Search

The intoxication caused by "kiken" drugs (law-evading drugs), such as synthetic cannabinoids, cathinones, and methoxetamine, has recently increased in Japan. We retrospectively examined the characteristics of patients poisoned with the "kiken" drugs. We included patients who presented at the emergency department at the Tokyo Metropolitan Bokutoh Hospital from January 2011 to December 2014. Eighteen patients admitted between January 2011 and December 2013 were included in the early period group and 10 patients admitted between January and December 2014 were categorized into the late period group. The number of the patients transported to our emergency department between 2011 and 2014 increased annually. Patients were mainly admitted between May and October 2014; no patients were admitted after November 2014. The patients' age, history of previous mental disease, habitual use, Triage DOA results, serum creatinine values on admission, and respiratory management differed significantly between the groups. However, the median serum creatinine values of both groups on admission were within the normal level. Patients poisoned with the "kiken" drugs showed more severe symptoms, higher rate of habitual use, and higher average age. The annual increase in the number of the patients observed thus far is expected to decrease in the future. Maintenance of the law and expansion of medical institutions that treat patients addicted to the "kiken" drugs are warranted.

Law-evading herbs may induce poisoning symptoms, especially when they contain synthetic cannabinoids. However, their detailed pharmacological effects have not yet been clarified. Some reports have previously described symptoms of poisoning, but only a few reports have so far described shock and myocardial damage (MD). We experienced a case of shock and MD in a patient who had smoked law-evading herbs. A 61-year-old male presented at an emergency department 8 hours after smoking law-evading herbs (Rush Trip, High Men Monster) with chest pain. A vasopressor agent was administered to treat shock and antiarrhythmic drugs were administered due to ventricular arrhythmia. The contents of the law-evading herbs were unknown, so an in-hospital follow-up was conducted to treat the patient's symptoms. The follow-up blood test showed an increased level of cardiac enzymes, which thereafter demonstrated a spontaneous remission. The systemic conditions tended to improve and the patient was discharged from the hospital on the 5th hospital day. The contents of the law-evading herbs in question were thereafter,analyzed, and synthetic cannabinoids (JWH-210, JWH-081 and JWH-122) as well as caffeine were detected. The cause for the poisoning symptoms were suspected to be the presence of synthetic cannabinoids and caffeine. Such law-evading herbs may contain synthetic cannabinoids and caffeine which both may induce shock and MD.