1-pentyl-1h-indole-3-carboxylic-acid-8-quinolinyl-ester and Substance-Related-Disorders

Synthetic cannabinoids (SC) are recreational designer drugs intended to mimic delta-9-tetrahydrocannabinol while surreptitiously circumventing classification by the Drug Enforcement Administration.. A 50-year-old black male arrived in the Emergency Department transported by Emergency Medical Services (EMS) for altered mental status after complaining of chest pain associated with smoking SCs. EMS found the patient with an empty foil pack labeled "Scooby Snax Limited Edition Blueberry Potpourri." The patient was somnolent, but became agitated when stimulated and complained of chest pain. Vital signs were blood pressure 87/52 mm Hg and pulse 52 beats/min. The electrocardiogram demonstrated an inferior wall myocardial infarction. Coronary angiography identified an occluded obtuse marginal second branch that was successfully opened with a drug-eluting stent. The patient recovered uneventfully. Urine drug screen was negative for cocaine, and gas chromatography/mass spectrometry testing of the smoked material identified PB-22 and AMB-FUBINACA as the active ingredients. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians and cardiologists need to be aware that the mechanism of action of synthetic cannabinoids on the endocannabinoid system may result in acute ST-segment elevation myocardial infarction requiring percutaneous coronary intervention.

Topics: Chest Pain; Emergency Service, Hospital; Endocannabinoids; Humans; Hypotension; Indazoles; Indoles; Male; Middle Aged; Percutaneous Coronary Intervention; Quinolines; ST Elevation Myocardial Infarction; Substance-Related Disorders; Valine

Topics: Adolescent; Adult; Australia; Cannabinoids; Designer Drugs; Forensic Toxicology; Humans; Indoles; Quinolines; Substance-Related Disorders; Young Adult

Synthetic cannabinoids have been manufactured, sold, and consumed for recreational purposes since at least 2004; their use has been associated with adverse psychiatric, cardiovascular, renal, pulmonary, and neurologic effects. We report simultaneous canine and human clinical cases associated with exposure to a novel synthetic cannabinoid, PB-22 (QUPIC).. A 22-year-old man brought his dog to a veterinary clinic after it had a seizure. During the course of the canine's evaluation, the human patient was witnessed to have a generalized tonic-clonic seizure. He was intubated for agitation and combativeness after his arrival to the emergency department (ED). He was extubated the next day without discernable sequelae. The canine patient received intravenous hydration and was also discharged to home after a period of close observation. The man later endorsed smoking three containers of a substance called "Crazy Monkey" daily for several weeks, but would not disclose how his dog had been exposed. The convulsant effects of "Crazy Monkey" were confirmed in this patient when, three months later, he was sedated, paralyzed, intubated, and admitted to another local hospital for seizures in the context of smoking the same product.. Laboratory analysis of samples obtained from the human and canine patients. A sample of the product (labeled "Crazy Monkey") revealed the presence of PB-22 (QUPIC), a novel synthetic cannabinoid. Additionally, serum and urine samples from the human patient contained metabolites of a second compound, UR-144.. We present a laboratory-confirmed case report of human and canine neurotoxicity associated with a novel synthetic cannabinoid, PB-22 (QUIPIC).

Topics: Animals; Cannabinoids; Dog Diseases; Dogs; Humans; Indoles; Male; Quinolines; Seizures; Substance-Related Disorders; Young Adult