Clinical Effects of Synthetic Cannabinoid Receptor Agonists Compared with Marijuana in Emergency Department Patients with Acute Drug Overdose

Abstract

In the first clinical study comparing the adverse effects of SCRA overdose vs. marijuana controls in an ED population, we found that SCRA overdoses had significantly pronounced neurotoxicity and cardiotoxicity compared with marijuana.

Evolution of clinical characteristics and outcomes of synthetic cannabinoid receptor agonist exposure in the United States: analysis of National Poison Data System data from 2010 to 2015

“…Similar to previously published studies, our results showed that the majority of the single‐substance SCRA exposures resulted in self‐limited symptoms and required supportive care . The most commonly reported SCRA‐associated effects during the 6‐year period were tachycardia, followed by CNS effects: agitation, drowsiness/lethargy, confusion and hallucination.…”

“…Additionally, a recent report of ‘zombie‐like’ features of ABM‐FUBINACA exposure shows that the clinical effects of SCRA exposure appears to be changing with the introduction of new SCRA compounds . Numerous studies have described the characteristics of clinical effects of SCRA exposure . These studies showed that the most common symptoms for SCRA exposure were tachycardia followed by central nervous system (CNS) effects, including agitation, delirium and psychosis .…”

“…Numerous studies have described the characteristics of clinical effects of SCRA exposure . These studies showed that the most common symptoms for SCRA exposure were tachycardia followed by central nervous system (CNS) effects, including agitation, delirium and psychosis . However, they did not examine whether the clinical toxicity from SCRA exposure changed as newer SCRAs emerged.…”

Cannabinoid1 (CB-1) receptor antagonists: a molecular approach to treating acute cannabinoid overdose

“…c) Symptoms: Symptoms produced by both cannabis products and SCs that can precipitate an ED visit include extreme lethargy, ataxia, decreased concentration and generalized psychomotor impairment, feelings of panic and anxiety, agitation, delirium, hallucinations, psychosis, tachycardia, and nausea/vomiting. Symptom severity varies with the route of administration, quantities used, as well as the age of the patient (Castaneto et al 2014;Monte et al 2017;Winstock et al 2015;Kim and Monte 2016;Zaurova et al 2016). Hermanns-Clausen et al 2013report that the adverse events produced by SCs were mostly similar to those produced by high dose cannabis (i.e., THC-containing products).…”

“…Based on a recent analysis of the National Emergency Department Sample, we estimate there will be in excess of 1.7 million cannabis-related ED visits in 2019. There are currently no approved medications to reverse symptoms resulting from an acute cannabinoid overdose (ACO) which can trigger an ED visit (Zaurova et al 2016), and in more severe cases, hospitalization (Winstock et al 2015). Terms like cannabis poisoning and marijuana intoxication have also been used to describe ACO (Kim and Monte 2016;Ishak et al 2018); there are multiple International Classification of Diseases (ICD) codes using descriptors such as cannabis intoxication and cannabis poisoning (Monte et al 2019).…”