A Case of Acute Intoxication from Sublingually Administering a Liquid Inhalation Product Containing a Marijuana Analogue.

Abstract

A 20-year-old man was brought to the emergency room with chief complaints of dysarthria and vomiting after placing several drops of an inhalation liquid containing hexahydrocannabiphorol (HHCP) under his tongue. During ambulance transport, the patient had a post-vomiting convulsion that lasted approximately 1 minute. Upon arrival at the hospital, he was agitated, had dysarthria to the extent that he was in danger of falling from the stretcher, and was having visual hallucinations. Blood tests showed acidosis and a high lactic acid concentration. The patient was urgently admitted to the hospital with a diagnosis of acute poisoning and was started on supplemental intravenous fluids. The patient was able to communicate from the second day, started eating on the third day, finished receiving supplemental fluids on the fourth day, and was discharged from the hospital on the fifth day. HHCP was not illegal in Japan at the time and was distributed mainly through mail order. Clinical information on HHCP is lacking, but this case shows that the drug causes health problems. Although HHCP has been regulated by law in Japan since January 2024, clinicians and the general public should be aware that similar cases may occur in the future.