The cathinones are derivatives of naturally occurring phenylethylamines found in the leaves of the Catha edulis (Khat) plant. Some of these compounds include mephedrone, methylone, and methylenedioxypyrovalerone (MDPV). Example names on the packaging include “Molly’s plant food,” “bath salts,” and “flakka.” Adverse effects of these compounds include cardiac, psychiatric, and neurologic signs and symptoms similar to effects seen with other sympathomimetics.
Synthetic cannabinoids have been promoted as “spice” or “incense” products. These compounds have full agonist effects at the cannabinoid receptors, in contrast with tetrahydrocannabinol (THC), which demonstrates only partial agonism. While cannabinoids such as marijuana do not typically result in sympathomimetic effects, the synthetic cannabinoids may also cause acute sympathomimetic toxicity including seizures and tachydysrhythmias. Myocardial infarction, stroke, and acute kidney injury have all been reported with the use of synthetic cannabinoids.
Khat plant. The leaves of the Khat plant (Catha edulis) are chewed for the stimulant effects. The leaves must be fresh in order for cathinone to be present. (Photo contributor: US Drug Enforcement Administration.)
Bath Salts. Examples of typical packaging for bath salts. (Photo contributor: US Drug Enforcement Administration.)
Synthetic Cannabinoids—“Spice.” Examples of the packaging of synthetic cannabinoids, which are labeled “not for human consumption.” (Photo contributor: John G. Benitez, MD, MPH.)
Synthetic Cannabinoids Disclaimer. Close-up of the language used to suggest that the contents do not contain illegal substances. (Photo contributor: John G. Benitez, MD, MPH.)
Forensic analysis of these products has demonstrated significant variability in types and amounts of active products over time, both between and within marketed brands. As a result, individuals may experience different clinical effects with different exposures to the same product.
Management and Disposition
Patients under the influence of one of the synthetic compounds should be approached and managed similar to other acute sympathomimetic poisonings.
The ingredients in “bath salts” are not detected by routine testing for amphetamines as a class.
Vaping has become a popular method for abuse of “K2/spice” as liquid formulations become available.
Adulterants such as long-acting anticoagulants (vitamin K inhibitors) have been found in synthetic cannabinoids.