A case of panic attack developing after THC‐O acetate inhalation using an e‐cigarette device
Sugawara et al.
Department of Psychiatry Dokkyo Medical University School of Medicine Mibu Japan
* CorrespondenceNorio Sugawara, Department of Psychiatry, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi 321‐0293, Japan.
Email: nsuga3@dokkyomed.ac.jp
Abstract
Aim
Tetrahydrocannabinol acetate (THC‐O) is a cannabinoid‐based product, and few medical studies have evaluated the effects of THC‐O on humans. Recently, e‐cigarettes have become popular among teenagers and young adults worldwide. However, there have been reports of people misusing this device as a delivery system for drugs of abuse.
Case Presentation
We herein report a case of panic attack after THC‐O inhalation using an e‐cigarette device in an 18‐year‐old male with no history of psychiatric disorders. Although he started smoking both regular cigarettes and e‐cigarettes in junior high school, he had never vaped delta‐9 THC or THC‐O until the present episode. A total of 20 min after his first inhalation of THC‐O, he experienced a sudden attack that lasted 2 h. After this episode, he did not inhale THC‐O. Throughout the subsequent 6 months of follow‐up, he maintained improvement with no panic attacks.
Conclusion
In this case, we intend to emphasize that THC‐O is not safe, even if the substance is regarded as loophole drug. The use of e‐cigarette devices might accelerate substance abuse.
Short
We report a case of panic attack after THC‐O inhalation using an e‐cigarette device in a male with no history of psychiatric disorders. THC‐O is not safe, even if the substance is regarded as loophole drug. The use of e‐cigarette devices might accelerate substance abuse.
Article notes
Sugawara N , Yasui‐Furukori N , Shimoda K . A case of panic attack developing after THC‐O acetate inhalation using an e‐cigarette device. Neuropsychopharmacol Rep. 2023;43:647–649. 10.1002/npr2.12345 37143389 PMC10739058
1INTRODUCTION
Tetrahydrocannabinol acetate (THC‐O) is a cannabinoid‐based product that is anecdotally described as two or three times more potent than delta‐9 THC, the major psychoactive compound of cannabis. 1 Although the mechanism of the effect of cannabinoids on the central nervous system is not entirely known, the CB1 and CB2 cannabinoid receptors have been identified as the primary targets. Despite interest in cannabinoid use for clinical treatment, 2 several cognitive dysfunctions, such as difficulty maintaining attention, impaired coordination, memory loss, and difficulties in learning, problem solving, and thinking, have been reported in cannabis users. Furthermore, individuals with heavy cannabis use have a higher risk of developing psychiatric disorders, including depression and schizophrenia. However, there have been few medical studies evaluating the effects of THC‐O on humans, and pharmacological data are lacking. The legal status of cannabis use varies by country. However, even in countries prohibiting cannabis use, several loophole drugs, such as THC‐O, are marketed and sold online. Recently, electronic cigarettes (e‐cigarettes) have become popular among teenagers and young adults worldwide. However, there have been reports of people misusing this device as a delivery system for drugs of abuse. 3
The authors report a case of panic attack after THC‐O inhalation using an e‐cigarette device in a patient with no history of psychiatric disorders. To our knowledge, this is the first report of such an effect of THC‐O.
2CASE PRESENTATION
Mr. M is a single 18‐year‐old male with no psychiatric history. Although he started smoking both regular cigarettes and e‐cigarettes in junior high school, he had never vaped delta‐9 THC or THC‐O until the present episode. In August 2022, he purchased THC‐O online and inhaled it for the first time using an e‐cigarette device. After 20 min of inhalation, the patient experienced a sudden attack that lasted 2 h and was characterized by palpitations, shortness of breath, nausea, vomiting, feelings of unreality, and fear of dying. He went to the hospital emergency room due to his urgent condition. He was worried and complained of difficulty breathing. His body temperature was 37.8°C, and his heart rate had climbed to 101 bpm. Sinus tachycardia was discovered on electrocardiogram (ECG) at admission. His other vitals were stable. Complete blood counts, tests of electrolyte levels and liver and renal function, urinalysis, and chest X‐rays from the diagnostic workup were all within normal ranges (WNL). There was no history of head trauma or other medical conditions. He was brought to us, and a diagnosis of panic attack was made. Due to his persistent concern about additional attacks, the patient was given sertraline (25 mg). However, a few days after the prescription, he revisited our office and hoped to switch from sertraline to herbal medicine due to his concerns regarding the side effects of the antidepressant. Based on a shared decision‐making process, herbal medicine (Hangekobokuto) was prescribed to the patient. After the presented episode, he did not inhale THC‐O. Throughout the subsequent 6 months of follow‐up, he maintained improvement with no panic attacks, and his concern about additional attacks had been alleviated.
3DISCUSSION
This case of a THC‐O‐induced panic attack was consistent with the temporal relationship to inhalation as well as with the patient's clinical presentation, although a rechallenge with THC‐O was not attempted. In this case, it took 20 min after inhalation for the panic attack to develop, which is considered a drug administration route with a relatively rapid onset of effects. In many cases, symptoms of panic attacks last between 5 and 30 min; our patient experienced symptoms for 2 h. Despite a study using oral administration, the increase in anxiety and heart rate induced by delta‐9 lasted at least 2 h. 4 The duration of THC‐O‐induced panic attacks might be longer than that of those caused by panic disorder without cannabis use.
In this case, the patient inhaled THC‐O using an e‐cigarette device. E‐cigarette products have appealing flavors and designs, attract young people, and have become popular. 5 E‐cigarette devices for vaping cannabis are available to accommodate the variety of products containing cannabinoids. 6 E‐cigarette devices could provide a way for people to take illegal or harmful substances using a tool that is socially acceptable, rather than a crack pipe or needle. The use of e‐cigarette devices might accelerate substance abuse. Concurrent use of e‐cigarettes and cannabinoids among adolescents and young adults is a growing public health concern. 3 Although a previous study with a longitudinal design showed that cannabis use has links with both panic attacks and panic disorders, these associations disappeared after controlling for smoking behavior. 7 Regulations for regular cigarettes or e‐cigarettes might prevent an increase in substance abuse. In this case, the THC‐O product was sold by an online retailer and was shipped directly to the patient. Online purchasing could easily provide youth with access to THC‐O products. Current web policies are not sufficient to prevent youth from having access to loophole drugs. Because of the negative effects of cannabinoid use on health outcomes, more research and regulations are needed regarding substance abuse among e‐cigarette users.
4CONCLUSION
We reported a case of panic attack after THC‐O inhalation using an e‐cigarette device in a patient with no history of psychiatric disorders. To our knowledge, this is the first report of such an effect of THC‐O. Concurrent use of e‐cigarettes and cannabinoids is a growing public health concern, and the use of e‐cigarette devices might accelerate substance abuse. To avoid the cannabinoid‐induced development of mental health problems, more research and regulations are needed regarding substance abuse among e‐cigarette users.
FUNDING INFORMATION
The authors received no specific funding for this work.
CONFLICT OF INTEREST STATEMENT
Kazutaka Shimoda has received research support from Novartis Pharma K.K., Dainippon Sumitomo Pharma Co., Astellas Pharma Inc., Meiji Seika Pharma Co., Ltd., Eisai Co., Ltd., Pfizer Inc., Otsuka Pharmaceutical Co., Ltd., Daiichi Sankyo Co., and Takeda Pharmaceutical Co., Ltd., and honoraria from Eisai Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Co., Ltd., Meiji Seika Pharma Co., Ltd., Janssen Pharmaceutical K.K., Shionogi & Co., Ltd., Dainippon Sumitomo Pharma Co., Daiichi Sankyo Co., and Pfizer Inc. The funders did not have any role in data collection or in the study design, analysis, decision to publish, or preparation of the manuscript. The remaining authors declare that they have no competing interests to report.
ETHICS STATEMENT
Approval of the Research Protocol by an Institutional Reviewer Board: The ethics committee of Dokkyo Medical University determined that there was no need to review this case.
Informed Consent: Written informed consent was obtained from the patient for the publication of this case report.
Registry and the Registration No. of the Study/Trial: Not available.
Animal Studies: Not available.
ACKNOWLEDGMENTS
We express our sincere gratitude for the patient's cooperation.
DATA AVAILABILITY STATEMENT
Data sharing is not applicable to this article as details of the case cannot be disclosed in accordance with the Personal Information Protection Law.