title: Characteristics and Treatment of Patients with Clinical Illness Due to Synthetic Cannabinoid Inhalation Reported by Medical Toxicologists: A ToxIC Database Study.
abstract: Synthetic cannabinoid (SC) abuse has resulted in numerous outbreaks of severe clinical illness across the United States over the past decade. The primary objective of this study was to determine the clinical characteristics of patients abusing SC requiring bedside consultation by medical toxicologists.
  
  
  
  This was a multicenter analysis from a prospectively collected cohort of patients presenting to medical care after synthetic cannabinoid exposure, utilizing the ToxIC Registry. Management of cases by medical toxicologists in this cohort occurred in emergency departments, inpatient medical floors, and intensive care units. Cases were identified from January 5, 2010 - July 31, 2015. We characterized the clinical presentations, treatments, outcomes, and sociologic factors associated with SC use in these patients.
  
  
  
  Medical toxicologists participating in the ToxIC Registry cared for 39,925 cases between 2010 and 2015. Three hundred fifty three of these cases were determined to be SC toxicity. The median age of patients was 25 (IQR: 18, 36) and the majority were males (84%). The most common symptoms were agitation, delirium and toxic psychosis, n=146 (41%). Forty-four (12.5%) had heart rates above 140 beats per minute. Bradycardia was the second most commonly reported severe vital sign abnormality with 20 (5.7%) having heart rates of less than 50 beats per minute. Fifteen (4.2%) patients had hypotension. Fifty-nine (17%) had seizures. The most common pharmacologic treatment provided was benzodiazepines (n=131, 37%) followed by antipsychotics (n=36, 10%).Disposition was available for 276; of these 167 (61%) were managed in the emergency department, 42 (15%) were admitted to the hospital floor, and 67 (24%) were admitted to the ICU.
  
  
  
  Synthetic cannabinoids are associated with severe central nervous system and cardiovascular effects.
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA. andrew.monte@ucdenver.edu.|Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA. andrew.monte@ucdenver.edu.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Monte
authors.affiliation: New Jersey Poison Information and Education System, Rutgers Biomedical and Health Sciences, Department of Emergency Medicine, New Jersey Medical School, Newark, NJ, USA.
authors.forename: Diane P
authors.initials: DP
authors.lastname: Calello
authors.affiliation: Department of Laboratory Medicine, University of California-San Francisco, San Francisco, CA, USA.
authors.forename: Roy R
authors.initials: RR
authors.lastname: Gerona
authors.affiliation: Department of Emergency Medicine, University of Massachusetts, Worcester, MA, USA.
authors.forename: Eike
authors.initials: E
authors.lastname: Hamad
authors.affiliation: Toxicology Investigators Consortium, American College of Medical Toxicology, Phoenix, AZ, USA.
authors.forename: Sharan L
authors.initials: SL
authors.lastname: Campleman
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.|Toxicology Investigators Consortium, American College of Medical Toxicology, Phoenix, AZ, USA.
authors.forename: Jeffery
authors.initials: J
authors.lastname: Brent
authors.affiliation: Southwestern Medical School, University of Texas, Dallas, TX, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Wax
authors.affiliation: Department of Community Health, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Carlson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002186:Cannabinoids / Q000008:administration & dosage / Q000138:chemical synthesis / Q000506:poisoning*; D002319:Cardiovascular System / Q000187:drug effects* / Q000503:physiopathology; D002490:Central Nervous System / Q000187:drug effects* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011041:Poisoning / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D012042:Registries; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D002186:Cannabinoids
keywords: K2; Novel psychoactive substance; Spice; Synthetic cannabinoid; ToxIC