In recent years, news of legal “synthetic” forms of cannabis have saturated the airwaves to the point where even the most passive followers of current-events have heard of synthetic cannabis. These reports often speculate about the dangers of a legal “alternative” to cannabis. Despite the rapid popularity of synthetics throughout the market, the accompanying surge in collective awareness on the topic is still a bit blurry. This base-level of understanding concerning synthetic cannabis exists even for medical professionals tasked with treating those who have been harmed as a result of its consumption.

A recent study published in the Journal of Epilepsy and Behavior sought to explore the association between synthetic cannabinoid use and the development of seizures. The study was crafted in response to the increasing incidence of seizures seen in patients who have consumed synthetic cannabinoids. It aspired to add some dimension to the relatively superficial knowledge clinicians currently hold regarding this particular association. More specifically, this study sought to analyze data regarding the clinical features and ultimate prognosis of those who have experienced seizures after consuming synthetic cannabis. By doing so, it is the first of its kind to provide insight into this association.

An Overview of Synthetic Cannabinoids and Seizures

The term “synthetic cannabinoids” has been largely misinterpreted by most people who think they know what it is. Arguably a misnomer in itself, synthetic cannabis bears little similarity to naturally-harvested cannabis or marijuana. It is of pertinence to note that synthetic cannabinoids are not, in fact, derived from cannabis. The differences between the two substances are innumerable, beginning with the most fundamental point of origin: their chemical composition.

Synthetic cannabinoids are chemically unrelated to cannabis. However, they are function similarly to the active ingredient in cannabis: delta-9-tetrahydrocannabinol (THC). This “functional” similarity to THC, is the cause of a lot of the confusion and misinformation around the product. Although both natural and synthetic cannabinoids act upon THC receptors (i.e., cannabinoid receptors), the way both substances stimulate these receptors differs greatly.

Synthetic cannabis stimulates cannabinoid receptors with far greater intensity than naturally-derived cannabis. This allows synthetic cannabis to have significantly greater potency than natural THC, which creates a far more severe and potentially devastating effect for the user.

Manifestations of these effects can include unconsciousness, convulsions, psychosis, heart attack, kidney failure, stroke, hallucinations, as well as dangerous drops and increases in heart rate and blood pressure.

There have been many reports of tainted batches of synthetic cannabinoids laced with chemicals that have caused severe bleeding from the eyes and nose. Toxic effects of synthetics appear to commonly affect the brain, leading to seizures, coma, and even death.

As suggested in the name, synthetic cannabinoids are artificially produced chemicals that are then sprayed onto dried leaf or plant-matter and are consumed primarily via smoking.

There has been a surge of commercially produced synthetic cannabinoid products available for consumption within the legal market. This surge in product availability has also been followed by a subsequent surge in overdose and death related to its consumption.

There are many types of synthetic cannabis floating around, which means that there is very little consistency between each synthetic cannabis product. This is due, in part, to virtually no product evaluation or vetting during the production stage. These chemicals are oftentimes marketed as “not being suitable for human consumption” through intentionally subversive labeling.

The appeal of consuming an unpredictable product lies within its legal status. It’s become increasingly popular among people wanting to evade potential legal consequences of consuming real marijuana in states where it is not yet legal.

The Study

The goal of this study was to properly describe the clinical features and prognosis of patients who had seizures associated with the use of synthetic cannabinoids. Researchers looked at data collected from a first-seizure clinic in Perth, Australia. They then selected patients who had presented with both seizures and “seizure-like” episodes that had occurred within 24 hours of synthetic use. Seizure-like episodes refer to patients who present with findings that raise suspicion for seizure.

After sifting through 651 patients, researchers identified 30 who matched their selective criteria. The data collected from these 30 individuals was then further scrutinized in order to find evidence of any significant patterns or trends of interest.

Results

The data collected from these patients showed that there were many different “brands” of synthetic cannabinoids that were consumed amongst them. Although approximately half were reported to have consumed a particular brand of synthetic, there was no consistency of brand choice among the remaining half. However, all 30 patients consumed their synthetic via smoking.

27% of patients had experienced seizures within 5 minutes after using synthetic cannabinoids. 46% had seizures within 30 minutes after using, and 80% had seizures within 12 hours after use.

Researchers then wanted to determine how many patients, within this selected pool of individuals, had continued using synthetic cannabinoids and suffered any further seizures after they were released from the first-seizure clinic. This follow-up data was only available for 24 of the 30 selected patients. Of this group, half had reported continuing to use synthetics. 38% had experienced additional seizures after their first seizure. These additional seizures occurred, on average, approximately 71 days after the first seizure.

Prior to undergoing data analysis of the selected individuals of interest, researchers had collected data on these patients regarding any history of prior seizures as well as the particular risk factors that each selected patient had for seizure occurrence.

During the analysis of “follow-up” data that had occurred after the first seizure, it was found that out of 8 patients who had a history of prior seizures, 5 had suffered recurrent seizures. Four patients who did not have any history of prior seizures had experienced seizures during the follow-up period. Interestingly, of these four patients, two did not have any risk factors for seizure. Of the 12 (50%) individuals who had continued to use synthetic cannabinoids, 2 had experienced seizure recurrence during follow-up.

Significance

From the data pool analyzed in this study, there was a positive correlation determined between smoking synthetic cannabinoids and the subsequent development of seizures. The researchers found that this may be due to the nature of synthetic chemicals and their ability to potentially act as a catalyst for the development of seizures. They believed this property to be so strong that it not only acts as a catalyst for seizures in those already predisposed to seizure occurrence but also in those who have no risk factor for seizure at all.

The true significance of this study lies within its broader application throughout multiple realms of practical clinical application. It is the first of its kind to charter an exploratory inquiry toward the filling of vast swaths of unmapped territory concerning this unique subject. It’s important to understand the clinical role in the relationship between synthetic cannabis use and seizures. The information revealed in the study will ultimately help those who will benefit from it because of the availability of this information. This includes patients, healthcare providers, and many more.

Additionally, the results of this study find a broader application in the understanding of seizure development due to the overactivation of cannabinoid receptors. In one regard, similar to its synthetic counterpart, “natural” non-synthetic cannabis has experienced a rapidly burgeoning presence within North America. For both medicinal and recreational use, changes in legislation have welcomed its legal sale throughout many states and provinces. We can use our understanding of how other substances, including synthetic cannabinoids, act upon cannabinoid receptors in order to further understand how cannabis may act upon those receptors.

Limitations

The ability to apply the results of this study to a wider-range of applicability is primarily limited by the relatively small number of patients selected for data analysis. However, as it is the first study of its nature, future studies that follow in its footsteps will be able to provide a more solid level of understanding on this subject.

Additionally, as noted in the study, the ability to properly determine a causative relationship between synthetic cannabinoid use and seizure development is somewhat challenging. This is because of the high number of brands and chemical compositions of synthetic cannabis on the market. These formulations are constantly changing, oftentimes bearing little similarity to one another. Consistency is highly valued in any research study, and in this instance, it was hard to achieve.

Due to the inherently mysterious nature of synthetic cannabinoids, the composition of all the chemicals added to these products was not entirely known. This includes, in particular, chemicals of a non-cannabinoid nature. This hinders researchers from accurately identifying what products used in the synthetic cannabis contributes to the seizures.

Final Thoughts

We need to understand the nature of all substances that we choose to consume. This has particular relevance towards substances that may have the propensity to cause us great harm. This study does a fine job of examining a potentially detrimental outcome as a result of smoking synthetic cannabinoids. This arguably nefarious product that has swept international markets has had surprisingly little research devoted to its understanding. This study is a great start.

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