This study seeks to characterize the clinical manifestations, management, and outcomes of intoxication from strips in a correctional facility population, and to identify the specific substances present in these strips.
This study found that drug-soaked paper strips containing synthetic cannabinoid receptor agonists (SCRAs) can cause severe health outcomes. In this case series study of strip intoxication among incarcerated individuals, severe and variable clinical manifestations were observed, predominantly associated with their SCRA content. Bradycardia in the context of major central nervous system depression was an indicator of severe SCRA toxic effects. The authors sought to identify the clinical manifestations, management, and outcomes associated with exposure to drug-soaked paper strips among incarcerated individuals, and which substances are present in these strips. The authors found that this case series of 18 male patients with strip intoxication, clinical manifestations included central nervous system depression (94%) and bradycardia (61%). Strips primarily contained synthetic cannabinoid receptor agonists, nitazene opioids, and other novel psychoactive substances. Strip samples were tested using gas chromatography-mass spectrometry and liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS), and serum samples were analyzed via LC-QTOF-MS. All patients had suspected exposure to strips, thought to contain opioids, synthetic cannabinoid receptor agonists (SCRAs), and other novel synthetic drugs. The primary outcomes were clinical manifestations of strip exposure, including clinical signs and symptoms, vital sign derangements, laboratory and imaging findings, treatments administered, and patient outcomes. There were 18 patients (all male; median [IQR] age, 27.5 [18.0-45.0] years) in total. Bradycardia (11 patients [61%]) and central nervous system depression (17 patients [94%]) were the most common clinical findings. Other symptoms included agitation (6 patients [33%]) and seizures (4 patients [22%]). Analysis of strip samples revealed the presence of synthetic cannabinoids and benzimidazole opioids, but no household cleaners or pesticides. Serum testing confirmed the presence of SCRAs and their metabolites. (Published Abstract Provided)
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