What are synthetic cannabinoids?

Synthetic cannabinoids are chemicals made in a laboratory that mimic the cannabinoids found in cannabis.

Many synthetic cannabinoids have been created to replicate the desired effects of tetrahydrocannabinol (THC) and cannabidiol (CBD). However, their safety levels can vary. As a result, some synthetic cannabinoid products are illegal, while others are only available for use under medical supervision.

Learn more about synthetic cannabinoids, the potential risks and benefits, and which products contain them.

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Synthetic cannabinoids vs. natural cannabinoids

The cannabis plant contains over 100 cannabinoids that attach to cannabinoid receptors in your body.

Natural cannabinoids like THC are broken down quickly by enzymes belonging to your body’s endocannabinoid system. This allows them to leave the body rapidly instead of building up in your bloodstream and putting you at risk of overdose.

Synthetic cannabinoids work in the same way as natural ones by attaching to receptors in your endocannabinoid system. However, their chemical structures are different from natural cannabinoids, which means they might not be broken down as quickly. This means the risk of negative effects and overdose is higher.

For example, THC activates cannabinoid receptors in the brain called CB1 receptors. This produces a number of effects, including intoxication. THC’s chemical structure prevents it from fully attaching to CB1 receptors. This prevents the potency of THC from being too strong.

Some synthetic cannabinoids, on the other hand, fully attach to the brain’s CB1 receptors and produce far more potent effects than natural cannabinoids.

Sometimes, synthetic cannabinoids break down into small molecules called metabolites. Metabolites can be extremely toxic, even at low levels.

Still, some synthetic cannabinoids aren’t harmful and can even be beneficial. In fact, some types are approved by the Food and Drug Administration (FDA) to help treat certain medical conditions.

Products that contain synthetic cannabinoids

There are two types of synthetic cannabinoids: FDA-approved and non-FDA approved.

FDA-approved synthetic cannabinoids

Certain drug manufacturers have developed synthetic cannabinoids to improve the effectiveness of cannabinoids like THC and CBD. This is usually done by changing their chemical structure so that they attach better to the body’s receptors.

For example, nabilone (Cesamet) is a synthetic form of THC. Nabilone contains dronabinol (Marinol), a purified form of THC with a high absorption rate.

These synthetic cannabinoids can be used in people with certain conditions like AIDS/HIV and cancer to help manage symptoms and treatment side effects by:

• Soothing chemotherapy-induced nausea and vomiting
• Boosting appetite
• Reducing pain

Both nabilone and dronabinol are generally well-tolerated. Nabilone is stronger than THC, so some people may find its effects too powerful and prefer to use natural cannabis products. These contain other cannabinoids and terpenes that may reduce the risk of side effects.

You can only get FDA-approved synthetic cannabinoids with a doctor’s prescription.

Non-FDA-approved synthetic cannabinoids

Other synthetic cannabinoids are not evaluated by the FDA but can be found on the black market. These include:

• K2
• Spice
• Synthetic marijuana (like “potpourri” or “herbal incense”)
• Hexahydrocannabiphorol (HHC-P)
• Tetrahydrocannabinol acetate (THC-O)
• Delta-8-THC

Any synthetic cannabinoids that aren’t approved by the FDA should be avoided.

Side effects and risks

Side effects and risks can vary between FDA-approved and non-FDA-approved options.

Legal synthetic cannabinoids 

FDA-approved synthetic cannabinoids like dronabinol can cause some side effects, including:

• Nausea
• Vomiting
• Seizures
• Changes in blood pressure

Taking these FDA-approved synthetic cannabinoids as directed by your doctor can help reduce the risk of side effects.

Illegal synthetic cannabinoids 

Non-FDA-approved synthetic cannabinoids are known to pose serious health risks.

Some, like K2 and spice, contain synthetic cannabinoids that are illegal in many places throughout the world. They may also be highly addictive and can even lead to a fatal overdose.

These synthetic cannabinoids also don’t follow the same regulatory standards as medical marijuana products found in licensed dispensaries.

For example, producing synthetic marijuana usually involves spraying plant material with a solution of synthetic cannabinoids, which is then packaged and sold with no regulatory oversight. Many manufacturers don’t disclose if their products contain synthetic cannabinoids.

Side effects associated with non-FDA-approved synthetic cannabinoids include:

• Addiction
• Acute kidney injury
• Cardiac toxicity
• Dangerously low levels of potassium in the blood (hypokalemia)
• Rapid breakdown of skeletal muscle (rhabdomyolysis)
• Seizures
• Significantly depressed breathing
• Stroke
• Tremor

Unapproved synthetic cannabinoids should be avoided. They’re rarely tested for safety. As a result, researchers don’t know how they interact with the endocannabinoid system compared with natural cannabinoids.

The bottom line: Unless FDA-approved, synthetic cannabinoids should be avoided

Some FDA-approved synthetic cannabinoids, like nabilone and dronabinol, may offer health benefits. However, options that are not approved by the FDA can be dangerous and possibly even deadly.

Avoid purchasing synthetic cannabinoids or any synthetic form of cannabis from unlicensed dispensaries.

You can speak with your healthcare team to learn more about FDA-approved cannabinoid-based medications. And if you’re looking to experience the natural benefits of the cannabis plant, consider speaking with a qualified healthcare professional at Leafwell about getting a medical marijuana card.

Resources

• Acute kidney injury related to intoxication from synthetic cannabis: Don’t you know that you’re toxic? https://pmc.ncbi.nlm.nih.gov/articles/PMC9033635/
• Adverse effects of synthetic cannabinoids: Management of acute toxicity and withdrawal. https://pmc.ncbi.nlm.nih.gov/articles/PMC4923337/
• Cannabis, cannabinoids, and health. https://pmc.ncbi.nlm.nih.gov/articles/PMC5741114/
• Comparison of the analgesic effects of dronabinol and smoked marijuana in daily marijuana smokers. https://pmc.ncbi.nlm.nih.gov/articles/PMC3746706/
• Dronabinol. https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/dronabinol
• Dronabinol. https://www.ncbi.nlm.nih.gov/books/NBK557531/
• K2 and Spice. https://www.dea.gov/sites/default/files/2020-06/K2-spice-2020.pdf
• Synthetic and natural derivatives of cannabidiol. https://pubmed.ncbi.nlm.nih.gov/33537934/
• Synthetic cannabinoids: The multi-organ failure and metabolic derangements associated with getting high. https://pmc.ncbi.nlm.nih.gov/articles/PMC4558292/
• The “entourage effect”: Terpenes coupled with cannabinoids for the treatment of mood disorders and anxiety disorders. https://pmc.ncbi.nlm.nih.gov/articles/PMC7324885/

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