The Chameleon-Like Properties of Psychoactive Drugs: Examinations with HR LC-MS/MS Technology of Patients Presenting at the Emergency Department Following the Use of Synthetic Cannabinoids: A Case Series and Literature Review

Abstract

The chameleon can disguise itself in nature by taking on different colors and forms. As synthetic cannabinoids (SC) have clinically similar effects to those of several psychoactive agents, they are one of the most difficult intoxications to diagnose. The reasons for this are due to clinical variations throughout the world and the differences in symptoms having not been determined due to their similarity to the intoxication of several other drugs. The aim of this study was to obtain prospective data of patients presenting at the Emergency Department (ED) with suspected SC intoxication, and as a result of prospective examination of samples, to determine a new generation of SC use, SC types, clinical findings, and treatments. Method: A total of a 15 patients with suspected SC intoxication who presented at the ED of the Health Sciences University Kayseri Training and Research Hospital between January 2017 and January 2018 were examined. Samples taken prospectively from patients who were followed-up for a diagnosis of SC intoxication were examined with the HR LC-MS/MS method; SC were determined, and the test results of other psychoactive agents that were used concurrently were examined. Conclusions: Three significant findings emerged as a result of this study. Firstly, due to the different clinical forms of presentation at ED associated with SC use and the range of intoxications that cannot be diagnosed, advanced laboratory tests are required, in addition to routine tests for the determination of SC. Secondly, those diagnosed as having taken SC were also determined to have used it concurrently with substances that have a high potential for addiction, such as amphetamines and quetiapine. Thirdly, in regard to examples of cases presented in the literature, anti-psychotics, fluid hydration, and anxiolytics can be used as treatment options for those diagnosed with SC use.

Keywords

• synthetic cannabinoid
• Emergency Department
• intoxication
• cannabinoid metabolites
• laboratory