Introduction Synthetic cannabinoids (SCs) are psychoactive substances that are gaining popularity for their availability and lack of detection by standardized drug tests. Although some users may perceive SCs as safer alternatives to marijuana, some SCs are more potent and result in more severe toxicities. Methods A search of the literature was conducted in the PubMed and SciFinder databases. Results in PubMed were limited to human studies, and only articles in English were included. Results Review of the literature illustrates the hazards associated with SC use. A range of severe toxicities affecting numerous systems has been identified, such as arrhythmias, myocardial infarction, sudden cardiac death, psychosis, suicidal ideation, seizures, acute tubular necrosis, and intracranial hemorrhage. Additionally, a recent outbreak of coagulopathies and at least 4 associated deaths due to SCs tainted with brodifacoum have been reported. Discussion Synthetic cannabinoids may be perceived as a safer alternative to marijuana; however, SCs can be more potent at the cannabinoid receptors and in turn have greater toxicities. Limited information is available on the metabolism of SCs; however, cytochrome P450 pathways may be involved, which could result in drug interactions and unpredicted adverse effects. Toxicity with SC use is not just related to its effects, but also to additives that may taint these products and enhance their effects. Health care providers should be aware of the range of toxicities related to SC use, and tainted products such as these agents are not detected on routine drug screens.

Background: Poor medication adherence is a major public health concern. Patients living with a serious mental illness (SMI) commonly present with non-adherence to their medication regimen, which can lead to relapse and hospitalizations. The high rates of antipsychotic non-adherence continue to persist despite several interventions and medication advances. This review evaluates the possible role of the ingestible sensor technology for medication adherence in different conditions, with a focus on use in the SMI schizophrenia. Methods: Literature searches were conducted in July 2019 in the PubMed database. Results: In small studies of ingestible sensor use, the average adherence ranged from 73.9% to 88.6% for SMI and ≥ 80% for cardiac and transplant (99.4%) patients. In SMI studies, patients were clinically stable, and the majority had a clinical global impression severity of “mild disease”. Patients generally experienced relatively minor dermatological adverse effects related to wearable sensor use. Conclusions: A medication with an ingestible sensor may help provide real-time objective medication-taking adherence information for clinicians. However, further studies are needed to understand the impact of use on adherence and improvement on treatment outcomes with the ingestible sensor technology.

WorldMeds. No other conflicts were reported.

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Selection of an antidepressant medication is based on various factors, such as safety, tolerability, and cost. This article reviews the cost-effectiveness of the different serotonin-norepinephrine reuptake inhibitors (SNRIs).