Journal of Medical Toxicology

, Volume 9, Issue 2, pp 199–206 | Cite as

High Times, Low Sats: Diffuse Pulmonary Infiltrates Associated with Chronic Synthetic Cannabinoid Use

  • Sameir Alhadi
  • Anupama Tiwari
  • Rais Vohra
  • Roy Gerona
  • Janak Acharya
  • Kathryn Bilello
Toxicology Observation

Abstract

Introduction

In recent years, cases of severe adverse effects from recreational use of synthetic cannabinoids (SC) have established that these agents represent a novel toxicologic hazard.

Case Report

A 21-year-old male presenting as a vehicular trauma victim was noted with diffuse pulmonary infiltrates related to chronic inhalation of multiple synthetic cannabinoid-containing products. Chest imaging revealed bilateral, subacute lung infiltrates; histopathological analysis of bronchial and alveolar tissues revealed an inflammatory process. An extensive workup failed to identify infectious, malignant, autoimmune, or hematologic causes of the syndrome, and toxicological analysis of the blood and body fluids confirmed the presence of multiple synthetic cannabinoids and metabolites. The patient recovered after an 8-day ICU course, wherein he received antibiotics, steroids, and mechanical ventilation.

Discussion

This case contributes to the currently evolving knowledge about SC agents, adding a rarely described pulmonary complication to the growing list of adverse effects associated with these products.

Keywords

Synthetic cannabinoids New drugs of abuse AM-2201 JWH-018 Pulmonary toxicity 

References

  1. 1.
    Wells DL, Ott CA (2011) The “new” marijuana. Ann Pharmacother 45(3):414–417PubMedCrossRefGoogle Scholar
  2. 2.
    Vearrier D, Osterhoudt K (2010) A teenager with agitation: higher than she should have climbed. Ped Emerg Care 26(6):462-465Google Scholar
  3. 3.
    Seely KA, Lapoint J, Moran JH, Fattore L (2012) Spice drugs are more than harmless herbal blends: a review of the pharmacology and toxicology of synthetic cannabinoids. Prog Neuropsychopharmacol Biol Psychiatry 2012 Apr 26Google Scholar
  4. 4.
    Logan BK, Reinhold LE, Xu A, Diamond FX (2012) Identification of synthetic cannabinoids in herbal incense blends in the United States. J Forensic Sci 2012 Jul 26Google Scholar
  5. 5.
    Tofighi B, Lee JD (2012) Internet highs-seizures after consumption of synthetic cannabinoids purchased online. J Addict Med 6(3):240–241PubMedCrossRefGoogle Scholar
  6. 6.
    Forrester M, Kleinschmidt K, Schwarz E, Young A (2012) Synthetic cannabinoid and marijuana exposures reported to poison centers. Hum Exp Toxicol 2012 Aug 2Google Scholar
  7. 7.
    Cohen J, Morrison S, Greenberg J, Saidinejad M (2012) Clinical presentation of intoxication due to synthetic cannabinoids. Pediatrics 129(4):e1064–e1067PubMedCrossRefGoogle Scholar
  8. 8.
    Ashton JC (2012) Synthetic cannabinoids as drugs of abuse. Curr Drug Abuse Rev 5(2):158–168PubMedCrossRefGoogle Scholar
  9. 9.
    Castellanos D, Thornton G (2012) Synthetic cannabinoid use: recognition and management. J Psychiatr Pract 18(2):86–93PubMedCrossRefGoogle Scholar
  10. 10.
    Rosenbaum CD, Carreiro SP, Babu KM (2012) Here today, gone tomorrow…and back again? A review of herbal marijuana alternatives (K2, Spice), synthetic cathinones (bath salts), kratom, Salvia divinorum, methoxetamine, and piperazines. J Med Toxicol 8(1):15–32PubMedCrossRefGoogle Scholar
  11. 11.
    Vardakou I, Pistos C, Spiliopoulou C (2010) Spice drugs as a new trend: mode of action, identification and legislation. Toxicol Lett 197(3):157–162PubMedCrossRefGoogle Scholar
  12. 12.
    Atwood BK, Huffman JW, Straiker A et al (2010) JWH018, a common consitiuent of “Spice” herbal blends, is a potent and efficacious cannabinoid CB1 receptor agonist. Br J Pharm 160:585–593CrossRefGoogle Scholar
  13. 13.
    Simmons JR, Skinner CG, Williams J et al (2011) Intoxication from smoking “Spice. Ann Emerg Med 57(2):187–188PubMedCrossRefGoogle Scholar
  14. 14.
    Schneir AB, Cullen J, Ly BT (2011) “Spice” girls: synthetic cannabinoid intoxication. J Emerg Med 40(3):296–299PubMedCrossRefGoogle Scholar
  15. 15.
    Mir A, Obafemi A, Young A, Kane C (2011) Myocardial infarction associated with use of the synthetic cannabinoid K2. Pediatrics 128(6):e1622–e1627PubMedCrossRefGoogle Scholar
  16. 16.
    Hurst D, Loeffler G, McLay R (2011) Psychosis associated with synthetic cannabinoid agonists: a case series. Am J Psychiatry 168(10):1119PubMedCrossRefGoogle Scholar
  17. 17.
    Young AC, Schwarz E, Medina G, Obafemi A, Feng SY, Kane C, Kleinschmidt K (2011) Cardiotoxicity associated with the synthetic cannabinoid, K9, with laboratory confirmation. Am J Emerg Med 2011 Jul 28Google Scholar
  18. 18.
    Fattore L, Fratta W (2011) Beyond THC: the new generation of cannabinoid designer drugs. Front Behav Neurosci 5(60):1–12Google Scholar
  19. 19.
    Tetrault JM, Crothers K, Moore BA, Mehra R, Concato J, Fiellin DA (2007) Effects of marijuana smoking on pulmonary function and respiratory complications: a systematic review. Arch Intern Med 167:221–228PubMedCrossRefGoogle Scholar
  20. 20.
    Lieberman CM, Lieberman BW (1971) Marihuana—a medical review. N Engl J Med 284:88–91PubMedCrossRefGoogle Scholar
  21. 21.
    Guidotti TL, Laing L, Prakash UB (1989) Clove cigarettes. The basis for concern regarding health effects. West J Med 151(2):220–228PubMedGoogle Scholar
  22. 22.
    Bennett GL, Chew FS (1994) Pulmonary carcinoid tumorlets. AJR 162:568PubMedCrossRefGoogle Scholar
  23. 23.
    Loschner A, Cihla A, Jalali F et al (2011) Diffuse alveolar hemorrhage: add “greenhouse effect” to the growing list. Chest 140:149ACrossRefGoogle Scholar
  24. 24.
    Selman M, Pardo A, King TE (2012) Hypersensitivity pneumonitis: insights in diagnosis and pathobiology. Am J Respir Crit Care Med 186(4):314–324PubMedCrossRefGoogle Scholar
  25. 25.
    Sobolevsky T, Prasolov I, Rodchenkov G (2012) Detection of urinary metabolites of AM-2201 and UR-144, two novel synthetic cannabinoids. Drug Test Anal. doi:10.1002/dta.1418
  26. 26.
    McQuade D, Hudson S, Dargan PI, Wood D (2012) First European case of convulsions related to analytically confirmed use of the synthetic cannabinoid receptor agonist AM-2201. Eur J Clin Pharmacol. doi:10.1007/s00228-012-1379-2
  27. 27.
    EkaJ (20 February 2011). “The night i killed my friends”. Erowid.org. Retrieved 2 Dec 2012. http://www.Erowid.org/experiences/exp.php?ID=89294

Copyright information

© American College of Medical Toxicology 2013

Authors and Affiliations

  • Sameir Alhadi
    • 1
  • Anupama Tiwari
    • 1
  • Rais Vohra
    • 1
  • Roy Gerona
    • 2
  • Janak Acharya
    • 1
  • Kathryn Bilello
    • 1
  1. 1.UCSF-Fresno Medical CenterFresnoUSA
  2. 2.UCSF School of MedicineSan Francisco General HospitalSan FranciscoUSA

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