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Synthetic Marijuana and Current Treatment: A Literature Review

Nimmy Thomas*

Introduction: The number of users of synthetic marijuana is rising, and is responsible for many of the emergency room visits and inpatient psychiatric admissions in the United States. A unique characteristic of this substance is its varying composition from containing JWH-018 to new derivatives like JWH- 081, JWH-122 and AM-220 in attempts to avoid regulations. Compounds such as JWH-018 can cause psychosis in vulnerable individuals. Individuals with a history of psychosis, family history of psychosis and limited resources are vulnerable to experience psychosis after smoking synthetic marijuana.

Methods: This research paper is a comprehensive literature review to determine if successful pharmacological treatments have been developed to treat synthetic marijuana induced psychosis. The online databases, PubMed, Cinahl PLUS with full text, Ebscohost, and Google Scholar were all used to search for articles published after the year 2010. Any synthetic marijuana identified differently such as K2, spice, or JWH-018 was all used for inclusion. Exclusions to the study were articles that described cannabinoid or marijuana induced psychosis.

Results: After reviewing abstracts for 80 articles, nine articles conducted in the US, UK and Australia met inclusion criteria; which included either pharmacological treatment for synthetic marijuana induced psychosis or symptoms experienced related to synthetic marijuana use. Antipsychotics such as risperidone, haloperidol, Clopixol-Acuphase and clozapine were used to treat the psychosis. Clozapine was used in cases where other antipsychotics were ineffective. Benzodiazepines such as lorazepam and diazepam were used to treat agitation, and quetiapine was used for agitation as well. Lorazepam was used for catatonia, and ECT was used for treatment refractory catatonia not resolved by lorazepam.

Conclusions: Treatment for synthetic marijuana toxicity is mainly supportive. The most common symptoms of synthetic marijuana toxicity were tachycardia, agitation, nausea/vomiting and hallucinations. Withdrawal symptoms after using synthetic marijuana were described as anxiety and mood swings making relapse more likely. Also, synthetic marijuana may catalyse psychotic symptoms; making treatment more complex. Treatment for psychotic symptoms related to synthetic marijuana use may warrant treatment with high potency antipsychotics like haloperidol and clozapine. Also, severe catatonia from synthetic marijuana use can be treated with benzodiazepines and electroconvulsive therapy (ECT).