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Synthetic cannabis - Expert reaction

Synthetic cannabis - Expert reaction
21 July 2017

The Chief Coroner and NZ Police have issued a warning following at least seven recent deaths in Auckland that they say appears to be linked to the use of synthetic cannabis.

The SMC asked experts to comment on the police announcement. Feel free to use these comments in your reporting.

Dr Paul Quigley, emergency medicine specialist, Wellington Hospital, comments:

"Synthetic cannabis use is extremely variable around the country since it was made illegal. It is known that there is a significant supply available through the blackmarket and in particular the organised gangs. Much of this is supply that was legal then stockpiled when it became illegal.

"It appears that it has returned into illicit use particular into our lower socio-economic groups and those marginalised in society. We have very few (if any presentations) in Wellington ED, however, our colleagues at Hutt Valley Hospital report regular attendances by users of synthetic cannabis.

"Synthetic cannabis is 100% avid for the THC receptor of the body. THC is the active chemical within cannabis that is responsible for causing the hallucinogenic and psychoactive effects. It is usually balanced by the presence of Cannabidiol and other active chemicals in natural cannabis that mediates its effects. It is cannabinol that has the majority of the medicinal actions of cannabis.

"Not only is synthetic cannabis 100% THC active, the chemical is far more potent than naturally-occurring THC having up to 50x the effect of natural THC. However, most products available are in the 5 to 15x more active range.

"This doe, however, mean that even a single smoke of synthetic is the equivalent of up to 15 normal joints. This is why the effect is so very different and so very dangerous.

"Synthetic cannabis is one of the more dangerous products around and is responsible for some immediate health harms. When some products were temporarily legal in New Zealand we saw a range of effects within the Emergency Departments and these were recorded on drug harm reports and lead to the banning.

"Typical serious features we saw were;
• Epileptic seizures
• Heart palpitations (arrhythmias) especially Atrial Fibrillation. High does of THC appear to be particularly cardiac active and cases of more dangerous rhythms like ventricular tachycardia and ventricular fibrillation had been seen, especially in this users with pre-existing conditions like long-QT syndrome or Brugada syndrome.
• Significant anxiety and insomnia
"We also saw some patients with acute renal impairment, it is difficult to know if this is directly from the synthetic cannabis or from nitrates inhaled from smoking the product.

"Because synthetic cannabis is so much more potent than natural cannabis we were also seeing the effects related to substance abuse and addiction developing rapidly. Users would need to smoke regularly every 3-4 hours, even waking during the night to smoke and would exhibit signs of withdrawal on cessation.

"There were also increased presentation to mental health services with addiction and psychosis. As with natural cannabis you are more likely to develop the psychotic effects if you already have a pre-existing mental illness. Unfortunately, synthetic cannabis use is very popular in our mental health population."

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