Full length articleSynthetic cannabinoid use in a nationally representative sample of US high school seniors
Introduction
Synthetic cannabinoids are a large family of compounds that produce similar effects to Δ9-tetrahydrocannabinol (THC), the main psychoactive ingredient in cannabis (marijuana; Department of Justice [DOJ], 2014; Wiley et al., 2013). There are numerous compounds, mixtures and brands of synthetic cannabinoids, and two of the most well-known brands are K2 and Spice. Although many compounds are now illegal to possess or sell in the US (DOJ, 2014), synthetic cannabinoids remain available in many head shops and over the Internet, and they are often sold as herbal incense “not intended for human consumption.” Despite efforts to control sales, new compounds continue to emerge worldwide (European Monitoring Centre for Drugs and Drug Addiction, 2013) and many compounds are not yet illegal or detectable (Castaneto et al., 2014). Use has led to numerous adverse health outcomes and there is a strong need for population data to help guide prevention efforts (Castaneto et al., 2014).
Novel psychoactive drugs such as synthetic cannabinoids are often used because they are “legal” and use generally does not result in arrest (Van Hout and Brennan, 2011). Many individuals also use synthetic cannabinoids as opposed to natural marijuana to avoid detection during drug screenings (Castaneto et al., 2014, Vandrey et al., 2012). However, synthetic cannabinoids may be particularly dangerous as they may be perceived to be safe (Van Hout and Brennan, 2011), marketed products are not regulated, and neither the scientific community nor the public has an adequate understanding of the potential risks involved with use.
While effects of synthetic cannabinoids are often similar to effects of THC in natural marijuana, they have been found to be much more potent and to have stronger effects than THC. The stronger effects in particular appear to have led to numerous adverse outcomes (“poisonings”), which have often been more serious than adverse consequences resulting from natural marijuana use (Castaneto et al., 2014, Forrester et al., 2012, Kronstrand et al., 2013, Winstock and Barratt, 2013a). Adverse effects include severe agitation and anxiety, intense hallucinations, psychotic episodes, suicidal and other harmful thoughts or actions, hypertension, tachycardia, nausea and vomiting, muscle spasms, seizures, tremors, kidney injuries, and myocardial infarction and stroke, often in otherwise young healthy individuals (AAPCC, 2014, Bernson-Leung et al., 2013, Castaneto et al., 2014, Centers for Disease Control and Prevention, 2013a, Centers for Disease Control and Prevention, 2013b, Forrester et al., 2012, Hoyte et al., 2012, Hurst et al., 2011, Mir et al., 2011, Winstock and Barratt, 2013b). Use has also been found to be associated with more severe withdrawal when compared to natural marijuana (Nacca et al., 2013).
Some 11,561 poisonings were reported to AAPCC between January, 2009 and April, 2012 with the highest percentage of use among 13–19-year olds (Wood, 2013), and national data from the Drug Abuse Warning Network confirm that individuals at ages 18–20 are at highest risk for poisoning (60.8 per 100,000-population; Substance Abuse and Mental Health Services Administration, 2013). Although reported poisonings have begun to decrease nationally, there were at least 3359 reported poisonings in the US in 2014 (AAPCC, 2014). Although reports do not always adequately reflect incidence, particularly when a new drug emerges, some areas appear to be experiencing increases in use. In New York City (NYC), for example, there was a 220% increase in reports of related poisonings by mid-2014 (NYC DHMH, 2014). Increases in reported poisonings have often occurred in clusters due to “bad batches” (Centers for Disease Control and Prevention, 2013a, Hoyte et al., 2012, NYC DHMH, 2014).
Monitoring the Future (MTF) is one of few national surveys that ask about synthetic cannabinoid use. Results suggest that in 2011, annual prevalence of synthetic cannabinoid use was 11.4% among high school seniors (modal age: 18) making it the most prevalent drug used after natural marijuana (Johnston et al., 2014a). Likewise, the Global Drug Survey, conducted via Internet respondent-driven sampling, surveyed 3300 Americans in 2012 and results suggest that 14% of respondents used synthetic cannabinoids that year (Rogers, 2012). However, recent MTF reports now suggest that use began to decline in 2013, with prevalence dropping to 6% among high school seniors in 2014 (Johnston et al., 2014a, Johnston et al., 2015).
Although use appears to be declining, we know very little about use in national samples because the very few epidemiological studies have been based on small, self-selected or convenience samples, or from adverse outcomes reported to emergency rooms (Castaneto et al., 2014, Community Epidemiology Work Group, 2013). We thus also know very little about higher-frequency use at the national level. This study seeks to help fill in the gaps and provide researchers, policymakers, and educators, information regarding which teens and young adults are at highest risk for this potentially deleterious drug.
Section snippets
Procedure
MTF is a nationally representative study of US high school students. A cross-section of students is surveyed every year in approximately 130 public and private schools throughout 48 states. MTF uses a multi-stage random sampling procedure: geographic areas are selected, then schools within areas are selected, and then classes within schools are selected. Approximately 15,000 high school seniors are surveyed every year. MTF assesses content through six different survey forms, which are
Results
Sample characteristics are presented in Table 1. One out of ten (10.1%) students reported using synthetic cannabinoids in the last 12 months and 3.2% of the full sample reported “frequent” use. Table 2 presents comparisons of sample characteristics (covariates) according to whether use of synthetic cannabinoids was reported. These bivariable comparisons suggest that males, students with higher income, students who go out more frequently, and students who have used alcohol, cigarettes, marijuana
Discussion
Synthetic cannabinoid use is a potentially dangerous trend in the US; however, there has been a lack of published research on correlates of national rates of use to inform prevention efforts. This is among the first studies to utilize a nationally representative sample and delineate correlates of use. Moreover, this national study was conducted on those in a high risk age group—adolescents approaching adulthood.
This study corroborates evidence from previous studies in that males are more likely
Role of funding source
This work was funded by the NIH (K01 DA-038800, PI: Palamar). The Monitoring the Future principal investigators had no role in analysis, interpretation of results, or in the decision to submit the manuscript for publication.
Contributors
Both authors are responsible for this reported research. J. Palamar conceptualized and designed the study, conducted the statistical analyses, and drafted the initial manuscript. P. Acosta helped conduct literature searches and draft the manuscript. Both authors reviewed and revised the manuscript, and approved the final manuscript as submitted.
Conflict of interest
No conflict declared.
Acknowledgments
The authors would like to thank the principal investigators of Monitoring the Future (PIs: Johnston, Bachman, O’Malley, and Schulenberg) at The University of Michigan, Institute for Social Research, Survey Research Center, and the Inter-university Consortium for Political and Social Research for providing access to these data (http://www.icpsr.umich.edu/icpsrweb/landing.jsp). Monitoring the Future data were collected through a research grant (R01 DA-01411) from the National Institute on Drug
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