Synthetic cannabinoids

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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

Drugs of abuse

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

  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.