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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

(See also Drug Use and Abuse.)

Cannabis is a term for marijuana. Tetrahydrocannabinol (THC) is the main active ingredient in marijuana. Synthetic cannabinoids are man-made drugs that are similar to THC. They are usually sprayed on dried plant material and smoked or inhaled as vaporized liquid from e-cigarettes. There are many chemical families of synthetic cannabinoids, and new compounds are being reported regularly.

Symptoms

Different cannabinoids have different effects, and many of the short- and long-term effects remain unknown. However, there are three main categories of effects:

  • Psychiatric: Confusion, agitation, hallucinations, and psychosis (loss of contact with reality) that may be irreversible

  • Cardiovascular: High blood pressure, rapid heartbeat (tachycardia), and heart attack

  • Neurologic: Blurred vision, heavy sweating, and seizures

Additional effects include vomiting, high body temperature (hyperthermia) muscle breakdown, and kidney failure.

Diagnosis

  • A doctor's evaluation

Doctors usually make their diagnosis based on what drugs people or their friends say were taken. Routine urine tests do not detect synthetic cannabinoids.

People who show signs of severe acute intoxication often need tests to look for complications. Doctors typically do blood tests to check blood count, electrolytes, and kidney function and do an electrocardiogram (ECG) to check heart rhythm. Their urine also may be tested for myoglobin, which indicates muscle breakdown.

Treatment

  • IV sedatives

  • IV fluids

Typical treatments, which include IV sedatives (benzodiazepines) and fluids and supportive care, are usually adequate. Patients with dangerously high body temperature (hyperthermia), persistently high heart rate or agitation, and high serum creatinine (indicative of possible kidney problems) should be hospitalized and monitored for muscle breakdown and heart and kidney damage.

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