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Characteristics and Treatment of Patients with Clinical Illness Due to Synthetic Cannabinoid Inhalation Reported by Medical Toxicologists: A ToxIC Database Study

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Abstract

Introduction

Synthetic cannabinoid (SC) abuse has resulted in numerous outbreaks of severe clinical illness across the United States over the past decade. The primary objective of this study was to determine the clinical characteristics of patients abusing SC requiring bedside consultation by medical toxicologists.

Methods

This was a multicenter analysis from a prospectively collected cohort of patients presenting to medical care after synthetic cannabinoid exposure, utilizing the ToxIC Registry. Management of cases by medical toxicologists in this cohort occurred in emergency departments, inpatient medical floors, and intensive care units. Cases were identified from January 5, 2010 – July 31, 2015. We characterized the clinical presentations, treatments, outcomes, and sociologic factors associated with SC use in these patients.

Results

Medical toxicologists participating in the ToxIC Registry cared for 39,925 cases between 2010 and 2015. Three hundred fifty three of these cases were determined to be SC toxicity. The median age of patients was 25 (IQR: 18, 36) and the majority were males (84%). The most common symptoms were agitation, delirium and toxic psychosis, n=146 (41%). Forty-four (12.5%) had heart rates above 140 beats per minute. Bradycardia was the second most commonly reported severe vital sign abnormality with 20 (5.7%) having heart rates of less than 50 beats per minute. Fifteen (4.2%) patients had hypotension. Fifty-nine (17%) had seizures. The most common pharmacologic treatment provided was benzodiazepines (n=131, 37%) followed by antipsychotics (n=36, 10%).Disposition was available for 276; of these 167 (61%) were managed in the emergency department, 42 (15%) were admitted to the hospital floor, and 67 (24%) were admitted to the ICU.

Conclusions

Synthetic cannabinoids are associated with severe central nervous system and cardiovascular effects.

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Author information

Authors and Affiliations

  1. Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA

    Andrew A. Monte & Jeffery Brent

  2. Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA

    Andrew A. Monte

  3. New Jersey Poison Information and Education System, Rutgers Biomedical and Health Sciences, Department of Emergency Medicine, New Jersey Medical School, Newark, NJ, USA

    Diane P. Calello

  4. Department of Laboratory Medicine, University of California-San Francisco, San Francisco, CA, USA

    Roy R. Gerona

  5. Department of Emergency Medicine, University of Massachusetts, Worcester, MA, USA

    Eike Hamad

  6. Toxicology Investigators Consortium, American College of Medical Toxicology, Phoenix, AZ, USA

    Sharan L. Campleman & Jeffery Brent

  7. Southwestern Medical School, University of Texas, Dallas, TX, USA

    Paul Wax

  8. Department of Community Health, Wright State University Boonshoft School of Medicine, Dayton, OH, USA

    Robert G. Carlson

Authors
  1. Andrew A. Monte
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  2. Diane P. Calello
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  3. Roy R. Gerona
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  4. Eike Hamad
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  5. Sharan L. Campleman
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  6. Jeffery Brent
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  7. Paul Wax
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  8. Robert G. Carlson
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Consortia

On behalf of the ACMT Toxicology Investigators Consortium (ToxIC)

Corresponding author

Correspondence to Andrew A. Monte.

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Conflict of Interest

The contents of this work are the sole responsibility of the authors and do not necessarily represents the views of the National Institutes of Health (NIH). The authors declare that they have no conflict of interest.

Funding and Financial Disclosures

Dr. Monte receives support from NIH 1 K23 GM110516 and NIH CTSI UL1 TR001082. Dr. Monte has a patent pending for a synthetic cannabinoid clinical assay and has been awarded funding through the Department of Defense for examination of patterns of use of synthetic cannabinoids and assay development. A subset of the data collected was funded by the grant NIH R56 DA038366 (Carlson, Sheth, Boyer, PIs).

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Monte, A.A., Calello, D.P., Gerona, R.R. et al. Characteristics and Treatment of Patients with Clinical Illness Due to Synthetic Cannabinoid Inhalation Reported by Medical Toxicologists: A ToxIC Database Study. J. Med. Toxicol. 13, 146–152 (2017). https://doi.org/10.1007/s13181-017-0605-9

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  • DOI: https://doi.org/10.1007/s13181-017-0605-9

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