Has there been a decline in the prevalence of cannabis use among British nightclubbers? Five-year survey data

Risk of emergency medical treatment following consumption of cannabis or synthetic cannabinoids in a large global sample

BACKGROUND

Synthetic cannabinoids (SCs) have become increasingly popular in recent years. Diverse in chemical structure, many have been subjected to legislative regulation, but their availability and use persists. Often marketed to reflect their similar effects to cannabis, their use has been associated with a range of negative health effects. We sought to determine the relative risk of seeking emergency medical treatment (EMT) following use of SCs and natural cannabis.

METHODS

We utilized an anonymous online survey of drug use, obtaining data from 22,289 respondents. We calculated the relative risk of seeking EMT between the two substances using an estimate for days used in the past year.

RESULTS

Thirty-seven cannabis users (0.2%) and 21 SC users (1.0%) had sought EMT during the past year following use. The relative risk associated with the use of SCs was 30 (95% CI 17.5-51.2) times higher than that associated with cannabis. Significantly more symptoms (p=0.03) were reported by respondents seeking treatment for SCs than for cannabis.

CONCLUSIONS

Whilst these findings must be treated with caution, SCs potentially pose a greater risk to users' health than natural forms of cannabis. Regulation is unlikely to remove SCs from the market, so well-informed user-focused health promotion messages need to be crafted to discourage their use.

Synthetic cannabis: a comparison of patterns of use and effect profile with natural cannabis in a large global sample

BACKGROUND

The last decade has seen the appearance of myriad novel psychoactive substances with diverse effect profiles. Synthetic cannabinoids are among the most recently identified but least researched of these substances.

METHODS

An anonymous online survey was conducted in 2011 using a quantitative structured research tool. Missing data (median 2%) were treated by available-case analysis.

RESULTS

Of 14,966 participants, 2513 (17%) reported use of synthetic cannabis. Of these, 980 (41% of 2417) reported its use in the last 12 months. Almost all recent synthetic cannabis users (99% of 975) reported ever use of natural cannabis. Synthetic cannabis reportedly had both a shorter duration of action (z=17.82, p<.001) and quicker time to peak onset of effect (z=-9.44, p<.001) than natural cannabis. Natural cannabis was preferred to synthetic cannabis by 93% of users, with natural cannabis rated as having greater pleasurable effects when high (t(930)=-37.1, p<.001, d=-1.22) and being more able to function after use (t(884)=-13.3, p<.001, d=-0.45). Synthetic cannabis was associated with more negative effects (t(859)=18.7, p<.001, d=0.64), hangover effects (t(854)=6.45, p<.001, d=0.22) and greater paranoia (t(889)=7.91, p<.001, d=0.27).

CONCLUSIONS

Users report a strong preference for natural over synthetic cannabis. The latter has a less desirable effect profile. Further research is required to determine longer term consequences of use and comparative dependence potential.

The 12-month prevalence and nature of adverse experiences resulting in emergency medical presentations associated with the use of synthetic cannabinoid products

OBJECTIVE

A wide range of synthetic cannabinoid products have recently become available through the Internet and shop fronts across the globe. Concerns about the consequences of their use have been prompted by increasing reports of emergency department presentations.

METHODS

An anonymous global online survey was conducted using a research tool based on previous work carried out by the group. Data collection took place during a 4-week period at the end of 2011.

RESULTS

Among 950 last-year users, 23 (2.4%) reported having sought emergency medical treatment following the use of a synthetic cannabinoid product. The most common presentations were panic and anxiety, followed by paranoia and breathing difficulties. Recent users who reported seeking emergency medical treatment were significantly younger (median age 20 years, interquartile range 18-22) than those who did not report seeking treatment (median age 23 years, interquartile range 19-28; Mann-Whitney test, z = 2.89, p = 0.004).

CONCLUSIONS

Synthetic cannabinoid use appears to be associated with a high prevalence of adverse experiences among users, especially younger users. Further research is required to determine whether particular compounds carry a higher risk of harm than others and to assess potential consequences of longer term use.