Abstract
IntroductionSynthetic cannabinoids are a rapidly expanding subset of designer drugs widely available in the United States since 2008. In Illinois during the spring of 2018, over 160 documented cases of bleeding and prolonged coagulopathy occurred secondary to contaminated synthetic cannabinoids.MethodsWe conducted a retrospective cohort study consisting of 38 patients to describe the initial emergency department (ED) presentation, diagnosis, and treatment.ResultsThrough serum testing we found that three long-acting anticoagulant rodenticides (LAAR) were detected in patients who had inhaled these tainted products: brodifacoum, difenacoum, and bromodialone.DiscussionThis study encompasses the largest ED presentation of LAAR poisoning via the inhalational route known to date.ConclusionThe emergency physician should be aware of the potential for tainted coingestants as the cause of undifferentiated coagulopathy.
Highlights
Synthetic cannabinoids are a rapidly expanding subset of designer drugs widely available in the United States since 2008
Through serum testing we found that three long-acting anticoagulant rodenticides (LAAR) were detected in patients who had inhaled these tainted products: brodifacoum, difenacoum, and bromodialone
The emergency physician should be aware of the potential for tainted coingestants as the cause of undifferentiated coagulopathy. [West J Emerg Med. 2021;22(4)1014–1019.]
Summary
Synthetic cannabinoids are a rapidly expanding subset of designer drugs widely available in the United States since 2008. Synthetic cannabinoids have become a widely used type of designer drug in the global drug market.[1] Synthetic cannabinoids first made their appearance in the United States in 2008 and are sold under numerous names including “K2,” “Spice,” and “Black Magic.”. These drugs have long evaded law enforcement due to the drug manufacturers’ ability to quickly alter chemical formulas and generate novel products that have yet to be made illegal under the Controlled Substances Act. In addition, most of these are packaged and sold as herbal products and labeled as “not for human consumption” to further circumvent drug laws.[2]. There are many reports describing associations of synthetic cannabinoids with acute medical conditions including ischemic and hemorrhagic strokes, thrombotic microangiopathy, disseminated intravascular coagulation, immune thrombocytopenic purpura, rhabdomyolysis, and death.[5,6,7,8,9]
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