Clinical effects of cannabis compared to synthetic cannabinoid receptor agonists (SCRAs): a retrospective cohort study of presentations with acute toxicity to European hospitals between 2013 and 2020
Creators: name: Waters, Mitchell L.
name: Dargan, Paul I.
name: Yates, Christopher
name: Dines, Alison M.
name: Eyer, Florian
name: Giraudon, Isabelle
name: Heyerdahl, Fridtjof
name: Hovda, Knut Erik
name: Liechti, Matthias E.
name: Miró, Òscar
name: Vallersnes, Odd Martin
name: Anseeuw, Kurt
name: Badaras, Robertas
name: Bitel, Marcin
name: Bonnici, Jeffrey
name: Brvar, Miran
name: Caganova, Blazena
name: Calýskan, Feriyde
name: Ceschi, Alessandro
name: Chamoun, Karam
name: Daveloose, Laurence
name: Galicia, Miguel
name: Gartner, Birgit
name: Gorozia, Ketevan
name: Grenc, Damjan
name: Gresnigt, Femke M. J.
name: Hondebrink, Laura
name: Jürgens, Gesche
name: Konstari, Jutta
name: Kutubidze, Soso
name: Laubner, Gabija
name: Liakoni, Evangelia
name: Liguts, Viesturs
name: Lyphout, Cathelijne
name: McKenna, Roy
name: Mégarbane, Bruno
name: Moughty, Adrian
name: Nitescu, Gabriela Viorela
name: Noseda, Roberta
name: O'Connor, Niall
name: Paasma, Raido
name: Perez, Juan Ortega
name: Perminas, Marius
name: Persett, Per Sverre
name: Põld, Kristiina
name: Puchon, Erik
name: Puiguriguer, Jordi
name: Radenkova-Saeva, Julia
name: Rulisek, Jan
name: Samer, Caroline
name: Schmid, Yasmin
name: Scholz, Irene
name: Stašinskis, Roberts
name: Surkus, Jonas
name: Van den Hengel-Koot, Irma
name: Vigorita, Federico
name: Vogt, Severin
name: Waldman, Wojciech
name: Waring, William Stephen
name: Zacharov, Sergej
name: Zellner, Tobias
name: Wood, David M.
Publisher: name: Taylor & Francis
Year: 2024
Subjects: subject: Medicine
subject: Cell Biology
subject: Neuroscience
subject: Pharmacology
subject: Biotechnology
subject: Mental Health
subject: Infectious Diseases
subject: FOS: Health sciences

description: Cannabis is the most common recreational drug worldwide and synthetic cannabinoid receptor agonists are currently the largest group of new psychoactive substances. The aim of this study was to compare the clinical features and outcomes of lone acute cannabis toxicity with lone acute synthetic cannabinoid receptor agonist toxicity in a large series of presentations to European emergency departments between 2013-2020. Self-reported drug exposure, clinical, and outcome data were extracted from the European Drug Emergencies Network Plus which is a surveillance network that records data on drug-related emergency department presentations to 36 centres in 24 European countries. Cannabis exposure was considered the control in all analyses. To compare the lone cannabis and lone synthetic cannabinoid receptor agonist groups, univariate analysis using chi squared testing was used for categorical variables and non-parametric Mann-Whitney U- testing for continuous variables. Statistical significance was defined as a <i>P</i> value of &lt;0.05. Between 2013-2020 there were 54,314 drug related presentations of which 2,657 were lone cannabis exposures and 503 lone synthetic cannabinoid receptor agonist exposures. Synthetic cannabinoid receptor agonist presentations had statistically significantly higher rates of drowsiness, coma, agitation, seizures and bradycardia at the time of presentation. Cannabis presentations were significantly more likely to have palpitations, chest pain, hypertension, tachycardia, anxiety, vomiting and headache. Emergency department presentations involving lone synthetic cannabinoid receptor agonist exposures were more likely to have neuropsychiatric features and be admitted to a psychiatric ward, and lone cannabis exposures were more likely to have cardiovascular features. Previous studies have shown variability in the acute toxicity of synthetic cannabinoid receptor agonists compared with cannabis but there is little comparative data available on lone exposures. There is limited direct comparison in the current literature between lone synthetic cannabinoid receptor agonist and lone cannabis exposure, with only two previous poison centre series and two clinical series. Whilst this study is limited by self-report being used to identify the drug(s) involved in the presentations, previous studies have demonstrated that self-report is reliable in emergency department presentations with acute drug toxicity. This study directly compares presentations with acute drug toxicity related to the lone use of cannabis or synthetic cannabinoid receptor agonists. It supports previous findings of increased neuropsychiatric toxicity from synthetic cannabinoid receptor agonists compared to cannabis and provides further data on cardiovascular toxicity in lone cannabis use.