Synthetic cannabinoids: Variety is definitely not the spice of life

Post-Mortem Toxicology: A Systematic Review of Death Cases Involving Synthetic Cannabinoid Receptor Agonists

“…In most cases in which a SC was later discovered during toxicological analysis, the post-mortem examination had revealed only non-specific signs of intoxication, such as pulmonary edema and congestion, brain edema, hemolysis, and signs of aspiration (34,40). In some cases, stomach and gastroduodenal erosions (20,35), abundant hypostasis coupled to petechiae (27,29,37) and intracutaneous skin bleedings (vibices) (30) were reported. Lastly, cardiac abnormalities, such as cardiomegaly (33,43), dilatative or hypertrophic cardiomyopathy (21), stenosis due to atherosclerosis (33,46) or acute thrombosis of the coronary arteries were seen (32).…”

“…Cause of death was stated in all but 4 cases (5%). Cardiac arrhythmias and cardio-circulatory acute effects were listed in 17 cases (23%) as cause of death or as underlying mechanisms in a group of mono and poly-drug intoxications, involving both teenagers and adults (20,21,35,40,48). A number of death cases were associated with excited delirium and police restraints (33), as well as fall from height, either due to drug-induced psychosis or reduced awareness with accidental falling (24,26).…”

“…Once a new methodology for the analysis of biological specimens has been established, even in case reports, a socalled short validation, including selectivity, linearity, accuracy, precision, and matrix effect, is strongly recommended even if not always performed or published (59). In the case described by Langford et al, for example, the analyses were granted by a private licensed forensic laboratory, and no information was disclosed due to alleged "competition and market issues" (20). The absence of a clearly stated methodology and validation process questions the reliability of the analytical results and limits the comparability of the data.…”

“…Sasaki et al (45) found signs of hypertension and aging in a 20-year-old victim, coupled to myocardial suffering, and thus hypothesized a cardio-circulatory hyperactivity due to prolonged SCRA use. The diversity of potential injury mechanisms (between myocardial infarction and arrhythmia) may explain why in some cases band necrosis proved a myocardial damage (21,45), while in others neither macroscopic nor microscopic signs were noted (20,21,35).…”

Synthetic Cannabinoids: A Disturbing Trend

“…Acute kidney injury, abdominal pain, and hyperthermia are additional complications that have been described with SCs but seen with cannabis [7]. SCs have been involved in the death of some individuals, usually in combination with another substance [8]. The psychoactive properties of SCs have similarities to THC, but most cases are more severe.…”