Two patients with schizophrenia injured their own eyes while intoxicated on synthetic cannabis | Research

The takeaway

Two patients with untreated schizophrenia presented with self-inflicted eye injuries after using the synthetic cannabinoid K2, both hallucinating that a bug was behind their eye.

Emergency medicine providers, psychiatrists, and anyone concerned about the dangers of synthetic cannabinoids.

First reported cases of ocular self-injury from synthetic cannabinoid intoxication

What the researchers found

Both patients had untreated schizophrenia and used K2 (synthetic cannabinoid). Each hallucinated a bug behind their eye and caused periocular soft tissue damage attempting to remove it. These are reported as the first cases of ocular self-injury from synthetic cannabinoid intoxication.

Why it matters

Synthetic cannabinoids carry significantly more serious psychiatric side effects than natural cannabis. These cases illustrate the potential for severe self-harm when synthetic cannabinoids interact with pre-existing psychotic disorders.

The numbers in context

2 patients; both with untreated schizophrenia; both intoxicated on K2; identical hallucination of bug behind eye; first reported cases of this type

How the study worked

Clinical case reports of two patients presenting to a single institution with ocular self-injury following synthetic cannabinoid (K2) use, both with pre-existing untreated schizophrenia.

What this study cannot tell us

Only two cases reported. Both patients had pre-existing untreated schizophrenia, making it difficult to attribute effects solely to the drug. No toxicological confirmation of specific synthetic cannabinoid compound.

How to read the evidence

Case report of only two patients, but documents a novel and clinically important adverse event.

When this study was published

Published in 2021.

The bigger picture

Synthetic cannabinoids are full agonists at CB1 receptors and can be dramatically more potent than THC. Their interaction with pre-existing psychiatric conditions creates a high-risk scenario for severe neuropsychiatric toxicity and self-harm.

Questions still open

How common is self-injury during synthetic cannabinoid intoxication? Does the combination of untreated psychosis and synthetic cannabinoids create a uniquely dangerous situation? Would natural cannabis have triggered similar events?

Common questions

Were these patients using regular cannabis?

No. Both patients used K2, a synthetic cannabinoid that acts as a full agonist at CB1 receptors and is far more potent than THC in natural cannabis.

Did the patients have pre-existing mental health conditions?

Yes. Both had untreated schizophrenia, which likely contributed to the severity of their hallucinatory experience and subsequent self-injury.

Read the original research

Synthetic cannabinoid induced ocular self-injury.

Orbit (Amsterdam, Netherlands), 40(4), 326-328

View on PubMed ↗Publisher’s paper ↗

Citation

Malik, Kunal; Kommana, Sumana; Paul, Joshua; Krakauer, Mark. (2021). Synthetic cannabinoid induced ocular self-injury.. Orbit (Amsterdam, Netherlands), 40(4), 326-328. https://doi.org/10.1080/01676830.2020.1781199