Prevalence of psychoactive substances as an anesthesiological problem




psychoactive substances, amphetamine, mephedrone, cannabis, tetrahydrocannabinol, general anesthesia, review


The problem of drug abuse is extremely actual these days; it is a big challenge for health care system. According to the UN data, about 275 million people around the world aged 15–64 years, which is about 5.6 % of the world’s population, has used illicit drugs at least once in 2016. According to WHO, 45,0000 people died because of drug use in 2015, including cases related to AIDS and hepatitis C. Last trend shows that a record level of herbal drug production was reached. The most popular drug is cannabis; amphetamines are on the second place. During the last few years, hundreds of novel synthetic drugs were synthesized and brought to market, the main amount of them are stimulants, cannabinoid receptor agonists, and classic hallucinogens. Last time there is a trend to increased use of novel synthetic drugs (derivatives of tetrahydrocannabinol and cations) by young adults. A large amount of new researches are dedicated to pharmacology and mechanism of action of novel synthetic drugs on human organism. A high rate of comorbid disorders associated with substance abuse, including those among youngs is observed. Cardiovascular complications hold a special place. Amphetamin has a cardiotoxic effect, induces dilatation cardiomyopathy, hemorrhagic stroke. Mephedrone, frequently used with alcohol, is characterized by typical sympathomimetic toxic syndome. According to WHO report on mephedrone, users of this drug can have related regressive dilatation cardiomyopathy, pneumomediastinum, subcutaneous emphysema, acute kidney disorders and recurrent posterior encephalopathic syndrome. Acute mephedrone intoxication leads to tachycardia, chest pain, seizures, headache; there are reported death cases. Synthetic cannabinoids compared to cannabis has stronger affinity to cannabinoid receptors type 2, due to their more pronounced toxicity. There are numbers of reported cases regarding acute miocardial infarction related to using spice among young people. Despite no angiogram signs of coronary pathology, myocardial infarction was induced by vasospasm. The most often cardial complication of using cannabis was myocardial infarction, as well as reported cases of arrhythmia, including atrial and ventricular fibrillation, stroke, peripheral arteriopathy, Takotsubo cardiomyopathy. Cannabis users showed variable response to propofol anesthesia compared to individuals who haven’t used cannabis. Propofol high doses were needed for conscious loss, adequate relaxation and depression of respiratory reflexes. Tetrahydrocannabinol was reported to prolong a sedative effect of general anesthesia on experimental models and was involved in development of perioperative complications, such as bronchospasm, tachycardia, uvula oedema. Either cannabis and tabacco smoking causes direct airway irritation. Cannabis use was also reported to be likely associated with diffuse alveolar haemorrhage in post-operative period. If sedative hypnotic drugs are used in cannabis users, excessive depression of the central nervous system may occur; therefore, barbiturates, opioids, and benzodiazepines are preferably avoided. Intraoperative and immediate postoperative doses of opiates for analgesia in patients with history of recent or chronic cannabis consumption may be significantly increased.


Download data is not yet available.


Марков Ю.І., Недашківський С.М., Лоскутов О.А. Тлумачний словник з клінічної токсикології. — К.: ФОП Коляда О.П., 2018. — 152 с.

Інструкція про порядок перевірки точності результатів вимірювань у вимірювальних лабораторіях, затверджена МОЗ України, зареєстрована у Міністерстві юстиції України 02.12.1999 за № 33/4126.

United Nations Office on Drugs and Crime. World Drug Report 2018. (United Nations publication, Sales No. E.18.XI.9). ISBN: 978-92-1-148304-8. eISBN: 978-92-1-045058-4.

Global Health Estimates 2015: Deaths by Cause, Age, Sex, by Country and by Region, 2000–2015. Geneva, World Health Organization, 2016.

WHO, Disease burden and mortality estimates, Global Health Estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Available at].

Soelberg C.D., Brown R.E., Du Vivier D., Meyer J.E., Ramachandran B.K. The US Opioid Crisis: Current Federal and State Legal Issues // Anesth. Analg. 2017 Nov; 125(5): 1675-1681.

Degenhardt L. et al. Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the Global Burden of Disease Study 2013 // The Lancet Infectious Diseases. 2016; 16(12): 1385-1398.

Личко А.Е. Подростковая наркология. Руководство для врачей / А.Е. Личко, В.С. Битенский. — СПб.: Медицина, 1991. — 304 с.

Heslin K.C. (AHRQ), Elixhauser A. (AHRQ). Mental and Substance Use Disorders Among Hospitalized Teenagers, 2012. HCUP Statistical Brief #202. March 2016. Agency for Healthcare Research and Quality, Rockville, MD. Available at

David J. Heal, Sharon L. Smith, Jane Gosden, David J. Nutt. Amphetamine, past and present — a pharmacological and clinical perspective // J. Psychopharmacol. 2013 Jun; 27(6): 479-496.

David Kinas, Michael Dalley, Kayla Guidry, Mark A. Newberry, David A. Farcy. Point-of-Care Ultrasound Identifies Decompensated Heart Failure in a Young Male with Methamphetamine-Associated Cardiomyopathy Presenting in Severe Sepsis to the Emergency Department // Case reports in emergency medicine, 2018. doi: [10.1155/2018/2859676 available at].

Westover A.N., McBride S., Haley R.W. Stroke in young adults who abuse amphetamines or cocaine: a population-based study of hospitalized patients // Arch. Gen. Psychiatry. 2007 Apr; 64(4): 495-502. doi: 10.1001/archpsyc.64.4.495 PMID: 17404126. Available at

Pani P.P., Trogu E., Maremmani I., Pacini M. QTc interval screening for cardiac risk in methadone treatment of opioid dependence // Cochrane Database Syst Rev. 2013 Jun 20; (6): CD008939.

Zawilska J.B., AndrzeJczak D. Next generation of novel psychoactive substances on the horizon — A complex problem to face // Drug Alkogol Depend. 2015 Dec 1; 157: 1-17.

Chintalova-Dallas R., Case P., Kitsenko N., Lazzarini Z. Boltushka: a homemade amphetamine-type stimulant and HIV risk in Odessa, Ukraine // Int. J. Drug. Policy. 2009 Jul; 20(4): 347-51.

United Nations Office on Drugs and Crime. Systematic Literature Rewiew on HIV and Stimulant Drugs Use (A) Part 4/5. NPS and HIV Risk and Transmission. UNODC; Vienna, 2017.

Farré M., Perez-Maña C., de Souza E., Mateus J., Theunisen E., Kuypers K., Ramaekers J., Fonseca F., Torrens M., Olesti E., de la Torre R., Papaseit E. Interactions between mephedrone and alcohol in humans: Cardiovascular and subjective effects // European. Psychiatry. 2016; 33: 115.

Tyrkkö E., Andersson M., Kronstrand R. The Toxico­logy of New Psychoactive Substances: Synthetic Cathinones and Phenylethylamines // Therapeutic drug. monitoring. 2016 Apr; 38(2): 190-216.

Carhart-Harris R.L., King L.A., Nutt D.J. A web-based survey on mephedrone // Drug Alcohol Depend. 2011;

: 19-22.

Vardakou I., Pistos C., Spiliopoulou Ch. Drugs for youth via Internet and the example of mephedrone // Toxicol. Lett. 2011; 201: 191-195.

Wood D.M., Greene S.L., Dargan P.I. Clinical pattern of toxicity associated with the novel synthetic cathinone mephedrone // Emerg. Med. J. 2011; 28: 280-282.

Baumann M.H., Ayestas M.A. Jr., Partilla J.S., Sink J.R., Shulgin A.T., Daley P.F. et al. The designer methcathinone analogs, mephedrone and methylone, are substrates for monoamine transporters in brain tissue // Neuropsychopharmacology. 2012; 37: 1192-1203.

Kehr J., Ichinose F., Yoshitake S., Goiny M., Sieverts-

son T., Nyberg F. et al. Mephedrone, compared with MDMA (ecstasy) and amphetamine, rapidly increases both dopamine and 5-HT levels in nucleus accumbens of awake rats // Br. J. Pharmacol. 2011; 164: 1949-1958.

Esther Papaseit, Clara Pérez-Mañá, Julián-Andrés Mateus, Mitona Pujadas, Francina Fonseca, Marta Torrens, Eulàlia Olesti, Rafael de la Torre, Magí Farré. Human Pharmacology of Mephedrone in Comparison with MDMA // Neuropsychopharmacology. 2016; 41(11): 2704-2713.

Gustavsson D., Escher C. Mephedrone — Internet drug which seems to have come and stayed. Fatal cases in Sweden have drawn attention to previously unknown substance // Lakartidningen. 2009; 106: 2769-2771.

WHO, 2014. Mephedrone Critical Review Report Expert Committee on Drug Dependence. Thirty-sixth Meeting. Geneva, 16–20 June 2014 Agenda item 4.12. Available at

McKeever R.G., Vearrier D., Jacobs D., LaSala G., Okaneku J., Greenberg M.I. K2 — not the spice of life; synthetic cannabinoids and ST elevation myocardial infarction: a case report // J. Med. Toxicol. 2015; 11: 129-131.

Mir A., Obafemi A., Young A., Kane C. Myocardial infarction associated with use of the synthetic cannabinoid K2 // Pediatrics. 2011; 128: 1622-1627.

Brooke Mills, Emma Dishner and Carlos E. Velasco. Acute myocardial infarction triggered by use of synthetic cannabis // Proc. (Bayl. Univ. Med. Cent.). 2018 Apr; 31(2): 200-202.

Demirkıran A., Albayrak N., Albayrak Y., Zorkun C.S. Speckle-tracking strain assessment of left ventricular dysfunction in synthetic cannabinoid and heroin users // Anatol. J. Cardiol. 2018 Jun; 19(6): 388-393.

Yamanoglu A., Celebi Yamanoglu N.G., Evran T., Sogut O.J. How much can synthetic cannabinoid damage the heart? A case of cardiogenic shock following resistant ventricular fibrillation after synthetic cannabinoid use // Clinical Ultrasound. 2018; 46(9): 605-609.

Singh A., Saluja S., Kumar A., Agrawal S., Thind M., Nanda S., Shirani J. Cardiovascular Complications of Marijuana and Related Substances: A Review // Cardiol. Ther. 2018 Jun; 7(1): 45-59.

Charbonney E., Sztajzel J.M., Poletti P.A., Rutschmann O. Paroxysmal atrial fibrillation after recreational marijuana smoking: another “holiday heart”? // Swiss Med. Wkly. 2005; 135: 412-414.

Kosior D.A., Filipiak K.J., Stolarz P., Opolski G. Paroxysmal atrial fibrillation following marijuana intoxication: a two-case report of possible association // Int. J. Cardiol. 2001; 78: 183-184.

Singh G.K. Atrial fibrillation associated with marijuana use // Pediatr. Cardiol. 2000; 21: 284.

Fernández-Fernández F.J., Caínzos-Romero T., Mesías Prego A., Sesma P. Ectopic atrial rhythm associated with cannabis use // Minerva Cardioangiol. 2011; 59: 119-120.

Mohan H., Sood G.C. Conjugate deviation of the eyes after Cannabis indica intoxication // Br. J. Ophthalmol. 1964; 48: 160-161.

Kamijo Y., Takai M., Fujita Y., Sakamoto T.. A multicenter retrospective survey of poisoning after consumption of products containing novel psychoactive substances from 2013 to 2014 in Japan // Am. J. Drug Alcohol Abuse. 2016 Sep; 42(5): 513-519.

Flisberg P., Paech M.J., Shah T. et al. Induction dose of propofol in patients using cannabis // Eur. J. Anaesthesiol. 2009; 26: 192-195.

Chesher G.B., Jackson D.M., Starmer G.A. Interaction of cannabis and general anaesthetic agents in mice // Br. J. Pharmacol. 1974; 50: 593-599.

Mallat A., Roberson J., Brock-Utne J.G. Preoperative marijuana inhalation — an airway concern // Can. J. Anaesth. 1996; 43: 691-693.

Hemant Goyal, Hamza H. Awad, Jalal K. Ghali. Role of cannabis in cardiovascular disorders // J. Thorac. Dis. 2017 Jul; 9(7): 2079-2092.



How to Cite

Markov, Y., Loskutov, O., & Polishchuk, V. (2021). Prevalence of psychoactive substances as an anesthesiological problem. EMERGENCY MEDICINE, (2.97), 45–53.



Scientific Review

Most read articles by the same author(s)

1 2 3 4 5 6 > >>