Like warfarin, brodifacoum blocks vitamin K epoxide reductase (VKOR), leading to lower levels of vitamin Kâ€“dependent coagulation proteins. The cause of the synthetic cannabinoidâ€“induced coagulopathy has been identified as contamination with brodifacoum, a potent vitamin K antagonist routinely used as a rodenticide. To date, four deaths from severe bleeding have been linked to these products. Most people with a coagulopathy have smoked the drug, but this condition also has been reported in patients who vaporized the drug or made it into a tea. Patients typically present with either severe bleeding or are found to have a coagulopathy when being evaluated for another condition. The outbreak has also been observed in eight other states. 1 The first cases occurred in Illinois in March 2018 more than 160 cases have now been reported.

The rising popularity of synthetic cannabinoids/marijuana is accompanied by reports of severe bleeding and coagulopathies among users. Certain products also may contain psychoactive substances.

However, the risk to users can be substantial because synthetic marijuana does not routinely undergo any regulatory quality control, chemical content evaluation, or inspection. The appeal of such products is that they are inexpensive, available in states without legalized marijuana, and undetectable in urine drug screens. Synthetic marijuana is a poorly regulated substance, and is routinely found in convenience stores, gas stations, and other retail outlets. These products generally consist of plant material sprayed with chemicals that can interact with the cannabinoid receptor, leading to intoxication when smoked. Over the past decade, the use of synthetic cannabinoids/marijuana has increased.

Antidote for warfarin toxicity