Severe toxicity following synthetic cannabinoid ingestion

Area of Science:

• Toxicology
• Emergency Medicine
• Pharmacology

Background:

• Synthetic cannabinoids are widely available and often perceived as safe.
• Reports of severe toxicity from confirmed synthetic cannabinoid use are infrequent.
• This case details severe adverse events following intentional JWH-018 ingestion.

Observation:

• A healthy adult experienced a generalized seizure shortly after ingesting a synthetic cannabinoid powder purchased online.
• The patient developed medically refractory supraventricular tachycardia (SVT) on hospital day 1.
• Laboratory analysis confirmed the powder as JWH-018 and detected a primary metabolite in the patient's urine.

Findings:

• Ingestion of JWH-018 can lead to significant neurological and cardiac adverse events, including seizures and tachyarrhythmias.
• Standard drug screening may not detect synthetic cannabinoids or their metabolites.
• Gas chromatography-mass spectrometry and liquid chromatography-tandem mass spectrometry are crucial for confirming JWH-018 exposure.

Implications:

• Clinicians must be aware of the potential for severe toxicity from synthetic cannabinoids.
• The ease of access and limited toxicity data necessitate increased public and regulatory awareness.
• Misconceptions about the safety profile of synthetic cannabinoids compared to marijuana can lead to dangerous use patterns.