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Psychological effects of synthetic cannabinoids

The issue of synthetic cannabinoids (SCs) often comes up in connection with cannabis, cannabinoids, THC and CBD.  SCs might be sold as a legal alternative to marijuana. However, they are dangerous illegal drugsThis review assesses the psychological effects of SCs. We are discussing the following in this article:

What are synthetic cannabinoids?

Chemists first created synthetic cannabinoids for potential medical uses in the 1960s. However, increasingly many people have been using them as recreational drugs in the past decade.  Their use has been spreading especially among poor and socially disadvantaged people, because these drugs are cheap and strong.

SCs bind to and activate CB1 receptors. However, they are much stronger drugs than natural cannabis, because:

  • they bind 4-5 times stronger to CB1 than THC, and
  • they can therefore be even 600 times as potent as THC.  

Many media accounts report on “zombies”, who are people that become either unresponsive or psychotic after synthetic cannabinoid use.

Watch this 2:18 minute video by the New England Journal of Medicine: “Mass Intoxication with a Synthetic Cannabinoid”

Due to a lack of clinical data, much of the report below was comparisons of synthetic cannabinoid users with other clinical populations, such as schizophrenic patients. In addition, often times what we have is only self-reports of these users themselves without any comparison to any other group.

Reports of the effects of synthetic cannabinoids

Very little clinical research is available on SCs. What we know though from user reports is that these drugs might have the following effects:

  • Impairment of motor skills
  • Poor coordination
  • Agitation
  • Confusion
  • Mood swings
  • Anxiety

Complications of taking synthetic cannabinoids might call for hospitalization, especially among people with already existing health condition.  Theses complications include:

  • Tachycardia (meaning: very fast – over 100 beats per minute – heart beat)
  • Seizures
  • Kidney failure
  • Myocardial infarction
  • Gastrointestinal problems
  • Liver failure
  • Cardiac arrest (the stopping of the heart)
  • Death

Watch this 1:56 minute video by LegitScript: “Synthetic Cannabinoids”

The effects of synthetic cannabinoids compared to placebo

Comparing to placebo, SC users were unsurprisingly more likely to have a “high”, meaning they tended to:

  • Have elevated mood
  • Move slowly or unnaturally
  • Be more tired after half a day
  • Respond and talk slower

Psychosis among users of synthetic cannabinoids

A large proportion of people who used SC reported that they experienced hallucination and paranoia.

As a matter of fact, compared to people who used other drugs, those who used SCs were more prone to:

  • Psychological distress
  • Paranoia, and
  • Psychosis

Natural cannabis users were more likely than SC users to:

  • be emotionally withdrawn and
  • move slower.

Nevertheless, users of SCs were more likely than natural cannabis users to have symptoms of:

  • delusions
  • persecutions
  • disorganization, and
  • hallucinations 

As a contrast, patients in a psychiatry ward who developed psychosis after they had used SCs had less severe psychotic episodes than schizophrenic patients. Moreover, they had less severe psychiatric symptoms as well.

Depression and anxiety among users of synthetic cannabinoids

Compared to people who did not use any cannabis or cannabinoids, people who used SCs reported more depressive symptoms, such as:

  • Sad feelings
  • Depression
  • Suicidal thoughts
  • Suicide attempts

In addition, users of SCs reported higher levels of anxiety than:

  • User of natural cannabis and
  • People who had schizophrenia but never used drugs.

Cognitive functions among users of synthetic cannabinoids

Compared to schizophrenic patients, synthetic cannabinoid users had about the same levels of:

  • Executive functioning
  • Inhibition, and
  • Sensitivity to interference
  • Long-term memory.

There was another study that actually found these measures to be worse among users of SCs. However, in that study SC users had lower education and had a more socially disadvantaged background than the comparison group.  As such, these background differences – and not their substance use – might have contributed to the observed cognitive differences.

Watch this 3:25 minute video by Addaction: “Synthetic Cannabinoids (Spice, Black Mamba) – what you need to know”

Self-report of symptoms of synthetic cannabinoid use

Some studies used online questionnaires. In these studies, people use SCs reported that the effect of the drugs lasted for about 1-2 hours. Moreover, these where the symptoms that users reported:

  • Unpredictable physical and psychological effects
  • Anxiety or panic
  • Anger
  • Memory impairments and difficulties
  • Breathlessness
  • Emotional numbness
  • Emotional and social distance
  • Paranoia
  • Acute intoxication
  • Hangover
  • Increased appetite
  • Dependence
  • Strong withdrawal symptoms

Intoxication symptoms included:

  • Nausea
  • Tachycardia (very fast heartbeat)
  • Restlessness
  • Fear and paranoia
  • Warm and happy feelings
  • Tiredness
  • Sluggish and dull feelings
  • Dehydration
  • Respiratory difficulties

Withdrawal symptoms were:

  • Memory and concentration problems
  • Disconnection
  • Mood swings
  • Agitation
  • Pains and aches
  • Diarrhea
  • Insomnia
  • Sweating
  • Suicidal thoughts.

Available research shows fairly similar results across studies. However, given the diversity and different potency of SCs, it is very difficult to draw appropriate clinical conclusions.


As of 2018, the European Monitoring Centre for Drugs and Drug Addictions (EMCDDA) reported almost 200 SC compounds, which is more than the number of known natural cannabinoids. Given the ease of producing newer compounds (this is why here drugs are also called designer drugs), it is almost impossible to regulate them.

It is very important, however, to inform people who use or are interested in using recreational drugs that SCs are:

  • not regulated compounds,
  • not natural alternatives but designer chemicals
  • and can have unpredictable and more severe effects than cannabis.

Watch this 13:54 minute video by Vice: “The Hard Lives of Britain’s Synthetic Marijuana Addicts”

NOTICE: Age restricted material


Akram H, Mokrysz C, Curran HV. What are the psychological effects of using synthetic cannabinoids? A systematic review. J Psychopharmacol. 2019 Mar;33(3):271-283. 

Peacock A, Bruno R, Gisev N, Degenhardt L, Hall W, Sedefov R, White J, Thomas KV, Farrell M, Griffiths P. New psychoactive substances: challenges for drug surveillance, control, and public health responses. Lancet. 2019 Nov 2;394(10209):1668-1684.