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Cannabinoids, Synthetic

By Gerald F. O’Malley, DO, Professor of Emergency Medicine, Sidney Kimmel School of Medicine, Thomas Jefferson University and Hospital ; Rika O’Malley, MD, Attending Physician, Department of Emergency Medicine, Einstein Medical Center

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Patient Education

Synthetic cannabinoids are man-made drugs that are tetrahydrocannabinol (THC) receptor agonists. They are typically applied to dried plant material and smoked.

THC is the primary active ingredient in marijuana (cannabis). There are many chemical families of synthetic cannabinoids, including HU-210, JWH-073, JWH-018, JWH-200, AM-2201, UR-144, and XLR-11; new compounds are being reported regularly.

Effects vary greatly depending on the specific cannabinoid, and many of the acute and chronic effects remain unknown. However, stimulation of the THC receptor causes altered mental status with agitation, hallucinations, and psychosis (that may be irreversible). Cardiovascular effects include hypertension, tachycardia and myocardial infarction. Neurologic effects include seizures and blurred vision. Additional reported effects include vomiting, hyperthermia, rhabdomyolysis, and renal failure.

Symptoms and Signs

Patients may have severe agitation, hallucinations, tachycardia, hypertension, diaphoresis, and seizures.


  • Clinical evaluation

Synthetic cannabinoids are not detected on routine urine screening.

Patients with severe acute intoxication should typically have blood tests (CBC, electrolytes, BUN, creatinine, CK), urine testing for myoglobinuria, and ECG.


  • IV sedation with benzodiazepines

Sedation with IV benzodiazepines, IV fluids, and supportive care are typically adequate. Patients with hyperthermia, persistent tachycardia or agitation, and elevated serum creatinine should be admitted for further monitoring for rhabdomyolysis and cardiac and renal injury.