BMJ: 25 year old prison inmate was left with permanent disability in absence of other traditional risk factors. Synthetic
cannabis, also popularly known as ‘spice’ or ‘k2,’ may boost the risk
of a stroke in young users, warn US doctors writing in the journal BMJ Case Reports. The
warning follows their treatment of a 25 year old prison inmate who had
no family history of heart disease or traditional cardiovascular risk
factors, and who was left with a permanent disability.
He
was brought to emergency care in a state of severe confusion, with
weakness on the right side of his body and double incontinence.
Prison
warders had found him collapsed on the bathroom floor and thought that
he might have used synthetic marijuana as a ‘suspicious’ looking
substance had been found by his side, and he had had several episodes of
confusion after using ‘spice’ in the preceding six months.
He
had smoked cigarettes for five years, but had given up two years
previously, and tests for traditional cardiovascular risk factors were
all within the normal range.
But
a scan revealed an extensive area of stroke and swelling in the brain
while a heart trace showed evidence of a previous heart attack.
He
was treated with drugs to stave off further strokes and to stabilise
his heart failure, and given physiotherapy to correct his right sided
weakness: this improved but didn’t return to normal, leaving him with a
permanent degree of disability.
His
doctors attributed his stroke and heart attack to his use of synthetic
cannabis, although they couldn’t be absolutely sure: the active
ingredient of cannabis (THC) didn’t show up in a urine test. But this
isn’t unusual as the standard battery of tests can’t detect synthetic
variants, say the authors.
This
is only one case, and the authors caution that they were unable to
glean whether genetic factors might have been involved, added to which
this young man had high levels of clotting factor (factor VIII), which
may have increased his risk of cardiovascular problems.
But
they point out that several other studies have linked synthetic
cannabis use with a heightened risk of heart attack/stroke and that its
low cost and ready availability are fuelling an increase in popularity.
Synthetic
cannabis has also been linked to a wide range of other reported side
effects. These include anxiety; psychotic episodes; rapid or slowed
heartbeat; chest pain; low blood pressure; fainting; kidney damage
(tubular necrosis); and inflamed arteries and veins in the hands and
feet (thromboangiitis obliterans).
Greater awareness of the dangers of synthetic cannabis use is needed, they suggest.
“The
development of immunoassays aimed at detecting these drugs in serum or
urine will also help in stratifying the population at risk,” they write.
“However, the diversity among different drugs under this common
umbrella of ‘synthetic marijuana’ will remain a barrier to successful
testing of all chemicals with a single battery of tests,” they conclude.
Report: Ischaemic cardiomyopathy and embolic stroke in a young adult with suspected synthetic cannabinoid use doi 10.1136/bcr-2018-224755
Journal: BMJ Case Reports