Characteristics and circumstances of synthetic cannabinoid-related death.

Synthetic cannabinoids are an emerging clinical and public health concern. The current study aimed to determine: (1) The characteristics and circumstances of death of all recorded cases of synthetic cannabinoid-related sudden or unnatural death in Australia, (2) The toxicology of cases and (3) Their major organ pathology. Retrospective study of all cases in Australia in which synthetic cannabinoid use was a mechanism contributory to death (  =  55) retrieved from the National Coronial Information System (2000-2017). Information was collected on cause of death, demographics, drug use history, circumstances of death, toxicology and major organ pathology. The mean age was 37.2 years and 91.1% were male. Causes of death comprised of accidental toxicity (38.2%), accidental toxicity/cardiovascular disease (9.1%), natural disease (20.0%), suicide (10.9%) and traumatic accident (10.9%). The most common clinical presentation proximal to death was sudden collapse (25.5%). Cardiovascular disease was prominent: severe atherosclerosis (20.0%), myocardial replacement fibrosis (18.0%), cardiomegaly (12.0%). The most frequent synthetic cannabinoids were the indazolecarboxemides (61.8%), most commonly AB-CHMINACA (38.2%). The most frequent other substances were alcohol (34.5%) and Δ-THC (23.6%). AB-CHMINACA was the most commonly seen synthetic cannabinoid. There was a high representation of relatively older decedents and of older males in particular. While acute toxicity was the most common cause of death, cardiovascular disease was prominent.