Synthetic Cannabinoid Use in a Transitional Housing Shelter: A Survey to Characterize Awareness of Risks and Reasons for Use

Synthetic cannabinoids are man-made compounds that act through the brain's cannabinoid receptors (CB1 and CB2) to induce mind-altering effects. The CB1 receptor affects the dopamine system, which is thought to modulate psychotic symptoms (1, 2). One common synthetic cannabinoid, JWH-018, has four times greater the affinity for CB1 than tetrahydrocannabinol, the primary cannabinoid found in cannabis. Another synthetic cannabinoid, AM-694, has recently begun to appear on the illicit market and is associated with hallucinations and delirium (2). In contrast, cannabis contains cannabidiol, an antagonist to both CB1 and CB2 that may protect against psychosis but is not found in synthetic cannabinoid mixtures being sold (1–3). This may explain why synthetic cannabinoids are associated with higher risk of episodic psychosis following use than cannabis (3, 4). In addition to psychosis, there have been multiple other reported morbidities associated with synthetic cannabinoids usage, including tachycardia, hypertension, cardiac arrest, pulmonary infiltrates, renal impairment, seizures, and suicidality (5, 6).

Originally developed in the 1970s (5), synthetic cannabinoids are now being covertly synthesized, sprayed on plant material, and sold in convenience stores as incense or potpourri under names such as K2, spice, and Scooby snacks. Illicit laboratories have circumvented issues of legality by introducing novel compounds that differ slightly from previous versions, especially when older versions were outlawed. The Synthetic Drug Abuse Prevention Act of 2012 now enables the Food and Drug Administration to ban all cannabimimetic substances, allowing for the inclusion of current and unreleased synthetic cannabinoids. Therefore, all synthetic cannabinoids are now technically illegal for human consumption in the United States. However, they continue to be marketed under the guise of use as incense or potpourri.

Few studies have explored why and how individuals use synthetic cannabinoids. In one survey of users, 54% of participants reported that the intoxication from synthetic cannabinoids, which often includes hallucinations, is unique (7). More than half reported use in group settings, and one-third reported an inability to decrease usage and development of tolerance. A New Zealand study examining the use of synthetic cannabinoids in psychiatric patients on a forensic inpatient unit (1) revealed that patients preferentially used synthetic cannabinoids due to easy procurement, increased potency compared with marijuana, non-detection in urine, and beliefs that they were safe because they were legal and sold as “herbal” products.

In 2014, staff at a local Boston Department of Mental Health transitional housing shelter noted a rapid increase in synthetic cannabinoid usage among residents, who discussed their use in the shelter's substance use group therapy sessions. We investigated shelter resident attitudes about synthetic cannabinoids and their use patterns in order to find potential points of intervention to increase awareness of the dangers of synthetic cannabinoids and decrease resident usage.