Delirium and High Creatine Kinase and Myoglobin Levels Related to Synthetic Cannabinoid Withdrawal

Abstract

Synthetic cannabinoids (SCs) are included in a group of drugs called new psychoactive substances. Effects of SCs on the central nervous system are similar to other cannabinoids, but 2–100 times more potent than marijuana. Thus, addiction and withdrawal symptoms are more severe than natural cannabinoids. Withdrawal symptoms of SCs were reported in the literature previously. But there is no report about SC withdrawal delirium and its treatment. Several studies reported that agonists of CB1 receptors play a role in GABA and glutamatergic neurotransmission, which is similar to the effects of alcohol on GABA and glutamatergic receptors. Previous studies on alcohol delirium cases suggested that elevated creatine kinase (CK) can be a marker of progress. This study reports delirium and high serum CK levels related to SC withdrawal and offers a treatment with benzodiazepine for them. We described two cases treated in our inpatient clinic about SC withdrawal with increase of serum CK level and other laboratory parameters. One of them demonstrated delirium symptoms and the other did not with early rapid treatment.

Synthetic Cannabinoid Bonzai Related Creatine Kinase Enzyme Elevation: a Turkish Center Study

“…Besides the psychological and emotional effects of these compounds, their other adverse health effects are not well known. Another important issue is that the exact content and/or concentration of these substances is not known (therefore, their effects and/or adverse effects cannot be estimated and they change from one user to another) [1][2][3][4] . Although there are many case reports of rhabdomyolysis and CK elevation associated with synthetic cannabinoid use, clinical (case-control) studies in this field are scarce 3,4,8 .…”

“…Another important issue is that the exact content and/or concentration of these substances is not known (therefore, their effects and/or adverse effects cannot be estimated and they change from one user to another) [1][2][3][4] . Although there are many case reports of rhabdomyolysis and CK elevation associated with synthetic cannabinoid use, clinical (case-control) studies in this field are scarce 3,4,8 . The rate of CK elevation that might be related to synthetic cannabinoid use in our center was 10.68% (of all elevated CK cases).…”

“…In Turkey, they are named Bonzai. The chemical name for Bonzai is (1-pentyl-1H-indol-3-yl)-1-naphthalenyl-methanone; the accurate concentration of the active substance found in the under-the-counter products is not known [1][2][3] . Bonzai use is associated with many health problems and/or complications [3][4][5][6] .…”

“…The chemical name for Bonzai is (1-pentyl-1H-indol-3-yl)-1-naphthalenyl-methanone; the accurate concentration of the active substance found in the under-the-counter products is not known [1][2][3] . Bonzai use is associated with many health problems and/or complications [3][4][5][6] . One of these medical conditions related to the use of Bonzai and other addictive drugs is withdrawal-related rhabdomyolysis and/or elevations in muscle enzymes (such as creatine kinase, CK).…”

“…The rate of this complication related to synthetic cannabinoid use is around 0.1% 4 . On the other hand, many other conditions may also cause elevated CK levels and CK elevation is a somewhat frequent condition encountered in daily practice 3 . Therefore, we aimed to determine the prevalence of Bonzai use in patients with elevated CK levels admitted to our center during the past year.…”