Three cases of "spice" exposure.

Area of Science:

• Synthetic Cannabinoid Research
• Clinical Toxicology
• Emergency Medicine

Background:

• Synthetic cannabinoids, such as
• spice
• are increasingly abused for their psychoactive properties.
• Standard urine drug screens often fail to detect these novel psychoactive substances.
• Confirmed exposure to synthetic cannabinoids was established through metabolite detection (JWH-018 and/or JWH-073) in urine.

Observation:

• Three cases of emergency department visits following synthetic cannabinoid (
• spice
• ) use are presented.
• Patients exhibited a range of symptoms including seizure, tachycardia, acidosis, unresponsiveness, hypertension, agitation, paranoia, and delusions.
• Clinical presentations were consistent with anticholinergic or sympathomimetic agent toxicity.

Findings:

• Urine analysis confirmed the presence of JWH-018 and/or JWH-073 metabolites in all three cases.
• Despite severe initial symptoms, all patients recovered with supportive care, including benzodiazepines, IV fluids, and observation.
• Symptoms resolved without specific antidotes, highlighting the importance of supportive management.

Implications:

• These cases underscore the potential for severe adverse events associated with synthetic cannabinoid use.
• The detection of specific metabolites is vital for diagnosing synthetic cannabinoid intoxication when standard drug screens are negative.
• Prompt supportive care is effective in managing the acute toxicity of these substances.