Characteristics and Treatment of Patients with Clinical Illness Due to Synthetic Cannabinoid Inhalation Reported by Medical Toxicologists: A ToxIC Database Study

Monte, Andrew A.; Calello, Diane P.; Gerona, Roy; Hamad, Eike; Campleman, Sharan L.; Brent, Jeffery; Wax, Paul M.; Carlson, Robert G.

doi:10.1007/s13181-017-0605-9

Cited by 45 publications

(41 citation statements)

References 22 publications

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“…In this cohort, SCs led to less severe clinical outcomes, as demonstrated by a lower ICU and hospital admission rates compared to other drug classes. This is contrary to other studies that have focused on critically ill patients with SC abuse . As the numbers of cases involving other NPS products increase through PSCAN, we will probably see a more representative spectrum of clinical illness, as we have demonstrated with SCs.…”

Section: Discussioncontrasting

confidence: 90%

“…This allows for broad capture of cases by front‐line providers resulting in data collection from the full range of mild to severe clinical illness. This design differs from case–series to date, which are biased towards the most severe presentations, while patients who are transiently intoxicated and rapidly discharged from emergency departments (ED) are not represented …”

Section: Methodsmentioning

confidence: 99%

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The Psychoactive Surveillance Consortium and Analysis Network (PSCAN): the first year

et al. 2019

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Background and aims The Psychoactive Surveillance Consortium and Analysis Network (PSCAN) is a national network of academic emergency departments (ED), analytical toxicologists and pharmacologists that collects clinical data paired with biological samples to identify and improve treatments of medical conditions arising from use of new psychoactive substances (NPS). The aim of this study was to gather clinical data with paired drug identification from NPS users who presented to EDs within PSCAN during its first year . Design Observational study involving patient records and biological samples. Setting Seven academic emergency medical centers across the United States. Participants ED patients (n = 127) > 8 years of age with possible NPS use who were identified and enrolled in PSCAN by clinical providers or research personnel. Measurements Clinical signs, symptoms and treatments were abstracted from the patients' health records. Biological samples were collected from leftover urine, serum and whole blood. Biological and drug samples, when available, were tested for drugs and drug metabolites via liquid chromatography-quadrupole time-of-flight mass spectrometry (LC-QTOF/MS). Findings Patients in whom synthetic opioids were detected (n = 9) showed higher rates of intubation (four of nine), impaired mental status (four of nine) and respiratory acidosis (five of nine) compared with the rest of the cohort (nine of 118, P-value < 0.05). Patients in whom synthetic cannabinoid (SC) were found (n = 27) had lower median diastolic blood pressures (70.5 versus 77 mmHg, P = 0.046) compared with the rest of the cohort. In 64 cases of single drug ingestion, benzodiazepines were administered in 25 cases and considered effective by the treating physician in 21 (84%) cases. Conclusions During its first year of operation, the Psychoactive Surveillance Consortium and Analysis Network captured clinical data on new classes of drugs paired with biological samples over a large geographical area in the United States. Synthetic cannabinoids were the most common new psychoactive drug identified. Synthetic opioids were associated with a high rate of intubation and respiratory acidosis.

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Section: Discussioncontrasting

confidence: 90%

Section: Methodsmentioning

confidence: 99%

The Psychoactive Surveillance Consortium and Analysis Network (PSCAN): the first year

et al. 2019

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“…Indeed, administration of rimonabant or THC effectively attenuated convulsant effects of the SCBs at doses that did not alter PTZ-induced convulsions, while treatment with diazepam abolished PTZ-elicited convulsions but afforded no protection whatsoever against convulsant effects of the SCBs. This is particularly alarming since benzodiazepine administration is the most common emergency department treatment of convulsion associated with acute SCB intoxication (Finkelstein et al, 2017;Monte et al, 2017;Brandehoff et al, 2018). Given that drug effects typically ameliorate with time, and the nature of clinical case reports describing treatment of seizure and convulsion elicited by SCBs, it is impossible to determine whether benzodiazepine administration in the emergency setting has any beneficial effects at all, and it would of course be unethical to study the possible anticonvulsant effects of benzodiazepines against an inactive placebo in individuals acutely intoxicated with SCBs.…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, convulsions are not exclusively associated with seizure activity (Burn et al, 1989;Naik and Chakrapani, 2009). Nevertheless, in cases of acute SCB intoxication, emergency department physicians typically administer benzodiazepines to manage convulsion, delirium, and agitation (Finkelstein et al, 2017;Monte et al, 2017;Brandehoff et al, 2018). Unfortunately, this course of treatment is not evidence based and its efficacy is unknown.…”

Section: Introductionmentioning

confidence: 99%

Convulsant Effects of Abused Synthetic Cannabinoids JWH-018 and 5F-AB-PINACA Are Mediated by Agonist Actions at CB1 Receptors in Mice

Wilson

Tai

Ewing

et al. 2018

J Pharmacol Exp Ther

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Convulsant effects of abused synthetic cannabinoid (SCB) drugs have been reported in humans and laboratory animals, but the mechanism of these effects is not known. We compared convulsant effects of partial CB1R agonist Δ 9 -tetrahydrocannabinol (THC), full CB1R agonist SCBs JWH-018 and 5F-AB-PINACA, and classic chemical convulsant pentylenetetrazol (PTZ) using an observational rating scale in mice. THC did not elicit convulsions, but both SCBs did so as effectively as and more potently than PTZ. SCB-elicited convulsions were attenuated by the CB1R antagonist rimonabant or by THC, or by dose regimens of THC and JWH-018, which downregulate and desensitize CB1Rs. None of these treatments altered the convulsant effects of PTZ, although diazepam attenuated PTZelicited convulsions without altering SCB-induced convulsant effects. Repeated administration of a subthreshold dose of PTZ kindled convulsant effects, but this was not observed with the SCBs, and no cross-kindling was observed. Repeated administration of the SCBs resulted in tolerance to convulsant effects, but no cross-tolerance to PTZ was observed. Inhibition on Phase I metabolism via nonselective inhibition of CYP450s with 1-aminobenzotriazole potentiated the hypothermic effects of the SCBs and protected against the convulsant effects of JWH-018, but not those of 5F-AB-PINACA or PTZ. Incubation of human liver microsomes with the SCBs showed that JWH-018 is eliminated via oxidation, whereas 5F-AB-PINACA is not. These studies suggest that SCB-elicited convulsions are mediated by high intrinsic efficacy at CB1Rs and that benzodiazepines may not be effective treatments. Finally, drug metabolism may dramatically modulate the convulsant effects of some, but not all, SCBs.

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“…Since the pharmacology of these substances is complex or unknown, benzodiazepines may possibly be a choice, although they may require frequent dosage adjustment and high doses to achieve a proper sedative effect, and this can be a problem when people have also ingested alcohol; when patients cannot be controlled with only benzodiazepines, antipsychotics may be considered [9,40,41]. Hospital admission to intensive care units will sometimes be necessary [40][41][42].…”

Section: Treatmentmentioning

confidence: 99%

Synthetic cannabinoids: characteristics, use and clinical implications

Hervás¹

2017

Arch Psych Psych

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Synthetic cannabinoids are chemicals that bind to cannabinoid receptors and produce effects similar to those of tetrahydrocannabinol. Although initially designed as possible pharmacological tools, they are currently one of the most important of the so-called new drugs. Some of these cannabinoids are extremely potent and have serious effects on the health of the users who are primarily young people. Its use can affect the behavior unpredictably (many users do not really know what they are consuming), and produce more adverse consequences than marijuana.This article reviews the most important characteristics of these substances, the consequences of their consumption and the clinical implications that derive from it.

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Characteristics and Treatment of Patients with Clinical Illness Due to Synthetic Cannabinoid Inhalation Reported by Medical Toxicologists: A ToxIC Database Study

Abstract: Synthetic cannabinoids are associated with severe central nervous system and cardiovascular effects.

Cited by 45 publications

References 22 publications

The Psychoactive Surveillance Consortium and Analysis Network (PSCAN): the first year

The Psychoactive Surveillance Consortium and Analysis Network (PSCAN): the first year

Convulsant Effects of Abused Synthetic Cannabinoids JWH-018 and 5F-AB-PINACA Are Mediated by Agonist Actions at CB1 Receptors in Mice

Synthetic cannabinoids: characteristics, use and clinical implications

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