Turkiye Klinikleri Journal of Forensic Medicine and Forensic Sciences

.: ORIGINAL RESEARCH
Sentetik Kannabinoid İlişkili Ölümlerde İç Organ Patolojileri: Tek Merkezli Kesitsel Otopsi Çalışması
Internal Organ Pathologies in Synthetic Cannabinoid-Related Deaths: A Single-Centered Sectional Autopsy Study
Halil İlhan AYDOĞDUa, Hüseyin Çetin KETENCİb, Gökhan KAZINDIRc, Bülent ŞAMa
aAdli Tıp Kurumu Başkanlığı, İstanbul, Türkiye
bRecep Tayyip Erdoğan Üniversitesi Tıp Fakültesi, Adli Tıp ABD, Rize, Türkiye
cAdli Tıp Kurumu, Trabzon Grup Başkanlığı, Trabzon, Türkiye
Turkiye Klinikleri J Foren Sci Leg Med. 2022;19(2):79-84
doi: 10.5336/forensic.2021-87059
Article Language: TR
Full Text
ÖZET
Amaç: Sentetik kannabinoidler, CB1 ve CB2 reseptörleri aracılığıyla vücutta tetrahidrokannabinolün etkisini taklit eden psikoaktif maddelerdir. Sentetik kannabinoidlerin bu ölümcül yan etkileri ile ilgili bilgiler, olgu sunumları ve geniş olgu serileri ile sınırlıdır. Çalışmamızın amacı, sentetik kannabinoid ilişkili ölümlerde kardiyovasküler ve solunum sistemi organlarının patolojileri üzerinden ölüm mekanizmasının anlaşılmasına ve madde kullanımı/bağımlılığını önleme çalışmalarına katkı sunmaktır. Gereç ve Yöntemler: 'Adli Tıp Kurumu Trabzon Adli Tıp Grup Başkanlığı' 2010-2019 yılları arasındaki 10 yıllık dönemde, ölümü sentetik kannabinoid kullanımına bağlanan olgulara ait otopsi raporları incelendi. Kan ve idrar örnekleri, AB-SCIEX 5500 QTRAP model sıvı kromatografi-kütle spektrometresi/kütle spektrometresi cihazı ile analiz edildi. Bulgular: Bu çalışmaya 22 olgu dâhil edildi. Olguların yaşları 18-50 arasında değişmekteydi. Medyan yaş 31, ortalama yaş ise 31,59±9,58 idi. Adli otopsileri yapılan olguların hiçbirinde travma bulgusu tespit edilmedi. Organların ağırlıkları -özellikle akciğer- artmış olarak bulundu. Organların makroskobik ve mikroskobik incelemesinde; 20 (%90,9) olguda akciğerde yaygın ödem tespit edildi. Akciğerlerin mikroskobik incelemesinde; 8 (%36,4) olguda intraalveoler kanama, 6 (%27,3) olguda atelektazi, 3 (%13,6) olguda pnömoni bulguları ve 2 (%9,1) olguda kalp hatası hücreleri olduğu görüldü. Sonuç: Uyutucu-uyuşturucu madde kullanımı dünya genelinde ciddi bir halk sağlığı sorunudur. Hem bu çalışmadaki hem literatürde diğer çalışmalardaki veriler ışığında, akciğer ağırlıklarında artış tespit edilmesi spesifik bir bulgu olmasa da sentetik kannabinoid ilişkili ölümlerde ciddi bir bulgu olarak tanımlanabilir.

Anahtar Kelimeler: Sentetik kannabinoid; intoksikasyon; ölüm; otopsi
ABSTRACT
Objective: Synthetic cannabinoids are psychoactive substances that mimic the effect of tetrahydrocannabinol in the body via CB1 and CB2 receptors. Information on these fatal adverse effects of synthetic cannabinoids is limited to case reports and large case series. The aim of our study is to contribute to the elucidation of the death mechanism in synthetic cannabinoid-related deaths through the organ pathologies of the cardiovascular and respiratory system organs and to the studies on the prevention of substance use/addiction. Material and Methods: Autopsy reports of cases whose death was attributed to the use of synthetic cannabinoid in the 10-year period between 2010-2019 at the 'Council of Forensic Medicine of Trabzon Forensic Medicine Group Department' were analyzed. Blood and urine samples were analyzed via AB-SCIEX 5500 QTRAP model liquid chromatography-mass spectrometry/mass spectrometry device. Results: Twenty-two cases were included in the study. The ages of the cases ranged between 18 and 50 years. The median age was 31, and the mean age was 31.59±9.58. Trauma findings were not found in any of the cases whose forensic autopsies were conducted. The weights of the organs, in particular the lung weights, were found to be increased. In the macroscopic and microscopic examination of the organs, diffuse edema in the lungs was detected in 20 (90.9%) cases. In the microscopic examination of the lungs; Intraalveolar hemorrhage in 8 (36.4%) cases, atelectasis in 6 (27.3%) cases, pneumonia in 3 (13.6%) cases, and siderophages in 2 (9.1%) cases were observed. Conclusion: Narcotic drug use is a serious public health concern across the world. Considering the data in both this study and other studies in the literature, an increase in lung weights can be defined as a serious finding in synthetic cannabinoid-related deaths, albeit it is not a specific finding.

Keywords: Synthetic cannabinoid; intoxication; death; autopsy
REFERENCES:
  1. European Monitoring Centre for Drugs and Drug Addiction. Perspectives on drugs, synthetic cannabinoids in Europe. 2017. [Link] 
  2. Lindigkeit R, Boehme A, Eiserloh I, Luebbecke M, Wiggermann M, Ernst L, et al. Spice: a never ending story? Forensic Sci Int. 2009; 191(1-3):58-63. [Crossref]  [PubMed] 
  3. Karadeniz H, Özer E, Aydoğdu Hİ, Askay M. Sentetik kannabinoid: sokak dilinde "bonzai" [Synthetic cannabinoid: in the street language "bonsai"]. Karadeniz Chem Sci Tech. 2017; 1:1-8. [Link] 
  4. Debruyne D, Le Boisselier R. Emerging drugs of abuse: current perspectives on synthetic cannabinoids. Subst Abuse Rehabil. 2015; 6:113-29. [Crossref]  [PubMed]  [PMC] 
  5. Schneir AB, Cullen J, Ly BT. "Spice" girls: synthetic cannabinoid intoxication. J Emerg Med. 2011;40(3):296-9. [Crossref]  [PubMed] 
  6. Castellanos D, Singh S, Thornton G, Avila M, Moreno A. Synthetic cannabinoid use: a case series of adolescents. J Adolesc Health. 2011;49(4):347-9. [Crossref]  [PubMed] 
  7. Hoyte CO, Jacob J, Monte AA, Al-Jumaan M, Bronstein AC, Heard KJ. A characterization of synthetic cannabinoid exposures reported to the National Poison Data System in 2010. Ann Emerg Med. 2012;60(4):435-8. [Crossref]  [PubMed] 
  8. Behonick G, Shanks KG, Firchau DJ, Mathur G, Lynch CF, Nashelsky M, et al. Four postmortem case reports with quantitative detection of the synthetic cannabinoid, 5F-PB-22. J Anal Toxicol. 2014;38(8):559-62. [Crossref]  [PubMed]  [PMC] 
  9. Kasper AM, Ridpath AD, Arnold JK, Chatham-Stephens K, Morrison M, Olayinka O, et al. Severe Illness Associated with Reported Use of Synthetic Cannabinoids - Mississippi, April 2015. MMWR Morb Mortal Wkly Rep. 2015; 64(39):1121-2. [Crossref]  [PubMed] 
  10. Hudson S, Ramsey J. The emergence and analysis of synthetic cannabinoids. Drug Test Anal. 2011;3(7-8):466-78. [Crossref]  [PubMed] 
  11. Kneisel S, Speck M, Moosmann B, Corneillie TM, Butlin NG, Auwärter V. LC/ESI-MS/MS method for quantification of 28 synthetic cannabinoids in neat oral fluid and its application to preliminary studies on their detection windows. Anal Bioanal Chem. 2013;405(14): 4691-706. [Crossref]  [PubMed] 
  12. Balcı I, Yılmaz A, Yetiş Y, Emiral E, Karbeyaz K. Analysis of deaths related to synthetic cannabinoid ("Bonsai") in Eskişehir, Turkey. AU Sağlık Bil Derg. 2019;5(2):1459-69. [Crossref] 
  13. İritaş SB, Dip A, Tezer N, Dinç AH. Sentetik kannabinoid zehirlenme vakalarında otopsi bulgularının değerlendirilmesi [Assessment of autopsy findings in synthetic cannabinoid intoxication cases]. Namık Kemal Tıp Dergisi. 2019;7(2):96-103. [Link] 
  14. Angerer V, Jacobi S, Franz F, Auwärter V, Pietsch J. Three fatalities associated with the synthetic cannabinoids 5F-ADB, 5F-PB-22, and AB-CHMINACA. Forensic Sci Int. 2017; 281:e9-e15. [Crossref]  [PubMed] 
  15. Ezaki J, Ro A, Hasegawa M, Kibayashi K. Fatal overdose from synthetic cannabinoids and cathinones in Japan: demographics and autopsy findings. Am J Drug Alcohol Abuse. 2016;42(5):520-9. [Crossref]  [PubMed] 
  16. Fantegrossi WE, Moran JH, Radominska-Pandya A, Prather PL. Distinct pharmacology and metabolism of K2 synthetic cannabinoids compared to Δ(9)-THC: mechanism underlying greater toxicity? Life Sci. 2014;97(1):45-54. [Crossref]  [PubMed]  [PMC] 
  17. Darke S, Duflou J, Farrell M, Peacock A, Lappin J. Characteristics and circumstances of synthetic cannabinoid-related death. Clin Toxicol (Phila). 2020;58(5):368-74. [Crossref]  [PubMed] 
  18. Besli GE, Ikiz MA, Yildirim S, Saltik S. Synthetic cannabinoid abuse in adolescents: a case series. J Emerg Med. 2015;49(5):644-50. [Crossref]  [PubMed] 
  19. Gunderson EW, Haughey HM, Ait-Daoud N, Joshi AS, Hart CL. "Spice" and "K2" herbal highs: a case series and systematic review of the clinical effects and biopsychosocial implications of synthetic cannabinoid use in humans. Am J Addict. 2012;21(5):320-6. [Crossref]  [PubMed] 
  20. Doğan A, Oylumlu M, Özgeyik M, Kilit C, Amasyalı B. Bonzai kullanımı sonrası gelişen akut koroner sendrom [Acute coronary syndrome following the use of the bonsai]. Koşuyolu Heart J. 2017;20(2):172-4. [Crossref] 
  21. Ayhan H, Aslan AN, Süygün H, Durmaz T. Bonsai induced acute myocardial infarction. Arch Turk Soc Cardiol. 2014;42(6):560-3. [Crossref]  [PubMed] 
  22. Köklü E, Yüksel İÖ, Bayar N, Üreyen ÇM, Arslan Ş. A new cause of silent myocardial infarction: Bonsai. Anatol J Cardiol. 2015;15(1): 69-70. [Crossref]  [PubMed]  [PMC] 
  23. Eminler AT, Yıldırım M, Uslan Mİ, Köksal AŞ, Parlak E. Sentetik kannabinoidler (BONZAİ) ve gastrointestinal sistem üzerine etkileri: "Kannabinoid hiperemezis sendromu" [Synthetic cannabinoids (BONZAI) and effects on the gastrointestinal system: "Cannabinoid hyperemesis syndrome]. Güncel Gastroenteroloji. 2014;18(4):460-3.
  24. Alhadi S, Tiwari A, Vohra R, Gerona R, Acharya J, Bilello K. High times, low sats: diffuse pulmonary infiltrates associated with chronic synthetic cannabinoid use. J Med Toxicol. 2013;9(2):199-206. [Crossref]  [PubMed]  [PMC] 
  25. Akçan R, Lale A. Commentary on: Chen HI, deJong J. Increased lung weights in drug-related fatalities. J Forensic Sci 2017;62(6): 1632-4. J Forensic Sci. 2018;63(4):1331-2. [Crossref]  [PubMed] 
  26. Efeoğlu Özşeker P, Dip A, Dağlıoğlu N, Gülmen MK. Sentetik kannabinoidler: Yeni nesil esrar [Synthetic cannabinoids: A new generation marihuana]. Türk Aile Hek Derg. 2017; 21(1):34-40. [Crossref] 

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