Clinical and toxicological findings of acute intoxication with synthetic cannabinoids and cathinones

Abstract

Aim:Reporting of the analytical and clinical findings of synthetic cannabinoids and cathinones is essential in carrying out a complete clinical assessment of new psychoactive substances. Methods:From 2012 to 2014, we examined synthetic cathinone and cannabinoid poisoning in six patients aged 22-42 years old.Analyses of these compounds were carried out using liquid chromatography-tandem mass spectrometry. Results:The observed clinical symptoms were similar to those reported for intoxication with synthetic cathinones and cannabinoids.In cases of intoxication with synthetic cathinones, the psychiatric and neurological symptoms were long-lasting, and these compounds were detected in serum for 15-48 h after use. Although the clinical symptoms induced by the synthetic cannabinoids disappeared within several hours after use, the range of serum concentrations of these compounds was ≤5 ng/mL for 1-3 h after use. In one fatal case, in which high serum concentrations of synthetic cathinones and cannabinoids were detected, the most plausible cause of death was heart failure due to overdose with these drugs. The long-lasting symptoms induced by synthetic cathinones correlated with the long detection window in serum, whereas the early disappearance of symptoms induced by synthetic cannabinoids corresponded to the short detection window in serum.Conclusions: This study shows that the profiles of synthetic cathinones and cannabinoids in serum are closely related to the duration of the toxic symptoms and that concomitant use of two psychoactive drugs with different pharmacological actions may have the potential for fatal cardiotoxicity.

Identification and quantification of mepirapim and acetyl fentanyl in authentic human whole blood and urine samples by GC–MS/MS and LC–MS/MS

“…We encountered a case of substance abuse involving two individuals, one fatal and the other non-fatal, which involved the same product, “Angela,” self-administered intravenously and by inhalation, respectively. Although mepirapim was first identified in herbal blends in Japan [ 4 ], with the exception of a brief mention of serum mepirapim concentration in one of six poisoning cases encountered in emergency medicine [ 16 ], this is the first report dealing with identification and quantification of mepirapim in biological specimens. Acetyl fentanyl has also been identified repeatedly in Japan in herbal products sold through the Internet and/or quantified in human specimens [ 8 – 15 ].…”

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

“…Sample preparation and extraction procedures varied widely: liquid-liquid extraction was the most frequently used, though solid-phase extraction (24,44,47,53) and QuEChERS dispersive solid-phase extraction (29,30,35,50) were also reported. Only in a minority of the cases, the standard addition method was employed for quantification (19,23,28,30).…”

“…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).…”

Exploring the Baseline Knowledge and Experience of Healthcare Professionals in the United Kingdom on Novel Psychoactive Substances

“…Furthermore, violence during pre-admission and during admission to acute mental health services is more prevalent in NPS users compared to non-NPS users; thus, more education and support in the management of NPS users has been requested by HCPs who experienced an increasing risk of violence within their workplace [24]. Synthetic cathinones (SC) were the second most frequently seized group of NPS in 2016, where symptoms of intoxication can be long-lasting compared to SCRAs and may potentially be fatal [25,26]. Furthermore, SC such as mephedrone are commonly used during 'chemsex' [27,28].…”