Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2022 Apr;60(4):524-526.
doi: 10.1080/15563650.2021.1975734. Epub 2021 Sep 9.

Respiratory failure in confirmed synthetic cannabinoid overdose

Alex F Manini  1 , Alex J Krotulski  2 , Jonathan Schimmel  1 , Lisa Allen  3 , Yasmin L Hurd  4 , Lynne D Richardson  5 , Kavey Vidal  3 , Barry K Logan  2   6
Affiliations
Observational Study

Respiratory failure in confirmed synthetic cannabinoid overdose

Alex F Manini et al. Clin Toxicol (Phila). 2022 Apr.

Abstract

Context: Synthetic cannabinoids (SCs) are a structurally heterogenous synthetic class of drugs of abuse. The objective was to describe the incidence of acute respiratory failure in Emergency Department (ED) patients with confirmed SC exposure, and to investigate the association between SC overdose with respiratory failure compared to non-SC overdose.

Methods: This was an observational cohort of ED patients ≥18 years with suspected cannabinoid overdose between 2015 and 2020 at two tertiary-care hospitals. Patient serum was analyzed via liquid chromatography/quadrupole time-of-flight mass spectrometry using a library with >800 drugs including novel psychoactive substances. The primary outcome was acute respiratory failure.

Discussion: Of 83 patients with suspected cannabinoid overdose, there were 29 confirmed SC overdoses: 5 F-MDMB-PICA (n = 18) and its metabolite 5OH-MDMB-PICA (n = 16), ADB-FUBINACA (n = 4), AB-CHIMINACA (n = 4), AB-FUBINACA (n = 1), AB-PINACA (n = 1), MDMB-4en-PINACA (n = 1), and 4 F-MDMB-BINACA (n = 1). Overall, incidence of acute respiratory failure was 31.3% (95%CI 21.6-42.4). Compared to non-SC overdose, confirmed SC overdose was significantly associated with respiratory failure (25.0% SC vs. 4.2% non-SC, p = 0.05).

Conclusion: This study demonstrates that SCs are associated with respiratory failure. Since respiratory depression is a potentially lethal adverse effect of SC overdose, future research is warranted.

Keywords: SCRAs; Synthetic cannabinoids; naloxone; respiratory failure; synthetic cannabinoid receptor agonists.

PubMed Disclaimer

Conflict of interest statement

Disclosure statement

The authors declare no commercial conflicts of interest.

Figures

Figure 1.
Figure 1.
Confirmed Synthetic Cannabinoid drugs in this cohort (N).
See this image and copyright information in PMC

References

    1. Alves VL, Gonçalves JL, Aguiar J, et al. The synthetic cannabinoids phenomenon: from structure to toxicological properties. A review. Crit Rev Toxicol. 2020;50(5):359–382. - PubMed
    1. Hermanns-Clausen M, Müller D, Kithinji J, et al. Acute side effects after consumption of the new synthetic cannabinoids AB-CHMINACA and MDMB-CHMICA. Clin Toxicol (Phila)). 2018;56(6):404–411. - PubMed
    1. Drenzek C, Geller RJ, Steck A, et al. Severe illness associated with synthetic cannabinoid Use-Brunswick, Georgia, 2013. MMWR Morbidity and Mortality Weekly Report. 2013;62(46):939. - PMC - PubMed
    1. Jinwala FN, Gupta M. Synthetic cannabis and respiratory depression. J Child Adolesc Psychopharmacol. 2012;22(6):459–462. - PubMed
    1. Richards JR, Schandera V, Elder JW. Treatment of acute cannabinoid overdose with naloxone infusion. Toxicology Communications. 2017;1(1):29–33.

Publication types

MeSH terms