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

Cordeiro, Samuel K.; Daro, Ryan C.; Seung, Hyunuk; Kim, Hong

doi:10.1111/add.14281

Cited by 6 publications

(5 citation statements)

References 43 publications

(59 reference statements)

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“…In the UK, this is especially relevant in the prisoner population and amongst those facing homelessness [3,7]. Not only are the clinical features of acute SC toxicity difficult to identify and treat, particularly for the more recent third-generation SCs [6,8,9], but the analysis of these compounds in bulk-drug seizures and in biological samples can also be challenging, even using the most modern analytical instrumentation. Analysis is complicated by (1) the sheer number of SCs that exist [10,11], (2) their physicochemical diversity, (3) the frequent formation of multiple (pharmacologically active) metabolites [10,[12][13][14], (4) their (in)stability and chemical transformations when ingested via smoking (i.e., their pyrolysis products [15][16][17][18]), (5) their potency, which transpires to low concentrations in biological samples, and (6) the limited availability of reference materials.…”

Section: Introductionmentioning

confidence: 99%

Evidence of enzyme-mediated transesterification of synthetic cannabinoids with ethanol: potential toxicological impact

et al. 2019

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Purpose Synthetic cannabinoids (SCs) represent a large proportion of novel psychoactive substances on the black market and have caused a number of deaths. Polydrug use including combination of SCs and ethanol could further complicate the toxicological impact. To the best of our knowledge, there have been no reports presenting evidence of transesterification between SCs and ethanol in vitro. Methods The in vitro metabolism of the four carboxylate SCs PB-22, NPB-22, 5-fluoro-PB-22 (5F-PB-22), and 5-fluoro-NPB-22 (5F-NPB-22) in the presence of ethanol using human liver microsomes with and without appropriate enzyme inhibitors was studied. Newly identified SC ethyl esters were chemically synthesised and fully characterised. The activity of these SCs and their ethanol transesterification products were assessed using cannabinoid receptor (CB 1 and CB 2) activation assays. Results SCs/ethanol transesterification products were detected and studied using liquid chromatography-high-resolution mass spectrometry. We have shown that the SC ethyl ester formation is mediated by human carboxyl esterase enzymes. The ethyl esters exhibited a reduced activity for the CB receptors compared with their parent compounds. Conclusions These novel ethyl esters may be useful additional markers of cannabinoid administration, and especially so if they prove to have longer half-lives than their parent compounds.

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Section: Introductionmentioning

confidence: 99%

Evidence of enzyme-mediated transesterification of synthetic cannabinoids with ethanol: potential toxicological impact

et al. 2019

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“…For synthetic cannabinoids, a possible explanation for the association with self-discharge may be agitation, a frequently reported feature of synthetic cannabinoid toxicity [ 30 ]. Agitation may also be associated with self-discharge as a feature of opioid withdrawal.…”

Section: Discussionmentioning

confidence: 99%

Self-discharge during treatment for acute recreational drug toxicity: an observational study from emergency departments in seven European countries

Vallersnes,

Dines,

Wood

et al. 2023

Int J Emerg Med

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Background Self-discharge is a risk factor for readmission and excess mortality. We assess the rate of self-discharge from the emergency department (ED) among presentations for acute recreational drug toxicity and identify factors associated with self-discharge. Methods From the Euro-DEN Plus database of presentations to the ED with acute recreational drug toxicity, we extracted data from 11 centres in seven European countries from 2014 to 2017. Self-discharge was defined as taking one’s own discharge or escaping from the ED before being medically cleared. We used multiple logistic regression analyses to look for factors associated with self-discharge. Results Among 15,135 included presentations, 1807 (11.9%) self-discharged. Self-discharge rates varied from 1.7 to 17.1% between centres. Synthetic cannabinoids were associated with self-discharge, adjusted odds ratio 1.44 (95% confidence interval 1.10–1.89), as were heroin, 1.44 (1.26–1.64), agitation, 1.27 (1.10–1.46), and naloxone treatment, 1.27 (1.07–1.51), while sedation protected from self-discharge, 0.38 (0.30–0.48). Conclusion One in eight presentations self-discharged. There was a large variation in self-discharge rates across the participating centres, possibly partly reflecting different discharge procedures and practices. Measures to improve the management of agitation and cautious administration of naloxone to avoid opioid withdrawal symptoms may be approaches worth exploring to reduce self-discharge.

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“…Tracking emergence and prevalence of use of new and uncommon drugs is important for informing prevention and educational efforts. For example, the quick emergence of synthetic cannabinoids and synthetic cathinones (“bath salts”) in the United States was associated with tens of thousands of poisonings (American Association of Poison Control Centers, ; Cordeiro, Daro, Seung, Klein‐Schwartz, & Kim, ), suggesting the need for better monitoring of emerging drugs in order to help prevent adverse outcomes associated with use. Surveys are the leading source of gathering data on use of drugs, but they tend to focus heavily on the most common drugs (e.g., cannabis and cocaine) and drugs known to be associated with high rates of dependence (e.g., heroin and methamphetamine; Johnston, O'Malley, Miech, Bachman, & Schulenberg, ; Kann et al, ; Substance Abuse and Mental Health Services Administration, ).…”

Section: Introductionmentioning

confidence: 99%

Use of new and uncommon synthetic psychoactive drugs among a nationally representative sample in the United States, 2005–2017

Palamar

2019

Human Psychopharmacology

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Objectives: This study aims to examine patterns and first mentions of reported use of new or uncommon drugs across 13 years, among nationally representative samples in the United States.Methods: Participants (ages ≥12) in the National Surveys on Drug Use and Health (2005-2017, N = 730,418) were provided opportunities to type in names of new or uncommon drugs they had ever used that were not specifically queried. We examined self-reported use across survey years and determined years of first mentions. Results: From 2005 to 2017, there were 2,343 type-in responses for use of 79 new or uncommon synthetic drugs, and 54 were first-ever mentions of these drugs. The majority (65.8%) of mentions were phenethylamines (e.g., 2C-x, NBOMe), which were also the plurality of new drug mentions (n = 22; 40.7%). Mentions of 2C-x drugs in particular increased from 30 mentions in 2005 to 147 mentions in 2013. We estimate an upward trend in use of new or uncommon drugs between 2005 and 2017 (p < 0.001). Conclusion: Although type-in responses on surveys are limited and underestimate prevalence of use, such responses can help inform researchers when new compounds are used. Continued surveillance of use of new and uncommon drugs is needed to inform adequate public health response.

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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

Abstract: Hospitalization resulting from toxicity from synthetic cannabinoid receptor agonists exposure in the United States increased significantly between 2010 and 2015.

Cited by 6 publications

References 43 publications

Evidence of enzyme-mediated transesterification of synthetic cannabinoids with ethanol: potential toxicological impact

Evidence of enzyme-mediated transesterification of synthetic cannabinoids with ethanol: potential toxicological impact

Self-discharge during treatment for acute recreational drug toxicity: an observational study from emergency departments in seven European countries

Use of new and uncommon synthetic psychoactive drugs among a nationally representative sample in the United States, 2005–2017

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