Investigation of the negative effects of the synthetic cannabinoid jwh-018: a literature review

Despite legal regulations restricting their use, synthetic cannabinoids (SCs) (e.g., JWH-018, K2)can be easily found on the Internet. Today, less than one percent of the general community uses SCs, which is rather a low rate. However, this rate is higher among students and some niche groups subject to drug testing. A meta-analysis of 323 records from the database search has shown that using JWH-018 may lead to more negative and severer effects than using cannabis.
To these records, we added 41 studies obtained as a result of manually looking through references. After eliminating duplicates and screening titles, we took into consideration a total of 136 full texts. Then, we excluded 30 studies. Eventually, the study included a total of 106 papers, letters, and conference abstracts, which represented data for more than 4,000 cases and at least 26 deaths. Cardiovascular events (ischemic stroke, emboli, and myocardial infarction), acute renal damage, generalized tonic-clonic seizures, psychiatric presentations (including first episode psychosis, paranoia, suicidal ideation, and hyperemesis) are among the significant consequences. On the other hand, the majority of the cases were not severe: young male individuals with tachyarrhythmia (≈ 37-77%), agitation (≈ 16-41%), and nausea (≈ 13-94%), who received only supportive therapy during less than eight-hour hospital stay.
Tachyarrhythmia, restlessness, and uneasiness of the stomach are the most prevalent effects, which are usually treated with supportive care, including the use of antiemetics, benzodiazepines, and intravenous fluids; so they do not often require overnight hospitalization. Severerproblems such as death, seizure, stroke, rhabdomyolysis, myocardialinfarction, hyperemesis, psychosis, or acute kidney injury are less prevalent.