The Wide and Unpredictable Scope of Synthetic Cannabinoids Toxicity

Abstract

Drug use and abuse continue to be a large public health concern worldwide. Over the past decade, novel or atypical drugs have emerged and become increasingly popular. In the recent past, compounds similar to tetrahydrocannabinoid (THC), the active ingredient of marijuana, have been synthetically produced and offered commercially as legal substances. Since the initial communications of their abuse in 2008, few case reports have been published illustrating the misuse of these substances with signs and symptoms of intoxication. Even though synthetic cannabinoids have been restricted, they are still readily available across USA and their use has been dramatically increasing, with a concomitant increment in reports to poison control centers and emergency department (ED) visits. We describe a case of acute hypoxemic/hypercapnic respiratory failure as a consequence of acute congestive heart failure (CHF) developed from myocardial stunning resulting from a non-ST-segment elevation myocardial infarction (MI) following the consumption of synthetic cannabinoids.

Marijuana medusa: The many pulmonary faces of marijuana inhalation in adolescent males

“…Acute respiratory failure is a common complication of inhalation drug abuse, most commonly from cocaine and amphetamines abuse . An increasing number of cases of respiratory failure from marijuana abuse have been reported in adults . The most common pulmonary injuries from marijuana inhalation are bronchospasm, pneumothorax, and aspergillus infection from contaminated inhalants .…”

“…9,10 An increasing number of cases of respiratory failure from marijuana abuse have been reported in adults. [11][12][13][14][15][16][17][18] The most common pulmonary injuries from marijuana inhalation are bronchospasm, pneumothorax, and aspergillus infection from contaminated inhalants. 9,19,20 Though rare, reports of tainted forms of marijuana, referred to as "smoking wet" or "fry," leading to respiratory failure requiring extracorporeal membrane oxygenation (ECMO), have been reported.…”

Role of cannabis in cardiovascular disorders

“…Synthetic cannabinoids (SCs) are cannabis preparations that were synthesized during the process of identifying cannabinoid receptors. They were first sold under the name "spice" which is made of cannabinomimetic JWH-018 and other cannabinoids such as CP-47, 497,497-C8 (78). JWH-018 has stronger affinity for CB1 and CB2 receptors and produces extreme cannabinomimetic effects compared to marijuana.…”

“…SCs are marketed under various other names including K2, skunk, joker, mojo, aroma, dream and black mamba etc. (78,79) and have gained increasing popularity because they are considered "legal" alternatives to marijuana that is safe (80). The rising popularity of these products has been accompanied by a significant increase in the number of emergency admissions due to SCs.…”

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

“…ability to activate receptors to produce maximal effect) compared to THC . Consequently, SCRAs produce a wide range of clinical effects beyond their cannabinomimetic properties, including potentially life‐threatening sympathomimetic‐like toxicity and end‐organ injury .…”