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Heroin Addiction and Related Clinical Problems: 2018, 20, N3 (pages: 13 - 24)

Novel Psychoactive Synthetic Cannabinoids and Synthetic Cathinones: The Never-Ending Story of Potential Clinical Toxicity

Lovrecic B., and Lovrecic M.

Summary: Background: Over the last ten years, there has been an unprecedented increase in the use of new psychoactive substances (NPS) that are not yet under international control. This poses an emerging and demanding challenge to public health, clinical work and researchers worldwide. Synthetic cannabinoids (SCs) and synthetic cathinones (SKs) are the substances most frequently involved in producing states of intoxication; acute toxicity due to SKs is the most problematic prognosis from the viewpoint of public safety and health. Aim: To raise awareness among clinicians regarding NPS (especially SC- and SK-related) signs, symptoms and clinical toxicities. Methods: An electronic search was carried out on the Medline/PubMed and Google Scholar databases to find selected search terms with a particular focus on reporting acute toxicity and psychopathology. Results: Acute toxicity due to SCs and SKs has been implicated in the emergence mostly of neuropsychiatric and cardiovascular clinical manifestations. A majority of emergency medical problems are minor to moderate poisonings; however, severe intoxication can lead to life-threatening adverse effects and death. These substances cannot be detected by conventional drug screening methods. Clinicians should maintain a high level of suspicion of finding synthetic toxicity in patients presenting with unexplained agitation or cardiovascular symptoms, especially in cases of altered mental status with acute onset, excited delirium, renal failure or sympathomimetic symptoms. Conclusions: The acute and chronic toxicity of many NPSs is still unknown, as data from poison centres should be interpreted within their limitations (absence of analytical confirmation, secondary reporting of clinical features). There is a need for evidence-based treatment recommendations for cases of acute intoxication.