ReviewTop 10 Facts You Need to Know About Synthetic Cannabinoids: Not So Nice Spice
Section snippets
Synthetic Cannabinoids Are Not Marijuana/Cannabis
Although these illegal substances are commonly referred to as synthetic cannabinoids, cannabinoid receptor agonists, cannabimimetic agents, Spice, synthetic marijuana, or even legal marijuana, they should not be confused with marijuana/cannabis or the legal synthetic cannabinoids/cannabinoid receptor agonists such as Cesamet (nabilone; Meda Pharmaceuticals Inc, Somerset, NJ) or Marinol (dronabinol; Δ9-tetrahydrocannabinol; AbbVie Inc, North Chicago, IL).1, 3, 4, 5 Illegal synthetic
Synthetic Cannabinoids Are Often More Potent Than Marijuana/Cannabis4
One reason Spice may be more potent than marijuana is because the chemical components bind more strongly to the cannabinoid receptor in the brain; they also may interact with other receptors in the brain that marijuana does not.3 Symptoms may resolve spontaneously without intervention and vary, including mild to moderate intoxication-like symptoms, nausea, emesis, weakness, tachycardia, hypertension, and agitation.1, 4 Several news reports have described users in states of “excited delirium,”
Synthetic Cannabinoids Are Ever-changing
The 2012 Synthetic Drug Abuse Prevention Act made 15 synthetic cannabinoids Schedule I8; the Drug Enforcement Administration continues to designate active Spice chemicals and their analogs Schedule I, making these products illegal to sell, buy, or possess.8 In January 2015, 3 more were made Schedule I, including AB-CHMINACA8 (Figure 1). However, the clandestine manufacturers change the chemical formulations frequently to evade law enforcement.3 MAB-CHMINACA is an example of the tweaked
Synthetic Cannabinoid Research Was “High Jacked”9,10
Synthetic cannabinoids research began over 40 years ago to evaluate their use as pharmaceutical agents.11 These synthetic cannabinoids were never designed to be abused as they are today but were legitimate scientific and medical research. Unfortunately, clandestine manufacturers began illegally synthesizing some of the compounds and distributing for illicit use.9 Early examples of legitimate research compounds that started showing up in illegal products include JWH-018 and HU-210, as well as
Synthetic Cannabinoids Are Dangerous Chemicals with Unpredictable Composition and Human Toxicity
The user does not really know what he/she is consuming because the chemicals are rapidly changing; amount of drug is unknown; and the herbal components are typically unknown.11 The vast majority of these chemicals have never been evaluated in a controlled setting with laboratory animals or humans. Many of these products are laced with substances ranging from simple flavors to more dangerous substances such as other drugs, rat poison, and embalming fluids.11, 12
Synthetic Cannabinoids Have Many Street Names
Common street names for Spice are listed in the Table.4, 13 The “trade names,” along with catchy packaging, are used to “market” the products; dealers may also try to increase sales by adding flavors or mixing other drugs such as methamphetamine, ecstasy, bath salts, or phencyclidine, making the products even more dangerous.12 “Trade names” are not necessarily indicative of a specific synthetic cannabinoid; any available type could be present in any labeled package or an unlabeled bag.12 Newly
Synthetic Cannabinoids Usage Is Not Limited to Young People
The 2014 Monitoring the Future survey reports Spice usage by 12th graders has fallen steadily since 2012.14 Its overall decline nationally with young people, according to the National Institute on Drug Abuse likely stems from increased perception of risk.13 The recent outbreaks, however, could represent that the perception of risk is reversing, and its use is not limited to young people. In our state, the ages for the recent emergency department visits ranged from 12-69 years.15 Perceived
Synthetic Cannabinoids Are Easily Obtained
Individual drug dealers were involved in the majority of our state cases and likely were selling chemicals being imported from overseas (ie, China/India).11, 12 A recent article in The Guardian stated that the majority of these chemicals are being produced in China, which is now being called the “new front in the global drug war.”17 The chemicals are usually white, mixed with acetone, and typically sprayed onto an herbal concoction, labeled “not for human consumption.”3, 4, 8, 11 They usually
Synthetic Cannabinoids Can Be Addicting, with Unknown Long-term Consequences
Proposed factors that contribute to their addiction potential include the increased binding affinity, full agonism of the receptor (THC partially agonizes the receptor), and active metabolites; some bind over 100 times more tightly than THC.5, 20 Cannabinoid-1 (CB1) and CB2 receptors are found mainly in the central nervous system and immune tissues, respectively. While both receptor types are affected by synthetic cannabinoids, stimulation of CB1 causes a greater psychoactive effect through its
Provider Education Is Key
Numerous misconceptions about synthetic cannabinoids exist in the community, including that these products are “natural,” “safe,” or “legal marijuana.”3 Any Spice product is likely to be of different chemical composition and of varying potency at different points of sale, leading to inconsistency in effect.11 Spice can be unsafe in any quantity or frequency of use; using these products is a big risk.11 It may seem to be a daunting task for providers to keep up with all of the changes in
Conclusion
Synthetic cannabinoids have emerged as a significant problem resulting in many emergency department visits and even fatalities. To counter this growing problem, it is imperative that providers be aware of these dangerous substances and their effects on patients. Also, given the variability in clinical presentations, providers need to keep the use of synthetic cannabinoids in the differential for any patient who presents with symptoms described above. Educational tools such as the ones mentioned
References (22)
- et al.
Spice drugs are more than harmless herbal blends: a review of the pharmacology and toxicology of synthetic cannabinoids
Prog Neuropsychopharmacol Biol Psychiatry
(2012) - et al.
Substance abuse treatment need among older adults in 2020: the impact of the aging baby-boom cohort
Drug Alcohol Depend
(2003) Adverse events associated with the use of synthetic cannabinoids—Mississippi, 2015
Mississippi Morb Rep
(2015)- et al.
Notes from the field: increase in reported adverse health effects related to synthetic cannabinoid use — United States, January–May 2015
MMWR Morb Mortal Wkly Rep
(2015) - National Institute on Drug Abuse. DrugFacts: K2/Spice (“Synthetic Marijuana”). Available at:...
Patients may be using synthetic cannabinoids more than you think
JEMS
(2014)- European Monitoring Centre for Drugs and Drug Addiction. Synthetic cannabinoids and “Spice” profile. Available at:...
Synthetic cannabinoids: acute intoxication
(2015)- et al.
Synthetic cannabinoid use: recognition and management
J Psychiatr Pract
(2012) - U.S. Department of Justice, Drug Enforcement Administration/Office of Diversion Control. Rules – 2013. Available at:...
Hijacking of basic research: the case of synthetic cannabinoids
Methods Rep RTI Press
Cited by (0)
Funding: None.
Conflict of Interest: None.
Authorship: We verify that all authors had access to the data and a role in writing the manuscript.