Synthetic cannabinoids, also known by street names such as K2, Spice, or AK-47, are dangerous designer drugs that appear to have less appeal in states where natural forms of marijuana have already been legalized.
A study led by Washington State University has found that states where marijuana is legalized have seen a 37% decrease in reports of synthetic cannabinoid intoxication compared to states that restrict marijuana. These findings show that it is difficult to detect synthetic cannabinoid use with standard drug tests.
Tracy Klein, associate professor of nursing at WSU, stated, "This study demonstrates some potential public health benefits of legalizing and regulating marijuana use among adults. Based on prior research and the findings of this study, it appears that individuals may opt for products with lower toxicity levels.
Synthetic cannabinoids are not actually marijuana. They are named as such because they share similarities with the psychoactive components of the marijuana plant, tetrahydrocannabinol (THC) and cannabidiol (CBD), on the cannabinoid receptors of the brain. However, illegal synthetics have binding powers up to 100 times higher than these receptors, and lack any intermediary components found in full-plant marijuana such as THC or CBD. As a result, synthetic cannabinoids carry a high toxicity and can lead to serious harm, even death.
In a study published in the Journal of Clinical Toxicology, researchers analyzed data from the National Poison Data System from 2016 to 2019, prior to the outbreak of the pandemic. They focused only on states with relatively stable policies during those years and classified them into three categories: those with lenient policies, like Washington state, which allow for both medical and recreational use of marijuana for adults; those with medical-only policies, like Hawaii, where marijuana is only allowed for medical purposes; and those with restrictive policies, like Idaho, where almost all marijuana use is prohibited.
In this sample, 7600 individuals received reports of poisonings related to the use of synthetic cannabinoids, with approximately 65% requiring medical care. There were also 61 deaths. Researchers found that during this period, reports of poisonings related to synthetics decreased overall, but medical referrals decreased by 13% and dropped by 37% in states where they were legal.
Early research from JAMA Open has found that from 2017 to 2019, poison control calls related to natural marijuana use have increased across the United States. The increase, however, is primarily driven by plant-based e-cigarette materials and edibles that may contain high levels of THC. In contrast, during the same period, there has been a decrease in poison control calls related to whole-plant marijuana.
Although some synthetic cannabinoids have been used for medical purposes, namely dronabinol and nabiximols primarily used to treat nausea related to cancer treatment, illegal versions are illegal in all states and have no medical purpose. Enforcement may be difficult as manufacturers frequently change their formulas. They are also often not detected in standard urine drug tests, which may be one reason people in restricted states use them.
Klein stated that further research is needed to better understand the usage of these drugs and the differences between them. She noted that the dataset of this research does not include Delta-8, a synthetically derived chemical that is becoming more popular, which is sold as a less potent form of Delta-9, a psychoactive cannabinoid found in natural plant products.
Klein, the Assistant Director of WSU's marijuana policy, research, and outreach center, stated, "We are aware that there are many cannabis derivatives currently being developed on the market - regulatory agencies are working to catch up.
The author points out that current research may underestimate the use of these drugs as they are difficult to detect.
You cannot easily detect illegal marijuana compounds. Often, we only discover that patients have used them because they are hospitalized or have already died," Klein said.
The co-authors of this study, apart from Klein, include Julie Dilley from the Multnomah County Health Department and the Oregon Health Authority, Janessa Graves from the WSU College of Nursing, and Erica Liebelt from the University of Arkansas for Medical Sciences.
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