Saturday, August 29, 2015

Unintentional exposure to AB-PINACA and more...

This case report from Thornton et al. published in the Annals of Emergency Medicine's most recent issue describes an 10 month old child's unintentional exposure to a synthetic cannabinoid substance.

Thornton, S.L., Akpunonu, P., Glauner, K., Sarah Hoehn, K., Gerona, R. (2015) Unintentional pediatric exposure to a synthetic cannabinoid (AB-PINACA) resulting in coma and intubation, Annals of Emergency Medicine, 66, 343-344.

In summary:
A 10 month old female chewed on a synthetic cannabinoid-containing cigarette and was taken to the emergency department by her mother within thirty minutes of being found. Body temperature was 97.9 F.
Pulse rate 132 beats/minute
Blood pressure was 106/69 mm Hg
Respiratory rate was 34 breaths/minute
Oxygen saturation was 97% on room air.
Normal mental status was documented.

Within 90 minutes, the child's response to verbal and physical stimuli stopped.
The child developed respiratory depression which required intubation.

The child was admitted to the hospital and later tested positive for influenza A.

The child was intubated for 36 hours but recovered fully.

Serum was collected at hospital admission and was analyzed for the presence of drugs  by liquid chromatography with quadrupole time of flight mass spectrometry (LC/qToF). Analysis was positive for the synthetic cannabinoid AB-PINACA (42 ng/mL) and its metabolite AB-PINACA  N-pentanoic acid (345 ng/mL). No other compounds were detected in the toxicological analyses.

In addition to this Annals of Emergency Medicine report, this case appeared in Clinical Toxicology (Philadelphia) journal as part of the proceedings of the annual meeting of the North American Congress on Clinical Toxicology (NACCT). Here is the citation and link:

Thornton et al. (2015) Severe symptoms from an unintentional pediatric exposure to AB-PINACA with laboratory confirmation. Clinical Toxicology, 53, 7: Abstract 184.

We covered a little bit about AB-PINACA here at TDMTP when it was originally placed into Schedule I in December 2014, but as with most new psychoactive substances, at emergence, very little is known about a substance's pharmacological or toxicological profile. But now we do know a little more about AB-PINACA.
In a 2015 paper, Wiley et al. reported that AB-PINACA had binding affinity (Ki) equal to 2.87 nM at the CB1 receptor and 0.88 nM at the CB2 receptor.  EC50 was 71 nM at CB1 and 14.9 nM at CB2 (1). AB-PINACA is considered a high efficacy CB1 and CB2 receptor agonist.
The National Forensic Laboratory Information System (NFLIS) midyear report for 2014 listed AB-PINACA as the 3rd most commonly detected synthetic cannabinoid in drug seizures in the USA. The United States Federal government officially placed AB-PINACA into Schedule I of the Controlled Substances Act in January 2015 (2).
1. Wiley, JL, Marusich, JA, Lefever TW, Antonazzo KG, Wallgren MT, Cortes RA, Patel PR, Grabenauer M, Moore KN, Thomas BF (2015) AB-CHMINACA, AB-PINACA, and FUBIMINA: Affinity and potency of novel synthetic cannabinoids in producing delta-9-tetrahydrocannabinoil like effects in mice. Journal of Pharmacology and Experimental Therapeutics. Article in Press, doi: 10.1124/jpet.115.225326
2. Drug Enforcement Administration (2015) Schedules of controlled substances: temporary placement of three synthetic cannabinoids into Schedule I. Final Order. Federal Register. Vol. 80, 5042-5047.


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