Acute toxicity due to the confirmed consumption of synthetic cannabinoids: clinical and laboratory findings
TL;DR: Acute toxic symptoms associated with their use are also reported after intake of high doses of cannabis, but agitation, seizures, hypertension, emesis and hypokalaemia seem to be characteristic to the synthetic cannabinoids, which are high-affinity and high-efficacy agonists of the CB(1) receptor.
Abstract: Aims
Recently, several synthetic cannabinoids were identified in herbal mixtures consumed as recreational drugs alternative to cannabis products. The aim was to characterize the acute toxicity of synthetic cannabinoids as experienced by emergency patients.
Design
This was a retrospective study targeting patients seeking emergency treatment after recreational use of synthetic cannabinoids.
Setting and participants
Patients were selected from the database of the Poisons Information Center Freiburg between September 2008 and February 2011. The inclusion criteria were: hospitalization, available clinical reports and analytical verification of synthetic cannabinoid uptake. In total, 29 patients were included (age 14–30 years, median 19; 25 males, four females).
Measurements
Clinical reports were evaluated and synthetic cannabinoids and other drugs were determined analytically.
Findings
CP-47,497-C8 (one), JWH-015 (one), JWH-018 (eight), JWH-073 (one), JWH-081 (seven), JWH-122 (11), JWH-210 (11), JWH-250 (four) and AM 694 (one) were quantified in blood samples. JWH-018 was most common in 2008–9, JWH-122 in 2010, and JWH-210 in 2011. Tachycardia, agitation, hallucination, hypertension, minor elevation of blood glucose, hypokalaemia and vomiting were reported most frequently. Chest pain, seizures, myoclonia and acute psychosis were also noted.
Conclusions
There appears to have been an increase in use of the extremely potent synthetic cannabinoids JWH-122 and JWH-210. Acute toxic symptoms associated with their use are also reported after intake of high doses of cannabis, but agitation, seizures, hypertension, emesis and hypokalaemia seem to be characteristic to the synthetic cannabinoids, which are high-affinity and high-efficacy agonists of the CB1 receptor. Thus, these effects are due probably to a strong CB1 receptor stimulation.
Citations
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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.
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...It remains unclear as to why THC can have such a high safety margin, while the synthetic cannabinoid constituents can prove toxic with varying severities of serious side effects (Hermanns-Clausen et al., 2013)....
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Journal Article•
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Abstract: Despite significant declines in cigarette smoking among U.S. adults over the past five decades, progress has slowed in recent years, and the prevalence of use of other tobacco products such as cigars and smokeless tobacco has not changed. Additionally, the prevalence of use of emerging products, including electronic cigarettes (e-cigarettes), has rapidly increased. This report provides the most recent national estimates of tobacco use among adults aged ≥18 years, using data from the 2012-2013 National Adult Tobacco Survey (NATS). The findings indicate that 21.3% of U.S. adults used a tobacco product every day or some days, and 25.2% used a tobacco product every day, some days, or rarely. Population-level interventions focused on the diversity of tobacco product use, including tobacco price increases, high-impact antitobacco mass media campaigns, comprehensive smoke-free laws, and enhanced access to help quitting, in conjunction with Food and Drug Administration (FDA) regulation of tobacco products, are critical to reducing tobacco-related diseases and deaths in the United States.
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TL;DR: To identify systematically the scientific reports of adverse events associated with the consumption of SCs in the medical literature and poison centre data, this work searched online databases and manually searched reference lists up to December 2014 to identify eligible studies.
Abstract: Context: Synthetic cannabinoids (SCs) such as “Spice”, “K2”, etc. are widely available via the internet despite increasing legal restrictions. Currently, the prevalence of use is typically low in the general community (<1%) although it is higher among students and some niche groups subject to drug testing. Early evidence suggests that adverse outcomes associated with the use of SCs may be more prevalent and severe than those arising from cannabis consumption. Objectives: To identify systematically the scientific reports of adverse events associated with the consumption of SCs in the medical literature and poison centre data. Method: We searched online databases (Medline, PsycInfo, Embase, Google Scholar and Pubmed) and manually searched reference lists up to December 2014. To be eligible for inclusion, data had to be from hospital, emergency department, drug rehabilitation services or poison centre records of adverse events involving SCs and included both self-reported and/or analytically confirme...
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...Acute SC intoxication is characterized by agitation/anxiety and visual/auditory hallucinations (34-36), together with tachycardia, hypertension, mydriasis, hyperglycaemia, dyspnoea, vomiting and seizures....
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References
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TL;DR: This review aims to integrate the current understanding of functions of the endocannabinoid system, especially focusing on the control of synaptic transmission in the brain, and summarizes recent electrophysiological studies carried out on synapses of various brain regions and discusses how synaptic transmission is regulated by endoc cannabinoidoid signaling.
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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...
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