What are synthetic cannabinoids?

From the Guidelines

Synthetic cannabinoids are highly potent and unpredictable substances that pose significant health risks, including severe adverse effects and even death, and their use should be strongly discouraged due to their potential to cause harm. These substances are laboratory-created chemicals designed to mimic the effects of THC, the main psychoactive compound in cannabis, but they bind to the same cannabinoid receptors in the brain with greater potency and unpredictable effects 1. Common synthetic cannabinoids include compounds like JWH-018, K2, and Spice, which are typically sprayed onto dried plant material and smoked, though they may also be sold as liquids for vaping or as edibles 1. Unlike natural cannabis, synthetic cannabinoids can cause severe adverse effects including extreme anxiety, paranoia, hallucinations, seizures, rapid heart rate, kidney damage, and even death 1. The chemical composition of these substances frequently changes to circumvent drug laws, making their potency and effects highly variable, and they are not detectable on standard drug tests designed for natural cannabis 1. Users often mistakenly believe synthetic cannabinoids are safe alternatives to cannabis, when in reality they pose significantly greater health risks 1. The resurgence of synthetic cannabinoid receptor agonists as adulterants in the era of cannabis legalization has created new clinical challenges, emphasizing the need for clinical preparedness, robust quality control measures, enhanced public awareness campaigns, and development of evidence-based clinical guidelines to mitigate the health risks associated with intentional and unintentional use of synthetic cannabinoids 1.

Key Points

• Synthetic cannabinoids are highly potent and unpredictable substances
• They can cause severe adverse effects, including extreme anxiety, paranoia, hallucinations, seizures, rapid heart rate, kidney damage, and even death
• Their chemical composition frequently changes, making their potency and effects highly variable
• They are not detectable on standard drug tests designed for natural cannabis
• Users often mistakenly believe synthetic cannabinoids are safe alternatives to cannabis, when in reality they pose significantly greater health risks

Clinical Implications

• Clinicians should be aware of the potential for synthetic cannabinoid toxicity in patients presenting with severe symptoms
• Patient history, physical examination, and judicious use of supportive laboratory tests are crucial in addressing the nuanced presentations of cannabinoid toxicity
• There is a need for robust quality control measures, enhanced public awareness campaigns, and development of evidence-based clinical guidelines to mitigate the health risks associated with intentional and unintentional use of synthetic cannabinoids 1.

From the Research

Definition and Classification of Synthetic Cannabinoids

• Synthetic cannabinoids are chemical substances that bind to cannabinoid receptors in the body and brain, producing effects similar to those of the Cannabis plant 2.
• They can be classified into different types based on their chemical structure and origin, and are often sprayed on natural herb mixtures to mimic the euphoria effect of cannabis 2.
• Synthetic cannabinoids are available on websites and are often sold as "herbal smoking blends" or "herbal incense" under brand names like "Spice" or "K2" 2.

Effects and Toxicity of Synthetic Cannabinoids

• Synthetic cannabinoids can produce significant psychoactive and physical effects, including changes in cognition, behavioral disturbances, alterations in mood, and perceptual changes 3.
• They are often associated with anxiety, negative mood changes, and psychotic symptoms, including new-onset psychosis and psychotic relapses 3, 4.
• The toxic effects of synthetic cannabinoids can be devastating and unpredictable, varying with the dose, route of administration, individual vulnerability, and concomitant intake with other drugs 5.
• Chronic use of synthetic cannabinoids has been associated with serious psychiatric and medical conditions, including respiratory difficulties, hypertension, tachycardia, chest pain, muscle twitches, acute renal failure, and cognitive impairment 6.

Legal Status and Challenges

• The legal status of synthetic cannabinoids varies by country, with many government institutions pushing for their control 2.
• However, the emergence of new substances requires a constant update of the list of controlled drugs, posing a significant challenge to current drug policy models 2.
• Clinicians should be aware of the effects of synthetic cannabinoid use and have a high index of suspicion, as the diagnosis can be difficult due to the lack of validated testing procedures 3.