Acute intoxication by synthetic cannabinoids - Four case reports (2013)

Recently, synthetic cannabinoids appeared on the drug market, mostly as undeclared additives in 'herbal mixtures' named for example 'Spice', 'Lava Red' or 'Jamaican Gold'. The use of synthetic cannabinoids is driven by several factors. After the introduction of new compounds, their use is initially not restricted by prohibition. Moreover, their consumption cannot be verified by standard drug tests, which is particularly interesting for people facing regular drug testing. Easy access via the Internet and affordability also contribute to the popularity of these drugs.
Since their first detection in herbal mixtures, more than 30 different synthetic cannabinoids have been identified in such products. The abused synthetic CB1 receptor agonists are chemically heterogeneous. Most of the identified compounds are non-classical cannabinoids (e.g. CP-47,497-C8) or aminoalkylindole derivatives, such as naphthoylindoles (e.g. JWH-018, JWH-081, JWH-122 and AM-2201), phenylacetylindoles (e.g. JWH-203, JWH-250 and JWH-251) or benzoylindoles (e.g. AM-694 and RCS-4).
The frequent use of synthetic cannabinoids led to a recent increase in emergencies elicited by these compounds. Here we report on four patients treated in emergency departments after consumption of synthetic cannabinoids. Serum and urine samples were examined for synthetic cannabinoids and other drugs. The analytical results are discussed in the context of the clinical findings. [Extract]