Prolonged sedation and unconsciousness after intoxication with the novel semisynthetic cannabinoid...

Semisynthetic cannabinoids (SSCs) are compounds closely related to the major phytocannabinoids. SSCs have recently appeared as legal alternatives to Δ⁹-tetrahydrocannabinol (Δ⁹-THC), the primary psychoactive compound in the Cannabis plant. Δ⁹-THC has been consumed by humans for millennia and has low acute toxicity, but recent evidence indicates elevated toxicity from exposure to some SSCs. The present study describes two case reports with confirmed intoxication with a novel SSC, hexahydrocannabioctyl (HHC-C8). In the first case, a young male was found deeply unconscious and hospitalized. The clinical picture was mostly neurological with recurring seizures and coma. The patient was comatose for two days with a slow gradual improvement over the following two weeks. An HHC-C8 blood concentration of 72 ng/mL was determined in a sample taken at time of admission and the compound was also confirmed at a concentration of 6 % in a cannabis product of the same type and purchased at the same store. In the second case, a female was hospitalized after having slept for 14 hours and found in a minimally responsive state. The patient suffered pronounced somnolence and sedation for 3 days after which she gradually recovered. In a blood sample taken 40 hours after ingestion, HHC-C8 was detected at trace amounts along with two putative metabolites. The ingested product, which the patient had purchased at a web shop, was found to contain 7 % HHC-C8. The two cases demonstrate the toxic potential of widely available and often mislabeled cannabis products, the intake of which can lead to intoxications requiring extensive medical treatment.