Merck Manual

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Cannabinoids, Synthetic

By

Gerald F. O’Malley

, DO, Grand Strand Regional Medical Center;


Rika O’Malley

, MD, Grand Strand Medical Center

Last review/revision Dec 2022
View Patient Education

Synthetic cannabinoids are manufactured 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. Slang terms for these include "K2" and "spice."

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 of Synthetic Cannabinoid Use

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

Diagnosis of Synthetic Cannabinoid Intoxication

  • Usually a clinical diagnosis

Synthetic cannabinoids are not detected on routine urine screening.

Patients with severe acute intoxication who are severely agitated may need to be evaluated for rhabdomyolysis Rhabdomyolysis Rhabdomyolysis is a clinical syndrome involving the breakdown of skeletal muscle tissue. Symptoms and signs include muscle weakness, myalgias, and reddish-brown urine, although this triad is... read more with blood tests (complete blood count, electrolytes, blood urea nitrogen, creatinine, creatine kinase), urine testing for myoglobinuria, and ECG.

Treatment of Synthetic Cannabinoid Intoxication

  • IV sedation with benzodiazepines

For patients taking synthetic cannabinoids, the treatment is supportive. IV fluids and sedation with IV benzodiazepines 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: View Consumer Version
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