David Baxter PhD
Late Founder
Synthetic Marijuana Sending Teens to the ED
by Megan Brooks
March 19, 2012
Synthetic cannabinoid compounds are increasingly popular among adolescents and young adults in the United States, and many are ending up in the hospital after smoking these products, a report published March 19 in Pediatrics warns.
The herbs and spices found in these products ? commonly known as K2, Spice, Aroma, Mr. Smiley, Zohai, Eclipse, Black Mama, Red X Dawn, Blaze, and Dream ? have been sprayed with toxic chemicals that produce euphoric and psychoactive effects akin to those associated with delta-9-tetrahydrocannabinol (THC), the active ingredient in marijuana.
However, it is becoming apparent that these synthetic marijuana products can cause agitation, aggressive behavior, catatonia, intense sweating, and trouble speaking, Joanna Cohen, MD, of the Division of Emergency Medicine, Children's National Medical Center, Washington, DC, and colleagues note in their report.
Until recently, these products were sold in gas stations, convenience stores, and over the Internet. From 2010 to 2011, the American Association of Poison Control Centers reported 4500 calls involving synthetic cannabinoid toxicity.
On March 1, 2011, the US Drug Enforcement Administration (DEA) listed 5 chemicals used to make synthetic marijuana as schedule 1 controlled substances (ie, JWH-018, JWH-073, JWH-200, CP-47,497, and cannabicyclohexanol). These chemicals "have not been approved by the FDA for human consumption, and there is no oversight of the manufacturing process," the DEA wrote in a statement.
Synthetic cannabinoids are relatively novel substances of abuse, and there is "little information" in the medical literature on it, said Dr. Cohen in a statement.
"Recognition of the signs and symptoms of intoxication of synthetic cannabinoids and a high index of suspicion are necessary to diagnose toxicity," the investigators write. These chemicals are hard to detect with available drug tests, increasing their popularity among youth.
Typical Symptoms
The report highlights 3 case studies of teenagers seen in the emergency department (ED) with suspected synthetic cannabinoid intoxication and discusses typical signs and symptoms of intoxication with these substances.
Case 1 involved a 16-year-old girl transferred from an outside hospital with altered mental status; she was awake with her eyes open but was not responding to verbal or painful stimuli. Her boyfriend reported that they had been smoking marijuana containing K2.
She was catatonic on arrival at the ED at Children's National; her lower extremities were rigid and flexed. Her heart rate was 105 beats/min, her respiratory rate was 18 breaths/min, and her blood pressure was 118/ 73 mm Hg. She had sinus tachycardia and remained unresponsive to verbal and painful stimuli.
The patient was treated with single dose of 50 mg intravenous (IV) diphenhydramine, after which she began to move her lips in an attempt to speak. She was subsequently treated with lorazepam 2 mg IV twice, after which she began to speak slowly. She was observed overnight, during which time she slowly recovered her motor and verbal functions and was discharged.
Case 2 involved an 18-year-old boy who was brought to the ED after he became agitated and was sweating profusely at a party. In the ED, he was uncooperative, restless, and aggressive. On examination, his vital signs included a temperature of 37.6˚ C (99.68˚ F), a heart rate of 131 beats/min, and a blood pressure of 131/89 mm Hg. He remained diaphoretic and anxious. His pupils were dilated and "sluggishly reactive." He too had sinus tachycardia.
When the patient continued to be aggressive and agitated, he was given a dose of lorazepam 2 mg IV. He finally admitted to smoking Spice at the party. He was given 50 mg diphenhydramine IV and was admitted to the hospital. Over the next several hours, he showed clear signs of recovery and was discharged.
Case 3 involved a 16-year-old previously healthy boy who was a resident of a group home. He was brought to the ED by his case worker when she noticed that his face seemed "frozen" and that his speech was slowed. She also reported that he was agitated and seemed to be hallucinating. The boy said he had smoked Spice roughly 5 hours before.
Upon arrival at the ED, the patient was agitated and dysarthric with pressured speech. He appeared dystonic. He was alert and able to answer simple questions but seemed confused. He received a normal saline bolus of 1000 mL and 4 mg of lorazepam IV. A urine toxicology screen was negative, as was an expanded serum toxicology screen. After 3 to 4 hours, he began to recover and was discharged at his baseline neurologic status.
Potential for Long-Term Effects
Dr. Cohen and colleagues note that the dystonic reactions seen in 2 of the cases are "unusual side effects." It is also possible that the dystonia observed was actually a combination of catatonia and catalepsy combined with agitation. "Dystonia from synthetic cannabinoids would be a curious phenomenon," because the effects of THC on the basal ganglia have been studied in the treatment of dystonia.
No antidote is currently available for synthetic cannabinoid intoxication. And although symptoms are usually short-lived and self-limited, "the potential for multiple long-term effects, including immunomodulation and carcinogenicity, memory loss, psychiatric complications, and dependence, have been described," the authors write.
As reported by Medscape Medical News, there is evidence that synthetic cannabis may pose an even greater risk for psychosis than natural cannabis, even among users with no history of a psychiatric disorder.
"Given the sensitivity of the developing brain and association between early cannabis use and psychosis, adolescent use of these new synthetic cannabinoids is particularly concerning," the authors write.
"Recognition of the signs and symptoms of patients with synthetic cannabinoid ingestion can help physicians who treat adolescents be better prepared to diagnose and manage patients presenting with this toxicity," they conclude.
The authors have disclosed no relevant financial relationships.
Pediatrics. 2012;129:e1064-e1067. Abstract
by Megan Brooks
March 19, 2012
Synthetic cannabinoid compounds are increasingly popular among adolescents and young adults in the United States, and many are ending up in the hospital after smoking these products, a report published March 19 in Pediatrics warns.
The herbs and spices found in these products ? commonly known as K2, Spice, Aroma, Mr. Smiley, Zohai, Eclipse, Black Mama, Red X Dawn, Blaze, and Dream ? have been sprayed with toxic chemicals that produce euphoric and psychoactive effects akin to those associated with delta-9-tetrahydrocannabinol (THC), the active ingredient in marijuana.
However, it is becoming apparent that these synthetic marijuana products can cause agitation, aggressive behavior, catatonia, intense sweating, and trouble speaking, Joanna Cohen, MD, of the Division of Emergency Medicine, Children's National Medical Center, Washington, DC, and colleagues note in their report.
Until recently, these products were sold in gas stations, convenience stores, and over the Internet. From 2010 to 2011, the American Association of Poison Control Centers reported 4500 calls involving synthetic cannabinoid toxicity.
On March 1, 2011, the US Drug Enforcement Administration (DEA) listed 5 chemicals used to make synthetic marijuana as schedule 1 controlled substances (ie, JWH-018, JWH-073, JWH-200, CP-47,497, and cannabicyclohexanol). These chemicals "have not been approved by the FDA for human consumption, and there is no oversight of the manufacturing process," the DEA wrote in a statement.
Synthetic cannabinoids are relatively novel substances of abuse, and there is "little information" in the medical literature on it, said Dr. Cohen in a statement.
"Recognition of the signs and symptoms of intoxication of synthetic cannabinoids and a high index of suspicion are necessary to diagnose toxicity," the investigators write. These chemicals are hard to detect with available drug tests, increasing their popularity among youth.
Typical Symptoms
The report highlights 3 case studies of teenagers seen in the emergency department (ED) with suspected synthetic cannabinoid intoxication and discusses typical signs and symptoms of intoxication with these substances.
Case 1 involved a 16-year-old girl transferred from an outside hospital with altered mental status; she was awake with her eyes open but was not responding to verbal or painful stimuli. Her boyfriend reported that they had been smoking marijuana containing K2.
She was catatonic on arrival at the ED at Children's National; her lower extremities were rigid and flexed. Her heart rate was 105 beats/min, her respiratory rate was 18 breaths/min, and her blood pressure was 118/ 73 mm Hg. She had sinus tachycardia and remained unresponsive to verbal and painful stimuli.
The patient was treated with single dose of 50 mg intravenous (IV) diphenhydramine, after which she began to move her lips in an attempt to speak. She was subsequently treated with lorazepam 2 mg IV twice, after which she began to speak slowly. She was observed overnight, during which time she slowly recovered her motor and verbal functions and was discharged.
Case 2 involved an 18-year-old boy who was brought to the ED after he became agitated and was sweating profusely at a party. In the ED, he was uncooperative, restless, and aggressive. On examination, his vital signs included a temperature of 37.6˚ C (99.68˚ F), a heart rate of 131 beats/min, and a blood pressure of 131/89 mm Hg. He remained diaphoretic and anxious. His pupils were dilated and "sluggishly reactive." He too had sinus tachycardia.
When the patient continued to be aggressive and agitated, he was given a dose of lorazepam 2 mg IV. He finally admitted to smoking Spice at the party. He was given 50 mg diphenhydramine IV and was admitted to the hospital. Over the next several hours, he showed clear signs of recovery and was discharged.
Case 3 involved a 16-year-old previously healthy boy who was a resident of a group home. He was brought to the ED by his case worker when she noticed that his face seemed "frozen" and that his speech was slowed. She also reported that he was agitated and seemed to be hallucinating. The boy said he had smoked Spice roughly 5 hours before.
Upon arrival at the ED, the patient was agitated and dysarthric with pressured speech. He appeared dystonic. He was alert and able to answer simple questions but seemed confused. He received a normal saline bolus of 1000 mL and 4 mg of lorazepam IV. A urine toxicology screen was negative, as was an expanded serum toxicology screen. After 3 to 4 hours, he began to recover and was discharged at his baseline neurologic status.
Potential for Long-Term Effects
Dr. Cohen and colleagues note that the dystonic reactions seen in 2 of the cases are "unusual side effects." It is also possible that the dystonia observed was actually a combination of catatonia and catalepsy combined with agitation. "Dystonia from synthetic cannabinoids would be a curious phenomenon," because the effects of THC on the basal ganglia have been studied in the treatment of dystonia.
No antidote is currently available for synthetic cannabinoid intoxication. And although symptoms are usually short-lived and self-limited, "the potential for multiple long-term effects, including immunomodulation and carcinogenicity, memory loss, psychiatric complications, and dependence, have been described," the authors write.
As reported by Medscape Medical News, there is evidence that synthetic cannabis may pose an even greater risk for psychosis than natural cannabis, even among users with no history of a psychiatric disorder.
"Given the sensitivity of the developing brain and association between early cannabis use and psychosis, adolescent use of these new synthetic cannabinoids is particularly concerning," the authors write.
"Recognition of the signs and symptoms of patients with synthetic cannabinoid ingestion can help physicians who treat adolescents be better prepared to diagnose and manage patients presenting with this toxicity," they conclude.
The authors have disclosed no relevant financial relationships.
Pediatrics. 2012;129:e1064-e1067. Abstract
