Clinical and analytical experience of the National Poison Control Centre with synthetic cannabinoids

Abstract

A rising number of patients are being treated for overdosing with new psychoactive substances (NPS) available at the illegal drug market in Serbia. The aim of this study was to report clinical and analytical experience of the National Poison Control Centre of Serbia (NPCC) with synthetic cannabinoids (SCs) and point to the NPS available at the illegal drug market in our country. From January 2013 to December 2016, 58 patients (aged between 14 and 25) were treated for the effects of synthetic cannabinoids at the NPCC. Tachycardia was established in 53, mydriasis in 31, somnolence, nausea, vomiting, and agitation in 16, dizziness in 10, disorientation in 9, dyspnoea and chest pain in 4, and loss of consciousness, pallor, paraesthesia, muscle twitches, and short-term memory impairment in 2 patients. After receiving symptomatic and supportive treatment in the emergency ward, all patients had fully recovered within 8 h and were discharged shortly afterwards. Another part of the study was focused on the analysis of the products known under their local street names as "Biljni tamjan" (herbal incense), "Beli slez", and "Rainbow Special" and the analysis of urine sampled from the patients with gas chromatography - mass spectrometry and high performance liquid chromatography. The detected synthetic cannabinoids were AB-PINACA, JWH-018, JWH-122, JWH-210, 5F-AKB48, and MDMB-CHMICA in herbal products and AB-FUBINACA, AB-CHMINACA, and MDMB-CHMICA in the urine samples. Our findings have shown the great capacity of NPCC to I) monitor NPS abuse in Serbia, II) reliably detect SCs in illicit products and biological samples, and III) clinically manage the adverse effects in their users. Future commitments of the NPCC will include systematic collection of relevant data on SCs and their adverse effects, detection of changes in purity and composition of the controlled NPS-based products, and raising the public awareness of NPS to improve the effectiveness of the national Early Warning System.

Psychotomimetic symptoms after a moderate dose of a synthetic cannabinoid (JWH-018): implications for psychosis

“…Many of these compounds are structurally similar to JWH-018 (Musah et al 2012;Alam and Keating 2020;World Health Organization 2016). The use of JWH-018 however never vanished entirely, and it is still prevalent in large parts of the world (Oberenko et al 2019;Vučinić et al 2018;Darke et al 2020).…”

A regulatory take on cannabis and cannabinoids for medicinal use in the European Union

“…Besides medicinal use, several CB1 receptor-selective agonists have been developed as psychoactive ingredients in products for recreational use. Since little is known about their effects in humans, and since some of them cause more distress and panic than phytocannabinoids, they represent a significant health risk ( 10 , 11 , 12 , 13 ).…”

“…Lipnik-Štangelj M, Razinger B. A regulatory take on cannabis and cannabinoids for medicinal use in the European Union Arh Hig Rada Toksikol 2020;71:[12][13][14][15][16][17][18] …”

Off-target pharmacological profiling of synthetic cannabinoid receptor agonists including AMB-FUBINACA, CUMYL-PINACA, PB-22, and XLR-11

“…SCRAs have been associated with multiple instances and types of toxicity, ranging from transient adverse effects like anxiety, paranoia, and catalepsy, to severe and potentially long-lasting adverse effects like cardiac and kidney injuries, encephalopathy, coma, and even death ( 15 – 17 ). Notable instances of SCRA toxicity include a mass hospitalization event in New York, linked to AMB-FUBINACA ( 18 ), as well as fatal intoxications linked to this compound in New Zealand ( 19 ), poisonings linked to XLR-11 and associated in vitro nephrotoxicity ( 20 , 21 ), and a range of poisonings that occurred in Russia linked to AB-CHMINACA, MDMB-CHMICA, and AB-PINACA, among others ( 22 ).…”