Among 342 drug-dependent patients in Israel, 16.1% reported recent synthetic cannabinoid use, with cannabis use being the strongest predictor (adjusted OR 9.86), while 24.9% used prescription opioids or fentanyl patches.
Addiction treatment clinicians, toxicologists, and drug use epidemiologists.
Cannabis use: AOR 9.86 for synthetic cannabinoid use; gabapentinoids: AOR 14.33 for opioid use
What the researchers found
Of 342 patients in drug dependence treatment, 16.1% reported past-12-month synthetic cannabinoid receptor agonist (SCRA) use and 24.9% reported recent prescription opioid or fentanyl patch use. SCRA use was strongly associated with cannabis use (AOR 9.86) and synthetic cathinone use (AOR 5.47). Prescription opioid/fentanyl use was associated with gabapentinoids (AOR 14.33), stimulants (AOR 7.12), heroin (AOR 5.81), and benzodiazepines (AOR 4.63).
Why it matters
The near 10-fold association between cannabis and SCRA use confirms that cannabis users are the primary population at risk for synthetic cannabinoid exposure. Clinicians treating cannabis users should screen for SCRA use, which carries far greater toxicity risks.
The numbers in context
342 patients; 16.1% recent SCRA use; 24.9% prescription opioid/fentanyl use; SCRA→cannabis AOR 9.86; SCRA→cathinones AOR 5.47; opioid→gabapentinoids AOR 14.33.
How the study worked
Cross-sectional study of 342 patients in drug dependence treatment in Israel, using questionnaires on recent drug use with adjusted odds ratios from logistic regression.
What this study cannot tell us
Treatment-seeking population in Israel; self-report of drug use; cross-sectional (cannot determine directionality); 342 patients is moderate sample; Israeli drug market may differ from other countries.
How to read the evidence
Moderate: clinical treatment population with adjusted regression, but cross-sectional and self-report.
When this study was published
Published 2020.
The bigger picture
The polysubstance patterns are clinically important: SCRA users cluster with cannabis and stimulant users, while prescription opioid users cluster with benzodiazepine and gabapentinoid users. These distinct drug use clusters may need different treatment approaches.
Questions still open
- Would cannabis legalization reduce SCRA use by eliminating the "legal alternative" motivation? Should gabapentinoid prescribing be more closely monitored in opioid-using populations?
Common questions
Who uses synthetic cannabinoids?
What prescription drugs are associated with opioid misuse?
Read the original research
Recent Use of Synthetic Cannabinoids, Synthetic Opioids, and Other Psychoactive Drug Groups among High-risk Drug Users.
Journal of psychoactive drugs, 52(4), 334-343
Citation
Shapira, Barak; Berkovitz, Ronny; Rosca, Paola; Neumark, Yehuda. (2020). Recent Use of Synthetic Cannabinoids, Synthetic Opioids, and Other Psychoactive Drug Groups among High-risk Drug Users.. Journal of psychoactive drugs, 52(4), 334-343. https://doi.org/10.1080/02791072.2020.1754534
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