Cluster of Acute Toxicity from Ingestion of Synthetic Cannabinoid-Laced Brownies.

Eleven patients who unknowingly ate brownies laced with the synthetic cannabinoid receptor agonist AM-2201 developed neuropsychiatric and cardiovascular symptoms within an hour. All experienced light-headedness, facial numbness, blurred vision, dry mouth, and sluggishness; memory impairment occurred in 91% and inappropriate giggling in 36%. Two patients had elevated heart rates, four had high blood pressure, and one had chest pain. Symptoms resolved within four hours except for lingering weakness and fatigue in two patients. Urine drug screens were negative for common drugs, and all patients were discharged from the emergency department within ten hours.

Study at a glance

Abstract

Synthetic cannabinoid receptor agonists (SCRAs) are emerging designer drugs of abuse. Most reports on the health effects of these drugs are case reports. Unlike SCRAs, marijuana has classically been used via many routes of exposure including oral, such as in brownies. We report on 11 symptomatic patients who unknowingly ingested brownies laced with analytically confirmed SCRA and presented with mostly neuropsychiatric and cardiovascular symptoms. All 11 patients were taken to the ED within 1 h of exposure with the onset of various symptoms. There were five males and six females, age range 20-57 years. Neuropsychiatric and cardiovascular symptoms predominated: memory impairment (91 %, 10/11) and inappropriate giggling (36 %, 4/11). All the patients had light-headedness, perioral and facial numbness and tingling sensation, dry mouth, difficulty focusing/blurring of vision, and sluggishness. No patient had depressed consciousness. Two patients had heart rates >100, and 4 of 11 (36 %) had BP >140/80. One patient had chest pain. All the symptoms were completely resolved 4 h following their onset except two patients who had ongoing weakness and fatigue. All patients had negative urine drugs of abuse immunoassays and ethanol, acetaminophen, and salicylate concentrations, as well as normal electrocardiograms (ECGS) and metabolic panels. The SCRA was confirmed to be AM-2201. All the patients were discharged from the ED in stable condition within 10 h of the exposure. Oral exposure of 11 patients to brownies laced with analytically confirmed SCRA resulted in neuropsychiatric and cardiovascular symptoms. This series reflects that like marijuana, oral exposures to SCRAs can lead to symptoms.