Gastrointestinal manifestations of synthetic cannabinoids: a retrospective cohort study

David Hakimian,Tawfik Khoury,Sarah Israel,Yonatan Gershinsky,Mordechai Muszkat,Barak Shapira,Muhammad Massarwa,Ariel A Benson,Shaden Salameh

doi:10.1186/s12876-021-01847-w

Abstract

BackgroundSynthetic cannabinoids (SC) are chemical substances which activate cannabinoid receptors similarly to tetrahydrocannabinol, but with a higher efficacy. These substances are used as illicit recreational drugs, often smoked as herbal mixtures. The continuing availability and rapid evolution of SC is an ongoing health risk. The adverse effects of SC are wide ranging, and span from mild behavioral changes to death. Knowledge regarding gastrointestinal (GI) manifestations of SC use is sparse.MethodsSingle tertiary-care referral medical center retrospective study.ResultsThe medical records of patients presented to hospital emergency care due to SC use between January 2014 and February 2018 were retrieved from Hadassah Mount Scopus Hospital’s computerized database. The records were reviewed for clinical outcomes and laboratory tests. Fifty-five (55) patients were identified with a hospital presentation due to SC use. Twenty-one (21) out of 55 patients (38%) reported gastrointestinal complaints. The most common complaints were abdominal pain and vomiting. Of those, 28% had recurrent emergency department presentations due to abdominal pain and 66% presented with leukocytosis. Serum lactate was elevated in 66% of patients with GI manifestations. One patient had an abnormal computerized tomography (CT) abdominal angiography scan, which was compatible with intestinal ischemia.ConclusionsThe clinical spectrum of gastrointestinal manifestations in SC intoxication ranges from mild symptoms, such as abdominal pain and vomiting, to even more severe symptoms suggestive of intestinal ischemia. Clinicians should be aware that abdominal pain and other gastrointestinal complaints can be associated with SC use.

Highlights

Synthetic cannabinoids (SC) are chemical substances which activate cannabinoid receptors to tetrahydrocannabinol, but with a higher efficacy
We examine the association between SC use and the GI tract manifestations, using a cohort of patients which presented to the hospital after SC use
GI manifestations were defined as symptoms of abdominal pain, vomiting, or diarrhea that were reported in the emergency department (ED), as documented in the medical records

Summary

Introduction

Synthetic cannabinoids (SC) are chemical substances which activate cannabinoid receptors to tetrahydrocannabinol, but with a higher efficacy. These substances are used as illicit recreational drugs, often smoked as herbal mixtures. SC usually appear in the illicit drug market as smokable herbal mixtures containing shrub leaves. These substances can be consumed via vaporized liquid, Hakimian et al BMC Gastroenterol (2021) 21:274 inhaled in e-cigarettes, or by ingestion. The active chemicals are not characterized using controlled laboratory testing, and many products are mixed with potentially dangerous substances such as other illicit drugs, animal-oriented poisons, or embalming fluids [6]. The clinical consequences of SC use are myriad, yet not well-defined [7]

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