Australian study of 55 synthetic cannabinoid-related deaths found cardiovascular disease was prominent alongside acute toxicity | Research

The takeaway

Among 55 synthetic cannabinoid-related deaths in Australia, acute toxicity was the most common cause (38%) but cardiovascular disease was strikingly prevalent, with 20% having severe atherosclerosis and the most common compound being AB-CHMINACA.

Emergency physicians, toxicologists, harm reduction professionals, forensic pathologists

20% had severe atherosclerosis; mean age only 37.2 years; 91% male

What the researchers found

Causes of death: accidental toxicity (38.2%), natural disease (20%), suicide (10.9%), accidental toxicity with CVD (9.1%), traumatic accident (10.9%). Cardiovascular findings included severe atherosclerosis (20%), myocardial fibrosis (18%), and cardiomegaly (12%). AB-CHMINACA was found in 38.2% of cases. Mean age was 37.2 years; 91.1% male.

Why it matters

The prominence of cardiovascular disease in relatively young decedents raises concerns about chronic cardiovascular toxicity from synthetic cannabinoids, beyond the acute toxicity risk.

The numbers in context

55 deaths; mean age 37.2; 91.1% male. Accidental toxicity 38.2%. Severe atherosclerosis 20%. AB-CHMINACA 38.2%. Sudden collapse was most common presentation (25.5%). Co-substances: alcohol 34.5%, THC 23.6%.

How the study worked

Retrospective study of all 55 cases in Australia's National Coronial Information System (2000-2017) where synthetic cannabinoid use contributed to death. Demographics, circumstances, toxicology, and organ pathology analyzed.

What this study cannot tell us

Australian data may not reflect SC composition in other countries; retrospective coronial data; cardiovascular disease may reflect pre-existing conditions rather than SC-caused damage; selection bias toward most severe outcomes.

How to read the evidence

National coronial database with comprehensive case review, though limited to the most severe outcomes.

When this study was published

Published in 2020.

The bigger picture

Unlike natural cannabis, synthetic cannabinoids appear to carry significant cardiovascular and acute toxicity risks that can be fatal, underscoring the harm reduction case for regulated natural cannabis access.

Questions still open

Do synthetic cannabinoids directly cause cardiovascular damage, or are users a population with pre-existing cardiovascular risk? Would rapid identification of new compounds prevent some deaths?

Common questions

Are synthetic cannabinoids deadlier than natural cannabis?

The pattern of deaths in this study, including acute toxicity, sudden collapse, and cardiovascular disease in relatively young people, is far more severe than what is typically associated with natural cannabis. AB-CHMINACA, the most common compound found, is a potent full agonist at cannabinoid receptors, unlike THC which is a partial agonist.

Why was cardiovascular disease so common?

Severe atherosclerosis in 20% and myocardial fibrosis in 18% of cases (mean age 37) is unusual. Whether synthetic cannabinoids directly damaged the cardiovascular system or whether these individuals had pre-existing conditions is unknown.

Read the original research

Characteristics and circumstances of synthetic cannabinoid-related death.

Clinical toxicology (Philadelphia, Pa.), 58(5), 368-374

View on PubMed ↗Publisher’s paper ↗

Citation

Darke, Shane; Duflou, Johan; Farrell, Michael; Peacock, Amy; Lappin, Julia. (2020). Characteristics and circumstances of synthetic cannabinoid-related death.. Clinical toxicology (Philadelphia, Pa.), 58(5), 368-374. https://doi.org/10.1080/15563650.2019.1647344