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Alcohol, drugs, toxins and post-mortem toxicology
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
Colin Smith, Christopher Milroy
New drugs are always emerging into the recreational drug use scene and are known as novel psychoactive substances (NPS) (Schifano et al. 2015; Logan et al. 2017). The term was first used in respect of heroin-like derivatives, but when drugs such as MDMA emerged in the 1980s, they were also referred to as designer drugs. The term NPS been used for a number of different substances with different actions. Various groups of drugs that have emerged include synthetic cannabinoids, designer benzodiazepines, synthetic cathinones, novel hallucinogens and designer opioids being the main groups. These drugs have all been associated with adverse effects. Synthetic cannabinoids may cause central nervous symptom symptoms and signs, including delirium and seizure activity and have caused death. Synthetic cathinones are stimulants and can cause hyperpyrexia, hypertension and an excited delirium (ED) picture. Novel hallucinogens can also cause hyperpyrexia, hypertension and delirium. Designer benzodiazepines have similar actions to traditional benzodiazepines, and synthetic opioids have actions like other opioids and have been associated with many adverse events and deaths. Neuropathological changes similar to other stimulant and opioid drugs can be expected but neuropathological studies have not yet been reported.
Endocannabinoid System & Cannabinoid Receptors
Published in Betty Wedman-St Louis, Cannabis as Medicine, 2019
Synthetic cannabinoids are products that are sold as K2, spice, “fake weed,” or synthetic marijuana. They are made from various chemicals that can cause serious side effects. Synthetic cannabinoid products can be toxic in addition to causing psychoactive effects. They are designed to be similar to natural THC from the cannabis plant but often have greater binding effects to CB1 receptors that can cause paranoia, anxiety, and seizures [21].
Some psychobiological implications of cannabis use
Published in Philip N. Murphy, The Routledge International Handbook of Psychobiology, 2018
Another cannabinoid, cannabidiol (CBD), is not generally considered psychoactive because of its minimal affinity for endogenous cannabinoid receptors (see below), but has well-documented beneficial effects for the treatment of anxiety and psychosis (Blessing et al., 2015; Fakhoury, 2015; Scuderi et al., 2009). From a psychological perspective, therefore, the description of CBD as non-psychoactive in psychopharmacological literature does not mean that it is without effect upon psychological processes and related behaviour. As most of the research on cannabinoids relevant to psychological functioning has focused particularly upon THC, this chapter will also adopt this focus. Cannabinoids originating from plant extract in their production are referred to collectively as phytocannabinoids. However, synthetic cannabinoids have been produced for clinical purposes (e.g. dronabinol and nabilone; see Wright & Guy, 2014), and have more recently also been produced for illegal distribution for recreational purposes (Thomas et al., 2014).
A Case of Presumed Bonsai-induced Severe Toxic Optic Neuropathy
Published in Neuro-Ophthalmology, 2022
Erdogan Yasar, Hatice Suhan Tomac, Ugur Gurlevik
“Bonsai” is a type of synthetic cannabinoid. Two cannabinoid receptors have been defined so far, CB1 and CB2. They are G protein-coupled receptors that suppress adenylcyclase activity. It has been published in various studies that cannabinoids are neuroprotective and anti-glaucomatous and show this effect by lowering intraocular pressure and decreasing retinal ganglion cell loss.7 However, in some studies, it has been shown that they have no effect according to the form and amount of administration.8 In some studies, a decrease in systemic blood pressure was found due with cannabinoid intake and it was thought that the blood flow to the optic nerve could be reduced due to this decrease in systemic blood pressure.9 Although cannabinoids exert their effects through the CB1 and CB2 receptors, it has been reported that they can act as antagonists to both receptors and that additional receptors may also be present. There are more than 180 analytically verified synthetic cannabinoid receptor agonists.10,11 Most of the studies conducted were animal experiments or on a limited number of humans and there has been no randomised controlled study with a large number of patients. As a result, the exact effects of the synthetic cannabinoids are still unknown due to the large amount of substances often present. It is possible that the side effects may vary depending on the method and amount of intake. It is possible that our patient had pigmented optic atrophy in this way.
Content versus Label Claims in Cannabidiol (CBD)-Containing Products Obtained from Commercial Outlets in the State of Mississippi
Published in Journal of Dietary Supplements, 2020
Bill J. Gurley, Timothy P. Murphy, Waseem Gul, Larry A. Walker, Mahmoud ElSohly
Perhaps the most alarming aspect of this study was the frequency with which CBD vaping products were adulterated with synthetic cannabinoids. Synthetic cannabinoids are a novel class of designer drugs intended to mimic the psychoactive effects of THC in marijuana (Pintori et al. 2017). They emerged as a new drug of abuse category in 2008. Synthetic cannabinoid use/abuse can have devastating toxicological consequences ranging from agitation and psychosis to arrhythmia, seizures, and death (Davidson et al. 2017; Armenian et al. 2018; Pacher et al. 2018). Their unpredictable toxicity may vary with dose, route of administration, individual vulnerability, and concomitant intake with other drugs (Davidson et al. 2017; Pintori et al. 2017). Compounding the harmful effects of synthetic cannabinoids when delivered via electronic cigarette is lung injury associated with vaping alone (Cherian et al. 2020). Recently, CBD oil vaping has been linked to a number of serious lung injuries (Conuel et al. 2019; Heinzerling et al. 2020). Our findings, while not conclusive, suggest that adulterated CBD products designed for e-cigarette use may exacerbate vaping-associated respiratory failure (Conuel et al. 2019; Fryman et al. 2020; Heinzerling et al. 2020). The number of liquid vaping products that provided no manufacturer information was also surprising as such practices only worsen the safety concerns surrounding these products.
Characteristics and circumstances of synthetic cannabinoid-related death
Published in Clinical Toxicology, 2020
Shane Darke, Johan Duflou, Michael Farrell, Amy Peacock, Julia Lappin
Anecdotal reports of a legal herbal mixture with cannabis-like effects emerged in Europe from 2004, with the first analytical confirmation of synthetic cannabinoids (JWH-018) in these products in 2008 [1]. Since then, the number of synthetic cannabinoids available has proliferated, with more than 260 unique substances between 2009 and 2018 [2]. Synthetic cannabinoids are typically dissolved in solvent, applied to an inert herbal substrate and smoked [3–7]. Less commonly, they are available in liquid or powder form. These drugs may be classified into four major pharmacological sub-categories: indazolecarboxemides (e.g., AB-CHMINACA), acylindoles (e.g., JWH-018), indolecarboxylates (e.g., PB-22) and gamma-carbolines (e.g., CUMYL-PEGACLONE) [4]. The potency of synthetic cannabinoids exceeds that of cannabis, having a stronger binding affinity with the cannabinoid receptors. Indeed, there have been numerous reports of mass intoxications in recent years with the appearance of more potent synthetic cannabinoids, including chemicals with off-target activity [3,4].