Kuai David, Rivera Blanco Liz Eneida, Krotulski Alex, Walton Sara, Denn Max, Kelly Byron, Kiernan Emily, Steck Alaina, Carpenter Joseph
Department of Emergency Medicine, Emory University, Atlanta, Georgia.
The Center for Forensic Science Research & Education, Horsham, Pennsylvania.
JAMA Netw Open. 2024 Dec 2;7(12):e2451951. doi: 10.1001/jamanetworkopen.2024.51951.
Recreational use of drug-soaked paper strips (hereafter, strips) in correctional facilities poses a major public health risk owing to the diverse and potentially severe toxic effects of the substances they contain. Understanding the clinical manifestations and outcomes of exposure to these strips is important for developing effective management and prevention strategies.
To characterize the clinical manifestations, management, and outcomes of intoxication from strips in a correctional facility population, and to identify the specific substances present in these strips.
DESIGN, SETTING, AND PARTICIPANTS: This is a case series with a retrospective medical record review and biospecimen analysis. Participants were incarcerated individuals from a county jail who presented to the emergency department of an urban hospital in Atlanta, Georgia, with suspected strip exposure between August 1, 2022, and November 1, 2023. Strip samples were tested using gas chromatography-mass spectrometry and liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS), and serum samples were analyzed via LC-QTOF-MS.
All patients had suspected exposure to strips, thought to contain opioids, synthetic cannabinoid receptor agonists (SCRAs), and other novel synthetic drugs.
The primary outcomes were clinical manifestations of strip exposure, including clinical signs and symptoms, vital sign derangements, laboratory and imaging findings, treatments administered, and patient outcomes.
There were 18 patients (all male; median [IQR] age, 27.5 [18.0-45.0] years) in total. Bradycardia (11 patients [61%]) and central nervous system depression (17 patients [94%]) were the most common clinical findings. Other symptoms included agitation (6 patients [33%]) and seizures (4 patients [22%]). Treatment primarily involved supportive care, with 2 patients requiring intubation. One patient died as a result of hypoxic ischemic encephalopathy. Analysis of strip samples revealed the presence of synthetic cannabinoids and benzimidazole opioids, but no household cleaners or pesticides. Serum testing confirmed the presence of SCRAs and their metabolites.
In this case series study of strip intoxication among incarcerated individuals, severe and variable clinical manifestations were observed, predominantly associated with their SCRA content. Bradycardia in the context of major central nervous system depression was an indicator of severe SCRA toxic effects. Further research is needed to better understand strip use and to develop effective prevention and treatment strategies.
在惩教设施中消遣性使用浸有毒品的纸条（以下简称纸条）会带来重大公共卫生风险，因为纸条所含物质具有多样且潜在的严重毒性作用。了解接触这些纸条的临床表现和后果对于制定有效的管理和预防策略至关重要。
描述惩教设施人群中纸条中毒的临床表现、管理及后果，并确定这些纸条中存在的具体物质。
设计、地点和参与者：这是一项通过回顾病历和进行生物样本分析的病例系列研究。参与者是来自佐治亚州亚特兰大市一家城市医院急诊科的某县监狱在押人员，他们在2022年8月1日至2023年11月1日期间疑似接触了纸条。纸条样本采用气相色谱 - 质谱联用仪和液相色谱四极杆飞行时间质谱仪（LC - QTOF - MS）进行检测，血清样本通过LC - QTOF - MS进行分析。
所有患者均疑似接触了纸条，据认为纸条中含有阿片类药物、合成大麻素受体激动剂（SCRAs）及其他新型合成药物。
主要结局为纸条接触的临床表现，包括临床体征和症状、生命体征紊乱、实验室及影像学检查结果、所给予的治疗以及患者结局。
总共有18例患者（均为男性；年龄中位数[四分位间距]为27.5[18.0 - 45.0]岁）。心动过缓（11例患者[61%]）和中枢神经系统抑制（17例患者[94%]）是最常见的临床表现。其他症状包括躁动（6例患者[33%]）和癫痫发作（4例患者[22%]）。治疗主要包括支持性护理，2例患者需要插管。1例患者因缺氧缺血性脑病死亡。纸条样本分析显示存在合成大麻素和苯并咪唑类阿片类药物，但未发现家用清洁剂或杀虫剂。血清检测证实存在SCRAs及其代谢产物。
在这项关于在押人员纸条中毒的病例系列研究中，观察到了严重且多样临床表现，主要与其SCRAs含量有关。在严重中枢神经系统抑制背景下的心动过缓是严重SCRAs毒性作用的一个指标。需要进一步研究以更好地了解纸条的使用情况，并制定有效的预防和治疗策略。
