Drug and Substance abuse including synthetic cannabinoids or marijuana, is fast becoming an epidemic across the United States, and around the world. The National Institute on Drug Abuse has estimated that the abuse of tobacco, alcohol and illicit drugs comes at a cost, roughly $700 billion annually in costs related to crime, loss of work productivity and health care. This multi-billion-dollar industry preys on the weaknesses of the individuals that it “supplies” with illicit drugs. In order to maintain a steady flow of customers, “innovative” techniques are utilized. The formation of synthetic drugs is gaining increasing popularity, and is one of the main reasons that the United States is going through the “Opioid Epidemic”.
Synthetic cannabinoids have come to light recently as a stronger and easier substitute for traditional marijuana, especially in younger adults. In today’s day and age, much advancement is taking place in the field of scientific discovery and innovation. Disease states that were once considered to be incurable now have therapeutic modalities that allow one to live long lives, without the hindrances of disease processes. Mortality rates are going down, and we have an aging population that is living longer due to effective chronic care management. When looking at it from that perspective, scientific innovation and discovery are viewed as things which benefit society. However, with all good things, there are ways to divert and use it for wrong.
Through the advent of the global market place, the American market has become flooded with a number of different substances of abuse, such as heroin, oxycodone, oxycontin, methamphetamine, amongst others, many of them more potent than the other. In order to have higher profit margins, and ensure that there is a steady flow of customers, many dealers lace their substances with synthetic, man-made substances to increase the addictiveness of the drug. The opioid crisis does partially stem from this exact reason where customers were buying heroin laced with fentanyl.
One drug which has much controversy surrounding it in the present time is marijuana. There is much medical utility for the drug, which makes proponents for the drug fight for its legalization and decriminalization. However, on the other side of the spectrum, many organizations, and professionals in the healthcare field do not encourage the recreational use of marijuana, especially for teenagers and young adults. Many consider it to be a “gateway drug” which leads one to start abusing “harder drugs” such as heroin, benzodiazepines and methamphetamine.
Studies have shown that approximately 35 million Americans report use of marijuana on a monthly basis. 78 million reported having tried the substance at some point in their lives. These alarming numbers top that of the number of active tobacco smokers, which, according to the Centers for Disease Control, is currently 36.5 million individuals.
With the advent of “synthetic marijuana” an often-misleading term, individuals were able to use an “alternative” form of marijuana without triggering any red flags on a traditional drug screen, while acting on the same cannabinoid receptors. Synthetic marijuana is known by a number of street name such as “Spice” or “K2”. In laboratory research, it was found that various synthetic cannabinoids, such as JWH series were banned from the market. These synthetic cannabinoids were shown to have a full agonistic effect on the cannabinoid receptor system in the brain along with the immune system, versus THC which is a partial agonist. This results in markedly different effects when using one substance versus the other.
Recently, in several states across the nation, there has been a link established between serious, unexplained bleeding and the usage of synthetic cannabinoids. It has been reported that from March 10th through April 5th, 94 individuals have presented to the Emergency Department with severe, life-threatening bleeds. These bleeds were linked to Vitamin K –dependent antagonist coagulopathy after using synthetic cannabinoids. There have been two reported deaths. When conducting laboratory testing on these individuals, it was found that 18 of those patients were exposed to brodifacoum, which is a highly lethal Vitamin K antagonist, commonly found in products used to kill rodents and pests.
When CDC Epidemiologists interviewed 63 affected individuals, one commonality amongst all of them was that they were using synthetic cannabinoids. It was also noted that at least three synthetic cannabinoid samples, which were directly related to the outbreak, tested positive for brodifacoum. The CDC is conducting multiple investigations in the states affected by the recent events. They are also requesting that healthcare providers remain vigilant for vitamin K–dependent antagonist coagulopathy in patients presenting with clinical signs of coagulopathy, bleeding unrelated to an injury, or bleeding without another explanation and with a possible history of use of synthetic cannabinoids.
Common signs and symptoms of coagulopathy that results from synthetic marijuana could include: bruising, epistaxis, bleeding gums, bleeding disproportionate to injury, hematemesis, coughing up blood, hematuria, hematochezia, menorrhagia, back or flank pain, altered mental status, feeling faint or fainting, loss of consciousness, and syncope. It was also noted that several patients had INR values ranging between 6 to 10, where the reference value should be around 1.
Several patients from Illinois had international normalized ratio (INR) values ranging from 6 to greater than 20 on presentation (much higher than the reference value of 1). It is recommended that healthcare providers contact the poison information center network in order to establish what the best treatment and long-term planning would be for each particular patient. Periodic INR testing along with long-term IV or oral vitamin K may be required.
“Detox of South Florida”, one of the best Drug and Alcohol addiction treatment centers in South Florida, works with patients dealing with all forms of chemical and alcohol dependencies and abuse. The vast majority of patients do come for Heroin abuse treatment, alcohol abuse treatment, benzodiazepine abuse treatment, and amphetamine dependencies and abuse treatment. A number of our patients are using synthetic substances such as fentanyl and synthetic cannabinoids, which do not always have the characteristic signs and symptoms of those who take the raw, natural forms. At “Detox of South Florida”, a holistic approach is adopted to ensure that the patient is receiving top-notch substance abuse addiction treatment services.
It is imperative that healthcare providers, school districts, and the public health authorities work on primary prevention and patient education to prevent the usage of potentially lethal substances. It is estimated by statistics that synthetic cannabinoid is the second most widely used substance amongst high school students, second only to THC.
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