Acil serviste yeni bir tehlike: Sentetik kannabinoidler (Bonzai, Jameika)

Amaç: Bu çalışmanın amacı, acil servisimize Bonzai ya da Jameika adı ile bilinen sentetik kannabinoid alımı ile doğrudan başvuran hastaların epidemiyolojik özelliklerini incelemektir. Gereç ve yöntem: 01.02.2014 - 31.07.2014 tarihleri arasındaki 6 aylık sürede, Bonzai ya da Jameika adı ile bilinen sentetik kannabinoidleri kullanarak doğrudan acil servisimize başvuran hastalar, hastane polisi adli kayıtlarından belirlendi. Hastalar yaş, cinsiyet, başvuru şikâyeti, başvuru tarihi ve acil servisteki tedavi sürecine göre değerlendirildi. Bulgular: Belirtilen sürede toplam 112 hastanın acil servisimize başvurduğu ve hastaların 111'nin erkek, sadece 1'nin kadın olduğu belirlendi. Hastaların yaş ortalaması 23.32 ± 6.14 idi. Üçüncü dekatta bulunan hasta sayısı 60 olup, ikinci dekatta 35, dördüncü dekatta 15, beşinci dekatta ise 2 hasta bulunuyordu. Son iki ay içerisinde 83 hastanın doğrudan acil servisimize başvurduğu belirlendi. Toplam 37 hastada kardiyak yan etkilerin olduğu görüldü. Altmış bir hastanın acil serviste değerlendirilerek taburcu edildiği, yatarak tedavi ihtiyacı belirlenen hastaların büyük oranda yoğun bakım ünitelerine yatırıldığı belirlendi. Elli iki hasta için acil serviste konsültasyon istendiği, bu konsültasyonların çoğunlukla dahiliye ve anestezi kliniklerinden istendiği belirlendi. Sonuç: Özellikle erkeklerde ve genç erişkinlerde görülen, sentetik kannabinoid zehirlenmeleri son aylarda artış göstermektedir. Bu zehirlenmelerde en fazla kardiyak yan etkiler ortaya çıkmaktadır. Konuyla ilgili eğitimlerle hekimlerin bilgi düzeyi artırılmalı ve daha kapsamlı epidemiyolojik veriler için, çok merkezli çalışmalar yapılmalıdır.

A new threat in the emergency department: Synthetic cannabinoids (Bonzai, Jameika)

Objectives: The aim of this study is to examine the epidemiological characteristics of patients who admitted directly to our emergency department with the use of synthetic cannabinoids known as Bonzai or Jameika. Material and methods: Patients who presented to the emergency department with the using of synthetic cannabinoids known as Jameika, Bonzai were determined from judicial re- cords of hospital police between date of 01.02.2014 - 31.07.2014. Patients were evaluated according to age, sex, presenting complaint, the date of application and treatment process in the emergency department. Results: A total of 112 patients were admitted to our emergency department between the specified dates, 111 patients were male and only 1 patient was female. Mean age of patients was 23.32 ± 6.14. There were 60 patients in the third decade of life, 35 patients in the second decade, 15 patients in the fourth decade and 2 patients in the fifth decade of life. A total of 83 patients were admitted directly to emergency clinic in the last two months. Cardiac side effects were found in 37 patients. Sixty-one patients were evaluated in the emergency department and discharged from hospital. Most of the patients who need inpatient treatment, were admitted to intensive care units. Fifty-two patients were consulted in the emer- gency department, most of them were obtained from internal medicine and anesthesia clinics. Conclusion: Synthetic cannabinoid intoxication is especially seen in male young adults, and has been increasing in recent months. Cardiac side effects are more common. Knowledge level of physicians should be increased with trainings about this subject and for more comprehensive epidemiological data, multicenter studies should be carried out.

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  • Brents LK, Prather PL. The K2/Spice Phenomenon: emergence, identification, legislation and metabolic characterization of synt- hetic cannabinoids in herbal incense products. Drug Metab Rev 2014;46:72-85.
  • Evren C, Bozkurt M. Sentetik Kannabinoidler: Son Yılların Krizi. Düşünen Adam 2013;26:1-11.
  • Vandrey R, Dunn KE, Fry JA, Girling ER. A survey study to chara- cterize use of Spice products (synthetic cannabinoids). Drug Alco- hol Depend 2012;120:238-41.
  • Szily E, Bitter I. Designer drugs in psychiatric practice - a review of the literature and the recent situation in Hungary. Neuropsychop- harmacol Hung 2013;15:223-31.
  • Bretteville-Jensen AL, Tuv SS, Bilgrei OR, Fijeld B. Synthetic Can- nabinoids and Cathinones: Prevalence and Markets. Forensic Sci Rev 2013;25:8-26.
  • Aoun EG, Christopher PP, Ingraham JW. Emerging drugs of abu- se: clinical and legal considerations. R I Med J 2014;97:41-5.
  • Ibrahim S, Al-Saffar F, Wannenburg TA. Unique Case of Cardiac Arrest following K2 Abuse. Case Rep Cardiol 2014;2014:120607.
  • Hudson S, Ramsey J, King L, et al. Use of high resolution accurate mass spectrometry to detect reported and previously unrepor- ted cannabinomimetics in "herbal high" products. J Anal Toxicol 2010;34:252-60.
  • Cohen J, Morrison S, Greenberg J, Saidinejad M. Clinical Presen- tation of Intoxication Due to Synthetic Cannabinoids. Pediatrics 2012;129;1064-7.
  • Gregori A, Damiano F, Bonavia M, et al. Identification of two can- nabimimetic compounds WIN48098 and AM679 in illegal produ- cts. Sci Justice 2013;53:286-92.
  • Rosenbaum CD, Carreiro SP, Babu KM. Here today, gone tomor- row and back again? A review of herbal marijuana alternatives (K2, Spice), synthetic cathinones bath salts, Kratom, Salvia divinorum, methoxetamine, and piperazines. J Med Toxicol 2012;8:15-32.
  • Merola G, Aturkib Z, D'Oraziob G, et al. Analysis of synthetic can- nabinoids in herbal blends by means of nano-liquid hromatograp- hy. J Pharm Biomed Anal 2012;71:45-53.
  • Brentsa LK, Gallus-Zawada A, Radominska-Pandya A, et al. Monohydroxylated metabolites of the K2 synthetic cannabino- id JWH-073 retain intermediate to high cannabinoid 1 receptor (CB1R) affinity and exhibit neutral antagonist to partial agonist activity. Biochem Pharmacol 2012;83:952-61.
  • Heath TS, Burroughs Z, ThompsonAJ, Tecklenburg FW. Acute Intoxication Caused by a Synthetic Cannabinoid in Two Adoles- cents. J Pediatr Pharmacol Ther 2012;17:177-81.
  • Heyman RB, Anglin TM, Copperman SM, et al. American Aca- demy of Pediatrics. Committee on Substance Abuse. Marijuana: A continuing concern for pediatricians. Pediatrics 1999;104:982-5.
  • Hu X, Primack BA, Barnett TE, Cook RL. College students and the use of K2: An emerging drug of abuse in young persons. Subst Abuse Treat Prev Policy 2011;6:16.
  • Barratt MJ, Cakic V, Lenton S. Patterns of synthetic cannabinoid use in Australia. Drug Alcohol Rev 2013;32:141-6.
  • Hoyte CO, Jacob J, Monte AA, et al. A characterization of synthetic cannabinoid exposures reported to the National Poison Data Sys- tem in 2010. Ann Emerg Med 2012;60:435-8.
  • Johnson LA, Johnson RL, Alfonzo C. Spice: A legal marijuana equ- ivalent. Mil Med 2011;176:718-20.
  • AAPCC Issues Statement on the Synthetic Drug Abuse Preven- tion Act. American Association of Poison Control Centre, 2012. Available at: http://www.aapcc.org/press/2/. (Accessed August 26,2014).
  • Wood KE. Exposure to bath salts and synthetic tetrahydrocannabi- nol from 2009 to 2012 in the United States. J Pediatr 2013;163:213- 6.
  • Ashton JC, Wright JL, McPartland JM, Tyndall JD. Cannabinoid CB1 and CB2 receptor ligand specificity and the development of CB2-selective agonists. Curr Med Chem 2008;15:1428-43.
  • Forrester MB. Adolescent synthetic cannabinoid exposures repor- ted to Texas poison centers. Pediatr Emerg Care 2012;28:985-9.
  • Wiegand TJ, Wax PM, Schwartz T, et al. The Toxicology Investi- gators Consortium Case Registry--The 2011 Experience. J Med Toxicol 2012;8:360-77.
  • Monte AA, Bronstein AC, Cao DJ, et al. An outbreak of exposure to a novel synthetic cannabinoid. N Engl J Med 2014;370:389-90.
  • Lank PM, Pines E, Mycyk MB. Emergency PhysiciaSakarya Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalı, Sakaryans' Knowledge of Cannabinoid Designer Drugs. West J Emerg Med 2013;14:467- 70.