Teens and Spice: A Review of Adolescent Fatalities Associated with Synthetic Cannabinoid Use

Abstract

Synthetic cannabinoids (SCs) are commonly abused by adolescents with reported past year (2013) use in high school students between 3 and 10%. Standard adolescent postmortem toxicology does not include routine SC analysis, and thus, the true burden of fatalities related to SCs is unknown. A retrospective case review of two cases included scene investigation, interviews, autopsy, and toxicology. SCs were confirmed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Review of the eight adolescent SC-associated fatalities in the literature revealed five of eight cases had no other discernible cause of death on autopsy. Compounds detected included PB-22 (1.1 ng/mL), JWH-210 (12 ng/mL), XLR-11 (1.3 ng/mL), JWH-122, AB-CHMINACA (8.2 ng/mL), UR-144 (12.3 ng/mL), and JWH-022 (3 ng/mL). With synthetic drug use on the rise, forensic experts should have a high index of suspicion for the possibility of SC intoxication in adolescent fatalities with no other discernible cause of death.

New/emerging psychoactive substances and associated psychopathological consequences

“…Typical medical untoward effects include: vomiting/nausea; hypertension and tachycardia; tachypnoea/dyspnoea; hyperglycaemia; mydriasis (Hermanns-Clausen et al, 2013;Schifano et al, 2015;Winstock and Barratt, 2013b); nystagmus; seizures (Hopkins and Gilchrist, 2013); encephalopathy (Louh and Freeman, 2014); coma; and stroke (Freeman et al, 2013;Mir et al, 2011;Rose et al, 2015). Ultimately, deaths have been associated with the use of synthetic cannabinoids, either on their own or in combination (Angerer et al, 2017;Corkery et al, 2014;Maeda et al, 2018;Olsen, 2018;Paul et al, 2018;Tait et al, 2015;Trecki et al, 2015). These may result from direct lethality of the molecule; behavioural dyscontrol; or suicide (Lászik et al, 2015;Patton et al, 2013;Rosenbaum et al, 2012;Shanks et al, 2012).…”

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

“…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). "-": further analyses were performed on a previously published case.…”

“…Cause of death was stated in all but 4 cases (5%). Cardiac arrhythmias and cardio-circulatory acute effects were listed in 17 cases (23%) as cause of death or as underlying mechanisms in a group of mono and poly-drug intoxications, involving both teenagers and adults (20,21,35,40,48). A number of death cases were associated with excited delirium and police restraints (33), as well as fall from height, either due to drug-induced psychosis or reduced awareness with accidental falling (24,26).…”

A Perspetiva da Toxicologia Clínica Sobre a Utilização Terapêutica da Cannabis e dos Canabinoides

“…Para além dos fitocanabinoides e dos endocanabinoides, nos últimos anos tem-se assistido à introdução de novas substâncias psicoativas, como é o caso dos cana-binoides sintéticos usados com fins recreativos, e que são muitas vezes mais potentes do que os presentes na planta e podem apresentar efeitos tóxicos imprevisíveis, inclusive fatais. 13,33,34 Enquanto nestes derivados a realidade é sombria e de repercussões clínicas e forenses negativas, 35 os fitocanabinoides têm já várias ações terapêuticas comprovadas cientificamente. Em ciência vivemos do apoio da estatística para suportar as nossas evidências.…”