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WEDNESDAY, Sept. 26, 2018 (HealthDay News) – Synthetic marijuana soaked with rat poison has caused hundreds of hospitalizations in the United States this year, and a new study says how serious poisoning can be.
In July, the US Food and Drug Administration warned of recent epidemics of serious bleeding related to synthetic marijuana contaminated with brodifacoum – an anticoagulant used in rat poison.
At the time, the FDA had stated that hundreds of people in a dozen states had been hospitalized for bleeding after using the contaminated products and that many had died.
Synthetic cannabinoids are human-made compounds that target the same brain receptors as marijuana. Known under names such as Spice and K2, they are sold online and at gas stations and convenience stores, according to the FDA.
The compounds are usually sprayed on various herbs so that they can be smoked.
It's still unclear how or why an ingredient of rat poison has entered certain products, according to experts. But the consequences have been clear.
The new study, published on 27 September in the New England Journal of Medicine, describes the cases of 34 patients who used the contaminated products. All were admitted to the same hospital in Illinois in March or April.
Of the patients who were tested, all had brodifacoum in their systems. Some have also been tested positive for additional anticoagulants.
Most came to the hospital with multiple symptoms – including blood in their urine or stools, unexplained bruising, nose bleeds and a blood cough. A patient died of cerebral hemorrhage.
And while the others survived, the treatment was not simple.
The brodifacoum and other anticoagulants used in rat poisons are designed to have a long half-life. And their effects last for hours or days, but for months, explained the report's author, Dr. Amar Kelkar.
This meant that patients needed long-term treatment with vitamin K, which helps the blood clot. One patient, for example, needed 50 milligrams (mg) of vitamin K each day for about nine months.
Kelkar, who is currently working at Shands Hospital at the University of Florida, was then based at the University of Illinois.
He said that there were several obstacles to the care of patients. Eight people left the hospital against medical advice, and six of them had to be readmitted. Two even used the contaminated products again.
And then there is the high cost of treatment.
According to Dr. Jean Connors, a hematologist at Brigham Hospital and Women's in Boston, "vitamin K is very expensive."
Only three 5 mg generic vitamin K tablets cost about $ 81, said Connors, who wrote an editorial published with the study.
Kelkar and his colleagues worked to provide patients with the offer they needed – by contacting insurance companies, federal programs and pharmacies. The Illinois Department of Health has finally received a donation of 800,000 vitamin K tablets from the drug maker Valeant.
Who added rat poison to products and why? Nobody knows for sure yet, said Kelkar.
But the main theory is that the contaminants were added to prolong the "high" of the drug, he noted.
It's far from the first time that synthetic cannabinoids have been linked to serious problems, Kelkar said. Even though they are not contaminated with rat poison, the products are risky – partly because manufacturers are constantly tweaking the chemical composition.
"So people who take these drugs end up being a test population, which is very dangerous," Kelkar said.
Connors emphasized the same point. "I think people may not realize that there is a difference between synthetic cannabinoids and marijuana," she said. "But these drugs are very different from the leaves that [cannabis] plant. They can have unexpected effects different from those of marijuana. "
Kelkar said that, in fact, some patients in this report did not realize that they were taking a synthetic product.
Authorities have banned some chemicals used in synthetic cannabinoids, according to the US National Institute of Drugs. But manufacturers continue to change the chemical formulas of products to stay ahead of the law.
More information
The US National Institute on Drug Abuse has more to do on synthetic cannabinoids.
SOURCES: Amar Kelkar, MD, Hematology Fellow, University of Florida Shands Hospital, Gainesville; Jean Connors, M.D., Hematologist, Brigham and Women's Hospital, and Associate Professor, Medicine, Harvard Medical School, Boston; September 27, 2018, New England Journal of Medicine
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