CD
Synthetic Cannabinoid
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Synthetic Cannabinoid
, Synthetic Marijuana, K2, JWH
See Also
Marijuana
Synthetic Cathinone
(Bath Salts)
NBOMe
Chemical Dependency
Substance Abuse Evaluation
Agitated Delirium
Pharmacology
Synthetic Cannabinoids
Originally produced as research chemicals to study receptor binding in the 1980s
Synthetic Cannabinoids may have 10-200 times the potency at specific receptor sites
Produced by spraying dried, shredded herbal plant leaves with cannabinoid receptor agonists
Synthetic agonists are THC-like agents based on one of four synthetic parent agents
Synthetic agonists are small, lipid soluble, non-polar molecules (22 to 26 carbons)
Agents act at two cannabinoid receptors (with high affinity to CB1)
CB1 - CNS receptors (decrease intracellular cAMP and increase MAP kinase)
Elevates mood and increases feelings of well being
Affects pain tolerance, time perception, memory
CB2 - T Cells,
B Cell
s and
Macrophage
s as well as peripheral nerves
Most agents are pure agonists at cannabinoid CB1 cerebral receptor (contrast with THC as a partial agonist)
Synthetics result in more intense, and unpredictable
Intoxication
than THC
Synthetic THC lacks the
Cannabidiol
(
Antipsychotic
, anticonvulsant) effects of
Cannabis
sativa (
Marijuana
)
Hence the unpredictable psychotic effects and
Seizure
s with synthetic THC
In addition, formulations frequently change to overcome detection
Typically smoked in pipe or
Cigarette
paper
Has also been vaporized and inhaled, as well as ingested
Preparations
Sold in 1-3 gram foil pouches of dried
Herbals
Typically labeled as "not for human consumption" or marketed as incense
More than 50 distinct products have been identified in the U.S.
Various
Herbals
and crushed leaves are added for appearance only (drug is dripped onto the leaves)
Inconsistent effects across products as well as within the same brand (unpredictable)
Even different effects in the same package shared by different users
May occur with concentrated portions within the package
Street Names
K2
Kronic
Spice
JWH (John W. Huffman)
Legal
Marijuana
Fake Weed
Black Mamba
Mojo
Scooby Snax
Death Ride
Intensely aromatic incense
Cloud-9 (AB-PINACA)
Liquid form vaporized and resulted in multiple hospitalizations in 2014
Symptoms
Intoxication
Marijuana
-like
Intoxication
(sought effects)
Euphoria, elevated mood or intense "high"
Uncontrolled laughter
Disinhibition
Other effects
Hyperadrenergic effects
Agitated Delirium
(with possible
Seizure
s)
Altered Mental Status
with sedation
Signs
Intoxication
Diaphoresis
Hyperreflexia
Nystagmus
Conjunctiva
l injection
Symptoms
Withdrawal
Headache
Anxiety
Depressed Mood
Irritability
Adverse Effects
Effects vary due to the ever changing formulations and compositions of Synthetic Cannabinoids and contaminants
Life threatening bleeding (2018)
Related to
Anticoagulant
-laced Synthetic Cannabinoids in 2018
Cannabinoids were laced with Brodifacoum (rat poison) with effects that last for months
May require high dose
Vitamin K
(50 mg PO three times daily) for months (at up to $45,000 per month)
(2018) Presc Lett 25(6):35 [PubMed]
Neuropsychiatric effects
Confusion
Agitation
, irritation or
Violent Behavior
Severe anxiety
Memory loss
Loss of consciousness
Generalized Seizure
s
Acute
Psychosis
("Spiceophrenia")
Severe paranoia and
Hallucination
s (auditory and visual)
May persist for days to months
May occur after a single dose
Gastrointestinal effects
Nausea
or
Vomiting
Diarrhea
Cardiovascular effects
Palpitation
s and
Cardiac Arrhythmia
Heart Rate
changes (
Tachycardia
or
Bradycardia
)
Blood Pressure
changes (
Hypertension
or
Hypotension
)
Cardiac ischemia
Endocrine and renal effects
Hypokalemia
Metabolic Acidosis
Hyperglycemia
Acute Kidney Injury
Rhabdomyolysis
Withdrawal symptoms with regular use
Anxiety, irritability,
Insomnia
Chills
Profuse diaphoresis
Tremor
s
Myalgias
Headache
s
Anorexia
,
Nausea
,
Vomiting
Labs
Serum Creatinine
Serum Glucose
Creatine Kinase
(CK)
Serum
Lactic Acid
Serum
Troponin
Diagnostics
Electrocardiogram
Management
Acute
Aggressive supportive care management
No specific antidotes
Avoid unnecessary intubation
Protect patients and staff
See
Agitated Delirium
Sedation allows for
IV Access
, patient exposure, labs and diagnostics
IV crystalloid fluid
Resuscitation
Indicated for dehydration
Benzodiazepine
s
First-line agent
Indicated for
Agitation
Diphenhydramine
Indicated for
Dystonia
Cooling
Indicated for hyperthermia
Antipsychotic
s (e.g.
Zyprexa
,
Haloperidol
)
Indicated for acute
Psychosis
, esp. refractory to
Benzodiazepine
s
Avoid prophylactically due to theoretical risk of
Seizure
Management
Chemical Dependency
Cognitive Behavioral Therapy
Motivational Enhancement Therapy with abstinence-based incentives
No medication is supported with sufficient evidence
Precautions
Agents are unregulated and unpredictable with variable components, potency and toxicity
Acute
Psychosis
lasting months may occur after only a single dose
Intentionally adulterated products with life threatening effects have been reported
Life threatening bleeding due to
Anticoagulant
-laced Synthetic Cannabinoids in 2018
See Adverse Effects as above
Associated with 24 deaths in Mississippi in 2015
Resources
NIH
Drug Abuse
http://www.drugabuse.gov/publications/drugfacts/synthetic-cannabinoids
DEA K2 or Spice
http://www.dea.gov/druginfo/drug_data_sheets/K2_Spice.pdf
References
Tomaszewski (2016)
Drugs of Abuse
, ACEP PEM Conference, Orlando, attended 3/8/2016
Fattore (2011) Front Behav Neurosci 5: 60
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3187647/
Haynes, Meadors and Yuan (2016) Crit Dec Emerg Med 30(2): 3-9
Rosenbaum (2012) J Med Toxicol 8(1): 15–32
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3550220/
Swaminathan and LaPoint in Herbert (2019) EM:Rap 19(5): 6-7
Kemp (2016) Am J Med 129(3):240 [PubMed]
Khullar (2014) J Gen Intern Med 29(8):1200-4 +PMID:24553958 [PubMed]
Klega (2018) Am Fam Physician 98(2): 85-92 [PubMed]
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