Synthetic Cannabinoid Receptor Agonist-related Intoxication: Impact and Legislative Success

Synthetic cannabinoids Receptor Agonist (SCRA) intoxication presents with various medical and psychiatric symptoms. The products are sold as K2 or Spice. The symptoms range from agitation, altered mental status (AMS), lethargy, paranoid behavior, psychosis and seizures. In some cases, brief psychiatric or inpatient medicine admission was required for stabilization. Some patients seem to stay longer for observation in the ED. These patients worsen the already problematic ED crowding. To assess K2-related ED presentation, length of stay in the ED and types of disposition over a 5 year period. A retrospective chart review of patients who presented with K2 intoxication. Charts were reviewed from January 1, 2012 until December 31st, 2016 excluding 2016. Demographics, age, gender, past psychiatric illness and other substance abuse history were reviewed. A total of 1405 patients were seen for K2-related ED visits from January 1, 2012 until December 31st, 2016 of which 1279 patients (91%) were male and 126 patients (9%) were female. One hundred thirty nine patients (9.9%) were hospitalized and 1266 patients (90.1%) were either discharged or left from the ED. Twenty-eight (2.0%) stayed more than 16 hours in the ED. Of the 53 patients, whose urine the showed benzodiazepine or opiates 36 patients stayed more than 6 hours in the ED. Most patients with K2 use were male (91%) between the ages of 19 and 50 years (76.4%). There was a surge in K2-related presentation in 2015, particularly in the months of April until November. In addition, K2-related intoxication led to prolonged ED stay, which could affect the ED crowding phenomenon. A concerted effort from public pressure and legislative measures led to a reduction of K2-related visits to the ED.