Emma Hitt, PhD

April 27, 2012

April 27, 2012 (Atlanta, Georgia) — About 50% of marijuana users have tried synthetic cannabis, and 22% continued using these synthetic products after a federal ban was enacted in early 2011, a new survey shows.

Erik Gunderson, MD, assistant professor in the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, presented the findings here at the American Society of Addiction Medicine (ASAM) 43rd Annual Medical-Scientific Conference.

According to Dr. Gunderson and colleagues, there is "growing public health concern about increasing use of a new generation of synthetic cannabinoid (SC) agonists (eg, JWH-018, CP-47497) marketed as natural herbal incense mixtures under brand names such as "Spice" and "K2."

"The SCs are sprayed on psychoactively inert organic material and marketed as novelty herbal blends," Dr. Gunderson told Medscape Medical News. "Use has been associated with primarily psychopathological effects, including psychosis, anxiety, and panic attacks."

To evaluate the use of SCs among marijuana users, the researchers conducted a phone survey of marijuana and tobacco users from January to May 2011. Among the 42 responders, most who had tried SCs were novelty seeking, with 67% reporting SC product use to "try a new high."

In addition, approximately 50% used the products when they could not obtain marijuana, and approximately 20% used them to decrease the irritability of cannabis withdrawal. A quarter used SCs in the prior month, and over one half reported using SC products to be able pass a drug test.

"Clinicians should inquire about novelty herbal blend product use among their marijuana-using patients, and recognize that many may be using the products to evade urine drug screen detection in various settings," Dr. Gunderson said.

"Some new urine immunoassay 'dip' tests are being marketed, although I am not sure about their accuracy," he said. "Physicians involved in drug treatment and monitoring should inquire with their laboratory to see if confirmatory GC/MS [gas chromatography–mass spectrometry] analysis is available (and the cost)," he added.

As an aside, Dr. Gunderson told Medscape Medical News that while he was here attending the meeting in Atlanta, he visited a nearby "novelty shop" where synthetic cannabinoid and substituted cathinone products, known as bath salts, were being sold.

Dr. Gunderson inquired about the products after he identified himself as a clinician and researcher and told the store workers that they would remain anonymous.

"One of the staff estimated that there are about 1000 different SC brands and just under 100 stimulant products available," he said.

"At the time of the visit, the store had probably about 50 different SC products for sale, and approximately 30 individuals came in to purchase the products during a 45-minute span, most of whom were probably mid-late teens to early 20s."

"SCs have grown in popularity and may be encountered more than health professionals realize," said session moderator Gavin Bart, MD, director of the Division of Addiction Medicine at the Hennepin County Medical Center, in Minneapolis, Minnesota.

"Given that the high-school data indicate 11% of seniors had used SC in the past year, it is important to begin asking about these substances lest we miss important information that influences our patients' health issues, risks for addiction, or need for treatment," he told Medscape Medical News.

According to Dr. Bart, the overall health burden of SC remains unclear. "Marijuana remains one of the main reasons people seek treatment for illicit drug use," he said. "There are now a number of people who are turning to SC out of curiosity or as a means of avoiding standard drug toxicology tests."

"All health professionals should be screening for substance use anyway, but extra care must be taken to not leave out these emerging drugs when interviewing patients," he said.

The presentation was not commercially funded. The authors and commentator have disclosed no relevant financial relationships.

American Society of Addiction Medicine (ASAM) 43rd Annual Medical-Scientific Conference. 33, presented April 20, 2012.

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