Synthetic cannabinoid users report worse withdrawal, faster tolerance, and harder dose control than natural cannabis users | Research

The takeaway

Among 284 frequent synthetic cannabinoid users, withdrawal averaged 4.4 symptoms, with sleep issues, irritability, and low mood most common, and users rated synthetic cannabinoids as having faster onset, shorter duration, faster tolerance, and more severe withdrawal than high-potency natural cannabis.

Addiction specialists, emergency physicians, harm reduction workers, and policymakers.

SCRAs: faster onset, faster tolerance, more severe withdrawal than cannabis

What the researchers found

Users reported a mean of 4.4 withdrawal symptoms after 1+ day without SCRAs. Most frequent: sleep issues (59.2%), irritability (55.6%), low mood (54.2%). Higher SCRA use frequency and quantity predicted more withdrawal symptoms. Compared to high-potency cannabis, SCRAs had faster onset, shorter duration of effects, faster tolerance development, and more severe withdrawal (all p<0.001).

Why it matters

Synthetic cannabinoids are often used by people who cannot access or afford natural cannabis. Understanding their worse withdrawal profile is crucial for treatment planning in this vulnerable population.

The numbers in context

N=284; mean 4.4 withdrawal symptoms; sleep issues 59.2%; irritability 55.6%; low mood 54.2%. Frequency >51x/year: IRR=1.43 for symptoms. Greater grams/session: IRR=1.13.

How the study worked

Global Drug Survey data (2015-2016) from 284 people reporting SCRA use >10 times in the past year, a previous quit attempt, and lifetime high-potency cannabis use. 11-item withdrawal checklist and comparative ratings of SCRAs vs. natural cannabis.

What this study cannot tell us

Self-selected online survey sample. Retrospective self-report of withdrawal. Cannot verify specific SCRA products used. Comparison to high-potency cannabis is subjective. No clinical verification of withdrawal.

How to read the evidence

Large self-selected online survey with useful comparative data, but no clinical verification.

When this study was published

Published in 2022 using 2015-2016 survey data.

The bigger picture

The worse withdrawal and faster tolerance profile of synthetic cannabinoids compared to natural cannabis supports the argument that these substances pose substantially greater dependence risk, consistent with their higher potency at CB1 receptors.

Questions still open

Would medical-grade cannabis help manage SCRA withdrawal? Does the faster tolerance drive users to escalate doses dangerously? Should SCRA withdrawal be managed differently from cannabis withdrawal?

Common questions

Are synthetic cannabinoid withdrawals worse than cannabis withdrawals?

Users in this study rated synthetic cannabinoids as having significantly more severe withdrawal than high-potency natural cannabis. Synthetic users also developed tolerance faster and found doses harder to control.

What are the most common synthetic cannabinoid withdrawal symptoms?

Sleep problems (59.2%), irritability (55.6%), and low mood (54.2%) were most commonly reported. On average, users experienced 4.4 withdrawal symptoms after just one day without use.

Read the original research

Clinical withdrawal symptom profile of synthetic cannabinoid receptor agonists and comparison of effects with high potency cannabis.

Psychopharmacology, 239(5), 1349-1357

View on PubMed ↗Publisher’s paper ↗

Citation

Craft, Sam; Ferris, Jason A; Barratt, Monica J; Maier, Larissa J; Lynskey, Michael T; Winstock, Adam R; Freeman, Tom P. (2022). Clinical withdrawal symptom profile of synthetic cannabinoid receptor agonists and comparison of effects with high potency cannabis.. Psychopharmacology, 239(5), 1349-1357. https://doi.org/10.1007/s00213-021-05945-1