Critical Illness Secondary to Synthetic Cannabinoid Ingestion

Abstract

IMPORTANCE Synthetic cannabinoids (SCs), commonly known as K2, spice, or fake weed, are cheap, artificially manufactured recreational drugs that have emerged as a major public health threat in various regions of the US. OBJECTIVE To describe the clinical manifestations of SC intoxication. DESIGN, SETTING, AND PARTICIPANTS This case series assessed adults admitted to the intensive care unit from 2014 to 2016 with acute life-threatening complications of SC use. Data analysis was completed in October 2016. EXPOSURES Use of SCs such as K2, spice, or other synthetic versions of cannabinoids. MAIN OUTCOMES AND MEASURES Data collected included patient demographic data, medical history, presenting symptoms, physical findings, laboratory and imaging data, and intensive care unit and hospital course. RESULTS Thirty patients (mean age, 41 years [range, 21-59 years]; 24 men [80%]) with SC ingestion were admitted to the intensive care unit over a 2-year period. Thirteen patients were undomiciled. The majority had a history of polysubstance abuse, psychiatric illness, or personality disorder. The admission diagnoses were coma (10 patients [33%]), agitation (10 patients [33%]), and seizure (6 patients [20%]). Eighteen patients (60%) had acute respiratory failure, and tracheal intubation was required in 21 patients (70%) for either airway protection or acute respiratory failure. Rhabdomyolysis was noted in 8 patients (26%). A man developed transient cerebral edema with loss of gray-white differentiation but had complete recovery. A woman with history of asthma died of acute respiratory distress syndrome. All patients underwent routine toxicology testing, which was unrevealing in 16 cases and revealed coingestion in the remainder. Sixteen patients (53%) left the hospital against medical advice. CONCLUSIONS AND RELEVANCE Ingestion of SCs can lead to life-threatening complications, including severe toxic encephalopathy, acute respiratory failure, and death. Synthetic cannabinoids are undetectable in routine serum and urine toxicology testing but can be suspected on the basis of history and clinical presentation, which may include extreme agitation or coma. Frontline clinicians must be aware of the presentation and be vigilant in suspecting SC intoxication.

Defining Steric Requirements at CB1 and CB2 Cannabinoid Receptors Using Synthetic Cannabinoid Receptor Agonists 5F-AB-PINACA, 5F-ADB-PINACA, PX-1, PX-2, NNL-1, and Their Analogues

“…Currently, the most prevalent SCRA chemotypes are indole-3-carboxamides and indazole-3-carboxamides featuring pendant amino acid derivatives, inspired by two historical Pfizer patents disclosing this class of ligands as novel analgesics, and exemplified by structures such as MMB-5F-PINACA (also known as 5F-AMB, 6 ), MDMB-CHMICA ( 7 ), and AB-FUBINACA ( 8 ) . These amino acid-derived compounds are seemingly more frequently associated with mass overdoses and fatalities to a greater extent than previous generations of SCRAs, suggesting that they may warrant greater concern and pose a greater risk of serious adverse effects. − …”

Synthesis and in Vitro Cannabinoid Receptor 1 Activity of Recently Detected Synthetic Cannabinoids 4F-MDMB-BICA, 5F-MPP-PICA, MMB-4en-PICA, CUMYL-CBMICA, ADB-BINACA, APP-BINACA, 4F-MDMB-BINACA, MDMB-4en-PINACA, A-CHMINACA, 5F-AB-P7AICA, 5F-MDMB-P7AICA, and 5F-AP7AICA

“…SCRAs often have greater potency and efficacy at CB receptors compared to THC, which acts as a partial agonist at both subtypes, which may partially explain the limited toxicity seen with the use of cannabis . In contrast, SCRAs are linked to numerous health issues, including dependence, psychosis, seizures, organ toxicity, and death. − Many legislative approaches have been implemented at the national and international levels to control the manufacturing, trafficking, and possession of these substances. , However, increased control of specific SCRAs has had the perverse consequence of motivating the design, synthesis, and sale of novel compounds that circumvent existing controls. ,, Due to the rapid pace at which these substances enter the market, there is often little or no information regarding the pharmacology of these substances despite widespread human use.…”

Evaluation of Substance Abuse Cases Admitted in ICU of Poison Control Center- Ain Shams University Hospitals by Certain Clinical Scoring Systems

“…On the other hand, absence of recorded mortality in group II (cannabinoids) was not unexpected as other studies recorded that rapid improvement was the usual course although cases were critically ill at admission (Kourouni et al, 2020). These findings are also mirrored in lower mean APACHE II score among group II in comparison to other implicated substances.…”