Journal of General Practice

ISSN: 2329-9126

Journal of General Practice
Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on Medical, Pharma, Engineering, Science, Technology and Business

Synthetic Cannabinoids and Dysphonia: A Case Report

Raythatha1, Avani BS1, Asim Shah2, Veronica Tucci3 and Nidal Moukaddam2*
1Baylor College of Medicine, USA
2Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, USA
3Section of Emergency Medicine, Baylor College of Medicine, USA
Corresponding Author : Nidal Moukaddam
Baylor College of Medicine
Department of Psychiatry & Behavioral Sciences, USA
Tel: 713-873-4901
Received: January 01, 2016 Accepted: January 08, 2016 Published: January 18, 2016
Citation: Raythatha, Avani BS, Shah A, Tucci A, Moukaddam N (2016) Synthetic Cannabinoids and Dysphonia: A Case Report. J Gen Practice 4:220. doi:10.4172/2329-9126.1000220
Copyright: © 2016 Raythatha, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Related article at Pubmed, Scholar Google
Visit for more related articles at Journal of General Practice


Synthetic cannabinoids (SC) have been increasing in popularity throughout the past decade, and are now mainstream drugs of abuse. Undetectable by many urine drug screens, SC are a heterogeneous group of chemicals with various documented side effects including myocardial infarctions, tachycardia, agitation, psychosis, nausea, and vomiting. Methods: In this case report, we present a 38 year-old female with dysphonia secondary to SC. Our patient developed dysphonia after 2.5 years of regular SC use. She was thoroughly evaluated by her primary care physician and referred to both, otorhinolaryngology and pulmonology, with an exhaustively negative workup. Her dysphonia persisted for 13 months and only improved after she abstained from using SC. Conclusions and Significance: We could find no previous cases of dysphonia or hoarseness attributed t SC use/ abuse in the literature and is yet another kind of health sequelae frontline providers should look for in chronic users of SC. The previously unrecognized relationship between SC and dysphonia demonstrates our limited understanding of the chemicals’ adverse effects. Just as nicotine affects the larynx and causes dysphonia and laryngeal carcinoma, this case also raises the question of whether the chemical composition of SC affects the larynx in the same way and its use leads to an increased risk of laryngeal cancer for users/abusers
Synthetic cannabinoids; Dysphonia; Hoarseness; Laryngeal cancer
Over the past decade, synthetic cannabinoids (SC) have been growing in popularity around the world. Also known as “K2”, “spice”, or “kush”, SC are full agonists of cannabinoid receptors (CB); their effect is more pronounced than natural cannabis because the active ingredient of cannabis tetrahydrocannabinol (THC), is only a weak agonist at CB1.
Over the past decade, synthetic cannabinoids (SC) have been growing in popularity around the world. Also known as “K2”, “spice”, or “kush”, SC are full agonists of cannabinoid receptors (CB); their effect is more pronounced than natural cannabis because the active ingredient of cannabis tetrahydrocannabinol (THC), is only a weak agonist at CB1.
These characteristics make the drug widely popular in the teenage and young adult populations. In an anonymous online survey conducted in 2011 resulting in 14,966 participants with a median age of 26 years, 2513 responders or 17% reported use of SC. Of those participants, 980 responders used SC within the last 12 months and 93 preferred SC over cannabis.
Known side effects of SC include myocardial infarctions, tachycardia, agitation, paranoia, delusions, hallucinations, seizures, nausea, and vomiting. In this case report, we present dysphonia as a side effect of SC, a previously unreported relationship. This case is of importance as it highlights our limited knowledge of the possible health sequelae of SC.
Case Report
The patient is a 38 year-old Hispanic female with a past medical history significant for bipolar disorder, asthma, and tobacco use who originally presented to the clinic with a five-week history of hoarseness, cough, and xerostomia. The patient had a 23 pack-year history of smoking tobacco and a 2.5 year history of smoking SC through an unfiltered pipe. She had asthma as a child that required inhaler use, but stopped using medication at the age of 10. The patient also reported an allergy to cats but despite this allergy, lived living with 7 cats in her house.
On initial evaluation by otorhinolaryngology (ENT), she was diagnosed with chronic laryngitis secondary to tobacco use. A flexible fiberoptic laryngoscopy showed leukoplakia, edema, and ulceration of the larynx but no masses. She was advised to discontinue smoking and prescribed a proton pump inhibitor (PPI) and tessalon perlels (benzonatate capsules). However, the PPI did not reduce symptoms. Over the next six months, she had three more episodes of hoarseness. A biopsy of her existing lesion showed an ulcer with reactive squamous mucosa. Repeat laryngoscope was negative for new abnormalities. As her symptoms persisted, she was then referred to pulmonology where infectious disease, autoimmune, and allergic workup was initiated. The patient’s pulmonary function tests showed no abnormalities. HIV, hepatitis, ANA, anti-dsDNA, CCP IgG/IgA antibody, and allergen panels were all negative. Her CBC showed no eosinophils. A trial of certizine did not alleviate her symptoms. The patient was then prescribed bronchodilators and albuterol inhalers, which she elected not to use.
While being evaluated by ENT and pulmonology, the patient was seen concomitantly by psychiatry for individual psychotherapy and chemical dependency group therapy. During these sessions, the patient noted that cessation of SC use tremendously improved the quality of her voice. However, she was only able to remain abstinent for one to three months at a time. She continued to relapse with acute worsening of her voice. About 13 months after her initial presentation to ENT, she stopped using SC. Her voice significantly improved and eventually returned to baseline. Repeat laryngoscope continued to show chronic laryngitis, but showed no recurrence of a vocal fold lesion. She remains symptom-free 13 months after cessation of SC use despite continued daily use of tobacco and intermittent use of cannabis [1-7].
In this case report we discuss SC as a cause of hoarse voice, a previously unreported side effect of the drug. The differential diagnoses for a hoarse voice include vocal cord nodules, malignancy, gastroesophageal reflux, allergies, and nicotine. A hoarse voice can also be due to other illicit drug use, such as cocaine and methamphetamines.
This patient was well evaluated by ENT and pulmonology, with work-up for traditional causes of hoarseness returning negative. Her hoarseness only improved after cessation of SC use This case highlights the need to inquire about SC in patients presenting with a chief complaint of dysphonia, especially as our understanding of the longterm effects of SC remains limited.
Dysphonia has been a well-recognized side effect of nicotine, but not synthetic cannabinoids. Dysphonia is often the initial presentation of laryngeal carcinoma in smokers. It is possible that SC may act by a similar mechanism, with concern that the development of dysphonia puts the patient at an increased risk for laryngeal carcinoma. Given the prevalence of SC use and its accessibility, it is important to better understand the side effects of SC and its impact on human health.
Furthermore, the extent of necessary otorhinolaryngology and pulmonary workup for patients who present with hoarseness in the setting of SC use is still not fully known, but SC misuse should be considered by primary care physicians and generalists when formulating a differential diagnosis for dysphonia.
Select your language of interest to view the total content in your interested language
Post your comment
Share This Article
Relevant Topics
Disc A Healthcare Advertising
Disc Adolescent Medicine
Disc Adult Diseases
Disc Advances in health care
Disc Child Healthcare
Disc Chronic Disease
Disc Chronic Illness
Disc Clinical Guidelines
Disc Clinical Medicine
Disc Community Health
Disc Community Health Doctors
Disc Community Healthcare
Disc Community Medicine
Disc Contraceptive Choice
Disc Critical Care Medicine
Disc Cross-Sectional Study
Disc Dental Medicine
Disc Disease
Disc Emergency Care
Disc Ethical issues in Health care
Disc Family Healthcare
Disc Family Medicine
Disc Family Physician
Disc Family Planning
Disc Family Planning Methods
Disc Family Practice
Disc Future of health care
Disc General Diagnosis
Disc General Health
Disc General Internal Medicine
Disc General Medical Services
Disc General Medicine Doctor
Disc General Pharmacology
Disc General Practice Training
Disc General Practitioner
Disc General Surgery
Disc Health Insurances like
Disc Health Policy
Disc Health administration
Disc Health care communications
Disc Health care databases
Disc Health care economics
Disc Health care equipment
Disc Health care finance
Disc Health care innovation
Disc Health care insurance
Disc Health care insurance business
Disc Health care legislation
Disc Health care market analysis
Disc Health care products and market analysis
Disc Health care software’s
Disc Health care statistics
Disc Healthcare
Disc Hospitalized
Disc Life Threatening Disease
Disc Maternal Health
Disc Medical Profession
Disc Medication
Disc Medicine and Surgery
Disc Nurse Practitioner
Disc Patients
Disc Physician
Disc Physiology
Disc Pregnant Women Diabetes
Disc Prescription
Disc Prescription Drug
Disc Primary Care Physician
Disc Primary Care Sports Medicines
Disc Primary Care internal Medicine
Disc Primary Health Care
Disc Primary Health Organisation
Disc Risk Factors
Disc Rural Healthcare
Disc Sexual Health
Disc Social Service
Disc Systemic Disease
Disc Transfusion Medicine
Disc Treatment and Diagnosis
Recommended Journals
Disc Journal of Primary Health Care: Open Access
Disc Journal of Health Care : Current Reviews
Disc Journal of General Medicine: Open Access
Disc Journal of Family Medicine & Medical Science Research
  View More»
Recommended Conferences
Disc Internal Medicine Conference
Nov 03-05, 2016, Baltimore, USA
Article Tools
Disc Export citation
Disc Share/Blog this article
Article usage
  Total views: 7768
  [From(publication date):
February-2016 - Oct 28, 2016]
  Breakdown by view type
  HTML page views : 7726
  PDF downloads :42

Review summary

  1. Breonia Cale
    Posted on Oct 18 2016 at 2:31 pm
    The authors considered a previously unreported problem in usage of drug in relation to those who treat patients with toxic drug use. The consensus regarding tobacco use and its association with cancer took quite some time to develop - involving epidemiologic studies, chemical studies, and some biologic experiments. The assertion that SC might involve similar mechanisms and might lead to squamous cancer seems unwarranted by current evidence.

Post your comment

captcha    Reload  Can't read the image? click here to refresh

OMICS International Journals
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
OMICS International Conferences 2016-17
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri, Food, Aqua and Veterinary Science Journals

Dr. Krish

1-702-714-7001 Extn: 9040

Clinical and Biochemistry Journals

Datta A

1-702-714-7001Extn: 9037

Business & Management Journals


1-702-714-7001Extn: 9042

Chemical Engineering and Chemistry Journals

Gabriel Shaw

1-702-714-7001 Extn: 9040

Earth & Environmental Sciences

Katie Wilson

1-702-714-7001Extn: 9042

Engineering Journals

James Franklin

1-702-714-7001Extn: 9042

General Science and Health care Journals

Andrea Jason

1-702-714-7001Extn: 9043

Genetics and Molecular Biology Journals

Anna Melissa

1-702-714-7001 Extn: 9006

Immunology & Microbiology Journals

David Gorantl

1-702-714-7001Extn: 9014

Informatics Journals

Stephanie Skinner

1-702-714-7001Extn: 9039

Material Sciences Journals

Rachle Green

1-702-714-7001Extn: 9039

Mathematics and Physics Journals

Jim Willison

1-702-714-7001 Extn: 9042

Medical Journals

Nimmi Anna

1-702-714-7001 Extn: 9038

Neuroscience & Psychology Journals

Nathan T

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

John Behannon

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

1-702-714-7001 Extn: 9042

© 2008-2016 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version