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Jones AT, Marwan Abu Taha A, Miller GP. The resurgence of synthetic cannabinoid receptor agonists as adulterants in the Era of Cannabis legalization: Lessons from prior epidemics and clinical implications. Neurosci Biobehav Rev 2025; 170:106043. [PMID: 39922438 PMCID: PMC11870277 DOI: 10.1016/j.neubiorev.2025.106043] [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: 07/25/2024] [Revised: 01/30/2025] [Accepted: 02/03/2025] [Indexed: 02/10/2025]
Abstract
Momentum towards legalization of medical and recreational cannabis drives a convergence between natural cannabinoids and their synthetic counterparts, creating new clinical challenges in a second wave of exposures. This review critically examines the emerging challenges posed by synthetic cannabinoid receptor agonists (SCRAs) and semi-synthetic cannabinoids, emphasizing their clinical implications. SCRAs are potent full agonist activity that have been identified as adulterants in several recreational substances, including cannabis and opioids. Adulteration often leads to unpredictable clinical outcomes and exacerbates the potential for drug interactions. Drawing parallels with other drug epidemics, this paper highlights the urgent need for clinical preparedness to address the nuanced presentations of cannabinoid toxicity, stressing the importance of patient history, physical examination, and judicious use of supportive laboratory tests. This review serves as a cautionary tale and call to action for researchers and policymakers. There is a clear need for robust quality control measures, enhanced public awareness campaigns, and development of evidence-based clinical guidelines to mitigate the health risks associated with intentional and unintentional use of synthetic cannabinoids.
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Affiliation(s)
- Austin T Jones
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Alaa Marwan Abu Taha
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Grover P Miller
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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2
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Ricci V, Maina G. Clinical and Public Health Challenge of Handling Synthetic Cathinone and Cannabinoid Abuse in Pediatric Care: A Narrative Review. Pediatr Rep 2025; 17:19. [PMID: 39997626 PMCID: PMC11857941 DOI: 10.3390/pediatric17010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Revised: 01/22/2025] [Accepted: 02/05/2025] [Indexed: 02/26/2025] Open
Abstract
BACKGROUND Synthetic cathinones and cannabinoids have emerged as significant public health concerns, particularly in pediatric populations. Marketed under deceptive names such as "bath salts" and "K2/Spice", these substances pose unique challenges due to their accessibility, potency, and unpredictable effects. This narrative review synthesizes evidence on the toxicological effects of synthetic cathinones and cannabinoids in pediatric patients, emphasizing clinical presentations, management challenges, and public health implications. METHODS A structured narrative review was conducted using PubMed and Scopus databases to identify peer-reviewed studies published between January 2010 and September 2024. The selected articles focus on neuropsychiatric, systemic, and management outcomes associated with these substances in individuals aged 0-18 years. RESULTS Five studies demonstrate that synthetic cathinones frequently cause seizures, sympathomimetic toxidrome (tachycardia, hypertension), and neuropsychiatric effects like paranoia and catatonia. Seven studies show synthetic cannabinoids induce psychosis, respiratory depression requiring ventilation in 12% of cases, and cardiovascular complications like myocardial ischemia. One study highlighted severe outcomes in pediatric accidental exposures, emphasizing the unpredictable and life-threatening effects of these substances, often exacerbated by co-ingestion with alcohol or THC. CONCLUSIONS Pediatric exposure to synthetic cathinones and cannabinoids results in severe and unpredictable toxicological effects, necessitating tailored clinical management strategies and enhanced diagnostic capabilities. Public health measures, including stringent regulatory controls, targeted education initiatives, and robust surveillance systems, are critical to mitigating these risks. A multidisciplinary approach is essential to safeguard vulnerable pediatric populations from the escalating dangers posed by synthetic drugs, and future research must address the long-term impacts and mechanisms of toxicity.
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Affiliation(s)
- Valerio Ricci
- Psychiatry Department, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, Italy;
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, Via Cherasco n. 15, 10126 Torino, Italy
| | - Giuseppe Maina
- Psychiatry Department, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, Italy;
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, Via Cherasco n. 15, 10126 Torino, Italy
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3
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Chiappini S, Vaccaro G, Mosca A, Miuli A, Stigliano G, Stefanelli G, Giovannetti G, Carullo R, d'Andrea G, Di Carlo F, Cavallotto C, Pettorruso M, Di Petta G, Corkery JM, Guirguis A, Stair JL, Martinotti G, Fazel S, Schifano F. New trends of drug abuse in custodial settings: A systematic review on the misuse of over-the-counter drugs, prescription-only-medications, and new psychoactive substances. Neurosci Biobehav Rev 2024; 162:105691. [PMID: 38733894 DOI: 10.1016/j.neubiorev.2024.105691] [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: 10/13/2023] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024]
Abstract
The article presents a systematic literature review on the use and the psychiatric implications of over-the-counter drugs (OTC), prescription-only-medications (POM), and new psychoactive substances (NPS) within custodial settings. The searches wer carried out on 2 November 2022 on PubMed, Scopus, and Web of Science in line with PRISMA guidelines. A total of 538 records were identified, of which 37 met the inclusion criteria. Findings showed the most prevalent NPS and OTC and POM classes reported in prisons were synthetic cannabinoids receptor agonists (SCRAs) and opioids, respectively. NPS markets were shown to be in constant evolution following the pace of legislations aimed to reduce their spread. The use of such substances heavily impacts the conditions and rehabilitation of persons in custody, with consequent physical and mental health risks. It is important to raise awareness of the use and misuse of such substances in prisons (i) from an early warning perspective for law enforcement and policy makers (ii) to prompt doctors to cautiously prescribe substances that may be misused (iii) to improve and increase access to treatment provided (iv) to add such substances to routine toxicological screening procedures (v) to improve harm reduction programmes.
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Affiliation(s)
- Stefania Chiappini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK; Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti 66100, Italy
| | - Giorgia Vaccaro
- Department of Clinical, Pharmaceutical and Biological Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK
| | - Alessio Mosca
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti 66100, Italy.
| | - Andrea Miuli
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti 66100, Italy
| | - Gianfranco Stigliano
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti 66100, Italy
| | - Giulia Stefanelli
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti 66100, Italy
| | - Giulia Giovannetti
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti 66100, Italy
| | - Rosalba Carullo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti 66100, Italy
| | - Giacomo d'Andrea
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti 66100, Italy
| | - Francesco Di Carlo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti 66100, Italy
| | - Clara Cavallotto
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti 66100, Italy
| | - Mauro Pettorruso
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti 66100, Italy
| | - Gilberto Di Petta
- Department of Neuroscience Department of Mental Health, ASL Napoli 2, Napoli, Nord, Italy
| | - John Martin Corkery
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK
| | - Amira Guirguis
- Swansea University Medical School, Grove Building, Swansea University, Singleton Park, Swansea, Wales SA28PP, UK
| | - Jacqueline L Stair
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK
| | - Giovanni Martinotti
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK; Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti 66100, Italy
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, and Oxford Health NHS Foundation Trust, England
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK
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4
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Mendonça-Ferreira P, Bombana H, Castaldelli-Maia JM. The rise of so-called adolescent "zombie" behavior: a spotlight on synthetic cannabinoid abuse. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2024; 46:e20243587. [PMID: 38875494 PMCID: PMC11474444 DOI: 10.47626/1516-4446-2024-3587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/13/2024] [Indexed: 06/16/2024]
Affiliation(s)
- Pedro Mendonça-Ferreira
- Instituto Perdizes (IPer), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Henrique Bombana
- Departamento de Medicina Legal, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - João Mauricio Castaldelli-Maia
- Instituto Perdizes (IPer), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Departamento de Neurociência, Faculdade de Medicina, Centro Universitário FMABC, Santo André, SP, Brazil. Departamento de Psiquiatria, Escola de Medicina, USP, São Paulo, SP, Brazil
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5
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Su YJ, Chen TH, Liao WH, Chang KS, Lai YC. Clinical characteristics in new psychoactive substance users: A single center study. Medicine (Baltimore) 2023; 102:e34084. [PMID: 37352073 PMCID: PMC10289540 DOI: 10.1097/md.0000000000034084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 06/25/2023] Open
Abstract
New psychoactive substances (NPS) are emerging illegal substances or synthetic drugs that pose public health threats worldwide. This study was aimed at reporting the clinical characteristics of NPS and classical illicit substances used by patients who presented to the emergency room. We conducted a retrospective cohort study on patients with suspected illicit substance use who visited the emergency department (ED) with the suspicion of illicit substance use. We divided the patients into 4 groups based on the NPS testing results: NPS positive, NPS negative, NPS combined with classical illicit drugs (INPS), and subjects with negative testing results. The majority of patients in all groups were male. The NPS users were significantly younger than those with negative results on toxic testing (26.4 vs 37.5, P = .005 < 0.05). The heart rate of NPS users was significantly faster than that of the group with negative results of toxic testing (111.1 vs 93.5 beats per minute, P = .046). The heartbeats of INPS group were also significantly faster than those with a negative result in toxicology screen (119.6 vs 93.5 beats per minute, P = .024). Those who used classical illicit drugs combined with NPS had significantly higher palpitation than those with negative results of toxic testing (27.3% vs 3.1%, P = .017). Patients who were highly suspicious of NPS use were younger, had tachycardia, felt palpitations, and had fair oxygen saturation compared to patients who were negative for urine toxicity screening.
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Affiliation(s)
- Yu-Jang Su
- Toxicology Division, Department of Emergency Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Emergency Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei City, Taiwan
- Department of Nursing, Yuanpei University of Medical Technology, HsinChu, Taiwan
| | - Tse-Hao Chen
- Department of Emergency Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wei-Hsiang Liao
- Department of Emergency Medicine, TAMSUI BRANCH, Mackay Memorial Hospital, Taipei, Taiwan
| | - Kuo-Song Chang
- Department of Emergency Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei City, Taiwan
- Department of Disaster Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yen-Chun Lai
- Department of Anesthesiology. Taipei Medical University Hospital, Taipei, Taiwan
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6
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Abdelmoneim WM, Bakr MH, Ghandour NM, Mohammed MK, Fawzy M, Ramadan AG, Abdellah NZ. Cytotoxicity associated with acute and chronic administration of synthetic cannabinoids “Strox” in the brain, liver, heart, and testes of male albino rats: histological and immunohistochemical study. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2023. [DOI: 10.1186/s41935-023-00331-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Abstract
Background
Synthetic cannabinoids are one of the largest groups of new psychoactive substances that invaded Egypt’s drug abuse market over the past few years.
Aim
Randomized controlled trial study to demonstrate the effects of acute and chronic toxicity by synthetic cannabinoid (Strox) on the brain, liver, heart, and testes in adult male albino rats through histopathological examination by light microscope and immunohistochemistry.
Methods
Total number of fifty male albino rats were divided into five different groups, two control and three treated groups. Negative and positive control groups received distilled water and dimethyl sulfoxide, respectively, acute group received LD50 (lethal dose 50) once and observed for 14 days, chronic group received 1/10 LD50 for 3 months, and finally chronic withdrawal groups received 1/10 LD50 for 3 months and then left 2 weeks without the substance to observe the withdrawal manifestations.
Results
The current study revealed various histopathological changes in all organs with increased expression of cannabinoid receptor 1. The most important findings observed by light microscope examination were shrinkage and degenerative changes in Purkinje cells in brain sections, abnormalities in blood sinusoids and architecture in liver section, disruption in cardiac muscle fiber in heart sections, and finally testes showed irregularities in seminiferous tubules and germinal cells. Immunohistochemical staining for caspase-3 in the brain, liver, and heart showed weak-positive reaction in acute group and a strong reaction with chronic groups. Additionally, increase in collagen fiber was observed in sections of the liver and heart of chronic group.
Conclusions
Synthetic cannabinoid sample (Strox) toxicity caused adverse effects on the brain, liver, heart, and testes as shown by increasing cannabinoid receptor 1 and caspase-3 expression.
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7
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Methyl (S)-2-(1-7 (5-fluoropentyl)-1H-indole-3-carboxamido)-3,3-dimethylbutanoate (5F-MDMB-PICA) intoxication in a child with identification of two new metabolites (ultra-high-performance liquid chromatography-tandem mass spectrometry). Forensic Toxicol 2023; 41:47-58. [PMID: 36652054 DOI: 10.1007/s11419-022-00629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/12/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Methyl (S)-2-(1-7 (5-fluoropentyl)-1H-indole-3-carboxamido)-3,3-dimethylbutanoate (5F-MDMA-PICA) intoxication in 1.5-year-old child was presented, together with diagnostic parameters discussion and 5F-MDMB-PICA determination in biological material. Furthermore, 5F-MDMB-PICA metabolites were identified in a urine sample as markers of exposure in situation when a parent compound is not present in specimens. METHODS Drugs and metabolites were extracted from serum and urine with ethyl acetate both under alkaline (pH 9) and acidic (pH 3) conditions. Hair, after decontamination and pulverization, were incubated with methanol (16 h, 60 °C). The analysis was carried out using ultra-high-performance liquid chromatography-tandem mass spectrometry. For the identification of 5F-MDMB-PICA metabolites, an urine sample was precipitated with cold acetonitrile. Analysis was performed using ultra-high-performance liquid chromatograph with quadrupole time-of-flight mass spectrometer. RESULTS 5F-MDMB-PICA was determined only in serum sample at concentration of 298 ng/mL. After 1 year, when analysis was repeated, concentration of synthetic cannabinoid in the same sample was only 17.6 ng/mL which revealed high instability of 5F-MDMB-PICA in serum sample. Eight 5F-MDMB-PICA metabolites were identified in urine sample, including two potentially new ones with m/z 391.18964 and m/z 275.14016. CONCLUSIONS Toxicological analysis confirmed a 1.5-year-old boy intoxication with 5F-MDMB-PICA. Besides the parent drug, metabolites of 5F-MDMB-PICA were identified, including two potentially new ones, together with possible metabolic reactions which they resulted from. Metabolites determination could serve as a marker of 5F-MDMB-PICA exposure when no parent drug is present in biological material.
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8
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Abu Jad AA, Ravanavena A, Ravindra C, Igweonu-Nwakile EO, Ali S, Paul S, Yakkali S, Teresa Selvin S, Thomas S, Bikeyeva V, Abdullah A, Radivojevic A, Balani P. Adverse Effects of Cannabinoids and Tobacco Consumption on the Cardiovascular System: A Systematic Review. Cureus 2022; 14:e29208. [PMID: 36159363 PMCID: PMC9484787 DOI: 10.7759/cureus.29208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/15/2022] [Indexed: 12/03/2022] Open
Abstract
With the recent legalization of marijuana in several countries for recreational use, a controversial belief is spreading about it being "safe". In this systematic review, we decided to investigate this belief and present the adverse effects of marijuana and tobacco smoking on the cardiovascular system. We carried out an electronic search on databases including PubMed, PubMed Central, and Medline. Medical Subject Headings (MeSH) terms and different keywords were used for data collection. We included studies published in the last 10 years that were in English. All types of study subjects were accepted. Grey literature, books, case reports and case series, overlapping and duplicate studies, and studies older than 10 years were excluded. In this review, we included 18 studies, which we then separated into the "tobacco and cardiovascular disease" arm and the "cannabinoids and cardiovascular disease" arm. We had 11 and seven studies for each of the arms, respectively. The types of articles included in this review were traditional and systematic reviews and meta-analyses. After reviewing all the data included in this article, we found out that cannabinoid consumption has a more devastating effect on the cardiovascular system when compared to tobacco. The shocking fact was that in several cases, deadly adverse effects were observed in patients within a few hours after consumption or even during their first time using cannabinoids.
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Affiliation(s)
- Anas A Abu Jad
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Anvesh Ravanavena
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Chetna Ravindra
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Safina Ali
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Salomi Paul
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Shreyas Yakkali
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sneha Teresa Selvin
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sonu Thomas
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Viktoriya Bikeyeva
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ahmed Abdullah
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aleksandra Radivojevic
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Prachi Balani
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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9
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Gaunitz F, Andresen-Streichert H. Analytical findings in a non-fatal intoxication with the synthetic cannabinoid 5F-ADB (5F-MDMB-PINACA): a case report. Int J Legal Med 2021; 136:577-589. [PMID: 34921326 PMCID: PMC8847293 DOI: 10.1007/s00414-021-02717-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/27/2021] [Indexed: 11/23/2022]
Abstract
The case report centres on analytical findings from a spice sample (mixed with tobacco (as a cigarette) for consumption), and its corresponding plasma sample, smoked by a 31-year-old man who was attended by emergency services following collapse. The man was fully conscious and cooperative during initial medical treatment. Suddenly, he suffered a complete loss of self-control, whereupon the police was notified. The man encountered the police officers when exiting the apartment, at which point he threatened them with clenched fists and reached for a plant bucket in order to strike out in the direction of the officers. At the trial, he described himself as confused and as being completely overwhelmed, having lost self-control, suffered a panic attack and “just wanted to get out the situation”. Furthermore, he stated that he had no recollection of the incident. He feared death due to palpitations, heart pain, dizziness and repetitive anxiety states. Routine systematic as well as extended toxicological analysis of the plasma sample, taken approximately 2 h after the incident, confirmed the use of cannabis and spice. Plasma concentrations of THC, OH-THC and THC-COOH were 8.0 μg/L, 4.0 μg/L and 147 μg/L, respectively. Furthermore, analysis confirmed uptake of 5F-ADB (5F-MDMB-PINACA) via detection of both 5F-ADB and the 5F-ADB N-(5-OH-pentyl) metabolite. The spice sample additionally contained 5F-MDMB-PICA, which was not detected in the plasma sample. A differentiation between a possible co-use and a recent use of cannabis was not possible. In summary, this case once more underlines the health risks of spice use.
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Affiliation(s)
- Franziska Gaunitz
- Institute of Legal Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany.
| | - Hilke Andresen-Streichert
- Institute of Legal Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
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10
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Lim CCW, Leung JKY, Connor JP, Hall WD, Gartner C, Cheng BHC, Scheurer RW, Sun T, Chan GCK. Availability of substances for use in personal vaporisers on three online cryptomarkets. Drug Alcohol Depend 2020; 217:108254. [PMID: 32979736 DOI: 10.1016/j.drugalcdep.2020.108254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Personal vaporisers are gaining popularity as an alternative route of administration for a range of substances. Online cryptomarkets are becoming increasingly popular among people who use substances due to their perceived anonymity, ease of use, and reduced risk of violence compared to traditional face-to-face dealers. We examined the diversity of substances marketed for use in a personal vaporiser on these marketplaces. METHODS Vaping related listings were extracted from three online cryptomarkets ('Agartha', 'Cryptonia', and 'Tochka') using The Onion Router browser. Data collection occurred between October and November 2019. RESULTS We identified 1929 listings from 201 unique sellers. The top product on Agartha, Cryptonia, and Tochka were vape cartridges prefilled with the e-liquid (70.4 %, 39.4 %, 52.3 % respectively). The most common substance in these products was cannabis oil (96.1 %, 82.1 %, 87.8 %), followed by synthetic cannabinoids (3.7 %, 9.7 %, 9.8 %) and psychedelic substances (0.2 %, 6.4 %, 1.2 %). Vendors were primarily from the USA. Many products offered worldwide shipping (96.3 %, 42.4 %, 51.2 %). CONCLUSION Vaping products listed on online cryptomarkets in 2019 primarily contained cannabis oils. Future studies should continue to examine cryptomarkets to identify emerging trends of substances that can be used in personal vaporisers.
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Affiliation(s)
- Carmen C W Lim
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia; School of Psychology, The University of Queensland, St Lucia, QLD, 4072, Australia.
| | - Janni K Y Leung
- School of Psychology, The University of Queensland, St Lucia, QLD, 4072, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2031, Australia; Institute for Health Metrics and Evaluation, University of Washington, USA
| | - Jason P Connor
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia; Discipline of Psychiatry, Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia
| | - Wayne D Hall
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia; Discipline of Psychiatry, Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia; National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, United Kingdom
| | - Coral Gartner
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia; Queensland Alliance for Environmental Health Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Woolloongabba, QLD, 4102, Australia
| | - Brandon H C Cheng
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia; School of Psychology, The University of Queensland, St Lucia, QLD, 4072, Australia
| | - Roman W Scheurer
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, 4076, Australia
| | - Tianze Sun
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia; School of Psychology, The University of Queensland, St Lucia, QLD, 4072, Australia
| | - Gary C K Chan
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia
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11
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Guler EM, Bektay MY, Akyildiz AG, Sisman BH, Izzettin FV, Kocyigit A. Investigation of DNA damage, oxidative stress, and inflammation in synthetic cannabinoid users. Hum Exp Toxicol 2020; 39:1454-1462. [PMID: 32508150 DOI: 10.1177/0960327120930057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The widespread use of synthetic cannabinoids (SCs) among youth has become an important public health problem. Several life-threatening side effects of SC have been reported, including cardiovascular, gastrointestinal, neurological, renal, metabolic, ophthalmologic, and pulmonary effects, besides skin toxicity and hepatotoxicity. METHODS Given that high levels of SC can lead to oxidative stress, DNA damage, and inflammation, it has been aimed in this study to investigate the effects of SC in aspects of primary DNA damage, plasma total oxidant status (TOS)/total antioxidant status (TAS), thiol-disulfide homeostasis, myeloperoxidase (MPO) level, and cytokine levels (interleukin 1 beta (IL-1β), interleukin 6 (IL-6), and tumor necrosis factor-alpha (TNF-α)) of 40 SC users (SCUs) in Turkey. RESULTS Mean plasma TOS levels were significantly higher in the SCUs group than in the healthy group (HG). Similarly, mononuclear leukocyte DNA damage, plasma TOS, MPO activity, disulfide, oxidative stress index levels, IL-1β, IL-6, and TNF-α levels were significantly higher in the SCU group than in the HG, whereas plasma TAS, total, and native thiol levels were significantly lower in the SCU group than in the HG. CONCLUSION It is concluded that SC can cause increase in oxidative stress and in inflammatory processes in addition to its potential for DNA damage. Additional studies with larger sample sizes and longer durations should be held to understand more specific outcomes of SC use.
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Affiliation(s)
- E M Guler
- Faculty of Medicine, Department of Medical Biochemistry, Bezmialem Vakif University, Istanbul, Turkey.,Traditional and Complementary Medicine, Advanced Research and Application Center, Bezmialem Vakif University, Istanbul, Turkey
| | - M Y Bektay
- Faculty of Pharmacy, Department of Clinical Pharmacy, Bezmialem Vakif University, Istanbul, Turkey.,Faculty of Pharmacy, Department of Clinical Pharmacy, Marmara University, Istanbul, Turkey
| | - A G Akyildiz
- Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Bezmialem Vakif University, Istanbul, Turkey.,Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Istanbul University, Istanbul, Turkey
| | - B H Sisman
- Department of Emergency Medicine, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - F V Izzettin
- Faculty of Pharmacy, Department of Clinical Pharmacy, Bezmialem Vakif University, Istanbul, Turkey
| | - A Kocyigit
- Faculty of Medicine, Department of Medical Biochemistry, Bezmialem Vakif University, Istanbul, Turkey.,Traditional and Complementary Medicine, Advanced Research and Application Center, Bezmialem Vakif University, Istanbul, Turkey
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12
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Mohite S, Wu H, Sharma S, Lavagnino L, Zeni CP, Currie TT, Soares JC, Pigott TA. Higher Prevalence of Metabolic Syndrome in Child-adolescent Patients with Bipolar Disorder. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:279-288. [PMID: 32329308 PMCID: PMC7242098 DOI: 10.9758/cpn.2020.18.2.279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/08/2020] [Accepted: 02/07/2020] [Indexed: 01/19/2023]
Abstract
Objective Previous studies have indicated a convergent and bidirectional relationship between metabolic syndrome (MetS) and bipolar disorder (BD). As most of these studies focused mainly on adults diagnosed with BD, our study aims to investigate and characterize metabolic disturbances in child-adolescents diagnosed with BD. Methods We retrospectively examined the medical records of psychiatric hospitalizations with admitting diagnosis of BD in child-adolescents (age < 18 years). Body mass index (BMI), lipid profile, fasting blood glucose, and blood pressure were primary variables. National Cholesterol Education Program criteria were used to define MetS. Reference group data was obtained from the National Health and Nutrition Examination Survey study. Statistical analyses included ttests, chi-square tests, and Fisher’s exact tests. Results We identified 140 child-adolescent patients with BD (mean age = 15.12 ± 1.70 years, 53% male). MetS was significantly more common in BD compared to the reference group: 14% (95% confidence interval [95% CI] 8−20) vs. 6.7% (95% CI 4.1−9.2), p = 0.001 with no significant difference by sex. MetS components were higher in the BD group, particularly BMI ≥ 95% (25% vs. 11.8%, p < 0.001) and high blood pressure (17% vs. 8%, p = 0.05). Moreover, female patients had lower odds of high blood pressure (odds ratio = 0.24 [95% CI 0.08−0.69], p = 0.005). Conclusion Compared with the general child-adolescent population, the prevalence of MetS was significantly higher in patients with BD of same age. This reiterates the notion of an increased risk of MetS in patients diagnosed with BD; and thus, further exploration is warranted.
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Affiliation(s)
- Satyajit Mohite
- The University of Texas Harris County Psychiatric Center, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, Houston, TX, USA
| | - Hanjing Wu
- The University of Texas Harris County Psychiatric Center, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, Houston, TX, USA
| | - Shiva Sharma
- The University of Texas Harris County Psychiatric Center, Houston, TX, USA
| | - Luca Lavagnino
- The University of Texas Harris County Psychiatric Center, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, Houston, TX, USA
| | - Cristian P. Zeni
- The University of Texas Harris County Psychiatric Center, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, Houston, TX, USA
| | - Terrence T. Currie
- The University of Texas Harris County Psychiatric Center, Houston, TX, USA
| | - Jair C. Soares
- The University of Texas Harris County Psychiatric Center, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, Houston, TX, USA
| | - Teresa A. Pigott
- The University of Texas Harris County Psychiatric Center, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, Houston, TX, USA
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13
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Cohen K, Rosenzweig S, Rosca P, Pinhasov A, Weizman A, Weinstein A. Personality Traits and Psychotic Proneness Among Chronic Synthetic Cannabinoid Users. Front Psychiatry 2020; 11:355. [PMID: 32477173 PMCID: PMC7242629 DOI: 10.3389/fpsyt.2020.00355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 04/07/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Chronic use of synthetic cannabinoids (SCs) has been associated with a wide range of negative consequences for health including psychotic and affective disturbances. Accumulating evidence indicates that cannabinoids use may be a risk factor for schizophrenia, and chronic natural cannabis users score higher than non-users on measures of schizotypal personality traits. However, little is known regarding the personality characteristics of SC users, especially in comparison with recreational cannabis users and healthy individuals. This study aimed to examine the differences in personality characteristics and schizotypy between SC users, regular cannabis users, and non-users and to compare these measures between groups. METHODS Forty-two chronic SC users, 39 natural cannabis users, and 47 non-using control participants, without history of mental disorder, or current substance use diagnosis (mean age 26± 4.47 years; 23 females, 105 males), completed the Big-Five Factor Inventory (BFI), the Schizotypal Personality Questionnaire-Brief (SPQ-B), substance use history, rating scales of depression and anxiety, and a demographic questionnaire. RESULTS On the BFI, SC users scored higher than natural cannabis users and non-users on neuroticism, but lower on agreeableness and extraversion, and endorsed greater schizotypal symptoms on the SPQ-B. In addition, SC users had lower scores on conscientiousness than non-users, and natural cannabis users were more extroverted than non-users. Higher openness and lower conscientiousness predicted schizotypy for both SC and natural cannabis users. Finally, greater neuroticism predicted schizotypy for natural cannabis users, and introversion predicted schizotypy for non-users. CONCLUSIONS These results show that chronic SC users differ from natural cannabis users and non-users on dimensions of specific personality traits and schizotypy that may indicate psychotic proneness.
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Affiliation(s)
- Koby Cohen
- Department of Behavioral Science, Ariel University, Ariel, Israel
| | - Shiri Rosenzweig
- Department of Behavioral Science, Ariel University, Ariel, Israel
| | - Paola Rosca
- Ministry of Health (Israel), Jerusalem, Israel
| | - Albert Pinhasov
- Adelson School of Medicine, Ariel University, Ariel, Israel
- Department of Molecular Biology, Ariel University, Ariel, Israel
| | | | - Aviv Weinstein
- Department of Behavioral Science, Ariel University, Ariel, Israel
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14
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Brandon B, Nicholas M. Using Sesame Seed Oil to Preserve and Preconcentrate Cannabinoids for Paper Spray Mass Spectrometry. JOURNAL OF THE AMERICAN SOCIETY FOR MASS SPECTROMETRY 2020; 31:675-684. [PMID: 32013413 PMCID: PMC7322731 DOI: 10.1021/jasms.9b00113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Cannabinoids present a unique set of analytical challenges. An increasing number of states have voted to decriminalize recreational marijuana use, creating a need for new kinds of rapid testing. At the same time, synthetic compounds with activity similar to THC, termed synthetic cannabinoids, have become more prevalent and pose significant health risks. A rapid method capable of detecting both natural and synthetic cannabinoids would be useful in cases of driving under the influence of drugs, where it might not be obvious whether the suspect consumed marijuana, a synthetic cannabinoid, or both. Paper spray mass spectrometry is an ambient ionization technique which allows for the direct ionization of analyte from a biofluid spot on a piece of paper. Natural cannabinoids like THC, however, are labile and rapidly disappear from dried sample spots, making it difficult to detect them at clinically relevant levels. Presented here is a method to concentrate and preserve THC and synthetic cannabinoids in urine and oral fluid on paper for analysis by paper spray mass spectrometry. Sesame seed oil was investigated both as a means of preserving THC and as part of a technique, termed paper strip extraction, wherein urine or oral fluid is flowed through an oil spot on a strip of paper to preconcentrate cannabinoids. This technique preserved THC in dried biofluid samples for at least 27 days at room temperature; paper spray MS/MS analysis of these preserved dried spots was capable of detecting THC and synthetic cannabinoids at low ng/mL concentrations, making it suitable as a rapid screening technique. The technique was adapted to be used with a commercially available autosampler.
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15
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Cohen K, Mama Y, Rosca P, Pinhasov A, Weinstein A. Chronic Use of Synthetic Cannabinoids Is Associated With Impairment in Working Memory and Mental Flexibility. Front Psychiatry 2020; 11:602. [PMID: 32695029 PMCID: PMC7339911 DOI: 10.3389/fpsyt.2020.00602] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 06/10/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We have recently shown that chronic use of Synthetic Cannabinoids (SCs) has been associated with mood disorders and impairments in executive functions. There is also evidence indicating that chronic SC users have higher rates of comorbidity with depression and psychotic symptoms. Here, we investigate performance on executive function and emotional processing tasks in regular SC users and a measure of schizotypal traits. METHOD Thirty chronic SC users, 32 recreational cannabis users, and 32 non-using control participants, without history of mental disorder, or current substance abuse diagnosis (mean age 26 ± 4.27 years; 85 males, 9 females), were tested in addiction treatment centers in Israel. Computerized neurocognitive function tests; the N-back task, Go/No-Go task, Wisconsin Sorting Card-like Task (WSCT), and emotional face recognition task and questionnaires of depression, anxiety and schizotypal traits and symptoms were used. RESULTS SC users have performed worse than recreational cannabis users and non-cannabis users on the N-back working-memory task (lower accuracy) and the WSCT cognitive flexibility task. SC users showed greater schizotypal traits and symptoms compared with recreational cannabis users and non-user control participants. A positive association was found in cannabinoid-user groups between schizotypal traits and symptoms and cognitive and emotional processing measures. Finally, SC users have scored higher on depression and state-trait anxiety measures than recreational cannabis users or healthy control participants. CONCLUSIONS Repeated use of SCs is associated with impairment in executive functions and emotional processing. These alterations are associated with depression and schizotypal traits and symptoms. This adds to existing evidence on the long-term consequences of SC drugs and their risks for mental health.
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Affiliation(s)
- Koby Cohen
- Department of Behavioral Science, Ariel University, Ariel, Israel
| | - Yaniv Mama
- Department of Behavioral Science, Ariel University, Ariel, Israel
| | - Paola Rosca
- Ministry of Health (Israel), Jerusalem, Israel
| | - Albert Pinhasov
- Adelson School of Medicine, Ariel University, Ariel, Israel.,Department of Molecular Biology, Ariel University, Ariel, Israel
| | - Aviv Weinstein
- Department of Behavioral Science, Ariel University, Ariel, Israel
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16
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Campos S, Benoit E, Dunlap E. Risk management strategies of synthetic cannabis users. DRUGS AND ALCOHOL TODAY 2019; 19:270-281. [PMID: 34046079 DOI: 10.1108/dat-04-2019-0012] [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: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to explore the various ways users of synthetic cannabinoids (SCs) managed the dangers associated with the consumption of this substance.
Design/methodology/approach
This paper is based on a parent study of the use and market of synthetic cathinones (also known as “bath salts”) in New York City, Houston, Galveston and New Orleans. Focus groups were conducted in all four cities with a total of 20 individuals who identified as users of SCs. Grounded theory was used to analyse focus group transcripts.
Findings
Participants were aware of drug-related risks and implemented strategies to reduce harm to health. Protective measures fell into two broad categories: marketing and consumption. They noted the instability of SC products and consumer manipulation through packaging. Harm reduction (HR) strategies included: carefully selecting SC sources; sticking to one brand; handling their own SC; managing amount of K2 consumed in one sitting; controlling the pace.
Originality/value
Given the small amount of data on user experience with SCs and its risk to health, it is important to learn from users themselves how they create methods to keep themselves safe. This is one of the first studies recording HR practices of SC users and can contribute to intervention programs and organisations serving substance users.
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17
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Bahouth MN, Kraus P, Dane K, Plazas Montana M, Tsao W, Tabaac B, Jasem J, Schmidlin H, Einstein E, Streiff MB, Shanbhag S. Synthetic cannabinoid-associated coagulopathy secondary to long-acting anticoagulant rodenticides: Observational case series and management recommendations. Medicine (Baltimore) 2019; 98:e17015. [PMID: 31490385 PMCID: PMC6739027 DOI: 10.1097/md.0000000000017015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Synthetic cannabinoids have become increasingly popular drugs of abuse due to low cost and inability to detect these substances on routine drug screenings. In the United States, incidence of synthetic cannabinoid contamination with long-acting anticoagulant rodenticides (LAARs) resulting in coagulopathy and bleeding complications has been described.We sought to describe the natural history, management approach, and outcomes of bleeding secondary to synthetic cannabinoid-associated LAAR toxicity in an observational case series of patients evaluated at an urban academic medical system.We conducted an observational study of patients with suspected exposure to LAAR-contaminated synthetic cannabinoids and associated bleeding treated within the Johns Hopkins Health System.In this 16 subject cohort, hematuria was the most common bleeding symptom at presentation. The majority of the cohort (75%) had international normalized ratio (INR) > 9.6 at presentation. Of the 13 patients with brodifacoum testing, 12/13 (92%) were positive. Twelve patients (75%) had at least 1 INR value below 2 within 24 hours of the first INR measurement. Of this cohort, 1/16 (6%) died in hospital. The median length of hospital stay was 4 days, (interquartile range = 3-6). The average cost of pharmacological treatment for coagulopathy during inpatient hospitalization was $5300 (range, $2241-$8086).In patients presenting with unexplained coagulopathy it is important for emergency department providers to consider LAAR intoxication and consider formal testing for brodifacoum to assist with treatment planning. Use of a standardized management algorithm including intravenous/oral vitamin K, judicious use of blood products and close laboratory monitoring is essential to optimizing outcomes.
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Affiliation(s)
| | | | | | | | - William Tsao
- Department of Neurology, Johns Hopkins School of Medicine
| | | | - Jagar Jasem
- Department of Hematology, Johns Hopkins Hospital
| | | | - Evan Einstein
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
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18
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Kelmer E, Shimshoni JA, Merbl Y, Kolski O, Klainbart S. Use of gas chromatography-mass spectrometry for definitive diagnosis of synthetic cannabinoid toxicity in a dog. J Vet Emerg Crit Care (San Antonio) 2019; 29:573-577. [PMID: 31342645 DOI: 10.1111/vec.12872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 09/19/2017] [Accepted: 11/01/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report the use of gas chromatography-mass spectrometry to confirm a diagnosis of synthetic cannabis toxicosis in a dog and to describe the clinical course of the intoxication. CASE SUMMARY An 11-year-old neutered female Boxer dog was referred due to acute onset of vomiting, ataxia, dull mentation, and delirium that progressed to generalized seizures, unresponsive to diazepam. Prior to presentation, the dog was found lying down, minimally responsive with vomitus around it. A chewed bag containing dried plant material was found next to the dog. The dog was anesthetized and ventilated with positive pressure for 16 hours, and eventually made a full recovery. Gas chromatography-mass spectrometry analysis of the plant material and a plasma sample from the dog revealed presence of the synthetic cannabinoid N-[(1S)-1-(aminocarbonyl)-2-methylpropyl]-1-(cyclohexylmethyl)-1H-indazole-3-carboxamide, also known as AB-CHMINACA, a relatively new illegal synthetic cannabinoid, known by the local forensic police department as a drug of recreational abuse. NEW OR UNIQUE INFORMATION PROVIDED Reports of synthetic cannabinoid toxicosis in dogs are scarce and are based on urine test kits for tetrahydrocannabinol that have not been validated in the veterinary literature. This is the first report to describe utilization of gas chromatography-mass spectrometry on canine plasma to reach a definitive diagnosis.
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Affiliation(s)
- Efrat Kelmer
- Department of Small Animal Emergency and Critical Care, Koret School of Veterinary Medicine, the Hebrew University of Jerusalem, Rehovot, Israel
| | - Jakob A Shimshoni
- Department of Toxicology, Kimron Veterinary Institute, Ministry of Agriculture, Bet Dagan, Israel
| | - Yael Merbl
- Department of Small Animal Emergency and Critical Care, Koret School of Veterinary Medicine, the Hebrew University of Jerusalem, Rehovot, Israel
| | | | - Sigal Klainbart
- Department of Small Animal Emergency and Critical Care, Koret School of Veterinary Medicine, the Hebrew University of Jerusalem, Rehovot, Israel
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Hamel-Senecal L, Philippe V, Chrétien B, Lechevrel M, Le Boisselier R. Vapoter les drogues, un usage à risques. Therapie 2018. [DOI: 10.1016/j.therap.2018.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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The impacts of paper properties on matrix effects during paper spray mass spectrometry analysis of prescription drugs, fentanyl and synthetic cannabinoids. Forensic Chem 2018. [DOI: 10.1016/j.forc.2018.08.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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Breitbarth AK, Morgan J, Jones AL. E-cigarettes-An unintended illicit drug delivery system. Drug Alcohol Depend 2018; 192:98-111. [PMID: 30245461 DOI: 10.1016/j.drugalcdep.2018.07.031] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/12/2018] [Accepted: 07/04/2018] [Indexed: 12/15/2022]
Abstract
Since the introduction of electronic cigarettes (e-cigarettes) in 2003, the technology has advanced allowing for greater user modifications, with users now able to control voltage, battery power, and constituents of the e-cigarette liquid. E-cigarettes have been the subject of a growing body of research with most research justifiably focused on the chemical makeup and risk analysis of chemicals, metals, and particulates found in e-cigarette liquids and vapor. Little research to date has focused on assessing the risks associated with the drug delivery unit itself and its potential for use as an illicit drug delivery system. In light of this, a range of illicit drugs was researched focusing on pharmacodynamics, usual method of administration, the dosage required for toxicity, toxic effects, and evidence of existing use in e-cigarettes in both literature and online illicit drug forums. A systematic literature search found evidence of current use of e-cigarettes to vape almost all illicit drug types analyzed. This presents both a potential population health risk and a management issue for clinicians. It also raises the issue of policing illicit drugs due to potential altered characteristic smells and storage within e-cigarette fluids. E-cigarettes are a viable illicit drug delivery system with evidence both inside and outside of the formal medical literature detailing their potential use for drug delivery of a wide range of illicit and legal drugs.
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Affiliation(s)
| | - Jody Morgan
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Alison L Jones
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia
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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: 0.4] [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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Post-mortem distribution of the synthetic cannabinoid MDMB-CHMICA and its metabolites in a case of combined drug intoxication. Int J Legal Med 2018; 132:1645-1657. [PMID: 30219927 DOI: 10.1007/s00414-018-1911-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
This case report centres on the post-mortem distribution of the synthetic cannabinoid MDMB-CHMICA and its metabolites in the case of a 27-year-old man found dead after falling from the 24th floor of a high-rise building. Toxicological analysis of post-mortem samples confirmed, besides consumption of the synthetic cannabinoids MDMB-CHMICA (1.7 ng/mL femoral blood) and EG-018, the abuse of THC (9.3 ng/mL femoral blood), amphetamine (1050 ng/mL femoral blood), MDMA (275 ng/mL femoral blood), and cocaine. Regarding EG-018 and cocaine, only traces were detected in heart blood as well as in the brain (EG-018) and urine (cocaine), respectively, which is why no quantification was conducted in the femoral blood sample. It was concluded from femoral blood analysis that, at the time of death, the man was under the influence of the synthetic cannabinoid MDMB-CHMICA, THC, amphetamine and MDMA. Comprehensive screenings of all post-mortem specimens were conducted to elucidate the post-mortem distribution of MDMB-CHMICA and its metabolites. The MDMB-CHMICA concentrations ranged between 0.01 ng/mL (urine) and 5.5 ng/g (brain). Comparably low concentrations were detected in cardiac and femoral blood (2.1 ng/mL and 1.7 ng/mL, respectively) as well as in the psoas major muscle (1.2 ng/g). Higher concentrations were found in the lung (2.6 ng/g), liver (2.6 ng/g), and kidney (3.8 ng/g). Gastric content yielded a MDMB-CHMICA concentration of 2.4 ng/g (1.1 μg absolute). Screening for MDMB-CHMICA metabolites resulted in the detection of mainly monohydroxylated metabolites in the blood, kidney, and liver specimens. Results indicated that monohydroxylated metabolites of MDMB-CHMICA are appropriate target analytes for detecting MDMB-CHMICA intake.
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Abstract
Cannabis (also known as marijuana) is the most frequently used illicit psychoactive substance in the world. Though it was long considered to be a "soft" drug, studies have proven the harmful psychiatric and addictive effects associated with its use. A number of elements are responsible for the increased complications of cannabis use, including the increase in the potency of cannabis and an evolution in the ratio between the two primary components, Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (toward a higher proportion of Δ9-THC), Synthetic cannabinoid (SC) use has rapidly progressed over the last few years, primarily among frequent cannabis users, because SCs provide similar psychoactive effects to cannabis. However, their composition and pharmacological properties make them dangerous substances. Cannabis does have therapeutic properties for certain indications. These therapeutic applications pertain only to certain cannabinoids and their synthetic derivatives. The objective of this article is to summarize current developments concerning cannabis and the spread of SCs. Future studies must further explore the benefit-risk profile of medical cannabis use.
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Affiliation(s)
- Genevieve Lafaye
- Author affiliations: AP-HP, GH Paris-Sud, Hopital Paul Brousse, Dpt Addictologie, F94800 Villejuif, France; INSERM U1178, F94800 Villejuif, France
| | - Laurent Karila
- Author affiliations: AP-HP, GH Paris-Sud, Hopital Paul Brousse, Dpt Addictologie, F94800 Villejuif, France; INSERM U1178, F94800 Villejuif, France
| | - Lisa Blecha
- Author affiliations: AP-HP, GH Paris-Sud, Hopital Paul Brousse, Dpt Addictologie, F94800 Villejuif, France; INSERM U1178, F94800 Villejuif, France
| | - Amine Benyamina
- Author affiliations: AP-HP, GH Paris-Sud, Hopital Paul Brousse, Dpt Addictologie, F94800 Villejuif, France; INSERM U1178, F94800 Villejuif, France
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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: 0.1] [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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Sweet G, Kim S, Martin S, Washington NB, Brahm N. Psychiatric symptoms and synthetic cannabinoid use: Information for clinicians. Ment Health Clin 2018; 7:156-159. [PMID: 29955515 PMCID: PMC6007529 DOI: 10.9740/mhc.2017.07.156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Limited treatment information is available when patients present with psychotic symptoms secondary to synthetic cannabinoid (SC) use. Symptoms associated with use are often indistinguishable from those encountered with a primary mental illness and also include aggression, confusion, and anxiety. For these patients, clinicians rely on physical presentation, symptom(s) onset, and episode duration when evaluating patients. Patient History An adult man was involuntarily admitted to inpatient status secondary to reports of bizarre behaviors that included paranoia and psychomotor agitation. Because of the severity of the symptoms, he was unable to participate in the admission assessment. On day 2, he reported having smoked a substance provided by a friend. In addition, he admitted to previous SC use on 3 occasions, with each occasion resulting in an involuntary admission to inpatient status. The course of this admission was unremarkable. Conclusions A brief overview of psychiatric signs and symptoms of SC use and information to help clinicians are included. The presentation of psychotic symptoms secondary to SC may be consistent with those of psychosis or other substances of abuse. Because of the variability in the symptoms produced by SC use, clinicians are encouraged to consider SC use in the diagnostic evaluation.
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Affiliation(s)
- Gary Sweet
- PGY-2 Psychiatric Pharmacy Resident, Veterans Affairs Health System of Western NY, Buffalo, New York. Previously: Department of Clinical Pharmacy Services, Saint John Medical Center, Tulsa, Oklahoma
| | - Sara Kim
- PGY-1 Pharmacy Resident, Oklahoma State University Medical Center, Tulsa, Oklahoma. Previously: University of Oklahoma College of Pharmacy, Tulsa, Oklahoma
| | - Samuel Martin
- Assistant Professor of Psychiatry, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma. Previously: Department of Psychiatry, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma
| | - Nicole B Washington
- Medical Director, Crisis Care Center, Family and Children's Services, Tulsa, Oklahoma
| | - Nancy Brahm
- Clinical Professor, University of Oklahoma College of Pharmacy, Tulsa, Oklahoma,
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Cohen K, Weinstein A. The Effects of Cannabinoids on Executive Functions: Evidence from Cannabis and Synthetic Cannabinoids-A Systematic Review. Brain Sci 2018; 8:brainsci8030040. [PMID: 29495540 PMCID: PMC5870358 DOI: 10.3390/brainsci8030040] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/08/2018] [Accepted: 02/24/2018] [Indexed: 12/21/2022] Open
Abstract
Background—Cannabis is the most popular illicit drug in the Western world. Repeated cannabis use has been associated with short and long-term range of adverse effects. Recently, new types of designer-drugs containing synthetic cannabinoids have been widespread. These synthetic cannabinoid drugs are associated with undesired adverse effects similar to those seen with cannabis use, yet, in more severe and long-lasting forms. Method—A literature search was conducted using electronic bibliographic databases up to 31 December 2017. Specific search strategies were employed using multiple keywords (e.g., “synthetic cannabinoids AND cognition,” “cannabis AND cognition” and “cannabinoids AND cognition”). Results—The search has yielded 160 eligible studies including 37 preclinical studies (5 attention, 25 short-term memory, 7 cognitive flexibility) and 44 human studies (16 attention, 15 working memory, 13 cognitive flexibility). Both pre-clinical and clinical studies demonstrated an association between synthetic cannabinoids and executive-function impairment either after acute or repeated consumptions. These deficits differ in severity depending on several factors including the type of drug, dose of use, quantity, age of onset and duration of use. Conclusions—Understanding the nature of the impaired executive function following consumption of synthetic cannabinoids is crucial in view of the increasing use of these drugs.
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Affiliation(s)
- Koby Cohen
- Department of Behavioral Science, Ariel University, Ariel 40700, Israel.
| | - Aviv Weinstein
- Department of Behavioral Science, Ariel University, Ariel 40700, Israel.
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Aguilar DD, Giuffrida A, Lodge DJ. Adolescent Synthetic Cannabinoid Exposure Produces Enduring Changes in Dopamine Neuron Activity in a Rodent Model of Schizophrenia Susceptibility. Int J Neuropsychopharmacol 2018; 21:393-403. [PMID: 29329382 PMCID: PMC5887672 DOI: 10.1093/ijnp/pyy003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/05/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Epidemiological studies recognize cannabis intake as a risk factor for schizophrenia, yet the majority of adolescents who use marijuana do not develop psychosis. Similarly, the abuse of synthetic cannabinoids poses a risk for psychosis. For these reasons, it is imperative to understand the effects of adolescent cannabinoid exposure in susceptible individuals. METHODS We recently developed a novel rodent model of schizophrenia susceptibility, the F2 methylazoxymethanol acetate rat, where only a proportion (~40%) of rats display a schizophrenia-like phenotype. Using this model, we examined the effects of adolescent synthetic cannabinoid exposure (0.2 mg/kg WIN55, 212-2, i.p.) or adolescent endocannabinoid upregulation (0.3 mg/kg URB597, i.p.) on dopamine neuron activity and amphetamine sensitivity in adulthood. RESULTS Adolescent synthetic cannabinoid exposure significantly increased the proportion of susceptible rats displaying a schizophrenia-like hyperdopaminergic phenotype after puberty without producing any observable alterations in control rats. Furthermore, this acquired phenotype appears to correspond with alterations in parvalbumin interneuron function within the hippocampus. Endocannabinoid upregulation during adolescence also increased the proportion of susceptible rats developing an increase in dopamine neuron activity; however, it did not alter the behavioral response to amphetamine, further emphasizing differences between exogenous and endogenous cannabinoids. CONCLUSIONS Taken together, these studies provide experimental evidence that adolescent synthetic cannabinoid exposure may contribute to psychosis in susceptible individuals.
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Affiliation(s)
- David D Aguilar
- Department of Pharmacology and Center for Biomedical Neuroscience, University of Texas Health Science Center at San Antonio, Texas,Correspondence: David D. Aguilar, PhD, Boston VA Medical Center, West Roxbury Research, Bldg 3, 2A115 1400 VFW Parkway, West Roxbury, MA, 02132 ()
| | - Andrea Giuffrida
- Department of Pharmacology and Center for Biomedical Neuroscience, University of Texas Health Science Center at San Antonio, Texas
| | - Daniel J Lodge
- Department of Pharmacology and Center for Biomedical Neuroscience, University of Texas Health Science Center at San Antonio, Texas
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Fatal Mesenteric Ischemia Induced by Synthetic Cannabinoids: A Case Report and Literature Review. Case Rep Emerg Med 2017; 2017:6964078. [PMID: 29403666 PMCID: PMC5748310 DOI: 10.1155/2017/6964078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/10/2017] [Accepted: 11/14/2017] [Indexed: 01/18/2023] Open
Abstract
Worldwide use of synthetic cannabinoids (SCs) is rapidly increasing, in part due to the generation of numerous new compounds, sidestepping legal restrictions. Their detection using standard toxicology panels is difficult, due to their vast heterogeneity and lack of structural resemblance to cannabinoids. Sympathetic overactivity and arterial spasm play a role in some of the life-threatening reactions to SCs, such as coronary or cerebral vasoconstriction. Here we report a patient with repeated consumption of SCs that led to mesenteric ischemia and death. A 29-year-old man was frequently evaluated in the Emergency Medicine Department for recurrent transient crampy abdominal pain, associated with the use of the SCs colloquially known as “Mr. Nice Guy.” He was finally hospitalized with a protracted attack, associated with diarrhea and leukocytosis. Initial evaluation including computed tomography was unremarkable. Diarrhea and leukocytosis gradually resolved, but bouts of hypertension and abdominal pain occurred in association with repeated consumption of the SCs. On the fifth hospital day, the patient developed abrupt abdominal pain, associated with profound shock and signs of peritoneal irritation and succumbed within an hour. Postmortem CT scan was consistent with intestinal perforation most probably due to a nonobstructive mesenteric infarction. There was no evidence of a single vessel infarction.
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Abstract
New psychoactive substances (NPS), namely cannabinoids, cathinones, and opioids, have surged in popularity among school-age children, resulting in serious morbidity and mortality globally. In the last decade, there has been a rapid evolution of NPS resulting in hundreds of new compounds. Little to no evidence for humans is available on most compounds. The clinical presentations of patients intoxicated with cannabinoids and cathinones are highly variable but most commonly present with a sympathomimetic toxidrome, for example, agitation, delirium, and tachycardia. Those with opioids present with a classic opioid toxidrome: coma, dilated pupils, and respiratory failure.
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Affiliation(s)
- Brandon J Warrick
- University of New Mexico, NMPDIC MSC07 4390, 1 University of New Mexico, Albuquerque, NM 87107-0001, USA.
| | - Anita Paula Tataru
- Faculty of Pharmaceutical Sciences, University of British Columbia, British Columbia, Canada
| | - Roy Gerona
- Clinical Toxicology and Environmental Biomonitoring Lab, University of California, San Francisco, 513 Parnassus Avenue, Medical Sciences Building S864, San Francisco, CA 94143, USA
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Assessment of types of synthetic cannabinoids in narcotic cases assessed by the Council of Forensic Medicine between 2011–2015, Ankara, Turkey. Forensic Sci Int 2017; 280:124-129. [DOI: 10.1016/j.forsciint.2017.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/14/2017] [Accepted: 09/24/2017] [Indexed: 11/17/2022]
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Hermanns-Clausen M, Müller D, Kithinji J, Angerer V, Franz F, Eyer F, Neurath H, Liebetrau G, Auwärter V. Acute side effects after consumption of the new synthetic cannabinoids AB-CHMINACA and MDMB-CHMICA. Clin Toxicol (Phila) 2017; 56:404-411. [DOI: 10.1080/15563650.2017.1393082] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Maren Hermanns-Clausen
- Poisons Information Center, Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Dieter Müller
- GIZ-Nord Poisons Center, University Hospital Göttingen, Göttingen, Germany
| | - Josephine Kithinji
- Poisons Information Center, Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Verena Angerer
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- Hermann Staudinger Graduate School, University of Freiburg, Freiburg, Germany
| | - Florian Franz
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- Hermann Staudinger Graduate School, University of Freiburg, Freiburg, Germany
| | - Florian Eyer
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hartmud Neurath
- GIZ-Nord Poisons Center, University Hospital Göttingen, Göttingen, Germany
| | | | - Volker Auwärter
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Abstract
The purpose of this paper is to review the most common and quickest growing classes of novel, or new, psychoactive substances. Abuse of novel psychoactive substances continues to increase, resulting in subsequent increases in hospitalizations. Furthermore, the chemical structures are ever-changing and substances are increasing in potency. Reviewing the chemistry behind these agents will facilitate a better understanding of the toxicity associated with them and allow for successful identification of and management in the critical care unit. Being familiar with the most common psychoactive substances and trends of abuse, as well as the challenges health care providers face when managing intoxication, is essential to the overall understanding and care of these critically ill patients.
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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: 1.3] [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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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
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36
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Lafaye G. Cannabis, cannabinoids, and health. DIALOGUES IN CLINICAL NEUROSCIENCE 2017; 19:309-316. [PMID: 29302228 PMCID: PMC5741114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Cannabis (also known as marijuana) is the most frequently used illicit psychoactive substance in the world. Though it was long considered to be a "soft" drug, studies have proven the harmful psychiatric and addictive effects associated with its use. A number of elements are responsible for the increased complications of cannabis use, including the increase in the potency of cannabis and an evolution in the ratio between the two primary components, Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (toward a higher proportion of Δ9-THC), Synthetic cannabinoid (SC) use has rapidly progressed over the last few years, primarily among frequent cannabis users, because SCs provide similar psychoactive effects to cannabis. However, their composition and pharmacological properties make them dangerous substances. Cannabis does have therapeutic properties for certain indications. These therapeutic applications pertain only to certain cannabinoids and their synthetic derivatives. The objective of this article is to summarize current developments concerning cannabis and the spread of SCs. Future studies must further explore the benefit-risk profile of medical cannabis use.
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Affiliation(s)
- Genevieve Lafaye
- Author affiliations: AP-HP, GH Paris-Sud, Hopital Paul Brousse, Dpt Addictologie, F94800 Villejuif, France; INSERM U1178, F94800 Villejuif, France
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Smith KE, Bunting AM, Staton M, Walker R, Shalash S, Winston E, Pangburn K. Examination of Synthetic Cannabinoid and Cathinone Use among a Drug-Using Offender Sample, 2013-2015. J Psychoactive Drugs 2017; 49:436-445. [PMID: 28813207 DOI: 10.1080/02791072.2017.1361560] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Use of novel psychoactive substances (NPS) such as synthetic cannabinoids (e.g., "Spice," "Serenity") and cathinones (e.g., "bath salts") has proliferated in recent years; however, there is a gap in research examining prevalence among offender samples. This study examined demographics, drug use, mental health characteristics, and criminal histories of NPS users compared to non-NPS users within an offender sample entering drug treatment. Using logistic regression analysis, combined 2013-2015 assessment data were examined (N = 8,791). NPS users offended more often (x̄ = 10.3), were more likely to have experienced homelessness (12.2%), and to have lived in a metro area (59.0%). NPS users reported significantly more past-year drug use, including substances not readily detected by standard urine analysis (e.g., hallucinogens, alcohol, and inhalants). Individuals with higher anxiety symptom counts (OR = 1.07; p < .001) and those who reported drinking to intoxication (OR = 1.30; p < .001) had an increased likelihood of NPS use. Older individuals (OR = 0.95; p < .001) and those who began using drugs at an older age (OR = 0.95; p < .001) were less likely to report NPS use. NPS use may be a marker of more severe using patterns in an offender sample. Future investigation should focus on NPS use as a possible method for bypassing drug testing measures.
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Affiliation(s)
- Kirsten Elin Smith
- a Former Senior Data Coordinator, Center on Drug and Alcohol Research , University of Kentucky , Lexington , KY , USA.,b Doctoral Student and Research Assistant, Kent School of Social Work , University of Louisville , Louisville , KY , USA
| | - Amanda M Bunting
- c Research Assistant, Center on Drug and Alcohol Research , University of Kentucky , Lexington , KY , USA.,d Doctoral Candidate, Department of Sociology , University of Kentucky , Lexington , KY , USA
| | - Michele Staton
- e Associate Professor, Center on Drug and Alcohol Research , University of Kentucky , Lexington , KY , USA.,f Associate Professor, College of Medicine, Department of Behavioral Science , University of Kentucky , Lexington , KY , USA
| | - Robert Walker
- g Assistant Professor, College of Medicine, Department of Behavioral Science , University of Kentucky , Lexington , KY , USA
| | - Sara Shalash
- h Senior Data Coordinator, Center on Drug and Alcohol Research , University of Kentucky , Lexington , KY , USA
| | - Erin Winston
- i Study Director, Center of Drug and Alcohol Research , University of Kentucky , Lexington , KY , USA
| | - Kevin Pangburn
- j Director of Substance Abuse Division, Kentucky Department of Corrections , Lexington , KY , USA
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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: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BackgroundAlthough illegal drug use has largely been declining in the UK over the past decade, this period has witnessed the emergence of a range of novel psychoactive substances (NPS) (‘legal highs’). These are new, mostly synthetic, substances that mimic the effects of existing drugs). Despite there being many causes for concern in relation to NPS, there has been little prior study of the burden associated with their use in public health terms. Clarity is lacking on research priorities in this rapidly developing literature.ObjectivesTo inform the development of public health intervention research on NPS by reviewing existing data on their use, associated problems and potential responses to such problems.DesignA scoping review and narrative synthesis of selected bodies of evidence was undertaken to summarise and evaluate what is known about NPS use and the related harms of, and responses to, such use. Relevant literature was identified from electronic databases (covering January 2006 to June 2016 inclusive), Google (Google Inc., Mountain View, CA, USA), relevant websites and online drug forums and by contacting experts. Articles were included if they were primary studies, secondary studies involving the analysis and interpretation of primary research or discussion papers. A conceptual framework postulating an evidence-informed public health approach to NPS use in the UK was developed through a pragmatic literature review, the iterative development of concepts and finalisation in light of the results from the empirical review work. The process also involved feedback from various stakeholders. Research recommendations were developed from both strands of work.ResultsA total of 995 articles were included in the scoping review, the majority of which related to individual-level health-related adverse effects attributable to NPS use. The prevalence of lifetime NPS use varied widely between (e.g. with higher prevalence in young males) and within population subgroups. The most commonly reported adverse effects were psychiatric/other neurological, cardiovascular, renal and gastrointestinal manifestations, and there is limited evidence available on responses. In these and other respects, available evidence is at an early stage of development. Initial evidence challenges the view that NPS should be treated differently from other illicit drugs. The conceptual framework indicated that much of the evidence that would be useful to inform public health responses does not yet exist. We propose a systems-based prevention approach that develops existing responses, is multilevel and life course informed in character, and emphasises commonalities between NPS and other legal and illegal drug use. We make 20 recommendations for research, including nine key recommendations.LimitationsScoping reviews do not interrogate evidence in depth, and the disjunction between the scoping review and the conceptual framework findings is worthy of careful attention.ConclusionsKey research recommendations build on those that have previously been made and offer more evidence-based justification and detail, as previous recommendations have not yet been acted on. The case for decision-making on commissioning new research based on these recommendations is both strong and urgent.Future workThe validity of recommendations generated through this project could be enhanced via further work with research commissioners, policy-makers, researchers and the public.Study registrationThe systematic review element of this study is registered as PROSPERO CRD42016026415.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Noreen D Mdege
- Department of Health Sciences, University of York, York, UK
| | - Nick Meader
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Charlie Lloyd
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
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Asaoka N, Kawai H, Nishitani N, Kinoshita H, Shibui N, Nagayasu K, Shirakawa H, Kaneko S. A new designer drug 5F-ADB activates midbrain dopaminergic neurons but not serotonergic neurons. J Toxicol Sci 2017; 41:813-816. [PMID: 27853110 DOI: 10.2131/jts.41.813] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
N-[[1-(5-fluoropentyl)-1H-indazol-3-yl]carbonyl]-3-methyl-D-valine methyl ester (5F-ADB) is one of the most potent synthetic cannabinoids and elicits severe psychotic symptoms in humans, sometimes causing death. To investigate the neuronal mechanisms underlying its toxicity, we examined the effects of 5F-ADB on midbrain dopaminergic and serotonergic systems, which modulate various basic brain functions such as those in reward-related behavior. 5F-ADB-induced changes in spontaneous firing activity of dopaminergic and serotonergic neurons were recorded by ex vivo electrophysiological techniques. In dopaminergic neurons, 5F-ADB (1 μM) significantly increased the spontaneous firing rate, while 5F-ADB failed to activate dopaminergic neurons in the presence of the CB1 antagonist AM251 (1 μM). However, the same concentration of 5F-ADB did not affect serotonergic-neuron activity. These results suggest that 5F-ADB activates local CB1 receptors and potentiates midbrain dopaminergic systems with no direct effects on midbrain serotonergic systems.
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Affiliation(s)
- Nozomi Asaoka
- Department of Molecular Pharmacology, Graduate School of Pharmaceutical Sciences, Kyoto University
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Lefever TW, Marusich JA, Thomas BF, Barrus DG, Peiper NC, Kevin RC, Wiley JL. Vaping Synthetic Cannabinoids: A Novel Preclinical Model of E-Cigarette Use in Mice. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2017; 11:1178221817701739. [PMID: 28469427 PMCID: PMC5398321 DOI: 10.1177/1178221817701739] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 02/16/2017] [Indexed: 11/15/2022]
Abstract
Smoking is the most common route of administration for cannabis; however, vaping cannabis extracts and synthetic cannabinoids ("fake marijuana") in electronic cigarette devices has become increasingly popular. Yet, most animal models used to investigate biological mechanisms underlying cannabis use employ injection as the route of administration. This study evaluated a novel e-cigarette device that delivers aerosolized cannabinoids to mice. The effects of aerosolized and injected synthetic cannabinoids (CP 55,940, AB-CHMINACA, XLR-11, and JWH-018) in mice were compared in a battery of bioassays in which psychoactive cannabinoids produce characteristic effects. The most potent cannabinoids (CP 55,940 and AB-CHMINACA) produced the full cannabinoid profile (ie, hypothermia, hypolocomotion, and analgesia), regardless of the route of administration. In contrast, aerosolized JWH-018 and XLR-11 did not produce the full profile of cannabimimetic effects. Results of time course analysis for hypothermia showed that aerosol exposure to CP 55,940 and AB-CHMINACA produced faster onset of effects and shorter duration of action than injection. The ability to administer cannabinoids to rodents using the most common route of administration among humans provides a method for collecting preclinical data with enhanced translational relevance.
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Affiliation(s)
| | | | - Brian F Thomas
- Analytical Chemistry and Pharmaceuticals, RTI International, Durham, NC, USA
| | - Daniel G Barrus
- Center for Drug Discovery, RTI International, Durham, NC, USA
| | - Nicholas C Peiper
- Behavioral and Urban Health Program, RTI International, Durham, NC, USA
| | - Richard C Kevin
- Analytical Chemistry and Pharmaceuticals, RTI International, Durham, NC, USA
| | - Jenny L Wiley
- Center for Drug Discovery, RTI International, Durham, NC, USA
- Jenny L Wiley, RTI International, 3040 Cornwallis Road, Research Triangle Park, Durham, NC 27709, USA.
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Thurtle N, Abouchedid R, Archer JRH, Ho J, Yamamoto T, Dargan PI, Wood DM. Prevalence of Use of Electronic Nicotine Delivery Systems (ENDS) to Vape Recreational Drugs by Club Patrons in South London. J Med Toxicol 2017; 13:61-65. [PMID: 27599520 PMCID: PMC5330959 DOI: 10.1007/s13181-016-0583-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 08/05/2016] [Accepted: 08/17/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Electronic nicotine delivery systems (ENDS, often called e-cigarettes) are nicotine delivery devices that heat nicotine into vapour that is inhaled, a process called 'vaping'. Use eclipsed nicotine-replacement therapy (NRT) in 2014 but ENDS role in smoking cessation remains controversial. Safety has not been proven and there have been reports to US poison centres regarding potential ENDS-related nicotine toxicity. A further concern is use of ENDS to vape recreational drugs, but there is limited data to substantiate this. The aim of this study was to report on ENDS use to vape recreational drugs in patrons of a South London nightclub where high prevalence of recreational drug use has previously been shown. METHODS A convenience sample of 101 participants was surveyed in March 2015 as part of a larger survey on drug use. Individuals were asked if they used ENDS to vape nicotine and/or other substances (and if so which substances). RESULTS Ninety (89.1 %) of respondents were male with median age of 28 years (IQR 23-34). Eighty (79.2 %) currently smoked cigarettes; 20 (19.8 %) currently used ENDS for nicotine. Six (5.9 %) reported using ENDS to take other substances: 2 for 'liquid cannabis' and 4 did not elaborate on the substance(s) used. Of these 6, 3 were using ENDS to vape nicotine and 3 had never used them for nicotine. CONCLUSION 5.9 % of individuals in this sample reported using ENDS to vape substances other than nicotine. Further work is required in larger populations to determine how common this is, evaluate which agents are being vaped and to inform appropriate public education.
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Affiliation(s)
- Natalie Thurtle
- Clinical Toxicology, Guys and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.
| | - Rachelle Abouchedid
- Clinical Toxicology, Guys and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - John R H Archer
- Clinical Toxicology, Guys and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - James Ho
- Clinical Toxicology, Guys and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - Takahiro Yamamoto
- Clinical Toxicology, Guys and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - Paul I Dargan
- Clinical Toxicology, Guys and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - David M Wood
- Clinical Toxicology, Guys and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
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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.
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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
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43
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Scocard A, Benyamina A, Coscas S, Karila L. [Synthetic cannabinoids: A new addiction matrix]. Presse Med 2017; 46:11-22. [PMID: 28063756 DOI: 10.1016/j.lpm.2016.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/01/2016] [Accepted: 11/28/2016] [Indexed: 12/16/2022] Open
Abstract
Synthetic cannabinoids (SC) belong to the emergent market of new psychoactive substances, sold on the Internet or specialized shops. Since the 1970s, more than 160 new SC have invaded the drug market. These substances imitate the psychoactive effects of cannabis. Underestimated for too long, SC's market growth and consequences are no longer to be ignored, first of all in terms of public health. SC were first synthesized during researches on the endocannabinoid system. Though they are agonists of the cannabinoid receptors 1 and 2, as Δ9-tetrahydrocannabinol in cannabis, they can also have a really high affinity with these receptors, rising up their potency. Each country in the world has chosen various ways how to deal with SC: scheduling, blanket ban, regulation… In order to contour the legal system, producers regularly modify the chemical formulas of those substances and hand out an attracting packaging looking harmless. However, the content of those small packets is extremely unstable and unreliable, including harmful compounds to health. Reports show an increasing number of non-fatal intoxications but also fatalities. Consequences on the body are numerous but there have been also reports of mental health imbalance and appearances of addiction-linked clinical signs. This review of literature aims at establishing a picture on SC in order to raise awareness among professionals in the health field on this new addiction matrix.
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Affiliation(s)
- Amandine Scocard
- Université Paris Sud, AP-HP, hôpital Paul-Brousse, département d'addictologie, 94800 Villejuif, France.
| | - Amine Benyamina
- Université Paris Sud, AP-HP, hôpital Paul-Brousse, département d'addictologie, 94800 Villejuif, France
| | - Sarah Coscas
- Université Paris Sud, AP-HP, hôpital Paul-Brousse, département d'addictologie, 94800 Villejuif, France
| | - Laurent Karila
- Inserm U1000, université Paris Sud, AP-HP, hôpital Paul-Brousse, département d'addictologie, 94800 Villejuif, France
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Le Boisselier R, Alexandre J, Lelong-Boulouard V, Debruyne D. Focus on cannabinoids and synthetic cannabinoids. Clin Pharmacol Ther 2016; 101:220-229. [PMID: 27861784 DOI: 10.1002/cpt.563] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 02/06/2023]
Abstract
The recent emergence of a multitude of synthetic cannabinoids (SCs) has generated a wealth of new information, suggesting the usefulness of state-of-the-art on lato sensu cannabinoids. By modulating a plurality of neurotransmission pathways, the endocannabinoid system is involved in many physiological processes that are increasingly explored. SCs desired and adverse effects are considered to be more intense than those observed with cannabis smoking, which is partly explained by the full agonist activity and higher affinity for cannabinoid receptors. Neurological and cardiovascular side effects observed after cannabinoid poisoning generally respond to conventional supportive care, but severe outcomes may occur in a minority of cases, mainly observed with SCs. The likelihood of severe abuse and addiction produced by SCs are of concern for the scientific community also interested in the potential therapeutic value of cannabinoids.
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Affiliation(s)
- R Le Boisselier
- University Hospital Centre Côte de Nacre, Centre for Evaluation and Information on Pharmacodependance - Addictovigilance (CEIP-A), F-14033, Caen, France.,University Hospital Centre Côte de Nacre, Department of Pharmacology, Caen, France
| | - J Alexandre
- University Hospital Centre Côte de Nacre, Department of Pharmacology, Caen, France.,Normandy University, UNICAEN, University Hospital Centre Côte de Nacre, Caen, France
| | - V Lelong-Boulouard
- University Hospital Centre Côte de Nacre, Department of Pharmacology, Caen, France.,Normandy University, UNICAEN, University Hospital Centre Côte de Nacre, Inserm U 1075 COMETE Caen, France
| | - D Debruyne
- University Hospital Centre Côte de Nacre, Centre for Evaluation and Information on Pharmacodependance - Addictovigilance (CEIP-A), F-14033, Caen, France.,University Hospital Centre Côte de Nacre, Department of Pharmacology, Caen, France.,Medical School, Normandy University, Caen, France
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46
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Springer YP, Gerona R, Scheunemann E, Shafer SL, Lin T, Banister SD, Cooper MP, Castrodale LJ, Levy M, Butler JC, McLaughlin JB. Increase in Adverse Reactions Associated with Use of Synthetic Cannabinoids — Anchorage, Alaska, 2015–2016. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2016; 65:1108-1111. [DOI: 10.15585/mmwr.mm6540a4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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47
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Banister SD, Longworth M, Kevin R, Sachdev S, Santiago M, Stuart J, Mack JBC, Glass M, McGregor IS, Connor M, Kassiou M. Pharmacology of Valinate and tert-Leucinate Synthetic Cannabinoids 5F-AMBICA, 5F-AMB, 5F-ADB, AMB-FUBINACA, MDMB-FUBINACA, MDMB-CHMICA, and Their Analogues. ACS Chem Neurosci 2016; 7:1241-54. [PMID: 27421060 DOI: 10.1021/acschemneuro.6b00137] [Citation(s) in RCA: 202] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Indole and indazole synthetic cannabinoids (SCs) featuring l-valinate or l-tert-leucinate pendant group have recently emerged as prevalent recreational drugs, and their use has been associated with serious adverse health effects. Due to the limited pharmacological data available for these compounds, 5F-AMBICA, 5F-AMB, 5F-ADB, AMB-FUBINACA, MDMB-FUBINACA, MDMB-CHMICA, and their analogues were synthesized and assessed for cannabimimetic activity in vitro and in vivo. All SCs acted as potent, highly efficacious agonists at CB1 (EC50 = 0.45-36 nM) and CB2 (EC50 = 4.6-128 nM) receptors in a fluorometric assay of membrane potential, with a general preference for CB1 activation. The cannabimimetic properties of two prevalent compounds with confirmed toxicity in humans, 5F-AMB and MDMB-FUBINACA, were demonstrated in vivo using biotelemetry in rats. Bradycardia and hypothermia were induced by 5F-AMB and MDMB-FUBINACA doses of 0.1-1 mg/kg (and 3 mg/kg for 5F-AMB), with MDMB-FUBINACA showing the most dramatic hypothermic response recorded in our laboratory for any SC (>3 °C at 0.3 mg/kg). Reversal of hypothermia by pretreatment with a CB1, but not CB2, antagonist was demonstrated for 5F-AMB and MDMB-FUBINACA, consistent with CB1-mediated effects in vivo. The in vitro and in vivo data indicate that these SCs act as highly efficacious CB receptor agonists with greater potency than Δ(9)-THC and earlier generations of SCs.
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Affiliation(s)
- Samuel D. Banister
- Department
of Radiation Oncology, Stanford University School of Medicine, Stanford, California 94305, United States
| | | | | | - Shivani Sachdev
- Department
of Biomedical Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Marina Santiago
- Department
of Biomedical Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Jordyn Stuart
- Department
of Biomedical Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - James B. C. Mack
- Department
of Chemistry, Stanford University, Stanford, California 94304, United States
| | - Michelle Glass
- School
of Medical Sciences, The University of Auckland, Auckland 1142, New Zealand
| | | | - Mark Connor
- Department
of Biomedical Sciences, Macquarie University, Sydney, NSW 2109, Australia
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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: 12] [Impact Index Per Article: 1.3] [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.
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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
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