“Legal” marijuana: patients with confirmed exposure to JWH-018 and JWH-073

March 30, 2011, 12:00 am

★★★☆☆

“Spice” Girls: Synthetic Cannabinoid Intoxication. Schneir AB et al. J Emerg Med March 2011;40:296-299.

Abstract

This paper, from UC-San Diego, reports on two patients who presented to the emergency department after smoking a product labelled “Banana Cream Nuke”. It had been purchased at a convenience store and carried the warning “not for human consumption”.  The ingredients listed on the label were: alfalfa, marshmallow, blue violet, nettle leaf, comfrey leaf, Gymnema sylvestre, passion flower leaf, horehound, and neem leaf.

Patient #1, a 22-year-old woman, described feelings of anxiety, tremulousness, and palpitations after using the product.  These symptoms had mostly resolved on arrival at the hospital.  Findings included normal vital signs and pupil size with some lateral gaze nystagmus.  Urine drug screen, including THC, was negative.  She was observed for one hour and discharged.

Patient #2,  a 20-year-old woman, complained of anxiety.  She was tachycardic (126 bpm) but otherwise had a normal physical exam.

Residual “Banana Cream Nuke” from the package was sent for analysis, which identified the synthetic cannabinoids JWH-018 and JWH-073 — chemicals also found in “Spice” and “K2”.

Congratulations to the authors for taking the extra step and having the product these patients smoked analyzed.  This confirms previous observations that “Spice”-like products predominantly cause transient anxiety and tachycardia, although paranoia and hallucinations have also been described. However, as the authors point out, they couldn’t test for every possible drug and “Banana Cream Nuke” might contain other chemicals not yet identified.

A letter in the February issue of Annals of Emergency Medicine (2011;57:187-8) described 3 patients who smoked “Spice” or similar products.  Clinical features included agitation, vomiting, somnolence, tachycardia, and mydriasis. Urine drug screens were negative in all three.  No analysis of the product( s) was carried out.

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