Sentetik Kannabinoid Zehirlenme Vakalarında Otopsi Bulgularının Değerlendirilmesi

Servet Birgin Iritas; Aybike Dip; Nevriye Tezer; Ahmet Hakan Dinç

Research Article

Sentetik Kannabinoid Zehirlenme Vakalarında Otopsi Bulgularının Değerlendirilmesi

Year 2019, Volume: 7 Issue: 2, 96 - 103, 27.08.2019

Servet Birgin Iritas , Aybike Dip Nevriye Tezer Ahmet Hakan Dinç

Abstract

Amaç:
Sentetik
kannabinoidler, laboratuvar ortamlarında sentezlenen ve kannabinoid
reseptörleri üzerinden etki eden yeni nesil psikoaktif maddelerdir. Hint
keneviri bitkisinden elde edilen kannabinoidlere göre daha potent ve uzun
süreli etkilidirler. Bu çalışma ile kullanıcı sayısındaki artış nedeniyle
zararlı etkileri daha belirgin görülmeye başlanan sentetik kannabinoid (SK), intoksikasyonuna
bağlı ölümlerde, demografi ve sistematik otopsi verilerinin değerlendirilmesi
amaçlanmıştır.

Material
ve Metod: Adli Tıp Kurumu Ankara Grup Başkanlığında 2013-2015
yılları arasında yapılan toplam 6165 otopsi vakası incelenmiş, SK kullanımına
bağlı ölümler yaş, cinsiyet, fiziksel özellikler, kan ve dokularda tespit
edilen SK türleri, otopsilere ait makroskobik ve histopatolojik inceleme
verileri ile birlikte sunularak değerlendirilmiştir.

Bulgular:
Sentetik
kannabinoidlere bağlı 21 adet ölüm vakasına ait kan ve doku örneklerinde,
JWH-0122, JWH-018, JWH-073, CP47,497 C8 HOMOLOG, AB-CHMINACA ve AM 2201 olmak
üzere 6 farklı SK türü tespit edilmiştir. Hastane tedavisi sırasında bir olguda
enzimatik yöntemle SK tespit edilmiş, ancak 11 günlük tedavi sonrasında
hayatını kaybeden vakanın kan ve doku örneklerinde SK tespit edilememiştir.
Kalp’de makroskobik bulgu olarak 16 vakada koroner arterlede aterom
plakları, mikroskobik olarak 4 vakada
iskemi, 7 vakada konjesyon, 6 vakada fibrozis tespit edilmiştir. Akciğerlerde
makroskobik olarak 15 vakada kanlı köpüklü mayi varlığı, 9 vakada alveolar
ödem, 7 vakada amfizematöz değişiklikler ve 8 vakada alveolar makrofaj
infiltrasyonu tespit edilmiştir.

Sonuç:
Son
yıllarda SK kullanımına bağlı ölüm vakalarındaki artış dikkat çekicidir. Bu
maddelerin kandaki konsantrasyonları ile etkileri arasında herhangi bir
bilimsel korelasyon olmaması nedeni ile, ölüm sebebinin belirlenmesinde
laboratuvar analizlerine ek olarak, olayın öyküsü ve otopsi bulguları
destekleyici olabilir.

Keywords

Sentetik kannabinoid, otopsi, JWH, AB-CHMINACA, AM 2201

References

1. United Nation Office on Drugs and Crime (UNODC). World Drug Report 2011. p. 175-193
2. Özşeker PE, Dip A, Dağlıoğlu N, Gülmen MK. Sentetik kannabinoidler: Yeni nesil esrar. Türk Aile Hek Derg. 2017; 21 (1): 34-40
3. Solimini R, Busardo FP, Rotolo MC, Ricci S, Mastrobattista L, Mortali C, Graziano S, Pellegrini M, DI Luca NM, Palmi I. Hepatotoxicity associated to synthetic cannabinoids use. European Review for Medical and Pharmacological Sciences. 2017; 21 (1 Suppl): 1-6
4. Musselman ME, Hamptob JP. "Not for human consumption": a review of emerging designer drugs. Pharmacotherapy. 2014; 34: 745-57
5. T.C. Resmi Gazete. 13.02.2011; sayı:27845 Erişim: http://www.resmigazete.gov.tr/eskiler/2011/02/20110213-4.htm
6. United Nations Office on Drugs and Crime (UNODC) World Drug Report 2017, Volume 4— Market Analysıs Of Synthetıc Drugs; Amphetamine-type stimulants, new psychoactive substances. United Nations Office on Drugs and Crime; Vienna, Austria: 2017. [atıf 10.06.2019]. Erişim: https://www.unodc.org/wdr2017/field/Booklet_4_ATSNPS.pdf
7. United Nations Office on Drugs and Crime (UNODC) World Drug Report 2018, Volume 3—Analysis of Drug Markets: Opiates, Cocaine, Cannabis, Synthetic Drugs. United Nations Office on Drugs and Crime; Vienna, Austria: 2018. [atıf 10.06.2019]. Erişim: https://www.unodc.org/wdr2018/prelaunch/WDR18_Booklet_3_DRUG_MARKETS.pdf
8. Huffman JW, Padgett LW. Recent developments in the medicinal chemistry of cannabinomimetic indoles, pyrroles and indenes. Curr. Med. Chem. 2005; 12:1395–411
9. Brents LK, Reichard EE, Zimmerman SM, Moran JH, Fantegrossi WE, Prather PL. Phase I hydroxylated metabolites of the K2 synthetic cannabinoid JWH-018 retain in vitro and in vivo cannabinoid 1 receptor affinity and activity. PLoS One. 2011; 6(7):e21917
10. Brents LK, Gallus-Zawada A, Radominska-Pandya A, Vasiljevik T, Prisinzano TE, Fantegrossi WE, Moran JH, Prather PL. Monohydroxylated metabolites of the K2 synthetic cannabinoid JWH-073 retain intermediate to high cannabinoid 1 receptor (CB1R) affinity and exhibit neutral antagonist to partial agonist activity. Biochem. Pharmacol. 2012;83(7):952–61
11. Zawilska JB, Wojcieszak J. Spice/K2 drugs—more than innocent substitutes for marijuana. Int J Neuropsychopharmacol 2014; 17: 509-25
12. Gurney SM, Scott KS, Kacinko SL, Presley BC, Logan BK. Pharmacology, toxicology, and adverse effects of synthetic cannabinoid drugs. Forensic Sci Rev 2014;26:54–77
13. Besli GE, Ikiz MA, Yildirim S, Saltik S. Synthetic cannabinoid abuse in adolescents: a case series. Emerg Med 2015; 49(5):644–50
14. Bernson-Leung ME, Leung LY, Kumar S. Synthetic cannabis and acute isch-emic stroke. J Stroke Cerebrovasc Dis 2014; 23(5):1239–41
15. McKeever RG, Vearrier D, Jacobs D, LaSala G, Okaneku J, Greenberg MI. K2-not the spice of life; synthetic cannabinoids and ST elevation myocardial infarction: a case report. J Med Toxicol 2015; 11(1):129–31
16. Heath TS, Burroughs Z, Thompson AJ, Tecklenburg FW. Acute intoxication caused by a synthetic cannabinoid in two adolescents. J Pediatr Pharmacol Ther 2012; 17(2):177–81
17. Gudsoorkar VS, Perez JA Jr. A new differential diagnosis: synthetic cannabi-noids-associated acute renal failure. Methodist Debakey Cardiovasc J 2015; 11(3):189–91
18. World Health Organisation, JWH‐073 Critical Review Report Agenda item 4.11, Expert Committee on Drug Dependence Thirty-eight Meeting Geneva, 14-18 November 2016
19. World Health Organisation, JWH‐018 Critical Review Report Agenda item 4.5, Expert Committee on Drug Dependence Thirty‐sixth Meeting Geneva, 16‐20 June 2014
20. World Health Organisation, AM-2201 Critical Review Report Agenda item 4.7, Expert Committee on Drug Dependence Thirty‐sixth Meeting Geneva, 16‐20 June 2014
21. Schaefer N, Peters B, Bregel D, Kneisel S, Auwärter V, Schmidt ph, Ewald AH. A fatal case involving several synthetic cannabinoids. Toxichem Krimtech 2013; 80: 248‐ 51
22. Wikstrom M, Thelander G, Dahlgren M, Kronstrand R. An accidental fatal intoxication with methoxetamine. Journal of Analytical Toxicology. 2013; 37(1):43-6
23. Labay LM, Caruso JL, Gilson TP, Phipps RJ, Knight LD, Lemos NP, et al. Synthetic cannabinoid drug use as a cause or contributory cause of death. Forensic Sci Int 2016;260:31–9
24. Patton AL, Chimalakonda KC, Moran CL, McCain KR, Radominska-Pandya A, James LP, et al. K2 toxicity: fatal case of psychiatric complications following AM2201 exposure. J Forensic Sci. 2013;58:1676–80
25. Paul ABM, Simms L, Amini S, Paul AE. Teens and spice: a review of adolescent fatalities associated with synthetic cannabinoid use. J. Forens. Sci. 2018; 63(4), 1321–24

Year 2019, Volume: 7 Issue: 2, 96 - 103, 27.08.2019

Servet Birgin Iritas , Aybike Dip Nevriye Tezer Ahmet Hakan Dinç

Abstract

References

1. United Nation Office on Drugs and Crime (UNODC). World Drug Report 2011. p. 175-193
2. Özşeker PE, Dip A, Dağlıoğlu N, Gülmen MK. Sentetik kannabinoidler: Yeni nesil esrar. Türk Aile Hek Derg. 2017; 21 (1): 34-40
3. Solimini R, Busardo FP, Rotolo MC, Ricci S, Mastrobattista L, Mortali C, Graziano S, Pellegrini M, DI Luca NM, Palmi I. Hepatotoxicity associated to synthetic cannabinoids use. European Review for Medical and Pharmacological Sciences. 2017; 21 (1 Suppl): 1-6
4. Musselman ME, Hamptob JP. "Not for human consumption": a review of emerging designer drugs. Pharmacotherapy. 2014; 34: 745-57
5. T.C. Resmi Gazete. 13.02.2011; sayı:27845 Erişim: http://www.resmigazete.gov.tr/eskiler/2011/02/20110213-4.htm
6. United Nations Office on Drugs and Crime (UNODC) World Drug Report 2017, Volume 4— Market Analysıs Of Synthetıc Drugs; Amphetamine-type stimulants, new psychoactive substances. United Nations Office on Drugs and Crime; Vienna, Austria: 2017. [atıf 10.06.2019]. Erişim: https://www.unodc.org/wdr2017/field/Booklet_4_ATSNPS.pdf
7. United Nations Office on Drugs and Crime (UNODC) World Drug Report 2018, Volume 3—Analysis of Drug Markets: Opiates, Cocaine, Cannabis, Synthetic Drugs. United Nations Office on Drugs and Crime; Vienna, Austria: 2018. [atıf 10.06.2019]. Erişim: https://www.unodc.org/wdr2018/prelaunch/WDR18_Booklet_3_DRUG_MARKETS.pdf
8. Huffman JW, Padgett LW. Recent developments in the medicinal chemistry of cannabinomimetic indoles, pyrroles and indenes. Curr. Med. Chem. 2005; 12:1395–411
9. Brents LK, Reichard EE, Zimmerman SM, Moran JH, Fantegrossi WE, Prather PL. Phase I hydroxylated metabolites of the K2 synthetic cannabinoid JWH-018 retain in vitro and in vivo cannabinoid 1 receptor affinity and activity. PLoS One. 2011; 6(7):e21917
10. Brents LK, Gallus-Zawada A, Radominska-Pandya A, Vasiljevik T, Prisinzano TE, Fantegrossi WE, Moran JH, Prather PL. Monohydroxylated metabolites of the K2 synthetic cannabinoid JWH-073 retain intermediate to high cannabinoid 1 receptor (CB1R) affinity and exhibit neutral antagonist to partial agonist activity. Biochem. Pharmacol. 2012;83(7):952–61
11. Zawilska JB, Wojcieszak J. Spice/K2 drugs—more than innocent substitutes for marijuana. Int J Neuropsychopharmacol 2014; 17: 509-25
12. Gurney SM, Scott KS, Kacinko SL, Presley BC, Logan BK. Pharmacology, toxicology, and adverse effects of synthetic cannabinoid drugs. Forensic Sci Rev 2014;26:54–77
13. Besli GE, Ikiz MA, Yildirim S, Saltik S. Synthetic cannabinoid abuse in adolescents: a case series. Emerg Med 2015; 49(5):644–50
14. Bernson-Leung ME, Leung LY, Kumar S. Synthetic cannabis and acute isch-emic stroke. J Stroke Cerebrovasc Dis 2014; 23(5):1239–41
15. McKeever RG, Vearrier D, Jacobs D, LaSala G, Okaneku J, Greenberg MI. K2-not the spice of life; synthetic cannabinoids and ST elevation myocardial infarction: a case report. J Med Toxicol 2015; 11(1):129–31
16. Heath TS, Burroughs Z, Thompson AJ, Tecklenburg FW. Acute intoxication caused by a synthetic cannabinoid in two adolescents. J Pediatr Pharmacol Ther 2012; 17(2):177–81
17. Gudsoorkar VS, Perez JA Jr. A new differential diagnosis: synthetic cannabi-noids-associated acute renal failure. Methodist Debakey Cardiovasc J 2015; 11(3):189–91
18. World Health Organisation, JWH‐073 Critical Review Report Agenda item 4.11, Expert Committee on Drug Dependence Thirty-eight Meeting Geneva, 14-18 November 2016
19. World Health Organisation, JWH‐018 Critical Review Report Agenda item 4.5, Expert Committee on Drug Dependence Thirty‐sixth Meeting Geneva, 16‐20 June 2014
20. World Health Organisation, AM-2201 Critical Review Report Agenda item 4.7, Expert Committee on Drug Dependence Thirty‐sixth Meeting Geneva, 16‐20 June 2014
21. Schaefer N, Peters B, Bregel D, Kneisel S, Auwärter V, Schmidt ph, Ewald AH. A fatal case involving several synthetic cannabinoids. Toxichem Krimtech 2013; 80: 248‐ 51
22. Wikstrom M, Thelander G, Dahlgren M, Kronstrand R. An accidental fatal intoxication with methoxetamine. Journal of Analytical Toxicology. 2013; 37(1):43-6
23. Labay LM, Caruso JL, Gilson TP, Phipps RJ, Knight LD, Lemos NP, et al. Synthetic cannabinoid drug use as a cause or contributory cause of death. Forensic Sci Int 2016;260:31–9
24. Patton AL, Chimalakonda KC, Moran CL, McCain KR, Radominska-Pandya A, James LP, et al. K2 toxicity: fatal case of psychiatric complications following AM2201 exposure. J Forensic Sci. 2013;58:1676–80
25. Paul ABM, Simms L, Amini S, Paul AE. Teens and spice: a review of adolescent fatalities associated with synthetic cannabinoid use. J. Forens. Sci. 2018; 63(4), 1321–24

There are 25 citations in total.

Details

Primary Language	Turkish
Journal Section	Orginal Article
Authors	Servet Birgin Iritas 0000-0001-5283-9973 Aybike Dip This is me 0000-0001-8686-2637 Nevriye Tezer This is me 0000-0003-3037-0056 Ahmet Hakan Dinç This is me 0000-0002-5320-9161
Publication Date	August 27, 2019
Published in Issue	Year 2019 Volume: 7 Issue: 2

Cite

APA	Iritas, S. B., Dip, A., Tezer, N., Dinç, A. H. (2019). Sentetik Kannabinoid Zehirlenme Vakalarında Otopsi Bulgularının Değerlendirilmesi. Namık Kemal Tıp Dergisi, 7(2), 96-103.
AMA	Iritas SB, Dip A, Tezer N, Dinç AH. Sentetik Kannabinoid Zehirlenme Vakalarında Otopsi Bulgularının Değerlendirilmesi. NKMJ. August 2019;7(2):96-103.
Chicago	Iritas, Servet Birgin, Aybike Dip, Nevriye Tezer, and Ahmet Hakan Dinç. “Sentetik Kannabinoid Zehirlenme Vakalarında Otopsi Bulgularının Değerlendirilmesi”. Namık Kemal Tıp Dergisi 7, no. 2 (August 2019): 96-103.
EndNote	Iritas SB, Dip A, Tezer N, Dinç AH (August 1, 2019) Sentetik Kannabinoid Zehirlenme Vakalarında Otopsi Bulgularının Değerlendirilmesi. Namık Kemal Tıp Dergisi 7 2 96–103.
IEEE	S. B. Iritas, A. Dip, N. Tezer, and A. H. Dinç, “Sentetik Kannabinoid Zehirlenme Vakalarında Otopsi Bulgularının Değerlendirilmesi”, NKMJ, vol. 7, no. 2, pp. 96–103, 2019.
ISNAD	Iritas, Servet Birgin et al. “Sentetik Kannabinoid Zehirlenme Vakalarında Otopsi Bulgularının Değerlendirilmesi”. Namık Kemal Tıp Dergisi 7/2 (August 2019), 96-103.
JAMA	Iritas SB, Dip A, Tezer N, Dinç AH. Sentetik Kannabinoid Zehirlenme Vakalarında Otopsi Bulgularının Değerlendirilmesi. NKMJ. 2019;7:96–103.
MLA	Iritas, Servet Birgin et al. “Sentetik Kannabinoid Zehirlenme Vakalarında Otopsi Bulgularının Değerlendirilmesi”. Namık Kemal Tıp Dergisi, vol. 7, no. 2, 2019, pp. 96-103.
Vancouver	Iritas SB, Dip A, Tezer N, Dinç AH. Sentetik Kannabinoid Zehirlenme Vakalarında Otopsi Bulgularının Değerlendirilmesi. NKMJ. 2019;7(2):96-103.

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