Objective: Hashish oil is a dark viscous organic substance produced from the resin collected from the flowering tops of Cannabis sativa plants. It contains varying concentrations of tetrahydrocannabinol (THC) up to 50 %. Despite the prohibition, abuse of THC is widespread among Slovenian population. The use of hashish oil is propagated for medicinal purposes, as it is believed to be generally beneficent. The aim of the study was to evaluate epidemiology of hashish oil poisoning in Ljubljana, Slovenia. Methods: In this retrospective study we analyzed the clinical presentation of adult patients poisoned with hashish oil who were treated in the University Medical Center Ljubljana (UMCL), the primary city hospital for the Slovenian capital city of Ljubljana serving a population of 600,000 inhabitants, in the past 7 years. We analysed the demographic data, clinical picture and treatment of hashish oil poisoned patients. Results: 19 adult patients poisoned with hashish oil were hospitalized in UMCL during the past 7 years (2008: 1 patient; 2009: 1 patient; 2011: 1 patient; 2012: 2 patients; 2013: 4 patients; 2014: 10 patients). Patients poisoned with hashish oil were older than other cannabis users (mean age 47.4 years) and they did not combine hashish oil with other illegal substances or alcohol. 9/19 patients consumed hashish oil in anticipation of symptomatic relief or resolution of their illness (e.g. malignancies, gout, arterial hypertension) or to achieve relaxation (5/19). On the presentation they had drowsiness (10/19), slowness (5/19), malaise (4/19), confusion (3/19), anxiety (3/19), hallucinations (2/19), distorted perception of the body or surroundings (2/19) and euphoria (2/19). Patients often felt nausea (9/19) and vomited (3/19). They also had dysarthria (5/19), mydriasis (4/19), diaphoresis (3/19), tremor (2/19) and muscle spasms (2/19). There were tachycardic (7/19) and bradycardic (6/19). 16/19 patients needed active treatment, mostly parenteral hydration (11/19), benzodiazepines (5/19) and antiemetics (1/19). Decontamination with activated charcoal was performed in 2 patients. 11/19 patients were hospitalized for a brief period (1–2 days). All of them survived poisoning with hashish oil. Conclusion: The frequency of hashish oil poisonings is growing exponentially in Slovenia during the last years. Accordingly, urine THC screening is becoming essential in older patients with unexplained altered consciousness and nausea.
B.03 Paper at an international scientific conference
COBISS.SI-ID: 32673753Context: Synthetic cannabinoids are getting more popular among young people and illicit manufacturers. We report a case series of occupational transdermal poisoning with synthetic cannabinoids. Case details: Three customs inspectors got in contact with a sticky substance with their fingertips because they were not wearing protection gloves and the delivered package was damaged. Despite washing their hands with water, signs of synthetic cannabinoids intoxication started occurring half an hour after exposure. On arrival at the Emergency Department six hours later, they were somnolent, lethargic and confused. They showed signs of mydriasis, blurred vision, ataxia, weakness, numbness, tachycardia and one of them had orthostatic hypotension. Two days later, they were feeling much better and reported amnesia and slowed perception of time after exposure. Toxicology analysis by LC-MS/MS revealed synthetic cannabinoid cumyl-PINACA (SGT-24) in their blood samples taken on admission. cumyl-PINACA was also confirmed with NMR method in liquid samples seized at the airport. It was 98% pure substance with the purpose of being diluted and sold further in the drug market by drug dealer. Discussion: This case series highlights the possible transdermal exposure to synthetic cannabinoids oil resulting in prolonged cannabinoid syndrome.
B.03 Paper at an international scientific conference
COBISS.SI-ID: 32674777The number of new psychoactive substances (NPS) has increased, as NPS cause euphoria, create a sense of energy and relaxation, and stimulate the need to socialize. NPS are divided into five groups: phenethylamines, piperazines, piperidines, tryptamines and synthetic cannabinoids. The information regarding their toxicity is very scarce. Therefore, some national and European projects for monitoring the consumption of NPS and the occurrence of poisonings with NPS are being carried out. In Slovenia, a national system for continuous monitoring of NPS poisonings (SONDA) has been developed. When emergency department staff consult with the Centre for Clinical Toxicology and Pharmacology on suspected cases of acute NPS intoxication, they are asked to collect blood and urine samples for free-of-charge toxicological analysis in the Institute for Forensic Medicine. The advantage of the proposed project is also the collection of medical records. This enables us to link clinical presentation and treatment to the identified NPS. The results of the project are reported to Early Warning System of the European Monitoring Centre for Drugs and Euro-DEN.
B.04 Guest lecture
COBISS.SI-ID: 32984537