Teens on synthetic cannabinoids were far more likely to have coma and seizures than those using regular cannabis | Research

The takeaway

Adolescents presenting to emergency departments after synthetic cannabinoid exposure had 3.4 times higher odds of coma/CNS depression and 3.9 times higher odds of seizures compared to those with traditional cannabis exposure.

Emergency physicians, parents, school health officials, and anyone working with adolescent substance use.

3.9x higher seizure odds

What the researchers found

Synthetic cannabinoid-only exposure (n=107) was associated with 3.4x higher odds of coma/CNS depression (OR 3.42, 95% CI 1.51-7.75) and 3.9x higher odds of seizures (OR 3.89, 95% CI 1.39-10.94) compared to cannabis-only exposure (n=86). Interestingly, SC-only exposure was associated with lower odds of agitation (OR 0.18), while SC-polydrug exposure showed the opposite pattern.

Why it matters

This provides the first large multicenter comparison of neuropsychiatric outcomes between synthetic cannabinoid and traditional cannabis use specifically in adolescents, the age group most likely to use these products.

The numbers in context

SC-only: OR 3.42 for coma/CNS depression, OR 3.89 for seizures, OR 0.18 for agitation. SC-polydrug: OR 3.11 for agitation, OR 4.8 for seizures. 107 SC-only cases, 86 cannabis-only cases, 38 SC-polydrug cases, 117 cannabis-polydrug cases.

How the study worked

Retrospective analysis of the Toxicology Investigators Consortium Case Registry, a multicenter registry with data prospectively collected by medical toxicologists. Reviewed SC and cannabis exposures in adolescents from 2010-2018 across four exposure groups.

What this study cannot tell us

Retrospective design with potential selection bias (only captures ED presentations). Specific synthetic cannabinoid compounds were generally unknown. Polydrug use complicates attribution. The registry may not capture milder cases.

How to read the evidence

Rated moderate because this is a large multicenter registry study with prospective data collection, though the retrospective analysis and inability to identify specific SC compounds are limitations.

When this study was published

Published in 2019 covering 2010-2018 data. New synthetic cannabinoid compounds have continued to appear since.

The bigger picture

The distinct neuropsychiatric profiles of SC versus cannabis exposure suggest fundamentally different pharmacological effects, not just stronger versions of the same thing. The CNS depression and seizure risk with SC use represents a qualitatively different danger.

Questions still open

Which specific synthetic cannabinoid compounds are most associated with seizures? Why does SC-only exposure cause CNS depression while SC-polydrug causes agitation? Are there long-term neurological consequences of adolescent SC exposure?

Common questions

Are synthetic cannabinoids more dangerous than marijuana for teens?

In this study, yes. Teens arriving at the ED after synthetic cannabinoid use were 3.4 times more likely to have coma or CNS depression and 3.9 times more likely to have seizures compared to those using traditional cannabis.

What neuropsychiatric effects do synthetic cannabinoids cause?

The most prominent effects were coma/CNS depression and seizures with SC-only use. When combined with other drugs, agitation became more common. These patterns differ significantly from traditional cannabis, which was more associated with agitation alone.

Why are synthetic cannabinoids so much more harmful?

Synthetic cannabinoids are typically much more potent at cannabinoid receptors than THC, and many also bind to other receptor types. Their chemical compositions vary widely and are often unknown, making effects unpredictable.

Read the original research

Neuropsychiatric Sequelae in Adolescents With Acute Synthetic Cannabinoid Toxicity.

Pediatrics, 144(2)

View on PubMed ↗Publisher’s paper ↗

Citation

Anderson, Sarah Ann R; Oprescu, Anna M; Calello, Diane; Monte, Andrew; Dayan, Peter S; Hurd, Yasmin L; Manini, Alex F. (2019). Neuropsychiatric Sequelae in Adolescents With Acute Synthetic Cannabinoid Toxicity.. Pediatrics, 144(2). https://doi.org/10.1542/peds.2018-2690