Mixing synthetic cannabinoids with other drugs significantly increases toxicity
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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.
Why This Research Matters
Most synthetic cannabinoid users also use other substances, and the combination significantly increases the severity of toxicity and healthcare utilization.
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.
What This Study Doesn't Tell Us
Small sample (49 patients). Single country (Turkey). Only patients with positive urinary metabolites included. Self-reported substance use history.
Questions This Raises
- ?Which substance combinations with synthetic cannabinoids are most dangerous?
- ?Would targeted harm reduction about mixing reduce hospitalizations?
Trust & Context
- Key Stat:
- No hospitalizations needed for bonsai-only users
- Evidence Grade:
- Prospective study with confirmed toxicology, but small sample and single-center.
- Study Age:
- 2020 study using 2014-2016 data.
- Original Title:
- Concomitant Substance Use Increases the Toxic Effect of synthetic cannabinoid (Bonsai): A Prospective Study.
- Published In:
- Acta bio-medica : Atenei Parmensis, 92(1), e2021006 (2020)
- Authors:
- 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
- Database ID:
- RTHC-02421
Evidence Hierarchy
Enrolls participants and follows them forward in time.
What do these levels mean? →Frequently Asked 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.
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Cite This Study
https://rethinkthc.com/research/RTHC-02421APA
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
MLA
Beydilli, İnan, et al. "Concomitant Substance Use Increases the Toxic Effect of synthetic cannabinoid (Bonsai): A Prospective Study.." Acta bio-medica : Atenei Parmensis, 2020. https://doi.org/10.23750/abm.v92i1.9989
RethinkTHC
RethinkTHC Research Database. "Concomitant Substance Use Increases the Toxic Effect of synt..." RTHC-02421. Retrieved from https://rethinkthc.com/research/beydilli-2020-concomitant-substance-use-increases
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.