Mixing synthetic cannabinoids with other drugs significantly increases toxicity | Research

The takeaway

Among 49 emergency department patients with confirmed synthetic cannabinoid ("bonsai") use, those who also used other substances had lower consciousness scores, longer symptom duration, and higher hospitalization rates.

Emergency physicians, synthetic cannabinoid users, and harm reduction workers.

No hospitalizations needed for bonsai-only users

What the researchers found

69.4% of patients had concomitant drug intake. Most common co-substances: THC (32.7%), alcohol (30.6%), cocaine (20.4%), opiates (18.4%), amphetamines (14.3%). The concomitant group had significantly lower Glasgow Coma Scores (p=0.003), longer symptom remission times, and higher hospitalization rates (p=0.020). No patients in the bonsai-only group required hospitalization. Median symptom remission time was 3 hours; median ED follow-up was 6 hours.

Why it matters

Most synthetic cannabinoid users also use other substances, and the combination significantly increases the severity of toxicity and healthcare utilization.

The numbers in context

49 patients analyzed (91.8% male, mean age 26.7). 69.4% had concomitant drug use. GCS significantly lower in poly-drug group (p=0.003). No hospitalizations in bonsai-only group. Most common symptom: tachycardia (75.5%).

How the study worked

Prospective study of 217 ED patients with reported bonsai intake. 49 with confirmed positive urinary metabolites were analyzed in two groups: bonsai-only and bonsai with concomitant substances.

What this study cannot tell us

Small sample (49 patients). Single country (Turkey). Only patients with positive urinary metabolites included. Self-reported substance use history.

How to read the evidence

Prospective study with confirmed toxicology, but small sample and single-center.

When this study was published

2020 study using 2014-2016 data.

The bigger picture

Harm reduction messaging should emphasize the particular danger of combining synthetic cannabinoids with other substances, as the bonsai-only group had relatively mild outcomes.

Questions still open

Which substance combinations with synthetic cannabinoids are most dangerous? Would targeted harm reduction about mixing reduce hospitalizations?

Common questions

Is mixing synthetic cannabinoids with other drugs dangerous?

This study found that patients who combined synthetic cannabinoids with other substances had significantly lower consciousness, longer symptom duration, and higher hospitalization rates than those using synthetic cannabinoids alone.

What are the effects of synthetic cannabinoid use alone?

In this study, patients using only synthetic cannabinoids had tachycardia as the most common symptom, with symptoms resolving in about 3 hours and none requiring hospitalization.

Read the original research

Concomitant Substance Use Increases the Toxic Effect of synthetic cannabinoid (Bonsai): A Prospective Study.

Acta bio-medica : Atenei Parmensis, 92(1), e2021006

View on PubMed ↗Publisher’s paper ↗

Citation

Beydilli, İnan; Duyan, Murat; Yılmaz, Fevzi; Arslan, Engin Deniz; Korkmaz, İlhan; Akçimen, Mehmet; Keşaplı, Mustafa; İmak, Arefe; Çakır, Umut Cengiz; Kavalcı, Cemil; Ararat, Ertan; Ellidağ, Hamit. (2020). Concomitant Substance Use Increases the Toxic Effect of synthetic cannabinoid (Bonsai): A Prospective Study.. Acta bio-medica : Atenei Parmensis, 92(1), e2021006. https://doi.org/10.23750/abm.v92i1.9989