Synthetic cannabinoids showed higher toxicity than THC with more seizures, deaths, and psychiatric emergencies

Across 64 studies (10 original papers and 54 case studies), synthetic cannabinoid use was associated with severe toxicity including death (14 studies), with AB-CHMINACA and MDMB-CHMICA most commonly involved in fatalities. Tachycardia and seizures were the most common toxicity symptoms. Third-generation synthetic cannabinoids produced higher rates of neuropsychiatric symptoms compared to earlier generations. SCs showed higher potential than THC for triggering convulsions, consciousness decline, and hemodynamic instability.

Systematic review searching PubMed, Google Scholar, CompTox Chemicals, and Web of Science up to May 2022. Included studies analyzing synthetic cannabinoid toxicity and dependence in humans.

Synthetic cannabinoids are often used by people seeking to avoid drug tests or who cannot access regulated cannabis. Understanding their dramatically higher toxicity profile is essential for harm reduction messaging.

As synthetic cannabinoids evolve through generations to evade legal restrictions, they become increasingly potent and unpredictable. The irony is that cannabis prohibition drives some users toward far more dangerous synthetic alternatives.

Heavy reliance on case reports and case studies (54/64). Publication bias toward severe outcomes. Difficulty identifying specific SC compounds in many cases. Polysubstance use common in reported cases.