Cic edizioni internazionali
Research and Advances in Psychiatry

Current challenges of synthetic cannabinoids: clinical and psychopathological aspects

Review article, 58 - 63
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Introduction: Synthetic cannabinoids (SC) among other groups of Novel Psychoactive Substances demonstrates an unprecedented growth and variability of formulas and products. A great number of anecdotal clinical cases indicate side and addictive effects of SC. Health practitioners in various medical fields (psychiatry, gastroenterology, nephrology, hepatology, cardiology) meet consequences of acute and chronic SC intoxication and experience the lack of reliable information and applying recommendations. Aim of the review is to provide a synthesis of the most recent and relevant insights on the clinical and psychopathological aspects of SC.
Methods: To reach this goal, a literature search was performed on two representative databases (PubMed and Scopus). The terms used for the database search were: “synthetic cannabinoid”, “synthetic cannabimimetic”, “synthetic cannabis”, “synthetic marijuana” and “Spice AND cannabinoid”.
Papers not in English; mini reviews, letters, book chapters, case reports erratum, and papers related to SC as therapeutic options were excluded from the search results. 521 articles were preliminarly identified, among which 228 relevant results were included in the review.
Results: The findings were structured in three thematic domains: I) clinical aspects, II) psychoses, III) fatalities. The literature on the SC clinical symptoms were analyzed both in the traditional scope of systemic effects (gastrointestinal, neurological, cardiovascular, psychopathological and other side effects) and in terms of the time-applying approach (acute and subacute phases of SC intoxication, withdrawal symptoms). The SC psychotomimetic properties were reviewed within the frame of their direct impact on manifestation of acute hallucinations/delusions and precipitation of outlasting schizophrenia-like positive and negative symptoms.
The different psychotic potential of various formulas within SC group that goes beyond the CB1 receptors approach was underlined. The contributing role of SC in lethal cases was specifically reported according to links between SC abuse and two formal causes of fatalities - neurological severe complications and self-injuries or suicides.
Conclusions: SCs demonstrate a range of risks for both individual and public health. The further systematic studies applying the combination of clinical and laboratory methods for SC-risks assessment are required for developing effective and evidence-based treatment and prevention recommendations.