Speaking of acute agitation, I was thinking about the last few times I’ve sedated patients to enable their safe management to hospital, and at least a few of those cases involved the patient having consumed synthetic cannabinoids (by one name or another).

It’s a happy coincidence that the team at ALiEM have just posted this great backgrounder;

http://www.aliem.com/2016/synthetic-cannabinoid-use-reaches-new-heights

I did know that there were literally hundreds of analogues out there, but I didn’t realise that the main reason that their effects are so variable (read unpredictable) is that the distribution medium (the plant matter) contains a random amount of the active compound.

It’s an (un)lucky dip – and I haven’t heard of anyone who sells this stuff accepting returns..

I was exposed to this in my practice a few months ago;

http://www.thepoisonreview.com/2015/04/24/severe-reactions-to-spice-on-rise-some-associated-with-drug-mab-chminaca

The legality of selling this stuff, and the ethics associated with doing so continues to astound me;

http://www.thepoisonreview.com/2015/03/24/review-23-patients-with-laboratory-confirmed-mdpv-exposure