SYNTHETIC CANNABINOID RECEPTOR AGONISTS AND DEATH CASES A LITERATURE REVIEW

Synthetic cannabinoid receptor agonists (SCRAs) have become the largest group of new psychoactive substances monitored by the European Union Early Warning System. Despite the wide diffusion on the market, data regarding effects, toxicities, and mechanisms as well as toxic/lethal doses are still scarce. A comprehensive literature search for articles published up to now was performed in multiple electronic databases. Only cases of death in which toxicological analyses revealed the presence of SCRAs in blood or urine and at least an external examination was performed, including those that occurred in emergency departments, were included. 354 of the 380 studies found were eliminated, while 8 more manuscripts were found through a review of pertinent references cited in the selected papers. A total of 34 publications were considered in the study (8 case series and 26 case reports). Toxicological analyses should be taken with caution because typical toxic ranges for SCRAs have yet to be determined. In death situations involving SCRAs, a complete post-mortem examination is required to determine the involvement of the deceased's substance usage and to determine a likely cause of death. In certain situations, the cause and manner of death remain unknown even after a thorough examination of clinical, circumstantial, toxicological, and autoptic evidence.