The Dangers of Synthetic Cannabinoids

Synthetic cannabinoids are man-made chemicals that some people use as an alternative to cannabis, sold as "synthetic marijuana", "Spice" or "K2" (CDC). They bind to and activate the type 1 cannabinoid receptor, the same receptor THC acts on, although their chemical structures may or may not resemble THC (Canada Gazette, 2015).

The typical product is dried plant material sprayed with a solution of 1 or more synthetic cannabinoids and sold in a foil packet, often about 3 grams. The plants named on the packaging are often not present, and the mixtures contain no tobacco or cannabis (European Union Drugs Agency). The Canadian Centre on Substance Use and Addiction (CCSA) has described these products being sold as "herbal incense" or "herbal smoking blends", often labelled "not for human consumption", and made in clandestine labs.

Many started as legitimate research. The EUDA notes they were first developed as potential medicines, but it proved difficult to separate the desired effects from unwanted psychoactive ones, and a 2016 report in the CDC's journal MMWR describes them as research compounds of the 1980s (CDC MMWR, 2016).

The name suggests a substitute for weed, but the chemistry and the risks are different.

The CDC says their health effects are unpredictable and can be harmful or even life-threatening, including a rapid heart rate, vomiting, agitation, confusion and hallucinations; some people need emergency or intensive care (CDC).

A US registry of cases serious enough to need a medical toxicologist logged 456 synthetic cannabinoid poisonings from 2010 to 2015, compared with 13 cases where cannabis was the only substance involved, most of them in children or teenagers. Among the 277 patients who had used only synthetic cannabinoids, the most common signs were agitation, coma or depressed consciousness, and delirium or toxic psychosis; seizures and hallucinations were less common, and 4% had acute kidney injury. The registry recorded 3 deaths, and no specific antidote exists (CDC MMWR 2016).

CCSA adds irregular heartbeat and panic attacks to the list, notes that chronic use can lead to dependence and withdrawal, and warns that people with a personal or family history of psychosis or schizophrenia may face a greater risk of a psychotic episode. Long-term effects are largely unknown because most of these compounds have never been studied in humans (CCSA).

Because the supply chain is unregulated, product makeup varies (CDC MMWR, 2018). In March 2018, Illinois began investigating patients with unexplained bleeding who had used synthetic cannabinoids. By April 25, 155 cases had been identified, 95% of patients were hospitalized and 4 died from major bleeding. All 81 patient samples tested were positive for brodifacoum, a long-acting blood thinner used in rat poison, and some products in other states also tested positive (CDC MMWR 2018).

Contamination questions apply to regular cannabis too, in a different way; see whether your cannabis contains pesticides.

Canada first controlled these products by treating them as "similar synthetic preparations" of cannabis. In 2015 it made their status explicit, adding "synthetic cannabinoid receptor type 1 agonists" and their salts, derivatives and isomers to Schedule II of the Controlled Drugs and Substances Act, and noted they had been falsely marketed as legal alternatives to cannabis (Canada Gazette). Health Canada had already said that all activities with these products, from production and distribution to import and export, are illegal in Canada (as quoted by CCSA).

Toronto has dealt with them directly. In November 2013 and March 2014, the Toronto Drug Squad executed search warrants and reportedly seized several thousand packages, including products sold as IZMS, which Health Canada confirmed contained controlled substances (CCSA). More recently, Toronto's drug checking service found a synthetic cannabinoid, AMB-FUBINACA, in 7 of 555 samples checked between October 2019 and April 2020, all in samples people expected to be fentanyl (Harm Reduction Journal, 2022).

People have used them because they were sold as legal alternatives, were relatively cheap and were not detected by routine drug tests (CDC MMWR 2018).

A separate group of products uses other cannabinoids that activate the same CB1 receptor, some of which occur naturally in small amounts in cannabis. Health Canada calls these "intoxicating cannabinoids" and lists delta-8-THC, delta-10-THC, THC-O and HHC among them. It says data on their effects are very limited or unknown, that products using them to get around THC controls pose an increased risk, and that whether a substance falls under the Cannabis Act or the Controlled Drugs and Substances Act is decided case by case (Health Canada). See also what HHC is and what it does.

Treat any "herbal incense", "potpourri" or smoking blend sold for its effects, especially one labelled "not for human consumption", as a likely synthetic cannabinoid product (CCSA; CDC MMWR 2018). As the Toronto drug checking results show, these chemicals can also turn up in drugs sold as something else.

If someone has a serious reaction, such as a seizure, a racing heart, severe agitation or confusion, or is hard to wake, call 911 or go to an emergency department right away (CDC). For poisoning advice anywhere in Canada, call 1-844-POISON-X (1-844-764-7669), which routes you to your local poison centre; in Quebec, call the Centre antipoison du Québec at 1-800-463-5060 (Health Canada). Tell responders what was taken if you know.

For questions about your own health or medications, talk to a doctor or pharmacist.

GasDank delivers same day across Toronto and the GTA, usually within 1 to 2 hours, and ships across Canada by mail order. The menu carries lab-tested products; browse all flower to see what is available. Customers must be 19 or older (21 in Quebec), with ID checked at the door.