Depressed Teens More Likely to Use Synthetic Marijuana

Megan Brooks

March 15, 2017

Adolescents struggling with depressive symptoms or experimenting with marijuana or alcohol may be at the greatest risk for synthetic cannabinoid (SC) use in the future, new research suggests.

These results pinpoint a "specific clinical sample that may assist in tailoring drug prevention treatment and discussions with patients," first author Andrew Ninnemann, Department of Psychology, University of Maryland, College Park, told Medscape Medical News.

The study was published online March 13 in Pediatrics.

Risky Business

SCs, sold under a variety of brand names, including Spice, K2, and Black Mamba, are a mixture of dried herbs and spices sprayed with chemicals that, when smoked, create a high that is designed to mimic the effects of tetrahydrocannabinol (THC), the active ingredient in marijuana.

"SCs are substantially more potent than THC, making them riskier substances to use," Ninnemann said.

Until now, no study has examined the risk factors for SC use across time. "Our study contributes this much needed investigation to the literature and shows which common risk factors for substance use contribute to eventual use of synthetic cannabinoids in teens 1 year later," Ninnemann said.

As part of a longitudinal study examining adolescent risk behaviors, data were collected across two time points 12 months apart for 964 high school students from southwest Texas.

Path analysis revealed that depressive symptoms, marijuana use, alcohol use, and SC use at baseline were predictive of SC use 12 months later, whereas anxiety symptoms and impulsivity were not.

Factor Odds Ratio of SC Use at 1 Year
Depressive symptoms 1.42 (P < .05)
Marijuana use (baseline) 2.47 (P < .001)
Alcohol use (baseline) 1.85 (P < .05)
SC use (baseline) 2.36 (P < .001)
Anxiety 0.85
Impulsivity 1.03


Although rates of SC use among adolescents declined between 2012 and 2015, reports to poison control centers related to SC use increased threefold between 2013 and 2015.

"Even single-time SC use could potentially harm an adolescent," said Ninnemann. "It is in the best interests of adolescent patients for clinicians and health providers to be discussing the risks of synthetic cannabinoid use with their patients and making clear the unique dangers and differences synthetic cannabinoids pose in contrast to marijuana."

Concerning Trajectory

A related study, also published in Pediatrics, shows that adolescents who use SCs tend to engage in more risky behaviors than students who only use marijuana. The findings stem from a nationally representative sample of 15,624 high school students responding to the 2015 Youth Risk Behavior Survey.

Prior results from this survey showed that nearly 1 in 10 high school students had used synthetic marijuana at some point in their lifetime, Heather Clayton, PhD, health scientist in the Division of Adolescent School Health at the Centers for Disease Control and Prevention, told Medscape Medical News.

However, this new analysis found that the students who reported using SCs were more likely to engage in risky sexual behaviors, use other drugs, and engage in violent behaviors compared to students who had only used marijuana, she said.

For example, students who ever used SCs were more than twice as likely to have tried marijuana before age 13 years compared to students who had ever used only marijuana.

This finding, said Dr Clayton, suggests that students who report using synthetic marijuana are "possibly on a very concerning health trajectory, which is particularly serious given that synthetic marijuana use is relatively common among adolescents."

The investigators also found that most of the health risk behaviors in the domains of injury/violence, mental health, and sexual health were more prevalent in students who ever used SCs compared to students who ever used marijuana only.

"Synthetic marijuana use may be an indication of other concerning health risk behaviors, and early marijuana use may be a risk factor for synthetic marijuana use," said Dr Clayton.

"While the study does not show that synthetic marijuana use causes these risk behaviors, it's still important for health professionals and school-based substance prevention programs to focus on strategies that reduce the initiation of marijuana and synthetic marijuana use, particularly for youth younger than 13 years of age," she noted.

Neither study had commercial funding. None of the authors have disclosed any relevant financial relationships.

Pediatrics. Published online March 13, 2017. Ninnemann et al, Full text; Clayton et al, Full text


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.