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Cannabis Legalization is Associated with Fewer Synthetic Cannabis Poisonings

By Alexander Beadle

Published: Aug 11, 2022   
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Synthetic cannabinoid drugs, such as K2 or spice, appear to have less of an appeal in states where recreational adult-use cannabis is legal, according to a new study from experts at Washington State University.

The study, published this week in the Journal of Clinical Toxicology, found a significant reduction in reported illicit synthetic cannabinoid poisonings in states with recreational cannabis policies, compared to those with no legal recreational or medical cannabis laws.

This finding highlights a potential public health benefit to legalizing cannabis, the study authors say, as those who may otherwise choose to use synthetic cannabinoids are instead able to access safer herbal or plant-derived cannabis products.

Exposures declined over time

This study analyzed records from the National Poison Data System dated between 2016 and 2019 to determine the number of poisoning reports related to synthetic cannabinoid exposure in each US state throughout this period. States were broadly classified as being restrictive, medical, or permissive states based on the extent of their cannabis policies.

In total, there were 7,600 reports logged relating to synthetic cannabinoid poisonings, of which around 65% required medical attention. Sixty-one exposure cases resulted in a death.

The researchers found that permissive states were associated with a 37% drop in annual synthetic cannabinoid exposures, compared to restrictive states with active cannabis prohibition policies.

“Synthetic cannabinoid products, they go under different names but they are very dangerous, and they're very toxic,” lead study author Dr. Tracy Klein, associate professor of nursing at Washington State University and the assistant director of the WSU Center for Cannabis Policy, Research and Outreach, told Analytical Cannabis.

“Our study showed that for many consumers, if they have a choice, they might choose a product that is safer for them to use.”

Medical use states appeared to have a slight decrease in synthetic-related poisoning reports relative to restrictive ones, however this trend was not determined to be statistically significant.

The researchers also analyzed quarterly synthetic cannabis poisoning data in order to assess any changes taking place in the small number of states that implemented recreational cannabis legalization during the study period. They found that the opening of a legal cannabis retail market resulted in a 36% reduction in exposures, relative to states with medical use policies only.

Concerns over synthetic cannabinoids

Synthetic cannabinoids are not actually cannabis, they are a diverse range of drugs which are designed to act on the same brain receptors as THC, the major psychoactive component in cannabis. While some cannabinoids may be produced synthetically for use in approved medical formulations, illicit synthetic cannabinoids have no medical applications.

“From the UN's Early Warning Advisory on new psychoactive substances, this class [of drug] is the second largest class,” Klein said. “There are many, many different formulations. This is, internationally, even a bigger problem right now than synthetic opioids. And I think that's an important message.”

A total of 320 unique synthetic cannabinoid receptor agonists (SCRAs) have been identified since 2009. The diversity of these SCRAs is an issue, as typical urine drug screens are not designed to be able to detect this vast swathe of novel drug compounds. Their extreme potency and severe withdrawal symptoms are also of concern.

“THC content has gone up and up and CBD content has gone down in our legal recreational markets. But these synthetics are 100 times more potent than your average natural cannabis, for lack of a better word,” Klein said. “These are really bad drugs, they have no medical use. There is nothing that you would take them for that would have any kind of benefit, and that is really different to a medical cannabis preparation.”

The finding that cannabis legalization could help reduce synthetic cannabinoid exposures through offering a safer alternative is an important new perspective on harm reduction, the researchers say.

“This [study] is a new lens for harm reduction. A new lens to look at harm reduction and how we might think about cannabis regulation,” Klein said.

Real number of synthetic cannabinoid poisonings may be higher

The authors do note some limitations with the study. For example, the National Poison Data System did not record any information on delta-8 THC exposures between 2016 and 2019.

Delta-8 THC is a complex problem for the cannabis industry. While this psychoactive compound is not explicitly mentioned by name in important drug control legislation, its legal status has come under intense scrutiny in recent years. It can be naturally isolated from hemp, but it can also be synthetically derived from legal hemp-derived CBD, which is where it enters the conversation regarding synthetic cannabinoids.

More generally, underreporting is likely to be an issue in the dataset because that SCRAs often evade standard drug screening tests. This means that the recording of exposure cases is reliant upon accurate patient reporting or physician diagnoses.

“Your average clinician doesn't have much understanding of these drugs. It's not something that we tend to ask patients about,” Klein explained. “And even if a patient told me they were using it, I wouldn't have a very good idea about how to test for it or what to advise them.”

“This is just the start of a journey. My hope is to educate clinicians a little bit more about these things.”


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