Recently, there has been a surge in synthetic cannabinoid in the U.S., including the Baltimore area. According to U.S. poison control center data, there has been 229% increase in calls related to SC between January to May of 2015 compared to similar time period in 2014.

The most commonly reported adverse/clinical effects included:

Agitation: 35.3%

Tachycardia: 29%

Drowsiness/lethargy: 26.3%

Vomiting: 16.4%

Confusion: 16.4%

End-organ injuries have been also reported in case reports, including AKI, seizure, MI, and CVA.

Synthetic cannabinoid includes a list of chemical compounds that are structurally different compared to THC – the active compound in marijuana. However, they possess full CB1 (cannabinoid) receptor agonism effect, unlike the THC, which is a partial CB1 receptor agonist.

These chemicals (particularly JWH series) were originally synthesized to study the effect of cannabinoid receptors. Overall, it is difficult to identify the compound and the dose within each packets of SC.

Commonly marketed names include: Spice, K2, K9, herbal highs, Scooby snax, WTF.

Table. Identified synthetic cannabinoids

Chemical name Chemical origin JWH-018; JWH-073; JWH-250 Laboratory of J.W. Huffman CP47,497; CP47,497-C8; CP59,540; cannabicyclohexanol Pfizer laboratory HU-210 Hebrew University laboratory Oleamide Fatty acid UR-144 CB2 receptor agonist XLR-11, AKB-48, AM-2201, AM-694

Management: Majority of the patients with acute SC intoxication mostly requires supportive care, including benzodiazepine for acute agitation. However, ED providers should be mindful of potential end-organ injury.

References