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Synthetic cannabinoids: Acute intoxication

George Sam Wang, MD
Section Editors
Michele M Burns, MD, MPH
Stephen J Traub, MD
Deputy Editor
James F Wiley, II, MD, MPH


This topic discusses the epidemiology, pharmacology, toxicity, clinical manifestations, and management of acute intoxication with synthetic cannabinoids will be discussed here.

The clinical manifestations and management of toxicity from cannabis (marijuana), medical uses of cannabinoids, and the manifestations and treatment of cannabis use disorder are provided separately:

(See "Cannabis (marijuana): Acute intoxication".)

(See "Cancer pain management: Adjuvant analgesics (coanalgesics)", section on 'Cannabis and cannabinoids'.)

(See "Symptom management of multiple sclerosis in adults", section on 'Cannabinoids'.)

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Literature review current through: Nov 2017. | This topic last updated: Nov 15, 2017.
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  1. Understanding the Spice Phenomenon. European Monitoring Centre for Drugs and Drug Addiction. http://www.emcdda.europa.eu/attachements.cfm/att_80086_EN_Spice%20Thematic%20paper%20—%20final%20version.pdf (Accessed on July 01, 2014).
  2. Drug Enforcement Administration, Department of Justice. Schedules of controlled substances: temporary placement of four synthetic cannabinoids into Schedule I. Final order. Fed Regist 2014; 79:7577.
  3. Musselman ME, Hampton JP. "Not for human consumption": a review of emerging designer drugs. Pharmacotherapy 2014; 34:745.
  4. Nelson ME, Bryant SM, Aks SE. Emerging drugs of abuse. Emerg Med Clin North Am 2014; 32:1.
  5. Rosenbaum CD, Carreiro SP, Babu KM. Here today, gone tomorrow…and back again? A review of herbal marijuana alternatives (K2, Spice), synthetic cathinones (bath salts), kratom, Salvia divinorum, methoxetamine, and piperazines. J Med Toxicol 2012; 8:15.
  6. Wells DL, Ott CA. The "new" marijuana. Ann Pharmacother 2011; 45:414.
  7. Ashton JC. Synthetic cannabinoids as drugs of abuse. Curr Drug Abuse Rev 2012; 5:158.
  8. Adams AJ, Banister SD, Irizarry L, et al. "Zombie" Outbreak Caused by the Synthetic Cannabinoid AMB-FUBINACA in New York. N Engl J Med 2017; 376:235.
  9. European Monitoring Centre for Drugs and Drug Addiction: Annual report on the state of the drugs problem in Europe; Lisabon, Portugal, November 2012. https://www.emcdda.europa.eu/publications/annual-report/2012 (Accessed on July 01, 2014).
  10. Trecki J, Gerona RR, Schwartz MD. Synthetic Cannabinoid-Related Illnesses and Deaths. N Engl J Med 2015; 373:103.
  11. Law R, Schier J, Martin C, et al. Notes from the Field: Increase in Reported Adverse Health Effects Related to Synthetic Cannabinoid Use - United States, January-May 2015. MMWR Morb Mortal Wkly Rep 2015; 64:618.
  12. Hoyte CO, Jacob J, Monte AA, et al. A characterization of synthetic cannabinoid exposures reported to the National Poison Data System in 2010. Ann Emerg Med 2012; 60:435.
  13. Wood KE. Exposure to bath salts and synthetic tetrahydrocannabinol from 2009 to 2012 in the United States. J Pediatr 2013; 163:213.
  14. Monte AA, Bronstein AC, Cao DJ, et al. An outbreak of exposure to a novel synthetic cannabinoid. N Engl J Med 2014; 370:389.
  15. Kasper AM, Ridpath AD, Arnold JK, et al. Severe Illness Associated with Reported Use of Synthetic Cannabinoids - Mississippi, April 2015. MMWR Morb Mortal Wkly Rep 2015; 64:1121.
  16. Kemp AM, Clark MS, Dobbs T, et al. Top 10 Facts You Need to Know About Synthetic Cannabinoids: Not So Nice Spice. Am J Med 2016; 129:240.
  17. Springer YP, Gerona R, Scheunemann E, et al. Increase in Adverse Reactions Associated with Use of Synthetic Cannabinoids - Anchorage, Alaska, 2015-2016. MMWR Morb Mortal Wkly Rep 2016; 65:1108.
  18. Palamar JJ, Barratt MJ, Coney L, Martins SS. Synthetic Cannabinoid Use Among High School Seniors. Pediatrics 2017; 140.
  19. Riederer AM, Campleman SL, Carlson RG, et al. Acute Poisonings from Synthetic Cannabinoids - 50 U.S. Toxicology Investigators Consortium Registry Sites, 2010-2015. MMWR Morb Mortal Wkly Rep 2016; 65:692.
  20. Cohen J, Morrison S, Greenberg J, Saidinejad M. Clinical presentation of intoxication due to synthetic cannabinoids. Pediatrics 2012; 129:e1064.
  21. Harris CR, Brown A. Synthetic cannabinoid intoxication: a case series and review. J Emerg Med 2013; 44:360.
  22. Hermanns-Clausen M, Kneisel S, Szabo B, Auwärter V. Acute toxicity due to the confirmed consumption of synthetic cannabinoids: clinical and laboratory findings. Addiction 2013; 108:534.
  23. Lapoint J, James LP, Moran CL, et al. Severe toxicity following synthetic cannabinoid ingestion. Clin Toxicol (Phila) 2011; 49:760.
  24. Winstock AR, Barratt MJ. The 12-month prevalence and nature of adverse experiences resulting in emergency medical presentations associated with the use of synthetic cannabinoid products. Hum Psychopharmacol 2013; 28:390.
  25. Auwärter V, Dresen S, Weinmann W, et al. 'Spice' and other herbal blends: harmless incense or cannabinoid designer drugs? J Mass Spectrom 2009; 44:832.
  26. Ammann J, McLaren JM, Gerostamoulos D, Beyer J. Detection and quantification of new designer drugs in human blood: Part 1 - Synthetic cannabinoids. J Anal Toxicol 2012; 36:372.
  27. Fantegrossi WE, Moran JH, Radominska-Pandya A, Prather PL. Distinct pharmacology and metabolism of K2 synthetic cannabinoids compared to Δ(9)-THC: mechanism underlying greater toxicity? Life Sci 2014; 97:45.
  28. Rajasekaran M, Brents LK, Franks LN, et al. Human metabolites of synthetic cannabinoids JWH-018 and JWH-073 bind with high affinity and act as potent agonists at cannabinoid type-2 receptors. Toxicol Appl Pharmacol 2013; 269:100.
  29. Dresen S, Ferreirós N, Pütz M, et al. Monitoring of herbal mixtures potentially containing synthetic cannabinoids as psychoactive compounds. J Mass Spectrom 2010; 45:1186.
  30. De Petrocellis L, Melck D, Bisogno T, Di Marzo V. Endocannabinoids and fatty acid amides in cancer, inflammation and related disorders. Chem Phys Lipids 2000; 108:191.
  31. Kronstrand R, Roman M, Andersson M, Eklund A. Toxicological findings of synthetic cannabinoids in recreational users. J Anal Toxicol 2013; 37:534.
  32. Seywright A, Torrance HJ, Wylie FM, et al. Analysis and clinical findings of cases positive for the novel synthetic cannabinoid receptor agonist MDMB-CHMICA. Clin Toxicol (Phila) 2016; 54:632.
  33. Hill SL, Najafi J, Dunn M, et al. Clinical toxicity following analytically confirmed use of the synthetic cannabinoid receptor agonist MDMB-CHMICA. A report from the Identification Of Novel psychoActive substances (IONA) study. Clin Toxicol (Phila) 2016; 54:638.
  34. Mir A, Obafemi A, Young A, Kane C. Myocardial infarction associated with use of the synthetic cannabinoid K2. Pediatrics 2011; 128:e1622.
  35. Young AC, Schwarz E, Medina G, et al. Cardiotoxicity associated with the synthetic cannabinoid, K9, with laboratory confirmation. Am J Emerg Med 2012; 30:1320.e5.
  36. Clark BC, Georgekutty J, Berul CI. Myocardial Ischemia Secondary to Synthetic Cannabinoid (K2) Use in Pediatric Patients. J Pediatr 2015; 167:757.
  37. Rose DZ, Guerrero WR, Mokin MV, et al. Hemorrhagic stroke following use of the synthetic marijuana "spice". Neurology 2015; 85:1177.
  38. Freeman MJ, Rose DZ, Myers MA, et al. Ischemic stroke after use of the synthetic marijuana "spice". Neurology 2013; 81:2090.
  39. Bhanushali GK, Jain G, Fatima H, et al. AKI associated with synthetic cannabinoids: a case series. Clin J Am Soc Nephrol 2013; 8:523.
  40. Centers for Disease Control and Prevention (CDC). Acute kidney injury associated with synthetic cannabinoid use--multiple states, 2012. MMWR Morb Mortal Wkly Rep 2013; 62:93.
  41. Thornton SL, Wood C, Friesen MW, Gerona RR. Synthetic cannabinoid use associated with acute kidney injury. Clin Toxicol (Phila) 2013; 51:189.
  42. Buser GL, Gerona RR, Horowitz BZ, et al. Acute kidney injury associated with smoking synthetic cannabinoid. Clin Toxicol (Phila) 2014; 52:664.
  43. Arntson A, Ofsa B, Lancaster D, et al. Validation of a novel immunoassay for the detection of synthetic cannabinoids and metabolites in urine specimens. J Anal Toxicol 2013; 37:284.
  44. Hutter M, Broecker S, Kneisel S, Auwärter V. Identification of the major urinary metabolites in man of seven synthetic cannabinoids of the aminoalkylindole type present as adulterants in 'herbal mixtures' using LC-MS/MS techniques. J Mass Spectrom 2012; 47:54.
  45. Moran CL, Le VH, Chimalakonda KC, et al. Quantitative measurement of JWH-018 and JWH-073 metabolites excreted in human urine. Anal Chem 2011; 83:4228.
  46. Penn HJ, Langman LJ, Unold D, et al. Detection of synthetic cannabinoids in herbal incense products. Clin Biochem 2011; 44:1163.
  47. Sobolevsky T, Prasolov I, Rodchenkov G. Detection of JWH-018 metabolites in smoking mixture post-administration urine. Forensic Sci Int 2010; 200:141.
  48. Freijo TD Jr, Harris SE, Kala SV. A rapid quantitative method for the analysis of synthetic cannabinoids by liquid chromatography-tandem mass spectrometry. J Anal Toxicol 2014; 38:466.
  49. Caldicott DG, Holmes J, Roberts-Thomson KC, Mahar L. Keep off the grass: marijuana use and acute cardiovascular events. Eur J Emerg Med 2005; 12:236.
  50. Deharo P, Massoure PL, Fourcade L. Exercise-induced acute coronary syndrome in a 24-year-old man with massive cannabis consumption. Acta Cardiol 2013; 68:425.