Department of Emergency Medicine, University of California, San Francisco-Fresno. 155 N Fresno St., Fresno, CA 93701, USA.
Central Valley Toxicology, 1580 Tollhouse Rd, Clovis, CA 93611, USA.
Neuropharmacology. 2018 May 15;134(Pt A):82-91. doi: 10.1016/j.neuropharm.2017.10.017. Epub 2017 Oct 14.
Synthetic cannabinoids (SC), are a novel class of designer drugs which emerged as a drug of abuse in the late 2000's. We report a case series of 6 patients who may have smoked a synthetic cannabinoid product in a remote wilderness setting. They presented with varying degrees of altered mental status, agitation, and seizures. Two were confirmed to have AB-PINACA, ADB-PINACA and their respective pentanoic acid metabolites in biological specimens via liquid chromatography time-of-flight mass spectrometry (LC-TOF/MS). Both compounds had DEA Schedule I classification at the time of case presentation, and 22 SCs are currently temporary or permanent DEA Schedule I. More than 150 SCs are known to date, and new compounds are appearing at a rapid rate on darknet and surface web e-commerce websites, marketed as "research chemicals" or "legal highs." The scale and rapidity of SC evolution make legal control and analytical detection difficult. Nontargeted testing with liquid chromatography high resolution mass spectrometry (LC-HRMS), examining both parent compounds and metabolites, is the ideal method for novel SC identification and confirmation. Due to full agonism at the cannabinoid receptors CB1 and CB2, clinical effects are more severe than marijuana, which is a partial cannabinoid receptor agonist. They include agitated delirium, lethargy and coma, seizures, tachycardia, hypertension, and hallucinations, among other findings. Treatment is primarily symptomatic and aimed at airway protection and control of agitation and seizures. SCs do not appear to be abating anytime soon and require the cooperation of law enforcement, analytical scientists, and clinicians to adequately control. This article is part of the Special Issue entitled 'Designer Drugs and Legal Highs.'
合成大麻素（SC）是一类新型的设计毒品，于 21 世纪 10 年代后期开始作为滥用药物出现。我们报告了 6 例可能在偏远野外环境中吸食合成大麻素产品的患者系列病例。他们表现出不同程度的意识改变、激越和癫痫发作。通过液相色谱飞行时间质谱法（LC-TOF/MS），2 例患者的生物样本中证实含有 AB-PINACA、ADB-PINACA 及其各自的戊酸代谢物。在病例报告时，这两种化合物均被 DEA 归类为附表 I 管制物质，目前有 22 种 SC 被临时或永久归类为 DEA 附表 I。迄今为止，已知有超过 150 种 SC，新的化合物正以惊人的速度出现在暗网和表面网络电子商务网站上，被宣传为“研究用化学品”或“合法兴奋剂”。SC 的发展规模和速度使得法律管制和分析检测变得困难。采用液相色谱高分辨质谱法（LC-HRMS）进行非靶向测试，同时检测母体化合物和代谢物，是鉴定和确认新型 SC 的理想方法。由于对大麻素受体 CB1 和 CB2 具有完全激动作用，其临床效应比大麻更为严重，大麻是一种部分大麻素受体激动剂。其包括激越性谵妄、昏睡和昏迷、癫痫发作、心动过速、高血压和幻觉等。治疗主要是对症治疗，旨在保护气道、控制激越和癫痫发作。SC 似乎不会很快减少，需要执法部门、分析科学家和临床医生的合作，才能有效地进行控制。本文是专题“设计毒品和合法兴奋剂”的一部分。
