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Deventer MH, Persson M, Norman C, Liu H, Connolly MJ, Daéid NN, McKenzie C, Gréen H, Stove CP. In vitro cannabinoid activity profiling of generic ban-evading brominated synthetic cannabinoid receptor agonists and their analogs. Drug Test Anal 2024; 16:616-628. [PMID: 37903509 DOI: 10.1002/dta.3592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 11/01/2023]
Abstract
Following the enactment of a generic ban in China in 2021, the synthetic cannabinoid market has been evolving, now encompassing even wider structural diversity. Compounds carrying a brominated core such as ADB-5'Br-BUTINACA (ADMB-B-5Br-INACA) and tail-less analogs, such as ADB-5'Br-INACA (ADMB-5Br-INACA), MDMB-5'Br-INACA, and ADB-INACA (ADMB-INACA), have been detected since late 2021. This study investigated the cannabinoid receptor (CB) activation potential of synthesized (S)-enantiomers of these substances, as well as of two predicted analogs MDMB-5'Br-BUTINACA (MDMB-B-5Br-INACA) and ADB-5'F-BUTINACA (ADMB-B-5F-INACA), using CB1 and CB2 β-arrestin 2 recruitment assays and a CB1 intracellular calcium release assay. Surprisingly, the tail-less (S)-ADB-5'Br-INACA and (S)-MDMB-5'Br-INACA retained CB activity, albeit with a decreased potency compared to their tailed counterparts (S)-ADB-5'Br-BUTINACA and (S)-MDMB-5'Br-BUTINACA, respectively, which were potent and efficacious CB1 agonists. Also, at CB2, tail-less analogs showed a lower potency but increased efficacy. Removing the bromine substitution ((S)-ADB-INACA) resulted in a reduced activity at CB1; however, this effect was less prominent at CB2. Looking at tailed analogs, replacing the bromine with a fluorine substitution ((S)-ADB-5'F-BUTINACA) resulted in an increased potency and efficacy at both receptors. Furthermore, as ADB-5'Br-INACA and MDMB-5'Br-INACA have been frequently detected together in Scottish prisons, this study also evaluated the CB1 receptor activation potential of different mixtures of their respective reference standards, showing no unexpected cannabimimetic effect of combining both substances. Lastly, two powders seized by Belgian Customs and confirmed to contain ADB-5'Br-INACA and MDMB-5'Br-INACA, respectively, were assessed for CB activity. Based on the comparison with their reference standards, varying degrees of purity were suspected.
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Affiliation(s)
- Marie H Deventer
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Mattias Persson
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Caitlyn Norman
- Leverhulme Research Centre for Forensic Science, School of Science and Engineering, University of Dundee, Dundee, UK
| | | | | | - Niamh Nic Daéid
- Leverhulme Research Centre for Forensic Science, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Craig McKenzie
- Leverhulme Research Centre for Forensic Science, School of Science and Engineering, University of Dundee, Dundee, UK
- Chiron AS, Trondheim, Norway
| | - Henrik Gréen
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Christophe P Stove
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
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Ahmed H, Mujeebuddin S. GC-MS/MS analysis of synthetic cannabinoids 5F-MDMB-PICA and 5F-CUMYL-PICA in forensic cases. Bioanalysis 2024. [PMID: 38466892 DOI: 10.4155/bio-2023-0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
Aim: Validate a method to quantify 1-(5-fluoropentyl)-N-(2-phenylpropan-2-yl)-1H-indole-3-carboxamide (5F-CUMYL-PICA) and methyl 2-[[1-(5-fluoropentyl) indole-3-carbonyl] amino]-3,3-dimethyl-butanoate (5F-MDMB-PICA) in blood samples using GC-MS/MS. Materials & methods: A solid-phase extraction (SPE) method has been developed to quantify 5F-MDMB-PICA and 5F-CUMYL-PICA in authentic human blood samples. Results & conclusion: The limit of detection (LOD) was 0.1 and 0.11 ng/ml for 5F-CUMYL-PICA and 5F-MDMB-PICA, respectively, while the limit of quantification (LOQ) was 0.50 ng/ml for both two compounds. Recovery was 91.40, 82.54 and 85.10% for SPE, supported liquid extraction (SLE) and ISOLUTE C18; matrix effects 15, 24 and 22.5% for SPE, SLE and ISOLUTE C18; accuracy was 2.4-5.5 and 3.9-7.3% for SPE, SLE and ISOLUTE C18, while precision was 4.6-7.7 and 6.4-8.3% for SPE, SLE and ISOLUTE C18, respectively. The concentrations of 5F-CUMYL-PICA and 5F-MDMB-PICA in the authentic human blood samples were 2.18 and 3.07 ng/ml, respectively. The validated method was successfully used in supporting the quantification of analytes in blood.
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Affiliation(s)
- Hatem Ahmed
- Department of Forensic Sciences, College of Criminal Justice, Naif Arab University for Security Sciences, Riyadh, 14812, Saudi Arabia
| | - Syed Mujeebuddin
- Department of Forensic Sciences, College of Criminal Justice, Naif Arab University for Security Sciences, Riyadh, 14812, Saudi Arabia
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de Oliveira MC, Vides MC, Lassi DLS, Torales J, Ventriglio A, Bombana HS, Leyton V, Périco CDAM, Negrão AB, Malbergier A, Castaldelli-Maia JM. Toxicity of Synthetic Cannabinoids in K2/Spice: A Systematic Review. Brain Sci 2023; 13:990. [PMID: 37508922 PMCID: PMC10377539 DOI: 10.3390/brainsci13070990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Synthetic cannabinoids (SCs) are emerging drugs of abuse sold as 'K2', 'K9' or 'Spice'. Evidence shows that using SCs products leads to greater health risks than cannabis. They have been associated with greater toxicity and higher addiction potential unrelated to the primary psychoactive component of marijuana, Δ9-tetrahydrocannabinol (Δ9-THC). Moreover, early cases of intoxication and death related to SCs highlight the inherent danger that may accompany the use of these substances. However, there is limited knowledge of the toxicology of Spice ingredients. This systematic review intends to analyze the toxicity of SCs compounds in Spice/K2 drugs. (2) Methods: Studies analyzing synthetic cannabinoid toxicity and dependence were included in the present review. We searched the PubMed database of the US National Library of Medicine, Google Scholar, CompTox Chemicals, and Web of Science up to May 2022. (3) Results: Sixty-four articles reporting the effects of synthetic cannabinoids in humans were included in our review. Ten original papers and fifty-four case studies were also included. Fourteen studies reported death associated with synthetic cannabinoid use, with AB-CHMINACA and MDMB-CHMICA being the main reported SCs. Tachycardia and seizures were the most common toxicity symptoms. The prevalence of neuropsychiatric symptoms was higher in third-generation SCs. (4) Conclusion: SCs may exhibit higher toxicity than THC and longer-lasting effects. Their use may be harmful, especially in people with epilepsy and schizophrenia, because of the increased risk of the precipitation of psychiatric and neurologic disorders. Compared to other drugs, SCs have a higher potential to trigger a convulsive crisis, a decline in consciousness, and hemodynamic changes. Therefore, it is crucial to clarify their potential harms and increase the availability of toxicology data in both clinical and research settings.
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Affiliation(s)
- Mariana Campello de Oliveira
- Interdisciplinary Group of Alcohol and Drug Studies (GREA), Institute Perdizes, Department of Psychiatry Medical School, São Paulo University, São Paulo 05403-903, SP, Brazil
| | - Mariana Capelo Vides
- Interdisciplinary Group of Alcohol and Drug Studies (GREA), Institute Perdizes, Department of Psychiatry Medical School, São Paulo University, São Paulo 05403-903, SP, Brazil
| | - Dângela Layne Silva Lassi
- Interdisciplinary Group of Alcohol and Drug Studies (GREA), Institute Perdizes, Department of Psychiatry Medical School, São Paulo University, São Paulo 05403-903, SP, Brazil
| | - Julio Torales
- Department of Psychological Medicine, School of Medical Sciences, National University of Asuncion, San Lorenzo 111421, Paraguay
| | - Antonio Ventriglio
- Department of Experimental Medicine, Medical School, University of Foggia, 71122 Foggia, Italy
| | - Henrique Silva Bombana
- Department of Legal Medicine, Medical School, São Paulo University, São Paulo 05508-090, SP, Brazil
| | - Vilma Leyton
- Department of Legal Medicine, Medical School, São Paulo University, São Paulo 05508-090, SP, Brazil
| | | | - André Brooking Negrão
- Interdisciplinary Group of Alcohol and Drug Studies (GREA), Institute Perdizes, Department of Psychiatry Medical School, São Paulo University, São Paulo 05403-903, SP, Brazil
| | - André Malbergier
- Interdisciplinary Group of Alcohol and Drug Studies (GREA), Institute Perdizes, Department of Psychiatry Medical School, São Paulo University, São Paulo 05403-903, SP, Brazil
| | - João Maurício Castaldelli-Maia
- Interdisciplinary Group of Alcohol and Drug Studies (GREA), Institute Perdizes, Department of Psychiatry Medical School, São Paulo University, São Paulo 05403-903, SP, Brazil
- Department of Neuroscience, Medical School, FMABC University Center, Santo André 09060-870, SP, Brazil
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
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De Baerdemaeker KSC, Dines AM, Hudson S, Sund LJ, Waters ML, Hunter LJ, Blundell MS, Archer JRH, Wood DM, Dargan PI. Isotonitazene, a novel psychoactive substance opioid, detected in two cases following a local surge in opioid overdoses. QJM 2023; 116:115-119. [PMID: 35169852 DOI: 10.1093/qjmed/hcac039] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Isotonitazene is a novel opioid that was first reported in Europe in 2019. There have been no reports of the detection of isotonitazene in patients presenting to the emergency department with acute drug toxicity. AIM There was an increase in presentations to our emergency department with acute opioid toxicity in August 2021. We aim to describe this outbreak and provide detail on two cases in which isotonitazene was quantified in serum samples. METHODS Serum samples were available for comprehensive toxicological analysis for two presentations. Written consent was obtained and the samples were analysed through a Thermo XRS ultrahigh-performance liquid chromatography system, interfaced to a Thermo Q Exactive high-resolution accurate mass spectrometer, operating in heated positive ion electrospray mode. Acquired data were processed using Toxfinder software (Thermo) against a regularly updated in-house database. RESULTS There was an increase in acute opioid presentations to our emergency department from a median of 10 per month to 36 in August 2021. Twenty were treated with naloxone, and 23 were admitted to the hospital for observation and treatment. Serum sample analysis from two patients with acute opioid toxicity responsive to naloxone detected the presence of isotonitazene (0.18 and 0.81 ng/ml). CONCLUSION We report a cluster of acute opioid toxicity presentations to our Emergency Department with detection of isotonitazene in two cases. Analytical screening is important in determining the presence of novel psychoactive substances (NPS) and to help inform the public health of the implications of NPS use, particularly during clusters of acute recreational drug toxicity presentations.
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Affiliation(s)
- K S C De Baerdemaeker
- From the Clinical Toxicology, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Emergency Medicine, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - A M Dines
- From the Clinical Toxicology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - S Hudson
- Sport and Specialised Analytical Services, LGC Ltd, Fordham, UK
| | - L J Sund
- From the Clinical Toxicology, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Emergency Medicine, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - M L Waters
- From the Clinical Toxicology, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Emergency Medicine, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - L J Hunter
- From the Clinical Toxicology, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Emergency Medicine, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - M S Blundell
- From the Clinical Toxicology, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Emergency Medicine, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - J R H Archer
- From the Clinical Toxicology, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Sport and Specialised Analytical Services, LGC Ltd, Fordham, UK
- General Medicine, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - D M Wood
- From the Clinical Toxicology, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Sport and Specialised Analytical Services, LGC Ltd, Fordham, UK
- General Medicine, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - P I Dargan
- From the Clinical Toxicology, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Sport and Specialised Analytical Services, LGC Ltd, Fordham, UK
- General Medicine, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
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Deventer MH, Norman C, Reid R, McKenzie C, Nic Daéid N, Stove CP. In vitro characterization of the pyrazole-carrying synthetic cannabinoid receptor agonist 5F-3,5-AB-PFUPPYCA and its structural analogs. Forensic Sci Int 2023; 343:111565. [PMID: 36640535 DOI: 10.1016/j.forsciint.2023.111565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/27/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
The synthetic cannabinoid receptor agonist (SCRA) market is undergoing important changes since the enactment of the 2021 class-wide generic SCRA ban in China, one of the most important source countries for new psychoactive substances (NPS). Recently, various compounds with new structural features, synthesized to bypass this legislation, have entered the recreational drug market. Certain monocyclic pyrazole-carrying "FUPPYCA" SCRAs have been sporadically detected since 2015 without gaining further popularity. However, as evidenced by their recent detection in Scottish prisons, 5F-3,5-AB-PFUPPYCA and 3,5-ADB-4en-PFUPPYCA have re-emerged, potentially triggered by the new legislative ban. The aim of this study was to characterize the in vitro intrinsic CB1 and CB2 receptor activation potential of 5F-3,5-AB-PFUPPYCA and 3,5-ADB-4en-PFUPPYCA, as well as 4 analogs (5F-3,5-ADB-PFUPPYCA, 3,5-AB-CHMFUPPYCA, 5,3-AB-CHMFUPPYCA and 5,3-ADB-4en-PFUPPYCA) using live cell β-arrestin 2 recruitment assays. Most analogs were essentially inactive at either CB1 or CB2, with only 3,5-AB-CHMFUPPYCA, 5,3-AB-CHMFUPPYCA and 5,3-ADB-4en-PFUPPYCA showing a limited activation potential at CB1. Furthermore, the importance of the position of the tail structure was demonstrated, with 5,3 regioisomers being more active than their 3,5 analogs. Moreover, all compounds exhibited antagonistic behavior at both receptors, which may be associated with their structural resemblance to cannabinoid antagonists and inverse agonists. Although the 3,5 regioisomers of these "FUPPYCA" SCRAs circumvent the Chinese ban, it is unlikely that these SCRAs will pose a major threat to public health, given the lack of pronounced CB receptor activity.
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Affiliation(s)
- Marie H Deventer
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Caitlyn Norman
- Leverhulme Research Centre for Forensic Science, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Robert Reid
- Leverhulme Research Centre for Forensic Science, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Craig McKenzie
- Leverhulme Research Centre for Forensic Science, School of Science and Engineering, University of Dundee, Dundee, UK; Chiron AS, Trondheim, Norway
| | - Niamh Nic Daéid
- Leverhulme Research Centre for Forensic Science, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Christophe P Stove
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.
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Seywright A, Irvine AFD, McKeown DA, Wylie FM, Torrance HJ. Synthetic Cannabinoid Receptor Agonists in Postmortem Casework in Scotland. J Anal Toxicol 2023; 46:1066-1072. [PMID: 34994788 DOI: 10.1093/jat/bkac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/24/2021] [Accepted: 01/05/2022] [Indexed: 01/26/2023] Open
Abstract
Synthetic cannabinoid receptor agonists (SCRAs) have been a concern to forensic toxicologists since their emergence as drugs of abuse in the mid-late 2000s. The extent of their use in Scotland appears to be low especially when compared to other drug groups such as opioids and benzodiazepines. There is a concern, however, that the use is widespread in prison populations in particular. In this work, samples of blood and urine collected during routine postmortem examination between April 2017 and March 2019 were subjected to analysis of SCRA compounds. Circumstantial and demographic information was collected on positive cases to build up a body of evidence for where SCRAs may be most likely to contribute to the cause of death. Thirteen out of 133 cases (10%) tested were positive for one or more compound in one or more matrix. Overall, the detection of 5F-MDMB-PINACA or its O-desmethyl acid metabolite was most common, followed by the metabolite shared by AB-FUBINACA and MMB-FUBINACA. SCRA-positive cases were predominantly males (92%), and the age range of all decedents was 21-49 years old (median 36 years). The majority of cases were certified as drug-related deaths (DRDs, 38%), natural/medical (31%) or suicide (23%), and two of the DRDs mentioned SCRAs specifically in the cause of death. The concentrations of SCRAs detected did not seem to be as important to the determination of the cause of death as their mere presence, but quantitative results were reported (where possible) in order to build up a body of evidence for SCRA concentrations in different case types.
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Affiliation(s)
- Alice Seywright
- Department of Forensic Medicine and Science, University of Glasgow, Joseph Black Building, University Place, Glasgow G12 8QQ, UK
| | - Alexander F D Irvine
- Department of Forensic Medicine and Science, University of Glasgow, Joseph Black Building, University Place, Glasgow G12 8QQ, UK
| | - Denise A McKeown
- Department of Forensic Medicine and Science, University of Glasgow, Joseph Black Building, University Place, Glasgow G12 8QQ, UK
| | - Fiona M Wylie
- Department of Forensic Medicine and Science, University of Glasgow, Joseph Black Building, University Place, Glasgow G12 8QQ, UK
| | - Hazel J Torrance
- Department of Forensic Medicine and Science, University of Glasgow, Joseph Black Building, University Place, Glasgow G12 8QQ, UK
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Virmani I, Oteo A, Dunn M, Vidler D, Roper C, Officer J, Hardy G, Dargan PI, Eddleston M, Cooper JG, Hill SL, Macfarlane R, Keating L, Haden M, Hudson S, Thomas SHL. Accuracy of substance exposure history in patients attending emergency departments after substance misuse; a comparison with biological sample analysis. Clin Toxicol (Phila) 2023; 61:39-46. [PMID: 36322622 DOI: 10.1080/15563650.2022.2131566] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Acute toxicity caused by illicit substance use is a common reason for emergency department (ED) presentation. Knowledge of the substances involved is helpful for predicting and managing potential toxicity, but limited information is available about the accuracy of patient-reported substance exposure. This study assessed the accuracy of the history of exposure in those reporting use of a single substance by comparison with those identified by detailed toxicological analysis, focusing on synthetic cannabinoid receptor agonists (SCRA). METHODS Adults (≥16 years) presenting between March 2015 and July 2021 to participating UK hospitals with toxicity after reporting use of a single illicit substance were included. Exposure details were documented from medical records and blood and/or urine samples analysed using high-resolution accurate mass liquid chromatography-mass spectrometry (HRAM LCMS). Sensitivity, specificity, and positive and negative predictive values of the exposure history were calculated by comparison with biological sample analysis ("gold standard"). RESULTS Single substance exposure was reported for 474 (median age 33 years, IQR: 18 range 16-75, 80% males) patients. Analysis commonly identified multiple substances (Median 3, IQR 2-5). A history of exposure was documented for 121 of 151 patients where a SCRA or metabolite was detected on analysis (sensitivity 80.1%, 95% CI 72.9, 86.2%). Corresponding proportions were lower for 3,4-methylenedioxymethamphetamine (MDMA, 44/70, 62.9%., 95% CI 50.5%, 74.1%), heroin 41/108 (38.0% 95% CI 28.8-47.8%) and cocaine (22/56, 31.3%, 95% CI 20.9, 43.6%). CONCLUSIONS Multiple undeclared substances were detected analytically in most patients reporting single substance use. Clinicians should be alert to the potential presence and toxicity of unreported substances when managing patients presenting after substance misuse.
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Affiliation(s)
- Ishita Virmani
- Medical Toxicology Centre, Newcastle University, Newcastle, UK.,RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Alberto Oteo
- Addictions and Inclusion Directorate, Department of Health and Social Care, Office for Health Improvement & Disparities, London, UK
| | - Michael Dunn
- Medical Toxicology Centre, Newcastle University, Newcastle, UK
| | - Daniel Vidler
- Medical Toxicology Centre, Newcastle University, Newcastle, UK
| | - Clair Roper
- Medical Toxicology Centre, Newcastle University, Newcastle, UK
| | - Jane Officer
- Scottish Police Authority Forensic Services, Edinburgh, UK
| | - Gareth Hardy
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Paul I Dargan
- Clinical Toxicology, Guys & St Thomas' NHS Foundation Trust, London and Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Michael Eddleston
- Pharmacology, Toxicology & Therapeutics, University of Edinburgh, Edinburgh, UK
| | | | - Simon L Hill
- Medical Toxicology Centre, Newcastle University, Newcastle, UK.,Newcastle Hospitals NHS Foundation Trust and National Poisons Information Service, Newcastle, UK
| | | | - Liza Keating
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Mark Haden
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Simon Hudson
- LGC Sport and Specialised Analytical Services, Fordham, UK
| | - Simon H L Thomas
- Medical Toxicology Centre, Newcastle University, Newcastle, UK.,Newcastle Hospitals NHS Foundation Trust and National Poisons Information Service, Newcastle, UK
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Craft S, Dunn M, Vidler D, Officer J, Blagbrough IS, Pudney CR, Henderson G, Abouzeid A, Dargan PI, Eddleston M, Cooper J, Hill SL, Roper C, Freeman TP, Thomas SHL. Trends in hospital presentations following analytically confirmed synthetic cannabinoid receptor agonist exposure before and after implementation of the 2016 UK Psychoactive Substances Act. Addiction 2022; 117:2899-2906. [PMID: 35665553 PMCID: PMC9796520 DOI: 10.1111/add.15967] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/23/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS The United Kingdom (UK) Psychoactive Substances Act (PSA), implemented on the 26th May 2016, made the production, supply and sale of all non-exempted psychoactive substances illegal. The aim of this study was to measure trends in hospital presentations for severe toxicity following analytically confirmed synthetic cannabinoid receptor agonist (SCRA) exposure before and after implementation of the PSA. DESIGN Observational study. SETTING Thirty-four hospitals across the UK participating in the Identification of Novel Psychoactive Substances (IONA) study. PARTICIPANTS A total of 627 (79.9% male) consenting individuals who presented to participating hospitals between July 2015 and December 2019 with severe acute toxicity and suspected novel psychoactive substances exposure. MEASUREMENTS Toxicological analyses of patient samples were conducted using liquid-chromatography tandem mass-spectrometry. Time-series analysis was conducted on the monthly number of patients with and without analytically confirmed SCRA exposure using Poisson segmented regression. FINDINGS SCRAs were detected in 35.7% (n = 224) of patients. After adjusting for seasonality and the number of active sites, models showed no clear evidence of an upward or downward trend in the number of SCRA exposure cases in the period before (incidence rate ratio [IRR], 1.12; 95% CI, 0.99-1.26; P = 0.068) or after (IRR, 0.97; 95% CI, 0.94-1.01; P = 0.202) the implementation of the PSA. There was also no clear evidence of an upward or downward trend in non-SCRA exposure cases before (IRR, 1.12; 95% CI, 0.98-1.27; P = 0.105) or after (IRR, 1.01; 95% CI, 0.98-1.04; P = 0.478) implementation of the PSA. CONCLUSIONS There is no clear evidence of an upward or downward trend in the number of patients presenting to UK hospitals with severe acute toxicity following analytically confirmed synthetic cannabinoid receptor agonist exposure since the implementation of the Psychoactive Substances Act.
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Affiliation(s)
- Sam Craft
- Addiction and Mental Health Group (AIM), Department of PsychologyUniversity of BathBathUK
| | - Michael Dunn
- Translational and Clinical Research InstituteNewcastle UniversityNewcastleUK
| | - Dan Vidler
- Translational and Clinical Research InstituteNewcastle UniversityNewcastleUK
| | - Jane Officer
- Scottish Police Authority Forensic ServicesEdinburghUK
| | | | | | - Graeme Henderson
- School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
| | - Ahmed Abouzeid
- Blackpool Teaching Hospitals NHS Foundation TrustBlackpoolBlackpoolUK
| | | | | | | | - Simon L. Hill
- Newcastle Hospitals NHS Foundation Trust, Royal Victoria InfirmaryNewcastleUK
| | - Clair Roper
- Translational and Clinical Research InstituteNewcastle UniversityNewcastleUK
| | - Tom P. Freeman
- Addiction and Mental Health Group (AIM), Department of PsychologyUniversity of BathBathUK
| | - Simon H. L. Thomas
- Translational and Clinical Research InstituteNewcastle UniversityNewcastleUK
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Malaca S, Busardò FP, Nittari G, Sirignano A, Ricci G. Fourth Generation of Synthetic Cannabinoid Receptor Agonists: A Review on the Latest Insights. Curr Pharm Des 2022; 28:2603-2617. [PMID: 34781870 DOI: 10.2174/1381612827666211115170521] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/08/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Over the past few years, an emerging number of new psychoactive substances (NPSs) entered the illicit market. NPSs are designed to resemble the effects of classical drugs of abuse, reinforcing their effects and duration. Among the most abused NPS, synthetic cannabinoids are cannabinoid receptor agonists (SCRAs) that mimic the effect of the main psychotropic phytocannabinoid Δ9-tetrahydrocannabinol (THC). METHODS We herein reviewed the international literature to provide available information on the newest SCRAs generation. RESULTS Compared to the previous SCRAs generations, the structures of the last generation result in increased affinity for and efficacy at cannabinoid CB1 receptors, which are thought to be mainly responsible for the psychoactive effects of THC and its analogues. Accordingly, these more potent cannabimimetic effects may increase the number of adverse reactions such as neurological disorders (e.g., psychosis, agitation, irritability, paranoia, confusion, and anxiety), psychiatric episodes (e.g., hallucinations, delusions, self-harm), other physical conditions (e.g., tachycardia, hypertension, arrhythmia, chest pain, nausea, vomiting, and fever) and deaths. In the last decade, more than a hundred SCRAs from different chemical classes emerged on the illicit web market. SCRAs have been thoroughly studied: they were physico-chemically characterized, and pharmaco-toxicological characteristics were investigated. The last SCRAs generations include increasingly potent and toxic compounds, posing a potential health threat to consumers. CONCLUSION From November 2017 to February 2021, at least 20 new "fourth-generation" SCRAs were formally reported to international drug agencies. Our understanding of the neurotoxicity of these compounds is still limited due to the lack of global data, but their potency and their toxicity are likely higher than those of the previous generations.
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Affiliation(s)
- Sara Malaca
- Department of Excellence of Biomedical Sciences and Public Health, University "Politecnica delle Marche" of Ancona, Ancona, Italy
| | - Francesco P Busardò
- Department of Excellence of Biomedical Sciences and Public Health, University "Politecnica delle Marche" of Ancona, Ancona, Italy
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10
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Xinze Liu, Liu W, Xiang P, Hang T, Shi Y, Yue L, Yan H. Metabolism of ADB-4en-PINACA in Zebrafish and Rat Liver Microsomes Determined by Liquid Chromatography–High Resolution Mass Spectrometry. JOURNAL OF ANALYTICAL CHEMISTRY 2022. [DOI: 10.1134/s1061934822080184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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11
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Deventer MH, Van Uytfanghe K, Vinckier IMJ, Reniero F, Guillou C, Stove CP. Cannabinoid receptor activation potential of the next generation, generic ban evading OXIZID synthetic cannabinoid receptor agonists. Drug Test Anal 2022; 14:1565-1575. [PMID: 35560866 DOI: 10.1002/dta.3283] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/07/2022]
Abstract
In recent years, several nations have implemented various measures to control the surge of new synthetic cannabinoid receptor agonists (SCRAs) entering the recreational drug market. In July 2021, China put into effect a new generic legislation, banning SCRAs containing one of 7 general core scaffolds. However, this has driven manufacturers towards the synthesis of SCRAs with alternative core structures, exemplified by the recent emergence of "OXIZID SCRAs". Here, using in vitro β-arrestin2 recruitment assays, we report on the CB1 and CB2 potency and efficacy of five members of this new class of SCRAs: BZO-HEXOXIZID, BZO-POXIZID, 5-fluoro BZO-POXIZID, BZO-4en-POXIZID and BZO-CHMOXIZID. All compounds behaved as full agonists at CB1 and partial agonists at CB2 . Potencies ranged from 84.6 - 721 nM at CB1 and 2.21 - 25.9 nM at CB2 . Shortening the n-hexyl tail to a pentyl tail enhanced activity at both receptors. Fluorination of this pentyl analog did not yield a higher receptor activation potential, whereas an unsaturated tail resulted in decreased potency and efficacy at CB1 . The cyclohexyl methyl analog BZO-CHMOXIZID was the most potent compound at both receptors, with EC50 values of 84.6 and 2.21 nM at CB1 and CB2 , respectively. Evaluation of the activity of a seized powder containing BZO-4en-POXIZID suggested a high purity, in line with HPLC-DAD, GC-MS, LC-QTOF-MS and FTIR and NMR analysis. Furthermore, all tested compounds showed a preference for CB2 , except for BZO-POXIZID. Overall, these findings inform public health officials, law enforcement agencies and clinicians on these newly emerging SCRAs.
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Affiliation(s)
- M H Deventer
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - K Van Uytfanghe
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | | | - F Reniero
- European Commission, Joint Research Centre, Directorate F-Health, Consumers and Reference Materials, Ispra, VA, Italy
| | - C Guillou
- European Commission, Joint Research Centre, Directorate F-Health, Consumers and Reference Materials, Ispra, VA, Italy
| | - C P Stove
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
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12
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13
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Ametovski A, Cairns EA, Grafinger KE, Cannaert A, Deventer MH, Chen S, Wu X, Shepperson CE, Lai F, Ellison R, Gerona R, Blakey K, Kevin R, McGregor IS, Hibbs DE, Glass M, Stove C, Auwärter V, Banister SD. NNL-3: A Synthetic Intermediate or a New Class of Hydroxybenzotriazole Esters with Cannabinoid Receptor Activity? ACS Chem Neurosci 2021; 12:4020-4036. [PMID: 34676751 DOI: 10.1021/acschemneuro.1c00348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Synthetic cannabinoid receptor agonists (SCRAs) remain a prolific class of new psychoactive substances (NPS) and continue to expand rapidly. Despite the recent identification of hydroxybenzotriazole (HOBt) containing SCRAs in synthetic cannabis samples, there is currently no information regarding the pharmacological profile of these NPS with respect to human CB1 and CB2 receptors. In the current study, a series consisting of seven HOBt indole-, indazole-, and 7-azaindole-carboxylates bearing a range of N-alkyl substituents were synthesized and pharmacologically evaluated. Competitive binding assays at CB1 and CB2 demonstrated that all analogues except a 2-methyl-substituted derivative had low affinity for CB1 (Ki = 3.80-43.7 μM) and CB2 (Ki = 2.75-18.2 μM). A fluorometric functional assay revealed that 2-methylindole- and indole-derived HOBt carboxylates were potent and efficacious agonists of CB1 (EC50 = 12.0 and 63.7 nM; Emax = 118 and 120%) and CB2 (EC50 = 10.9 and 321 nM; Emax = 91 and 126%). All other analogues incorporating indazole and 7-azaindole cores and bearing a range of N1-substituents showed relatively low potency for CB1 and CB2. Additionally, a reporter assay monitoring β-arrestin 2 (βarr2) recruitment to the receptor revealed that the 2-methylindole example was the most potent and efficacious at CB1 (EC50 = 131 nM; Emax = 724%) and the most potent at CB2 (EC50 = 38.2 nM; Emax = 51%). As with the membrane potential assay, the indazole and other indole HOBt carboxylates were considerably less potent at both receptors, and analogues comprising a 7-azaindole core showed little activity. Taken together, these data suggest that NNL-3 demonstrates little CB1 receptor activity and is unlikely to be psychoactive in humans. NNL-3 is likely an unintended SCRA manufacturing byproduct. However, the synthesis of NNL-3 analogues proved simple and general, and some of these showed potent cannabimetic profiles in vitro, indicating that HOBt esters of this type may represent an emerging class of SCRA NPS.
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Affiliation(s)
- Adam Ametovski
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- School of Chemistry, The University of Sydney, Sydney, NSW 2006, Australia
| | - Elizabeth A. Cairns
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia
| | - Katharina Elisabeth Grafinger
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany
| | - Annelies Cannaert
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, 9000 Ghent, Belgium
| | - Marie H. Deventer
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, 9000 Ghent, Belgium
| | - Shuli Chen
- Department of Pharmacology and Toxicology, University of Otago, Dunedin 9016, New Zealand
| | - Xinyi Wu
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- School of Chemistry, The University of Sydney, Sydney, NSW 2006, Australia
| | - Caitlin E. Shepperson
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- School of Chemistry, The University of Sydney, Sydney, NSW 2006, Australia
| | - Felcia Lai
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales 2050, Australia
| | - Ross Ellison
- Clinical Toxicology and Environmental Biomonitoring Laboratory, University of California, San Francisco, California 94143, United States
| | - Roy Gerona
- Clinical Toxicology and Environmental Biomonitoring Laboratory, University of California, San Francisco, California 94143, United States
| | - Karen Blakey
- Illicit Drug Group, Forensic Chemistry, QHFSS, Queensland Health, Coopers Plains, Brisbane, QLD 4108, Australia
| | - Richard Kevin
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia
| | - Iain S. McGregor
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia
| | - David E. Hibbs
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales 2050, Australia
| | - Michelle Glass
- Department of Pharmacology and Toxicology, University of Otago, Dunedin 9016, New Zealand
| | - Christophe Stove
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, 9000 Ghent, Belgium
| | - Volker Auwärter
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany
| | - Samuel D. Banister
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- School of Chemistry, The University of Sydney, Sydney, NSW 2006, Australia
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14
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Blanco G, Vidler D, Roper C, Wood DM, Dargan PI, Keating L, Macfarlane R, Emmett S, Johnson G, Eddleston M, Hill SL, Thomas SHL. Acute toxicity from the synthetic cathinone N-ethylpentylone (ephylone) in the United Kingdom. Clin Toxicol (Phila) 2021; 59:1270-1273. [PMID: 33855924 DOI: 10.1080/15563650.2021.1909730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Acute toxicity caused by New Psychoactive Substances (NPS) has created a significant burden for Emergency Departments (EDs). Here we report characteristics of people presenting with toxicity after exposure to the synthetic cathinone N-ethylpentylone (NEP). METHODS Adults presenting to hospital with severe acute toxicity after suspected NPS use were recruited between March 2015 and October 2020. Clinical features were recorded using consistent methodology and biological samples analysed using liquid chromatography-tandem mass-spectrometry. RESULTS NEP was detected in at least one sample from 9 of 893 patients recruited during the period of study, all presenting between 2016 and 2019 and 8 presenting in southern England. Commonly reported clinical features included tachycardia (6), agitation (6), confusion (6), mydriasis (5), hallucinations (4), acidosis (3) and elevated creatine kinase (3). Co-used drugs, detected in 6 patients, may have contributed to these features, but agitation and hallucinations were also reported in all 3 patients without analytical evidence of co-use. CONCLUSIONS NEP was detected infrequently in episodes of drug toxicity in the UK between 2016 and 2019, especially in southern England. Clinical characteristics of toxicity are similar to those of other cathinones, although co-use of other drugs is common and may contribute to the features observed.
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Affiliation(s)
- Georgina Blanco
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Dan Vidler
- NIHR Health Protection Research Unit for Chemical Threats and Hazards, Newcastle University, Newcastle, UK
| | - Clair Roper
- NIHR Health Protection Research Unit for Chemical Threats and Hazards, Newcastle University, Newcastle, UK
| | - David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Paul I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Liza Keating
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | | | - Stevan Emmett
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Graham Johnson
- University Hospitals of Derby, Burton NHS Foundation Trust, Derby, UK
| | - Michael Eddleston
- Clinical Toxicology, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Simon L Hill
- Clinical Toxicology, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Simon H L Thomas
- NIHR Health Protection Research Unit for Chemical Threats and Hazards, Newcastle University, Newcastle, UK.,Clinical Toxicology, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
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15
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Grafinger KE, Cannaert A, Ametovski A, Sparkes E, Cairns E, Banister SD, Auwärter V, Stove CP. Systematic evaluation of a panel of 30 synthetic cannabinoid receptor agonists structurally related to MMB-4en-PICA, MDMB-4en-PINACA, ADB-4en-PINACA, and MMB-4CN-BUTINACA using a combination of binding and different CB 1 receptor activation assays-Part II: Structure activity relationship assessment via a β-arrestin recruitment assay. Drug Test Anal 2021; 13:1402-1411. [PMID: 33769699 DOI: 10.1002/dta.3035] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 12/17/2022]
Abstract
Synthetic cannabinoid receptor agonists (SCRAs) are the second largest class of new psychoactive substances (NPS) and are associated with serious adverse effects and even death. Despite this, little pharmacological data are available for many of the most recent SCRAs. This study consists of three different parts, aiming to systematically evaluate a panel of 30 SCRAs using binding and different in vitro human cannabinoid 1 receptor (CB1 ) activation assays. The present Part II investigated the SCRA analogs for their CB1 activation via a β-arrestin recruitment assay. The panel was systematically designed to include key structural sub-features of recent SCRAs. Thus, the 4-pentenyl tail of MMB-4en-PICA and MDMB-4en-PINACA was retained while incorporating varying head groups from other prevalent SCRAs, including amides and esters of L-valine, L-tert-leucine, and L-phenylalanine, and adamantyl and cumyl moieties. All 30 SCRAs activated CB1 , with indazoles generally showing the greatest potency (EC50 = 1.88-281 nM), followed by indoles (EC50 = 11.5-2293 nM), and the corresponding 7-azaindoles (EC50 = 62.4-9251 nM). Several subunit-linked structure-activity relationships were identified: (i) tert-leucine-functionalized SCRAs were more potent than the corresponding valine derivatives; (ii) no major difference in potency or efficacy was observed between tert-leucine/valine-derived amides and the corresponding methyl esters; however, phenylalanine analogs were affected by this change; and (iii) minor structural changes to the 4-pentenyl substituent had little influence on activity. These findings elucidate structural features that modulate the CB1 activation potential of currently prevalent SCRAs and a systematic panel of analogs, some of which may appear in NPS markets in future.
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Affiliation(s)
- Katharina Elisabeth Grafinger
- Laboratory of Toxicology Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.,Institute of Forensic Medicine, Forensic Toxicology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Annelies Cannaert
- Laboratory of Toxicology Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Adam Ametovski
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia.,School of Chemistry, The University of Sydney, Sydney, New South Wales, Australia
| | - Eric Sparkes
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia.,School of Chemistry, The University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth Cairns
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Samuel D Banister
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia.,School of Chemistry, The University of Sydney, Sydney, New South Wales, Australia
| | - Volker Auwärter
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christophe P Stove
- Laboratory of Toxicology Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
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16
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Piccioni A, Cicchinelli S, Saviano L, Gilardi E, Zanza C, Brigida M, Tullo G, Volonnino G, Covino M, Franceschi F, La Russa R. Risk Management in First Aid for Acute Drug Intoxication. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218021. [PMID: 33143348 PMCID: PMC7663746 DOI: 10.3390/ijerph17218021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023]
Abstract
Drug abuse (cannabis, cocaine, opiates, and synthetic drugs) is an increasing phenomenon, especially in the younger population, thus leading to more cases of intoxication requiring evaluation in the emergency department and subsequent hospitalization. In 2017, 34.2% of students reported having used an illegal psychoactive substance in their lifetime, while 26% reported having done so over the past year. We made a review about the effectiveness of the role of the temporary observation unit in the emergency department to improve management of acute drugs intoxication. We checked medical literature from the last 10 years (2009-2019). The following electronic databases were systematically searched: MEDLINE-PubMed, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials. Then, a systematic review was carried out according to the Preferred Reporting Items for Systematic Review standards. Intoxicated patients usually display a favorable medical course, few diagnostic and therapeutic interventions, a short stay in the hospital, and, when hospitalization is needed, semi-intensive therapy is a feasible solution; therefore, intoxicated patients are ideal candidates for a temporary observation unit. The emergency department is very important to manage intoxicated patients; however, the hospitalization of these patients is often not necessary.
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Affiliation(s)
- Andrea Piccioni
- Emergency Medicine Department, University Polyclinic Foundation A. Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), 00168 Rome, Italy; (A.P.); (S.C.); (L.S.); (M.B.); (G.T.); (M.C.)
| | - Sara Cicchinelli
- Emergency Medicine Department, University Polyclinic Foundation A. Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), 00168 Rome, Italy; (A.P.); (S.C.); (L.S.); (M.B.); (G.T.); (M.C.)
| | - Luisa Saviano
- Emergency Medicine Department, University Polyclinic Foundation A. Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), 00168 Rome, Italy; (A.P.); (S.C.); (L.S.); (M.B.); (G.T.); (M.C.)
| | - Emanuele Gilardi
- Emergency-Admission Department, Biomedical Campus, 00128 Rome, Italy;
| | - Christian Zanza
- Department of Anesthesia, Critical Care and Emergency Medicine, Pietro and Michele Ferrero Hospital, 12051 Verduno, Italy;
| | - Mattia Brigida
- Emergency Medicine Department, University Polyclinic Foundation A. Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), 00168 Rome, Italy; (A.P.); (S.C.); (L.S.); (M.B.); (G.T.); (M.C.)
| | - Gianluca Tullo
- Emergency Medicine Department, University Polyclinic Foundation A. Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), 00168 Rome, Italy; (A.P.); (S.C.); (L.S.); (M.B.); (G.T.); (M.C.)
| | - Gianpietro Volonnino
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, 00161 Rome, Italy;
| | - Marcello Covino
- Emergency Medicine Department, University Polyclinic Foundation A. Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), 00168 Rome, Italy; (A.P.); (S.C.); (L.S.); (M.B.); (G.T.); (M.C.)
| | | | - Raffaele La Russa
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, 00161 Rome, Italy;
- Correspondence:
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17
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Zawadzki M, Chłopaś-Konowałek A, Nowak K, Wachełko O, Szpot P. Quantification of 5F-CUMYL-P7AICA in blood and urine from an authentic fatality associated with its consumption by UHPLC–MS/MS. Forensic Toxicol 2020. [DOI: 10.1007/s11419-020-00555-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Janssens L, Cannaert A, Connolly MJ, Liu H, Stove CP. In vitro
activity profiling of Cumyl‐PEGACLONE variants at the CB
1
receptor: Fluorination
versus
isomer exploration. Drug Test Anal 2020; 12:1336-1343. [DOI: 10.1002/dta.2870] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Liesl Janssens
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences Ghent University Ghent Belgium
| | - Annelies Cannaert
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences Ghent University Ghent Belgium
| | | | | | - Christophe P. Stove
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences Ghent University Ghent Belgium
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19
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Affiliation(s)
- Piotr Adamowicz
- Department of Forensic Toxicology, Institute of Forensic Research, Kraków, Poland
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20
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Metabolism, CB1 cannabinoid receptor binding and in vivo activity of synthetic cannabinoid 5F-AKB48: Implications for toxicity. Pharmacol Biochem Behav 2020; 195:172949. [PMID: 32413436 DOI: 10.1016/j.pbb.2020.172949] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/11/2020] [Indexed: 11/20/2022]
Abstract
AKB48 and its fluorinated derivative 5F-AKB48 are synthetic cannabinoids (SCs) which have caused hospitalizations and deaths in human users. Abuse of SCs is dangerous because users may mistake them for natural cannabis, which is generally considered to be unlikely to elicit adverse effects. The present studies were designed to investigate the in vitro oxidative metabolism of 5F-AKB48 by human microsomal fractions from different organs and sexes as well as recombinant human cytochrome P450s (P450s). Mass spectrometry data tentatively provides evidence for the existence of mono-, di-, and trihydroxylated metabolites in a successive metabolism. Experiments utilizing P450s revealed that the most active enzymes (CYP2D6, CYP2J2, CYP3A4, and CYP3A5) effectively produced mono- and dihydroxylated metabolites, while CYP3A4/5 also produced significant amounts of the trihydroxylated metabolite. Moreover, although the affinity and potency of Phase I metabolite 4OH-5F-AKB48 is reduced when compared to that of the parent drug, this metabolite nevertheless retains similar high affinity for CB1 receptors, and greater efficacy for G protein activation, when compared to THC. Finally, 5F-AKB48 produced time- and dose-dependent cannabimimetic effects in mice which were more potent, but shorter acting, than those of Δ9-THC, and were attenuated by prior treatment with the CB1 antagonist rimonabant. Based on our data, we hypothesize that while many cases of toxicity result from genetic mutations, which can lead to a decrease or even absence of activity for Phase I drug-metabolizing enzymes, other P450s could potentially increase their role in the metabolism of these SCs. Because many metabolites of SCs remain biologically active, they could contribute to the deleterious effects of these substances.
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21
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Wouters E, Walraed J, Banister SD, Stove CP. Insights into biased signaling at cannabinoid receptors: synthetic cannabinoid receptor agonists. Biochem Pharmacol 2019; 169:113623. [DOI: 10.1016/j.bcp.2019.08.025] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/26/2019] [Indexed: 01/09/2023]
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22
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Yalçın M, Tunalı N, Yıldız H, Oğuz A, Gültekin BK. Sociodemographic and clinical characteristics of synthetic cannabinoid users in a large psychiatric emergency department in Turkey. J Addict Dis 2019; 37:259-267. [PMID: 31581902 DOI: 10.1080/10550887.2019.1671146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Synthetic cannabinoid (SC) use is a global concern and is creating new challenges for treatment services. Although some studies have been reported, there is a need for further research regarding the sociodemographic and clinical characteristics of SC users so that general and psychiatric emergency departments can provide more effective treatments. We aimed to investigate the sociodemographic and clinical characteristics in a cohort of patients using SC who presented to the psychiatric emergency department of the University of Health Sciences, Istanbul Erenköy Training and Research Hospital for Psychiatry and Neurology (ERSHEAH) in Istanbul, Turkey. This cross-sectional and retrospective medical record review examined 340 SC users who presented to the emergency department of ERSHEAH in a 3-month period. The mean age of the SC users was 26.8 ± 7.5 years and 92.6% were men. Psychotic symptoms were present in 247 SC users (78.8%). Severe intoxication was diagnosed in 26 SC users (7.6%), although SC was detectable in the samples of only 6 patients (13.6%). Impaired consciousness (42.3%) was the most common reason for referral to the general hospital and increased liver enzyme levels (15.9%) were the most common indication in the laboratory findings. We observed that the SC users in our sample presenting as psychiatric emergencies were mostly young men experiencing psychotic symptoms. Determining the sociodemographic and clinical properties of SC users may provide an important contribution to fast recognition and more effective management of acute symptoms of SC users in emergency departments.
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Affiliation(s)
- Murat Yalçın
- Erenköy Training and Research Hospital for Psychiatry and Neurology, Psychiatry Department, University of Health Sciences, Istanbul, Turkey
| | - Nazlı Tunalı
- Erenköy Training and Research Hospital for Psychiatry and Neurology, Psychiatry Department, University of Health Sciences, Istanbul, Turkey
| | - Handan Yıldız
- Erenköy Training and Research Hospital for Psychiatry and Neurology, Psychiatry Department, University of Health Sciences, Istanbul, Turkey
| | - Ayşenur Oğuz
- Fatih Sultan Mehmet Training and Research Hospital, Psychiatry Department, University of Health Sciences, Istanbul, Turkey
| | - Bülent Kadri Gültekin
- Erenköy Training and Research Hospital for Psychiatry and Neurology, Psychiatry Department, University of Health Sciences, Istanbul, Turkey
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23
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Wouters E, Mogler L, Cannaert A, Auwärter V, Stove C. Functional evaluation of carboxy metabolites of synthetic cannabinoid receptor agonists featuring scaffolds based on L‐valine or L‐
tert
‐leucine. Drug Test Anal 2019; 11:1183-1191. [DOI: 10.1002/dta.2607] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/20/2019] [Accepted: 04/21/2019] [Indexed: 01/28/2023]
Affiliation(s)
- Elise Wouters
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical SciencesGhent University Ottergemsesteenweg 460 9000 Ghent Belgium
| | - Lukas Mogler
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center – University of Freiburg, Faculty of MedicineUniversity of Freiburg Albertstr. 9 79104 Freiburg Germany
| | - Annelies Cannaert
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical SciencesGhent University Ottergemsesteenweg 460 9000 Ghent Belgium
| | - Volker Auwärter
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center – University of Freiburg, Faculty of MedicineUniversity of Freiburg Albertstr. 9 79104 Freiburg Germany
| | - Christophe Stove
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical SciencesGhent University Ottergemsesteenweg 460 9000 Ghent Belgium
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24
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Kevin RC, Anderson L, McGregor IS, Boyd R, Manning JJ, Glass M, Connor M, Banister SD. CUMYL-4CN-BINACA Is an Efficacious and Potent Pro-Convulsant Synthetic Cannabinoid Receptor Agonist. Front Pharmacol 2019; 10:595. [PMID: 31191320 PMCID: PMC6549035 DOI: 10.3389/fphar.2019.00595] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/09/2019] [Indexed: 01/07/2023] Open
Abstract
Synthetic cannabinoid receptor agonists (SCRAs) are the largest class of new psychoactive substances (NPS). New examples are detected constantly, and some are associated with a series of adverse effects, including seizures. CUMYL-4CN-BINACA (1-(4-cyanobutyl)-N-(2-phenylpropan-2-yl)indazole-3-carboxamide) is structurally related to potent, cumylamine-derived SCRAs such as 5F-CUMYL-PINACA, but is unusual due to a terminal aliphatic nitrile group not frequently encountered in SCRAs or pharmaceuticals. We report here that CUMYL-4CN-BINACA is a potent CB1 receptor agonist (K i = 2.6 nM; EC50 = 0.58 nM) that produces pro-convulsant effects in mice at a lower dose than reported for any SCRA to date (0.3 mg/kg, i.p). Hypothermic and pro-convulsant effects in mice could be reduced or blocked, respectively, by pretreatment with CB1 receptor antagonist SR141716, pointing to at least partial involvement of CB1 receptors in vivo. Pretreatment with CB2 receptor antagonist AM-630 had no effect on pro-convulsant activity. The pro-convulsant properties and potency of CUMYL-4CN-BINACA may underpin the toxicity associated with this compound in humans.
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Affiliation(s)
- Richard C. Kevin
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, NSW, Australia
| | - Lyndsey Anderson
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, NSW, Australia
- Discipline of Pharmacology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Iain S. McGregor
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, NSW, Australia
| | - Rochelle Boyd
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Jamie J. Manning
- Department of Pharmacology and Toxicology, The University of Otago, Dunedin, New Zealand
| | - Michelle Glass
- Department of Pharmacology and Toxicology, The University of Otago, Dunedin, New Zealand
| | - Mark Connor
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Samuel D. Banister
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, NSW, Australia
- School of Chemistry, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
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25
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Van Wijk XMR, Goodnough R, Colby JM. Mass spectrometry in emergency toxicology: Current state and future applications. Crit Rev Clin Lab Sci 2019; 56:225-238. [DOI: 10.1080/10408363.2019.1585415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Xander M. R. Van Wijk
- Department of Pathology, Pritzker School of Medicine, University of Chicago, Chicago, IL, US
| | - Robert Goodnough
- California Poison Control System, San Francisco Division, San Francisco, CA, US
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, US
| | - Jennifer M. Colby
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, US
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26
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Cannaert A, Vandeputte M, Wille SMR, Stove CP. Activity-based reporter assays for the screening of abused substances in biological matrices. Crit Rev Toxicol 2019; 49:95-109. [DOI: 10.1080/10408444.2019.1576588] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Annelies Cannaert
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Toxicology, National Institute of Criminalistics and Criminology, Federal Public Service Justice, Brussels, Belgium
| | - Marthe Vandeputte
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Sarah M. R. Wille
- Department of Toxicology, National Institute of Criminalistics and Criminology, Federal Public Service Justice, Brussels, Belgium
| | - Christophe P. Stove
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
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27
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Cannaert A, Vandeputte M, Hudson S, Wood DM, Dargan PI, Stove CP. Validation of Activity-Based Screening for Synthetic Cannabinoid Receptor Agonists in a Large Set of Serum Samples. Clin Chem 2019; 65:347-349. [DOI: 10.1373/clinchem.2018.296905] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Annelies Cannaert
- Laboratory of Toxicology Department of Bioanalysis Faculty of Pharmaceutical Sciences Ghent University Ghent, Belgium
- Laboratory of Toxicology, National Institute of Criminalistics and Criminology Brussels, Belgium
| | - Marthe Vandeputte
- Laboratory of Toxicology Department of Bioanalysis Faculty of Pharmaceutical Sciences Ghent University Ghent, Belgium
| | - Simon Hudson
- Sport and Specialised Analytical Services, LGC Ltd Fordham, Cambridgeshire, UK
| | - David M Wood
- Clinical Toxicology Guy's and St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine King's College London London, UK
| | - Paul I Dargan
- Clinical Toxicology Guy's and St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine King's College London London, UK
| | - Christophe P Stove
- Laboratory of Toxicology Department of Bioanalysis Faculty of Pharmaceutical Sciences Ghent University Ghent, Belgium
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28
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Hobbs M, Kalk NJ, Morrison PD, Stone JM. Spicing it up - synthetic cannabinoid receptor agonists and psychosis - a systematic review. Eur Neuropsychopharmacol 2018; 28:1289-1304. [PMID: 30454908 DOI: 10.1016/j.euroneuro.2018.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 09/13/2018] [Accepted: 10/23/2018] [Indexed: 01/04/2023]
Abstract
Synthetic cannabinoid receptor agonists (SCRAs) are suggested to have increased potential to induce psychosis compared to natural cannabis (NC). In this review we synthesise current knowledge about the association of SCRA use with psychotic symptoms. Following a literature search we identified 2 toxicology reports, 4 case-control studies, 3 cross-sectional studies and 15 case reports. In each of the case reports, we identified the presence or absence of symptoms based on the items of the Postitive and Negative Syndrome Scele (PANSS). The toxicology reports highlighted the main presenting features as being toxic psychosis and delirium (40%), agitation (10%) and hallucinations (4-7%). The median age was 25 years, and around 80% cases were male. Cross-sectional studies reported that SCRA use was present in approximately 10-13% patients presenting to acute psychiatric services, and was often the cause of their presentation, and that psychotic symptoms were present in 15% patients attending emergency departments following SCRA use. Case-control studies reported that SCRA use was significantly associated with psychotic symptoms and that SCRA users had higher levels of positive psychotic symptoms than NC users. The case reports supported the association of SCRA use with a wide range of positive and negative psychotic symptoms as well as with self-harm, agitation and aggressive behaviour. SCRA use is relatively prevalent in patients with psychosis and may lead to psychotic symptoms in individuals with no past psychiatric history. Further work is required to understand the long term risks of SCRA use and optimal management strategies.
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Affiliation(s)
- Melissa Hobbs
- King's College London Institute of Psychiatry, Psychology and Neuroscience, United Kingdom
| | - Nicola J Kalk
- King's College London Institute of Psychiatry, Psychology and Neuroscience, United Kingdom
| | - Paul D Morrison
- King's College London Institute of Psychiatry, Psychology and Neuroscience, United Kingdom
| | - James M Stone
- King's College London Institute of Psychiatry, Psychology and Neuroscience, United Kingdom.
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29
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Noble C, Cannaert A, Linnet K, Stove CP. Application of an activity‐based receptor bioassay to investigate the in vitro activity of selected indole‐ and indazole‐3‐carboxamide‐based synthetic cannabinoids at CB1 and CB2 receptors. Drug Test Anal 2018; 11:501-511. [DOI: 10.1002/dta.2517] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/27/2018] [Accepted: 09/27/2018] [Indexed: 01/22/2023]
Affiliation(s)
- Carolina Noble
- Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health and Medical SciencesUniversity of Copenhagen Frederik V's Vej 11 2100 Copenhagen Denmark
| | - Annelies Cannaert
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical SciencesGhent University Ottergemsesteenweg 460 9000 Ghent Belgium
- Laboratory of ToxicologyNational Institute of Criminalistics and Criminology Vilvoordsesteenweg 100 1120 Brussels Belgium
| | - Kristian Linnet
- Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health and Medical SciencesUniversity of Copenhagen Frederik V's Vej 11 2100 Copenhagen Denmark
| | - Christophe P. Stove
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical SciencesGhent University Ottergemsesteenweg 460 9000 Ghent Belgium
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30
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Amar JY, Ruta J, Rahimian D, Dillinger RL, Katz P. Toxic leukoencephalopathy with extrapyramidal dysfunction due to synthetic cannabinoids. J Clin Neurosci 2018; 58:213-214. [PMID: 30327216 DOI: 10.1016/j.jocn.2018.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/05/2018] [Indexed: 10/28/2022]
Abstract
Neurologic sequelae of synthetic cannabinoids are not well understood. We report a case of a woman who developed hyperreflexia, paratonia and cogwheel rigidity after consumption of synthetic cannabinoids. MR imaging demonstrated T2/FLAIR signal enhancement in the supratentorial white matter and globus pallidus internus.
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Affiliation(s)
- Jordan Yardain Amar
- Department of Neurology, Washington University School of Medicine, 1 Brookings Road, Campus Box 8121, St. Louis, MO 63110, United States.
| | - Jeffrey Ruta
- Department of Neurology, Lewis Katz School of Medicine at Temple University, 3401 North Broad Street, Philadelphia, PA 19140, United States
| | - David Rahimian
- Department of Neurology, Lewis Katz School of Medicine at Temple University, 3401 North Broad Street, Philadelphia, PA 19140, United States
| | - Rachel Leah Dillinger
- Department of Psychiatry, University of Maryland School of Medicine, 110 South Paca Street, Baltimore, MD 21201, United States
| | - Paul Katz
- Department of Neurology, Lewis Katz School of Medicine at Temple University, 3401 North Broad Street, Philadelphia, PA 19140, United States; Temple Neurosciences Center, 3509 N. Broad Street, Philadelphia, PA 19140, United States
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31
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Cordeiro SK, Daro RC, Seung H, Klein-Schwartz W, Kim HK. Evolution of clinical characteristics and outcomes of synthetic cannabinoid receptor agonist exposure in the United States: analysis of National Poison Data System data from 2010 to 2015. Addiction 2018; 113:1850-1861. [PMID: 29806885 DOI: 10.1111/add.14281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 01/22/2018] [Accepted: 05/23/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND AIMS New synthetic cannabinoid receptor agonists (SCRAs) are synthesized each year to evade US governmental regulation and sold for recreational use. Our aim was to estimate the changes in the clinical effects and patient disposition associated with SCRA exposure from 2010 to 2015. DESIGN A retrospective observational cohort study. SETTING National Poison Data System that collects data on reports of poisonings from US poison centers. PARTICIPANTS A total of 19 388 isolated SCRA cases between 1 January 2010 and 31 December 2015 were identified. The mean age was 24.6 years and 77.8% were male. MEASUREMENTS Primary outcome was the change in the trend of patient disposition, i.e. treated and released versus hospitalization (e.g. non-critical care, critical care unit or psychiatry) between 2010 and 2015. Secondary outcomes included the trends in the clinical effects and their duration, and therapeutic interventions nationally and regionally. FINDINGS Reports of SCRA exposure peaked in 2011 (n = 5305) and 2015 (n = 5475). The majority of patients required supportive care and were treated and released from an emergency department. Hospitalization increased by annual percentage change in the log odds (APCO) of 21.0% (P < 0.0001) during the 6 years, with significant increases in admissions to critical care units and non-critical care units. Overall, tachycardia (32.1%), agitation/irritation (25.6%) and drowsiness/lethargy (20.4%) were the most frequently reported clinical effects from SCRA exposure. Clinical effects resolved within 2-8 hours in 52.8% of cases, but their duration increased markedly by 2015. Regionally, the largest number of SCRA cases was reported in the South (n = 9374, 48.6%). SCRA cases in the Northeast were hospitalized more frequently (27.4%), with cases in the Midwest being admitted more frequently to critical care units (15.3%). However, there were no significant differences in clinical toxicity or disposition among the regions. CONCLUSION Hospitalization resulting from toxicity from synthetic cannabinoid receptor agonists exposure in the United States increased significantly between 2010 and 2015.
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Affiliation(s)
- Samuel K Cordeiro
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ryan C Daro
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hyunuk Seung
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Wendy Klein-Schwartz
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Maryland Poison Center, Baltimore, MD, USA
| | - Hong K Kim
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.,Maryland Poison Center, Baltimore, MD, USA
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32
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Synthetic cannabinoid BB-22 (QUCHIC): Human hepatocytes metabolism with liquid chromatography-high resolution mass spectrometry detection. J Pharm Biomed Anal 2018; 157:27-35. [DOI: 10.1016/j.jpba.2018.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/02/2018] [Accepted: 05/06/2018] [Indexed: 11/22/2022]
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33
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Webb NE, Wood DM, Greene SL, Hunter LJ, Archer JRH, Dines AM, Dargan PI. Change in the new psychoactive substances associated with Emergency Department acute toxicity presentations associated with the introduction of the UK 2016 Psychoactive Substances Act. Clin Toxicol (Phila) 2018; 57:36-41. [PMID: 30067112 DOI: 10.1080/15563650.2018.1494277] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES In May 2016, the Psychoactive Substances Act (PSA) came into effect in UK making it an offence to produce or supply new psychoactive substances (NPS). The aim of this study was to determine whether this was associated with a change in Emergency Department (ED) presentations with acute NPS toxicity. METHOD ED presentations to our inner-city hospital in London, UK, with acute NPS toxicity in the 12 months before and after the PSA introduction [June 2015-May 2016 (2015/2016) and June 2016-May 2017 (2016/2017)] were obtained from our database. The following data were extracted: (i) demographics; (ii) NPS(s) self-reported [categorized as synthetic cannabinoids (SC), cathinones, and "other NPS")]; and (iii) month of presentation. RESULTS There were 1884 presentations with recreational drug toxicity, 447 (23.7%) involved NPS. There was no difference in the overall proportion of presentations involving an NPS in 2015/2016 [n = 196 (22.3%)] and 2016/2017 [251 (24.9%); (p = .48)]. There were a mean ± SD of 16.3 ± 3.7 NPS-related presentations per month in 2015/2016 and 20.9 ± 9.2 in 2016/2017; there was no significant change in overall monthly NPS-related presentations between these periods (p = .15). However, mean ± SD monthly SC-related presentations increased from 2015/2016 (5.9 ± 2.5) to 2016/2017 (17 ± 9.8); p = .004. Mean monthly cathinone-related presentations decreased from 2015/2016 (8.8 ± 4.2) to 2016/2017 (3.8 ± 2.7); p = .001. There was no significant change in monthly mean "other NPS" presentations from 2015/2016 (1.8 ± 2.2) to 2016/2017 (0.5 ± 0.8); p = .062. Between 2015/2016 and 2016/2017, SCs as a proportion of NPS-related presentations increased (r = .90) whilst cathinones decreased (r = -0.82). CONCLUSION NPS present front-line health services with unique challenges, and the PSA 2016 represents a major legislative effort in UK to limit their availability and supply. The burden of NPS use on this inner-city ED remains large 12 months after this legislation has come into force, with evolving patterns of NPS use.
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Affiliation(s)
- Nicholas E Webb
- a Department of Clinical Toxicology , Guy's and St. Thomas' NHS Foundation Trust , London , UK
| | - David M Wood
- a Department of Clinical Toxicology , Guy's and St. Thomas' NHS Foundation Trust , London , UK.,b Faculty of Life Sciences and Medicine , King's College London , London , UK
| | - Shaun L Greene
- a Department of Clinical Toxicology , Guy's and St. Thomas' NHS Foundation Trust , London , UK.,c Department of Clinical Toxicology , Austin Health , Melbourne , Australia
| | - Laura J Hunter
- a Department of Clinical Toxicology , Guy's and St. Thomas' NHS Foundation Trust , London , UK
| | - John R H Archer
- a Department of Clinical Toxicology , Guy's and St. Thomas' NHS Foundation Trust , London , UK.,b Faculty of Life Sciences and Medicine , King's College London , London , UK
| | - Alison M Dines
- a Department of Clinical Toxicology , Guy's and St. Thomas' NHS Foundation Trust , London , UK
| | - Paul I Dargan
- a Department of Clinical Toxicology , Guy's and St. Thomas' NHS Foundation Trust , London , UK.,b Faculty of Life Sciences and Medicine , King's College London , London , UK
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Synthetic Cannabinoid use in a Case Series of Patients with Psychosis Presenting to Acute Psychiatric Settings: Clinical Presentation and Management Issues. Brain Sci 2018; 8:brainsci8070133. [PMID: 30011896 PMCID: PMC6071094 DOI: 10.3390/brainsci8070133] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 06/29/2018] [Accepted: 07/05/2018] [Indexed: 12/16/2022] Open
Abstract
Background: Novel Psychoactive Substances (NPS) are a heterogeneous class of synthetic molecules including synthetic cannabinoid receptor agonists (SCRAs). Psychosis is associated with SCRAs use. There is limited knowledge regarding the structured assessment and psychometric evaluation of clinical presentations, analytical toxicology and clinical management plans of patients presenting with psychosis and SCRAs misuse. Methods: We gathered information regarding the clinical presentations, toxicology and care plans of patients with psychosis and SCRAs misuse admitted to inpatients services. Clinical presentations were assessed using the PANSS scale. Vital signs data were collected using the National Early Warning Signs tool. Analytic chemistry data were collected using urine drug screening tests for traditional psychoactive substances and NPS. Results: We described the clinical presentation and management plan of four patients with psychosis and misuse of SCRAs. Conclusion: The formulation of an informed clinical management plan requires a structured assessment, identification of the index NPS, pharmacological interventions, increases in nursing observations, changes to leave status and monitoring of the vital signs. The objective from using these interventions is to maintain stable physical health whilst rapidly improving the altered mental state.
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35
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Deng H, Mohite S, Suchting R, Nielsen DA, Okusaga OO. Impact of synthetic cannabinoid use on hospital stay in patients with bipolar disorder versus schizophrenia, or other psychotic disorders. Psychiatry Res 2018; 261:248-252. [PMID: 29329043 DOI: 10.1016/j.psychres.2017.12.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 11/14/2017] [Accepted: 12/31/2017] [Indexed: 11/15/2022]
Abstract
Synthetic cannabinoid products have become popular and have led to an increased number of patients presenting to emergency departments and psychiatric hospitals. The purpose of this study was to evaluate the impact of synthetic cannabinoid use at admission on length of stay and doses of antipsychotics at discharge in individuals with bipolar disorder, schizophrenia and other psychotic disorders. We retrospectively examined medical records of 324 inpatients admitted from January 2014 to July 2015. We found that synthetic cannabinoid use predicted length of stay and antipsychotic dose using structural equation modeling. Further, the association of synthetic cannabinoid use with length of stay was partly mediated by antipsychotic dose. These associations were independent of specific diagnosis. In conclusion, patients with bipolar disorder, schizophrenia, or other psychotic disorders who reported synthetic cannabinoid use at admission had shorter length of stay and received lower doses of antipsychotics, irrespective of clinical diagnoses.
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Affiliation(s)
- Huiqiong Deng
- Harris County Psychiatric Center, University of Texas Health Science Center at Houston, Houston, TX, United States; Department of Psychiatry and Behavioral Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States.
| | - Satyajit Mohite
- Harris County Psychiatric Center, University of Texas Health Science Center at Houston, Houston, TX, United States; Department of Psychiatry and Behavioral Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Robert Suchting
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - David A Nielsen
- The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Olaoluwa O Okusaga
- Harris County Psychiatric Center, University of Texas Health Science Center at Houston, Houston, TX, United States; Department of Psychiatry and Behavioral Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
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36
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Hill SL, Dargan PI. Patterns of Acute Toxicity Associated with New Psychoactive Substances. Handb Exp Pharmacol 2018; 252:475-494. [PMID: 29896654 DOI: 10.1007/164_2018_135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This chapter begins by considering why it is important to understand the clinical patterns of acute toxicity associated with new psychoactive substances (NPS), the challenges associated with gathering these data, the sources of information available and the limitations of each. It describes the data triangulation approach that can be used to combine individual, each inherently limited, data sources to help build the picture of the pattern of acute non-fatal toxicity associated with NPS. The chapter illustrates the data triangulation approach by the use of clinical examples and aims to consider mechanism of action data in conjunction with clinical features to provide an overarching understanding of the clinical presentation. Examples of the most important individual and groups of NPS were identified using multimodal literature searching based on the most relevant terms. The chapter provides descriptive accounts that are a complete reference source on the patterns of acute toxicity.
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Affiliation(s)
- Simon L Hill
- The Medical Toxicology Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
| | - Paul I Dargan
- Clinical Toxicology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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37
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Bovens M, Bissig C, Staeheli SN, Poetzsch M, Pfeiffer B, Kraemer T. Structural characterization of the new synthetic cannabinoids CUMYL-PINACA, 5F-CUMYL-PINACA, CUMYL-4CN-BINACA, 5F-CUMYL-P7AICA and CUMYL-4CN-B7AICA. Forensic Sci Int 2017; 281:98-105. [DOI: 10.1016/j.forsciint.2017.10.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/07/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
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38
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Staeheli SN, Poetzsch M, Veloso VP, Bovens M, Bissig C, Steuer AE, Kraemer T. In vitro metabolism of the synthetic cannabinoids CUMYL-PINACA, 5F-CUMYL-PINACA, CUMYL-4CN-BINACA, 5F-CUMYL-P7AICA and CUMYL-4CN-B7AICA. Drug Test Anal 2017; 10:148-157. [PMID: 28885775 DOI: 10.1002/dta.2298] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/25/2017] [Accepted: 09/04/2017] [Indexed: 12/12/2022]
Abstract
Synthetic cannabinoid consumption trends underlie fast changes and provide several challenges to clinical and forensic toxicologists. Due to their extensive metabolism, parent compounds are hardly detectable in urine. Therefore, knowledge of the metabolism of synthetic cannabinoids is essential to allow their detection in biological matrices. The aim of the present study was the elucidation of the metabolism of CUMYL-PINACA, 5F-CUMYL-PINACA, CUMYL-4CN-BINACA, 5F-CUMYL-P7AICA, and CUMYL-4CN-B7AICA with a focus on the analytical and interpretational differentiation of the compounds. Microsomal assay mixtures containing co-substrates, 10 μg/mL substrate and 1 mg/mL pooled human liver microsomes were incubated for 1 hour at 37°C. Investigation of the metabolites was performed on a Thermo Fischer Ultimate 3000 UHPLC system coupled to a Sciex 6600 QTOF System. Hydroxylation was observed to be a major biotransformation step for all 5 cumyl-derivatives, followed by dihydroxylation. For CUMYL-PINACA, a major metabolic pathway was hydroxylation at the pentyl moiety, followed by a second hydroxylation at that pentyl moiety or oxidation to ketone. A major metabolic pathway for the compounds containing a nitrile function was nitrile hydrolysis followed by carboxylation and further hydroxylation. For the fluorinated compounds, oxidative defluorination and carboxylation were abundant metabolic steps. Some of the metabolic transformations lead to structurally identical metabolites, which should not be used as marker for the intake of a particular parent compound. In addition, several constitutional isomers containing either an indazole or azaindole core structure were detected, which should be differentiated by retention time rather than by their mass spectra alone.
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Affiliation(s)
- Sandra N Staeheli
- Department of Forensic Pharmacology & Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Michael Poetzsch
- Department of Forensic Pharmacology & Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Veronica P Veloso
- Department of Forensic Pharmacology & Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | | | | | - Andrea E Steuer
- Department of Forensic Pharmacology & Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Thomas Kraemer
- Department of Forensic Pharmacology & Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
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39
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Hermanns-Clausen M, Müller D, Kithinji J, Angerer V, Franz F, Eyer F, Neurath H, Liebetrau G, Auwärter V. Acute side effects after consumption of the new synthetic cannabinoids AB-CHMINACA and MDMB-CHMICA. Clin Toxicol (Phila) 2017; 56:404-411. [DOI: 10.1080/15563650.2017.1393082] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Maren Hermanns-Clausen
- Poisons Information Center, Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Dieter Müller
- GIZ-Nord Poisons Center, University Hospital Göttingen, Göttingen, Germany
| | - Josephine Kithinji
- Poisons Information Center, Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Verena Angerer
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- Hermann Staudinger Graduate School, University of Freiburg, Freiburg, Germany
| | - Florian Franz
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- Hermann Staudinger Graduate School, University of Freiburg, Freiburg, Germany
| | - Florian Eyer
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hartmud Neurath
- GIZ-Nord Poisons Center, University Hospital Göttingen, Göttingen, Germany
| | | | - Volker Auwärter
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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40
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Longworth M, Banister SD, Boyd R, Kevin RC, Connor M, McGregor IS, Kassiou M. Pharmacology of Cumyl-Carboxamide Synthetic Cannabinoid New Psychoactive Substances (NPS) CUMYL-BICA, CUMYL-PICA, CUMYL-5F-PICA, CUMYL-5F-PINACA, and Their Analogues. ACS Chem Neurosci 2017; 8:2159-2167. [PMID: 28792725 DOI: 10.1021/acschemneuro.7b00267] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Synthetic cannabinoids (SC) are the largest class of new psychoactive substances (NPS), and are increasingly associated with serious adverse effects. The majority of SC NPS are 1,3-disubstituted indoles and indazoles featuring a diversity of subunits at the 1- and 3-positions. Most recently, cumyl-derived indole- and indazole-3-carboxamides have been detected by law enforcement agencies and by emergency departments. Herein we describe the synthesis, characterization, and pharmacology of SCs CUMYL-BICA, CUMYL-PICA, CUMYL-5F-PICA, CUMYL-PINACA, CUMYL-5F-PINACA, and related analogues. All cumyl-derived SCs were potent, efficacious agonists at CB1 (EC50 = 0.43-12.3 nM) and CB2 (EC50 = 11.3-122 nM) receptors in a fluorometric assay of membrane potential, with selectivity for CB1 activation (3.1-53 times over CB2). CUMYL-PICA and CUMYL-5F-PICA were evaluated in rats using biotelemetry, and induced hypothermia and bradycardia at doses of 1 mg/kg. Hypothermia was reversed by pretreatment with a CB1, but not CB2, antagonist, confirming that cumyl-derived SCs are cannabimimetic in vivo.
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Affiliation(s)
- Mitchell Longworth
- School of Chemistry, The University of Sydney, Sydney, NSW 2006, Australia
| | - Samuel D. Banister
- School of Chemistry, The University of Sydney, Sydney, NSW 2006, Australia
- Department of Pathology, Stanford University School of Medicine, Stanford, California 94305, United States
| | - Rochelle Boyd
- Department
of Biomedical Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Richard C. Kevin
- School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia
| | - Mark Connor
- Department
of Biomedical Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Iain S. McGregor
- School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia
| | - Michael Kassiou
- School of Chemistry, The University of Sydney, Sydney, NSW 2006, Australia
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41
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Cannaert A, Franz F, Auwärter V, Stove CP. Activity-Based Detection of Consumption of Synthetic Cannabinoids in Authentic Urine Samples Using a Stable Cannabinoid Reporter System. Anal Chem 2017; 89:9527-9536. [DOI: 10.1021/acs.analchem.7b02552] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Annelies Cannaert
- Laboratory
of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical
Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
| | - Florian Franz
- Institute
of Forensic Medicine, Forensic Toxicology, Medical Center—University
of Freiburg, Faculty of Medicine, University of Freiburg, Albertstrasse
9, 79104 Freiburg, Germany
| | - Volker Auwärter
- Institute
of Forensic Medicine, Forensic Toxicology, Medical Center—University
of Freiburg, Faculty of Medicine, University of Freiburg, Albertstrasse
9, 79104 Freiburg, Germany
| | - Christophe P. Stove
- Laboratory
of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical
Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
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