Synthetic Cannabinoids for Medicine: Pros and Cons

Synthetic cannabinoids have a street rep for danger (Spice, K2, Mojo, etc.). Even so, there are some potential benefits. Let’s check out the pros and cons of synthetic cannabinoids for medicine.

Pros

• Modern medicine and medical research: synthetic cannabinoids including dronabinol (synthetic tetrahydrocannabinol, THC) are already legal for medicinal use at the federal level. Isolated molecules can be easier to study and approve.
• Direct agonism: synthetic cannabinoids can have greater potency compared to tetrahydrocannabinol (THC) and other phytocannabinoids due to direct (not partial) agonism of cannabinoid receptors. [1]
• Novel compounds: synthetic cannabinoids can be designed for specific purposes. [2] For example, the University of California is planning a clinical trial on URB597, a fatty acid hydrolase (FAAH) inhibitor, against the symptoms of schizophrenia. Pfizer has also mounted several clinical trials for CP-945598 (otenabant), an endocannabinoid receptor type 1 (CB₁) agonist purposed for weight loss. Other interesting targets include anti-craving effects, nicotine dependence, and cognitive protection. [2]

That’s an attractive list. Unfortunately, synthetic cannabinoids are not completely innocent.

Cons

• Side effects: tend to be more severe and dangerous compared to phytocannabinoids. Side effects may include paranoid delusions, psychosis, hallucinations, suicidal thoughts, and seizures. [2] Recreational intoxication with synthetic cannabinoids can lead to fatal outcomes like brain trauma, organ failure, and heart attack. The high prevalence of serious side effects restricts clinical use. [2]
• Higher abuse risk: direct agonism of cannabinoid receptors create stronger effects that can be more dependency-forming compared to phytocannabinoids. [1] Furthermore, synthetic cannabinoids may interact with other receptors in potent ways, including serotonin. [3]
• No Plant Power: in whole plant preparations, phytocannabinoids and terpenes together amplify therapeutic outcomes for certain conditions. This is known as the entourage effect. Ultimately, synthetic cannabinoids have not surpassed the therapeutic potential of the natural cannabinoids in Cannabis sativa. [2]

The winner? Plant-based cannabinoid medicine triumphs in our pro-con analysis. We are plant people. That’s not say synthetic cannabinoids won’t find their place… (in the back seat).

Image: Michal Jarmoluk from Pixabay

References

1. Mills B, Yepes A, Nugent K. Synthetic cannabinoids. The American Journal of the Medical Sciences. 2015;350(1):59-62. [Impact Factor: 1.911; Times Cited: 63 (Semantic Scholar)]
2. De Luca MA, Fattore L. Therapeutic use of synthetic cannabinoids: still an open issue? Clinical Therapeutics. 2018;40(9):1457-1466. [Impact Factor: 3.119; Times Cited: 17 (Semantic Scholar)]
3. Fattore L. Synthetic cannabinoids—further evidence supporting the relationship between cannabinoids and psychosis. Biological Psychiatry. 2016;79(7):539-548. [Impact Factor: Times Cited: (Semantic Scholar)]