title: Signs and symptoms associated with synthetic cannabinoid toxicity: systematic review.
abstract: OBJECTIVE
  Use of synthetic cannabinoids is associated with significant physical and psychological harms. This research quantified reported toxicities from published reports and assessed the influence of size of the reported study population on rates of symptom reporting.
  
  
  METHODS
  Systematic review of published case reports and case series of toxicity associated with use of synthetic cannabinoids.
  
  
  RESULTS
  Symptoms associated with synthetic cannabinoid toxicity were reported for 3695 individuals, predominantly young males. Symptoms included physiological (e.g. tachycardia, hypertension, nausea/vomiting), emotional (e.g. agitation, irritability, paranoia), behavioural (e.g. drowsiness, aggression) and perceptual (e.g. hallucinations) domains. Most common symptoms were tachycardia (30.2% of cases), agitation (13.5%), drowsiness (12.3%), nausea/vomiting (8.2%) and hallucinations (7.6%). Death or serious medical complications were uncommon (e.g. death 0.2%, stroke 0.1%, myocardial infarction 0.09%). Case reports/smaller case series (n<10) reported statistically significantly higher rates for 29/34 symptoms than larger case series (n≥10), which could represent selection bias.
  
  
  CONCLUSIONS
  Symptoms of synthetic cannabinoid toxicity are variable and cover a number of physical and psychological domains. Symptom reporting varies by study population size. Due to the variable presenting symptoms of synthetic cannabinoid toxicity, clinicians in emergency services should consider synthetic cannabinoid toxicity when evaluating young adult male patients presenting with unexplained agitation or cardiovascular symptoms.
authors: Registered Nurse, Department of Psychological Medicine, University of Otago, Dunedin, New Zealand, and; Southern District Health Board, Dunedin, New Zealand.
authors: Julie
authors: J
authors: Courts
authors: Lecturer, Centre of Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand.
authors: Virginia
authors: V
authors: Maskill
authors: Consultant Statistician, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
authors: Andrew
authors: A
authors: Gray
authors: Hazel Buckland Chair of Psychological Medicine, Department of Psychological Medicine, University of Otago, Dunedin, New Zealand, and; Southern District Health Board, Dunedin, New Zealand paul.glue@otago.ac.nz.
authors: Paul
authors: P
authors: Glue
mesh_terms: D001526:Behavioral Symptoms / Q000139:chemically induced / Q000453:epidemiology*; D002186:Cannabinoids / Q000633:toxicity*; D006212:Hallucinations / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D013610:Tachycardia / Q000139:chemically induced / Q000453:epidemiology*
chemical_list: D002186:Cannabinoids
keywords: synthetic cannabis; systematic review; toxicity