Myocardial Infarction Associated With Use of the Synthetic Cannabinoid K2

Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX 75235, USA.
PEDIATRICS (Impact Factor: 5.47). 11/2011; 128(6):e1622-7. DOI: 10.1542/peds.2010-3823
Source: PubMed


Designer drugs have been problematic over the years. Products such as K2 and Spice, which contain synthetic cannabinoids, are marketed as incense and are widely available on the Internet and at various specialty shops. The effects are reported as cannabis-like after smoking them. In addition, use of these synthetic cannabinoids will not appear on a routine urine toxicology screen. Recently, K2 became a popular alternative to marijuana among youths. Health implications of these designer drugs are not completely understood. Little has been reported about the harmful effects of K2. We report here the first (to our knowledge) cases of myocardial infarction (MI) after smoking K2. Three patients presented separately to the emergency department complaining of chest pain within days after the use of K2. Acute MI was diagnosed in each case on the basis of electrocardiogram changes and elevated troponin levels. Coronary angiography was performed, and the results were normal for the first 2 patients. The incidence of ST-elevation MI is low among teenagers, and association with drug use should be suspected. Public education and awareness need to be heightened about the possible health implications of K2.

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    • "After the consumption of synthetic cannabinoids both symptoms which are also described after cannabis intoxications (tachycardia, sedation, psychosis, anxiety and panic attacks) and further symptoms like agitation, convulsions, nausea and emesis were detected [5] [6]. In one case a patient suffered from chest pain after the use of K2 which ended in electrocardiogram changes (ST elevation), elevated troponin levels and myocardial infarction in a 16-year old [1]. Another patient died from sudden cardiac arrest after K2 consumption [3]. "
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    ABSTRACT: We present a case study on a man who suffered from diabetic ketoacidosis, probably following consumption of synthetic cannabinoids. In blood from a femoral vein AB-CHMINACA, AB-FUBINACA, AM-2201, 5F-AMB, 5F-APINACA, EAM-2201, JWH-018, JWH-122, MAM-2201, STS135 and THJ 2201 could be detected by LC-MS/MS. Diagnosis of ketoacidosis as cause of death was carried out using biochemical measurements of glucose and lactate concentrations in vitreous humour (sum formula: 463mg/dl) and cerebrospinal fluid (sum formula: 506mg/dl), of acetone (163mg/l in femoral venous blood) and of HbA1c (98mmol/mol). Death due to hyperglycaemia could have been induced by skipping of insulin doses due to his intoxicated state or by the cannabinoids which were described to be able to produce hyperglycaemia themselves.
    Forensic science international 08/2015; DOI:10.1016/j.forsciint.2015.08.012 · 2.14 Impact Factor
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    • "In conclusion, there are several evidences [10] [11] [12] [13] [14] [15] to think that cannabis and SC can lead to serious cardiac disorders but we think that this case report is speculative rather than affirmative (because of the study limitations described above) and therefore, conclusions should be more modulated. "
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    ABSTRACT: The authors declare that there is no conflict of interests regarding the publication of this paper.
    04/2015; 2015:739149. DOI:10.1155/2015/739149
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    • "Most abused SC are CB 1 receptor agonists with significantly higher affinity than delta-9-tetrahydrocannabinol (THC), yielding more pronounced cannabimimetic effects with more cognitive impairment, sensory perception changes and transient hallucinations (Papanti et al., 2013). SC also induce adverse physiological effects not observed with cannabis intake such as vomiting, seizures, hyperglycemia and hypokalemia (CDC, 2013b), stroke (Freeman et al., 2013), myocardial infarction (Mir et al., 2011) and acute kidney injury (CDC, 2013a). Controlled SC administration studies are needed; however, the lack of pre-clinical toxicology data makes conducting such studies in humans currently unfeasible. "
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    ABSTRACT: Synthetic cannabinoids (SC), originally developed as research tools, are now highly abused novel psychoactive substances. We present a comprehensive systematic review covering in vivo and in vitro animal and human pharmacokinetics and analytical methods for identifying SC and their metabolites in biological matrices. Of two main phases of SC research, the first investigated therapeutic applications, and the second abuse-related issues. Administration studies showed high lipophilicity and distribution into brain and fat tissue. Metabolite profiling studies, mostly with human liver microsomes and human hepatocytes, structurally elucidated metabolites and identified suitable SC markers. In general, SC underwent hydroxylation at various molecular sites, defluorination of fluorinated analogs and phase II metabolites were almost exclusively glucuronides. Analytical methods are critical for documenting intake, with different strategies applied to adequately address the continuous emergence of new compounds. Immunoassays have different cross-reactivities for different SC classes, but cannot keep pace with changing analyte targets. Gas chromatography and liquid chromatography mass spectrometry assays - first for a few, then numerous analytes - are available but constrained by reference standard availability, and must be continuously updated and revalidated. In blood and oral fluid, parent compounds are frequently present, albeit in low concentrations; for urinary detection, metabolites must be identified and interpretation is complex due to shared metabolic pathways. A new approach is non-targeted HRMS screening that is more flexible and permits retrospective data analysis. We suggest that streamlined assessment of new SC's pharmacokinetics and advanced HRMS screening provide a promising strategy to maintain relevant assays.
    Drug Metabolism Reviews 04/2015; 47(2). DOI:10.3109/03602532.2015.1029635 · 5.36 Impact Factor
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