Third-generation synthetic cannabinoids caused more severe poisoning with seizures in 27% and symptoms lasting 24+ hours in 34%
A clinical study of 44 ED patients who used AB-CHMINACA or MDMB-CHMICA found that these newer synthetic cannabinoids produced more severe neuropsychiatric symptoms than earlier generations, including seizures (27%), prolonged symptoms (34% lasting 24+ hours), and severe poisoning in 20%.
Quick Facts
What This Study Found
Researchers prospectively studied 44 patients treated in emergency departments after using synthetic cannabinoids, with lab confirmation of AB-CHMINACA and/or MDMB-CHMICA in blood or urine.
Based on the Poison Severity Score, poisoning severity was minor in 4 cases, moderate in 31 cases, and severe in 9 cases (20%).
The most common neuropsychiatric symptoms were CNS depression (61%), disorientation (45%), generalized seizures (27%), combativeness (18%), and extreme agitation (16%). Symptoms lasted 24 hours or longer in 34% of cases.
These rates were notably higher than those previously reported for earlier-generation synthetic cannabinoids (aminoalkylindole-type like JWH-018). The authors concluded that these "third generation" synthetic cannabinoids appear to be associated with more severe clinical toxicity.
In 19 of 44 cases, more than one synthetic cannabinoid was detected, complicating attribution of effects to specific compounds.
Key Numbers
44 patients (39 male, 5 female, ages 12-48). AB-CHMINACA detected in 20 serum samples, MDMB-CHMICA in 19. Severe poisoning: 20%. Seizures: 27%. Symptoms 24+ hours: 34%. CNS depression: 61%. Disorientation: 45%. Multiple SCs in 19 cases.
How They Did This
Prospective observational study of patients in EDs after synthetic cannabinoid use. Clinical and lab data reported to poison control centre. Serum and/or urine analyzed by LC-MS/MS. 44 patients (39 male, 5 female, ages 12-48). Severity graded by Poison Severity Score.
Why This Research Matters
As synthetic cannabinoid chemistry evolves, each new generation appears to carry increased risk. The finding that third-generation compounds produce more seizures, more severe poisoning, and longer symptom duration than earlier generations is a critical public health warning.
The Bigger Picture
The rapid turnover of synthetic cannabinoid compounds on the drug market means that users face an evolving and increasingly dangerous chemical landscape. Each new generation of compounds can be more potent and toxic than the last, with effects that are difficult to predict from earlier products.
What This Study Doesn't Tell Us
In 19 of 44 cases, multiple synthetic cannabinoids were present, making it difficult to attribute effects to specific compounds. Other psychoactive substances were found in 7 cases. Prospective design at select EDs may not capture all presentations. The sample size limits generalization about specific compounds.
Questions This Raises
- ?Will fourth-generation synthetic cannabinoids be even more toxic?
- ?What specific pharmacological properties make newer compounds more dangerous?
- ?Should synthetic cannabinoid presentations be managed differently based on generation?
Trust & Context
- Key Stat:
- 27% had seizures; 34% had symptoms lasting 24+ hours
- Evidence Grade:
- Prospective observational study with analytical confirmation of specific compounds provides moderate evidence on the clinical toxicity of these third-generation synthetic cannabinoids.
- Study Age:
- Published in 2018. New synthetic cannabinoid compounds have continued to emerge, and toxicity profiles continue to evolve.
- Original Title:
- Acute side effects after consumption of the new synthetic cannabinoids AB-CHMINACA and MDMB-CHMICA.
- Published In:
- Clinical toxicology (Philadelphia, Pa.), 56(6), 404-411 (2018)
- Authors:
- Hermanns-Clausen, Maren(2), Müller, Dieter, Kithinji, Josephine, Angerer, Verena, Franz, Florian, Eyer, Florian, Neurath, Hartmud, Liebetrau, Gesine, Auwärter, Volker
- Database ID:
- RTHC-01685
Evidence Hierarchy
Watches what happens naturally without intervening.
What do these levels mean? →Frequently Asked Questions
Are newer synthetic cannabinoids more dangerous?
This study found that AB-CHMINACA and MDMB-CHMICA (third-generation) produced higher rates of seizures (27%), severe poisoning (20%), and prolonged symptoms than previously reported for earlier synthetic cannabinoids like JWH-018.
What are the main symptoms?
The most common were CNS depression (61%), disorientation (45%), generalized seizures (27%), combativeness (18%), and extreme agitation (16%). Over a third of patients had symptoms lasting more than 24 hours.
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Cite This Study
https://rethinkthc.com/research/RTHC-01685APA
Hermanns-Clausen, Maren; Müller, Dieter; Kithinji, Josephine; Angerer, Verena; Franz, Florian; Eyer, Florian; Neurath, Hartmud; Liebetrau, Gesine; Auwärter, Volker. (2018). Acute side effects after consumption of the new synthetic cannabinoids AB-CHMINACA and MDMB-CHMICA.. Clinical toxicology (Philadelphia, Pa.), 56(6), 404-411. https://doi.org/10.1080/15563650.2017.1393082
MLA
Hermanns-Clausen, Maren, et al. "Acute side effects after consumption of the new synthetic cannabinoids AB-CHMINACA and MDMB-CHMICA.." Clinical toxicology (Philadelphia, 2018. https://doi.org/10.1080/15563650.2017.1393082
RethinkTHC
RethinkTHC Research Database. "Acute side effects after consumption of the new synthetic ca..." RTHC-01685. Retrieved from https://rethinkthc.com/research/hermanns-clausen-2018-acute-side-effects-after
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.