Synthetic Cannabis: It's Not The Real Thing. Buyers; Beware!

Global Drug Survey (GDS) has been researching synthetic cannabis products for the last four years. We've published the largest studies of their use in the world. The overall findings are that synthetic cannabis (SCs) products are far less desirable, with 93 percent stating a preference for the real thing and more risky with more unwanted effects than natural high potency weed (Winstock and Barrat 2013 -- Drug and Alcohol Dependence).

I initially thought the very high rate of those seeking emergency medical treatment after their use (about 1 in 30-40 last year users -- Winstock and Barratt 2013 Human Psychopharmacology) was simply a reflection of the fact that these compounds, unlike THC, are full receptor agonists (meaning that there is not a ceiling on how stoned you get) and were not manufactured with much care or precision when it came to the amount of active product being sprayed onto each gram of inert herbal material. Many SCs are much more potent (sometimes hundreds of times more) than THC and SC products contain no counterbalance such as CBD. A colleague suggested the reason for higher rates of adverse effects might be that these products were unregulated and therefore there was little quality control and this explained the increased risk. That suggestion lost some validity to my mind last year, when the findings from GDS2014 revealed that the highest rates seeking emergency medical treatment after using SC products was seen in the one country in the world where there was a regulated market for them, New Zealand. In as yet unpublished research by GDS, 3.8 percent of 345 last year users of SC products in New Zealand reported seeking emergency medical treatment. That's almost one in 25 users. That's huge. And one in four were admitted to hospital. Was it a surprise? Not really, given that new regulations only applied to new products in New Zealand so less potent products that have been used prior to the change in laws were forced to be removed from the market and replaced by less familiar and often more potent synthetic cannabis products. To date, based on our analysis of several thousand users, we estimate that compared to natural cannabis the risk of seeking emergency medical treatment is at least 30 times higher than with natural weed (Winstock et al paper in press and as reported at Stuff.Co.NZ).

The laws of common sense and basic economic theory (there's lots of natural weed supply in the world) would therefore suggest that the market for SC products should be dying. And yet, they represent the fastest growing group of novel psychoactive drugs reported to international monitoring agencies like the EMCDDA. One reason is that when one set of synthetic cannabinoids are regulated for -- there's a whole truck full waiting to be dissolved in acetone and sprayed on damiana and lettuce leaf, dried, packaged and sold for a hefty profit (really huge profits with no need for elegant hydro set-ups, electricity and water). Now of course just because new SC are being reported to monitoring agencies and are being sold online and in shops does not equal widespread use. And at least in most countries we surveyed last year as part GDS2014 (with almost 80,000 people taking part), only rarely did SC products make it into the top 20 drugs being used in the last year (by a group with higher drug use experience than the general population) with prevalence rates sitting between 0.5-2 percent. I think this is what we would expect however when there is easy access to good quality weed or other natural cannabis preparations in most countries. Even in New Zealand the last year prevalence of use only reached 6.8 percent, compared to 35 percent for natural cannabis. So it's not like there was huge supply deficit in the global cannabis market as there was when mephedrone (a now illegal synthetic cathinone) arrived to fill the tanks of European and especially British clubbers fed up with poor quality MDMA and expensive even poorer quality cocaine. So to be honest I am a bit surprised that SC products have hung around.

So why is there still demand? Why use a less desirable product when a more preferable one is usually available? Well at least in some cases (GDS data suggests only a minority) it will be to avoid workplace drug screens. I work in a prison and know at times these products have had real currency for some people and the same could be said for those in transport, mining and other risk critical areas. But it's not just avoidance of detection which I suspect is an issue for only a fraction of users. It's also price, potency and the bang for the buck. Because the truth is that over the last decade high potency weed has increased in price relative to other drugs in many parts of the world. At a mean price of around €10/gram and most people getting 3-4 joints out of gram, for many people, pot smoking has become an expensive habit (pity the Irish, home to the most expensive weed in the world with a gram costing €20-25). And for some people, using a more potent but less desirable product might just be function of economy. I bumped into a guy the other day in a head shop in London. He was buying a 3gm deal of Cherry Bomb for £25. I asked, "wouldn't you rather smoke some nice weed?"

"Yeah," he said, "I'm a weed man but I only get 3 spliffs from a gram; I can get 25 spliffs out of this -- I use it to sleep, saves on my use of nice weed."

I replied, "But the high you get from the synthetic stuff is not as nice, why use it?"

"Money bro, it's all about money, and I know I need more of this stuff now to get to sleep than I used to so I know my argument is rubbish."

Two minutes later, in walked a mother in her mid-thirties with her 9-year-old son. "I'll have the usual please -- three blueberry bags, please." So it is out there and people are using it. And sometimes, as I mentioned above, users end up in the ER, agitated, sweaty, paranoid and psychotic. I also worry that given all we know about the harms of early onset cannabis use impacting on the developing brain and increasing the risk of schizophrenia that use of SCs by young people might be a real public health issue. I have to remind people before you try and expand your brain, you have to let it grow.

So this year GDS is continuing its assessment of synthetic cannabis products. We'll be looking at the risks of getting dependent on it, whether or not people get withdrawal and whether or not the widespread availability of vaporizers and new preparations of these super potent cannabis-like products are leading to a whole new range of health risks (or benefits). We will keep assessing the risk of seeking emergency medical treatment and hope the manufacturers revise the potency and effect profile of what they are adding in to make these products safer. And we'll take a close look at New Zealand and see what has happened to the use of traditional weed now that once legal synthetic versions have, at least for the near future, been withdrawn from sale. So if you have dabbled with new cannabis products and would like to add your experiences to thousands of other people so we can get the best information to you next year, please take the time to take part in GDS2015 here.

References 
Winstock AR, Barratt M Synthetic cannabis comparison of patterns of use an effect profiles with natural cannabis Drug and Alcohol Dependence 2013 vol 131 (1-2) pp 106-11
Winstock AR, Barratt M The 12 month prevalence and nature of adverse experiences resulting in emergency medical presentations associated with the use fo synthetic cannabis products . Human Psychopharmacol 2013 vol 28 94) pp 390-3

New Zealand Drug Survey