1
|
Lafzi A, Yeşilyurt F, Demirci T, Hacımüftüoğlu A, Şişman T. Acute and subacute toxic effects of CUMYL-4CN-BINACA on male albino rats. Forensic Toxicol 2024; 42:125-141. [PMID: 38102417 DOI: 10.1007/s11419-023-00676-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE There is very little information about the toxicological and pathological effects of synthetic cannabinoids, which have cannabis-like properties. This study was carried out to histopathologically, hematologically, and biochemically determine the toxic effects of acute and subacute exposure to a novel synthetic cannabinoid 1-(4-cyanobutyl)-N-(2-phenylpropan-2-yl)indazole-3-carboxamide in internal organs of adult male rats. METHODS The cannabinoid was injected intraperitoneally at three doses (0.5, 1.0, and 2.0 mg/kg, body weight). The cannabinoid was administered to acute groups for 2 days and to subacute groups for 14 days. Observations were made for 14 days and various changes such as mortality, injury, and illness were recorded daily. Hematological and biochemical changes were evaluated and histopathological analyses in lung, liver, and kidney tissues were also performed. RESULTS No mortality was observed. It was observed that there were fluctuations in hematological and serum biochemical parameters. Among the oxidative stress parameters, significant decreases in superoxide dismutase, catalase levels and significant increases in lipid peroxidation levels were determined. Serious pathological changes such as necrosis, vacuolation, congestion, and fibrosis were observed in the internal organs in a dose-dependent and time-dependent manner. It was also found that the synthetic cannabinoid triggered apoptosis in the organs. The results demonstrated that the most affected organ by the cannabinoid was the kidney. CONCLUSION This study showed for the first time that CUMYL-4CN-BINACA adversely affects healthy male albino rats. It can be estimated that the abuse of the cannabinoid may harm human health in the same way.
Collapse
Affiliation(s)
- Ayşe Lafzi
- Department of Criminalistics, Graduate School of Natural and Applied Science, Atatürk University, 25240, Erzurum, Turkey
| | - Fatma Yeşilyurt
- Department of Medical Pharmacology, Medicine Faculty, Atatürk University, 25240, Erzurum, Turkey
| | - Tuba Demirci
- Department of Histology and Embryology, Medicine Faculty, Atatürk University, 25240, Erzurum, Turkey
| | - Ahmet Hacımüftüoğlu
- Department of Medical Pharmacology, Medicine Faculty, Atatürk University, 25240, Erzurum, Turkey
| | - Turgay Şişman
- Department of Criminalistics, Graduate School of Natural and Applied Science, Atatürk University, 25240, Erzurum, Turkey.
- Department of Molecular Biology and Genetics, Science Faculty, Atatürk University, 25240, Erzurum, Turkey.
| |
Collapse
|
2
|
Waters ML, Dargan PI, Yates C, Dines AM, Eyer F, Giraudon I, Heyerdahl F, Hovda KE, Liechti ME, Miró Ò, Vallersnes OM, Anseeuw K, Badaras R, Bitel M, Bonnici J, Brvar M, Caganova B, Calýskan F, Ceschi A, Chamoun K, Daveloose L, Galicia M, Gartner B, Gorozia K, Grenc D, Gresnigt FMJ, Hondebrink L, Jürgens G, Konstari J, Kutubidze S, Laubner G, Liakoni E, Liguts V, Lyphout C, McKenna R, Mégarbane B, Moughty A, Nitescu GV, Noseda R, O'Connor N, Paasma R, Ortega Perez J, Perminas M, Persett PS, Põld K, Puchon E, Puiguriguer J, Radenkova-Saeva J, Rulisek J, Samer C, Schmid Y, Scholz I, Stašinskis R, Surkus J, Van den Hengel-Koot I, Vigorita F, Vogt S, Waldman W, Waring WS, Zacharov S, Zellner T, Wood DM. Clinical effects of cannabis compared to synthetic cannabinoid receptor agonists (SCRAs): a retrospective cohort study of presentations with acute toxicity to European hospitals between 2013 and 2020. Clin Toxicol (Phila) 2024; 62:378-384. [PMID: 38934347 DOI: 10.1080/15563650.2024.2346125] [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: 02/15/2024] [Accepted: 04/16/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Cannabis is the most common recreational drug worldwide and synthetic cannabinoid receptor agonists are currently the largest group of new psychoactive substances. The aim of this study was to compare the clinical features and outcomes of lone acute cannabis toxicity with lone acute synthetic cannabinoid receptor agonist toxicity in a large series of presentations to European emergency departments between 2013-2020. METHODS Self-reported drug exposure, clinical, and outcome data were extracted from the European Drug Emergencies Network Plus which is a surveillance network that records data on drug-related emergency department presentations to 36 centres in 24 European countries. Cannabis exposure was considered the control in all analyses. To compare the lone cannabis and lone synthetic cannabinoid receptor agonist groups, univariate analysis using chi squared testing was used for categorical variables and non-parametric Mann-Whitney U- testing for continuous variables. Statistical significance was defined as a P value of <0.05. RESULTS Between 2013-2020 there were 54,314 drug related presentations of which 2,657 were lone cannabis exposures and 503 lone synthetic cannabinoid receptor agonist exposures. Synthetic cannabinoid receptor agonist presentations had statistically significantly higher rates of drowsiness, coma, agitation, seizures and bradycardia at the time of presentation. Cannabis presentations were significantly more likely to have palpitations, chest pain, hypertension, tachycardia, anxiety, vomiting and headache. DISCUSSION Emergency department presentations involving lone synthetic cannabinoid receptor agonist exposures were more likely to have neuropsychiatric features and be admitted to a psychiatric ward, and lone cannabis exposures were more likely to have cardiovascular features. Previous studies have shown variability in the acute toxicity of synthetic cannabinoid receptor agonists compared with cannabis but there is little comparative data available on lone exposures. There is limited direct comparison in the current literature between lone synthetic cannabinoid receptor agonist and lone cannabis exposure, with only two previous poison centre series and two clinical series. Whilst this study is limited by self-report being used to identify the drug(s) involved in the presentations, previous studies have demonstrated that self-report is reliable in emergency department presentations with acute drug toxicity. CONCLUSION This study directly compares presentations with acute drug toxicity related to the lone use of cannabis or synthetic cannabinoid receptor agonists. It supports previous findings of increased neuropsychiatric toxicity from synthetic cannabinoid receptor agonists compared to cannabis and provides further data on cardiovascular toxicity in lone cannabis use.
Collapse
Affiliation(s)
- Mitchell L Waters
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - Paul I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
- Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Christopher Yates
- Emergency Department and Clinical Toxicology Unit, Hospital Universitari Son Espases, Mallorca, Spain
| | - Alison M Dines
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - Florian Eyer
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Isabelle Giraudon
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Fridtjof Heyerdahl
- Prehospital Division, Oslo University Hospital, Oslo, Norway
- The Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Knut Erik Hovda
- The Norwegian CBRNe Centre of Medicine, Oslo University Hospital, Oslo, Norway
| | - Matthias E Liechti
- Clinical Pharmacology and Toxicology, University Hospital and University of Basel, Basel, Switzerland
| | - Òscar Miró
- Emergency Department, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Odd Martin Vallersnes
- Department of General Practice, University of Oslo, Oslo, Norway
- Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway
| | - Kurt Anseeuw
- Department of Emergency Medicine, ZNA Stuivenberg, Antwerp, Belgium
| | | | | | | | - Miran Brvar
- Centre for Clinical Toxicology and Pharmacology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Blazena Caganova
- National Toxicological Information Centre, University Hospital, Bratislava, Slovakia
| | - Feriyde Calýskan
- Izmir Medical Sciences University, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Alessandro Ceschi
- Institute of Pharmacological Sciences of Southern Switzerland, Division of Clinical Pharmacology and Toxicology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Karam Chamoun
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris University, Paris, France
| | | | | | - Birgit Gartner
- Emergency Department, Geneva University Hospitals, Geneva, Switzerland
| | - Ketevan Gorozia
- Archangel St. Michael Multiprofile Clinical Hospital, Tbilisi, Georgia
| | - Damjan Grenc
- Centre for Clinical Toxicology and Pharmacology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Laura Hondebrink
- Dutch Poisons Information Center, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Gesche Jürgens
- Zealand University Hospital Roskilde, Clinical Pharmacology Unit, Roskilde, Denmark
| | | | - Soso Kutubidze
- Archangel St. Michael Multiprofile Clinical Hospital, Tbilisi, Georgia
| | - Gabija Laubner
- Republic Vilnius University Hospital, Vilnius, Lithuania
| | - Evangelia Liakoni
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Roy McKenna
- Department of Emergency Medicine, Our Lady of Lourdes Hospital, Drogheda, County Louth, Republic of Ireland
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris University, Paris, France
| | - Adrian Moughty
- Emergency Department, Mater Misericordiae University Hospital, Dublin 7, Republic of Ireland
| | | | - Roberta Noseda
- Institute of Pharmacological Sciences of Southern Switzerland, Division of Clinical Pharmacology and Toxicology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Niall O'Connor
- Department of Emergency Medicine, Our Lady of Lourdes Hospital, Drogheda, County Louth, Republic of Ireland
| | | | - Juan Ortega Perez
- Clinical Toxicology Unit, Emergency Department, Hospital Son Espases, Palma de Mallorca, Balearic Island, Spain
| | | | - Per Sverre Persett
- Department of Acute Medicine, Medical Division, Oslo University Hospital, Oslo, Norway
| | - Kristiina Põld
- Emergeny Medicine Department, North-Estonia Medical Centre, Tallinn, Estonia
| | - Erik Puchon
- National Toxicological Information Centre, University Hospital, Bratislava, Slovakia
| | - Jordi Puiguriguer
- Clinical Toxicology Unit, Emergency Department, Hospital Son Espases, Palma de Mallorca, Balearic Island, Spain
| | | | - Jan Rulisek
- Department of Anesthesia and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague 2, Czech Republic
| | - Caroline Samer
- Clinical Pharmacology and Toxicology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Yasmin Schmid
- Clinical Pharmacology and Toxicology, University Hospital and University of Basel, Basel, Switzerland
| | - Irene Scholz
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Jonas Surkus
- Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Irma Van den Hengel-Koot
- Dutch Poisons Information Center, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | | | - Severin Vogt
- Clinical Pharmacology and Toxicology, University Hospital and University of Basel, Basel, Switzerland
| | - Wojciech Waldman
- Pomeranian Centre of Toxicology, Gdansk, Poland
- Medical University Gdansk, Department of Clinical Toxicology, Gdansk, Poland
| | | | - Sergej Zacharov
- Toxicological Information Centre, Department of Occupational Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague 2, Czech Republic
| | - Tobias Zellner
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
- Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| |
Collapse
|
3
|
Lafzi A, Demirci T, Yüce N, Annaç E, Çiçek M, Şişman T. A study on the possible neurotoxic effects of CUMYL-4CN-BINACA in Sprague Dawley rats. Leg Med (Tokyo) 2024; 67:102389. [PMID: 38185093 DOI: 10.1016/j.legalmed.2023.102389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 01/09/2024]
Abstract
Substances such as Δ9-tetrahydrocannabinol (THC) and cannabidiol cross the blood-brain barrier. Detecting the damage of these substances in the brain provides important data in drug abuse studies. The aim of the study is to define the neurotoxicity of a novel synthetic cannabinoid (CUMYL-4CN-BINACA) in the Sprague-Dawley rats. Histopathological, immunohistochemical, behavioral, and biochemical examinations were performed to determine the acute and subacute toxicity of the cannabinoid. Three cannabinoid doses were administered for 2 days in the acute exposure groups and 14 days in the subacute exposure groups. Observations were made for 14 days and various changes such as mortality, injury, and illness were recorded daily. No mortality was determined. Serious pathological changes such as neurodegeneration, focal plague formation, vacuolation, edema, congestion, and fibrosis were observed in the cerebral cortex and hippocampus of the brain in a dose-dependent manner. Brain tissue caspase-3 activity showed that the cannabinoid triggered apoptosis in the rat brain. The detected cellular oxidative stress (higher lipid peroxidation and lower antioxidant enzyme activity) also supported neurotoxicity. Significant behavioral abnormalities were also observed in the acute groups, while no behavioral changes were detected in the subacute groups. This study showed for the first time that CUMYL-4CN-BINACA adversely affects the rat brain. It can be estimated that the abuse of the cannabinoid may harm human health in the same way.
Collapse
Affiliation(s)
- Ayşe Lafzi
- Department of Criminalistics, Graduate School of Natural and Applied Science, Atatürk University, 25240 Erzurum, Turkey.
| | - Tuba Demirci
- Department of Histology and Embryology, Medicine Faculty, Atatürk University, 25240 Erzurum, Turkey.
| | - Neslihan Yüce
- Department of Medical Biochemistry, Medicine Faculty, Atatürk University, 25240 Erzurum, Turkey.
| | - Ebru Annaç
- Department of Histology and Embryology, Medicine Faculty, Adıyaman University, 02040 Adıyaman, Turkey.
| | - Mustafa Çiçek
- Department of Medical Biology and Genetics, Medicine Faculty, Kahramanmaraş Sütçü İmam University, 46050 Kahramanmaraş, Turkey.
| | - Turgay Şişman
- Department of Criminalistics, Graduate School of Natural and Applied Science, Atatürk University, 25240 Erzurum, Turkey; Department of Molecular Biology and Genetics, Science Faculty, Atatürk University, 25240 Erzurum, Turkey.
| |
Collapse
|
4
|
Madan K, Schmidt S, Chami RF, Ho R, Lewis JC, Apollonio DE. Reported exposures to derived cannabis products in California before and after the 2018 federal reclassification of hemp. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104313. [PMID: 38194724 DOI: 10.1016/j.drugpo.2023.104313] [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: 09/14/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND As of June 2023, a majority of states had legalized the sale of cannabis, which past research has found to be associated with increased exposures. In 2018, a change in federal policy increased access to cannabidiol (CBD) and derived psychoactive cannabis products, but there has been limited study of reported exposures following this change. METHODS This observational retrospective study analyzed exposures involving synthetic cannabinoid receptor agonists (SCRAs) and derived cannabis products, including CBD, reported to the California Poison Control System (CPCS) from 2010 to 2022. We focused primarily on potential shifts in reported exposures before and after the implementation of the 2018 Farm Bill, which removed products derived from hemp from the Controlled Substances Act. We reviewed and hand-coded individual call records to assess reported exposures over time and their characteristics, and conducted interrupted time series analysis to assess whether exposure counts changed after policy interventions. RESULTS Reported CBD exposures significantly increased following the federal reclassification of hemp products. Exposure reports were most common among young children and for edibles. Exposure reports provided limited information about derived psychoactive cannabis products. CONCLUSIONS Our findings suggest a need for improved data collection regarding derived psychoactive cannabis products, as well as potential public health value in modifying packaging regulations and in providing additional guidance to parents to help prevent CBD exposures.
Collapse
Affiliation(s)
- Kunal Madan
- School of Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - Samantha Schmidt
- School of Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - Raeiti Fouladi Chami
- School of Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - Raymond Ho
- School of Pharmacy, University of California San Francisco, San Francisco, CA, USA; California Poison Control System, San Francisco and Sacramento, CA, USA
| | - Justin C Lewis
- School of Pharmacy, University of California San Francisco, San Francisco, CA, USA; California Poison Control System, San Francisco and Sacramento, CA, USA
| | - Dorie E Apollonio
- School of Pharmacy, University of California San Francisco, San Francisco, CA, USA.
| |
Collapse
|
5
|
Creanga-Murariu I, Filipiuc LE, Cuciureanu M, Tamba BI, Alexa-Stratulat T. Should oncologists trust cannabinoids? Front Pharmacol 2023; 14:1211506. [PMID: 37521486 PMCID: PMC10373070 DOI: 10.3389/fphar.2023.1211506] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023] Open
Abstract
Cannabis enjoyed a "golden age" as a medicinal product in the late 19th, early 20th century, but the increased risk of overdose and abuse led to its criminalization. However, the 21st century have witnessed a resurgence of interest and a large body of literature regarding the benefits of cannabinoids have emerged. As legalization and decriminalization have spread around the world, cancer patients are increasingly interested in the potential utility of cannabinoids. Although eager to discuss cannabis use with their oncologist, patients often find them to be reluctant, mainly because clinicians are still not convinced by the existing evidence-based data to guide their treatment plans. Physicians should prescribe cannabis only if a careful explanation can be provided and follow up response evaluation ensured, making it mandatory for them to be up to date with the positive and also negative aspects of the cannabis in the case of cancer patients. Consequently, this article aims to bring some clarifications to clinicians regarding the sometimes-confusing various nomenclature under which this plant is mentioned, current legislation and the existing evidence (both preclinical and clinical) for the utility of cannabinoids in cancer patients, for either palliation of the associated symptoms or even the potential antitumor effects that cannabinoids may have.
Collapse
Affiliation(s)
- Ioana Creanga-Murariu
- Advanced Research and Development Center for Experimental Medicine (CEMEX), “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
- Oncology Department, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
| | - Leontina Elena Filipiuc
- Advanced Research and Development Center for Experimental Medicine (CEMEX), “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
| | - Magda Cuciureanu
- Pharmacology Department, Clinical Pharmacology and Algesiology, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
| | - Bogdan-Ionel Tamba
- Advanced Research and Development Center for Experimental Medicine (CEMEX), “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
- Pharmacology Department, Clinical Pharmacology and Algesiology, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
| | | |
Collapse
|
6
|
Rodrigues CHP, Mariotto LS, Castro JS, Peruquetti PH, Silva-Junior NC, Bruni AT. Acute, chronic, and post-mortem toxicity: a review focused on three different classes of new psychoactive substances. Forensic Toxicol 2023; 41:187-212. [PMID: 36604359 DOI: 10.1007/s11419-022-00657-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/22/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE New psychoactive substances (NPS) are not controlled under the Single Convention on Narcotic Drugs of 1961 or the 1971 Convention, but they may pose a public health threat. Knowledge of the main properties and toxicological effects of these substances is lacking. According to the current Drugs Law (Law n. 11.343/2006), the Brazilian Surveillance Agency issues directives for forbidden substances in Brazil, and structural classes of synthetic cannabinoids, cathinones, and phenylethylamines are considered illicit drugs. Considering that data on these controlled substances are scattered, the main objective of this work was to collect and organize data to generate relevant information on the toxicological properties of NPS. METHODS We carried out a literature review collecting information on the acute, chronic, and post-mortem toxicity of these classes of NSP. We searched info in five scientific databases considering works from 2017 to 2021 and performed a statistical evaluation of the data. RESULTS Results have shown a general lack of studies in this field given that many NPS have not had their toxicity evaluated. We observed a significant difference in the volume of data concerning acute and chronic/post-mortem toxicity. Moreover, studies on the adverse effects of polydrug use are scarce. CONCLUSIONS More in-depth information about the main threats involving NPS use are needed.
Collapse
Affiliation(s)
- Caio H P Rodrigues
- Department of Chemistry, Faculty of Philosophy, Science and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-901, Brazil
- INCT Forense - Department of Chemistry, Faculty of Philosophy, Science and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-901, Brazil
| | - Lívia S Mariotto
- Department of Chemistry, Faculty of Philosophy, Science and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-901, Brazil
- INCT Forense - Department of Chemistry, Faculty of Philosophy, Science and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-901, Brazil
| | - Jade S Castro
- Department of Chemistry, Faculty of Philosophy, Science and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-901, Brazil
- INCT Forense - Department of Chemistry, Faculty of Philosophy, Science and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-901, Brazil
| | - Paulo H Peruquetti
- Department of Chemistry, Faculty of Philosophy, Science and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-901, Brazil
| | - Newton C Silva-Junior
- Department of Chemistry, Faculty of Philosophy, Science and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-901, Brazil
- INCT Forense - Department of Chemistry, Faculty of Philosophy, Science and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-901, Brazil
| | - Aline T Bruni
- Department of Chemistry, Faculty of Philosophy, Science and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-901, Brazil.
- INCT Forense - Department of Chemistry, Faculty of Philosophy, Science and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-901, Brazil.
| |
Collapse
|
7
|
Synthetic Cannabinoids and Cannabis: How the Patterns of Use Differ: Results from the European Web Survey on Drugs. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00919-6] [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: 10/10/2022] Open
|
8
|
Theunissen EL, Reckweg JT, Hutten NRPW, Kuypers KPC, Toennes SW, Neukamm MA, Halter S, Ramaekers JG. Psychotomimetic symptoms after a moderate dose of a synthetic cannabinoid (JWH-018): implications for psychosis. Psychopharmacology (Berl) 2022; 239:1251-1261. [PMID: 33501595 PMCID: PMC9110546 DOI: 10.1007/s00213-021-05768-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/14/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Synthetic cannabinoids (SCs) are the largest class of novel psychoactive substances (NPS) and are associated with an increased risk of overdosing and adverse events such as psychosis. JWH-018 is one of the earliest SCs and still widely available in large parts of the world. Controlled studies to assess the safety and behavioural profiles of SCs are extremely scarce. AIM The current study was designed to assess the psychotomimetic effects of a moderate dose of JWH-018. METHODS Twenty-four healthy participants (10 males, 14 females) entered a placebo-controlled, double blind, within-subjects trial and inhaled vapour of placebo or 75μg/kg bodyweight JWH-018. To ascertain a minimum level of intoxication, a booster dose of JWH-018 was administered on an as-needed basis. The average dose of JWH-018 administered was 5.52 mg. Subjective high, dissociative states (CADSS), psychedelic symptoms (Bowdle), mood (POMS) and cannabis reinforcement (SCRQ) were assessed within a 4.5-h time window after drug administration. RESULTS JWH-018 caused psychedelic effects, such as altered internal and external perception, and dissociative effects, such as amnesia, derealisation and depersonalisation and induced feelings of confusion. CONCLUSION Overall, these findings suggest that a moderate dose of JWH-018 induces pronounced psychotomimetic symptoms in healthy participants with no history of mental illness, which confirms that SCs pose a serious risk for public health.
Collapse
Affiliation(s)
- Eef L Theunissen
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Johannes T Reckweg
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Nadia R P W Hutten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Kim P C Kuypers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Stefan W Toennes
- Department of Forensic Toxicology, Institute of Legal Medicine, Goethe University of Frankfurt, Frankfurt, Germany
| | - Merja A Neukamm
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Halter
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Hermann Staudinger Graduate School, University of Freiburg, Freiburg, Germany
| | - Johannes G Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| |
Collapse
|
9
|
Theunissen EL, Kuypers KPC, Mason NL, Ramaekers JG. A Comparison of Acute Neurocognitive and Psychotomimetic Effects of a Synthetic Cannabinoid and Natural Cannabis at Psychotropic Dose Equivalence. Front Psychiatry 2022; 13:891811. [PMID: 35664482 PMCID: PMC9160432 DOI: 10.3389/fpsyt.2022.891811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/26/2022] [Indexed: 01/12/2023] Open
Abstract
Due to differences in potency, efficacy, and affinity for CB1 receptors, similarities and differences in psychoactive effect profiles of natural cannabis and synthetic cannabinoids (SCs) cannot reliably be derived from equipotent dose comparisons. Instead, the current study proposes to compare the intrinsic psychoactive effects of natural cannabis (THC) and an SC, JWH-018, at psychotropic dose equivalence. Participants from two placebo-controlled studies were matched for their levels of subjective high to compare neurocognitive and psychotomimetic effects of THC and JWH-018. At equal subjective intoxication levels, both drugs impaired psychomotor, divided attention, and impulse control, with no significant difference between the two drugs. Both drugs also caused significant psychotomimetic effects, but dissociative effects were considerably more pronounced for JWH-018 than THC. We conclude that psychotropic dose equivalence provides a uniform approach for comparing the neurocognitive and psychotomimetic profiles of CB1 agonists, which can also be applied to other drug classes.
Collapse
Affiliation(s)
- Eef Lien Theunissen
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Kim Paula Colette Kuypers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Natasha Leigh Mason
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Johannes Gerardus Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
10
|
Yüncü Z, Cakmak Celik Z, Colak C, Thapa T, Fornito A, Bora E, Kitis O, Zorlu N. Resting state functional connectivity in adolescent synthetic cannabinoid users with and without attention-deficit/hyperactivity disorder. Hum Psychopharmacol 2021; 36:e2781. [PMID: 33675677 DOI: 10.1002/hup.2781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Synthetic cannabinoids (SCs) have become increasingly popular in recent years, especially among adolescents. The first aim of the current study was to examine resting-state functional connectivity (rsFC) in SC users compared to controls. Our second aim was to examine the influence of comorbid attention-deficit/hyperactivity disorder (ADHD) symptomatology on rsFC changes in SC users compared to controls. METHODS Resting-state functional magnetic resonance imaging (fMRI) analysis included 25 SC users (14 without ADHD and 11 with ADHD combined type) and 12 control subjects. RESULTS We found (i) higher rsFC between the default mode network (DMN) and salience network, dorsal attention network and cingulo-opercular network, and (ii) lower rsFC within the DMN and between the DMN and visual network in SC users compared to controls. There were no significant differences between SC users with ADHD and controls, nor were there any significant differences between SC users with and without ADHD. CONCLUSIONS We found the first evidence of abnormalities within and between resting state networks in adolescent SC users without ADHD. In contrast, SC users with ADHD showed no differences compared to controls. These results suggest that comorbidity of ADHD and substance dependence may show different rsFC alterations than substance use alone.
Collapse
Affiliation(s)
- Zeki Yüncü
- Department of Child Psychiatry, Ege University School of Medicine, Izmir, Turkey
| | | | - Ciğdem Colak
- Department of Psychiatry, Cigli Regional Training Hospital, Izmir, Turkey
| | - Tribikram Thapa
- Brain & Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Victoria, Australia
| | - Alex Fornito
- Brain & Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Victoria, Australia
| | - Emre Bora
- Department of Psychiatry, Dokuz Eylül University Medical School, Izmir, Turkey
| | - Omer Kitis
- Department of Radiodiagnostics, Ege University School of Medicine, Izmir, Turkey
| | - Nabi Zorlu
- Department of Psychiatry, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| |
Collapse
|
11
|
DeVuono MV, Hrelja KM, Petrie GN, Limebeer CL, Rock EM, Hill MN, Parker LA. Nausea-Induced Conditioned Gaping Reactions in Rats Produced by High-Dose Synthetic Cannabinoid, JWH-018. Cannabis Cannabinoid Res 2020; 5:298-304. [PMID: 33381644 DOI: 10.1089/can.2019.0103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction: Cannabinoid hyperemesis syndrome is becoming a more prominently reported side effect of cannabis containing high-dose Δ9-tetrahydrocannabinol (THC) and designer cannabinoid drugs such as "Spice." One active ingredient that has been found in "Spice" is 1-pentyl-3-(1-naphthoyl)indole (JWH-018), a synthetic full agonist of the cannabinoid 1 (CB1) receptor. In this study, we evaluated the potential of different doses of JWH-018 to produce conditioned gaping in rats, an index of nausea. Materials and Methods: Rats received 3 daily conditioning trials in which saccharin was paired with JWH-018 (0.0, 0.1, 1, and 3 mg/kg, intraperitoneal [i.p.]). Then the potential of pretreatment with the CB1 antagonist, rimonabant (SR), to prevent JWH-018-induced conditioned gaping was determined. To begin to understand the potential mechanism underlying JWH-018-induced nausea, serum collected from trunk blood was subjected to a corticosterone (CORT) analysis in rats receiving three daily injections with vehicle (VEH) or JWH-018 (3 mg/kg). Results: At doses of 1 and 3 mg/kg (i.p.), JWH-018 produced nausea-like conditioned gaping reactions. The conditioned gaping produced by 3 mg/kg JWH-018 was reversed by pretreatment with rimonabant, which did not modify gaping on its own. Treatment with JWH-018 elevated serum CORT levels compared to vehicle-treated rats. Conclusions: As we have previously reported with high-dose THC, JWH-018 produced conditioned gaping in rats, reflective of a nausea effect mediated by its action on CB1 receptors and accompanied by elevated CORT, reflective of hypothalamic-pituitary-adrenal (HPA) activation.
Collapse
Affiliation(s)
- Marieka V DeVuono
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, Canada
| | - Kelly M Hrelja
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, Canada
| | - Gavin N Petrie
- Department of Cell Biology and Anatomy, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Cheryl L Limebeer
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, Canada
| | - Erin M Rock
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, Canada
| | - Matthew N Hill
- Department of Cell Biology and Anatomy, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Linda A Parker
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, Canada
| |
Collapse
|
12
|
Tebo C, Mazer-Amirshahi M, Wax P, Campleman S, Boyer E, Brent J, Sheth A, Daniuaityte R, Carlson R. Characterizing Trends in Synthetic Cannabinoid Receptor Agonist Use from Patient Clinical Evaluations during Medical Toxicology Consultation. J Psychoactive Drugs 2020; 53:207-214. [PMID: 33225872 DOI: 10.1080/02791072.2020.1851826] [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: 10/22/2022]
Abstract
Synthetic cannabinoid receptor agonists (SCRAs) are a new class of compounds with profound psychoactive effects and potential toxicity. This study characterizes patterns in SCRA abuse using qualitative interviews with individuals receiving medical toxicology consultation. Patients with suspected exposure to a new psychoactive substance were interviewed by medical toxicologists upon presentation for acute care. Investigators collected clinical and qualitative data including knowledge, attitudes, beliefs, and practices related to psychoactive substance use. Responses were categorized by identifying themes, and statistics were generated to describe patterns of use. Overall, 69% (86) of the 124 cases of novel psychoactive substance use entered into the registry were associated with exposure to SCRAs. Most patients (68.8%) had used SCRAs at least once before the presenting episode. 47.7% considered SCRAs to be very easy to obtain, and 44.2% reported paying for the substances while 32.6% acquired it for free. Nearly half (48.8%) of patients reported their primary reason for use was to get high; a small proportion used SCRAs to avoid testing positive on drug screening (6.9%) or as an alternative to marijuana (4.6%). Findings suggest an independent and stable culture is developing around the use of SCRAs separate from their appeal as an "undetectable" alternative to marijuana.
Collapse
Affiliation(s)
- Collin Tebo
- School of Medicine, Georgetown University, Washington, DC, USA
| | - Maryann Mazer-Amirshahi
- School of Medicine, Georgetown University, Washington, DC, USA.,Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Paul Wax
- UT Southwestern Medical School.,American College of Medical Toxicology, Phoenix, AZ, USA
| | | | - Edward Boyer
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jeffrey Brent
- University of Colorado School of Medicine and Colorado School of Public Health, Aurora, CO, USA
| | - Amit Sheth
- Computer Science & Engineering, University of South Carolina, Columba, SC, USA
| | | | - Robert Carlson
- Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Luethi D, Liechti ME. Designer drugs: mechanism of action and adverse effects. Arch Toxicol 2020; 94:1085-1133. [PMID: 32249347 PMCID: PMC7225206 DOI: 10.1007/s00204-020-02693-7] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/25/2020] [Indexed: 12/18/2022]
Abstract
Psychoactive substances with chemical structures or pharmacological profiles that are similar to traditional drugs of abuse continue to emerge on the recreational drug market. Internet vendors may at least temporarily sell these so-called designer drugs without adhering to legal statutes or facing legal consequences. Overall, the mechanism of action and adverse effects of designer drugs are similar to traditional drugs of abuse. Stimulants, such as amphetamines and cathinones, primarily interact with monoamine transporters and mostly induce sympathomimetic adverse effects. Agonism at μ-opioid receptors and γ-aminobutyric acid-A (GABAA) or GABAB receptors mediates the pharmacological effects of sedatives, which may induce cardiorespiratory depression. Dissociative designer drugs primarily act as N-methyl-D-aspartate receptor antagonists and pose similar health risks as the medically approved dissociative anesthetic ketamine. The cannabinoid type 1 (CB1) receptor is thought to drive the psychoactive effects of synthetic cannabinoids, which are associated with a less desirable effect profile and more severe adverse effects compared with cannabis. Serotonergic 5-hydroxytryptamine-2A (5-HT2A) receptors mediate alterations of perception and cognition that are induced by serotonergic psychedelics. Because of their novelty, designer drugs may remain undetected by routine drug screening, thus hampering evaluations of adverse effects. Intoxication reports suggest that several designer drugs are used concurrently, posing a high risk for severe adverse effects and even death.
Collapse
Affiliation(s)
- Dino Luethi
- Center for Physiology and Pharmacology, Institute of Pharmacology, Medical University of Vienna, Währinger Strasse 13a, 1090, Vienna, Austria.
- Institute of Applied Physics, Vienna University of Technology, Getreidemarkt 9, 1060, Vienna, Austria.
- Division of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland.
| | - Matthias E Liechti
- Division of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland.
| |
Collapse
|
15
|
Cannabis and synthetic cannabinoid exposure reported to the Israel poison information center: Examining differences in exposures to medical and recreational compounds. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 77:102711. [DOI: 10.1016/j.drugpo.2020.102711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 02/09/2020] [Accepted: 02/14/2020] [Indexed: 01/30/2023]
|
16
|
Daniju Y, Bossong MG, Brandt K, Allen P. Do the effects of cannabis on the hippocampus and striatum increase risk for psychosis? Neurosci Biobehav Rev 2020; 112:324-335. [PMID: 32057817 DOI: 10.1016/j.neubiorev.2020.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 01/17/2020] [Accepted: 02/10/2020] [Indexed: 11/19/2022]
Abstract
Cannabis use is associated with increased risk of psychotic symptoms and in a small number of cases it can lead to psychoses. This review examines the neurobiological mechanisms that mediate the link between cannabis use and psychosis risk. We use an established preclinical model of psychosis, the methylazoxymethanol acetate (MAM) rodent model, as a framework to examine if psychosis risk in some cannabis users is mediated by the effects of cannabis on the hippocampus, and this region's role in the regulation of mesolimbic dopamine. We also examine how cannabis affects excitatory neurotransmission known to regulate hippocampal neural activity and output. Whilst there is clear evidence that cannabis/cannabinoids can affect hippocampal and medial temporal lobe function and structure, the evidence that cannabis/cannabinoids increase striatal dopamine function is less robust. There is limited evidence that cannabis use affects cortical and striatal glutamate levels, but there are currently too few studies to draw firm conclusions. Future work is needed to test the MAM model in relation to cannabis using multimodal neuroimaging approaches.
Collapse
Affiliation(s)
- Y Daniju
- Department of Psychology, University of Roehampton, London, UK
| | - M G Bossong
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands
| | - K Brandt
- Department of Psychology, University of Roehampton, London, UK
| | - P Allen
- Department of Psychology, University of Roehampton, London, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Icahn School of Medicine at Mount Sinai Hospital, New York, USA.
| |
Collapse
|
17
|
Abstract
Substances toxic to the kidney are legion in the modern world. The sheer number and variety, their mutual interactions and, metabolism within the body are a challenge to research. Moreover, the kidney is especially prone to injury owing to its physiology. Acute kidney injury (AKI) induced by poisonous or primarily nephrotoxic substances, may be community acquired with ingestion or inhalation or nosocomial. Many nephrotoxic plants, animal poisons, medications, chemicals and illicit drugs can induce AKI by varying pathophysiological pathways. Moreover, the epidemiology of toxic AKI varies depending on country, regions within countries, socioeconomic status and health care facilities. In this review, we have selected nephrotoxic insults due to medication, plants, animal including snake venom toxicity, environmental, (agri)chemicals and also illicit drugs. We conclude with a section on diagnosis, clinical presentation and management of poisoning accompanied by various organ dysfunction and AKI.
Collapse
Affiliation(s)
- Nadezda Petejova
- a Department of Internal Medicine , University Hospital Ostrava , Ostrava , Czech Republic.,b Department of Clinical Studies, Faculty of Medicine , University of Ostrava , Ostrava , Czech Republic.,c Department of Internal Medicine III - Nephrology, Rheumatology and Endocrinology , University Hospital and Faculty of Medicine and Dentistry, Palacky University Olomouc , Olomouc , Czech Republic
| | - Arnost Martinek
- a Department of Internal Medicine , University Hospital Ostrava , Ostrava , Czech Republic.,b Department of Clinical Studies, Faculty of Medicine , University of Ostrava , Ostrava , Czech Republic
| | - Josef Zadrazil
- c Department of Internal Medicine III - Nephrology, Rheumatology and Endocrinology , University Hospital and Faculty of Medicine and Dentistry, Palacky University Olomouc , Olomouc , Czech Republic
| | - Vladimir Teplan
- a Department of Internal Medicine , University Hospital Ostrava , Ostrava , Czech Republic.,d Department of Nephrology , Institute for Postgraduate Education Prague , Vinohrady , Czech Republic
| |
Collapse
|
18
|
O'Neill-Dee C, Spiller HA, Casavant MJ, Kistamgari S, Chounthirath T, Smith GA. Natural psychoactive substance-related exposures reported to United States poison control centers, 2000-2017. Clin Toxicol (Phila) 2019; 58:813-820. [PMID: 31766893 DOI: 10.1080/15563650.2019.1688341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Context/Objective: To investigate the epidemiology of exposures to psychoactive substances of natural origin in the United States.Methods: Data from the National Poison Data System were retrospectively analyzed to investigate exposures to psychoactive substances of natural origin.Results: From January 1, 2000 through December 31, 2017, there were 67,369 calls to poison control centers in the United States regarding exposures to natural psychoactive substances, equaling an average of 3,743 exposures annually. Individuals >19 years of age (41.4%) and 13-19-year-olds (34.8%) accounted for most exposures with the highest annual rate reported among 13-19-year-olds at 79.4 per million population. The substances most commonly involved were marijuana (46.9%), anticholinergic plants (21.1%), and hallucinogenic mushrooms (15.6%). Kratom, khat, anticholinergic plants, and hallucinogenic mushrooms were the substances with the highest percentages of hospital admission and serious medical outcomes. The overall rate of exposure to natural psychoactive substances per million population increased significantly by 74.1% from 17.6 in 2000 to 30.7 in 2017 (p < 0.001). This increase was driven by a significant 150.0% increase in the rate of exposure to marijuana from 9.9 in 2000 to 24.7 in 2017 (p < 0.001). Despite this overall increase, most substances showed a significant decrease in exposure rate from 2000 to 2017, except for marijuana, nutmeg, and kratom. Kratom demonstrated a significant 4,948.9% increase from 2011 to 2017 and accounted for 8 of the 42 deaths identified in this study.Conclusions: While rates of exposure to most natural psychoactive substances decreased during the 18-year study period, rates for marijuana, nutmeg, and kratom increased significantly.
Collapse
Affiliation(s)
- Connor O'Neill-Dee
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Creighton University School of Medicine, Omaha, NE, USA
| | - Henry A Spiller
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Central Ohio Poison Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - Marcel J Casavant
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Central Ohio Poison Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - Sandhya Kistamgari
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Thitphalak Chounthirath
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Gary A Smith
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Child Injury Prevention Alliance, Columbus, OH, USA
| |
Collapse
|
19
|
Grigg J, Manning V, Arunogiri S, Lubman DI. Synthetic cannabinoid use disorder: an update for general psychiatrists. Australas Psychiatry 2019; 27:279-283. [PMID: 30663326 DOI: 10.1177/1039856218822749] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Synthetic cannabinoid use disorder is emerging as a significant clinical issue. This article provides the general psychiatrist with an overview of the physical and psychiatric adverse effects of chronic synthetic cannabinoid use, as well as specific clinical responses. METHOD We performed electronic searches of Ovid MEDLINE and Ovid Embase to identify key articles, of all methodological designs, published up to June 2018. RESULTS The available evidence suggests that, compared to cannabis, use of synthetic cannabinoids is associated with the more rapid development of dependence, increased psychiatric risks and complex withdrawal, and serious physical adverse effects that include seizures, cardiotoxicity and death, denoting a potential need for more intensive management. CONCLUSION When synthetic cannabinoid use is identified, along with management of acute physical and psychiatric adverse effects, psychotherapeutic strategies to reduce use and/or harm are recommended.
Collapse
Affiliation(s)
- Jasmin Grigg
- Research Fellow, Turning Point, Eastern Health, Richmond, VIC, and; Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Victoria Manning
- Associate Professor, Turning Point, Eastern Health, Richmond, VIC, and; Eastern Health Clinical School, Monash University, Melbourne, VIC, and Australia
| | - Shalini Arunogiri
- Addiction Psychiatrist, Turning Point, Eastern Health, Richmond, VIC, and; Senior Lecturer, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Dan I Lubman
- Director, Turning Point, Eastern Health, Richmond, VIC, and; Professor of Addiction Studies and Services, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
20
|
Cohen K, Weizman A, Weinstein A. Modulatory effects of cannabinoids on brain neurotransmission. Eur J Neurosci 2019; 50:2322-2345. [DOI: 10.1111/ejn.14407] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Koby Cohen
- Department of Behavioral Science Ariel University Science Park 40700 Ariel Israel
| | | | - Aviv Weinstein
- Department of Behavioral Science Ariel University Science Park 40700 Ariel Israel
| |
Collapse
|
21
|
Yin S. Adolescents and Drug Abuse: 21st Century Synthetic Substances. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2019. [DOI: 10.1016/j.cpem.2019.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
22
|
Abstract
Tens of thousands of ED visits each year are related to synthetic psychoactive drug intoxication. Signs, symptoms, and treatment of toxicity with synthetic cathinones, synthetic cannabinoids, or dextromethorphan overlap greatly and can be challenging. This article describes signs and symptoms of psychoactive drug abuse and how to properly manage these symptoms.
Collapse
|
23
|
Angerer V, Franz F, Moosmann B, Bisel P, Auwärter V. 5F-Cumyl-PINACA in 'e-liquids' for electronic cigarettes: comprehensive characterization of a new type of synthetic cannabinoid in a trendy product including investigations on the in vitro and in vivo phase I metabolism of 5F-Cumyl-PINACA and its non-fluorinated analog Cumyl-PINACA. Forensic Toxicol 2018; 37:186-196. [PMID: 30636986 PMCID: PMC6315005 DOI: 10.1007/s11419-018-0451-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/31/2018] [Indexed: 11/09/2022]
Abstract
PURPOSE In recent years e-liquids used in electronic cigarettes have become an attractive alternative to smoking tobacco. A new trend is the use of e-liquids containing synthetic cannabinoids (SCs) instead of smoking cannabis or herbal mixtures laced with SCs. In the frame of a systematic monitoring of the online market of 'legal high' products, e-liquids from online retailers who also sell herbal blends were bought. METHODS The products were analyzed by gas chromatography-mass spectrometry. In some of the e-liquids an unknown compound was detected which was identified as the SC 5F-Cumyl-PINACA (1-(5-fluoropentyl)-N-(2-phenylpropan-2-yl)-1H-indazole-3-carboxamide) by nuclear magnetic resonance analysis. To investigate the phase I metabolism of this new class of compounds, 5F-Cumyl-PINACA and its non-fluorinated analog Cumyl-PINACA were incubated with pooled human liver microsomes (pHLM). Cumyl-PINACA was additionally ingested orally (0.6 mg) by a volunteer in a controlled self-experiment. To assess the relative potency of Cumyl-PINACA a set of SCs were characterized using a cAMP assay. RESULTS Metabolism of 5F-Cumyl-PINACA and Cumyl-PINACA showed similarities with AM-2201 and JWH-018. The main metabolites were formed by hydroxylation at the N-pentyl side chain. The main metabolites detected in the volunteer's urine sample were the same as in the pHLM assay. All SCs tested with the cAMP assay were full agonists at the CB1 receptor. Cumyl-PINACA was the most potent SC among the tested compounds and showed an EC50 value of 0.06 nM. CONCLUSIONS The increasing popularity of e-liquids particularly among young people, and the extreme potency of the added SCs, pose a serious threat to public health. To our knowledge, this is the first report describing the tentative identification of human in vivo metabolites of Cumyl-PINACA and 5F-Cumyl-PINACA.
Collapse
Affiliation(s)
- Verena Angerer
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center–University of Freiburg, Albertstr. 9, 79104 Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Breisacher Str. 153, 79110 Freiburg, Germany
| | - Florian Franz
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center–University of Freiburg, Albertstr. 9, 79104 Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Breisacher Str. 153, 79110 Freiburg, Germany
- Hermann Staudinger Graduate School, University of Freiburg, Hebelstr. 27, 79104 Freiburg, Germany
| | - Bjoern Moosmann
- Institute of Forensic Medicine, Forensic Toxicology, Kantonsspital St. Gallen, Rorschacher Str. 95, 9007 St. Gallen, Switzerland
| | - Philippe Bisel
- Institute for Pharmaceutical Sciences, University of Freiburg, Albertstr. 25, 79104 Freiburg, Germany
| | - Volker Auwärter
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center–University of Freiburg, Albertstr. 9, 79104 Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Breisacher Str. 153, 79110 Freiburg, Germany
| |
Collapse
|
24
|
Cordeiro SK, Daro RC, Seung H, Klein-Schwartz W, Kim HK. Evolution of clinical characteristics and outcomes of synthetic cannabinoid receptor agonist exposure in the United States: analysis of National Poison Data System data from 2010 to 2015. Addiction 2018; 113:1850-1861. [PMID: 29806885 DOI: 10.1111/add.14281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 01/22/2018] [Accepted: 05/23/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND AIMS New synthetic cannabinoid receptor agonists (SCRAs) are synthesized each year to evade US governmental regulation and sold for recreational use. Our aim was to estimate the changes in the clinical effects and patient disposition associated with SCRA exposure from 2010 to 2015. DESIGN A retrospective observational cohort study. SETTING National Poison Data System that collects data on reports of poisonings from US poison centers. PARTICIPANTS A total of 19 388 isolated SCRA cases between 1 January 2010 and 31 December 2015 were identified. The mean age was 24.6 years and 77.8% were male. MEASUREMENTS Primary outcome was the change in the trend of patient disposition, i.e. treated and released versus hospitalization (e.g. non-critical care, critical care unit or psychiatry) between 2010 and 2015. Secondary outcomes included the trends in the clinical effects and their duration, and therapeutic interventions nationally and regionally. FINDINGS Reports of SCRA exposure peaked in 2011 (n = 5305) and 2015 (n = 5475). The majority of patients required supportive care and were treated and released from an emergency department. Hospitalization increased by annual percentage change in the log odds (APCO) of 21.0% (P < 0.0001) during the 6 years, with significant increases in admissions to critical care units and non-critical care units. Overall, tachycardia (32.1%), agitation/irritation (25.6%) and drowsiness/lethargy (20.4%) were the most frequently reported clinical effects from SCRA exposure. Clinical effects resolved within 2-8 hours in 52.8% of cases, but their duration increased markedly by 2015. Regionally, the largest number of SCRA cases was reported in the South (n = 9374, 48.6%). SCRA cases in the Northeast were hospitalized more frequently (27.4%), with cases in the Midwest being admitted more frequently to critical care units (15.3%). However, there were no significant differences in clinical toxicity or disposition among the regions. CONCLUSION Hospitalization resulting from toxicity from synthetic cannabinoid receptor agonists exposure in the United States increased significantly between 2010 and 2015.
Collapse
Affiliation(s)
- Samuel K Cordeiro
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ryan C Daro
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hyunuk Seung
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Wendy Klein-Schwartz
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Maryland Poison Center, Baltimore, MD, USA
| | - Hong K Kim
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.,Maryland Poison Center, Baltimore, MD, USA
| |
Collapse
|
25
|
DeVuono MV, Hrelja KM, Sabaziotis L, Rajna A, Rock EM, Limebeer CL, Mutch DM, Parker LA. Conditioned gaping produced by high dose Δ 9-tetrahydracannabinol: Dysregulation of the hypothalamic endocannabinoid system. Neuropharmacology 2018; 141:272-282. [PMID: 30195587 DOI: 10.1016/j.neuropharm.2018.08.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/24/2018] [Accepted: 08/28/2018] [Indexed: 11/17/2022]
Abstract
Δ9-tetrahydracannabinol (THC) is recognized as an effective treatment for nausea and vomiting via its action on the cannabinoid 1 (CB1) receptor. Paradoxically, there is evidence that THC can also produce nausea and vomiting. Using the conditioned gaping model of nausea in rats, we evaluated the ability of several doses of THC (0.0, 0.5, 5 and 10 mg/kg, i.p.) to produced conditioned gaping reactions. We then investigated the ability of the CB1 receptor antagonist, rimonabant, to block the establishment of THC-induced conditioned gaping. Real-time polymerase chain reaction (RT-PCR) was then used to investigate changes in endocannabinoid related genes in various brain regions in rats chronically treated with vehicle (VEH), 0.5 or 10 mg/kg THC. THC produced dose-dependent gaping, with 5 and 10 mg/kg producing significantly more gaping reactions than VEH or 0.5 mg/kg THC, a dose known to have anti-emetic properties. Pre-treatment with rimonabant reversed this effect, indicating that THC-induced conditioned gaping was CB1 receptor mediated. The RT-PCR analysis revealed an upregulation of genes for the degrading enzyme, monoacylglycerol lipase (MAGL), of the endocannabinoid, 2-arachidolyl glycerol (2-AG), in the hypothalamus of rats treated with 10 mg/kg THC. No changes in the expression of relevant genes were found in nausea (interoceptive insular cortex) or vomiting (dorsal vagal complex) related brain regions. These findings support the hypothesis that THC-induced nausea is a result of a dysregulated hypothalamic-pituitary-adrenal axis leading to an overactive stress response.
Collapse
Affiliation(s)
- Marieka V DeVuono
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, N1G 2W1, ON, Canada
| | - Kelly M Hrelja
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, N1G 2W1, ON, Canada
| | - Lauren Sabaziotis
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, N1G 2W1, ON, Canada
| | - Alex Rajna
- Department of Human Health and Nutritional Science, University of Guelph, Guelph, N1G 2W1, ON, Canada
| | - Erin M Rock
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, N1G 2W1, ON, Canada
| | - Cheryl L Limebeer
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, N1G 2W1, ON, Canada
| | - David M Mutch
- Department of Human Health and Nutritional Science, University of Guelph, Guelph, N1G 2W1, ON, Canada
| | - Linda A Parker
- Department of Psychology and Collaborative Neuroscience Program, University of Guelph, Guelph, N1G 2W1, ON, Canada.
| |
Collapse
|
26
|
Metabolic and pharmacokinetic characterization of a new synthetic cannabinoid APINAC in rats. Forensic Toxicol 2017. [DOI: 10.1007/s11419-017-0387-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
27
|
Grady RM, Belostotsky V, Hallett KM, Grant CN. A 15-year-old boy with acute onset abdominal pain and hypertension. Paediatr Child Health 2017; 22:301-302. [DOI: 10.1093/pch/pxx089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
28
|
Öztürk YE, Yeter O, Öztürk S, Karakus G, Ates I, Buyuk Y, Yurdun T. Detection of metabolites of the new synthetic cannabinoid CUMYL-4CN-BINACA in authentic urine samples and human liver microsomes using high-resolution mass spectrometry. Drug Test Anal 2017; 10:449-459. [PMID: 28691766 DOI: 10.1002/dta.2248] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 01/01/2023]
Abstract
CUMYL-4CN-BINACA(1-(4-cyanobutyl)-N-(2-phenylpropan-2-yl)-1H-indazole-3-carboxamide) is a recently introduced indazole-3-carboxamide-type synthetic cannabinoid (SC) that was detected in herbal incense seized by of the Council of Forensic Medicine, Istanbul Narcotics Department, in May 2016 in Turkey. Recently introduced SCs are not detected in routine toxicological analysis; therefore, analytical methods to measure these compounds are in demand. The present study aims to identify urinary marker metabolites of CUMYL-4CN-BINACA by investigating its metabolism in human liver microsomes and to confirm the results in authentic urine samples (n = 80). In this study, 5 μM CUMYL-4CN-BINACA was incubated with human liver microsomes (HLMs) for up to 3 hours, and metabolites were identified using liquid chromatography-high-resolution mass spectrometry (LC-HRMS). Less than 21% of the CUMYL-4CN-BINACA parent compound remained after 3 hours of incubation. We identified 18 metabolites that were formed via monohydroxylation, dealkylation, oxidative decyanation to aldehyde, alcohol, and carboxylic acid formation, glucuronidation or reaction combinations. CUMYL-4CN-BINACA N-butanoic acid (M16) was found to be major metabolite in HLMs. In urine samples CUMYL-4CN-BINACA was not detected; CUMYL-4CN-BINACA N-butanoic acid (M16) was major metabolite after β-glucuronidase hydrolysis. Based on these findings, we recommend using M16 (CUMYL-4CN-BINACA N-butanoic acid), M8 and M11 (hydroxylcumyl CUMYL-4CN-BINACA) as urinary marker metabolites to confirm CUMYL-4CN-BINACA intake.
Collapse
Affiliation(s)
- Yeter Erol Öztürk
- Council of Forensic Medicine, Chemistry Department, Istanbul, Turkey
| | - Oya Yeter
- Council of Forensic Medicine, Chemistry Department, Istanbul, Turkey
| | - Serkan Öztürk
- Council of Forensic Medicine, Chemistry Department, Istanbul, Turkey
| | - Goksun Karakus
- Biruni University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Istanbul, Turkey.,Marmara University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Istanbul, Turkey
| | - Ismail Ates
- Council of Forensic Medicine, Chemistry Department, Istanbul, Turkey
| | - Yalçın Buyuk
- Council of Forensic Medicine, Morque Department, Istanbul, Turkey
| | - Turkan Yurdun
- Marmara University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Istanbul, Turkey
| |
Collapse
|
29
|
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.
Collapse
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
| | | |
Collapse
|
30
|
Liu X, Villamagna A, Yoo J. The Importance of Recognizing Cannabinoid Hyperemesis Syndrome from Synthetic Marijuana Use. J Med Toxicol 2017; 13:199-200. [PMID: 28353201 DOI: 10.1007/s13181-017-0612-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- Xibei Liu
- University of Nevada School of Medicine, Las Vegas, NV, USA
| | | | - Ji Yoo
- University of Nevada School of Medicine, Las Vegas, NV, USA.
| |
Collapse
|
31
|
Abstract
BACKGROUND Prescription drug, e-cigarette, smokeless tobacco, and synthetic marijuana use has risen dramatically in the United States over the past decade. OBJECTIVES This paper investigates the use of risky substances among adolescents, and examines disparities between sexual minority (i.e., mostly heterosexual and lesbian, gay, bisexual; LGB) and heterosexual adolescents in use of novel and emerging substances. Given the public health risk and the imminence of these substances in the media, emerging drug use was examined in a county wide sample of adolescents in a Southern state. METHODS A probability sample of middle and high school students (N = 3012; ages 11-18) using random cluster methods was obtained in a mid-sized school district in the Southeastern United States. RESULTS LGB adolescents reported higher past-30 day and lifetime use of cigarettes (AORs =2.77, 2.90, respectively), smokeless tobacco (lifetime only: AOR = 1.88), e-cigarettes (lifetime only; AOR = 1.92), alcohol (AORs = 1.7, 2.20), marijuana (AORs = 3.02, 3.06), synesthetic marijuana (AORs = 3.77, 2.48), and prescription drugs (AORs = 3.82, 2.55). Adolescents who self-identified as "mostly heterosexual" reported higher lifetime cigarette use, and past 30-day use of e-cigarettes and prescription drugs as compared with heterosexual adolescents. CONCLUSIONS Our results are notable given the dearth of data documenting use of increasingly emerging or "trendy" substances such as prescription drugs. More research is needed to understand the underlying cause of these disparities, and efforts should be targeted toward this population to reduce negative outcomes from misuse.
Collapse
Affiliation(s)
- Jeremy T Goldbach
- a School of Social Work, University of Southern California , Los Angeles , California , USA
| | - Ethan H Mereish
- b Center for Alcohol and Addiction Studies, Brown University , Providence , Rhode Island , USA
| | - Claire Burgess
- c Department of Clinical Science , University of Southern California , Los Angeles , California , USA
| |
Collapse
|
32
|
Diao X, Carlier J, Scheidweiler KB, Huestis MA. In vitro metabolism of new synthetic cannabinoid SDB-006 in human hepatocytes by high-resolution mass spectrometry. Forensic Toxicol 2017. [DOI: 10.1007/s11419-016-0350-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
33
|
Alp A, Akdam H, Avcıoğlu BY, Ersan S. Synthetic cannabinoids in the kidneys. Rev Assoc Med Bras (1992) 2017; 63:10-12. [DOI: 10.1590/1806-9282.63.01.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 06/26/2016] [Indexed: 11/21/2022] Open
|
34
|
Hassan Z, Bosch OG, Singh D, Narayanan S, Kasinather BV, Seifritz E, Kornhuber J, Quednow BB, Müller CP. Novel Psychoactive Substances-Recent Progress on Neuropharmacological Mechanisms of Action for Selected Drugs. Front Psychiatry 2017; 8:152. [PMID: 28868040 PMCID: PMC5563308 DOI: 10.3389/fpsyt.2017.00152] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/02/2017] [Indexed: 12/15/2022] Open
Abstract
A feature of human culture is that we can learn to consume chemical compounds, derived from natural plants or synthetic fabrication, for their psychoactive effects. These drugs change the mental state and/or the behavioral performance of an individual and can be instrumentalized for various purposes. After the emergence of a novel psychoactive substance (NPS) and a period of experimental consumption, personal and medical benefits and harm potential of the NPS can be estimated on evidence base. This may lead to a legal classification of the NPS, which may range from limited medical use, controlled availability up to a complete ban of the drug form publically accepted use. With these measures, however, a drug does not disappear, but frequently continues to be used, which eventually allows an even better estimate of the drug's properties. Thus, only in rare cases, there is a final verdict that is no more questioned. Instead, the view on a drug can change from tolerable to harmful but may also involve the new establishment of a desired medical application to a previously harmful drug. Here, we provide a summary review on a number of NPS for which the neuropharmacological evaluation has made important progress in recent years. They include mitragynine ("Kratom"), synthetic cannabinoids (e.g., "Spice"), dimethyltryptamine and novel serotonergic hallucinogens, the cathinones mephedrone and methylone, ketamine and novel dissociative drugs, γ-hydroxybutyrate, γ-butyrolactone, and 1,4-butanediol. This review shows not only emerging harm potentials but also some potential medical applications.
Collapse
Affiliation(s)
- Zurina Hassan
- Centre for Drug Research, Universiti Sains Malaysia, Minden, Malaysia
| | - Oliver G Bosch
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Darshan Singh
- Centre for Drug Research, Universiti Sains Malaysia, Minden, Malaysia
| | - Suresh Narayanan
- School of Social Sciences, Universiti Sains Malaysia, Minden, Malaysia
| | | | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Boris B Quednow
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Christian P Müller
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| |
Collapse
|
35
|
Welter S, Lücke C, Lam AP, Custal C, Moeller S, Sörös P, Thiel CM, Philipsen A, Müller HHO. Synthetic Cannabinoid Use in a Psychiatric Patient Population: A Pilot Study. Eur Addict Res 2017; 23:182-193. [PMID: 28848170 DOI: 10.1159/000479554] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/16/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Consumption of natural cannabis (NC) and synthetic cannabinoids (SCs) has been associated with psychotic disorders. We compared the prevalence of use, consumer profiles, and psychosis-inducing potential of NC and SCs in a specific high-risk population. METHODS This prospective pilot study included 332 patients (18-64 years, mean 36.83, SD 13.33). Patients' sociodemographics and medical histories as well as illicit substance use and psychiatric symptom histories were collected using a drug consumption survey that assessed the use of new psychoactive substances and the Psychotic Symptoms Interview. RESULTS In total, 7.2% of all patients, 10.6% of psychotic patients, and 4.5% of nonpsychotic patients reported SC consumption. Compared with SCs, NC was consumed much more frequently by its users (mean 222.73, SD 498.27). NC and SC use induced persistent psychosis. Psychotic symptoms were first experienced by patients with a history of NC or SC use during intoxication and persisted after cessation (>1 year) of drug use. Positive and negative symptoms tended to be more severe in SC and NC users, respectively. CONCLUSIONS NC and SCs may cause different symptom clusters. These relationships should be further evaluated.
Collapse
Affiliation(s)
- Stella Welter
- Department of Biological Psychology, Carl von Ossietzky University of Oldenburg, Faculty of Medicine and Health Sciences, Karl-Jaspers-Klinik, Bad Zwischenahn, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Wiley JL, Marusich JA, Thomas BF. Combination Chemistry: Structure-Activity Relationships of Novel Psychoactive Cannabinoids. Curr Top Behav Neurosci 2017; 32:231-248. [PMID: 27753007 DOI: 10.1007/7854_2016_17] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Originally developed as research tools for use in structure-activity relationship studies, synthetic cannabinoids contributed to significant scientific advances in the cannabinoid field. Unfortunately, a subset of these compounds was diverted for recreational use beginning in the early 2000s. As these compounds were banned, they were replaced with additional synthetic cannabinoids with increasingly diverse chemical structures. This chapter focuses on integration of recent results with those covered in previous reviews. Whereas most of the early compounds were derived from the prototypic naphthoylindole JWH-018, currently popular synthetic cannabinoids include tetramethylcyclopropyl ketones and indazole-derived cannabinoids (e.g., AB-PINACA, AB-CHMINACA). Despite their structural differences, psychoactive synthetic cannabinoids bind with high affinity to CB1 receptors in the brain and, when tested, have been shown to activate these receptors and to produce a characteristic profile of effects, including suppression of locomotor activity, antinociception, hypothermia, and catalepsy, as well as Δ9-tetrahydrocannabinol (THC)-like discriminative stimulus effects in mice. When they have been tested, synthetic cannabinoids are often found to be more efficacious at activation of the CB1 receptor and more potent in vivo. Further, their chemical alteration by thermolysis during use and their uncertain stability and purity may result in exposure to degradants that differ from the parent compound contained in the original product. Consequently, while their intoxicant effects may be similar to those of THC, use of synthetic cannabinoids may be accompanied by unpredicted, and sometimes harmful, effects.
Collapse
Affiliation(s)
- Jenny L Wiley
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA.
| | - Julie A Marusich
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Brian F Thomas
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| |
Collapse
|
37
|
Diao X, Carlier J, Zhu M, Pang S, Kronstrand R, Scheidweiler KB, Huestis MA. In vitro and in vivo human metabolism of a new synthetic cannabinoid NM-2201 (CBL-2201). Forensic Toxicol 2017; 35:20-32. [PMID: 28286577 PMCID: PMC5342258 DOI: 10.1007/s11419-016-0326-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
Abstract
In 2014, NM-2201 (CBL-2201), a novel synthetic cannabinoid (SC), was detected by Russian and United States laboratories. It was already added to the scheduled drugs list in Japan, Sweden and Germany. Unfortunately, no human metabolism data are currently available, making it challenging to confirm its intake because all previous investigated SCs were extensively metabolized. The present study aims to recommend appropriate marker metabolites by investigating NM-2201 metabolism in human hepatocytes and confirm the results in authentic human urine specimens. For the metabolic stability assay, 1 μM NM-2201 was incubated in human liver microsomes (HLMs) for up to 1 h; for metabolite profiling, 10 μM of NM-2201 was incubated in human hepatocytes for 3 h. Two authentic urine specimens from NM-2201 positive cases were analyzed after β-glucuronidase hydrolysis. Metabolite identification in hepatocyte samples and urine specimens was achieved with high-resolution mass spectrometry via information-dependent acquisition. NM-2201 was quickly metabolized in HLMs with an 8.0 min half-life. In human hepatocyte incubation samples, a total of thirteen NM-2201 metabolites were identified, generated mainly from ester hydrolysis and further hydroxylation, oxidative defluorination and subsequent glucuronidation. M13 (5-fluoro PB-22 3-carboxyindole) was the major metabolite. In the urine specimens, the parent drug NM-2201 was not detected; M13 was the predominant metabolite after β-glucuronidase hydrolysis. Therefore, based on our study, we recommend the M13 as a suitable urinary marker metabolite for confirming NM-2201 and/or 5F-PB-22 intake.
Collapse
Affiliation(s)
- Xingxing Diao
- Chemistry and Drug Metabolism Section, Clinical Pharmacology and Therapeutics Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Blvd, Suite 200 Room 05A727, Baltimore, MD 21224, USA
| | - Jeremy Carlier
- Chemistry and Drug Metabolism Section, Clinical Pharmacology and Therapeutics Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Blvd, Suite 200 Room 05A727, Baltimore, MD 21224, USA
| | - Mingshe Zhu
- Department of Biotransformation, Bristol-Myers Squibb, Research and Development, Princeton, NJ 08543, USA
| | | | - Robert Kronstrand
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, 58758 Linköping, Sweden
- Department of Drug Research, University of Linköping, 58185 Linköping, Sweden
| | - Karl B. Scheidweiler
- Chemistry and Drug Metabolism Section, Clinical Pharmacology and Therapeutics Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Blvd, Suite 200 Room 05A727, Baltimore, MD 21224, USA
| | - Marilyn A. Huestis
- Chemistry and Drug Metabolism Section, Clinical Pharmacology and Therapeutics Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Blvd, Suite 200 Room 05A727, Baltimore, MD 21224, USA
- University of Maryland School of Medicine, Baltimore, MD 21224, USA
| |
Collapse
|
38
|
Campbell A, O Neill N, Higgins K. Health and Social Care workers' perceptions of NPS use in Northern Ireland. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 40:93-101. [PMID: 27939297 DOI: 10.1016/j.drugpo.2016.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 10/04/2016] [Accepted: 11/14/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND The EU Early Warning System currently monitors more than 560 new psychoactive substances, far outweighing the total number of illicit drugs under international control. Due to the recent emergence of NPS and rapidly changing nature of the market, evidence about the way in which the emerging drugs are managed in health and social care settings is limited. METHODS The study adopted a mixed methods design, utilising a cross sectional survey and telephone interviews to capture data from staff working in drug and alcohol related services in statutory and voluntary sectors, across the five Health and Social Care (HSC) Trust areas in Northern Ireland. 196 staff participated in the survey and 13 participated in follow up in telephone interviews between August and November 2015. RESULTS Study respondents reported that addressing NPS related issues with service users was a key aspect of their daily role and function. Levels of injecting behaviours were also viewed as relatively high by study participants. Almost all workers used harm reduction as their primary approach when working with service users and the majority of respondents called for additional practical training in relation to addressing drug interactions and intervening with NPS related issues.
Collapse
Affiliation(s)
- Anne Campbell
- School of Social Sciences, Education and Social Work, Centre for Evidence and Social Innovation, Queen's University Belfast, BT7 1NN, United Kingdom.
| | - Nina O Neill
- School of Social Sciences, Education and Social Work, Centre for Evidence and Social Innovation, Queen's University Belfast, BT7 1NN, United Kingdom
| | - Kathryn Higgins
- School of Social Sciences, Education and Social Work, Centre for Evidence and Social Innovation, Queen's University Belfast, BT7 1NN, United Kingdom
| |
Collapse
|
39
|
Courts J, Maskill V, Gray A, Glue P. Signs and symptoms associated with synthetic cannabinoid toxicity: systematic review. Australas Psychiatry 2016; 24:598-601. [PMID: 27558216 DOI: 10.1177/1039856216663733] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Use of synthetic cannabinoids is associated with significant physical and psychological harms. This research quantified reported toxicities from published reports and assessed the influence of size of the reported study population on rates of symptom reporting. METHODS Systematic review of published case reports and case series of toxicity associated with use of synthetic cannabinoids. RESULTS Symptoms associated with synthetic cannabinoid toxicity were reported for 3695 individuals, predominantly young males. Symptoms included physiological (e.g. tachycardia, hypertension, nausea/vomiting), emotional (e.g. agitation, irritability, paranoia), behavioural (e.g. drowsiness, aggression) and perceptual (e.g. hallucinations) domains. Most common symptoms were tachycardia (30.2% of cases), agitation (13.5%), drowsiness (12.3%), nausea/vomiting (8.2%) and hallucinations (7.6%). Death or serious medical complications were uncommon (e.g. death 0.2%, stroke 0.1%, myocardial infarction 0.09%). Case reports/smaller case series (n<10) reported statistically significantly higher rates for 29/34 symptoms than larger case series (n≥10), which could represent selection bias. CONCLUSIONS Symptoms of synthetic cannabinoid toxicity are variable and cover a number of physical and psychological domains. Symptom reporting varies by study population size. Due to the variable presenting symptoms of synthetic cannabinoid toxicity, clinicians in emergency services should consider synthetic cannabinoid toxicity when evaluating young adult male patients presenting with unexplained agitation or cardiovascular symptoms.
Collapse
Affiliation(s)
- Julie Courts
- Registered Nurse, Department of Psychological Medicine, University of Otago, Dunedin, New Zealand, and; Southern District Health Board, Dunedin, New Zealand
| | - Virginia Maskill
- Lecturer, Centre of Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Andrew Gray
- Consultant Statistician, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Paul Glue
- Hazel Buckland Chair of Psychological Medicine, Department of Psychological Medicine, University of Otago, Dunedin, New Zealand, and; Southern District Health Board, Dunedin, New Zealand
| |
Collapse
|
40
|
Lynskey MT, Hindocha C, Freeman TP. Legal regulated markets have the potential to reduce population levels of harm associated with cannabis use. Addiction 2016; 111:2091-2092. [PMID: 27145424 DOI: 10.1111/add.13390] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 03/08/2016] [Accepted: 03/09/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Michael T Lynskey
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Chandni Hindocha
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Tom P Freeman
- Clinical Psychopharmacology Unit, University College London, London, UK
| |
Collapse
|
41
|
Bassir Nia A, Medrano B, Perkel C, Galynker I, Hurd YL. Psychiatric comorbidity associated with synthetic cannabinoid use compared to cannabis. J Psychopharmacol 2016; 30:1321-1330. [PMID: 27462088 DOI: 10.1177/0269881116658990] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Synthetic cannabinoids (SC) use has had a dramatic increase in recent years, but data regarding their adverse effects on mental health is limited. In this study, we compared clinical presentations of SC users with cannabis users in a psychiatric inpatient setting. METHODS Digital charts of all patients who were admitted to a dual diagnosis psychiatric unit in one year were reviewed. Patients who had any current substance use disorder were categorized in four groups: (1) SC use and cannabis use (SC+MJ+), (2) SC use without cannabis use (SC+MJ-), (3) cannabis use without SC use (SC-MJ+), and (4) No SC or cannabis use (SC-MJ-). RESULTS A total of 594 charts were included. SC+MJ- patients had significantly more psychotic symptoms (OR: 4.44, 95% CI: 1.98-9.94), followed by SC+MJ+ (OR: 3.61, 95% CI: 1.87-6.97) and SC-MJ+ (OR: 1.87, 95%CI: 1.33-2.64) patients. The SC+MJ- group also had more agitation and aggression was most prominent in SC+MJ+ subjects. Multivariate analyses showed that the psychiatric associations of SC and cannabis use remained significant even after controlling for potential confounds such as other substance use. CONCLUSIONS The prominent psychiatric features of SC users as compared to cannabis users in an inpatient setting are psychotic presentations and agitation, which have important treatment implications.
Collapse
Affiliation(s)
- Anahita Bassir Nia
- Department of Psychiatry and Behavioral Sciences, Mount Sinai Beth Israel Medical Center, Icahn School of Medicine at Mount Sinai at New York, NY, USA
| | - Benjamin Medrano
- Department of Psychiatry and Behavioral Sciences, Mount Sinai Beth Israel Medical Center, Icahn School of Medicine at Mount Sinai at New York, NY, USA
| | - Charles Perkel
- Department of Psychiatry and Behavioral Sciences, Mount Sinai Beth Israel Medical Center, Icahn School of Medicine at Mount Sinai at New York, NY, USA
| | - Igor Galynker
- Department of Psychiatry and Behavioral Sciences, Mount Sinai Beth Israel Medical Center, Icahn School of Medicine at Mount Sinai at New York, NY, USA
| | - Yasmin L Hurd
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai at New York, Mount Sinai Behavioral Health System, New York, NY, USA
| |
Collapse
|
42
|
Ninnemann AL, Lechner WV, Borges A, Lejuez CW. Synthetic cannabinoids to avoid urine drug screens: Implications for contingency management and other treatments for drug dependence. Addict Behav 2016; 63:72-3. [PMID: 27424166 DOI: 10.1016/j.addbeh.2016.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 05/24/2016] [Accepted: 07/07/2016] [Indexed: 11/29/2022]
Abstract
Contingency management (CM) is an effective treatment for substance use dependence. Within CM, rewards or vouchers promote continued abstinence by acting as alternative reinforcers to substance use. However, CM relies on the use of accurate biochemical verification methods, such as urinalysis, to verify abstinence. Synthetic cannabinoids (SCs) pose a risk for CM treatment because they are not easily detected by common urinalysis techniques. Although SCs pose a risk, there is limited information regarding current rates of SC use within substance dependent populations as well as rates of substance use and psychiatric disorders among those who use SCs in treatment. We discuss emerging research on these topics and potential implications for CM treatments. Findings suggest CM researchers should test for and query SC use among those being treated for cannabis and cocaine use problems as well as among younger populations of substance users. Implications of other novel psychoactive substances for drug treatment and drug urinalysis are also discussed.
Collapse
Affiliation(s)
- Andrew L Ninnemann
- University of Maryland, College Park, Department of Psychology, 2103 Cole Student Activities Building, College Park, MD 20742-4411, USA.
| | - William V Lechner
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, USA
| | - Allison Borges
- University of Maryland, College Park, Department of Psychology, 2103 Cole Student Activities Building, College Park, MD 20742-4411, USA
| | - C W Lejuez
- University of Maryland, College Park, Department of Psychology, 2103 Cole Student Activities Building, College Park, MD 20742-4411, USA
| |
Collapse
|
43
|
Nurmedov S, Yilmaz O, Darcin AE, Noyan OC, Dilbaz N. Frequency of Synthetic Cannabinoid Use and Its Relationship with Socio-Demographic Characteristics and Treatment Outcomes in Alcohol-and Substance-Dependent Inpatients: A retrospective study. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20150207072424] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Serdar Nurmedov
- Uskudar University, NP Istanbul Hospital, Psychiatry Clinic, Istanbul-Turkey
| | - Onat Yilmaz
- Kasimpasa Military Hospital, Psychiatry Clinic, Istanbul-Turkey
| | - Asli E. Darcin
- Kanuni Sultan Suleyman Hospital, Psychiatry Clinic, Istanbul-Turkey
| | - Onur C. Noyan
- Uskudar University, NP Istanbul Hospital, Psychiatry Clinic, Istanbul-Turkey
| | - Nesrin Dilbaz
- Uskudar University, NP Istanbul Hospital, Psychiatry Clinic, Istanbul-Turkey
| |
Collapse
|
44
|
Mathai DS, Verrico CD, Shorter D, Coverdale JH, Kosten TR. "Just one bad high:" considering synthetic cannabinoid outcome expectancies in adolescents. Am J Addict 2016; 25:620-622. [PMID: 27749024 DOI: 10.1111/ajad.12457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/09/2016] [Accepted: 10/02/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND/OBJECTIVES Certain medical consequences seem unique to synthetic cannabinoid (SC) and not cannabis use. We report the case of an adolescent, whose drug expectancies appear to minimize the severity of SC-related adverse events. METHODS/RESULTS An 18-year-old male presented with altered mental status and seizure, complicated by respiratory failure. He was stabilized and on discharge, despite counseling on the harms of SC usage, the patient planned to resume use, insisting that the hospitalization was "just one bad high". DISCUSSION/CONCLUSIONS/SCIENTIFIC SIGNIFICANCE Diminished negative expectancies related to SC use among adolescents may reflect generalizations from cannabis. Effective interventions should counter cannabis-related expectancies of minimal harm. (Am J Addict 2016;XX:1-3).
Collapse
Affiliation(s)
| | - Christopher D Verrico
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.,Department of Neuroscience, Pharmacology, Immunology & Pathology, Baylor College of Medicine, Houston, Texas.,Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Daryl Shorter
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.,Michael E. DeBakey VA Medical Center, Houston, Texas
| | - John H Coverdale
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Thomas R Kosten
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.,Department of Neuroscience, Pharmacology, Immunology & Pathology, Baylor College of Medicine, Houston, Texas.,Michael E. DeBakey VA Medical Center, Houston, Texas
| |
Collapse
|
45
|
Obafemi AI, Kleinschmidt K, Goto C, Fout D. Cluster of Acute Toxicity from Ingestion of Synthetic Cannabinoid-Laced Brownies. J Med Toxicol 2016; 11:426-9. [PMID: 25967137 DOI: 10.1007/s13181-015-0482-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Synthetic cannabinoid receptor agonists (SCRAs) are emerging designer drugs of abuse. Most reports on the health effects of these drugs are case reports. Unlike SCRAs, marijuana has classically been used via many routes of exposure including oral, such as in brownies. We report on 11 symptomatic patients who unknowingly ingested brownies laced with analytically confirmed SCRA and presented with mostly neuropsychiatric and cardiovascular symptoms. CASE SERIES All 11 patients were taken to the ED within 1 h of exposure with the onset of various symptoms. There were five males and six females, age range 20-57 years. Neuropsychiatric and cardiovascular symptoms predominated: memory impairment (91 %, 10/11) and inappropriate giggling (36 %, 4/11). All the patients had light-headedness, perioral and facial numbness and tingling sensation, dry mouth, difficulty focusing/blurring of vision, and sluggishness. No patient had depressed consciousness. Two patients had heart rates >100, and 4 of 11 (36 %) had BP >140/80. One patient had chest pain. All the symptoms were completely resolved 4 h following their onset except two patients who had ongoing weakness and fatigue. All patients had negative urine drugs of abuse immunoassays and ethanol, acetaminophen, and salicylate concentrations, as well as normal electrocardiograms (ECGS) and metabolic panels. The SCRA was confirmed to be AM-2201. All the patients were discharged from the ED in stable condition within 10 h of the exposure. CONCLUSION Oral exposure of 11 patients to brownies laced with analytically confirmed SCRA resulted in neuropsychiatric and cardiovascular symptoms. This series reflects that like marijuana, oral exposures to SCRAs can lead to symptoms.
Collapse
Affiliation(s)
| | | | - Collin Goto
- UT Southwestern Medical Center, Dallas, TX, USA
| | - Drew Fout
- Texas Department of Public Safety, Garland, TX, USA
| |
Collapse
|
46
|
Vallersnes OM, Dines AM, Wood DM, Yates C, Heyerdahl F, Hovda KE, Giraudon I, Dargan PI. Psychosis associated with acute recreational drug toxicity: a European case series. BMC Psychiatry 2016; 16:293. [PMID: 27538886 PMCID: PMC4990880 DOI: 10.1186/s12888-016-1002-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 08/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychosis can be associated with acute recreational drug and novel psychoactive substance (NPS) toxicity. However, there is limited data available on how common this is and which drugs are most frequently implicated. We describe a European case series of psychosis associated with acute recreational drug toxicity, and estimate the frequency of psychosis for different recreational drugs. METHODS The European Drug Emergencies Network (Euro-DEN) collects data on presentations to Emergency Departments (EDs) with acute recreational drug and NPS toxicity at 16 centres in ten countries. Euro-DEN data from October 2013 through September 2014 was retrospectively searched, and cases with psychosis were included. The proportion of cases with psychosis per drug was calculated in the searched Euro-DEN dataset. RESULTS Psychosis was present in 348 (6.3 %) of 5529 cases. The median (interquartile range) age was 29 (24-38) years, 276 (79.3 %) were male and 114 (32.8 %) were admitted to psychiatric ward. The drugs most commonly reported were cannabis in 90 (25.9 %) cases, amphetamine in 87 (25.0 %) and cocaine in 56 (16.1 %). More than one drug was taken in 189 (54.3 %) cases. Psychosis was frequent in those ED presentations involving tryptamines (4/7; 57.1 %), methylenedioxypyrovalerone (MDPV) (6/22; 27.3 %), methylphenidate (6/26; 23.1 %), lysergic acid diethylamide (LSD) (18/86; 20.9 %), psilocybe mushrooms (3/16; 18.8 %), synthetic cannabinoid receptor agonists (4/26; 15.4 %) and amphetamine (87/593; 14.7 %), but less common in those involving mephedrone (14/245; 5.7 %), methylenedioxymethamphetamine (MDMA) (20/461; 4.3 %) and methedrone (3/92; 3.3 %). Amphetamine was the most frequent drug associated with psychosis when only one agent was reported, with psychosis occurring in 32.4 % of these presentations. CONCLUSION The frequency of psychosis in acute recreational drug toxicity varies considerably between drugs, but is a major problem in amphetamine poisoning. In rapidly changing drug markets and patterns of use, the Euro-DEN sentinel network contributes to measuring the scale of drug-related harms in Europe beyond other more established indicators.
Collapse
Affiliation(s)
- Odd Martin Vallersnes
- Department of General Practice, University of Oslo, Oslo, Norway
- Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway
| | - Alison M. Dines
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK
| | - David M. Wood
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK
- Clinical Toxicology, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Christopher Yates
- Emergency Department and Clinical Toxicology Unit, Hospital Universitari Son Espases, Mallorca, Spain
| | - Fridtjof Heyerdahl
- The Norwegian CBRNe Centre of Medicine, Oslo University Hospital, Oslo, Norway
| | - Knut Erik Hovda
- The Norwegian CBRNe Centre of Medicine, Oslo University Hospital, Oslo, Norway
| | - Isabelle Giraudon
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Paul I. Dargan
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK
- Clinical Toxicology, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| |
Collapse
|
47
|
Clements-Nolle K, Lensch T, Larson S, Yang W. Prevalence and Correlates of Any and Frequent Synthetic Cannabinoid Use in a Representative Sample of High School Students. Subst Use Misuse 2016; 51:1139-46. [PMID: 27191966 DOI: 10.3109/10826084.2016.1160121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is increasing evidence that Synthetic Cannabinoid (SC) use is associated with adverse health effects, but little is known about the prevalence of SC use and risk and protective factors for SC use among adolescents. OBJECTIVES To determine the prevalence and correlates of any and frequent SC use in a representative sample of high school students. METHODS The 2013 Youth Risk Behavior Survey was administered to 3,928 high school students in Nevada. A state-added question assessed any and frequent SC use (10 or more times). Weighted logistic regression identified factors for both outcomes. RESULTS 17.3% of students reported SC use and 4.3% used SCs frequently. As expected, there were strong associations between SC use and other substance use. After controlling for substance use, any SC use was associated with being Hispanic (AOR = 1.74; 95% CI = 1.27, 2.38) and living in a rural county (AOR = 1.68; 95% CI = 1.26, 2.23). Frequent SC use was higher among students who were male (AOR = 2.14; 95% CI = 1.19, 3.84), 18 years of age (AOR = 2.34; 95% CI = 1.18, 4.67), lived in a rural county (AOR = 1.84; 95% CI = 1.11, 3.04), and were offered, sold, or given illegal drugs on school property (AOR = 2.40; 95% CI = 1.53, 3.79). Protective factors for frequent SC use included high parental monitoring (AOR = 0.54; 95% CI = 0.31, 0.93) and sports team participation (AOR = 0.61; 95% CI = 0.37, 0.99). CONCLUSIONS/IMPORTANCE SC prevention policies and programs should focus on adolescents who live in rural settings and engage in substance use. Initiatives to address drug availability as school and promote parent involvement are also warranted.
Collapse
Affiliation(s)
| | - Taylor Lensch
- a School of Community Health Sciences , University of Nevada , Reno , Nevada , USA
| | - Sandra Larson
- b Nevada Division of Public and Behavioral Health , Reno , Nevada , USA
| | - Wei Yang
- a School of Community Health Sciences , University of Nevada , Reno , Nevada , USA
| |
Collapse
|
48
|
Holm NB, Noble C, Linnet K. JWH-018 ω-OH, a shared hydroxy metabolite of the two synthetic cannabinoids JWH-018 and AM-2201, undergoes oxidation by alcohol dehydrogenase and aldehyde dehydrogenase enzymes in vitro forming the carboxylic acid metabolite. Toxicol Lett 2016; 259:35-43. [PMID: 27421777 DOI: 10.1016/j.toxlet.2016.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 07/06/2016] [Accepted: 07/12/2016] [Indexed: 01/14/2023]
Abstract
Synthetic cannabinoids are new psychoactive substances (NPS) acting as agonists at the cannabinoid receptors. The aminoalkylindole-type synthetic cannabinoid naphthalen-1-yl-(1-pentylindol-3-yl)methanone (JWH-018) was among the first to appear on the illicit drug market and its metabolism has been extensively investigated. The N-pentyl side chain is a major site of human cytochrome P450 (CYP)-mediated oxidative metabolism, and the ω-carboxylic acid metabolite appears to be a major in vivo human urinary metabolite. This metabolite is, however, not formed to any significant extent in human liver microsomal (HLM) incubations raising the possibility that the discrepancy is due to involvement of cytosolic enzymes. Here we demonstrate in incubations with human liver cytosol (HLC), that JWH-018 ω-OH, but not the JWH-018 parent compound, is a substrate for nicotinamide adenine dinucleotide (NAD(+))-dependent alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) enzymes. The sole end-product identified in HLC was the JWH-018 ω-COOH metabolite, while trapping tests with methoxyamine proved the presence of the aldehyde intermediate. ADH/ALDH and UDP-glucuronosyl-transferases (UGT) enzymes may therefore both act on the JWH-018 ω-OH substrate. Finally, we note that for [1-(5-fluoropentyl)indol-3-yl]-naphthalen-1-yl-methanone (AM-2201), the ω-fluorinated analog of JWH-018, a high amount of JWH-018 ω-OH was formed in HLM incubated without NADPH, suggesting that the oxidative defluorination is efficiently catalyzed by non-CYP enzyme(s). The pathway presented here may therefore be especially important for N-(5-fluoropentyl) substituted synthetic cannabinoids, because the oxidative defluorination can occur even if the CYP-mediated metabolism preferentially takes place on other parts of the molecule than the N-alkyl side chain. Controlled clinical studies in humans are ultimately required to demonstrate the in vivo importance of the oxidation pathway presented here.
Collapse
Affiliation(s)
- Niels Bjerre Holm
- Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Carolina Noble
- Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kristian Linnet
- Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
49
|
Roberto AJ, Lorenzo A, Li KJ, Young J, Mohan A, Pinnaka S, Lapidus KAB. First-Episode of Synthetic Cannabinoid-Induced Psychosis in a Young Adult, Successfully Managed with Hospitalization and Risperidone. Case Rep Psychiatry 2016; 2016:7257489. [PMID: 27429822 PMCID: PMC4939204 DOI: 10.1155/2016/7257489] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/15/2016] [Accepted: 05/18/2016] [Indexed: 11/23/2022] Open
Abstract
Synthetic cannabinoids- (SCs-) induced psychosis is a growing public health concern. It leads to significant impairment, including emotional distress, difficulty communicating, and other debilitating symptoms. In this case report, we discuss a patient with no previous history of psychotic symptoms, presenting with first-episode psychosis in the context of progressive, acutely worsening, disorganized, psychotic thoughts and behaviors following prolonged use of SCs. We also discuss relevant literature on SCs-induced psychosis, highlighting its prevalence, presentation, diagnosis, and recommended management. It is important to diagnose and treat SCs-induced psychosis as early and efficiently as possible, in order to alleviate symptoms while limiting functional impairment and emotional distress to the patient.
Collapse
Affiliation(s)
- Aaron J. Roberto
- Child and Adolescent Psychiatry, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Fegan 8, Boston, MA 02115, USA
| | - Aileen Lorenzo
- Adult Psychiatry, New York Medical College, Valhalla, NY, USA
| | - Kevin J. Li
- Adult Psychiatry, Harvard South Shore Psychiatry, Brockton, MA, USA
| | | | | | - Subhash Pinnaka
- Adult Psychiatry, New York Medical College, Valhalla, NY, USA
| | | |
Collapse
|
50
|
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.
Collapse
|