Synthetic Cannabinoids and E-Cigarettes

"Synthetic cannabinoids (SCs) are a class of designer drugs that replicate the physiological effects of tetrahydrocannabinol (THC) via binding to cannabinoid receptors CB1 and CB2.¹ Several structural classes of SCs have entered the illicit drug market, arising from iterative structural diversification around a common architecture.² Physiological effects of newer SCs are divergent from early compounds synthesized as cannabimimetics, whereby complex interactions outside of CB1/CB2 agonism have been reported.³ Notably, these off-target effects may be responsible for the toxicity reported for a wide range of SCs.⁴

"In the UK, SC consumption is prevalent in the homeless community, where SCs are smoked in herbal preparations, and in the prison estate, where SC-soaked paper is smuggled in as contraband.⁵⁻⁷ Recently, however, e-cigarettes have emerged as a popular delivery vehicle for SCs, consistent with their rise in popularity as nicotine delivery devices among young people.^8,9 E-cigarettes appeal to young people through attractive packing and availability in a wide variety of flavors, while also providing an unsuspicious route of drug administration.^10,11 Indeed, a major demographic for SC-containing e-cigarettes appears to be school age children. 31% of children up to age 17 have tried cannabis,¹² meaning dealers can exploit the appeal of e-cigarettes to mis-sell SC-containing e-liquid as cannabis extract.¹³ Data from the UK drug checking service WEDINOS shows that 41% of 122 drug-laced e-cigarettes submitted for testing between January 2023 and April 2024 contained SCs.¹⁴ Notably, none of these samples were submitted with the purchase intent of SCs (Figure 1A–C). As SCs are more potent than THC and present in e-liquid at unknown quantities, the risk of overdose is higher, with potentially severe side-effects including respiratory depression and cardiac arrest.¹⁵ Further, recent work demonstrates that SC e-cigarettes are becoming less expensive, with a median cost of as £3.39/mL, and as little as £1.60/mL; cheaper per unit volume than a commercial e-cigarette.¹⁶"