Merck Manual

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Cannabinoids, Synthetic


Gerald F. O’Malley

, DO, Grand Strand Regional Medical Center;

Rika O’Malley

, MD, Grand Strand Medical Center

Last full review/revision May 2020
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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 Marijuana (Cannabis) Marijuana is a euphoriant that can cause sedation or dysphoria in some users. Psychologic dependence can develop with chronic use, but very little physical dependence is clinically apparent... read more (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 Overview of Acute Coronary Syndromes (ACS) Acute coronary syndromes result from acute obstruction of a coronary artery. Consequences depend on degree and location of obstruction and range from unstable angina to non–ST-segment elevation... read more . Neurologic effects include seizures and blurred vision. Additional reported effects include vomiting, hyperthermia, rhabdomyolysis, and renal failure.

Symptoms and Signs

Patients taking synthetic cannabinoids 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 (complete blood count, electrolytes, blood urea nitrogen, creatinine, creatine kinase), urine testing for myoglobinuria, and ECG.


  • IV sedation with benzodiazepines

For patients taking synthetic cannabinoids, 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.

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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
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