Synthetic cannabinoids cause far more severe and unpredictable toxicities than marijuana | Research

The takeaway

A review of synthetic cannabinoid toxicities found severe effects across multiple organ systems, including cardiac arrest, psychosis, seizures, kidney failure, and deaths from products tainted with rat poison.

Emergency physicians, substance use counselors, public health officials, and anyone who might encounter synthetic cannabinoid products.

At least 4 deaths from contamination

What the researchers found

Synthetic cannabinoids produced a wide range of severe toxicities including arrhythmias, myocardial infarction, sudden cardiac death, psychosis, suicidal ideation, seizures, acute tubular necrosis, and intracranial hemorrhage. An outbreak of coagulopathies linked to brodifacoum-contaminated products caused at least 4 deaths.

Why it matters

Synthetic cannabinoids are marketed as safe marijuana alternatives, but they are far more potent at cannabinoid receptors and produce unpredictable, sometimes fatal toxicities. Their constantly changing chemical compositions and absence from standard drug tests make them particularly dangerous.

The numbers in context

At least 4 deaths from brodifacoum-contaminated synthetic cannabinoids. Toxicities affected cardiovascular, neurological, renal, and hematological systems. Products are not detected on routine drug screens.

How the study worked

Literature review searching PubMed and SciFinder databases for reports on synthetic cannabinoid toxicities, limited to human studies in English.

What this study cannot tell us

The review relied on published case reports and case series, which may overrepresent severe outcomes. The constantly changing composition of synthetic cannabinoids means findings may not apply to newer formulations.

How to read the evidence

Rated moderate because the review synthesizes multiple human case reports and series, though the evidence is observational rather than experimental.

When this study was published

Published in 2019. The synthetic cannabinoid landscape continues to evolve with new compounds appearing regularly.

The bigger picture

The synthetic cannabinoid problem is a moving target. New compounds appear faster than they can be studied or regulated. The toxicity profile is fundamentally different from natural cannabis, making the "synthetic marijuana" label dangerously misleading.

Questions still open

How can emergency departments better detect synthetic cannabinoid exposure? Are there common mechanisms underlying the diverse organ toxicities? Would expanded cannabis legalization reduce synthetic cannabinoid use?

Common questions

Are synthetic cannabinoids safer than marijuana?

No. This review documented far more severe toxicities from synthetic cannabinoids than are typically associated with natural cannabis, including cardiac arrest, kidney failure, and deaths. They are more potent and unpredictable.

Do drug tests detect synthetic cannabinoids?

Standard drug tests generally do not detect synthetic cannabinoids, which is one reason some users choose them. This also makes it harder for emergency physicians to identify exposure.

Why did some synthetic cannabinoids cause bleeding?

An outbreak of coagulopathy was caused by products contaminated with brodifacoum, a chemical used in rat poison. This illustrates how unregulated manufacturing introduces additional dangers beyond the drugs themselves.

Read the original research

Review of the many faces of synthetic cannabinoid toxicities.

The mental health clinician, 9(2), 93-99

View on PubMed ↗Publisher’s paper ↗

Citation

Alipour, Azita; Patel, Puja Baldev; Shabbir, Zaheera; Gabrielson, Stephen. (2019). Review of the many faces of synthetic cannabinoid toxicities.. The mental health clinician, 9(2), 93-99. https://doi.org/10.9740/mhc.2019.03.093