Severe Toxicity Following Synthetic Cannabinoid Ingestion

Abstract

Objective To report a case of seizures and supraventricular tachycardia (SVT) following confirmed synthetic cannabinoid ingestion. Background Despite widespread use of legal synthetic cannabinoids, reports of serious toxicity following confirmed use of synthetic cannabinoids are rare. We report severe toxicity including seizures following intentional ingestion of the synthetic cannabinoid JWH-018 and detail confirmation by laboratory analysis. Case Report A healthy 48 year old man had a generalized seizure within thirty minutes of ingesting an ethanol mixture containing a white powder he purchased from the Internet in an attempt to get high. Seizures recurred and abated with lorazepam. Initial vital signs were: pulse, 106/min; BP, 140/88 mmHg; respirations, 22/min; temperature, 37.7 °C. A noncontrast computed tomography of the brain and EEG were negative, and serum chemistry values were normal. The blood ethanol concentration was 3.8 mg/dL and the CPK 2,649 U/L. Urine drug screening by EMIT was negative for common drugs of abuse, including tetrahydrocannabinol. On hospital day 1, he developed medically refractory SVT. The patient had no further complications and was discharged in his normal state of health 10 days after admission. The original powder was confirmed by gas chromatography mass spectrometry to be JWH-018, and a primary JWH-018 metabolite was detected in the patient’s urine (200 nM) using liquid chromatography tandem mass spectrometry. Discussion Synthetic cannabinoids are legal in many parts of the world and easily obtained over the Internet. Data on human toxicity are limited and real-time confirmatory testing is unavailable to clinicians. The potential for toxicity exists for users mistakenly associating the dose and side effect profiles of synthetic cannabinoids to those of marijuana. Conclusion Ingestion of JWH-018 can produce seizures and tachyarrhythmias. Clinicians, lawmakers, and the general public need to be aware of the potential for toxicity associated with synthetic cannabinoid use.

Cannabinoids and Epilepsy

“…In the same study, a 60-year-old man with a 40-year history of cannabis usage (6-8 cigarettes per day) developed status epilepticus after cannabis withdrawal [225]. Additionally, synthetic "designer" cannabinoid drugs ("spice" or "K2") induce new-onset seizures, tacharrythmia, and psychosis, often with greater severity and toxicity than cannabis [237][238][239][240][241][242][243][244][245]. The toxicity of these synthetic agents may result from their properties as full agonists of CB 1 R, while Δ9-THC is a partial agonist.…”

Cytochrome P450-Mediated Oxidative Metabolism of Abused Synthetic Cannabinoids Found in K2/Spice: Identification of Novel Cannabinoid Receptor Ligands

“…Given the high abundance of CYP2C9 in the intestine, it is anticipated that this isoform will be intricately involved in the intestinal metabolism of synthetic cannabinoids taken orally, as well as other routes of exposures. Consideration of oral routes of exposure is important because we have previously shown that ingestion of JWH-018 can lead to rapid and severe toxicity in humans (Lapoint et al, 2011). Toxic drug-drug interactions are also an important concern for public health officials, especially because hepatic intrinsic clearance associated with CYP2C9 metabolism is greater than 50%.…”

“…Whereas use of cannabis, which contains the natural psychoactive cannabinoid ⌬ 9 -tetrahydrocannabinol (⌬ 9 -THC), is often associated with mild symptoms such as appetite stimulation and orthostatic hypotension (Jones, 2002;Randall et al, 2004), K2 users present to emergency departments with severe adverse effects including hypertension, visual and auditory hallucinations, tachycardia, sinus bradycardia, chest pain, dysrhythmias, seizures, psychosis, intracranial hemorrhage, and even death (Mü ller et al, 2010;Vearrier and Osterhoudt, 2010;Benford and Caplan, 2011;Every-Palmer, 2011;Lapoint et al, 2011;Schneir et al, 2011;Simmons et al, 2011a,b;Young et al, 2011;Pant et al, 2012). In addition, recent medical reports indicate that chronic K2 use may lead to the development of tolerance, dependence, and withdrawal (Zimmermann et al, 2009), as has been observed with marijuana abuse (Budney and Hughes, 2006).…”

A Common Source Outbreak of Severe Delirium Associated with Exposure to the Novel Synthetic Cannabinoid ADB-PINACA

“…Her initial vital signs were HR 82 bpm, BP 117/61 mm Hg, RR 20/min, SpO 2 96% on room air (RA), and temperature 99. 5 F. She left the hospital AMA after her initial blood draw. She did not receive any other interventions before she left the ED, and after her departure her laboratory results were reported to be within normal limits.…”

“…Reports of cases and outbreaks of unpredicted, severe toxicity have increased as the number of SCs introduced to the market has risen. Seizures are one of the most common unpredictable toxicities reported after SC exposure (4)(5)(6)(7)(8)(9)(10). Chest pain and cardiovascular toxicity after SC use have also been reported (11,12).…”