title: Synthetic cannabinoid drug use as a cause or contributory cause of death.
abstract: Adverse effects associated with synthetic cannabinoid use include agitation, psychosis, seizures and cardiovascular effects, all which may result in a lethal outcome. We report the collection of data from 25 medical examiner and coroner cases where the presence of synthetic cannabinoids was analytically determined. Participating offices provided case history, investigative and relevant autopsy findings and toxicology results along with the cause and manner of death determination. This information, with the agency and cause and manner of death determinations blinded, was sent to participants. Participants offered their opinions regarding the likely contribution of the toxicology findings to cause and manner of death. The results show that some deaths are being attributed to synthetic cannabinoids, with the highest risk areas being behavioral toxicity resulting in excited delirium, trauma or accidents and as contributing factors in subjects with pre-existing cardiopulmonary disease. While insufficient information exists to correlate blood synthetic cannabinoid concentrations to effect, in the absence of other reasonable causes, the drugs should be considered as a cause or contributory cause of death based on history and circumstances with supporting toxicological data.
authors.affiliation: NMS Labs, 3701 Welsh Rd, Willow Grove, PA, United States. Electronic address: Laura.Labay@nmslabs.com.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Labay
authors.affiliation: City and County of Denver, 660 Bannock Street, Denver, CO, United States.
authors.forename: James L
authors.initials: JL
authors.lastname: Caruso
authors.affiliation: Cuyahoga County Regional Forensic Science Laboratory, 11001 Cedar Avenue, Cleveland, OH, United States.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Gilson
authors.affiliation: Office of the Chief Medical Examiner, 900W. Baltimore Street, Baltimore, MD, United States.
authors.forename: Rebecca Jufer
authors.initials: RJ
authors.lastname: Phipps
authors.affiliation: SUNY Upstate Medical University, Syracuse, NY, United States.
authors.forename: Laura D
authors.initials: LD
authors.lastname: Knight
authors.affiliation: Department of Laboratory Medicine, School of Medicine, University of California, San Francisco, United States.
authors.forename: Nikolas P
authors.initials: NP
authors.lastname: Lemos
authors.affiliation: San Diego County Medical Examiner's Department, San Diego, CA, United States.
authors.forename: Iain M
authors.initials: IM
authors.lastname: McIntyre
authors.affiliation: Onondaga County Medical Examiner's Office, 100 Elizabeth Blackwell Street, Syracuse, NY, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Stoppacher
authors.affiliation: Medical University of South Carolina, 181 Ashley Avenue MSC 908, Charleston, SC, United States.
authors.forename: Lee Marie
authors.initials: LM
authors.lastname: Tormos
authors.affiliation: Oklahoma Office of the Chief Medical Examiner, 1115 West 17th Street, Tulsa, OK, United States.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Wiens
authors.affiliation: Coroner's Offices, Chester and Montgomery Counties, PA, United States.
authors.forename: Erica
authors.initials: E
authors.lastname: Williams
authors.affiliation: NMS Labs, 3701 Welsh Rd, Willow Grove, PA, United States.
authors.forename: Barry K
authors.initials: BK
authors.lastname: Logan
mesh_terms: D000293:Adolescent; D000328:Adult; D002186:Cannabinoids / Q000009:adverse effects*; D002423:Cause of Death; D003334:Coroners and Medical Examiners; D003693:Delirium / Q000139:chemically induced; D015198:Designer Drugs / Q000009:adverse effects*; D005260:Female; D049429:Forensic Pathology; D053593:Forensic Toxicology; D006331:Heart Diseases / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019966:Substance-Related Disorders / Q000150:complications* / Q000401:mortality*; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality; D055815:Young Adult
chemical_list: D002186:Cannabinoids; D015198:Designer Drugs
keywords: Cause and manner of death; Postmortem; Synthetic cannabinoids; Toxicology