Esrar ve Sentetik Kannabinoid Kullanım Bozukluğu Tedavi ve İzlemi
Özet
Esrar, tüm dünyada en yaygın kullanılan yasa dışı maddedir ve "Hint Keneviri" yapraklarından elde edilmektedir; primer psikoaktif bileşeni Delta 9-Tetrahydrocannabional (Δ9-THC) olup, son yıllarda yetişkinlerde kullanım oranları artış göstermiştir. Sentetik Kannabinoidler (SK) ise esrara alternatif olarak piyasaya sürülen, "tütsü" veya "bonzai" gibi isimlerle yaş sınırı olmaksızın satılan tam agonist tasarım ilaçlardır. Esrar reseptörlerin kısmi agonisti iken, SK'ler yüksek affiniteli tam agonist yapıları nedeniyle daha şiddetli intoksikasyon, ajitasyon, kardiyak aritmiler, akut böbrek hasarı ve psikoz riski barındırırlar. Klinik olarak esrar kullanımı bilişsel işlevlerde bozulma, taşikardi, gebelikte fetal gelişim geriliği ve adölesan dönemde kalıcı nöral hasara yol açarken; SK kullanımı epileptik nöbetler, katatoni, şiddetli gastrointestinal semptomlar ve intihar eğilimini tetiklemektedir. Her iki maddenin de spesifik bir panzehri bulunmamakta, intoksikasyon ile kesilme (yoksunluk) tabloları semptomatik olarak başta benzodiazepinler ve ketiapin gibi antipsikotiklerle tedavi edilmektedir.
Cannabis is the most widely abused illicit substance worldwide and is obtained from the leaves of the "Cannabis Sativa" plant; its primary psychoactive component is Delta 9-Tetrahydrocannabinol (Δ9-THC), and its utilization rates among adults have expanded in recent years. Synthetic Cannabinoids (SCs) are full agonist designer drugs introduced as alternatives to cannabis, marketed as "incense" or "bonzai" without age restrictions. While cannabis is a partial agonist of cannabinoid receptors, SCs induce more severe intoxication, agitation, cardiac arrhythmias, acute kidney injury, and psychosis due to their high-affinity full agonist properties. Clinically, cannabis use leads to cognitive impairment, tachycardia, fetal growth restriction during pregnancy, and permanent neural damage in adolescence, whereas SC use triggers epileptic seizures, catatonia, severe gastrointestinal symptoms, and suicidal tendencies. There is no specific antidote available for either substance; hence, intoxication and withdrawal syndromes are managed symptomatically, primarily leveraging benzodiazepines and antipsychotics such as quetiapine.
Referanslar
Alıcı T, Uzbay Tİ. Kannabinoidler: Ödüllendirici ve bağımlılık yapıcı etkilerinin nörobiyolojisi ve nöropsikofarmakolojisi üzerine bir gözden geçirme. Bağımlılık Dergisi. 2006; 3(7):140-149.
UNODC. Drug Use And Health Consequences. World Drug Report 2020. Available from: https://wdr.unodc.org/wdr2020/en/drug-use-health.html (Accessed 28.02.2022).
Drummer OH, Odell M. The Forensic Pharmacology of Drugs of Abuse. 1st ed. Hodder Education Publishers; 2001.
Zuardi AW. History of cannabis as a medicine: a review. Brazilian Journal of Psychiatry. 2006;28(2):153-157.
Charitos IA, Gagliano-Candela R, Santacroce L, et al. The Cannabis Spread throughout the Continents and its Therapeutic Use in History. Endocrine Metabolic and Immune Disorders-Drug Targets. 2021;21(3):407-417.
Loeffler G, Delaney E, Hann M. International trends in spice use: prevalence, motivation for use, relationship to other substances, and perception of use and safety for synthetic cannabinoids. Brain Research Bulletin. 2016;126:8-28.
Hudson S, Ramsey J. The emergence and analysis of synthetic cannabinoids. Drug Testing and Analysis. 2011;3(7-8):466-478.
Seely KA, Lapoint J, Moran JH, et al. Spice drugs are more than harmless herbal blends: a review of the pharmacology and toxicology of synthetic cannabinoids. Progress İn Neuro-Psychopharmacology and Biological Psychiatry. 2012;39(2):234-243.
Penn HJ, Langman LJ, Unold D, et al. Detection of synthetic cannabinoids in herbal incense products. Clinical Biochemistry. 2011;44(13):1163-1165.
Pakiş I, Polat O. Sentetik kannabinoidler. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi. 2016;1:6-13.
Nordstrom BR, Levin FR. Treatment of cannabis use disorders: a review of the literature. The American Journal On Addictions. 2007;16(5):331-342.
Mechoulam R, Devane W, Glaser R. Cannabinoid geometry and biological activity. In: Murphy L, Bartke A (eds.) Marijuana/Cannabinoids. 1st ed.CRC Press; 1992. pp.1-34.
Benson Jr JA, Watson Jr SJ, Joy JE: Marijuana and medicine: assessing the science base, National Academies Press; 1999.
Zuardi AW, Shirakawa I, Finkelfarb E, et al. Action of cannabidiol on the anxiety and other effects produced by Δ9-THC in normal subjects. Psychopharmacology. 1982;76(3):245-250.
Huestis MA. Human cannabinoid pharmacokinetics. Chemistry & biodiversity. 2007;4(8):1770-804.
Ashton CH. Pharmacology and effects of cannabis: a brief review. The British Journal of Psychiatry. 2001;178:101-106.
Zehra A, Burns J, Liu CK, et al. Cannabis addiction and the brain: a review. Journal of Neuroimmune Pharmacology. 2018;13(4):438-452.
European Monitoring Centre for Drugs and Drug Addiction (2021), European Drug Report 2021:Trends and Developments, Publications Office of the European Union, Luxembourg.
Solmi M, Radua J, Olivola M, et al. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry. 2021:1-15. doi: 10.1038/s41380-021-01161-7.
Khan SS, Secades-Villa R, Okuda M, et al. Gender differences in cannabis use disorders: results from the National Epidemiologic Survey of Alcohol and Related Conditions. Drug And Alcohol Dependence. 2013;130(1-3):101-108.
Lopez M, Blanco C. Epidemiology of Cannabis use disorder. In: Montoya I, Weiss S. (eds) Cannabis Use Disorders, Springer, Cham; 2019. pp. 7-12.
Bhanushali GK, Jain G, Fatima H, et al. AKI associated with synthetic cannabinoids: a case series. Clinical Journal of the American Society of Nephrology. 2013;8(4):523-526.
Karadeniz H, Bayrak HE, Tuna O, et al. Trabzon ve çevre illerde sentetik kannabinoid kullanan olguların değerlendirilmesi. Journal of Forensic Medicine. 2017;31(2):45-52
Musah RA, Domin MA, Walling MA, et al. Rapid identification of synthetic cannabinoids in herbal samples via direct analysis in real time mass spectrometry. Rapid Commun Mass Spectrom. 2012;26(9):1109-1114.
Özşeker PE, Dip A, Dağlıoğlu N, et al. Sentetik kannabinoidler: Yeni nesil esrar. Türk Aile Hekimleri Dergisi. 2017;21(1):34-40.
European Monitoring Centre for Drugs and Drug Addiction (2019), European drug report 2019: Trends and Developments, Publications Office of the European Union, Luxembourg. 2019.
Gül Ö, Gürses D, Özdemir E, et al. Ergenlerde Yeni Bir Sorun:“Bonzai”. The Journal of Pediatric Research, 2017;4(3):163-166.
DEA (US Drugs Enforcement Administration). "Spice" – Plantmaterial(s) laced with synthetic cannabinoids or cannabinoid mimicking compouinds. Microgram Bulletin. 2009;42(3):23.
Evren C, Bozkurt M. Sentetik kannabinoidler: son yillarin krizi. Dusunen Adam The Journal of Psychiatry and Neurological Sciences. 2013;26(1):1-11.
Castaneto MS, Gorelick DA, Desrosiers NA, et al. Synthetic cannabinoids: epidemiology, pharmacodynamics, and clinical implications. Drug and alcohol dependence. 2014;144:12-41.
Güleç G, Köşger F, Eşsizoğlu A. DSM-5'te alkol ve madde kullanım bozuklukları. Psikiyatride Güncel Yaklaşımlar. 2015;4(7):448-460.
Association AP: Diagnostic and statistical manual of mental disorders (DSM-5®), American Psychiatric Pub; 2013.
Grant KS, Petroff R, Isoherranen N, et al. Cannabis use during pregnancy: pharmacokinetics and effects on child development. Pharmacology & Therapeutics. 2018;182:133-151.
Lee D, Schroeder JR, Karschner EL, et al. Cannabis withdrawal in chronic, frequent cannabis smokers during sustained abstinence within a closed residential environment. The American Journal on Addictions. 2014;23(3):234-242.
Sobolevsky T, Prasolov I, Rodchenkov G. Detection of JWH-018 metabolites in smoking mixture post-administration urine. Forensic Science International. 2010;200(1-3):141-147.
Spaderna M, Addy PH, D’Souza DC. Spicing things up: synthetic cannabinoids. Psychopharmacology. 2013;228(4):525-540.
Evren C, Yilmaz Cengel H, Bozkurt M, et al. Psychometric Properties of the Turkish Versions of the Cannabis Use Problems Identification Test (CUPIT) and the Adult Cannabis Problems Questionnaire (CPQ). Journal of Psychoactive Drugs. 2017;49(1):83-89.
Lucas CJ, Galettis P, Schneider J. The pharmacokinetics and the pharmacodynamics of cannabinoids. British journal of clinical pharmacology. 2018;84(11):2477-2482.
Maykut MO. Health consequences of acute and chronic marihuana use. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 1985;9(3):209-238.
Chimalakonda KC, Seely KA, Bratton SM, et al. Cytochrome P450-mediated oxidative metabolism of abused synthetic cannabinoids found in K2/Spice: identification of novel cannabinoid receptor ligands. Drug Metabolism And Disposition. 2012;40(11):2174-2184.
Hermanns‐Clausen M, Kneisel S, Hutter M, et al. Acute intoxication by synthetic cannabinoids–four case reports. Drug Testing And Analysis. 2013;5(9-10):790-794.
Vandrey R, Dunn KE, Fry JA, et al. A survey study to characterize use of Spice products (synthetic cannabinoids). Drug And Alcohol Dependence. 2012;120(1-3):238-241.
Weaver MF, Hopper JA, Gunderson EW. Designer drugs 2015: assessment and management. Addiction Science & Clinical Practice. 2015;10(1):1-9.
Garry A, Rigourd V, Amirouche A, et al. Cannabis and breastfeeding. Journal Of Toxicology. 2009;2009:596149
Howlett AC. Cannabinoid receptor signaling. In: Pertwee R.G. (eds.) Cannabinoids. Handbook of Experimental Pharmacology, Springer, Berlin, Heidelberg; 2005.pp.53-79.
Mackie K. Cannabinoid receptors: where they are and what they do. Journal of Neuroendocrinology. 2008;20(Suppl 1):10-14.
Brents LK, Prather PL. The K2/Spice phenomenon: emergence, identification, legislation and metabolic characterization of synthetic cannabinoids in herbal incense products. Drug Metabolism Reviews. 2014;46(1):72-85.
Rieder SA, Chauhan A, Singh U, et al. Cannabinoid-induced apoptosis in immune cells as a pathway to immunosuppression. Immunobiology. 2010;215(8):598-605.
Sanchez Robles EM, Bagües Arias A, Martin Fontelles MI. Cannabinoids and muscular pain. Effectiveness of the local administration in rat. European Journal Of Pain, 2012;16(8):1116-1127.
Fattore L. Synthetic cannabinoids-further evidence supporting the relationship between cannabinoids and psychosis. Biological Psychiatry. 2016;79(7):539-548.
Englund A, Morrison PD, Nottage J, et al. Cannabidiol inhibits THC-elicited paranoid symptoms and hippocampal-dependent memory impairment. Journal of Psychopharmacology. 2013;27(1):19-27.
Lin CY, Wheelock ÅM, Morin D, et al. Toxicity and metabolism of methylnaphthalenes: Comparison with naphthalene and 1-nitronaphthalene. Toxicology. 2009;260(1-3):16-27.
Brents LK, Gallus-Zawada A, Radominska-Pandya A, et al. 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. Biochemical Pharmacology. 2012;83(7):952-961.
Cooper ZD. Adverse effects of synthetic cannabinoids: management of acute toxicity and withdrawal. Current Psychiatry Reports. 2016;18(5):1-10. doi: 10.1007/s11920-016-0694-1
Forrester MB, Kleinschmidt K, Schwarz E, et al. Synthetic cannabinoid exposures reported to Texas poison centers. Journal of Addictive Diseases. 2011;30(4):351-358.
Dogan H, Ozucelik D, Aciksari K, et al. New synthetic cannabinoid intoxications in emergency department (It's grass, it's no sin). Anatolian Journal of Psychıatry. 2016;17(1):18-25.
Eminler AT, Yıldırım M, Uslan Mİ, et al. Sentetik kannabinoidler (BONZAİ) ve gastrointestinal sistem üzerine etkileri:“Kannabinoid Hiperemezis Sendromu”. Güncel Gastroentereloji. 2014;18(4):460-463.
Ozen ME, Orum MH, Kalenderoğlu A. Hot shower therapy in cannabinoid hyperemesis syndrome: A case report. İstanbul Bilim Üniversitesi Florence Nightingale Tıp Dergisi. 2018;4(3):142-144.
Jones RT. Cardiovascular system effects of marijuana. The Journal of Clinical Pharmacology. 2002;42(1):58S-63S.
Mittleman MA, Lewis RA, Maclure M, et al. Triggering myocardial infarction by marijuana. Circulation. 2001;103(23):2805-2809.
Gurney S, Scott K, Kacinko S, et al. Pharmacology, toxicology, and adverse effects of synthetic cannabinoid drugs. Forensic Sci Rev. 2014;26(1):53-78.
Koroğlu A, Erşan EE. Kafein Yoksunluğu ve Kannabis Yoksunluğu. Hocaoğlu Ç (Ed.), DSM-5’in Yeni Tanıları içinde. Ankara: Türkiye Klinikleri; 2018. p.74-79
Quickfall J, Crockford D. Brain neuroimaging in cannabis use: a review. The Journal Of Neuropsychiatry And Clinical Neurosciences. 2006;18(3):318-332.
Weinstein AM, Rosca P, Fattore L, et al. Synthetic cathinone and cannabinoid designer drugs pose a major risk for public health. Frontiers In Psychiatry. 2017;8:156.
Sweet G, Kim S, Martin S, et al. Psychiatric symptoms and synthetic cannabinoid use: Information for clinicians. Mental Health Clinician. 2017;7(4):156-159.
Griffith-Lendering M, Wigman J, Prince van Leeuwen A, et al. Cannabis use and vulnerability for psychosis in early adolescence–a TRAILS study. Addiction. 2013;108(4):733-740.
Henquet C, Murray R, Linszen D. The environment and schizophrenia: the role of cannabis use. Schizophrenia Bulletin. 2005;31(3):608-612.
Fergusson DM, Poulton R, Smith PF. Cannabis and psychosis. Bmj. 2006;332(7534):172-175.
Agrawal A, Lynskey MT. Candidate genes for cannabis use disorders: findings, challenges and directions. Addiction. 2009;104(4):518-532.
Brown JD, Rivera Rivera KJ, Hernandez LYC, et al. Natural and synthetic cannabinoids: pharmacology, uses, adverse drug events, and drug interactions. The Journal of Clinical Pharmacology. 2021;61(Suppl 2):S37-S52.
Crume TL, Juhl AL, Brooks-Russell A, et al. Cannabis use during the perinatal period in a state with legalized recreational and medical marijuana: the association between maternal characteristics, breastfeeding patterns, and neonatal outcomes. The Journal of Pediatrics. 2018;197:90-96.
Roncero C, Valriberas-Herrero I, Mezzatesta-Gava M, et al. Cannabis use during pregnancy and its relationship with fetal developmental outcomes and psychiatric disorders. A systematic review. Reproductive Health. 2020;17(1):1-9.
Baker T, Datta P, Rewers-Felkins K, et al. Transfer of inhaled cannabis into human breast milk. Obstetrics & Gynecology. 2018;131(5):783-788.
Bertrand KA, Hanan NJ, Honerkamp-Smith G, et al. Marijuana use by breastfeeding mothers and cannabinoid concentrations in breast milk. Pediatrics. 2018;142(3): e20181076.
Davis E, Lee T, Weber JT, et al. Cannabis use in pregnancy and breastfeeding: The pharmacist’s role. Canadian Pharmacists Journal. 2020;153(2):95-100.
Thompson R, DeJong K, Lo J. Marijuana use in pregnancy: a review. Obstetrical & Gynecological Survey. 2019;74(7): 415-428.
Crippa JA, Derenusson GN, Chagas MH, et al. Pharmacological interventions in the treatment of the acute effects of cannabis: a systematic review of literature. Harm Reduction Journal. 2012;9(7): 1-6.
Weinstein AM, Gorelick AD. Pharmacological treatment of cannabis dependence. Current Pharmaceutical Design. 2011;17(14): 1351-1358.
Cohen K, Weinstein AM. Synthetic and non-synthetic cannabinoid drugs and their adverse effects-a review from public health prospective. Frontiers in Public Health. 2018;6:162.
Oznur T, Oznur H, Bolu A, et al. Relationship between suicide attempts and synthetic cannabinoids in adjustment disorder. Dusunen Adam The Journal of Psychiatry and Neurological Sciences. 2018;3(31):258-264.
Hoyte CO, Jacob J, Monte AA, et al. A characterization of synthetic cannabinoid exposures reported to the National Poison Data System in 2010. Annals of Emergency Medicine. 2012;60(4):435-438.
Debruyne D, Le Boisselier R. Emerging drugs of abuse: current perspectives on synthetic cannabinoids. Substance Abuse and Rehabilitation. 2015;6:113-129.
Mills B, Yepes A, Nugent K. Synthetic cannabinoids. The American Journal of the Medical Sciences. 2015;350(1):59-62.
Gupta A, D’Souza D. Synthetic cannabinoids: the pharmacokinetics and pharmacodynamics of spice and other synthetic cannabinoids. In:Wolff K, White J, Karch S (eds.) The SAGE Handbook of Drug & Alcohol Studies: Biological Approaches. London: SAGE; 2016.
Brezing CA, Levin FR. The current state of pharmacological treatments for cannabis use disorder and withdrawal. Neuropsychopharmacology. 2018;43(1):173-194.
Macfarlane V, Christie G. Synthetic cannabinoid withdrawal: a new demand on detoxification services. Drug Alcohol Rev. 2015;34(2):147-153.
