidality, misuse, and intent), vital signs, or serum chemistries. Mental status varied between SRCA and marijuana, with agitation significantly more likely in SCRA subgroup (OR = 3.8, CI = 1.2-11.9). Cardiotoxicity was more pronounced in the SCRA subgroup with dysrhythmia significantly more likely (OR = 9.2, CI = 1.0-108). CONCLUSIONS In the first clinical study comparing the adverse effects of SCRA overdose vs. marijuana controls in an ED population, we found that SCRA overdoses had significantly pronounced neurotoxicity and cardiotoxicity compared with marijuana.
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Seyit M, Ozen M, Oskay A, Kadioglu E. Effectiveness of the synthetic cannabinoids seminar. Turk J Emerg Med 2016; 16:57-59. [PMID: 27896322 PMCID: PMC5121273 DOI: 10.1016/j.tjem.2016.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 03/14/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Synthetic cannabinoid or "Bonzai" use is a public health issue as its use has increased in Turkey as well as all over the world. The aim of this study is to evaluate the effectiveness of the "Synthetic Cannabinoids Seminar" that was provided to physicians who work in emergency services, using multiple choice questionnaires before and after the seminar as a tool for evaluation. MATERIAL AND METHOD Synthetic cannabinoids seminars were provided to physicians who work in emergency services in two different cities, with the participation of 20 physicians in each scheduled seminar. The seminars were instructed by emergency medicine specialists and psychiatrists who were certified as an instructor by the Turkish Ministry of Health, after receiving an instructor course in synthetic cannabinoids. In order to measure basal knowledge levels of the participants, a pretest was performed for all participants before the seminar. After the seminar, a posttest was performed using the same questions in the pretest. The number of correct answers in both tests was then compared. RESULTS In total, 85 individuals attended the seminars; 29 individuals from Dumlupınar University Evliya Çelebi Training and Research Hospital constituted first group, and 56 individuals from Denizli State Hospital constituted second group. In both groups, the ratios of correct answers in the posttest were determined to be higher when compared to the pretest. CONCLUSION The seminars on synthetic cannabinoids are useful and necessary for physicians.
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Affiliation(s)
- Murat Seyit
- Dumlupınar University Evliya Çelebi Training and Research Hospital, Turkey
- Corresponding author.
| | | | | | - Emine Kadioglu
- Dumlupınar University Evliya Çelebi Training and Research Hospital, Turkey
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McIlroy G, Ford L, Khan JM. Acute myocardial infarction, associated with the use of a synthetic adamantyl-cannabinoid: a case report. BMC Pharmacol Toxicol 2016; 17:2. [PMID: 26772803 PMCID: PMC4715335 DOI: 10.1186/s40360-016-0045-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/07/2016] [Indexed: 12/21/2022] Open
Abstract
Background “Legal highs” are novel psychoactive substances that have evaded statutory control. Synthetic cannabinoid compounds with adamantane moieties have recently been identified, which have high potency at target receptors and are undetectable on conventional toxicology testing. However, little is known about any harmful effects, and their potential to cause serious ill health. We describe a case of myocardial infarction following the use of this class of drug. Case presentation We report the case of a 39-year-old man admitted after an out-of-hospital cardiac arrest, in whom ECG and elevated cardiac enzymes confirmed ST-elevation myocardial infarction. Normal coronary perfusion was restored after thrombectomy and coronary artery stenting. In the hours preceding his admission, the patient is known to have consumed the legal high product “Black Mamba”. Subsequent urine testing confirmed the presence of an adamantyl-group synthetic cannabinoid, whilst cannabis, cocaine, amphetamines and other drugs of abuse were not detected. Conclusion The use of legal highs is being increasingly recognised, but the chemical compositions and physiological effects of these drugs are poorly characterised and are continually changing. Synthetic cannabinoids, rarely identified on toxicological testing, can be linked to serious adverse cardiovascular events. This case highlights the importance of testing for novel psychoactive compounds, and recognising their potential to cause life-threatening conditions.
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Affiliation(s)
- Graham McIlroy
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH, UK.
| | - Loretta Ford
- Department of Clinical Biochemistry, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH, UK.
| | - Jawad M Khan
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH, UK.
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The Wide and Unpredictable Scope of Synthetic Cannabinoids Toxicity. Case Rep Crit Care 2015; 2015:542490. [PMID: 26788376 PMCID: PMC4691597 DOI: 10.1155/2015/542490] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 12/18/2022] Open
Abstract
Drug use and abuse continue to be a large public health concern worldwide. Over the past decade, novel or atypical drugs have emerged and become increasingly popular. In the recent past, compounds similar to tetrahydrocannabinoid (THC), the active ingredient of marijuana, have been synthetically produced and offered commercially as legal substances. Since the initial communications of their abuse in 2008, few case reports have been published illustrating the misuse of these substances with signs and symptoms of intoxication. Even though synthetic cannabinoids have been restricted, they are still readily available across USA and their use has been dramatically increasing, with a concomitant increment in reports to poison control centers and emergency department (ED) visits. We describe a case of acute hypoxemic/hypercapnic respiratory failure as a consequence of acute congestive heart failure (CHF) developed from myocardial stunning resulting from a non-ST-segment elevation myocardial infarction (MI) following the consumption of synthetic cannabinoids.
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Debruyne D, Le Boisselier R. Emerging drugs of abuse: current perspectives on synthetic cannabinoids. Subst Abuse Rehabil 2015; 6:113-29. [PMID: 26543389 PMCID: PMC4622447 DOI: 10.2147/sar.s73586] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
New psychoactive drugs that have appeared over the last decade are typically dominated by cathinones and synthetic cannabinoids (SCs). SCs have been emerging as recreational drugs because they mimic the euphoria effect of cannabis while still being legal. Sprayed on natural herb mixtures, SCs have been primarily sold as "herbal smoking blends" or "herbal incense" under brand names like "Spice" or "K2". Currently, SCs pure compounds are available from websites for the combination with herbal materials or for the use in e-cigarettes. For the past 5 years, an ever increasing number of compounds, representative of different chemical classes, have been promoted and now represent a large assortment of new popular drugs of abuse, which are difficult to properly identify. Their legal status varies by country with many government institutions currently pushing for their control. The in vitro binding to CB1/CB2 receptors is usually well-known and considerable differences have been found in the CB1 versus CB2 selectivity and potency within the different SCs, with several structure-activity relations being evident. Desired effects by CB1 agonist users are relaxation/recreative, however, cardiovascular, gastrointestinal, or psychiatric/neurological side effects are commonly reported. At present there is no specific antidote existing if an overdose of designer drugs was to occur, and no curative treatment has been approved by health authorities. Management of acute toxic effects is mainly symptomatic and extrapolated from experience with cannabis.
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Affiliation(s)
- Danièle Debruyne
- Centre for Evaluation and Information on Pharmacodependence - Addictovigilance (CEIP-A), University Hospital Centre Côte de Nacre, Caen, France ; Toxicology and Pharmacology Laboratory, Department of Pharmacology, University Hospital Centre Côte de Nacre, Caen, France
| | - Reynald Le Boisselier
- Centre for Evaluation and Information on Pharmacodependence - Addictovigilance (CEIP-A), University Hospital Centre Côte de Nacre, Caen, France
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Davis C, Boddington D. Teenage cardiac arrest following abuse of synthetic cannabis. Heart Lung Circ 2015; 24:e162-3. [PMID: 26256565 DOI: 10.1016/j.hlc.2015.04.176] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 03/25/2015] [Accepted: 04/14/2015] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The cardiac effects of many illegal substances (cocaine, methadone) have previously been well described [1,2]. However the association between synthetic cannabis and cardiac arrest is less well documented. Here we describe an out-of-hospital cardiac arrest in a previously healthy 16-year-old female associated with the use of inhaled synthetic cannabis. METHODS An electronic systematic search of online databases PubMed and Embase was performed using keywords, "synthetic cannabis death" and "cardiac arrest". RESULTS In this case study a previously healthy 16-year-old had a cardiac arrest after synthetic cannabis use. Despite extensive investigations no other cause for her arrest was found. To the best of our knowledge there has been one previous case report of cardiac arrest following synthetic cannabis use in a 56-year-old man [3]. CONCLUSIONS This case report augments the relationship between synthetic cannabis and cardiac arrest in the medical community. More awareness surrounding the risk of synthetic cannabinoids is warranted.
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Affiliation(s)
- C Davis
- Tauranga Hospital, New Zealand.
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Comment on "A Unique Case of Cardiac Arrest following K2 Abuse". Case Rep Cardiol 2015; 2015:739149. [PMID: 25883810 PMCID: PMC4391492 DOI: 10.1155/2015/739149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 01/18/2015] [Indexed: 11/18/2022] Open
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Atik SU, Dedeoğlu R, Varol F, Çam H, Eroğlu AG, Saltık L. Cardiovascular side effects related with use of synthetic cannabinoids "bonzai" : two case reports. Turk Arch Pediatr 2015; 50:61-4. [PMID: 26078698 DOI: 10.5152/tpa.2015.2609] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 01/21/2015] [Indexed: 11/22/2022]
Abstract
Information about the effects of synthetic cannabinoids "bonzai" on the cardiovascular system is limited. In this article, two patients in whom different cardiological side effects were observed following use of synthetic cannabinoids 'bonzai' were presented. Our first patient who was a 16-year old boy presented to pediatric emergency department with severe chest pain which had started one hour before. On electrocardiographic examination, ST segment elevations greater than 3 mm were observed in DII, DIII, AVF and V5-V6 derivations which caused to suspicious myocardial infarction. Cardiac catheterization was performed and coronary angiographic findings were found to be normal. When the patient was questioned again, it was learned that he used synthetic cannabinoid 'bonzai'. The second patient who was aged 18 years and addicted to synthetic cannabinoid 'bonzai' was brought to our emergency department by his friends because of clouding of consciousness. Dopamine treatment was started in the patient whose cardiac apical beat reduced to 40/min and who was found to develop hypertension, because bradycardia worsened. However, the blood pressure increased rapidly and dopamine treatment was stopped. Heart rate and blood pressure monitoring was continued. Use of synthetic cannabinoids 'bonzai' should be kept in mind in patients who present to emergency departments with chest pain and complaints related with the cardiovascular system.
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Affiliation(s)
- Sezen Ugan Atik
- Department of Pediatrics, Division of Pediatric Cardology, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Reyhan Dedeoğlu
- Department of Pediatrics, Division of Pediatric Cardology, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Fatih Varol
- Department of Pediatrics, Division of Pediatric Emergency, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Halit Çam
- Department of Pediatrics, Division of Pediatric Emergency, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Ayşe Güler Eroğlu
- Department of Pediatrics, Division of Pediatric Cardology, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Levent Saltık
- Department of Pediatrics, Division of Pediatric Cardology, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
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