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Celeste-Villalvir A, Crouch C, Witte L, Heads AM, Weaver M, Schmitz JM, Isbell F, Schick V. Assessing Stage of Change and Harm Reduction Strategies for Synthetic Cannabinoid Use Among Individuals Experiencing Homelessness in Houston, Texas. JOURNAL OF DRUG ISSUES 2023. [DOI: 10.1177/00220426231161284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Synthetic cannabinoids (SCs) are low-cost substances that have been associated with adverse health outcomes and an increase in emergency department visits over recent years, particularly among people experiencing homelessness. This mixed methods study explored the connection between homelessness, SC use, and readiness to quit in order to inform the development of harm reduction strategies. Individuals (18+) residing in homeless encampments in Houston, TX with experiences of SC use were eligible to participate. Participants ( N = 65) completed an interviewer-administered survey about their SC use. Most participants were Black/African American (65.7%), male (82.9%), and most (75.4%) reported using SCs to avoid positive drug tests. Many wanted to quit using SCs (69.2%) and already employed harm reduction strategies while using SCs. Organizations supporting individuals experiencing homelessness who use SCs should focus on reducing barriers to stopping SC use and increasing the availability of housing and supportive services.
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Affiliation(s)
- Alane Celeste-Villalvir
- Department of Management, Policy & Community Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Laura Witte
- Department of Management, Policy & Community Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Angela M. Heads
- Department of Psychiatry and Behavioral Health, University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - Michael Weaver
- Department of Psychiatry and Behavioral Health, University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
- Center for Neurobehavioral Research on Addiction, Houston, TX, USA
| | - Joy M. Schmitz
- Department of Psychiatry and Behavioral Health, University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
- Center for Neurobehavioral Research on Addiction, Houston, TX, USA
| | | | - Vanessa Schick
- Department of Management, Policy & Community Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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2
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Markham J, Sparkes E, Boyd R, Chen S, Manning JJ, Finlay D, Lai F, McGregor E, Maloney CJ, Gerona RR, Connor M, McGregor IS, Hibbs DE, Glass M, Kevin RC, Banister SD. Defining Steric Requirements at CB 1 and CB 2 Cannabinoid Receptors Using Synthetic Cannabinoid Receptor Agonists 5F-AB-PINACA, 5F-ADB-PINACA, PX-1, PX-2, NNL-1, and Their Analogues. ACS Chem Neurosci 2022; 13:1281-1295. [PMID: 35404067 DOI: 10.1021/acschemneuro.2c00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Synthetic cannabinoid receptor agonists (SCRAs) are a diverse class of new psychoactive substances (NPS). They commonly comprise N-alkylated indole, indazole, or 7-azaindole scaffolds with amide-linked pendant amino acid groups. To explore the contribution of the amino acid side chain to the cannabinoid pharmacology of SCRA NPS, a systematic library of side chain-modified SCRAs was prepared based on the recent detections of amino acid derivatives 17 (5F-AB-PINACA), 18 (5F-ADB-PINACA), 15 (PX-1), 19 (PX-2), and 20 (NNL-1). In vitro binding affinities and functional activities at cannabinoid type 1 and 2 receptors (CB1 and CB2, respectively) were determined for all the library members using radioligand competition experiments and a fluorescence-based membrane potential assay. Binding affinities and functional activities varied widely across compounds (Ki = 0.32 to >10 000 nM, EC50 = 0.24-1259 nM), with several clear structure-activity relationships (SARs) emerging. Affinity and potency at CB1 changed as a function of the heterocyclic core (indazole > indole > 7-azaindole) and the pendant amino acid side chain (tert-butyl > iso-propyl > iso-butyl > benzyl > ethyl > methyl > hydrogen). Ensemble docking at CB1 revealed a clear steric basis for observed SAR trends. Interestingly, although 15 (PX-1) and 19 (PX-2) have been detected in recreational drug markets, they failed to induce centrally CB1-mediated effects (e.g., hypothermia) in mice using radiobiotelemetry. Together, these data provide insights regarding structural contributions to the cannabimimetic profiles of 17 (5F-AB-PINACA), 18 (5F-ADB-PINACA), 15 (PX-1), 19 (PX-2), 20 (NNL-1), and other SCRA NPS.
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Affiliation(s)
- Jack Markham
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney 2050, New South Wales, Australia
- School of Chemistry, The University of Sydney, Sydney 2006, New South Wales, Australia
| | - Eric Sparkes
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney 2050, New South Wales, Australia
- School of Chemistry, The University of Sydney, Sydney 2006, New South Wales, Australia
| | - Rochelle Boyd
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney 2050, New South Wales, Australia
- School of Chemistry, The University of Sydney, Sydney 2006, New South Wales, Australia
| | - Shuli Chen
- Department of Pharmacology and Toxicology, University of Otago, Dunedin 9016, New Zealand
| | - Jamie J. Manning
- Department of Pharmacology and Toxicology, University of Otago, Dunedin 9016, New Zealand
| | - David Finlay
- Department of Pharmacology and Toxicology, University of Otago, Dunedin 9016, New Zealand
| | - Felcia Lai
- School of Pharmacy, The University of Sydney, Sydney 2006, New South Wales, Australia
| | - Eila McGregor
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney 2050, New South Wales, Australia
- School of Psychology, The University of Sydney, Sydney 2005, New South Wales, Australia
| | - Callan J. Maloney
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney 2050, New South Wales, Australia
- School of Chemistry, The University of Sydney, Sydney 2006, New South Wales, Australia
| | - Roy R. Gerona
- Clinical Toxicology and Environmental Biomonitoring Laboratory, University of California, San Francisco, California 94143, United States
| | - Mark Connor
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney 2109, New South Wales, Australia
| | - Iain S. McGregor
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney 2050, New South Wales, Australia
- School of Psychology, The University of Sydney, Sydney 2005, New South Wales, Australia
| | - David E. Hibbs
- School of Pharmacy, The University of Sydney, Sydney 2006, New South Wales, Australia
| | - Michelle Glass
- Department of Pharmacology and Toxicology, University of Otago, Dunedin 9016, New Zealand
| | - Richard C. Kevin
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney 2050, New South Wales, Australia
- School of Pharmacy, The University of Sydney, Sydney 2006, New South Wales, Australia
| | - Samuel D. Banister
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney 2050, New South Wales, Australia
- School of Chemistry, The University of Sydney, Sydney 2006, New South Wales, Australia
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3
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Sparkes E, Boyd R, Chen S, Markham JW, Luo JL, Foyzun T, Zaman H, Fletcher C, Ellison R, McGregor IS, Santiago MJ, Lai F, Gerona RR, Connor M, Hibbs DE, Cairns EA, Glass M, Ametovski A, Banister SD. Synthesis and pharmacological evaluation of newly detected synthetic cannabinoid receptor agonists AB-4CN-BUTICA, MMB-4CN-BUTINACA, MDMB-4F-BUTICA, MDMB-4F-BUTINACA and their analogs. Front Psychiatry 2022; 13:1010501. [PMID: 36245876 PMCID: PMC9558907 DOI: 10.3389/fpsyt.2022.1010501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Synthetic cannabinoid receptor agonists (SCRAs) continue to make up a significant portion new psychoactive substances (NPS) detected and seized worldwide. Due to their often potent activation of central cannabinoid receptors in vivo, use of SCRAs can result in severe intoxication, in addition to other adverse health effects. Recent detections of AB-4CN-BUTICA, MMB-4CN-BUTINACA, MDMB-4F-BUTICA and MDMB-4F-BUTINACA mark a continuation in the appearance of SCRAs bearing novel tail substituents. The proactive characterization campaign described here has facilitated the detection of several new SCRAs in toxicological case work. Here we detail the synthesis, characterization, and pharmacological evaluation of recently detected SCRAs, as well as a systematic library of 32 compounds bearing head, tail, and core group combinations likely to appear in future. In vitro radioligand binding assays revealed most compounds showed moderate to high affinity at both CB1 (pK i = < 5 to 8.89 ± 0.09 M) and CB2 (pK i = 5.49 ± 0.03 to 9.92 ± 0.09 M) receptors. In vitro functional evaluation using a fluorescence-based membrane potential assay showed that most compounds were sub-micromolar to sub-nanomolar agonists at CB1 (pEC50 = < 5 to 9.48 ± 0.14 M) and CB2 (pEC50 = 5.92 ± 0.16 to 8.64 ± 0.15 M) receptors. An in silico receptor-ligand docking approach was utilized to rationalize binding trends for CB2 with respect to the tail substituent, and indicated that rigidity in this region (i.e., 4-cyanobutyl) was detrimental to affinity.
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Affiliation(s)
- Eric Sparkes
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.,Faculty of Science, School of Chemistry, The University of Sydney, Sydney, NSW, Australia
| | - Rochelle Boyd
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.,Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Shuli Chen
- Department of Pharmacology and Toxicology, University of Otago, Dunedin, New Zealand
| | - Jack W Markham
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.,Faculty of Science, School of Chemistry, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Jia Lin Luo
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.,Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Tahira Foyzun
- Macquarie Medical School, Macquarie University, Sydney, NSW, Australia
| | - Humayra Zaman
- Macquarie Medical School, Macquarie University, Sydney, NSW, Australia
| | - Charlotte Fletcher
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.,Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Ross Ellison
- Clinical Toxicology and Environmental Biomonitoring Laboratory, University of California, San Francisco, San Francisco, CA, United States
| | - Iain S McGregor
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.,Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Marina J Santiago
- Macquarie Medical School, Macquarie University, Sydney, NSW, Australia
| | - Felcia Lai
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Roy R Gerona
- Clinical Toxicology and Environmental Biomonitoring Laboratory, University of California, San Francisco, San Francisco, CA, United States
| | - Mark Connor
- Macquarie Medical School, Macquarie University, Sydney, NSW, Australia
| | - David E Hibbs
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Elizabeth A Cairns
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.,Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Michelle Glass
- Department of Pharmacology and Toxicology, University of Otago, Dunedin, New Zealand
| | - Adam Ametovski
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.,Faculty of Science, School of Chemistry, The University of Sydney, Sydney, NSW, Australia
| | - Samuel D Banister
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.,Faculty of Science, School of Chemistry, The University of Sydney, Sydney, NSW, Australia
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4
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A 4-Year Retrospective Analysis of Patients Presenting at the Emergency Department With Synthetic Cannabinoid Intoxication in Turkey. J Clin Psychopharmacol 2021; 40:464-467. [PMID: 32815860 DOI: 10.1097/jcp.0000000000001275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/BACKGROUND The number of patients with acute synthetic cannabinoid intoxication (SCI) has increased in recent years although the prohibition of its legal sale and use in Turkey despite other countries allowing to some extent sale and use. The reported clinical findings of acute SCI are similar to the symptoms of several diseases. The first case of acute SCI seen in our hospital was in 2014. The aim of this study was to share the data of synthetic cannabinoid use in a research hospital in Turkey and to contribute the epidemiologic data globally betwen 2014 and 2017. METHODS/PROCEDURES A retrospective evaluation was made of patients who presented at emergency department (ED) because of SCI between January 2014 and December 2017. The initial diagnosis of the patients was done either via their self-report or clinician's clinical observation (family history with hallucination, lethargy, convulsions, dizziness, etc.). Totally, 352 patients were included to the study whose cannabioid use was proven with their urine drug analysis. FINDINGS/RESULTS Men were predominantly high (93.8%). Nearly all patients (93.5%) were followed up and discharged in 24 hours. Among them, 21 (5.9%) patients were admitted for hospitalization, and mortality was seen in 2 (0.6%). The mean number of previous presentations at ED with a similar diagnosis was 8.6 ± 10.31. IMPLICATIONS/CONCLUSIONS Great care must be taken in respect of complications related to SCI, which can even result in death. Patients have a tendency to not disclose the substance they have taken because it is illegal. Patients presenting at ED with recurrent symptoms must be referred to relevant legal authorities. For patients presenting with different clinical effects, SCI must be considered.
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5
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Gilley M, Brent J, Calello DP, Wax P, Finkelstein Y. Synthetic Cannabinoid Exposure in Adolescents Presenting for Emergency Care. Pediatr Emerg Care 2021; 37:e13-e16. [PMID: 29538266 DOI: 10.1097/pec.0000000000001454] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to characterize the clinical picture and management of synthetic cannabinoid exposure in a cohort of adolescents. METHODS Using the 45 participating sites of the Toxicology Investigators Consortium Registry, a North American database, we conducted an observational study of a prospectively collected cohort. We identified all adolescent (12-19 years) cases of synthetic cannabinoid exposure who have received medical toxicology consultation between January 2012 and December 2016. Clinical and demographic data were collected including age, sex, circumstances surrounding exposure, coingestants, clinical manifestations, treatment, disposition, and outcome. RESULTS We identified 75 adolescents who presented to the emergency department with synthetic cannabinoid exposure. Most were male (91%) and between the ages of 16 and 19 (66%). The most common symptoms were neuropsychiatric with 50 adolescents (67%) exhibiting central nervous system (CNS) manifestations. There was no predominant toxidrome, and 9 patients (12%) were mechanically ventilated. Mainstay of treatment was supportive care. No deaths were reported. CONCLUSIONS Synthetic cannabinoid exposure in adolescents is primarily characterized by CNS manifestations, which are varied and may be life-threatening. Frontline caregivers should maintain a high index of suspicion for synthetic cannabinoids, especially in adolescents who present with unexplained CNS manifestations, as there is no specific toxidrome or confirmatory rapid drug screen to detect them.
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Affiliation(s)
- Meghan Gilley
- From the Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Diane P Calello
- New Jersey Poison Information and Education System, Department of Emergency Medicine, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, NJ
| | - Paul Wax
- Department of Emergency Medicine (Medical Toxicology), UT Southwestern Medical School, Dallas, TX
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6
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Shafi A, Berry AJ, Sumnall H, Wood DM, Tracy DK. New psychoactive substances: a review and updates. Ther Adv Psychopharmacol 2020; 10:2045125320967197. [PMID: 33414905 PMCID: PMC7750892 DOI: 10.1177/2045125320967197] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/26/2020] [Indexed: 12/19/2022] Open
Abstract
New psychoactive substances (NPS) are a heterogeneous group of substances. They are associated with a number of health and social harms on an individual and societal level. NPS toxicity and dependence syndromes are recognised in primary care, emergency departments, psychiatric inpatient and community care settings. One pragmatic classification system is to divide NPS into one of four groups: synthetic stimulants, synthetic cannabinoids, synthetic hallucinogens and synthetic depressants (which include synthetic opioids and benzodiazepines). We review these four classes of NPS, including their chemical structures, mechanism of action, modes of use, intended intoxicant effects, and their associated physical and mental health harms. The current challenges faced by laboratory testing for NPS are also explored, in the context of the diverse range of NPS currently available, rate of production and emergence of new substances, the different formulations, and methods of acquisition and distribution.
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Affiliation(s)
- Abu Shafi
- East London Foundation Trust, London, UK
| | - Alex J. Berry
- Division of Psychiatry, University College London, UK
| | | | - David M. Wood
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Clinical Toxicology, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Derek K. Tracy
- Consultant Psychiatrist, Oxleas NHS Foundation Trust, London, UK
- Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, DeCrespigny Park, London, SE5 8AF, UK
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7
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Presley BC, Logan BK, Jansen-Varnum SA. In Vitro Metabolic Profile Elucidation of Synthetic Cannabinoid APP-CHMINACA (PX-3). J Anal Toxicol 2020; 44:226-236. [PMID: 31665324 DOI: 10.1093/jat/bkz086] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/25/2019] [Accepted: 07/28/2019] [Indexed: 11/13/2022] Open
Abstract
Indazole carboxamide synthetic cannabinoids remain the most prevalent subclass of new psychoactive substances (NPS) reported internationally. However, the metabolic and pharmacological properties of many of these compounds remain unknown. Elucidating these characteristics allows members of the clinical and forensic communities to identify causative agents in patient samples, as well as render conclusions regarding their toxic effects. This work presents a detailed report on the in vitro phase I metabolism of indazole carboxamide synthetic cannabinoid APP-CHMINACA (PX-3). Incubation of APP-CHMINACA with human liver microsomes, followed by analysis of extracts via high-resolution mass spectrometry, yielded 12 metabolites, encompassing 7 different metabolite classes. Characterization of the metabolites was achieved by evaluating the product ion spectra, accurate mass and chemical formula generated for each metabolite. The predominant biotransformations observed were hydrolysis of the distal amide group and hydroxylation of the cyclohexylmethyl (CHM) substituent. Nine metabolites were amide hydrolysis products, of which five were monohydroxylated, one dihydroxylated and two were ketone products. The metabolites in greatest abundance in the study were products of amide hydrolysis with no further biotransformation (M1), followed by amide hydrolysis with monohydroxylation (M2.1). Three APP-CHMINACA-specific metabolites were generated, all of which were hydroxylated on the CHM group; one mono-, di- and tri-hydroxylated metabolite each was produced, with dihydroxylation (M6) present in the greatest abundance. The authors propose that metabolites M1, M2.1 and M6 are the most appropriate markers to determine consumption of APP-CHMINACA. The methods used in the current study have broad applicability and have been used to determine the in vitro metabolic profiles of multiple synthetic cannabinoids and other classes of NPS. This research can be used to guide analytical scientists in method development, synthesis of reference material, pharmacological testing of proposed metabolites and prediction of metabolic processes of compounds yet to be studied.
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Affiliation(s)
- Brandon C Presley
- Department of Chemistry, Temple University, 1901 N. 13th St., Philadelphia, PA 19122, USA
| | - Barry K Logan
- The Center for Forensic Science Research and Education, Fredric Rieders Family Foundation, 2300 Stratford Ave., Willow Grove, PA 19090, USA
| | - Susan A Jansen-Varnum
- Department of Chemistry, Temple University, 1901 N. 13th St., Philadelphia, PA 19122, USA
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8
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Larabi IA, Riffi M, Fabresse N, Etting I, Alvarez JC. Validation of an UPLC-MS/MS method for the determination of sixteen synthetic cannabinoids in human hair. Application to document chronic use of JWH-122 following a non-fatal overdose. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2019. [DOI: 10.1016/j.toxac.2019.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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9
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Yalçın M, Tunalı N, Yıldız H, Oğuz A, Gültekin BK. Sociodemographic and clinical characteristics of synthetic cannabinoid users in a large psychiatric emergency department in Turkey. J Addict Dis 2019; 37:259-267. [PMID: 31581902 DOI: 10.1080/10550887.2019.1671146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Synthetic cannabinoid (SC) use is a global concern and is creating new challenges for treatment services. Although some studies have been reported, there is a need for further research regarding the sociodemographic and clinical characteristics of SC users so that general and psychiatric emergency departments can provide more effective treatments. We aimed to investigate the sociodemographic and clinical characteristics in a cohort of patients using SC who presented to the psychiatric emergency department of the University of Health Sciences, Istanbul Erenköy Training and Research Hospital for Psychiatry and Neurology (ERSHEAH) in Istanbul, Turkey. This cross-sectional and retrospective medical record review examined 340 SC users who presented to the emergency department of ERSHEAH in a 3-month period. The mean age of the SC users was 26.8 ± 7.5 years and 92.6% were men. Psychotic symptoms were present in 247 SC users (78.8%). Severe intoxication was diagnosed in 26 SC users (7.6%), although SC was detectable in the samples of only 6 patients (13.6%). Impaired consciousness (42.3%) was the most common reason for referral to the general hospital and increased liver enzyme levels (15.9%) were the most common indication in the laboratory findings. We observed that the SC users in our sample presenting as psychiatric emergencies were mostly young men experiencing psychotic symptoms. Determining the sociodemographic and clinical properties of SC users may provide an important contribution to fast recognition and more effective management of acute symptoms of SC users in emergency departments.
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Affiliation(s)
- Murat Yalçın
- Erenköy Training and Research Hospital for Psychiatry and Neurology, Psychiatry Department, University of Health Sciences, Istanbul, Turkey
| | - Nazlı Tunalı
- Erenköy Training and Research Hospital for Psychiatry and Neurology, Psychiatry Department, University of Health Sciences, Istanbul, Turkey
| | - Handan Yıldız
- Erenköy Training and Research Hospital for Psychiatry and Neurology, Psychiatry Department, University of Health Sciences, Istanbul, Turkey
| | - Ayşenur Oğuz
- Fatih Sultan Mehmet Training and Research Hospital, Psychiatry Department, University of Health Sciences, Istanbul, Turkey
| | - Bülent Kadri Gültekin
- Erenköy Training and Research Hospital for Psychiatry and Neurology, Psychiatry Department, University of Health Sciences, Istanbul, Turkey
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10
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Banister SD, Kevin RC, Martin L, Adams A, Macdonald C, Manning JJ, Boyd R, Cunningham M, Stevens MY, McGregor IS, Glass M, Connor M, Gerona RR. The chemistry and pharmacology of putative synthetic cannabinoid receptor agonist (SCRA) new psychoactive substances (NPS) 5F‐PY‐PICA, 5F‐PY‐PINACA, and their analogs. Drug Test Anal 2019; 11:976-989. [DOI: 10.1002/dta.2583] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Samuel D. Banister
- School of ChemistryThe University of Sydney NSW Australia
- Department of PathologyStanford University CA USA
| | - Richard C. Kevin
- School of PsychologyThe University of Sydney Camperdown NSW Australia
| | - Lewis Martin
- School of PsychologyThe University of Sydney Camperdown NSW Australia
| | - Axel Adams
- Clinical Toxicology and Environmental Biomonitoring LaboratoryUniversity of California San Francisco CA USA
| | - Christa Macdonald
- School of Medical SciencesThe University of Auckland Auckland New Zealand
| | - Jamie J. Manning
- School of Medical SciencesThe University of Auckland Auckland New Zealand
| | - Rochelle Boyd
- Faculty of Medicine and Health SciencesMacquarie University NSW Australia
| | - Michael Cunningham
- Division of Medicinal Chemistry, Department of Biomolecular Sciences, School of PharmacyThe University of Mississippi MS USA
| | | | - Iain S. McGregor
- School of PsychologyThe University of Sydney Camperdown NSW Australia
| | - Michelle Glass
- School of Medical SciencesThe University of Auckland Auckland New Zealand
| | - Mark Connor
- Faculty of Medicine and Health SciencesMacquarie University NSW Australia
| | - Roy R. Gerona
- Clinical Toxicology and Environmental Biomonitoring LaboratoryUniversity of California San Francisco CA USA
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Abstract
Novel drugs of abuse are synthetic illicit drugs, or analogues of known illicit drugs, that can be more potent. Novel drugs of abuse are often labeled as designer drugs, research chemicals, legal highs, or psychoactive substances. They are often sold as designated legal or nondrug products, such as incense, plant food, or bath salts, with labeling such as "Not for Human Consumption" or "For Use in Research Only." The prevalence of use of novel drugs of abuse is difficult to determine because specific drugs, compounds, and availability of these drugs are constantly evolving. Changes in chemical structures lead to heterogeneity in physiologic response and clinical symptoms, even within the same category of drug. Pediatricians and emergency medicine physicians should be knowledgeable about novel drugs of abuse and their resulting symptoms for prevention and identification of their use.
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Affiliation(s)
- George Sam Wang
- Section of Emergency Medicine and Medical Toxicology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO.,Rocky Mountain Poison and Drug Center, Denver Health Hospital, Denver, CO
| | - Christopher Hoyte
- Rocky Mountain Poison and Drug Center, Denver Health Hospital, Denver, CO.,Department of Emergency Medicine and Medical Toxicology, University of Colorado Anschutz Medical Campus, University Hospital, Aurora, CO
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12
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Cha HJ, Song YJ, Lee DE, Kim YH, Shin J, Jang CG, Suh SK, Kim SJ, Yun J. Receptor Binding Affinities of Synthetic Cannabinoids Determined by Non-Isotopic Receptor Binding Assay. Toxicol Res 2019; 35:37-44. [PMID: 30766656 PMCID: PMC6354946 DOI: 10.5487/tr.2019.35.1.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/07/2018] [Accepted: 08/21/2018] [Indexed: 01/24/2023] Open
Abstract
A major predictor of the efficacy of natural or synthetic cannabinoids is their binding affinity to the cannabinoid type I receptor (CB1) in the central nervous system, as the main psychological effects of cannabinoids are achieved via binding to this receptor. Conventionally, receptor binding assays have been performed using isotopes, which are inconvenient owing to the effects of radioactivity. In the present study, the binding affinities of five cannabinoids for purified CB1 were measured using a surface plasmon resonance (SPR) technique as a putative non-isotopic receptor binding assay. Results were compared with those of a radio-isotope-labeled receptor binding assay. The representative natural cannabinoid Δ9-tetrahydrocannabinol and four synthetic cannabinoids, JWH-015, JWH-210, RCS-4, and JWH-250, were assessed using both the SPR biosensor assay and the conventional isotopic receptor binding assay. The binding affinities of the test substances to CB1 were determined to be (from highest to lowest) 9.52 × 10-13 M (JWH-210), 6.54 × 10-12 M (JWH-250), 1.56 × 10-11 M (Δ9-tetrahydrocannabinol), 2.75 × 10-11 M (RCS-4), and 6.80 ×10-11 M (JWH-015) using the non-isotopic method. Using the conventional isotopic receptor binding assay, the same order of affinities was observed. In conclusion, our results support the use of kinetic analysis via SPR in place of the isotopic receptor binding assay. To replace the receptor binding affinity assay with SPR techniques in routine assays, further studies for method validation will be needed in the future.
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Affiliation(s)
- Hye Jin Cha
- Pharmacological Research Division, Toxicological Evaluation and Research Department, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Chungju,
Korea
| | - Yun Jeong Song
- Pharmacological Research Division, Toxicological Evaluation and Research Department, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Chungju,
Korea
| | - Da Eun Lee
- Pharmacological Research Division, Toxicological Evaluation and Research Department, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Chungju,
Korea
| | - Young-Hoon Kim
- Pharmacological Research Division, Toxicological Evaluation and Research Department, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Chungju,
Korea
| | - Jisoon Shin
- Pharmacological Research Division, Toxicological Evaluation and Research Department, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Chungju,
Korea
| | - Choon-Gon Jang
- Department of Pharmacology, School of Pharmacy, Sungkyunkwan University, Suwon,
Korea
| | - Soo Kyung Suh
- Pharmacological Research Division, Toxicological Evaluation and Research Department, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Chungju,
Korea
| | - Sung Jin Kim
- Cosmetics Policy Division, Ministry of Food and Drug Safety, Chungju,
Korea
| | - Jaesuk Yun
- Neuroimmunology Lab, College of Pharmacy, Wonkwang University, Iksan,
Korea
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13
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Joseph A, Lekas HM, Manseau M, Lewis C. A Polydrug and Psychosocial Profile of Synthetic Cannabinoid Use in a New York City Community Sample, 2016-2017. Subst Use Misuse 2019; 54:282-287. [PMID: 30526203 DOI: 10.1080/10826084.2018.1517178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Epidemiologic reports available on synthetic cannabinoids (SCs) have focused on sociodemographics, indicating high prevalence of SC use predominantly among white, relatively affluent, males. However, there is emerging evidence suggesting high SC prevalence among socioeconomically disadvantaged, racial/ethnic minority males. OBJECTIVES The purpose of this study is to investigate the risk correlates of SC use among psychosocial vulnerable communities. METHOD The sample of 100 participants was recruited from two harm reduction-focused, community-based organizations in the South Bronx and East Harlem neighborhoods in New York City. Consented individuals 18 years and older underwent a 30- minute survey ascertaining sociodemographics, psychosocial characteristics, SC and polydrug use characteristics, and mental health history. RESULTS The study population was majority male (61%), Latino (56%), commonly diagnosed with psychiatric illness (67%), and with a mean age of 45.4. Those reporting SC use (74%) were more likely to be male, homeless, and report polydrug use. After adjustment, being male (AOR = 5.64), homelessness (AOR = 4.88) along with cocaine (AOR = 5.63) and opiate use (AOR = 31.1) were independently associated with SC use. The most common reasons for using SC were affordability, inability to detect SC in drug tests, and perceived physical and emotional benefits. Conclusion/importance: This work is significant in expanding the populations thought to be impacted by and understanding social disparities related to SC use. Further investigation is needed to assess the relationship between concomitant use of SC and other drug, particularly opiates. This may suggest that the sequelae of one drug may enhance or alleviate the effects of the other.
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Affiliation(s)
- Adriana Joseph
- a Social Solutions and Services Research, Nathan S. Kline Institute for Psychiatric Research , Orangeburg , New York , USA
| | - Helen-Maria Lekas
- a Social Solutions and Services Research, Nathan S. Kline Institute for Psychiatric Research , Orangeburg , New York , USA.,b Department of Psychiatry , New York University School of Medicine , New York , New York , USA
| | - Marc Manseau
- b Department of Psychiatry , New York University School of Medicine , New York , New York , USA
| | - Crystal Lewis
- a Social Solutions and Services Research, Nathan S. Kline Institute for Psychiatric Research , Orangeburg , New York , USA.,b Department of Psychiatry , New York University School of Medicine , New York , New York , USA
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14
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Arens AM, Olives TD, Simpson NS, Laes JR, Anderson DL, Bangh SA, Lee SC, Martin S, Banister SD, Gerona RR, Cole JB. An outbreak of synthetic cannabinoid exposures reported to a regional poison center: "K2" identified as 5F-ADB. Clin Toxicol (Phila) 2018; 57:69-71. [PMID: 30430881 DOI: 10.1080/15563650.2018.1497170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ann M Arens
- a Minnesota Poison Control System , Minneapolis , MN , USA.,b Department of Emergency Medicine , Hennepin Healthcare , Minneapolis , MN , USA
| | - Travis D Olives
- a Minnesota Poison Control System , Minneapolis , MN , USA.,b Department of Emergency Medicine , Hennepin Healthcare , Minneapolis , MN , USA
| | - Nicholas S Simpson
- b Department of Emergency Medicine , Hennepin Healthcare , Minneapolis , MN , USA
| | - JoaAn R Laes
- a Minnesota Poison Control System , Minneapolis , MN , USA.,c Division of Addiction Medicine , Hennepin Healthcare , Minneapolis , MN , USA
| | | | - Stacey A Bangh
- a Minnesota Poison Control System , Minneapolis , MN , USA
| | - Samantha C Lee
- a Minnesota Poison Control System , Minneapolis , MN , USA
| | - Spencer Martin
- d University of California, San Francisco School of Medicine , San Francisco , CA , USA
| | - Samuel D Banister
- e The Lambert Initiative for Cannabinoid Therapeutics, University of Sydney , Camperdown , Australia
| | - Roy R Gerona
- f Clinical Toxicology and Environmental Biomonitoring Laboratory , University of California , San Francisco , CA , USA
| | - Jon B Cole
- a Minnesota Poison Control System , Minneapolis , MN , USA
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15
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The Chameleon-Like Properties of Psychoactive Drugs: Examinations with HR LC-MS/MS Technology of Patients Presenting at the Emergency Department Following the Use of Synthetic Cannabinoids: A Case Series and Literature Review. Behav Sci (Basel) 2018; 8:bs8100088. [PMID: 30248995 PMCID: PMC6210773 DOI: 10.3390/bs8100088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 11/16/2022] Open
Abstract
The chameleon can disguise itself in nature by taking on different colors and forms. As synthetic cannabinoids (SC) have clinically similar effects to those of several psychoactive agents, they are one of the most difficult intoxications to diagnose. The reasons for this are due to clinical variations throughout the world and the differences in symptoms having not been determined due to their similarity to the intoxication of several other drugs. The aim of this study was to obtain prospective data of patients presenting at the Emergency Department (ED) with suspected SC intoxication, and as a result of prospective examination of samples, to determine a new generation of SC use, SC types, clinical findings, and treatments. Method: A total of a 15 patients with suspected SC intoxication who presented at the ED of the Health Sciences University Kayseri Training and Research Hospital between January 2017 and January 2018 were examined. Samples taken prospectively from patients who were followed-up for a diagnosis of SC intoxication were examined with the HR LC-MS/MS method; SC were determined, and the test results of other psychoactive agents that were used concurrently were examined. Conclusions: Three significant findings emerged as a result of this study. Firstly, due to the different clinical forms of presentation at ED associated with SC use and the range of intoxications that cannot be diagnosed, advanced laboratory tests are required, in addition to routine tests for the determination of SC. Secondly, those diagnosed as having taken SC were also determined to have used it concurrently with substances that have a high potential for addiction, such as amphetamines and quetiapine. Thirdly, in regard to examples of cases presented in the literature, anti-psychotics, fluid hydration, and anxiolytics can be used as treatment options for those diagnosed with SC use.
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Abstract
Several novel psychoactive substances have emerged in recent years. Users are typically young men who use other substances. In the category of stimulants, cathinones ("bath salts") have predominated and can lead to agitation, psychosis, hyperthermia, and death. Synthetic cannabinoids ("spice") are more potent than marijuana and can lead to agitation, psychosis, seizures, and death. There are no rapid tests to identify these substances and general treatment includes benzodiazepines for agitation and supportive therapy. Many Synthetic opioids are potent analogues of fentanyl and carry a high risk of overdose. In addition, there are several designer benzodiazepines that have emerged.
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Affiliation(s)
- Ryan Graddy
- Division of Chemical Dependence, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite D5W, Baltimore, MD 21224, USA
| | - Megan E Buresh
- Division of Chemical Dependence, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite D5W, Baltimore, MD 21224, USA
| | - Darius A Rastegar
- Division of Chemical Dependence, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite D5W, Baltimore, MD 21224, USA.
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17
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Inayat F, Riaz I, Ali NS, Figueredo VM. Pseudo-Wellens' syndrome secondary to concurrent cannabis and phencyclidine intoxication. BMJ Case Rep 2018; 2018:bcr-2018-225755. [PMID: 29960973 DOI: 10.1136/bcr-2018-225755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Wellens' syndrome is an electrocardiographic pattern of T-wave changes associated with critical stenosis of the proximal left anterior descending artery, signifying imminent risk of an anterior-wall myocardial infarction. The Wellens' electrocardiographic pattern can also be noted in several cardiac and non-cardiac diseases. We chronicle here a unique case of a patient who presented with atypical left chest pain and dizziness for 6 hours. His pain started after he smoked phencyclidine-laced cannabis. Cardiac panel demonstrated normal troponin T levels. Electrocardiogram showed sinus rhythm with new deep biphasic T-wave inversions in anterolateral leads. Coronary angiography showed no pathological processes. Subsequently, ECG changes resolved coincidentally with the resolution of chest pain. He was eventually diagnosed with pseudo-Wellens' syndrome. This paper illustrates that physicians should be vigilant for Wellens' syndrome mimicked by acute phencyclidine and cannabis intoxication. Additionally, we present a review of various aetiologies of pseudo-Wellens' syndrome, especially in patients with substance abuse.
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Affiliation(s)
| | - Iqra Riaz
- Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | | | - Vincent M Figueredo
- Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania, USA
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18
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Emery DW, Iceman CR, Hayes SM. Geographic Variability of Active Ingredients in Spice as an Indicator of Mechanisms of Distribution and Manufacture Within Alaska. JOURNAL OF YOUNG INVESTIGATORS 2018; 34:7-16. [PMID: 30405322 DOI: 10.22186/jyi.34.4.7-16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Designer drugs, like Spice, are synthetic psychoactive analogs of illegal substances with understudied health effects since they have traditionally been sold in packages labeled "not for human consumption" and the molecular structures can be specifically altered to circumvent legislation. Recent legislation has focused on regulating packaging and has reduced, but not eliminated, the distribution of Spice in Alaska. Legally obtained Spice samples from three geographic regions in Alaska were analyzed using liquid injection gas chromatography-mass spectrometry (GC-MS). Most (70%) of the samples contained illegal cannabinoids that have been regulated by the Drug Enforcement Agency and 47% contained multiple active ingredients. We hypothesized that the heterogeneity of the active ingredients between brands and across regions could be used to indicate small- or larger-scale manufacturing, and the results indicate multiple manufacturing scales. Evidence for small-scale manufacturing included inconsistent packaging, several of which contained similar active ingredient profiles in different brands purchased from a single store. Evidence for large-scale production was also found with some brands having consistent active ingredient profiles across regions. This study provides preliminary data for the geographic variability of active ingredients in Spice as an indicator of mechanisms of manufacture and distribution to inform legislators and law enforcement and help prioritizing resource allocation in an effort to quell Spice use in Alaska.
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Affiliation(s)
- Dakota W Emery
- Department of Chemistry and Biochemistry, University of Alaska Fairbanks, 505 S. Chandalar Dr, Fairbanks AK 99775
| | - Christopher R Iceman
- Department of Chemistry and Biochemistry, University of Alaska Fairbanks, 505 S. Chandalar Dr, Fairbanks AK 99775.,Valparaiso University, 1700 Chapel Dr, Valparaiso IN 46383
| | - Sarah M Hayes
- Department of Chemistry and Biochemistry, University of Alaska Fairbanks, 505 S. Chandalar Dr, Fairbanks AK 99775
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19
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Banister SD, Olson A, Winchester M, Stuart J, Edington AR, Kevin RC, Longworth M, Herrera M, Connor M, McGregor IS, Gerona RR, Kassiou M. The chemistry and pharmacology of synthetic cannabinoid SDB-006 and its regioisomeric fluorinated and methoxylated analogs. Drug Test Anal 2018; 10:1099-1109. [PMID: 29350472 DOI: 10.1002/dta.2362] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 01/01/2023]
Abstract
Synthetic cannabinoids are the largest and most structurally diverse class of new psychoactive substances, with manufacturers often using isomerism to evade detection and circumvent legal restriction. The regioisomeric methoxy- and fluorine-substituted analogs of SDB-006 (N-benzyl-1-pentyl-1H-indole-3-carboxamide) were synthesized and could not be differentiated by gas chromatography-mass spectrometry (GC-MS), but were distinguishable by liquid chromatography-quadrupole time-of-flight-MS (LC-QTOF-MS). In a fluorescence-based plate reader membrane potential assay, SDB-006 acted as a potent agonist at human cannabinoid receptors (CB1 EC50 = 19 nM). All methoxy- and fluorine-substituted analogs showed reduced potency compared to SDB-006, although the 2-fluorinated analog (EC50 = 166 nM) was comparable to known synthetic cannabinoid RCS-4 (EC50 = 146 nM). Using biotelemetry in rats, SDB-006 and RCS-4 evoked comparable reduction in body temperature (~0.7°C at a dose of 10 mg/kg), suggesting lower potency than the recent synthetic cannabinoid AB-CHMINACA (>2°C, 3 mg/kg).
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Affiliation(s)
- Samuel D Banister
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Alexander Olson
- Clinical Toxicology and Environmental Biomonitoring Laboratory, University of California San Francisco, San Francisco, California, USA
| | - Matthew Winchester
- Clinical Toxicology and Environmental Biomonitoring Laboratory, University of California San Francisco, San Francisco, California, USA
- Department of Biological Sciences, University of Southern California, Los Angeles, California, USA
| | - Jordyn Stuart
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Amelia R Edington
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Richard C Kevin
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | | | - Marco Herrera
- Department of Immunology, Stanford University, Stanford, California, USA
| | - Mark Connor
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Iain S McGregor
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Roy R Gerona
- Clinical Toxicology and Environmental Biomonitoring Laboratory, University of California San Francisco, San Francisco, California, USA
| | - Michael Kassiou
- School of Chemistry, The University of Sydney, Sydney, NSW, Australia
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20
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Banister SD, Connor M. The Chemistry and Pharmacology of Synthetic Cannabinoid Receptor Agonist New Psychoactive Substances: Evolution. Handb Exp Pharmacol 2018; 252:191-226. [PMID: 30105473 DOI: 10.1007/164_2018_144] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Synthetic cannabinoid receptor agonists (SCRAs) are the largest and most structurally diverse class of new psychoactive substances (NPS). Although the earliest SCRA NPS were simply repurposed from historical academic manuscripts or pharmaceutical patents describing cannabinoid ligands, recent examples bear hallmarks of rational design. SCRA NPS manufacturers have applied traditional medicinal chemistry strategies (such as molecular hybridization, bioisosteric replacement, and scaffold hopping) to existing cannabinoid templates in order to generate new molecules that circumvent structure-based legislation. Most SCRAs potently activate cannabinoid type 1 and type 2 receptors (CB1 and CB2, respectively), with the former contributing to the psychoactivity of these substances. SCRAs are generally more toxic than the Δ9-tetrahydrocannabinol (Δ9-THC) found in cannabis, and this may be due to ligand bias, metabolism, or off-target activity. This chapter will chart the evolution of recently identified SCRA NPS chemotypes, as well as their putative manufacturing by-products and thermolytic degradants, and describe structure-activity relationships within each class.
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Affiliation(s)
- Samuel D Banister
- Department of Pathology, Stanford University, Stanford, CA, USA.
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.
| | - Mark Connor
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
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21
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Armenian P, Darracq M, Gevorkyan J, Clark S, Kaye B, Brandehoff NP. Intoxication from the novel synthetic cannabinoids AB-PINACA and ADB-PINACA: A case series and review of the literature. Neuropharmacology 2017; 134:82-91. [PMID: 29037744 DOI: 10.1016/j.neuropharm.2017.10.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/22/2017] [Accepted: 10/12/2017] [Indexed: 12/21/2022]
Abstract
Synthetic cannabinoids (SC), are a novel class of designer drugs which emerged as a drug of abuse in the late 2000's. We report a case series of 6 patients who may have smoked a synthetic cannabinoid product in a remote wilderness setting. They presented with varying degrees of altered mental status, agitation, and seizures. Two were confirmed to have AB-PINACA, ADB-PINACA and their respective pentanoic acid metabolites in biological specimens via liquid chromatography time-of-flight mass spectrometry (LC-TOF/MS). Both compounds had DEA Schedule I classification at the time of case presentation, and 22 SCs are currently temporary or permanent DEA Schedule I. More than 150 SCs are known to date, and new compounds are appearing at a rapid rate on darknet and surface web e-commerce websites, marketed as "research chemicals" or "legal highs." The scale and rapidity of SC evolution make legal control and analytical detection difficult. Nontargeted testing with liquid chromatography high resolution mass spectrometry (LC-HRMS), examining both parent compounds and metabolites, is the ideal method for novel SC identification and confirmation. Due to full agonism at the cannabinoid receptors CB1 and CB2, clinical effects are more severe than marijuana, which is a partial cannabinoid receptor agonist. They include agitated delirium, lethargy and coma, seizures, tachycardia, hypertension, and hallucinations, among other findings. Treatment is primarily symptomatic and aimed at airway protection and control of agitation and seizures. SCs do not appear to be abating anytime soon and require the cooperation of law enforcement, analytical scientists, and clinicians to adequately control. This article is part of the Special Issue entitled 'Designer Drugs and Legal Highs.'
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Affiliation(s)
- Patil Armenian
- Department of Emergency Medicine, University of California, San Francisco-Fresno. 155 N Fresno St., Fresno, CA 93701, USA.
| | - Michael Darracq
- Department of Emergency Medicine, University of California, San Francisco-Fresno. 155 N Fresno St., Fresno, CA 93701, USA.
| | - Jirair Gevorkyan
- Central Valley Toxicology, 1580 Tollhouse Rd, Clovis, CA 93611, USA.
| | - Shane Clark
- SkyLife Air Ambulance, 5526 E Aircorp Way, Fresno, CA 93727, USA.
| | - Bryan Kaye
- Department of Emergency Medicine, University of California, San Francisco-Fresno. 155 N Fresno St., Fresno, CA 93701, USA.
| | - Nicklaus P Brandehoff
- Department of Emergency Medicine, University of California, San Francisco-Fresno. 155 N Fresno St., Fresno, CA 93701, USA.
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22
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Rowley E, Benson D, Tiffee A, Hockensmith A, Zeng H, Jones GN, Musso MW. Clinical and financial implications of emergency department visits for synthetic marijuana. Am J Emerg Med 2017; 35:1506-1509. [DOI: 10.1016/j.ajem.2017.04.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/10/2017] [Accepted: 04/19/2017] [Indexed: 12/20/2022] Open
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Pergam SA, Woodfield MC, Lee CM, Cheng G, Baker KK, Marquis SR, Fann JR. Cannabis use among patients at a comprehensive cancer center in a state with legalized medicinal and recreational use. Cancer 2017; 123:4488-4497. [PMID: 28944449 PMCID: PMC5698756 DOI: 10.1002/cncr.30879] [Citation(s) in RCA: 161] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/26/2017] [Accepted: 06/05/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cannabis is purported to alleviate symptoms related to cancer treatment, although the patterns of use among cancer patients are not well known. This study was designed to determine the prevalence and methods of use among cancer patients, the perceived benefits, and the sources of information in a state with legalized cannabis. METHODS A cross‐sectional, anonymous survey of adult cancer patients was performed at a National Cancer Institute–designated cancer center in Washington State. Random urine samples for tetrahydrocannabinol provided survey validation. RESULTS Nine hundred twenty‐six of 2737 eligible patients (34%) completed the survey, and the median age was 58 years (interquartile range [IQR], 46‐66 years). Most had a strong interest in learning about cannabis during treatment (6 on a 1‐10 scale; IQR, 3‐10) and wanted information from cancer providers (677 of 911 [74%]). Previous use was common (607 of 926 [66%]); 24% (222 of 926) used cannabis in the last year, and 21% (192 of 926) used cannabis in the last month. Random urine samples found similar percentages of users who reported weekly use (27 of 193 [14%] vs 164 of 926 [18%]). Active users inhaled (153 of 220 [70%]) or consumed edibles (154 of 220 [70%]); 89 (40%) used both modalities. Cannabis was used primarily for physical (165 of 219 [75%]) and neuropsychiatric symptoms (139 of 219 [63%]). Legalization significantly increased the likelihood of use in more than half of the respondents. CONCLUSIONS This study of cancer patients in a state with legalized cannabis found high rates of active use across broad subgroups, and legalization was reported to be important in patients' decision to use. Cancer patients desire but are not receiving information about cannabis use during their treatment from oncology providers. Cancer 2017;123:4488‐97. © 2017 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. Cannabis use is common among patients receiving treatment at a large cancer center in a state with legalized recreational and medical cannabis. Active use is reported across broad demographic and diagnostic cancer subgroups, and legalization is reported to be important in patients' decision to use.
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Affiliation(s)
- Steven A. Pergam
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWashington
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashington
- Department of MedicineUniversity of WashingtonSeattleWashington
- Infection PreventionSeattle Cancer Care AllianceSeattleWashington
| | - Maresa C. Woodfield
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWashington
| | - Christine M. Lee
- Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleWashington
- Center for the Study of Health and Risk BehaviorsUniversity of WashingtonSeattleWashington
| | - Guang‐Shing Cheng
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashington
- Department of MedicineUniversity of WashingtonSeattleWashington
| | - Kelsey K. Baker
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashington
| | - Sara R. Marquis
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWashington
| | - Jesse R. Fann
- Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleWashington
- Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleWashington
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Butler JC. 2017 ASTHO President's Challenge: Public Health Approaches to Preventing Substance Misuse and Addiction. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 23:531-536. [PMID: 28759556 PMCID: PMC5548510 DOI: 10.1097/phh.0000000000000631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Jay C. Butler
- Alaska Department of Health and Social Services, Division of Public Health, Anchorage, Alaska
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25
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Donroe JH, Tetrault JM. Substance Use, Intoxication, and Withdrawal in the Critical Care Setting. Crit Care Clin 2017; 33:543-558. [PMID: 28601134 DOI: 10.1016/j.ccc.2017.03.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Substance use is common among individuals admitted to the critical care setting and may complicate treatment of underlying disorders. Management issues include the effects of intoxication as well as the risk posed by substance-withdrawal syndromes in patients being treated for critical illness. This article reviews the epidemiology of substance use in this population and the identification and treatment of common intoxication and withdrawal syndromes. The authors stress the importance of long-term planning as part of the overall treatment protocol beyond the acute presentation.
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Affiliation(s)
- Joseph H Donroe
- Department of Internal Medicine, Yale University School of Medicine, St. Raphael Campus, Office M330, 1450 Chapel Street, New Haven, CT 06511, USA.
| | - Jeanette M Tetrault
- Department of Internal Medicine, Yale University School of Medicine, 367 Cedar Street, Suite 305, New Haven, CT 06510, USA
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26
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Clayton HB, Lowry R, Ashley C, Wolkin A, Grant AM. Health Risk Behaviors With Synthetic Cannabinoids Versus Marijuana. Pediatrics 2017; 139:peds.2016-2675. [PMID: 28289138 DOI: 10.1542/peds.2016-2675] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Data are limited on the behavioral risk correlates of synthetic cannabinoid use. The purpose of this study was to compare the behavioral risk correlates of synthetic cannabinoid use with those among marijuana users. METHODS Data from the 2015 Youth Risk Behavior Survey, a cross-sectional survey conducted in a nationally representative sample of students in grades 9 through 12 (N = 15 624), were used to examine the association between self-reported type of marijuana use (ie, never use of marijuana and synthetic cannabinoids, ever use of marijuana only, and ever use of synthetic cannabinoids) and self-report of 36 risk behaviors across 4 domains: substance use, injury/violence, mental health, and sexual health. Multivariable models were used to calculate adjusted prevalence ratios. RESULTS Students who ever used synthetic cannabinoids had a significantly greater likelihood of engaging in each of the behaviors in the substance use and sexual risk domains compared with students who ever used marijuana only. Students who ever used synthetic cannabinoids were more likely than students who ever used marijuana only to have used marijuana before age 13 years, to have used marijuana ≥1 times during the past 30 days, and to have used marijuana ≥20 times during the past 30 days. Several injury/violence behaviors were more prevalent among students who ever used synthetic cannabinoids compared with students who ever used marijuana only. CONCLUSIONS Health professionals and school-based substance use prevention programs should include strategies focused on the prevention of both synthetic cannabinoids and marijuana.
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Affiliation(s)
- Heather B Clayton
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention,
| | - Richard Lowry
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
| | - Carmen Ashley
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
| | - Amy Wolkin
- Office of Applied Research, Office of Public Health Preparedness and Response, and
| | - Althea M Grant
- Office of Noncommunicable Diseases, Injury, and Environmental Health, Office of the Director, Centers for Disease Control and Prevention, Atlanta, Georgia
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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.
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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
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