Cannabinoid: Difference between revisions

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===Toxicity and harm potential===

Unlike [[cannabis]], there have been multiple deaths<ref name="death1">Brents, L. K.; Reichard, E. E.; Zimmerman, S. M.; Moran, J. H.; Fantegrossi, W. E.; Prather, P. L. (2011). "Phase I hydroxylated metabolites of the K2 synthetic cannabinoid JWH-018 retain in vitro and in vivo cannabinoid 1 receptor affinity and activity". PLoS ONE 6 (7) (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/21755008</ref><ref name="death2">Coroner: Lamar Jack ingested chemical found in fake marijuana before he died (IndependentMail.com) | https://web.archive.org/web/20131009101212/http://www.independentmail.com/news/2011/oct/15/coroner-lamar-jack-ingested-chemical-found-fake-ma/</ref><ref name="death3"> Coffman, K. (6 September 2013). "Colorado probes three deaths possibly linked to synthetic marijuana". Reuters (Denver). | http://www.reuters.com/article/us-usa-colorado-spice-idUSBRE98516A20130906</ref><ref name="death4">Perspectives of drugs: synthetic cannabinoids in Europe (European Monitoring Centre for Drugs and Drug Addiction | http://www.emcdda.europa.eu/topics/pods/synthetic-cannabinoids</ref><ref name="death5">Westin AA, Frost J, Brede WR, Gundersen PO, Einvik S, Aarset H, Slørdal L. “Sudden Cardiac Death Following Use of the Synthetic Cannabinoid MDMB-CHMICA”. J Anal Toxicol. 2016 Jan 19;40(1):86-7. | https://www.erowid.org/references/refs_view.php?ID=8961</ref><ref name="death6">Adamowicz P. “Fatal intoxication with synthetic cannabinoid MDMB-CHMICA”. Forensic Sci Int. 2016 Mar;. | https://www.erowid.org/references/refs_view.php?ID=8963</ref><ref name="death7">Synthetic Cannabinoid–Related Illnesses and Deaths | http://www.nejm.org/doi/full/10.1056/NEJMp1505328</ref> associated with the repeated abuse of synthetic cannabinoids as well as serious side effects resulting from its long-term use.<ref> Vardakou, I; Pistos, C; Spiliopoulou, Ch (2010). "Spice ~~drugs~~ as a new trend: Mode of action, identification and legislation". Toxicology Letters 197 (3): 157–62. (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/20566335</ref><ref> Auwärter, V.; et al. (2009). "'Spice' and other herbal blends: harmless incense or cannabinoid designer drugs?". Journal of mass spectrometry : JMS 44 (5) | http://onlinelibrary.wiley.com/doi/10.1002/jms.1558/abstract</ref><ref>Toxicological Findings of Synthetic Cannabinoids in Recreational Users | http://jat.oxfordjournals.org/content/37/8/534.full</ref> Therefore, it is strongly discouraged to take this substance for extended periods of time or in excessive doses. Compared to cannabis and its active cannabinoid THC, the adverse effects are often much more severe and can include [[high blood pressure]], [[increased heart rate]], heart attacks,<ref>Mir, A; Obafemi, A; Young, A; Kane, C (December 2011). "Myocardial infarction associated with use of the synthetic cannabinoid k2.". Pediatrics 128 (6) | http://pediatrics.aappublications.org/content/pediatrics/early/2011/11/04/peds.2010-3823.full.pdf</ref><ref>Acute myocardial infarction, associated with the use of a synthetic adamantyl-cannabinoid: a case report (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4715335/</ref> agitation,<ref name="teen">A Teenager With Agitation: Higher Than She Should Have Climbed - Pediatric Emergency Care: June 2010 - Volume 26 - Issue 6 - pp 462-465 | http://journals.lww.com/pec-online/Abstract/2010/06000/A_Teenager_With_Agitation__Higher_Than_She_Should.16.aspx</ref> [[nausea|vomiting]],<ref>T. "Extreme Nausea, Incoherent: An Experience with JWH-018 (ID 84443)". Erowid.org. Oct 12, 2010. erowid.org/exp/84443 | https://www.erowid.org/experiences/exp.php?ID=84443</ref><ref>Exdrugaddict. "Playing With Fire: An Experience with Spice (ID 90178)". Erowid.org. Dec 16, 2013. erowid.org/exp/90178 | https://www.erowid.org/experiences/exp.php?ID=90178</ref><ref>Boss Lok. "Non-Allergic Adverse Reaction: An Experience with Spice and Synthetic Cannabinoids ('Drill') (ID 85853)". Erowid.org. Oct 12, 2010. erowid.org/exp/85853 | https://www.erowid.org/experiences/exp.php?ID=85853</ref> [[external hallucinations|hallucinations]],<ref> Jeanna Bryner (March 3, 2010). "Fake Weed, Real Drug: K2 Causing hallucinations in Teens". LiveScience. | http://www.livescience.com/6149-fake-weed-real-drug-k2-causing-hallucinations-teens.html</ref> [[psychosis|psychosis]],<ref> Every-Palmer, S (2010). "Warning: Legal synthetic cannabinoid-receptor agonists such as JWH-018 may precipitate psychosis in vulnerable individuals". Addiction 105 (10): 1859–60. (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/20840203</ref><ref name="british">Causal association between cannabis and psychosis: examination of the evidence - The British Journal of Psychiatry Jan 2004, 184 (2) 110-117 | http://bjp.rcpsych.org/content/184/2/110.short</ref><ref name="teen">A Teenager With Agitation: Higher Than She Should Have Climbed - Pediatric Emergency Care: June 2010 - Volume 26 - Issue 6 - pp 462-465 | http://journals.lww.com/pec-online/Abstract/2010/06000/A_Teenager_With_Agitation__Higher_Than_She_Should.16.aspx</ref><ref name="muller"> Müller, H.; Sperling, W.; Köhrmann, M.; Huttner, H.; Kornhuber, J.; Maler, J. (2010). "The synthetic cannabinoid Spice as a trigger for an acute exacerbation of cannabis induced recurrent psychotic episodes". Schizophrenia Research 118 (1–3) (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/20056392</ref> [[seizures]],<ref>Thisisntover. "Most Insane Hour of My Life: experience with JWH-018 (ID 85936)". Erowid.org. Oct 1, 2010. erowid.org/exp/85936 | http://www.erowid.org/experiences/exp.php?ID=85936</ref><ref>Michael C. "The Night My Brain Caved: experience with AM-2201 (ID 92954)". Erowid.org. Sep 18, 2012. erowid.org/exp/92954 | https://www.erowid.org/experiences/exp.php?ID=92954</ref><ref>Steve. "Next-Night Seizures: experience with Products - Spice and Synthetic Cannabinoids ('Apocalypse'?) (ID 89290)". Erowid.org. Feb 3, 2011. erowid.org/exp/89290 | https://www.erowid.org/experiences/exp.php?ID=89290</ref> and convulsions<ref>ilovethagreenery. "Should've Called Poison Control Bro: An Experience with Products - Spice and Synthetic Cannabinoids ('Diamond Dove') & Alcohol (ID 92698)". Erowid.org. Jan 6, 2012. erowid.org/exp/92698 | https://www.erowid.org/experiences/exp.php?ID=88807 | https://www.erowid.org/experiences/exp.php?ID=88807</ref><ref> Schneir, AB; Baumbacher, T (December 13, 2011). "Convulsions Associated with the Use of a Synthetic Cannabinoid Product.". Journal of Medical Toxicology 8 (1): 62–4 (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/22160733</ref> as well as many others. Sixteen cases of acute kidney injury resulting from synthetic cannabinoid abuse have been reported.<ref>Acute Kidney Injury Associated with Synthetic Cannabinoid Use — Multiple States, 2012 (Centers for Disease Control and Prevention) | http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6206a1.htm</ref> [[JWH-018]] has also been associated with strokes in two healthy adults.<ref>Ischemic stroke after use of the synthetic marijuana "spice". (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/24212384</ref>

Unlike [[cannabis]], there have been multiple deaths<ref name="death1">Brents, L. K.; Reichard, E. E.; Zimmerman, S. M.; Moran, J. H.; Fantegrossi, W. E.; Prather, P. L. (2011). "Phase I hydroxylated metabolites of the K2 synthetic cannabinoid JWH-018 retain in vitro and in vivo cannabinoid 1 receptor affinity and activity". PLoS ONE 6 (7) (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/21755008</ref><ref name="death2">Coroner: Lamar Jack ingested chemical found in fake marijuana before he died (IndependentMail.com) | https://web.archive.org/web/20131009101212/http://www.independentmail.com/news/2011/oct/15/coroner-lamar-jack-ingested-chemical-found-fake-ma/</ref><ref name="death3"> Coffman, K. (6 September 2013). "Colorado probes three deaths possibly linked to synthetic marijuana". Reuters (Denver). | http://www.reuters.com/article/us-usa-colorado-spice-idUSBRE98516A20130906</ref><ref name="death4">Perspectives of drugs: synthetic cannabinoids in Europe (European Monitoring Centre for Drugs and Drug Addiction | http://www.emcdda.europa.eu/topics/pods/synthetic-cannabinoids</ref><ref name="death5">Westin AA, Frost J, Brede WR, Gundersen PO, Einvik S, Aarset H, Slørdal L. “Sudden Cardiac Death Following Use of the Synthetic Cannabinoid MDMB-CHMICA”. J Anal Toxicol. 2016 Jan 19;40(1):86-7. | https://www.erowid.org/references/refs_view.php?ID=8961</ref><ref name="death6">Adamowicz P. “Fatal intoxication with synthetic cannabinoid MDMB-CHMICA”. Forensic Sci Int. 2016 Mar;. | https://www.erowid.org/references/refs_view.php?ID=8963</ref><ref name="death7">Synthetic Cannabinoid–Related Illnesses and Deaths | http://www.nejm.org/doi/full/10.1056/NEJMp1505328</ref> associated with the repeated abuse of synthetic cannabinoids as well as serious side effects resulting from its long-term use.<ref> Vardakou, I; Pistos, C; Spiliopoulou, Ch (2010). "Spice substances as a new trend: Mode of action, identification and legislation". Toxicology Letters 197 (3): 157–62. (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/20566335</ref><ref> Auwärter, V.; et al. (2009). "'Spice' and other herbal blends: harmless incense or cannabinoid designer drugs?". Journal of mass spectrometry : JMS 44 (5) | http://onlinelibrary.wiley.com/doi/10.1002/jms.1558/abstract</ref><ref>Toxicological Findings of Synthetic Cannabinoids in Recreational Users | http://jat.oxfordjournals.org/content/37/8/534.full</ref> Therefore, it is strongly discouraged to take this substance for extended periods of time or in excessive doses. Compared to cannabis and its active cannabinoid THC, the adverse effects are often much more severe and can include [[high blood pressure]], [[increased heart rate]], heart attacks,<ref>Mir, A; Obafemi, A; Young, A; Kane, C (December 2011). "Myocardial infarction associated with use of the synthetic cannabinoid k2.". Pediatrics 128 (6) | http://pediatrics.aappublications.org/content/pediatrics/early/2011/11/04/peds.2010-3823.full.pdf</ref><ref>Acute myocardial infarction, associated with the use of a synthetic adamantyl-cannabinoid: a case report (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4715335/</ref> agitation,<ref name="teen">A Teenager With Agitation: Higher Than She Should Have Climbed - Pediatric Emergency Care: June 2010 - Volume 26 - Issue 6 - pp 462-465 | http://journals.lww.com/pec-online/Abstract/2010/06000/A_Teenager_With_Agitation__Higher_Than_She_Should.16.aspx</ref> [[nausea|vomiting]],<ref>T. "Extreme Nausea, Incoherent: An Experience with JWH-018 (ID 84443)". Erowid.org. Oct 12, 2010. erowid.org/exp/84443 | https://www.erowid.org/experiences/exp.php?ID=84443</ref><ref>Exdrugaddict. "Playing With Fire: An Experience with Spice (ID 90178)". Erowid.org. Dec 16, 2013. erowid.org/exp/90178 | https://www.erowid.org/experiences/exp.php?ID=90178</ref><ref>Boss Lok. "Non-Allergic Adverse Reaction: An Experience with Spice and Synthetic Cannabinoids ('Drill') (ID 85853)". Erowid.org. Oct 12, 2010. erowid.org/exp/85853 | https://www.erowid.org/experiences/exp.php?ID=85853</ref> [[external hallucinations|hallucinations]],<ref> Jeanna Bryner (March 3, 2010). "Fake Weed, Real Drug: K2 Causing hallucinations in Teens". LiveScience. | http://www.livescience.com/6149-fake-weed-real-drug-k2-causing-hallucinations-teens.html</ref> [[psychosis|psychosis]],<ref> Every-Palmer, S (2010). "Warning: Legal synthetic cannabinoid-receptor agonists such as JWH-018 may precipitate psychosis in vulnerable individuals". Addiction 105 (10): 1859–60. (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/20840203</ref><ref name="british">Causal association between cannabis and psychosis: examination of the evidence - The British Journal of Psychiatry Jan 2004, 184 (2) 110-117 | http://bjp.rcpsych.org/content/184/2/110.short</ref><ref name="teen">A Teenager With Agitation: Higher Than She Should Have Climbed - Pediatric Emergency Care: June 2010 - Volume 26 - Issue 6 - pp 462-465 | http://journals.lww.com/pec-online/Abstract/2010/06000/A_Teenager_With_Agitation__Higher_Than_She_Should.16.aspx</ref><ref name="muller"> Müller, H.; Sperling, W.; Köhrmann, M.; Huttner, H.; Kornhuber, J.; Maler, J. (2010). "The synthetic cannabinoid Spice as a trigger for an acute exacerbation of cannabis induced recurrent psychotic episodes". Schizophrenia Research 118 (1–3) (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/20056392</ref> [[seizures]],<ref>Thisisntover. "Most Insane Hour of My Life: experience with JWH-018 (ID 85936)". Erowid.org. Oct 1, 2010. erowid.org/exp/85936 | http://www.erowid.org/experiences/exp.php?ID=85936</ref><ref>Michael C. "The Night My Brain Caved: experience with AM-2201 (ID 92954)". Erowid.org. Sep 18, 2012. erowid.org/exp/92954 | https://www.erowid.org/experiences/exp.php?ID=92954</ref><ref>Steve. "Next-Night Seizures: experience with Products - Spice and Synthetic Cannabinoids ('Apocalypse'?) (ID 89290)". Erowid.org. Feb 3, 2011. erowid.org/exp/89290 | https://www.erowid.org/experiences/exp.php?ID=89290</ref> and convulsions<ref>ilovethagreenery. "Should've Called Poison Control Bro: An Experience with Products - Spice and Synthetic Cannabinoids ('Diamond Dove') & Alcohol (ID 92698)". Erowid.org. Jan 6, 2012. erowid.org/exp/92698 | https://www.erowid.org/experiences/exp.php?ID=88807 | https://www.erowid.org/experiences/exp.php?ID=88807</ref><ref> Schneir, AB; Baumbacher, T (December 13, 2011). "Convulsions Associated with the Use of a Synthetic Cannabinoid Product.". Journal of Medical Toxicology 8 (1): 62–4 (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/22160733</ref> as well as many others. Sixteen cases of acute kidney injury resulting from synthetic cannabinoid abuse have been reported.<ref>Acute Kidney Injury Associated with Synthetic Cannabinoid Use — Multiple States, 2012 (Centers for Disease Control and Prevention) | http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6206a1.htm</ref> [[JWH-018]] has also been associated with strokes in two healthy adults.<ref>Ischemic stroke after use of the synthetic marijuana "spice". (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/24212384</ref>

It should be noted that pre-mixed, branded blends (like Spice and K2) are more dangerous than pure powder because the specific chemicals and dosages are usually unlisted as well as the potential of inconsistent areas of dense powder, leading to an overdose. As synthetic cannabinoids are active in the milligram range (with below 5mg being a common dose), it is important to [[Dosage|use proper precautions when dosing]] to avoid a negative experience.

@@ Line 76: / Line 76: @@
 ===Toxicity and harm potential===
 {{Main|Synthetic cannabinoid#Toxicity and harm potential}}
-Unlike [[cannabis]], there have been multiple deaths<ref name="death1">Brents, L. K.; Reichard, E. E.; Zimmerman, S. M.; Moran, J. H.; Fantegrossi, W. E.; Prather, P. L. (2011). "Phase I hydroxylated metabolites of the K2 synthetic cannabinoid JWH-018 retain in vitro and in vivo cannabinoid 1 receptor affinity and activity". PLoS ONE 6 (7) (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/21755008</ref><ref name="death2">Coroner: Lamar Jack ingested chemical found in fake marijuana before he died (IndependentMail.com) | https://web.archive.org/web/20131009101212/http://www.independentmail.com/news/2011/oct/15/coroner-lamar-jack-ingested-chemical-found-fake-ma/</ref><ref name="death3"> Coffman, K. (6 September 2013). "Colorado probes three deaths possibly linked to synthetic marijuana". Reuters (Denver). | http://www.reuters.com/article/us-usa-colorado-spice-idUSBRE98516A20130906</ref><ref name="death4">Perspectives of drugs: synthetic cannabinoids in Europe (European Monitoring Centre for Drugs and Drug Addiction | http://www.emcdda.europa.eu/topics/pods/synthetic-cannabinoids</ref><ref name="death5">Westin AA, Frost J, Brede WR, Gundersen PO, Einvik S, Aarset H, Slørdal L. “Sudden Cardiac Death Following Use of the Synthetic Cannabinoid MDMB-CHMICA”. J Anal Toxicol. 2016 Jan 19;40(1):86-7. | https://www.erowid.org/references/refs_view.php?ID=8961</ref><ref name="death6">Adamowicz P. “Fatal intoxication with synthetic cannabinoid MDMB-CHMICA”. Forensic Sci Int. 2016 Mar;. | https://www.erowid.org/references/refs_view.php?ID=8963</ref><ref name="death7">Synthetic Cannabinoid–Related Illnesses and Deaths | http://www.nejm.org/doi/full/10.1056/NEJMp1505328</ref> associated with the repeated abuse of synthetic cannabinoids as well as serious side effects resulting from its long-term use.<ref> Vardakou, I; Pistos, C; Spiliopoulou, Ch (2010). "Spice drugs as a new trend: Mode of action, identification and legislation". Toxicology Letters 197 (3): 157–62. (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/20566335</ref><ref> Auwärter, V.; et al. (2009). "'Spice' and other herbal blends: harmless incense or cannabinoid designer drugs?". Journal of mass spectrometry : JMS 44 (5) | http://onlinelibrary.wiley.com/doi/10.1002/jms.1558/abstract</ref><ref>Toxicological Findings of Synthetic Cannabinoids in Recreational Users | http://jat.oxfordjournals.org/content/37/8/534.full</ref> Therefore, it is strongly discouraged to take this substance for extended periods of time or in excessive doses. Compared to cannabis and its active cannabinoid THC, the adverse effects are often much more severe and can include [[high blood pressure]], [[increased heart rate]], heart attacks,<ref>Mir, A; Obafemi, A; Young, A; Kane, C (December 2011). "Myocardial infarction associated with use of the synthetic cannabinoid k2.". Pediatrics 128 (6) | http://pediatrics.aappublications.org/content/pediatrics/early/2011/11/04/peds.2010-3823.full.pdf</ref><ref>Acute myocardial infarction, associated with the use of a synthetic adamantyl-cannabinoid: a case report (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4715335/</ref> agitation,<ref name="teen">A Teenager With Agitation: Higher Than She Should Have Climbed - Pediatric Emergency Care: June 2010 - Volume 26 - Issue 6 - pp 462-465 | http://journals.lww.com/pec-online/Abstract/2010/06000/A_Teenager_With_Agitation__Higher_Than_She_Should.16.aspx</ref> [[nausea|vomiting]],<ref>T. "Extreme Nausea, Incoherent: An Experience with JWH-018 (ID 84443)". Erowid.org. Oct 12, 2010. erowid.org/exp/84443 | https://www.erowid.org/experiences/exp.php?ID=84443</ref><ref>Exdrugaddict. "Playing With Fire: An Experience with Spice (ID 90178)". Erowid.org. Dec 16, 2013. erowid.org/exp/90178 | https://www.erowid.org/experiences/exp.php?ID=90178</ref><ref>Boss Lok. "Non-Allergic Adverse Reaction: An Experience with Spice and Synthetic Cannabinoids ('Drill') (ID 85853)". Erowid.org. Oct 12, 2010. erowid.org/exp/85853 | https://www.erowid.org/experiences/exp.php?ID=85853</ref> [[external hallucinations|hallucinations]],<ref> Jeanna Bryner (March 3, 2010). "Fake Weed, Real Drug: K2 Causing hallucinations in Teens". LiveScience. | http://www.livescience.com/6149-fake-weed-real-drug-k2-causing-hallucinations-teens.html</ref> [[psychosis|psychosis]],<ref> Every-Palmer, S (2010). "Warning: Legal synthetic cannabinoid-receptor agonists such as JWH-018 may precipitate psychosis in vulnerable individuals". Addiction 105 (10): 1859–60. (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/20840203</ref><ref name="british">Causal association between cannabis and psychosis: examination of the evidence - The British Journal of Psychiatry Jan 2004, 184 (2) 110-117  | http://bjp.rcpsych.org/content/184/2/110.short</ref><ref name="teen">A Teenager With Agitation: Higher Than She Should Have Climbed - Pediatric Emergency Care: June 2010 - Volume 26 - Issue 6 - pp 462-465 | http://journals.lww.com/pec-online/Abstract/2010/06000/A_Teenager_With_Agitation__Higher_Than_She_Should.16.aspx</ref><ref name="muller"> Müller, H.; Sperling, W.; Köhrmann, M.; Huttner, H.; Kornhuber, J.; Maler, J. (2010). "The synthetic cannabinoid Spice as a trigger for an acute exacerbation of cannabis induced recurrent psychotic episodes". Schizophrenia Research 118 (1–3) (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/20056392</ref> [[seizures]],<ref>Thisisntover. "Most Insane Hour of My Life: experience with JWH-018 (ID 85936)". Erowid.org. Oct 1, 2010. erowid.org/exp/85936 | http://www.erowid.org/experiences/exp.php?ID=85936</ref><ref>Michael C. "The Night My Brain Caved: experience with AM-2201 (ID 92954)". Erowid.org. Sep 18, 2012. erowid.org/exp/92954 | https://www.erowid.org/experiences/exp.php?ID=92954</ref><ref>Steve. "Next-Night Seizures: experience with Products - Spice and Synthetic Cannabinoids ('Apocalypse'?) (ID 89290)". Erowid.org. Feb 3, 2011. erowid.org/exp/89290 | https://www.erowid.org/experiences/exp.php?ID=89290</ref> and convulsions<ref>ilovethagreenery. "Should've Called Poison Control Bro: An Experience with Products - Spice and Synthetic Cannabinoids ('Diamond Dove') & Alcohol (ID 92698)". Erowid.org. Jan 6, 2012. erowid.org/exp/92698 | https://www.erowid.org/experiences/exp.php?ID=88807 | https://www.erowid.org/experiences/exp.php?ID=88807</ref><ref> Schneir, AB; Baumbacher, T (December 13, 2011). "Convulsions Associated with the Use of a Synthetic Cannabinoid Product.". Journal of Medical Toxicology 8 (1): 62–4 (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/22160733</ref> as well as many others. Sixteen cases of acute kidney injury resulting from synthetic cannabinoid abuse have been reported.<ref>Acute Kidney Injury Associated with Synthetic Cannabinoid Use — Multiple States, 2012 (Centers for Disease Control and Prevention) | http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6206a1.htm</ref> [[JWH-018]] has also been associated with strokes in two healthy adults.<ref>Ischemic stroke after use of the synthetic marijuana "spice". (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/24212384</ref>
+Unlike [[cannabis]], there have been multiple deaths<ref name="death1">Brents, L. K.; Reichard, E. E.; Zimmerman, S. M.; Moran, J. H.; Fantegrossi, W. E.; Prather, P. L. (2011). "Phase I hydroxylated metabolites of the K2 synthetic cannabinoid JWH-018 retain in vitro and in vivo cannabinoid 1 receptor affinity and activity". PLoS ONE 6 (7) (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/21755008</ref><ref name="death2">Coroner: Lamar Jack ingested chemical found in fake marijuana before he died (IndependentMail.com) | https://web.archive.org/web/20131009101212/http://www.independentmail.com/news/2011/oct/15/coroner-lamar-jack-ingested-chemical-found-fake-ma/</ref><ref name="death3"> Coffman, K. (6 September 2013). "Colorado probes three deaths possibly linked to synthetic marijuana". Reuters (Denver). | http://www.reuters.com/article/us-usa-colorado-spice-idUSBRE98516A20130906</ref><ref name="death4">Perspectives of drugs: synthetic cannabinoids in Europe (European Monitoring Centre for Drugs and Drug Addiction | http://www.emcdda.europa.eu/topics/pods/synthetic-cannabinoids</ref><ref name="death5">Westin AA, Frost J, Brede WR, Gundersen PO, Einvik S, Aarset H, Slørdal L. “Sudden Cardiac Death Following Use of the Synthetic Cannabinoid MDMB-CHMICA”. J Anal Toxicol. 2016 Jan 19;40(1):86-7. | https://www.erowid.org/references/refs_view.php?ID=8961</ref><ref name="death6">Adamowicz P. “Fatal intoxication with synthetic cannabinoid MDMB-CHMICA”. Forensic Sci Int. 2016 Mar;. | https://www.erowid.org/references/refs_view.php?ID=8963</ref><ref name="death7">Synthetic Cannabinoid–Related Illnesses and Deaths | http://www.nejm.org/doi/full/10.1056/NEJMp1505328</ref> associated with the repeated abuse of synthetic cannabinoids as well as serious side effects resulting from its long-term use.<ref> Vardakou, I; Pistos, C; Spiliopoulou, Ch (2010). "Spice substances as a new trend: Mode of action, identification and legislation". Toxicology Letters 197 (3): 157–62. (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/20566335</ref><ref> Auwärter, V.; et al. (2009). "'Spice' and other herbal blends: harmless incense or cannabinoid designer drugs?". Journal of mass spectrometry : JMS 44 (5) | http://onlinelibrary.wiley.com/doi/10.1002/jms.1558/abstract</ref><ref>Toxicological Findings of Synthetic Cannabinoids in Recreational Users | http://jat.oxfordjournals.org/content/37/8/534.full</ref> Therefore, it is strongly discouraged to take this substance for extended periods of time or in excessive doses. Compared to cannabis and its active cannabinoid THC, the adverse effects are often much more severe and can include [[high blood pressure]], [[increased heart rate]], heart attacks,<ref>Mir, A; Obafemi, A; Young, A; Kane, C (December 2011). "Myocardial infarction associated with use of the synthetic cannabinoid k2.". Pediatrics 128 (6) | http://pediatrics.aappublications.org/content/pediatrics/early/2011/11/04/peds.2010-3823.full.pdf</ref><ref>Acute myocardial infarction, associated with the use of a synthetic adamantyl-cannabinoid: a case report (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4715335/</ref> agitation,<ref name="teen">A Teenager With Agitation: Higher Than She Should Have Climbed - Pediatric Emergency Care: June 2010 - Volume 26 - Issue 6 - pp 462-465 | http://journals.lww.com/pec-online/Abstract/2010/06000/A_Teenager_With_Agitation__Higher_Than_She_Should.16.aspx</ref> [[nausea|vomiting]],<ref>T. "Extreme Nausea, Incoherent: An Experience with JWH-018 (ID 84443)". Erowid.org. Oct 12, 2010. erowid.org/exp/84443 | https://www.erowid.org/experiences/exp.php?ID=84443</ref><ref>Exdrugaddict. "Playing With Fire: An Experience with Spice (ID 90178)". Erowid.org. Dec 16, 2013. erowid.org/exp/90178 | https://www.erowid.org/experiences/exp.php?ID=90178</ref><ref>Boss Lok. "Non-Allergic Adverse Reaction: An Experience with Spice and Synthetic Cannabinoids ('Drill') (ID 85853)". Erowid.org. Oct 12, 2010. erowid.org/exp/85853 | https://www.erowid.org/experiences/exp.php?ID=85853</ref> [[external hallucinations|hallucinations]],<ref> Jeanna Bryner (March 3, 2010). "Fake Weed, Real Drug: K2 Causing hallucinations in Teens". LiveScience. | http://www.livescience.com/6149-fake-weed-real-drug-k2-causing-hallucinations-teens.html</ref> [[psychosis|psychosis]],<ref> Every-Palmer, S (2010). "Warning: Legal synthetic cannabinoid-receptor agonists such as JWH-018 may precipitate psychosis in vulnerable individuals". Addiction 105 (10): 1859–60. (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/20840203</ref><ref name="british">Causal association between cannabis and psychosis: examination of the evidence - The British Journal of Psychiatry Jan 2004, 184 (2) 110-117  | http://bjp.rcpsych.org/content/184/2/110.short</ref><ref name="teen">A Teenager With Agitation: Higher Than She Should Have Climbed - Pediatric Emergency Care: June 2010 - Volume 26 - Issue 6 - pp 462-465 | http://journals.lww.com/pec-online/Abstract/2010/06000/A_Teenager_With_Agitation__Higher_Than_She_Should.16.aspx</ref><ref name="muller"> Müller, H.; Sperling, W.; Köhrmann, M.; Huttner, H.; Kornhuber, J.; Maler, J. (2010). "The synthetic cannabinoid Spice as a trigger for an acute exacerbation of cannabis induced recurrent psychotic episodes". Schizophrenia Research 118 (1–3) (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/20056392</ref> [[seizures]],<ref>Thisisntover. "Most Insane Hour of My Life: experience with JWH-018 (ID 85936)". Erowid.org. Oct 1, 2010. erowid.org/exp/85936 | http://www.erowid.org/experiences/exp.php?ID=85936</ref><ref>Michael C. "The Night My Brain Caved: experience with AM-2201 (ID 92954)". Erowid.org. Sep 18, 2012. erowid.org/exp/92954 | https://www.erowid.org/experiences/exp.php?ID=92954</ref><ref>Steve. "Next-Night Seizures: experience with Products - Spice and Synthetic Cannabinoids ('Apocalypse'?) (ID 89290)". Erowid.org. Feb 3, 2011. erowid.org/exp/89290 | https://www.erowid.org/experiences/exp.php?ID=89290</ref> and convulsions<ref>ilovethagreenery. "Should've Called Poison Control Bro: An Experience with Products - Spice and Synthetic Cannabinoids ('Diamond Dove') & Alcohol (ID 92698)". Erowid.org. Jan 6, 2012. erowid.org/exp/92698 | https://www.erowid.org/experiences/exp.php?ID=88807 | https://www.erowid.org/experiences/exp.php?ID=88807</ref><ref> Schneir, AB; Baumbacher, T (December 13, 2011). "Convulsions Associated with the Use of a Synthetic Cannabinoid Product.". Journal of Medical Toxicology 8 (1): 62–4 (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/22160733</ref> as well as many others. Sixteen cases of acute kidney injury resulting from synthetic cannabinoid abuse have been reported.<ref>Acute Kidney Injury Associated with Synthetic Cannabinoid Use — Multiple States, 2012 (Centers for Disease Control and Prevention) | http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6206a1.htm</ref> [[JWH-018]] has also been associated with strokes in two healthy adults.<ref>Ischemic stroke after use of the synthetic marijuana "spice". (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/24212384</ref>
 It should be noted that pre-mixed, branded blends (like Spice and K2) are more dangerous than pure powder because the specific chemicals and dosages are usually unlisted as well as the potential of inconsistent areas of dense powder, leading to an overdose. As synthetic cannabinoids are active in the milligram range (with below 5mg being a common dose), it is important to [[Dosage|use proper precautions when dosing]] to avoid a negative experience.