Synthetic cannabinoids: Difference between revisions
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==Background== | ==Background== | ||
*Common names: spice, K2, Moon Rocks, Blue Lotus, many others | *Common street names: spice, K2, Moon Rocks, Blue Lotus, many others | ||
*Active ingredients | *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 | ||
*Generally smoked, but can be | |||
==Clinical Features== | ==Clinical Features== | ||
*Similar effect to marijuana at low doses, but may be more intense and cause an acute | *Similar effect to marijuana at low doses, but may be more intense and cause an acute [[Excited delirium]] | ||
*Typical | *Typical onset of 10-30 min and taper over 1-2 hours | ||
*'''Tachycardia and hypertension''' common (distinguishing it from MJ use) | *'''Tachycardia and hypertension''' common (distinguishing it from MJ use) | ||
*Adverse effects: | *Adverse effects:;nausea, vomiting, diaphoresis, anxiety, paranoia, hallucinations, agitation, delirium | ||
*Use has been associated with AKI and acute cerebral ischemia.<ref>Buser GL, Gerona RR, Horowitz BZ, et al. Acute kidney injury associated with smoking synthetic cannabinoid. Clin Toxicol (Phila). 2014;52(7):664–73.</ref><ref>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.</ref> | |||
*Serious bleeding as some synthetic cannibinoids contaminated with long acting vitamin K-dependent antagonists (brodifacoum) <ref>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.</ref> | |||
== | ==Differential Diagnosis== | ||
{{Sympathomimetic types}} | |||
{{Drugs of abuse types}} | |||
[[Category: | ==Evaluation== | ||
*Clinical diagnosis | |||
==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== | |||
*[[Sympathomimetic toxicity]] | |||
*[[Marijuana]] | |||
==References== | |||
<references/> | |||
[[Category:Toxicology]] |
Latest revision as of 18:49, 12 August 2018
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
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
Sympathomimetics
- Cocaine
- Amphetamines
- Synthetic cathinones (khat)
- Ketamine
- Ecstasy (MDMA)
- Synthetic cannabinoids
- Bath salts
Drugs of abuse
- 25C-NBOMe
- Alcohol
- Amphetamines
- Bath salts
- Cocaine
- Ecstasy
- Gamma hydroxybutyrate (GHB)
- Heroin
- Inhalant abuse
- Hydrocarbon toxicity
- Difluoroethane (electronics duster)
- Marijuana
- Kratom
- Phencyclidine (PCP)
- Psilocybin ("magic mushrooms")
- Synthetic cannabinoids
- Chloral hydrate
- Body packing
Evaluation
- Clinical diagnosis
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
- ↑ Buser GL, Gerona RR, Horowitz BZ, et al. Acute kidney injury associated with smoking synthetic cannabinoid. Clin Toxicol (Phila). 2014;52(7):664–73.
- ↑ 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.
- ↑ 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.