A systematic review of adverse events arising from the use of synthetic cannabinoids and their associated treatment

Robert J. Tait, D. Caldicott, David Mountain, Simon L. Hill, Simon Lenton

    Research output: Contribution to journalReview article

    122 Citations (Scopus)

    Abstract

    Context: Synthetic cannabinoids (SCs) such as “Spice”, “K2”, etc. are widely available via the internet despite increasing legal restrictions. Currently, the prevalence of use is typically low in the general community (<1%) although it is higher among students and some niche groups subject to drug testing. Early evidence suggests that adverse outcomes associated with the use of SCs may be more prevalent and severe than those arising from cannabis consumption. Objectives: To identify systematically the scientific reports of adverse events associated with the consumption of SCs in the medical literature and poison centre data. Method: We searched online databases (Medline, PsycInfo, Embase, Google Scholar and Pubmed) and manually searched reference lists up to December 2014. To be eligible for inclusion, data had to be from hospital, emergency department, drug rehabilitation services or poison centre records of adverse events involving SCs and included both self-reported and/or analytically confirmed consumption. Results: From 256 reports, we identified 106 eligible studies including 37 conference abstracts on about 4000 cases involving at least 26 deaths. Major complications include cardiovascular events (myocardial infarction, ischemic stroke and emboli), acute kidney injury (AKI), generalized tonic-clonic seizures, psychiatric presentations (including first episode psychosis, paranoia, self-harm/suicide ideation) and hyperemesis. However, most presentations were not serious, typically involved young males with tachycardia (≈37–77%), agitation (≈16–41%) and nausea (≈13–94%) requiring only symptomatic care with a length of stay of less than 8 hours. Conclusions: SCs most frequently result in tachycardia, agitation and nausea. These symptoms typically resolve with symptomatic care, including intravenous fluids, benzodiazepines and anti-emetics, and may not require inpatient care. Severe adverse events (stroke, seizure, myocardial infarction, rhabdomyolysis, AKI, psychosis and hyperemesis) and associated deaths manifest less commonly. Precise estimates of their incidence are difficult to calculate due to the lack of widely available, rapid laboratory confirmation, the variety of SC compounds and the unknown number of exposed individuals. Long-term consequences of SCs use are currently unknown
    Original languageEnglish
    Pages (from-to)1-13
    Number of pages13
    JournalClinical Toxicology
    Volume54
    Issue number1
    DOIs
    Publication statusPublished - 2016

    Fingerprint

    Cannabinoids
    Poisons
    Acute Kidney Injury
    Tachycardia
    Psychotic Disorders
    Nausea
    Therapeutics
    Seizures
    Stroke
    Myocardial Infarction
    Paranoid Disorders
    Spices
    Rhabdomyolysis
    Antiemetics
    Hospital Departments
    Cannabis
    Embolism
    Benzodiazepines
    PubMed
    Patient rehabilitation

    Cite this

    Tait, Robert J. ; Caldicott, D. ; Mountain, David ; Hill, Simon L. ; Lenton, Simon. / A systematic review of adverse events arising from the use of synthetic cannabinoids and their associated treatment. In: Clinical Toxicology. 2016 ; Vol. 54, No. 1. pp. 1-13.
    @article{9252360fdcca4d66aff08896e2d2eae2,
    title = "A systematic review of adverse events arising from the use of synthetic cannabinoids and their associated treatment",
    abstract = "Context: Synthetic cannabinoids (SCs) such as “Spice”, “K2”, etc. are widely available via the internet despite increasing legal restrictions. Currently, the prevalence of use is typically low in the general community (<1{\%}) although it is higher among students and some niche groups subject to drug testing. Early evidence suggests that adverse outcomes associated with the use of SCs may be more prevalent and severe than those arising from cannabis consumption. Objectives: To identify systematically the scientific reports of adverse events associated with the consumption of SCs in the medical literature and poison centre data. Method: We searched online databases (Medline, PsycInfo, Embase, Google Scholar and Pubmed) and manually searched reference lists up to December 2014. To be eligible for inclusion, data had to be from hospital, emergency department, drug rehabilitation services or poison centre records of adverse events involving SCs and included both self-reported and/or analytically confirmed consumption. Results: From 256 reports, we identified 106 eligible studies including 37 conference abstracts on about 4000 cases involving at least 26 deaths. Major complications include cardiovascular events (myocardial infarction, ischemic stroke and emboli), acute kidney injury (AKI), generalized tonic-clonic seizures, psychiatric presentations (including first episode psychosis, paranoia, self-harm/suicide ideation) and hyperemesis. However, most presentations were not serious, typically involved young males with tachycardia (≈37–77{\%}), agitation (≈16–41{\%}) and nausea (≈13–94{\%}) requiring only symptomatic care with a length of stay of less than 8 hours. Conclusions: SCs most frequently result in tachycardia, agitation and nausea. These symptoms typically resolve with symptomatic care, including intravenous fluids, benzodiazepines and anti-emetics, and may not require inpatient care. Severe adverse events (stroke, seizure, myocardial infarction, rhabdomyolysis, AKI, psychosis and hyperemesis) and associated deaths manifest less commonly. Precise estimates of their incidence are difficult to calculate due to the lack of widely available, rapid laboratory confirmation, the variety of SC compounds and the unknown number of exposed individuals. Long-term consequences of SCs use are currently unknown",
    keywords = "drug overdose, drugrelated side effects and adverse reactions, Emergency medical services, Mental disorders, Street drugs, cannabinoid derivative, poison, synthetic cannabinoid derivative, unclassified drug, cannabinoid, psychotropic agent, acute kidney failure, agitation, automutilation, brain ischemia, drug exposure, drug use, Embase, embolism, emergency ward, heart infarction, hospital department, hospital management, human, hyperemesis, intervention study, length of stay, medical literature, Medline, nausea, paranoia, psychosis, PsycINFO, rehabilitation center, Review, self report, side effect, suicidal ideation, systematic review, tachycardia, tonic clonic seizure, vomiting, adverse effects, cannabis smoking, Marijuana Abuse, mortality, prognosis, risk factor, substance abuse, synthesis, time factor, Cannabinoids, Drug Overdose, Humans, Marijuana Smoking, Prognosis, Psychotropic Drugs, Risk Factors, Substance Abuse Detection, Time Factors",
    author = "Tait, {Robert J.} and D. Caldicott and David Mountain and Hill, {Simon L.} and Simon Lenton",
    note = "Cited By :17 Export Date: 15 December 2016 Correspondence Address: Tait, R.J.; Faculty of Health Sciences, National Drug Research Institute, Curtin University, GPO Box U1987, Australia; email: robert.tait@curtin.edu.au Chemicals/CAS: Cannabinoids; Psychotropic Drugs References: (2009) Understanding the Spice Phenomenon, , European Monitoring Centre for Drugs and Drug Addiction. Luxembourg: Office for Official Publications of the European Communities: EMCDDA; Seely, K.A., Lapoint, J., Moran, J.H., Spice drugs are more than harmless herbal blends: A review of the pharmacology and toxicology of synthetic cannabinoids (2012) Prog Neuropsychopharmacol Biol Psychiatry, 39, pp. 234-243; Vardakou, I., Pistos, C., Spiliopoulou, C., Spice drugs as a new trend: Mode of action, identification and legislation (2010) Toxicol Lett, 197, pp. 157-162; Winstock, A.R., Lynskey, M., Borschmann, R., Risk of emergency medical treatment following consumption of cannabis or synthetic cannabinoids in a large global sample (2015) J Psychopharmacol, 29, pp. 698-703; Winstock, A.R., Barratt, M.J., The 12-month prevalence and nature of adverse experiences resulting in emergency medical presentations associated with the use of synthetic cannabinoid products (2013) Hum Psychopharmacol, 28, pp. 390-393; Smith, K., Flatley, J., (2011) Drug Misuse Declared: Findings from the 2010/11 British Crime Survey England and Wales, , Report No. 17597005. London: Home Office Statistics; Pabst, A., Daniela, P., Ludwig, K., Substance use and Substance use disorders. Results of the 2009 Epidemiological Survey of Substance Abuse (German) (2010) Sucht, 56, pp. 327-336; (2014) 2013 National Drug Strategy Household Survey: Detailed Report, , Australian Institute of Health and Welfare. Canberra: AIHW; Heltsley, R., Shelby, M.K., Crouch, D.J., Prevalence of synthetic cannabinoids in U.S. Athletes: Initial findings (2012) J Anal Toxicol, 36, pp. 588-593; Hu, X., Primack, B.A., Barnett, T.E., College students and use of K2: An emerging drug of abuse in young persons (2011) Subst Abuse Treat Prev Policy, 6, p. 16; Johnston, L.D., OMalley, P.M., Miech, R.A., (2015) Monitoring the Future National Survey Results on Drug Use: 1975-2014: Overview, Key Findings on Adolescent Drug Use, , Ann Arbor: Institute for Social Research, The University of Michigan; Perronea, D., Helgesena, R.D., Fischera, R.G., United States drug prohibition and legal highs: How drug testing may lead cannabis users to Spice (2013) Drugs Educ Prevent Policy, 20, pp. 216-224; Vandrey, R., Dunn, K.E., Fry, J.A., A survey study to characterize use of Spice products (synthetic cannabinoids) (2012) Drug Alcohol Depend, 120, pp. 238-241; Maxwell, J.C., Psychoactive substances - Some new, some old: A scan of the situation in the U.S (2014) Drug Alcohol Depend, 134, pp. 71-77; (2011) Emergency Department Excel Files - National Tables, , http://www.samhsa.gov/data/DAWN.aspx#DAWN, Drug Abuse Warning Network. 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Asian Arch Psychiatry, 22, pp. 31-33; Vearrier, D., Osterhoudt, K.C., A teenager with agitation: Higher than she should have climbed (2010) Pediatr Emerg Care, 26, pp. 462-465; Young, A.C., Schwarz, E., Medina, G., Cardiotoxicity associated with the synthetic cannabinoid, K9, with laboratory confirmation (2012) Am J Emerg Med, 30, pp. 1320e5-1320e7",
    year = "2016",
    doi = "10.3109/15563650.2015.1110590",
    language = "English",
    volume = "54",
    pages = "1--13",
    journal = "Journal of Toxicology - Clinical Toxicology",
    issn = "0731-3810",
    publisher = "Taylor and Francis",
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    }

    A systematic review of adverse events arising from the use of synthetic cannabinoids and their associated treatment. / Tait, Robert J.; Caldicott, D.; Mountain, David; Hill, Simon L.; Lenton, Simon.

    In: Clinical Toxicology, Vol. 54, No. 1, 2016, p. 1-13.

    Research output: Contribution to journalReview article

    TY - JOUR

    T1 - A systematic review of adverse events arising from the use of synthetic cannabinoids and their associated treatment

    AU - Tait, Robert J.

    AU - Caldicott, D.

    AU - Mountain, David

    AU - Hill, Simon L.

    AU - Lenton, Simon

    N1 - Cited By :17 Export Date: 15 December 2016 Correspondence Address: Tait, R.J.; Faculty of Health Sciences, National Drug Research Institute, Curtin University, GPO Box U1987, Australia; email: robert.tait@curtin.edu.au Chemicals/CAS: Cannabinoids; Psychotropic Drugs References: (2009) Understanding the Spice Phenomenon, , European Monitoring Centre for Drugs and Drug Addiction. Luxembourg: Office for Official Publications of the European Communities: EMCDDA; Seely, K.A., Lapoint, J., Moran, J.H., Spice drugs are more than harmless herbal blends: A review of the pharmacology and toxicology of synthetic cannabinoids (2012) Prog Neuropsychopharmacol Biol Psychiatry, 39, pp. 234-243; Vardakou, I., Pistos, C., Spiliopoulou, C., Spice drugs as a new trend: Mode of action, identification and legislation (2010) Toxicol Lett, 197, pp. 157-162; Winstock, A.R., Lynskey, M., Borschmann, R., Risk of emergency medical treatment following consumption of cannabis or synthetic cannabinoids in a large global sample (2015) J Psychopharmacol, 29, pp. 698-703; Winstock, A.R., Barratt, M.J., The 12-month prevalence and nature of adverse experiences resulting in emergency medical presentations associated with the use of synthetic cannabinoid products (2013) Hum Psychopharmacol, 28, pp. 390-393; Smith, K., Flatley, J., (2011) Drug Misuse Declared: Findings from the 2010/11 British Crime Survey England and Wales, , Report No. 17597005. London: Home Office Statistics; Pabst, A., Daniela, P., Ludwig, K., Substance use and Substance use disorders. Results of the 2009 Epidemiological Survey of Substance Abuse (German) (2010) Sucht, 56, pp. 327-336; (2014) 2013 National Drug Strategy Household Survey: Detailed Report, , Australian Institute of Health and Welfare. Canberra: AIHW; Heltsley, R., Shelby, M.K., Crouch, D.J., Prevalence of synthetic cannabinoids in U.S. Athletes: Initial findings (2012) J Anal Toxicol, 36, pp. 588-593; Hu, X., Primack, B.A., Barnett, T.E., College students and use of K2: An emerging drug of abuse in young persons (2011) Subst Abuse Treat Prev Policy, 6, p. 16; Johnston, L.D., OMalley, P.M., Miech, R.A., (2015) Monitoring the Future National Survey Results on Drug Use: 1975-2014: Overview, Key Findings on Adolescent Drug Use, , Ann Arbor: Institute for Social Research, The University of Michigan; Perronea, D., Helgesena, R.D., Fischera, R.G., United States drug prohibition and legal highs: How drug testing may lead cannabis users to Spice (2013) Drugs Educ Prevent Policy, 20, pp. 216-224; Vandrey, R., Dunn, K.E., Fry, J.A., A survey study to characterize use of Spice products (synthetic cannabinoids) (2012) Drug Alcohol Depend, 120, pp. 238-241; Maxwell, J.C., Psychoactive substances - Some new, some old: A scan of the situation in the U.S (2014) Drug Alcohol Depend, 134, pp. 71-77; (2011) Emergency Department Excel Files - National Tables, , http://www.samhsa.gov/data/DAWN.aspx#DAWN, Drug Abuse Warning Network. (DAWN) Substance Abuse and Mental Health Services; 2011 [updated 2011; cited 2014 Oct 3] 2011 ED Excel Files - National Tables; (2013) Report 2012/13, , National Poisons Information Service Didcot, Oxfordshire: Public Health England; Lank, P.M., Pines, E., Mycyk, M.B., Emergency physicians knowledge of cannabinoid designer drugs (2013) West J Emerg Med, 14, pp. 467-470; Dresen, S., Ferreirós, N., Pütz, M., Monitoring of herbal mixtures potentially containing synthetic cannabinoids as psychoactive compounds (2010) J Mass Spectrom, 45, pp. 1186-1194; Auwärter, V., Dresen, S., Weinmann, W., Spice and other herbal blends: Harmless incense or cannabinoid designer drugs? 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    PY - 2016

    Y1 - 2016

    N2 - Context: Synthetic cannabinoids (SCs) such as “Spice”, “K2”, etc. are widely available via the internet despite increasing legal restrictions. Currently, the prevalence of use is typically low in the general community (<1%) although it is higher among students and some niche groups subject to drug testing. Early evidence suggests that adverse outcomes associated with the use of SCs may be more prevalent and severe than those arising from cannabis consumption. Objectives: To identify systematically the scientific reports of adverse events associated with the consumption of SCs in the medical literature and poison centre data. Method: We searched online databases (Medline, PsycInfo, Embase, Google Scholar and Pubmed) and manually searched reference lists up to December 2014. To be eligible for inclusion, data had to be from hospital, emergency department, drug rehabilitation services or poison centre records of adverse events involving SCs and included both self-reported and/or analytically confirmed consumption. Results: From 256 reports, we identified 106 eligible studies including 37 conference abstracts on about 4000 cases involving at least 26 deaths. Major complications include cardiovascular events (myocardial infarction, ischemic stroke and emboli), acute kidney injury (AKI), generalized tonic-clonic seizures, psychiatric presentations (including first episode psychosis, paranoia, self-harm/suicide ideation) and hyperemesis. However, most presentations were not serious, typically involved young males with tachycardia (≈37–77%), agitation (≈16–41%) and nausea (≈13–94%) requiring only symptomatic care with a length of stay of less than 8 hours. Conclusions: SCs most frequently result in tachycardia, agitation and nausea. These symptoms typically resolve with symptomatic care, including intravenous fluids, benzodiazepines and anti-emetics, and may not require inpatient care. Severe adverse events (stroke, seizure, myocardial infarction, rhabdomyolysis, AKI, psychosis and hyperemesis) and associated deaths manifest less commonly. Precise estimates of their incidence are difficult to calculate due to the lack of widely available, rapid laboratory confirmation, the variety of SC compounds and the unknown number of exposed individuals. Long-term consequences of SCs use are currently unknown

    AB - Context: Synthetic cannabinoids (SCs) such as “Spice”, “K2”, etc. are widely available via the internet despite increasing legal restrictions. Currently, the prevalence of use is typically low in the general community (<1%) although it is higher among students and some niche groups subject to drug testing. Early evidence suggests that adverse outcomes associated with the use of SCs may be more prevalent and severe than those arising from cannabis consumption. Objectives: To identify systematically the scientific reports of adverse events associated with the consumption of SCs in the medical literature and poison centre data. Method: We searched online databases (Medline, PsycInfo, Embase, Google Scholar and Pubmed) and manually searched reference lists up to December 2014. To be eligible for inclusion, data had to be from hospital, emergency department, drug rehabilitation services or poison centre records of adverse events involving SCs and included both self-reported and/or analytically confirmed consumption. Results: From 256 reports, we identified 106 eligible studies including 37 conference abstracts on about 4000 cases involving at least 26 deaths. Major complications include cardiovascular events (myocardial infarction, ischemic stroke and emboli), acute kidney injury (AKI), generalized tonic-clonic seizures, psychiatric presentations (including first episode psychosis, paranoia, self-harm/suicide ideation) and hyperemesis. However, most presentations were not serious, typically involved young males with tachycardia (≈37–77%), agitation (≈16–41%) and nausea (≈13–94%) requiring only symptomatic care with a length of stay of less than 8 hours. Conclusions: SCs most frequently result in tachycardia, agitation and nausea. These symptoms typically resolve with symptomatic care, including intravenous fluids, benzodiazepines and anti-emetics, and may not require inpatient care. Severe adverse events (stroke, seizure, myocardial infarction, rhabdomyolysis, AKI, psychosis and hyperemesis) and associated deaths manifest less commonly. Precise estimates of their incidence are difficult to calculate due to the lack of widely available, rapid laboratory confirmation, the variety of SC compounds and the unknown number of exposed individuals. Long-term consequences of SCs use are currently unknown

    KW - drug overdose

    KW - drugrelated side effects and adverse reactions

    KW - Emergency medical services

    KW - Mental disorders

    KW - Street drugs

    KW - cannabinoid derivative

    KW - poison

    KW - synthetic cannabinoid derivative

    KW - unclassified drug

    KW - cannabinoid

    KW - psychotropic agent

    KW - acute kidney failure

    KW - agitation

    KW - automutilation

    KW - brain ischemia

    KW - drug exposure

    KW - drug use

    KW - Embase

    KW - embolism

    KW - emergency ward

    KW - heart infarction

    KW - hospital department

    KW - hospital management

    KW - human

    KW - hyperemesis

    KW - intervention study

    KW - length of stay

    KW - medical literature

    KW - Medline

    KW - nausea

    KW - paranoia

    KW - psychosis

    KW - PsycINFO

    KW - rehabilitation center

    KW - Review

    KW - self report

    KW - side effect

    KW - suicidal ideation

    KW - systematic review

    KW - tachycardia

    KW - tonic clonic seizure

    KW - vomiting

    KW - adverse effects

    KW - cannabis smoking

    KW - Marijuana Abuse

    KW - mortality

    KW - prognosis

    KW - risk factor

    KW - substance abuse

    KW - synthesis

    KW - time factor

    KW - Cannabinoids

    KW - Drug Overdose

    KW - Humans

    KW - Marijuana Smoking

    KW - Prognosis

    KW - Psychotropic Drugs

    KW - Risk Factors

    KW - Substance Abuse Detection

    KW - Time Factors

    UR - http://www.scopus.com/inward/record.url?scp=84951567352&partnerID=8YFLogxK

    UR - http://www.mendeley.com/research/systematic-review-adverse-events-arising-synthetic-cannabinoids-associated-treatment

    U2 - 10.3109/15563650.2015.1110590

    DO - 10.3109/15563650.2015.1110590

    M3 - Review article

    VL - 54

    SP - 1

    EP - 13

    JO - Journal of Toxicology - Clinical Toxicology

    JF - Journal of Toxicology - Clinical Toxicology

    SN - 0731-3810

    IS - 1

    ER -