Researchers at Rambam Health Care Campus (Rambam) in Haifa, Israel, have discovered how to accurately identify signs of poisoning from “Mr. Nice Guy”– a popular street drug – using advanced imaging technology. Their discovery could help prevent the deadly consequences of this drug’s use.
Patients arrive at Rambam’s Green-Wagner Department of Emergency Medicine. Photography: Rambam HCC
The synthetic marijuana substitute, “Mr. Nice Guy,” is one of the most popular and dangerous street drugs in Israel. A new diagnostic method uncovered by Rambam’s research team, using computed tomography (CT) imaging, may allow physicians to properly diagnose the drug’s presence and prevent users from falling victim to potentially fatal “Nice Guy” poisoning. These research findings were published in the latest issue of the prestigious medical journal, European Radiology.
Synthetic marijuana use, such as “Mr. Nice Guy,” represents a public health hazard worldwide, including in Israel. The popular drug was designed to imitate the hypnotic effect of smoking marijuana. It is packaged in bags containing herbs that are laced with rat poison. Users typically smoke the drug, but in some cases, it is snorted and even injected. Over a nine-month period spanning 2021 and 2022, nearly 100 patients in Northern Israel were hospitalized due to bleeding caused by severe “Mr. Nice Guy” poisoning. Four of these 100 cases resulted in death.
The drug initially elevates the mood and relaxes users, but this effect lasts only ten minutes, tempting users to take more. Some side effects that develop shortly after repeated and frequent use include extreme anxiety, confusion, paranoia, hallucinations, rapid heart rate, vomiting, aggressive behavior, and suicidal thoughts.
According to Dr. Nitai Bar who heads the team of researchers in the Department of Medical Imaging at Rambam, the active ingredient of the toxic substances is similar to that used in blood-thinning drugs. Yet, unlike drugs that remain in the body for several days, “Mr. Nice Guy” remains active in the blood for weeks and is fifteen times stronger.
Dr. Bar explains that the main problem in treating those poisoned by the drug is late diagnosis. In their study, Dr. Bar and colleagues reviewed all imaging tests performed on 48 poisoned victims treated at Rambam and noted a common thread in each case. The researchers found bleeding in the kidneys in most of the “Mr. Nice Guy” users, even in those who did not complain of related symptoms, such as blood in the urine.
“We found that, in 90% of users, typical signs of damage to the coagulation mechanism can be identified: very simply, through blood in the urine,” explains Dr. Bar. “These are subtle signs that are easy to miss if you don't know what you’re looking for. This type of bleeding has already been documented in rare cases in the past, but in the context of “Mr. Nice Guy” poisoning, we discovered it is extremely common. He adds, “Our discovery is significant since a routine imaging test performed for suspected stones in the urinary tract can be used to diagnose these patients. Quickly identifying the culprit and providing patients with the appropriate treatment can save their lives.”
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