Synthetic cannabinoid toxicity

Background

  • Common street names: spice, K2, Moon Rocks, Blue Lotus, many others
  • Active ingredients frequently change to avoid legal proscription
  • Generally contains cannabinoid receptor agonists (CB1 or CB2) that are far more potent than THC
  • Does not show up on routine tox screen
  • Generally smoked, but can be imbibed as a tea

Hallucinogen, designer drug, and club drug toxicities

Clinical Features

  • Similar effect to marijuana at low doses, but may be more intense and cause an acute Excited delirium
  • Typical onset of 10-30 min and taper over 1-2 hours
  • Tachycardia and hypertension common (distinguishing it from MJ use)
  • Adverse effects:;nausea, vomiting, diaphoresis, anxiety, paranoia, hallucinations, agitation, delirium
  • Use has been associated with AKI and acute cerebral ischemia.[1][2]
  • Serious bleeding as some synthetic cannibinoids contaminated with long acting vitamin K-dependent antagonists (brodifacoum) [3]

Differential Diagnosis

Sympathomimetic toxicities

Drugs of abuse

Evaluation

  • Clinical diagnosis

Diagnosis

Toxidrome Chart

Finding Cholinergic Anticholinergic Sympathomimetic Sympatholytic^ Sedative/Hypnotic
Example Organophosphates TCAs Cocaine Clonidine ETOH
Temp Nl Nl / ↑ Nl / ↑ Nl / ↓ Nl / ↓
RR Variable Nl / ↓ Variable Nl / ↓ Nl / ↓
HR Variable ↑ ↑ (sig) Nl / ↓ Nl / ↓
BP ↑ ↑ ↑ Nl / ↓ Nl / ↓
LOC Nl / Lethargic Nl, agitated, psychotic, comatose Nl, agitated, psychotic Nl, Lethargic, or Comatose Nl, Lethargic, or Comatose
Pupils Variable Mydriatic Mydriatic Nl / Miotic
Motor Fasciculations, Flacid Paralysis  Nl Nl / Agitated Nl
Skin Sweating (sig) Hot, dry Sweating Dry
Lungs Bronchospasm / rhinorrhea Nl Nl Nl
Bowel Sounds Hyperactive (SLUDGE) ↓ / Absent Nl / ↓ Nl / ↓
^Consider Sympatholytic when looking at Sedative OD or someone who doesn't respond to Narcan
Withdrawal from substances have the opposite effect

Management

  • Supportive care
  • May require sedative agent such as benzodiazepines or antipsychotics, as well as physical restraints, if severely agitated and posing a threat to self and staff

Disposition

  • Generally may be discharged once sober (assuming no adverse effects that would mandate admission)

See Also

References

  1. ↑ Buser GL, Gerona RR, Horowitz BZ, et al. Acute kidney injury associated with smoking synthetic cannabinoid. Clin Toxicol (Phila). 2014;52(7):664–73.
  2. ↑ Takematsu M, Hoffman RS, Nelson LS, Schechter JM, Moran JH, Wiener SW. A case of acute cerebral ischemia following inhalation of a synthetic cannabinoid. Clin Toxicol (Phila). 2014;52(9):973–5.
  3. ↑ Moritz, E., Austin, C., Wahl, M., DesLauriers, C., Navon, L., Walblay, K., … Layden, J. (2018). Notes from the Field: Outbreak of Severe Illness Linked to the Vitamin K Antagonist Brodifacoum and Use of Synthetic Cannabinoids - Illinois, March-April 2018. MMWR. Morbidity and Mortality Weekly Report, 67(21), 607–608.
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