title: Occupational transdermal poisoning with synthetic cannabinoid cumyl-PINACA.
abstract: BACKGROUND
  Synthetic cannabinoids are getting more popular among young people and illicit manufacturers. We report a case series of occupational transdermal poisoning with synthetic cannabinoids.
  
  
  METHODS
  Three customs inspectors got in contact with a sticky substance with their fingertips because they were not wearing protection gloves and the delivered package was damaged. Despite washing their hands with water, signs of synthetic cannabinoids intoxication started occurring half an hour after exposure. On arrival at the Emergency Department six hours later, they were somnolent, lethargic and confused. They showed signs of mydriasis, blurred vision, ataxia, weakness, numbness, tachycardia and one of them had orthostatic hypotension. Two days later, they were feeling much better and reported amnesia and slowed perception of time after exposure. Toxicology analysis by LC-MS/MS revealed synthetic cannabinoid cumyl-PINACA (SGT-24) in their blood samples taken on admission. cumyl-PINACA was also confirmed with NMR method in liquid samples seized at the airport. It was 98% pure substance with the purpose of being diluted and sold further in the drug market by drug dealer.
  
  
  CONCLUSIONS
  This case series highlights the possible transdermal exposure to synthetic cannabinoids oil resulting in prolonged cannabinoid syndrome.
authors.affiliation: a Centre for Clinical Toxicology and Pharmacology, Division of Internal Medicine , University Medical Centre Ljubljana , Ljubljana , Slovenia.
authors.forename: Mojca
authors.initials: M
authors.lastname: Dobaja
authors.affiliation: a Centre for Clinical Toxicology and Pharmacology, Division of Internal Medicine , University Medical Centre Ljubljana , Ljubljana , Slovenia.
authors.forename: Damjan
authors.initials: D
authors.lastname: Grenc
authors.affiliation: b Institute of Forensic Medicine, Faculty of Medicine , University of Ljubljana , Ljubljana , Slovenia.
authors.forename: Gordana
authors.initials: G
authors.lastname: Kozelj
authors.affiliation: a Centre for Clinical Toxicology and Pharmacology, Division of Internal Medicine , University Medical Centre Ljubljana , Ljubljana , Slovenia.|c Institute of Pathophysiology, Faculty of Medicine , University of Ljubljana , Ljubljana , Slovenia.
authors.forename: Miran
authors.initials: M
authors.lastname: Brvar
mesh_terms: D000328:Adult; D002186:Cannabinoids / Q000506:poisoning*; D002853:Chromatography, Liquid / Q000379:methods; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007191:Indazoles / Q000097:blood / Q000506:poisoning*; D008297:Male; D016273:Occupational Exposure / Q000009:adverse effects*; D012869:Skin Absorption; D015813:Substance Abuse Detection / Q000379:methods*; D053719:Tandem Mass Spectrometry / Q000379:methods; D055815:Young Adult
chemical_list: D002186:Cannabinoids; D007191:Indazoles; C000614729:cumyl-PINACA
keywords: SGT-24; Synthetic cannabinoids; cumyl-PINACA; occupational poisoning; potency; safety; transdermal exposure