Cannabinoids and Synthetic Cannabinoids Poisoning

Basics

Cannabinoids are a broad, structurally diverse group, united by their binding to and agonist properties at the cannabinoid receptor
Marijuana is plant matter from Cannabis sativa:
- It can be processed into:
  - A pressed resin (hashish, hash)
  - An oil extracted from the resin (hashish oil)
  - Extracted into a solvent (butane hash oil [BHO], 710, dab, wax, shatter, etc.)
- Primary psychoactive compound is tetrahydrocannabinol (THC):
  - THC content varies significantly between products, with the extracted forms typically having higher percentages
  - Cannabinol and cannabidiol (CBD) are less/minimally psychoactive and are present in varying proportions
  - The legal status of recreational and medicinal purposes varies on a state-to-state basis
Synthetic cannabinoids are an ever-changing group of cannabinoid receptor agonists, which may be more closely tied by their marketing strategy than by any similarities in chemical structure or toxidrome
- This group emerged in 2004, as herbal incense blends, laced with a synthetic cannabinoid receptor agonist
- Toxidromes are much more severe
Inhaled or ingested:
- When inhaled, peak concentrations are reached in 3–10 min
- When ingested, onset may take up to 3 hr, with peak effects at 2–6 hr

Incidence and Prevalence Estimates

Marijuana is the most commonly used illicit xenobiotic in the U.S.
Males have a higher incidence of use across other demographics
A 2017 survey reported 49.5% of respondents >12 yr had used marijuana in their lifetime with 19% having used in the past year
5.3% of respondents aged 12–17 had used marijuana in their lifetime, 12.4% in the past year, and 6.5% in the past month
Cannabinoid hyperemesis syndrome:
- Associated with chronic, heavy, marijuana use

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