Synthetic cannabinoids are more potent and far more dangerous than natural cannabis | Research

The takeaway

A public health review found that synthetic cannabinoids bind to brain receptors with much higher potency than natural cannabis and cause severe adverse effects including psychosis, kidney failure, and death.

Read this if you or someone you know uses synthetic cannabinoids and wants to understand how different they are from natural cannabis.

Synthetic cannabinoids cause psychosis, kidney failure, and death; natural cannabis does not

What the researchers found

Researchers reviewed the epidemiology and health effects of synthetic cannabinoids compared to natural cannabis from a public health perspective. The differences were stark.

Synthetic cannabinoid products contain mixtures of psychoactive compounds that bind to cannabinoid receptors with much higher potency than THC from natural cannabis. While they replicate the basic effects of cannabis, they induce substantially more severe adverse effects.

Acute effects include respiratory difficulties, hypertension, tachycardia, chest pain, muscle twitches, acute kidney failure, anxiety, agitation, psychosis, suicidal ideation, and cognitive impairment. Chronic use has been associated with serious psychiatric conditions, medical complications, and even death.

The unpredictability is a key danger: unlike natural cannabis with relatively predictable THC content, synthetic products contain unknown concentrations of multiple active compounds, any of which could produce toxic effects. As regulations ban specific compounds, manufacturers modify the chemical structure slightly, creating new untested substances.

Why it matters

Synthetic cannabinoids remain widely available despite regulatory efforts, and users often underestimate the risk because they view them as a form of cannabis. This review makes clear that synthetic cannabinoids are a fundamentally different and more dangerous class of drugs that happen to target the same receptors.

The numbers in context

Synthetic cannabinoids bind cannabinoid receptors with higher potency than THC. Adverse effects include: respiratory difficulties, hypertension, tachycardia, chest pain, acute renal failure, psychosis, suicidal ideation. Chronic use associated with death. Continuous chemical modification circumvents regulation.

How the study worked

Narrative review of current literature on the epidemiology, acute effects, and chronic effects of synthetic and natural cannabinoid drugs, conducted from a public health perspective.

What this study cannot tell us

This is a narrative review and does not systematically assess the quality of included studies. Adverse effect data come largely from case reports and poison control data rather than controlled studies. The rapidly evolving landscape of synthetic cannabinoids means any review quickly becomes outdated. Prevalence data are likely underestimates due to underreporting.

How to read the evidence

This is a comprehensive public health review synthesizing evidence on a well-documented but under-studied drug class.

When this study was published

Published in 2018. The synthetic cannabinoid landscape continues to evolve with new compounds.

The bigger picture

The synthetic cannabinoid epidemic illustrates the limitations of substance-by-substance regulation. As fast as authorities ban specific compounds, manufacturers create new analogs. A public health approach focused on education about the fundamental differences between synthetic and natural cannabinoids may be more effective than regulatory whack-a-mole.

Questions still open

Why do people choose synthetic cannabinoids over natural cannabis? Can regulation ever keep pace with the rate of new synthetic compound creation? Would expanded legal access to natural cannabis reduce synthetic cannabinoid use?

Common questions

Are synthetic cannabinoids the same as marijuana?

No. While they target the same brain receptors, synthetic cannabinoids are far more potent and unpredictable. They cause severe adverse effects including psychosis, kidney failure, heart problems, and death that are not typically seen with natural cannabis.

Why are synthetic cannabinoids more dangerous?

They bind to cannabinoid receptors with much higher potency, they contain unknown mixtures of active chemicals, and their composition changes constantly as manufacturers modify structures to evade regulations. Users have no way of knowing what or how much they are consuming.

Read the original research

Synthetic and Non-synthetic Cannabinoid Drugs and Their Adverse Effects-A Review From Public Health Prospective.

Frontiers in public health, 6, 162

View on PubMed ↗Publisher’s paper ↗

Citation

Cohen, Koby; Weinstein, Aviv M. (2018). Synthetic and Non-synthetic Cannabinoid Drugs and Their Adverse Effects-A Review From Public Health Prospective.. Frontiers in public health, 6, 162. https://doi.org/10.3389/fpubh.2018.00162