| | Topic of concern | Cannabis characteristics | Synthetic marijuana (SM) characteristics |
| | Adverse side effects | According to Karant, the following effects occur with cannabis use [18]:
(i) Elevated mood
(ii) Relaxation
(iii) Altered perception of surrounding conditions
(iv) Symptoms of psychosis (delusions, disorganized thinking, and detachment from reality)
(v) Cognitive deficits during acute intoxication
(vi) Precipitation of onset or relapse of schizophrenia
(vii) Cannabis dependence | According to Freeman et al., 2013 [19], the following side effects could occur with SM use:
(i) Ischemic stroke
(ii) Elevated mood
(iii) Relaxation
(iv) Altered perception of surrounding conditions
(v) Extreme psychosis (delusions, disorganized thinking, and detachment from reality to a great extent)
(vi) Violent behavior and suicidal thoughts
(vii) Tachycardia
(viii) Severe abdominal pain, nausea, and vomiting that occurs over several months and resolves when SM use has been discontinued (known as synthetic cannabinoid hyperemesis syndrome) |
| | Mechanism of action | (i) It binds to cannabinoid receptors in the brains and other organs as the endogenous ligand, anandamide [20] | (i) It binds to cannabinoid-like receptors in the brains and other organs as the endogenous ligand, anandamide [20]
(ii) Synthetic cannabinoids and other identical products seem to have a similar mode of action as marijuana, in which these substances have affinity to various cannabinoid receptors (e.g., CB1 and CB2) [20]
Synthetic cannabinoids (“spice”) fall into seven major structural groups:
Note that spice has high potency and high affinity for cannabinoid receptors thus making it very efficacious [21]:
(i) Naphthoylindoles (e.g., JWH-018, JWH-073, and JWH-398)
(ii) Naphthylmethylindoles
(iii) Naphthoylpyrroles
(iv) Naphthylmethylindenes
(v) Phenylacetylindoles (i.e., benzoylindoles, e.g., JWH-250)
(vi) Cyclohexylphenols (e.g., CP-47,497 and homologues of CP-47,497)
(vii) Classical cannabinoids (e.g., HU-210) |
| | Availability | (i) Remains illegal in most parts of the United States; State laws determine the legality of marijuana [22]
(ii) Available illegally in most US states | (i) It is readily available in the United States because manufacturers are able to bypass the law by changing chemical compounds that have been outlawed thus creating various cannabinoid-like substances which have not been studied for side effects [21]
(ii) In most countries around the world, including the United States, synthetic cannabis is illegal
(iii) Cannabinoids are becoming more readily available in the United States due to articles and documentaries showing its benefits in regulating mood and also control of epileptiform activities [23] |
| | Screening & Detection | (i) THC compound can be detected consistently by simple serum, urine, or oral swab tests [24]
(ii) Compound can be detected for up to 5–7 days depending on body fluid obtained and quantity of cannabis exposure [24] | (i) Newly developed laboratory tests are able to successfully detect up to 20 synthetic cannabinoid substances; due to the constant changes made to the compounds, it is difficult to have a single test determining the presence of synthetic cannabinoids in body fluids [24]
(ii) New advances have shown that liquid chromatography/tandem mass spectrometry (LC-MS/MS) and gas chromatography/mass spectrometry (GC/MS) can detect several metabolites of synthetic cannabinoid substances in the urine: JWH-018 and JWH-073, along with other various metabolites [24]
(iii) Compounds can be detected for up to 2-3 days based on immunoassay utilized and quantity of synthetic cannabinoid exposure [24] |
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