Synthetic cannabinoids in a legally regulated cannabis market

The emerging market for new psychoactive substances (NPS), also known as ‘legal highs’, has seen a growth in the range of products available that mimic the effects of cannabis. Transform argues that the emergence of synthetic cannabinoids and other NPS is a direct result of prohibition, and that a strict system of legal cannabis regulation would undermine the synthetic cannabinoid market and reduce the harms currently associated with it.

Below is a chapter from our recent major publication, 'How to Regulate Cannabis: A Practical Guide', in which the challenges associated with synthetic cannabinoids are identified as well as recommendations to address them. We welcome disucssion on the issues raised in the comments section below.

 

Challenges

  • Integrating controls over the production, supply and use of synthetic drugs that mimic the effects of cannabis within a system of legal cannabis regulation

Analysis

  • Synthetic cannabinoids make up a significant proportion of the number of new psychoactive substances (NPS) produced as legal alternatives to more ‘traditional’, illegal drugs
  • The risks of synthetic cannabinoid use are considerably higher than those associated with cannabis use. This is due to: a lack of research into the effects of such drugs on humans, some evidence that they may be more potent than real cannabis, wide variations in the products that contain them, and misleading or inaccurate ingredient listings
  • Although the prevalence of synthetic cannabinoids use has increased significantly in recent years, it is still relatively low in most countries

Recommendations

  • Under a system of legal cannabis regulation, drugs that mimic the effects of cannabis would not automatically be made legally available
  • Any synthetic cannabinoid products would be subject to a default prohibition and required to undergo testing in order to establish their risk profile. If such products did not meet defined safety criteria (and being less risky than real cannabis could serve as a sensible benchmark), they would remain prohibited and their production and supply would be subject to penalties. Penalties for the possession/use of synthetic cannabinoids would be removed
  • Such drugs are unlikely to pose a significant regulatory challenge if cannabis is made legally available. The current, rather small population of synthetic cannabinoid users will only decrease further given that an overwhelming majority prefer real cannabis over synthetic alternatives
  • The use of synthetic cannabinoids is a direct result of cannabis prohibition, with the market for these drugs emerging purely to meet the existing high levels of demand for the drug they seek to imitate

 

Recent years have seen a significant growth in the manufacture, sale and use of products containing synthetic cannabinoid receptor agonists – more commonly known as ‘synthetic cannabinoids’. Of the 73 new psychoactive substances identified by the EMCDDA in 2012, 30 were found to contain such chemical compounds. Yet despite the increasingly wide range of synthetic cannabinoid products now available, they all serve (or at least are intended to serve) the same purpose – namely, to mimic the effects of real cannabis. Typically sprayed onto a smokable herbal mixture, synthetic cannabinoids are functionally similar to the active ingredient of cannabis, THC, binding to the same cannabinoid receptors in the brain.

Synthetic cannabinoids such as JWH-018, JWH-073 and CP 47,497-C6 are the active ingredients of many products marketed under more consumer-friendly names such as ‘Spice’, ‘K-2’ and ‘Annihilation’. The relative increase in the variety and popularity of such products is mostly attributable to their being legally and easily available (yet subject to virtually no regulatory control) via online retailers. Synthetic cannabinoids are not prohibited by the UN drug conventions, which meant they once offered a legal – but not necessarily safe – alternative to actual cannabis. Now, however, as use and awareness of them has grown, many have been prohibited under various countries’ national drug control legislation.
 

'Spice', a brand of synthetic cannabinoid 
 

Risk Profile

While there is an established body of knowledge regarding the pharmacology and toxicology of cannabis and THC, there is little similar information about synthetic cannabinoids (that have distinct and different mode of action in the brain) or the products that contain them. Only a few formal human studies have been published, although there is evidence to suggest that some synthetic cannabinoids have a higher potency than THC. This, combined with the considerable variability of synthetic cannabinoid products, both in terms of the type and quantity of substances present, means there is a higher potential for overdose than with cannabis.

Compounding this risk is the lack of information about what is actually contained in many of these products. The plant material that is combined with synthetic cannabinoids to create a smokable herbal mixture may be dangerous in itself: the packaging for Spice, for example, has an ingredient list that features a range of potentially psychoactive plants whose pharmacological or toxicological properties are not well known. Despite this, analysis of Spice has revealed that it does not in fact contain most of its stated ingredients. They may have been listed simply as a marketing ploy, to give the impression that Spice is a natural herbal product, when in fact its effects are widely understood to be due solely to the added synthetic cannabinoids, which are not reported on the label.
 


 

Prevalence of use

The relative paucity of information on synthetic cannabinoids extends to levels of use. The limited amount of survey data available, however, suggests that in most countries, particularly those in Europe, prevalence of synthetic cannabinoid use is very low. The exception is the US, where at least among young people, prevalence appears to be relatively high. One national survey of adolescent drug use found that in 2012, 11.3% of 12th graders (those aged 17˛18) had used synthetic cannabinoids in the past twelve months, with lower but still substantial levels of annual prevalence found among younger age groups.

In contrast, in the UK, reported lifetime prevalence in 2011/12 was 0.1% for those aged 16 to 24, and in Spain, this figure was 1.1% among 14- to 18-year-olds in 2010. A less representative survey that was restricted to 15- to 19-year-old students in the German city of Frankfurt put lifetime levels of use at 9% in 2010 and found that the majority of students who reported synthetic cannabinoid use were already experienced cannabis users.

Again, despite the current lack of research into this emerging drug market, initial indications are that users strongly prefer natural cannabis to synthetic cannabinoids, with the former described as producing a more pleasant high and the latter associated with more negative effects.

Regulatory Response
Many synthetic cannabinoids are currently banned under domestic drug laws, and under a system of legal cannabis regulation their legal status would not automatically change. In fact, we recommend that within a legal regulatory framework to control cannabis, no new, functionally similar substance would be made available without at least a basic level of risk evaluation.

Manufacturers would be required to demonstrate that any synthetic cannabinoid products they wish to sell are low-risk, with regulators having the power to prohibit any that were shown to pose an unacceptably high risk to consumers (being lower-risk than real cannabis could be a sensible benchmark). While penalties for the possession/use of such products would be removed, penalties (whether administrative or criminal) for unauthorised production or supply would still be enforced. When cannabis is made available through a legally regulated market, a default prohibition on the production or supply of any synthetic cannabinoid products is therefore justified.

A regulatory system of this kind is already being implemented in New Zealand, where the manufacturers of all novel psychoactive substances (NPS), not just synthetic cannabinoids, will be required to demonstrate the safety of their products before they can be legally sold under strict conditions. Products deemed to pose more than a low risk will remain prohibited. The aim of such regulation is to protect users by guiding them towards safer products whose risks have been properly established. Nevertheless, although this is a pragmatic, commonsense approach to dealing with synthetic cannabinoid products, there is unlikely to be any great need for such regulation once cannabis has been made legally available. Demand for these products is already low and would only shrink further: users would have no incentive to buy imitation cannabis when they can simply purchase the real thing.
 

Interim licences for the manufacture of NPS in New Zealand
 

It is the current prohibitionist legal environment that has led to the emergence of synthetic cannabinoids and other NPS. Where there is demand for a particular drug or drug effect, there will also be a profit opportunity. And this opportunity ensures demand will always be met – whether legally or illegally. The frequent banning of NPS that occurs in many countries will never be effective as long as there is no means by which the pre-existing demand for drugs can be met. Without some form of legally regulated drug supply, banning NPS simply results in a game of cat and mouse, whereby once a new drug is discovered and prohibited, manufacturers simply adapt and produce another substance that gets around existing legislation. And as appears to be the case with synthetic cannabinoid products, the effects of these new and increasingly obscure substances are likely to be poorly understood and may in fact be more dangerous than ‘traditional’, illegal drugs.

 

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