Synthetic Cannabinoids and Brodifacoum
Synthetic cannabinoids (SCs) emerged as potential opioid alternatives in the 1960’s, but efforts were abandoned due to unwanted psychoactive side effects. Starting in the early 2000’s these drugs re-emerged as drugs of abuse (spice, K2) precisely based on those effects. Attempts to regulate these compounds have led to continued structural manipulation in an effort to evade legal detection. As a result, we have seen a wide range of clinical toxicity from SCs, with symptoms ranging from sympathomimetic toxicity (tachycardia, hypertension, agitation) to bradycardia and respiratory depression. Recently, reports of coagulopathy and severe bleeding events have been reported in patients using synthetic cannabinoids in the ToxIC registry and nationally. Advanced testing showed some SCs to be contaminated with brodifacoum, a long-acting Vitamin K antagonist found in rodenticides. The reason for adding these agents to SCs is yet unknown. Bleeding-related fatalities have been reported, and clinicians should remember to consider coagulopathy in patients with SC toxicity.