M.
Kim, T. Dzhakubaliev
Astana
Medical University, Kazakhstan
Harmful
effects of the use of synthetic cannabinoids
Currently, there is a lot of information about the
harmful effects of the use of synthetic cannabinoids. We tried to analyze the
level of scientific validity of the data.
The PubMed system was chosen as a tool.
PubMed is a free search engine accessing primarily the MEDLINE database
of references and abstracts on life sciences and biomedical topics. The United States National Library of Medicine
at the National Institutes of Health maintains
the database as part of the Entrez system of
information retrieval.
In search of information we requested «synthetic
cannabinoids» and used the filter – not more than 5 years. More than 400
publications were found, which based on this request. Almost all publications
were case series. In fact the synthetic cannabinoids are the drugs and
conduction of randomized controlled trials is impossible. Also were found
several systematic reviews. Next, we present some results of the search.
«Synthetic Cannabinoids: Epidemiology,
Pharmacodynamics, and Clinical Implications» – Marisol S. Castaneto, David A. Gorelick (2014). As the authors said, recreational synthetic
cannabinoids (SC) intake arose in the 2000’s and many adverse effects were
reported. Acute SC intoxication can lead to hospitalization, requiring
supportive care, benzodiazepines, and fluids. While most such patients were
released within 24h of admission, severe adverse effects such as cardiotoxicity,
and psychosis resulted in hospitalization for as long as 2 weeks. Deaths
directly linked to SC use were quite rare. Some chronic SC users experienced
withdrawal symptoms when they stopped drug intake [1].
«A systematic review of adverse events arising
from the use of synthetic cannabinoids and their associated treatment» – Tait RJ, Caldicott D, Mountain D (2016). From 256 reports, authors of this article identified
106 eligible studies including 37 conference abstracts on about 4000 cases
involving at least 26 deaths. Major complications include cardiovascular events
(myocardial infarction, ischemic stroke and emboli), acute kidney injury (AKI),
generalized tonic-clonic seizures, psychiatric presentations (including first
episode psychosis, paranoia, self-harm/suicide ideation) and hyperemesis.
However, most presentations were not serious, typically involved young males
with tachycardia (37-77%), agitation (16-41%) and nausea (13-94%) requiring
only symptomatic care with a length of stay of less than 8 hours. Authors made
next conclusions: SCs most frequently result in tachycardia, agitation and
nausea. These symptoms typically resolve with symptomatic care, including
intravenous fluids, benzodiazepines and anti-emetics, and may not require
inpatient care. Severe adverse events (stroke, seizure, myocardial infarction,
rhabdomyolysis, psychosis and hyperemesis) and associated deaths manifest less
commonly. Precise estimates of their incidence are difficult to calculate due
to the lack of widely available, rapid laboratory confirmation, the variety of
SC compounds and the unknown number of exposed individuals. Long-term
consequences of SCs use are currently unknown [2].
«Synthetic Cannabinoids-Further Evidence
Supporting the Relationship Between Cannabinoids and Psychosis» – Fattore L (2016). Reports suggesting that SCs may either exacerbate
previously stable psychotic symptoms (in vulnerable individuals) or trigger
new-onset psychosis (in individuals with no previous history of psychosis) are
reviewed [3].
«Hemorrhagic stroke following use of the
synthetic marijuana «spice» – David Z.
Rose, Waldo R. Guerrero, Maxim V. Mokin (2015). So far there were no cases of stroke due to use of SCs. The
authors provide evidence of hemorrhagic stroke on the background of the SCs smoking. The authors attribute the development of stroke with
an increase in blood pressure as a result of the SCs
smoking [4].
«Synthetic Cannabinoid Abuse in Adolescents: A Case
Series» – Besli
GE, Ikiz MA, Yildirim S (2015). Authors described the process of treatment of 16
patients. The mean age of
the 16 patients with a diagnosis of synthetic cannabinoid intoxication was 15,4
± 1,7 years (15 males, 1 female). The most common physical symptoms were eye
redness, nausea/vomiting, sweating, and altered mental status; the main
psychoactive findings were agitation, anxiety, hallucinations, and perceptual
changes. Researchers observed hypotension and bradycardia in 8 (50%) and 5
(31.3%) of the patients, respectively. Although most patients were discharged
from the ED, 25% were transferred to an intensive care unit. They all had
reduced school attendance and performance. The rates of cigarette smoking and
alcohol drinking were also significantly higher. Synthetic cannabinoids are unsafe and potentially
harmful drugs of abuse; they may even cause life-threatening effects. It is
important for pediatricians to be familiar with the signs and symptoms of
consumption of synthetic cannabinoid products [5].
«Spice/K2 synthetic marijuana-induced toxic
hepatitis treated with N-acetylcysteine» – Sheikh IA, Lukšič M, Ferstenberg R (2014).
Authors presented a case of a 45-year-old male substance abuser who was
admitted with evidence of hepatocellular necrosis and worsening liver failure.
Tests for acetaminophen were negative, as were tests for alcohol. The patient
was empirically treated with N-acetylcysteine. Hepatocellular damage was abated
and the patient made a full recovery. Upon regaining consciousness, the patient
admitted to smoking Spice/K2. Other toxicities have been reported with
synthetic marijuana use, but not liver toxicity. As conclusion, authors said
that physicians need to have a high index of suspicion for unknown hepatotoxins
in substance abusers [6].
«Spice» – synthetic cannabinoids with dangerous effects» – Personne M, Westerbergh J, Hammer-Pettersen L (2014). A case concerning a young male with convulsions and
acute kidney failure requiring temporary dialysis is presented. Other cases reported
serious effects of this group of substances are acute psychosis, unconsciousness,
cardiac ischemia, seizures and stroke. The vendors are very aware of the legal
situation in each country and adjust their supply according to current
narcotics classifications. New, previously unknown cannabinoids are constantly
appearing on the market [7].
«K2 – not the spice of life; synthetic cannabinoids and
ST elevation myocardial infarction: a case report» – McKeever RG, Vearrier D, Jacobs D (2015). The patient admitted to smoking «K2» 60-90 min prior
to the onset of symptoms. The patient manifested persistent ST elevations with
a peak troponin of 8,29 ng/mL. The urine drug immunoassay was positive for
benzodiazepines and opiates. Synthetic cannabinoids may have significant
potential adverse effects. Chest pain due to myocardial ischemia is rare in
adolescents. When evaluating patients with chest pain, it is important to
elicit a detailed drug history, specifically inquiring about synthetic
cannabinoid use [8].
«New Differential Diagnosis: Synthetic
Cannabinoids-Associated Acute Renal Failure» – Vineet S. Gudsoorkar and Jose A. Perez, Jr. (2015). Synthetic cannabinoid toxicity should be considered as
an important cause of ARF in the young population. SC-associated ARF is
potentially reversible with supportive treatment, although the long-term effects
are unknown. It is crucial that these patients have regular outpatient
follow-up with frequent monitoring of renal function. While public health
efforts are underway to control these substances, it is likely difficult to
eliminate their abuse. Thus, the physicians caring for adolescents with
unexplained ARF should be educated about the potential of SC-induced ARF and
the importance of appropriate reporting of these cases [9].
«Repeated Thrombosis After Synthetic Cannabinoid
Use» – Raheemullah A, Laurence T
(2016). This report shows that an association between
thrombosis and the use of synthetic cannabinoids is reproducible and involves
both venous and arterial thrombosis, suggesting activation of coagulation or
inflammatory pathways. Synthetic cannabinoid use should be included in the
differential diagnosis of young patients with no risk factors who present with
venous or arterial thrombosis [10].
Conclusions:
1. Scientific community accumulated a large quantity
of scientific data on the effects of synthetic cannabinoids.
2. The use of synthetic cannabinoids spread throughout
the world, as evidenced by the presence of scientific publications from
different countries.
3. Intervention of synthetic cannabinoids on the human
body is complex with the damage of the various organs and systems.
4. The harmful effects of synthetic cannabinoids are
scientifically proven.
References:
1.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4253059/
2. https://www.ncbi.nlm.nih.gov/pubmed/26567470
3. https://www.ncbi.nlm.nih.gov/pubmed/26970364
4.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4603886/
5. https://www.ncbi.nlm.nih.gov/pubmed/26293411
6. https://www.ncbi.nlm.nih.gov/pubmed/25548903
7. https://www.ncbi.nlm.nih.gov/pubmed/25386644
8. https://www.ncbi.nlm.nih.gov/pubmed/25154434
9.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4666428/
10. https://www.ncbi.nlm.nih.gov/pubmed/27595371