Hemorrhagic stroke following use of the synthetic marijuana “spice”

Rose, David Z.; Guerrero, Waldo R; Mokin, Maxim; Gooch, Clifton L.; Bozeman, Andrea; Pearson, Jay A.; Burgin, W. Scott

doi:10.1212/wnl.0000000000001973

Cited by 48 publications

(26 citation statements)

References 6 publications

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“…The intoxication/acute toxic effects of SCs appear to be more akin to those experienced with sympathomimetic/stimulant drug use (Naviglio et al, 2015;Wood and Dargan, 2012). Typical medical untoward effects include: vomiting/nausea; hypertension and tachycardia; tachypnoea/dyspnoea; hyperglycaemia; mydriasis (Hermanns-Clausen et al, 2013;Schifano et al, 2015;Winstock and Barratt, 2013b); nystagmus; seizures (Hopkins and Gilchrist, 2013); encephalopathy (Louh and Freeman, 2014); coma; and stroke (Freeman et al, 2013;Mir et al, 2011;Rose et al, 2015). Ultimately, deaths have been associated with the use of synthetic cannabinoids, either on their own or in combination (Angerer et al, 2017;Corkery et al, 2014;Maeda et al, 2018;Olsen, 2018;Paul et al, 2018;Tait et al, 2015;Trecki et al, 2015).…”

Section: Synthetic Cannabinoids/cannabimimetics (Sc)mentioning

confidence: 99%

New/emerging psychoactive substances and associated psychopathological consequences

et al. 2019

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Background The present paper provides an updated review of both the large number of new/novel/emerging psychoactive substances (NPS) and their associated psychopathological consequences. Focus was here given on identification of those NPS being commented in specialised online sources and the related short-/long-term psychopathological and medical ill-health effects. Methods NPS have been identified through an innovative crawling/navigating software, called the ‘NPS.Finder®’, created in order to facilitate the process of early recognition of NPS online. A range of information regarding NPS, including chemical and street names; chemical formula; three-dimensional image and anecdotally reported clinical/psychoactive effects, were here made available. Results Using the ‘NPS.Finder®’ approach, a few thousand NPS were here preliminarily identified, a number which is about 4-fold higher than those figures suggested by European and international drug agencies. NPS most commonly associated with the onset of psychopathological consequences included here synthetic cannabinoids/cannabimimetics; new synthetic opioids; ketamine-like dissociatives; novel stimulants; novel psychedelics and several prescription and over-the-counter medicines. Conclusions The ever-increasing changes in terms of recreational psychotropics' availability represent a relatively new challenge for psychiatry, as the pharmacodynamics and pharmacokinetics of many NPS have not been thoroughly understood. Health/mental health professionals should be informed about the range of NPS; their intake modalities; their psychoactive sought-after effects; the idiosyncratic psychotropics' combinations and finally, their medical and psychopathological risks.

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Section: Synthetic Cannabinoids/cannabimimetics (Sc)mentioning

confidence: 99%

New/emerging psychoactive substances and associated psychopathological consequences

et al. 2019

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“…Abuse of SCBs is associated with more frequent and severe adverse effects than those associated with cannabis use (Tait et al, 2016;Ford et al, 2017), including potentially life-threatening acute kidney injury (Bhanushali et al, 2013; Centers for Disease Control and Prevention (CDC), 2013), cardiovascular toxicity (Young et al, 2012;Varga et al, 2015), ischemia and stroke (Takematsu et al, 2014;Rose et al, 2015), and seizures and convulsions Schneir and Baumbacher, 2012;Schep et al, 2015). With regard to these later effects, seizures and convulsions are distinct and separable phenomena.…”

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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“…The mean age was 31 years (95%CI = 29-34). There were five cases of thromboangiitis obliterans [16,28,33,50,82], four hemorrhagic strokes [36,37,72,73], and two episodes of myopericarditis [55,85]. Heart rate and blood pressure for both genders were provided in 40 and 43 cases, respectively.…”

Section: Case Reportsmentioning

confidence: 99%

What is the Current Knowledge About the Cardiovascular Risk for Users of Cannabis-Based Products? A Systematic Review

Jouanjus

Raymond

Lapeyre‐Mestre

et al. 2017

Curr Atheroscler Rep

124

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The World Health Organization (WHO) emphasizes that cannabis use represents a risky behavior as it may lead to many adverse effects, and in particular, cardiovascular effects. A systematic review of articles published between January 1, 2011 and May 31, 2016 was performed in agreement with the PRISMA statement. Articles presenting data on humans exposed to cannabis-based products and suffering from any cardiovascular condition were eligible for inclusion. The inclusion process was based on a search algorithm and performed in a blinded standardized manner. Overall, 826 articles were found in the literature search, 115 of which remained after performing the inclusion procedure. These were 81 case reports, 29 observational studies, 3 clinical trials, and 2 experimental studies. A total of 116 individuals was the subject of case reports. The mean age was 31 years (95%CI = 29-34), and patients were more frequently men (81.9%) than women (18.1%). They mainly suffered from ischemic strokes or myocardial infarctions. Data provided by the 29 included observational studies evidenced an association between exposure to cannabis-based products and cardiovascular disease. Currently, this evidence is stronger for ischemic strokes than for any other cardiovascular diseases. While the data are limited, there is some suggestion that cannabis use may have negative cardiovascular consequences, particularly at large doses.

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Hemorrhagic stroke following use of the synthetic marijuana “spice”

Cited by 48 publications

References 6 publications

New/emerging psychoactive substances and associated psychopathological consequences

New/emerging psychoactive substances and associated psychopathological consequences

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

What is the Current Knowledge About the Cardiovascular Risk for Users of Cannabis-Based Products? A Systematic Review

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