Synthetic cannabinoid-associated coagulopathy secondary to long-acting anticoagulant rodenticides

Bahouth, Mona N.; Kraus, Peggy S.; Dane, Kathryn; Montana, Manuela Plazas; Tsao, William; Tabaac, Burton J.; Jasem, Jagar; Schmidlin, Holly; Einstein, Evan Hy; Streiff, Michael B.; Shanbhag, Satish

doi:10.1097/md.0000000000017015

Cited by 7 publications

(2 citation statements)

References 25 publications

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“…intravenous, PCC prothrombin complex concentrate, TOF train-offour (stimulations) Rationale Following the use of psychostimulant or hallucinogenic NPS, the toxic features comprise adrenergic signs (tachycardia, hypertension, restlessness, mydriasis), encephalopathy (confusion, hallucinations), serotonergic signs (myoclonus, fever) and/or organ failure [193][194][195][196]. There is a high risk of neurological complications (coma, seizures, stroke), as well as a risk of cardiovascular, respiratory, renal (tubular necrosis due to rhabdomyolysis, tubulo-interstitial nephritis with halogenated cannabinoids), liver and/or haematological failure (disseminated intravascular coagulation, haemorrhage due to contamination of synthetic cannabinoids with vitamin K antagonist rat poisons) [197,198]. Opioid syndrome is observed after consumption of a central nervous system depressant NPS, although atypical features have been reported (tachycardia, hypertension, kidney failure) [199].…”

Section: Question 63: When Should An Antidote (When One Exists) Be Amentioning

confidence: 99%

Management of pharmaceutical and recreational drug poisoning

Mégarbane

Oberlin

Alvarez

et al. 2020

Ann. Intensive Care

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Background Poisoning is one of the leading causes of admission to the emergency department and intensive care unit. A large number of epidemiological changes have occurred over the last years such as the exponential growth of new synthetic psychoactive substances. Major progress has also been made in analytical screening and assays, enabling the clinicians to rapidly obtain a definite diagnosis. Methods A committee composed of 30 experts from five scientific societies, the Société de Réanimation de Langue Française (SRLF), the Société Française de Médecine d’Urgence (SFMU), the Société de Toxicologie Clinique (STC), the Société Française de Toxicologie Analytique (SFTA) and the Groupe Francophone de Réanimation et d’Urgences Pédiatriques (GFRUP) evaluated eight fields: (1) severity assessment and initial triage; (2) diagnostic approach and role of toxicological analyses; (3) supportive care; (4) decontamination; (5) elimination enhancement; (6) place of antidotes; (7) specificities related to recreational drug poisoning; and (8) characteristics of cardiotoxicant poisoning. Population, Intervention, Comparison, and Outcome (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Analysis of the literature and formulation of recommendations were then conducted according to the GRADE® methodology. Results The SRLF-SFMU guideline panel provided 41 statements concerning the management of pharmaceutical and recreational drug poisoning. Ethanol and chemical poisoning were excluded from the scope of these recommendations. After two rounds of discussion and various amendments, a strong consensus was reached for all recommendations. Six of these recommendations had a high level of evidence (GRADE 1±) and six had a low level of evidence (GRADE 2±). Twenty-nine recommendations were in the form of expert opinion recommendations due to the low evidences in the literature. Conclusions The experts reached a substantial consensus for several strong recommendations for optimal management of pharmaceutical and recreational drug poisoning, mainly regarding the conditions and effectiveness of naloxone and N-acetylcystein as antidotes to treat opioid and acetaminophen poisoning, respectively.

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Section: Question 63: When Should An Antidote (When One Exists) Be Amentioning

confidence: 99%

Management of pharmaceutical and recreational drug poisoning

Mégarbane

Oberlin

Alvarez

et al. 2020

Ann. Intensive Care

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“…Outbreaks of coagulopathy from products marketed as cannabinoids but containing long-acting rodenticide raises life-threatening concerns [139]. Commercially available, mislabeled and adulterated cannabis products pose major health risks [137,138,140]. Therefore, awareness and education of individuals regarding potential harms of the adulterated and unreliable cannabis products needs to be raised and users and healthcare providers need to validate the reliability of the contents.…”

Section: Tsunami Of Cannabinoidsmentioning

confidence: 99%

Considerations for Cannabis Use to Treat Pain in Sickle Cell Disease

Argueta

Aich

Muqolli

et al. 2020

JCM

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Pain in Sickle Cell Disease (SCD) is a major comorbidity and unique with acute pain due to recurrent and episodic vaso-occlusive crises as well as chronic pain, which can span an individual’s entire life. Opioids are the mainstay treatment for pain in SCD. Due to recent health crises raised by adverse effects including deaths from opioid use, pain management in SCD is adversely affected. Cannabis and its products are most widely used for pain in multiple conditions and also by patients with SCD on their own. With the availability of “Medical Cannabis” and approval to use cannabis as medicine across majority of States in the United States as well as over-the-counter preparations, cannabis products are being used increasingly for SCD. The reliability of many of these products remains questionable, which poses a major health risk to the vulnerable individuals seeking pain relief. Therefore, this review provides up to date insights into available categories of cannabis-based treatment strategies, their mechanism of action and pre-clinical and clinical outcomes in SCD. It provides evidence for the benefits and risks of cannabis use in SCD and cautions about the unreliable and unvalidated products that may be adulterated with life-threatening non-cannabis compounds.

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