Acute effects of synthetic cannabinoids: Update 2015
TL;DR: It was showed that the use of these substances may cause minor and moderate side effects similar to those of cannabis intoxication, including tachycardia, nausea, somnolence, hallucinations, paranoia, xerostomia, and injected conjunctivae among others.
Abstract: Background: Cannabis is the most widely used illicit drug in the United States and Europe. In recent years, a range of new substances with cannabis-like effects—known as synthetic cannabinoids (SCs)—have suddenly burst on the drug scene. However, there is limited information about the clinical hazards linked to the use of these emerging substances. This review summarizes the literature to date relating the health effects of SCs. Method: A systematic literature review of original case studies was performed using PubMed and Web of Science (January 1980–July 2015). Only articles in which a drug screening was reported were included in this review. Results: Forty-six articles meeting the inclusion criteria were included in this review, reporting data on 114 patients who went to hospital emergency departments after exposure to SCs. The majority of patients were adolescent or young adult males (14–25 years; 24.5 ± 10.1 years). The most common route of administration was smoking. The SCs most involved wer...
Citations
More filters
TL;DR: More efforts are needed to increase awareness among the public, especially youth, about the cardiovascular risks associated with cannabis use and to disseminate the accumulated knowledge regarding its ill effects.
Abstract: The growing popularity of medical and recreational consumption of cannabis, especially among the youth, raises immediate concerns regarding its safety and long-terms effects. The cardiovascular effects of cannabis are not well known. Cannabis consumption has been shown to cause arrhythmia including ventricular tachycardia, and potentially sudden death, and to increase the risk of myocardial infarction (MI). These effects appear to be compounded by cigarette smoking and precipitated by excessive physical activity, especially during the first few hours of consumption. Cannabinoids, or the active compounds of cannabis, have been shown to have heterogeneous effects on central and peripheral circulation. Acute cannabis consumption has been shown to cause an increase in blood pressure, specifically systolic blood pressure (SBP), and orthostatic hypotension. Cannabis use has been reported to increase risk of ischemic stroke, particularly in the healthy young patients. The endocannabinoid system (ECS) is currently considered as a promising therapeutic target in the management of several disease conditions. Synthetic cannabinoids (SCs) are being increasingly investigated for their therapeutic effects; however, the value of their benefits over possible complications remains controversial. Despite the considerable research in this field, the benefits of cannabis and its synthetic derivatives remains questionable even in the face of an increasingly tolerating attitude towards recreational consumption and promotion of the therapeutic complications. More efforts are needed to increase awareness among the public, especially youth, about the cardiovascular risks associated with cannabis use and to disseminate the accumulated knowledge regarding its ill effects.
149 citations
Cites background from "Acute effects of synthetic cannabin..."
...Development of acute ischemic strokes due to consumption of SCs has also been reported in young adults without any history of predisposing factors (85)....
[...]
...Cases of ST-elevation MI, although rare, have been reported following the use of K2 in patients as young as 14 years old as well as in adults (85)....
[...]
TL;DR: Given the growing popularity in the use of cannabinoid-based drugs and their harmful potential, there is a need for further research in this field.
Abstract: There is a growing use of novel psychoactive substances containing synthetic cannabinoids. Synthetic cannabinoid products have effects similar to those of natural cannabis, yet, these drugs are more potent and dangerous, and have been associated with dangerous adverse effects. Here, we review current literature on the epidemiology, acute, and chronic effects of synthetic and natural cannabinoid-based drugs. Synthetic drugs contain a mixture of psychoactive compounds that mostly bind cannabinoid receptors with high potency. These synthetic drugs replicate the effects of natural cannabis and Δ9-tetrahydrocannabinol but they induce more severe adverse effects including respiratory difficulties, hypertension, tachycardia, chest pain, muscle twitches, acute renal failure, anxiety, agitation, psychosis, suicidal ideation, and cognitive impairment. Chronic use of synthetic cannabinoids has been associated with serious psychiatric and medical conditions and even death. Given the growing popularity in the use of cannabinoid-based drugs and their harmful potential, there is a need for further research in this field.
116 citations
TL;DR: Attention is focused on long‐term disturbances in epigenetic regulation in relation to prenatal, adolescent and parental germline cannabinoid exposure to identify novel targets to develop preventive strategies and treatments for behaviors relevant to neuropsychiatric risks associated with developmental cannabis exposure.
97 citations
Cites background from "Acute effects of synthetic cannabin..."
...In the last decade not only marijuana but also synthetic cannabinoids have become increasingly popular among young people (Tournebize et al., 2016)....
[...]
TL;DR: Five cases of acute intoxication by synthetic cannabinoids 5F-ADB and MMB-2201 with analytical confirmation are reported with analytical confirm.
71 citations
TL;DR: This work provides a review on existing literature about the development of synthetic cannabinoids as substances of abuse, current patterns of abuse and their legal status, chemical classification, and some pharmacological and toxicological properties.
Abstract: The word "cannabinoid" refers to every chemical substance, regardless of structure or origin, that joins the cannabinoid receptors of the body and brain and that have similar effects to those produced by the Cannabis plant and based on their source of production, cannabinoids can be classified into endocannabinoids, phytocannabinoids and synthetic cannabinoids. Synthetic cannabinoids represent the largest class of drugs detected through the EU Early Warning System with a total of 190 substances notified from 2008 to 2018 and about 280 have been reported worldwide to the United Nations Office on Drugs and Crime. Sprayed on natural herb mixtures with the aim to mimic the euphoria effect of cannabis and sold as "herbal smoking blends" or "herbal incense" under brand names like "Spice" or "K2", synthetic cannabinoids are available from websites for the combination with herbal materials or more recently, for the use in e-cigarettes. Currently labeled as "not for human consumption" to circumvent legislation, their legal status varies by country with many government institutions currently pushing for their control. However, due to the emergence of new substances, it requires a constant update of the list of controlled drugs. Little is known about how these substances work and their toxic effects in humans and the same product could vary not only in the amount and in the type of substance added. In the last years, synthetic cannabinoids have been associated with deaths and acute intoxications in Europe and, despite a range of new measures introduced in this area, continue to represent a challenge to current drug policy models. These synthetic substances are much more potent than natural cannabis, as well as displayed greater efficacy, acting as full agonists at the cannabinoid receptors. It is possible that, along with being highly potent, some may also have long half-lives, potentially leading to a prolonged psychoactive effect. The present work provides a review on existing literature about the development of synthetic cannabinoids as substances of abuse, current patterns of abuse and their legal status, chemical classification, and some pharmacological and toxicological properties.
67 citations
References
More filters
TL;DR: This review focuses on the manner with which three of these compounds, (−)‐trans‐Δ 9‐tetrahydrocannabinol (Δ9‐THC), (−]‐cannabidiol (CBD) and (−)-trans‐ Δ9‐TetrahYDrocannabivarin (Γ‐THCV), interact with cannabinoid CB1 and CB2 receptors.
Abstract: Cannabis sativa is the source of a unique set of compounds known collectively as plant cannabinoids or phytocannabinoids. This review focuses on the manner with which three of these compounds, (-)-trans-delta9-tetrahydrocannabinol (delta9-THC), (-)-cannabidiol (CBD) and (-)-trans-delta9-tetrahydrocannabivarin (delta9-THCV), interact with cannabinoid CB1 and CB2 receptors. Delta9-THC, the main psychotropic constituent of cannabis, is a CB1 and CB2 receptor partial agonist and in line with classical pharmacology, the responses it elicits appear to be strongly influenced both by the expression level and signalling efficiency of cannabinoid receptors and by ongoing endogenous cannabinoid release. CBD displays unexpectedly high potency as an antagonist of CB1/CB2 receptor agonists in CB1- and CB2-expressing cells or tissues, the manner with which it interacts with CB2 receptors providing a possible explanation for its ability to inhibit evoked immune cell migration. Delta9-THCV behaves as a potent CB2 receptor partial agonist in vitro. In contrast, it antagonizes cannabinoid receptor agonists in CB1-expressing tissues. This it does with relatively high potency and in a manner that is both tissue and ligand dependent. Delta9-THCV also interacts with CB1 receptors when administered in vivo, behaving either as a CB1 antagonist or, at higher doses, as a CB1 receptor agonist. Brief mention is also made in this review, first of the production by delta9-THC of pharmacodynamic tolerance, second of current knowledge about the extent to which delta9-THC, CBD and delta9-THCV interact with pharmacological targets other than CB1 or CB2 receptors, and third of actual and potential therapeutic applications for each of these cannabinoids.
1,492 citations
TL;DR: The most probable adverse effects include a dependence syndrome, increased risk of motor vehicle crashes, impaired respiratory function, cardiovascular disease, and adverse effects of regular use on adolescent psychosocial development and mental health.
982 citations
TL;DR: A Poisoning Severity Score has been developed and found applicable for grading the severity of poisoning and is intended to be an overall evaluation of the case, taking into account the most severe clinical features.
Abstract: Background; A standardized and generally applicable scheme for grading the severity of poisoning allows a qualitative evaluation of morbidity and facilitates comparability of data. Working from a simple grading scale proposed by the European Association of Poisons Centres and Clinical Toxicologists, a Poisoning Severity Score has been developed jointly with the International Programme on Chemical Safety and the European Commission. Methods: The Poisoning Severity Score has been elaborated, tested, and gradually revised during a project running 1991-1994. Fourteen poisons centers from various countries have participated. Each center independently graded 371 cases of acute poisoning by ten different toxic agents. The data were then analyzed and compared. Results: The concordance in grading the severity increased during the study period, and in the last phase there was an acceptable concordance among centers in 80% or more of the cases. Given the condition and quality of the original case records, th...
677 citations
"Acute effects of synthetic cannabin..." refers background or methods in this paper
...Based on these symptoms, the severity of poisoning was graded using the Poisoning Severity Score (PSS; Table 1).(64) The PSS is a 5-point severity scale developed jointly by the European Association of Poison Centers and Clinical Toxicologists, the International Programme on Chemical Safety, and the European Commission....
[...]
...Poisoning Severity Score (PSS).(64) Organ Mild (PSS D 1) Moderate (PSS D 2) Severe (PSS D 3) Fatal (PSSD 4) Nervous system Drowsiness, vertigo, tinnitus, ataxia Unconsciousness with appropriate response to pain Deep coma with inappropriate response to pain or unresponsive to pain Restlessness Brief apnea, bradypnea Respiratory depression with insufficiency Mild extrapyramidal symptoms Confusion, agitation, hallucinations, delirium Extreme agitation Mild cholinergic/anticholinergic symptoms Infrequent, generalized or local seizures Frequent, generalized seizures, status epilepticus, opisthotonus Paresthesia Pronounced extrapyramidal symptoms Generalized paralysis or paralysis affecting vital functions Mild visual or auditory disturbances Pronounced cholinergic/anticholinergic symptoms Blindness, deafness Localized paralysis not affecting vital functions Visual and auditory disturbances Respiratory system Irritation, coughing, breathlessness, mild dyspnea, mild bronchospasm Prolonged coughing, bronchospasm, dyspnea, stridor, hypoxemia requiring extra oxygen Manifest respiratory insufficiency (due to, e....
[...]
621 citations
"Acute effects of synthetic cannabin..." refers background in this paper
...These substances have become popular among young people mainly due their low price and easy accessibility via internet sites in many countries.(67,68) A multitude of health hazards, including psychiatric, neurological, and neuromuscular complications, cardiovascular and kidney damage, and metabolic and gastrointestinal disturbances have been attributed to SCs (Figure 1)....
[...]
TL;DR: A comprehensive review, based on a systematic electronic literature search, of SC epidemiology and pharmacology and their clinical implications is presented, showing in vitro and animal in vivo studies show SC pharmacological effects 2-100 times more potent than THC.
549 citations