Characterizing Trends in Synthetic Cannabinoid Receptor Agonist Use from Patient Clinical Evaluations during Medical Toxicology Consultation

ABSTRACT

Synthetic cannabinoid receptor agonists (SCRAs) are a new class of compounds with profound psychoactive effects and potential toxicity. This study characterizes patterns in SCRA abuse using qualitative interviews with individuals receiving medical toxicology consultation. Patients with suspected exposure to a new psychoactive substance were interviewed by medical toxicologists upon presentation for acute care. Investigators collected clinical and qualitative data including knowledge, attitudes, beliefs, and practices related to psychoactive substance use. Responses were categorized by identifying themes, and statistics were generated to describe patterns of use. Overall, 69% (86) of the 124 cases of novel psychoactive substance use entered into the registry were associated with exposure to SCRAs. Most patients (68.8%) had used SCRAs at least once before the presenting episode. 47.7% considered SCRAs to be very easy to obtain, and 44.2% reported paying for the substances while 32.6% acquired it for free. Nearly half (48.8%) of patients reported their primary reason for use was to get high; a small proportion used SCRAs to avoid testing positive on drug screening (6.9%) or as an alternative to marijuana (4.6%). Findings suggest an independent and stable culture is developing around the use of SCRAs separate from their appeal as an “undetectable” alternative to marijuana.

KEYWORDS:

• Synthetic cannabinoid receptor agonists
• spice
• medical toxicology consultation
• novel psychoactive substances
• emergency medicine

Acknowledgments

We would like to acknowledge and thank the following IN3 Study Group investigators who collected the data: Robert Hendrickson, MD, Oregon Health and Science University Hospital; Kurt Kleinschmidt, MD, Parkland Memorial Hospital; Alex Manini, MD, Mount Sinai Medical Center; Alex Monte, MD, Denver Health, Adam Pomerleau, MD, Grady Memorial Hospital; Anne-Michelle Ruha, MD, Banner Good Samaritan Medical Center; Daniel Rusyniak, MD, IU Health University Hospital; Evan Schwarz, MD, Washington University School of Medicine; David Vearrier, MD, Hahnemann University Hospital; Timothy Wiegand, MD, University of Rochester Medical Center. A previous version of this paper was presented as an abstract poster at the North American Congress of Clinical Toxicology, 2019, Nashville TN.

Disclosure statement

The authors have no financial relationships relevant to this article to disclose.

Additional information

Funding

This study was supported by the National Institute on Drug Abuse Grant Number: R56DA03866, “iN3 An Innovative Approach.” The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health.