Case Series of Synthetic Cannabinoid Intoxication from One Toxicology Center

Katz, Kenneth D.; Leonetti, Adam L.; Bailey, Blake C.; Surmaitis, Ryan; Eustice, Eric R.; Kacinko, Sherri L.; Wheatley, Scott M.

doi:10.5811/westjem.2016.2.29519

Cited by 74 publications

(22 citation statements)

References 7 publications

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“…In addition to lack of mechanistic insight, very little continues to be known concerning potential contributions of phase I and II metabolism of SCBs to toxicity observed following K2/Spice use (Outstanding Question 3). As reviewed here, the consequences of acute and chronic K2/Spice abuse have been examined in studies ranging from basic science reports to clinical cases [5, 21, 24, 44, 55–58, 133, 134]. Although much useful information has been gained, unfortunately, many important questions remain; such as, why adolescents appear to be more susceptible to the pro-psychotic actions of SCBs (reviewed in, for example, [186] and in [64]) (Outstanding Question 4).…”

Section: Discussionmentioning

confidence: 99%

“…Despite current interest in medical cannabis as a treatment for epilepsy and other seizure disorders (recently reviewed in [54], for example), the clinical literature is rife with reports of seizures and convulsions elicited by SCBs in humans ([44, 55–58]), and in one case, their exposed pets [59]. As may be expected from case reports, forensic determination of the specific SCBs responsible for these effects occurs only rarely, and the co-use of other drugs often confounds the causal attribution of these convulsant effects to SCBs.…”

Section: Distinct Scb Toxicity In Humans - Issues For Special Concernmentioning

confidence: 99%

“…One report describes the clinical course of 11 patients exposed to the SCB MAB-CHMINACA [58]. For the most part, the symptoms reported are consistent with known SCB effects, including altered consciousness, severe agitation, seizures and death, however, a 20-year-old male patient developed a malignant hyperthermia and died on his seventh day in the hospital.…”

Section: Scb Abuse Liability Tolerance Dependence and Withdrawalmentioning

confidence: 99%

See 2 more Smart Citations

Synthetic Pot: Not Your Grandfather’s Marijuana

Ford

Tai

Fantegrossi

et al. 2017

Trends in Pharmacological Sciences

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In the early 2000’s in Europe and shortly thereafter in the USA, it was reported that “legal” forms of marijuana were being sold under the name K2 and/or Spice. Active ingredients in K2/Spice products were determined to be synthetic cannabinoids (SCBs), producing psychotropic actions via CB1 cannabinoid receptors, similar to those of Δ9-THC, the primary active constituent in marijuana. Often abused by adolescents and military personnel to elude detection in drug tests due to their lack of structural similarity to Δ9-THC, SCBs are falsely marketed as safe marijuana substitutes. Instead, SCBs are a highly structural diverse group of compounds, easily synthesized, which produce very dangerous adverse effects occurring by, as of yet, unknown mechanisms. Therefore, available evidence indicates that K2/Spice products are clearly not safe marijuana alternatives.

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Section: Discussionmentioning

confidence: 99%

Section: Distinct Scb Toxicity In Humans - Issues For Special Concernmentioning

confidence: 99%

Section: Scb Abuse Liability Tolerance Dependence and Withdrawalmentioning

confidence: 99%

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Synthetic Pot: Not Your Grandfather’s Marijuana

Ford

Tai

Fantegrossi

et al. 2017

Trends in Pharmacological Sciences

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“…In recent years, synthetic cannabinoid receptor agonists (SCRAs) have become one of the largest groups of new psychoactive substances (NPS) in most countries of the world. [1][2][3][4][5][6][7] They are strictly controlled under regulation by Pharmaceutical Affairs Law, due to the epidemic abuse in 2013-2015 in Japan. Nowadays, over 2000 NPS including SCRAs and cathinone derivatives are extensively controlled in Japan.…”

Section: Introductionmentioning

confidence: 99%

Identification and quantification of predominant metabolites of synthetic cannabinoid MAB‐CHMINACA in an authentic human urine specimen

Hasegawa

Minakata

Gonmori

et al. 2017

Drug Testing and Analysis

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An autopsy case in which the cause of death was judged as drug poisoning by two synthetic cannabinoids, including MAB-CHMINACA, was investigated. Although unchanged MAB-CHMINACA could be detected from solid tissues, blood and stomach contents in the case, the compound could not be detected from a urine specimen. We obtained six kinds of reference standards of MAB-CHMINACA metabolites from a commercial source. The MAB-CHMINACA metabolites from the urine specimen of the abuser were extracted using a QuEChERS method including dispersive solid-phase extraction, and analyzed by liquid chromatography-tandem mass spectrometry with or without hydrolysis with β-glucuronidase. Among the six MAB-CHMINACA metabolites tested, two predominant metabolites could be identified and quantified in the urine specimen of the deceased. After hydrolysis with β-glucuronidase, an increase of the two metabolites was not observed. The metabolites detected were a 4-monohydroxycyclohexylmethyl metabolite M1 (N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1-((4-hydroxycyclohexyl)methyl)-1H-indazole-3-carboxamide) and a dihydroxyl (4-hydroxycyclohexylmethyl and tert-butylhydroxyl) metabolite M11 (N-(1-amino-4-hydroxy-3,3-dimethyl-1-oxobutan-2-yl)-1-((4-hydroxycyclohexyl)methyl)-1H-indazole-3-carboxamide). Their concentrations were 2.17 ± 0.15 and 10.2 ± 0.3 ng/mL (n = 3, each) for M1 and M11, respectively. Although there is one previous in vitro study showing the estimation of metabolism of MAB-CHMINACA using human hepatocytes, this is the first report dealing with in vivo identification and quantification of MAB-CHMINACA metabolites in an authentic human urine specimen.

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“…The seven studies that were not suitable for prevalence‐of‐intubation pooling had cohorts that consisted entirely of those that were intubated, making a calculation of prevalence impossible . A comprehensive listing of the 46 articles with a description of study characteristics, prevalence‐bias assessment, and intubation prevalence are shown in Table S1 …”

Section: Resultsmentioning

confidence: 99%

Review article: Emergency endotracheal intubation in non‐traumatic brain pathologies: A systematic review and meta‐analysis

Fouche

Stein

Jennings

et al. 2019

Emerg Medicine Australasia

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Endotracheal intubation is an advanced airway procedure performed in the ED and the out-ofhospital setting for acquired brain injuries that include non-traumatic brain pathologies such as stroke, encephalopathies, seizures and toxidromes. Controlled trial evidence supports intubation in traumatic brain injuries, but it is not clear that this evidence can be applied to nontraumatic brain pathologies. We sought to analyse the impact of emergency intubation on survival in non-traumatic brain pathologies and also to quantify the prevalence of intubation in these pathologies. We conducted a systematic literature search of Medline, Embase and the Cochrane Library. Eligibility, data extraction and assessment of risk of bias were assessed independently by two reviewers. A bias-adjusted metaanalysis using a quality-effects model pooled prevalence of intubation in non-traumatic brain pathologies. Forty-six studies were included in this systematic review. No studies were suitable for meta-analysis the primary outcome of survival. Thirtynine studies reported the prevalence of intubation in non-traumatic brain pathologies and a meta-analysis showed that emergency intubation was used in 12% (95% CI 0-33) of pathologies. Endotracheal intubation was used commonly in haemorrhagic stroke 79% (95% CI 47-100) and to a lesser extent for seizures 18% (95% CI 10-27) and toxidromes 25% (95% CI 6-48). This systematic review shows that there is no high-quality clinical evidence to support or refute emergency intubation in non-traumatic brain pathologies. Our analysis shows that intubation is commonly used in non-traumatic brain pathologies, and the need for rigorous evidence is apparent.

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Case Series of Synthetic Cannabinoid Intoxication from One Toxicology Center

Cited by 74 publications

References 7 publications

Synthetic Pot: Not Your Grandfather’s Marijuana

Synthetic Pot: Not Your Grandfather’s Marijuana

Identification and quantification of predominant metabolites of synthetic cannabinoid MAB‐CHMINACA in an authentic human urine specimen

Review article: Emergency endotracheal intubation in non‐traumatic brain pathologies: A systematic review and meta‐analysis

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