Synthetic marijuana products such as K2 and "spice" have been linked to reports of acute kidney injury (AKI), government researchers found.
Between March and December 2012, a total of 16 cases of AKI tied to these synthetic cannabinoids have been reported across the country, Michael Schwartz, MD, of the CDC, and colleagues reported in the Feb. 15 issue of the Morbidity & Mortality Weekly Report.
Clinicians who encounter otherwise healthy adolescents and young adults with unexplained kidney injury should ask about use of the drugs, they wrote, and cases should be reported to regional poison control centers and state health departments.
Synthetic cannabinoids were originally developed to facilitate study of cannabinoid receptor pharmacology, Schwartz and colleagues wrote, but recently they have emerged as drugs of abuse. There's a perception that they produce a more intense high than real marijuana and can't be detected on commonly used urine drug tests.
Initially, the Wyoming Department of Health discovered three cases of AKI among synthetic pot users in one county. After launching a wider investigation, they found 16 similar cases in six states among patients ranging in age from 15 to 33.
Nearly all (15) were male, and almost all presented with nausea and vomiting. Most also reported abdominal pain, and none had a history of kidney disease.
Their peak serum creatinine concentrations ranged from 3.3 to 21 mg/dL, with a median of 6.7 mg/dL, and the peak concentrations occurred 1 to 6 days after onset, with a median of 3 days.
Five of the 16 patients needed hemodialysis, four received corticosteroids, and none died.
There was no single brand or compound tied to AKI in the 16 cases, though toxicologic analysis found a fluorinated synthetic cannabinoid that was previously unreported in synthetic marijuana products -- methanone, also known as XLR-11, which acts as a potent agonist for cannabinoid receptors.
It first emerged on the synthetic cannabinoid market in the first half of 2012, so experience with it has been limited. Thus, the compound itself, a metabolite, or a contaminant associated with it might be responsible for AKI in these patients, the researchers wrote.
They cautioned, however, that its presence "may simply reflect the widespread use of this particular compound ... rather than a causal association with AKI."
The researchers reported no conflicts of interest.
Primary source: Morbidity & Mortality Weekly Report
Source reference:
Murphy TD, et al "Acute Kidney Injury associated with synthetic cannabinoid use -- Multiple states, 201
2" MMWR2013; 62(6): 93-98.
Source reference:
Murphy TD, et al "Acute Kidney Injury associated with synthetic cannabinoid use -- Multiple states, 201
2" MMWR2013; 62(6): 93-98.
Kristina Fiore
Staff Writer
Kristina Fiore joined MedPage Today after earning a degree in science, health, and environmental reporting from NYU. She's had bylines in newspapers and trade and consumer magazines includingNewsday, ABC News, New Jersey Monthly, and Earth Magazine. At MedPage Today, she reports with a focus on diabetes, nutrition, and addiction medicine.
The AP (2/14, Stobbe) reports a CDC report claims "sixteen people who smoked synthetic marijuana were hospitalized with kidney problems last year in six states." Five of the sixteen required dialysis. The synthetic drug is "sprayed with chemicals that can mimic the high from marijuana" and has been "tied to such health problems as a rapid heartbeat and seizures" in the past, but this is the first reported incident of kidney problems. The CDC said they are unsure what causes the kidney damage.
USA Today (2/14, Payne, 1.71M) reports the sixteen patients "became sick within days and sometimes even hours after smoking. Their symptoms included nausea and vomiting as well as abdominal and flank pain." The cases took place in New York, Kansas, Oklahoma, Oregon, Rhode Island and Wyoming. Michael Schwartz, a co-author of the report and medical officer in the CDC's National Center for Environmental Health, says, "Synthetic cannabinoids are not safe alternatives to marijuana. There are unexpected and unpredictable health problems that can occur."
The ABC News (2/14, Wasson) "Medical Unit" health blog reports that according to Dr. Gregory Collins, head of the Cleveland Clinic's Alcohol and Drug Recovery Center, "It's unusual for young people to have unexplained kidney failure," He adds, "We haven't seen that before with these substances, but this wouldn't surprise me. These are dangerous compounds that are made often in China and imported into the U.S." He urged people to "stay away" from the substance, and that parents should "be very vigilant."
MyHealthNewsDaily (2/15, Rettner) adds that researchers said the "analysis of synthetic marijuana samples smoked by the people involved showed that five samples contained a compound called XLR-11, which has only recently been found in synthetic marijuana products and might have been responsible for the kidney damage." HealthDay (2/15, Dallas) and MedPage Today (2/15, Fiore) also report on this story.
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