WARNING: LEGAL SYNTHETIC CANNABINOID-RECEPTOR AGONISTS SUCH AS JWH-018 MAY PRECIPITATE PSYCHOSIS IN VULNERABLE INDIVIDUALS
Article first published online: 15 SEP 2010
Addiction © 2010 Society for the Study of Addiction
Volume 105, Issue 10, pages 1859–1860, October 2010
How to Cite
EVERY-PALMER, S. (2010), WARNING: LEGAL SYNTHETIC CANNABINOID-RECEPTOR AGONISTS SUCH AS JWH-018 MAY PRECIPITATE PSYCHOSIS IN VULNERABLE INDIVIDUALS. Addiction, 105: 1859–1860. doi: 10.1111/j.1360-0443.2010.03119.x
- Issue published online: 15 SEP 2010
- Article first published online: 15 SEP 2010
Synthetic cannabinoid-receptor agonists may precipitate psychosis in vulnerable individuals, as shown by recent experience within a New Zealand forensic psychiatric in-patient service.
Since 2006, a number of novel products such as K2, Spice, Aroma and Dream have appeared, masquerading as ‘herbal incense’ but marketed as cannabis substitutes. These products are surprisingly psychoactive. Mass spectrometry reveals the reason for their potency: the benign ‘herbal’ ingredients specified on the packaging have been deliberately adulterated with unlisted synthetic cannabinoid-receptor agonists such as CP47,497 , JWH-018  and HU-210 . These cannabimimetics have been declared illegal in some countries, but JWH compounds remain unregulated in many countries, including New Zealand and the United States (although banned recently in seven American states).
While there is a significant growing body of evidence that cannabis is associated with the development and exacerbation of psychosis in some individuals (e.g. ), almost nothing is known about the metabolism, toxicology and psychiatric effects of these new cannabimimetic agents. A recent literature search found two case reports relating to Spice (which at that time contained JWH-018 and CP47,497): one report involved tolerance and withdrawal phenomena  and the other described drug-induced psychosis .
During the last year some patients within our service have been surreptitiously smoking a cannabimimetic called Aroma which, like K2, has been shown to contain JWH-018 (personal communication, Mark Heffernan, Analyst—National Drug Policy, New Zealand Ministry of Health). JWH-018 has similar receptor activity to 9-delta-tetrahydrocannabinol (THC), but its greater affinity to CB1 and CB2 cannabinoid receptors may make it more potent . JWH compounds cannot be detected currently by conventional urinalysis, limiting the ability to identify and regulate these substances.
The mental states of at least five forensic patients have deteriorated significantly after using products containing CP47,497 and/or JWH-018. This has manifested as the sudden re-emergence of florid psychosis; predominantly agitation, disorganization and delusional beliefs (paranoid and grandiose types) in previously stable patients with histories of mental illness.
We are conducting further research into the use and effects of synthetic cannabimimetics in our forensic population. However, until additional information becomes available, our experience suggests that JWH-018 and CP47,497 compounds may precipitate psychosis in a similar fashion to cannabis. People with risk factors for psychosis should be educated as to the potential risks and advised to avoid these substances. Clinicians should also consider the possible use of synthetic cannabimimetics in patients with unexplained psychotic relapses and negative drug screening.
- 2Drug Enforcement Agency (DEA), March 2009. Available from http://www.justice.gov/dea/programs/forensicsci/microgram/mg0309/mg0309.html (accessed 4 April 2010; Archived at Webcite http://www.webcitation.org/5rJQUwOS6)
- 4Withdrawal phenomena and dependence syndrome after the consumption of ‘Spice Gold’. Dtsh Artzebl Int 2009; 106: 464–67., , , , ,
- 6European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Understanding the ‘Spice’ phenomenon. Lisbon: EMCDDA; 2009. Available from http://www.emcdda.europa.eu/publications/thematic-papers/spice (accessed 19 July 2010; Archvied at Webcite http://www.webcitation.org/5rJRJmPMs)