Six synthetic cannabinoid users developed multiple organ failure, including the first case requiring a liver transplant | Research

The takeaway

A case series of six patients admitted with synthetic cannabinoid intoxication documented severe rhabdomyolysis, kidney failure, liver failure, seizures, and compartment syndrome, including the first reported case of SC-associated liver failure requiring transplantation.

Emergency and critical care physicians, toxicologists, and transplant teams who may encounter SC-related organ failure.

First liver transplant from SC

What the researchers found

All six patients had altered mental status and severe rhabdomyolysis (peak CK up to >320,000 U/L). Five of six had acute kidney injury, four required continuous dialysis. Five had fever, three had myocardial injury. Two needed emergency fasciotomies for compartment syndrome. Two developed fulminant liver failure, one requiring MARS therapy as bridge to successful transplant; the other patient without it died.

Why it matters

This case series documents the most severe end of the synthetic cannabinoid toxicity spectrum, including the first reported case requiring liver transplantation. It demonstrates that SC use can cause simultaneous failure of multiple organ systems.

The numbers in context

6 patients. Peak CK: 4,000 to >320,000 U/L. Acute kidney injury: 5/6. Continuous dialysis: 4/6. Fever: 5/6. Seizures: 3/6. Troponin elevation: 3/6. Emergency fasciotomies: 2/6. Fulminant liver failure: 2/6. Deaths: 1/6.

How the study worked

Multicenter descriptive case series of six patients admitted to intensive care units at three Maryland hospitals between March-July 2016 with known synthetic cannabinoid use and multiple organ failure.

What this study cannot tell us

Small case series from a single geographic region and time period. Specific synthetic cannabinoid compounds were not identified. Pre-existing conditions or co-ingestants may have contributed. Cannot determine incidence of severe outcomes among all SC users.

How to read the evidence

Rated preliminary because this is a small case series, though the severity and novelty of findings are clinically significant.

When this study was published

Published in 2019, covering 2016 cases from Maryland.

The bigger picture

As synthetic cannabinoid use grows, clinicians need to recognize that these substances can cause catastrophic multi-organ failure requiring ICU-level care, dialysis, and potentially organ transplantation. The range and severity of organ damage far exceeds anything seen with natural cannabis.

Questions still open

What specific compounds caused such severe organ damage? Is there a dose threshold for multi-organ failure? Could early aggressive treatment prevent progression to organ failure?

Common questions

Can synthetic cannabinoids cause organ failure?

Yes. This case series documented simultaneous failure of muscles, kidneys, liver, and heart in six patients. All required intensive care, and one patient died.

What is rhabdomyolysis?

A condition where muscle tissue breaks down rapidly, releasing proteins that can damage the kidneys. All six patients had it, with muscle breakdown markers reaching over 320,000 U/L (normal is under 200).

Has anyone needed a liver transplant from synthetic cannabinoids?

This series reported the first known case. One patient received MARS therapy as a bridge to successful transplant. Another patient with liver failure who did not receive MARS died.

Read the original research

Synthetic Cannabinoid-Associated Multiple Organ Failure: Case Series and Literature Review.

Pharmacotherapy, 39(4), 508-513

View on PubMed ↗Publisher’s paper ↗

Citation

Armstrong, Faith; McCurdy, Michael T; Heavner, Mojdeh S. (2019). Synthetic Cannabinoid-Associated Multiple Organ Failure: Case Series and Literature Review.. Pharmacotherapy, 39(4), 508-513. https://doi.org/10.1002/phar.2241