Retrospective Chart Review of Synthetic Cannabinoid Intoxication with Toxicologic Analysis

Area of Science:

• Toxicology
• Emergency Medicine
• Pharmacology

Background:

• Synthetic cannabinoid (SC) use has emerged as a significant drug epidemic.
• Emergency departments (EDs) are observing novel SC presentations, including lethargy and bradycardia, contrasting with earlier reports of agitation and tachycardia.

Purpose of the Study:

• To describe the novel clinical presentations of SC intoxication.
• To characterize the specific compounds responsible for these presentations.

Main Methods:

• A case series of 141 patients with SC intoxication was conducted in two tertiary care EDs.
• Retrospective chart review for vital signs and clinical course, alongside xenobiotic sample analysis (LC/MS, GC/MS).

Main Results:

• Sixty-eight percent of patients presented with lethargy or loss of consciousness; 24% experienced bradycardia.
• XLR-11 and carboxamide indazole derivative (CID) compounds were frequently detected in patient samples.
• No JWH compounds, opiates, or other sedative-hypnotics were identified, suggesting SCs were the primary cause.

Conclusions:

• Novel SCs, particularly CID and alkyl derivatives like XLR-11, are associated with central nervous system depression and bradycardia.
• These compounds are likely full agonists at cannabinoid receptors, leading to increased potency and novel clinical effects.
• SC intoxication should be considered in patients presenting with undifferentiated psychomotor depression and bradycardia.