The article by Sherry Yafai, MD, “The A to Z of Cannabis,” attempts to inform readers of terminology related to Cannabis. (EMN. 2020;42:24; http://bit.ly/2STiTrH.) Unfortunately, she conveyed factually inaccurate information, specifically in the section related to synthetic cannabinoids.
First, bath salts are not synthetic cannabinoids. This slang term refers to synthetic cathinones, which have a similar chemical backbone and physiologic effects to amphetamines. Secondly, Spice and K2 are not synthetic THC drugs. These are brand names that refer to a diverse group of chemical structures that are constantly changing.
It is important for readers to understand that there are structural differences that result in pathophysiologic differences between these synthetic drugs and THC. They act at the cannabinoid receptors, similar to THC, but have effects that are much more potent and would not necessarily be expected from THC intoxication, such as profound tachycardia, syncope, seizures, and death. These substances are more accurately referred to as synthetic cannabinoid receptor agonists rather than synthetic THC.
I hope to see Dr. Yafai highlight some of the dangers of Cannabis use in her future columns, such as its well-established link to psychosis. (Schizophr Bull. 2016;42:1262; https://bit.ly/2vBaRu4.)
Heather Borek, MD
Dr. Yafai responds: Thank you for the correction! Bath salts are indeed synthetic cathinones and more similarly mimic cocaine, MDMA, and amphetamines. Spice and K2 were designed to mimic Cannabis, but are not synthetic THC.
We will definitely discuss the link between Cannabis and psychosis and schizophrenia with the new potential treatments for schizophrenia symptoms with CBD (one chemical compound of Cannabis). Like all medications, benefits, side effects, dosage, and intention for use are always important and should be considered when discussing with patients. Please note that the discussion of Cannabis medications in my column is geared toward medical use and not recreational misuse.
Editor's Note: This has been corrected on our website. EMN apologizes for the error.