Synthetic Drug Intoxication in Children: Recognition and Management in the Emergency Department

Points and Pearls Excerpt

• For older children and adolescents, use a conventional screening tool such as HEADSS (Home; Education/Employment; Activities; Drugs; Sexuality; and Suicide/depression) to elicit key historical information, as those who use synthetic cannabinoids are more likely to engage in risky behaviors involving substance use and sexual activity when compared peers who use conventional marijuana only.
• Assess patients for suicidality and common co-ingestions, as polysubstance abuse is common. In particular, acetaminophen overdose is concerning given the brief window of opportunity for intervention.
• Conventional urine and serum laboratory studies cannot reliably detect the presence of all synthetic drugs and their metabolites. However, a urine toxicology screen that is positive for conventional marijuana should raise suspicion for synthetic marijuana use.
• Provide supportive care for mild cases of synthetic cannabinoid intoxication.

Most Important References

• Bhatty S, Wu W. Organic and synthetic cannabinoid use in adolescents. Pediatr Ann. 2013;42(1):31-35. (Review article) DOI: http://dx.doi.org/10.3928/00904481-20121221-16
• Castellanos D, Gralnik LM. Synthetic cannabinoids 2015: an update for pediatricians in clinical practice. World J Clin Pediatr. 2016;5(1):16-24. (Review article) DOI: http://dx.doi.org/10.5409/wjcp.v5.i1.16
• Nelson ME, Bryant SM, Aks SE. Emerging drugs of abuse. Emerg Med Clin North Am. 2014;32(1):1-28. (Review article) DOI: http://dx.doi.org/10.1016/j.emc.2013.09.001
• Rosenbaum CD, Carreiro SP, Babu KM. Here today, gone tomorrow...and back again? A review of herbal marijuana alternatives (K2, Spice), synthetic cathinones (bath salts), kratom, Salvia divinorum, methoxetamine, and piperazines. J Med Toxicol. 2012;8(1):15-32. (Review article) DOI: http://dx.doi.org/10.1007/s13181-011-0202-2
• Banks ML, Worst TJ, Rusyniak DE, et al. Synthetic cathinones (“bath salts”). J Emerg Med. 2014;46(5):632-642. (Review article) DOI: http://dx.doi.org/10.1016/j.jemermed.2013.11.104