Have you heard of or been offered 'spice?' This in the slang term used in the UK for a synthetic marijuana that the latest issue of Morbidity and Mortality Weekly Report, or MMWR, identifies as the causative agent in a number of cases of acute kidney injury domestically. As Rick and I opine on PodMed this week, that's a high price to pay for a questionable 'high' and although we are reluctant to say it, we advise just say no when it comes to smoking spice.
The active ingredients in 'Spice' were originally developed to help study drug receptor biology and came on the international drug scene in 2005 in the United Kingdom as a street legal means of mind-altering. The product is compounded of one or a number of these chemicals sprayed on plant material. The products appeared in the United States in 2009, most often marketed as 'K2' and sold largely in small, independent convenience stores or on the Internet. The packaging of these synthetic cannabinoids (SCs) is labeled to indicate that human consumption and smoking the material is not advisable, but the preparations have gained popularity for a number of reasons: in contrast to marijuana they are very easy to find and obtain, are less expensive, and metabolites are not tested for in routine drug screens. Most users say they also expect a more intense 'high' than that achieved with cannabis.
This issue of MMWR reports 16 cases of acute kidney injury secondary to smoking of SC products hours to days previous to development of symptoms. All 16 patients presented to the ED with abdominal pain, and all but one with nausea and vomiting. Fifteen of the 16 patients were male, with an age range of 15 to 33 years, and all were admitted to the hospital.
Serum creatinine concentrations peaked one to six days after symptom onset. Five of the 16 patients required hemodialysis, and 4 patients received corticosteroids, however, none died. Within 3 days of creatinine peak kidney function apparently recovered in all patients, but the authors caution that a propensity to the development of chronic kidney disease may exist secondary to this episode of acute injury.
Multiple attempts by drug enforcement authorities in the United States have been made to halt the use of SCs domestically, with the latest legislation enacted in July 2012 as the 'Synthetic Drug Abuse Prevention Act 2012,' specifically banning a number of the active compounds usually found in these products. However, sale and use continues apace, with authorities speculating that both sellers and users are unaware of the hazards. As Rick points out, physicians need to be aware of the potential for kidney injury in users of SCs and to ask about whether patients are smoking them.
Other studies this week include the USPSTF recommendations on vitamin D supplementation in Annals of Internal Medicine, a look at HIV infection and liver disease in the same journal, and medications for prevention of deep vein thrombosis (DVT) in the New England Journal of Medicine. Until next week, y'all live well.