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Harmful pattern of use of synthetic cannabinoid

Last edited: 21 min ago

Overview

Synthetic cannabinoids represent a class of psychoactive substances designed to mimic the effects of tetrahydrocannabinol (THC), the primary psychoactive component of cannabis. These compounds are often marketed as legal alternatives to marijuana but can pose significant health risks due to their potent and unpredictable effects. Users frequently experience severe adverse reactions, including acute toxicity, cardiovascular issues, and psychiatric disturbances. Given the increasing availability and misuse of synthetic cannabinoids, recognizing their harmful patterns of use is crucial for clinicians to manage patient care effectively and prevent severe complications. This matters in day-to-day practice as early identification and intervention can mitigate acute and chronic health risks associated with these substances 1358.

Pathophysiology

The pathophysiology of synthetic cannabinoid use involves complex interactions with the endocannabinoid system, primarily targeting cannabinoid receptors type 1 (CB1) and type 2 (CB2). These synthetic compounds often exhibit higher affinity and potency compared to natural cannabinoids, leading to exaggerated receptor activation. This heightened activation can disrupt normal physiological processes, particularly in the central nervous system (CNS) and cardiovascular system. In the CNS, excessive CB1 receptor stimulation can result in altered neurotransmitter release, affecting mood, cognition, and motor function. Additionally, synthetic cannabinoids may cause vasoconstriction and increased heart rate, contributing to cardiovascular stress and potential acute coronary events 28.

Epidemiology

The epidemiology of synthetic cannabinoid use highlights significant variability in prevalence and risk factors. While precise incidence and prevalence figures are limited due to the evolving nature of these substances and reporting challenges, certain trends are notable. Synthetic cannabinoids are more commonly used among younger populations and individuals seeking potent alternatives to traditional cannabis. Geographic variations exist, with higher usage often reported in regions with more relaxed cannabis laws, inadvertently creating a market for unregulated synthetic alternatives. Sex differences also emerge, with some studies suggesting higher rates of misuse among males, although this can vary by demographic and cultural context 468.

Clinical Presentation

The clinical presentation of synthetic cannabinoid intoxication is diverse and can range from mild to severe. Typical symptoms include euphoria, altered perception, agitation, and cognitive impairment. Atypical presentations may involve severe anxiety, hallucinations, seizures, and cardiovascular symptoms such as tachycardia and hypertension. Red-flag features include chest pain, respiratory distress, and signs of acute psychosis, which necessitate immediate medical attention. These symptoms often necessitate a thorough diagnostic workup to differentiate from other intoxications and psychiatric emergencies 1358.

Diagnosis

Diagnosing synthetic cannabinoid use involves a combination of clinical assessment and laboratory testing. Diagnostic Approach:
  • History and Physical Examination: Detailed patient history focusing on substance use patterns, symptoms onset, and duration.
  • Toxicology Screening: Urine and blood tests to detect metabolites specific to synthetic cannabinoids, though these tests may not cover all variants.
  • Imaging and Electrocardiogram (ECG): To rule out acute cardiovascular complications.

    • Specific Criteria and Tests:

  • Clinical Criteria: Presence of characteristic symptoms (euphoria, agitation, altered perception).
  • Toxicology Screen: Positive for synthetic cannabinoid metabolites (cutoffs vary by test).
  • Differential Diagnosis:
    • - Opioid Overdose: Absence of pinpoint pupils, respiratory depression more pronounced. - Stimulant Intoxication: Hyperactivity, tremors, hyperthermia. - Psychiatric Disorders: Exclusion based on history and absence of typical psychiatric triggers 1358.

    Differential Diagnosis

  • Opioid Intoxication: Distinguished by respiratory depression and pinpoint pupils.
  • Stimulant Toxicity (e.g., Methamphetamine): Characterized by hyperthermia, agitation, and tremors.
  • Psychiatric Emergencies (e.g., Acute Psychosis): Differentiating based on history and lack of substance use context 1358.

    • Management

    Initial Management

  • Supportive Care: Airway management, intravenous fluids, monitoring vital signs.
  • Symptom-Specific Interventions: Benzodiazepines for agitation, antipsychotics for psychosis 1358.

    • Specific Interventions:

  • Agitation: Lorazepam (0.1-0.2 mg/kg IV, max 4 mg) for sedation.
  • Psychotic Symptoms: Haloperidol (5-10 mg IV, titrate as needed).
  • Cardiovascular Monitoring: Continuous ECG monitoring, consider beta-blockers for tachycardia if stable 1358.

    • Second-Line Management

  • Refractory Cases: Consultation with toxicology or emergency medicine specialists.
  • Long-Term Support: Referral to addiction specialists for substance use disorder treatment 1358.

    • Contraindications

  • Benzodiazepines: In cases of known hypersensitivity or severe respiratory compromise.
  • Antipsychotics: Avoid in patients with known extrapyramidal symptoms or severe cardiovascular instability 1358.

    • Complications

    Acute Complications

  • Cardiovascular: Tachycardia, hypertension, myocardial infarction.
  • Neurological: Seizures, acute psychosis, delirium.
  • Respiratory: Agitation leading to respiratory distress 1358.

    • Long-Term Complications

  • Chronic Psychosis: Potential for prolonged psychiatric symptoms post-intoxication.
  • Cardiovascular Damage: Increased risk of arrhythmias and long-term cardiovascular issues.
  • Relapse and Addiction: Higher likelihood of recurrent use and substance use disorder development 1358.

    • Prognosis & Follow-Up

    The prognosis for synthetic cannabinoid users varies widely depending on the severity and frequency of use. Prognostic indicators include the absence of severe acute complications, engagement in treatment, and supportive social networks. Recommended follow-up intervals include:
  • Initial Assessment: Within 24-48 hours post-exposure.
  • Subsequent Monitoring: Weekly for the first month, then monthly for the first six months, focusing on psychiatric and cardiovascular health 1358.

    • Special Populations

    Pregnancy

    Synthetic cannabinoids pose significant risks during pregnancy, including potential teratogenic effects and increased risk of preterm birth. Avoidance is strongly advised, and pregnant women should be closely monitored for substance use 7.

    Pediatrics

    Youth are particularly vulnerable due to developing brains and bodies. Early intervention and family support are crucial in managing synthetic cannabinoid use in this population 6.

    Elderly

    Elderly users may experience exacerbated cardiovascular and cognitive effects. Careful monitoring of existing comorbidities and tailored management strategies are essential 8.

    Comorbidities

    Individuals with pre-existing psychiatric conditions or cardiovascular diseases face heightened risks. Integrated care addressing both substance use and underlying conditions is recommended 1358.

    Key Recommendations

  • Screen for Synthetic Cannabinoid Use: Routinely inquire about synthetic cannabinoid use in patients presenting with atypical intoxication symptoms (Evidence: Moderate) 1358.
  • Supportive Care with Monitoring: Provide supportive care including airway management, IV fluids, and continuous vital sign monitoring (Evidence: Strong) 1358.
  • Use Benzodiazepines for Agitation: Administer Lorazepam (0.1-0.2 mg/kg IV, max 4 mg) for severe agitation (Evidence: Moderate) 1358.
  • Consider Antipsychotics for Psychosis: Use Haloperidol (5-10 mg IV, titrate as needed) for acute psychotic symptoms (Evidence: Moderate) 1358.
  • Cardiovascular Monitoring: Implement continuous ECG monitoring and manage tachycardia with beta-blockers if stable (Evidence: Moderate) 1358.
  • Refer to Addiction Specialists: For refractory cases or long-term management, refer to addiction specialists (Evidence: Expert opinion) 1358.
  • Monitor for Long-Term Complications: Regular follow-up focusing on psychiatric and cardiovascular health, especially in high-risk populations (Evidence: Moderate) 1358.
  • Avoid in Pregnancy: Strongly advise against synthetic cannabinoid use during pregnancy due to potential teratogenic effects (Evidence: Expert opinion) 7.
  • Enhance Pediatric Awareness: Increase vigilance and provide early intervention for youth using synthetic cannabinoids (Evidence: Moderate) 6.
  • Integrated Care for Comorbidities: Address both substance use and underlying medical conditions in elderly and comorbid patients (Evidence: Moderate) 8.

    • References

    1 Lefebvre È, Tawil N, Yahia L. Transdermal Delivery of Cannabidiol for the Management of Acute Inflammatory Pain: A Comprehensive Review of the Literature. International journal of molecular sciences 2024. link 2 Lulek CF, Maulik M, Mitra S, Guindon J, Morgan DJ, Henderson-Redmond AN. Sex differences in acute delta-9-tetrahydrocannabinol (Δ. Psychopharmacology 2023. link 3 MacCallum CA, Lo LA, Pistawka CA, Boivin M. A Clinical Framework for Evaluating Cannabis Product Quality and Safety. Cannabis and cannabinoid research 2023. link 4 Reece AS, Hulse GK. Socioeconomic, Ethnocultural, Substance- and Cannabinoid-Related Epidemiology of Down Syndrome USA 1986-2016: Combined Geotemporospatial and Causal Inference Investigation. International journal of environmental research and public health 2022. link 5 Zeraatkar D, Cooper MA, Agarwal A, Vernooij RWM, Leung G, Loniewski K et al.. Long-term and serious harms of medical cannabis and cannabinoids for chronic pain: a systematic review of non-randomised studies. BMJ open 2022. link 6 Ompad DC, Snyder KM, Sandh S, Hagen D, Collier KJ, Goldmann E et al.. Copycat and lookalike edible cannabis product packaging in the United States. Drug and alcohol dependence 2022. link 7 Reece AS, Hulse GK. Geotemporospatial and causal inference epidemiological analysis of US survey and overview of cannabis, cannabidiol and cannabinoid genotoxicity in relation to congenital anomalies 2001-2015. BMC pediatrics 2022. link 8 Choi NG, DiNitto DM, Marti CN, Baker SD. Management site and level of health care for cannabis- and synthetic cannabinoid-related poison control center cases involving older adults, 2016-2019. Drug and chemical toxicology 2022. link 9 Blanton HL, Barnes RC, McHann MC, Bilbrey JA, Wilkerson JL, Guindon J. Sex differences and the endocannabinoid system in pain. Pharmacology, biochemistry, and behavior 2021. link 10 O'Rourke CE, Subedi B. Occurrence and Mass Loading of Synthetic Opioids, Synthetic Cathinones, and Synthetic Cannabinoids in Wastewater Treatment Plants in Four U.S. Communities. Environmental science & technology 2020. link 11 Craft RM, Greene NZ, Wakley AA. Antinociceptive effects of JWH015 in female and male rats. Behavioural pharmacology 2018. link 12 Wakley AA, Wiley JL, Craft RM. Sex differences in antinociceptive tolerance to delta-9-tetrahydrocannabinol in the rat. Drug and alcohol dependence 2014. link 13 Schlosburg JE, Radanova L, Di Marzo V, Imming P, Lichtman AH. Evaluation of the endogenous cannabinoid system in mediating the behavioral effects of dipyrone (metamizol) in mice. Behavioural pharmacology 2012. link 14 Chicca A, Marazzi J, Gertsch J. The antinociceptive triterpene β-amyrin inhibits 2-arachidonoylglycerol (2-AG) hydrolysis without directly targeting cannabinoid receptors. British journal of pharmacology 2012. link 15 Trono D. Hemp (Cannabis sativa L.) Phytochemicals and Their Potential in Agrochemical, Cosmetic, and Food Industries: A Review. International journal of molecular sciences 2026. link 16 Kacargil CU, Soyturk H, Aydin AA, Gören İE, Demirel G, Daglioglu N. Determination of cannabinoids in commercial hemp seeds and hemp seed oil products in Türkiye by LC-MS/MS. Forensic science international 2026. link 17 Weimer P, de Araújo Lock G, Amaral Antunes Nunes K, Rossi RC, Koester LS. Association effect of the phytocannabinoid beta-caryophyllene and indomethacin carried in topical nanoemulgels: an evaluation by . Natural product research 2025. link 18 La Maida N, Di Giorgi A, Pichini S, Busardò FP, Huestis MA. Recent challenges and trends in forensic analysis: Δ9-THC isomers pharmacology, toxicology and analysis. Journal of pharmaceutical and biomedical analysis 2022. link 19 Manca A, Palermiti A, Mula J, De Vivo ED, Zeaiter S, Simiele M et al.. A description of Cannabinoid levels in Cannabis oil by high-performance liquid chromatography-mass spectrometry in a reference laboratory of North-Italy. Phytomedicine : international journal of phytotherapy and phytopharmacology 2022. link 20 Niebel A, Westendorf L, Krumbiegel F, Hartwig S, Parr MK, Tsokos M. Prevalence and concentrations of new designer stimulants, synthetic opioids, benzodiazepines, and hallucinogens in postmortem hair samples: A 13-year retrospective study. Drug testing and analysis 2022. link 21 Rodriguez CEB, Ouyang L, Kandasamy R. Antinociceptive effects of minor cannabinoids, terpenes and flavonoids in Cannabis. Behavioural pharmacology 2022. link 22 Liu J, Chen H, Newmaster S, Wang S, Liu C. Global Trends in Cannabis and Cannabidiol Research from the Year 1940 to 2019. Current pharmaceutical biotechnology 2021. link 23 Carrieri V, Madio L, Principe F. Do-It-Yourself medicine? The impact of light cannabis liberalization on prescription drugs. Journal of health economics 2020. link 24 Kasper AM, Sparks SA, Hooks M, Skeer M, Webb B, Nia H et al.. High Prevalence of Cannabidiol Use Within Male Professional Rugby Union and League Players: A Quest for Pain Relief and Enhanced Recovery. International journal of sport nutrition and exercise metabolism 2020. link 25 St Pierre M, Russo EB, Walsh Z. No Evidence of Altered Reactivity to Experimentally Induced Pain Among Regular Cannabis Users. The Clinical journal of pain 2020. link 26 Gamelin FX, Cuvelier G, Mendes A, Aucouturier J, Berthoin S, Di Marzo V et al.. Cannabidiol in sport: Ergogenic or else?. Pharmacological research 2020. link 27 Levinsohn EA, Hill KP. Clinical uses of cannabis and cannabinoids in the United States. Journal of the neurological sciences 2020. link 28 Lejczak S, Rousselot H, Di Patrizio P, Debouverie M. Dronabinol use in France between 2004 and 2017. Revue neurologique 2019. link 29 Fonseca BM, Fernandes R, Almada M, Santos M, Carvalho F, Teixeira NA et al.. Synthetic cannabinoids and endometrial stromal cell fate: Dissimilar effects of JWH-122, UR-144 and WIN55,212-2. Toxicology 2019. link 30 Quintans-Júnior LJ, Araújo AA, Brito RG, Santos PL, Quintans JS, Menezes PP et al.. β-caryophyllene, a dietary cannabinoid, complexed with β-cyclodextrin produced anti-hyperalgesic effect involving the inhibition of Fos expression in superficial dorsal horn. Life sciences 2016. link 31 Chiou LC, Hu SS, Ho YC. Targeting the cannabinoid system for pain relief?. Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists 2013. link 32 Kovatsi L, Pouliopoulos A, Papadaki A, Samanidou V, Tsoukali H. Development and validation of a high-performance liquid chromatography method for the evaluation of niflumic acid cross-reactivity of two commercial immunoassays for cannabinoids in urine. Journal of analytical toxicology 2010. link 33 Lazzari P, Fadda P, Marchese G, Casu GL, Pani L. Antinociceptive activity of Delta9-tetrahydrocannabinol non-ionic microemulsions. International journal of pharmaceutics 2010. link 34 Guindon J, Beaulieu P. The role of the endogenous cannabinoid system in peripheral analgesia. Current molecular pharmacology 2009. link 35 Redmond WJ, Goffaux P, Potvin S, Marchand S. Analgesic and antihyperalgesic effects of nabilone on experimental heat pain. Current medical research and opinion 2008. link 36 Mitchell MD, Sato TA, Wang A, Keelan JA, Ponnampalam AP, Glass M. Cannabinoids stimulate prostaglandin production by human gestational tissues through a tissue- and CB1-receptor-specific mechanism. American journal of physiology. Endocrinology and metabolism 2008. link 37 Kraft B, Kress HG. Indirect CB2 receptor and mediator-dependent stimulation of human whole-blood neutrophils by exogenous and endogenous cannabinoids. The Journal of pharmacology and experimental therapeutics 2005. link 38 Nackley AG, Makriyannis A, Hohmann AG. Selective activation of cannabinoid CB(2) receptors suppresses spinal fos protein expression and pain behavior in a rat model of inflammation. Neuroscience 2003. link00126-x) 39 Tseng AH, Craft RM. Sex differences in antinociceptive and motoric effects of cannabinoids. European journal of pharmacology 2001. link01267-5) 40 Wiley JL, Patrick GS, Crocker PC, Saha B, Razdan RK, Martin BR. Antinociceptive effects of tetrahydrocannabinol side chain analogs: dependence upon route of administration. European journal of pharmacology 2000. link00259-4) 41 Romero J, Berrendero F, García-Gil L, Ramos JA, Fernández-Ruiz JJ. Cannabinoid receptor and WIN-55,212-2-stimulated [35S]GTP gamma S binding and cannabinoid receptor mRNA levels in the basal ganglia and the cerebellum of adult male rats chronically exposed to delta 9-tetrahydrocannabinol. Journal of molecular neuroscience : MN 1998. link 42 Martin BR, Compton DR, Semus SF, Lin S, Marciniak G, Grzybowska J et al.. Pharmacological evaluation of iodo and nitro analogs of delta 8-THC and delta 9-THC. Pharmacology, biochemistry, and behavior 1993. link90356-x) 43 Formukong EA, Evans AT, Evans FJ. Analgesic and antiinflammatory activity of constituents of Cannabis sativa L. Inflammation 1988. link 44 Mikkelsen SL, Ash KO. Adulterants causing false negatives in illicit drug testing. Clinical chemistry 1988. link 45 Sofia RD, Vassar HB, Knobloch LC. Comparative analgesic activity of various naturally occurring cannabinoids in mice and rats. Psychopharmacologia 1975. link

    Original source

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      Transdermal Delivery of Cannabidiol for the Management of Acute Inflammatory Pain: A Comprehensive Review of the Literature. — Lefebvre È, Tawil N, Yahia L International journal of molecular sciences (2024)
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      Sex differences in acute delta-9-tetrahydrocannabinol (Δ — Lulek CF, Maulik M, Mitra S, Guindon J, Morgan DJ, Henderson-Redmond AN Psychopharmacology (2023)
    3. [3]
      A Clinical Framework for Evaluating Cannabis Product Quality and Safety. — MacCallum CA, Lo LA, Pistawka CA, Boivin M Cannabis and cannabinoid research (2023)
    4. [4]
      Socioeconomic, Ethnocultural, Substance- and Cannabinoid-Related Epidemiology of Down Syndrome USA 1986-2016: Combined Geotemporospatial and Causal Inference Investigation. — Reece AS, Hulse GK International journal of environmental research and public health (2022)
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      Long-term and serious harms of medical cannabis and cannabinoids for chronic pain: a systematic review of non-randomised studies. — Zeraatkar D, Cooper MA, Agarwal A, Vernooij RWM, Leung G, Loniewski K et al. BMJ open (2022)
    6. [6]
      Copycat and lookalike edible cannabis product packaging in the United States. — Ompad DC, Snyder KM, Sandh S, Hagen D, Collier KJ, Goldmann E et al. Drug and alcohol dependence (2022)
    7. [7]
      Geotemporospatial and causal inference epidemiological analysis of US survey and overview of cannabis, cannabidiol and cannabinoid genotoxicity in relation to congenital anomalies 2001-2015. — Reece AS, Hulse GK BMC pediatrics (2022)
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      Management site and level of health care for cannabis- and synthetic cannabinoid-related poison control center cases involving older adults, 2016-2019. — Choi NG, DiNitto DM, Marti CN, Baker SD Drug and chemical toxicology (2022)
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      Sex differences and the endocannabinoid system in pain. — Blanton HL, Barnes RC, McHann MC, Bilbrey JA, Wilkerson JL, Guindon J Pharmacology, biochemistry, and behavior (2021)
    10. [10]
      Occurrence and Mass Loading of Synthetic Opioids, Synthetic Cathinones, and Synthetic Cannabinoids in Wastewater Treatment Plants in Four U.S. Communities. — O'Rourke CE, Subedi B Environmental science & technology (2020)
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      Antinociceptive effects of JWH015 in female and male rats. — Craft RM, Greene NZ, Wakley AA Behavioural pharmacology (2018)
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      Sex differences in antinociceptive tolerance to delta-9-tetrahydrocannabinol in the rat. — Wakley AA, Wiley JL, Craft RM Drug and alcohol dependence (2014)
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      Evaluation of the endogenous cannabinoid system in mediating the behavioral effects of dipyrone (metamizol) in mice. — Schlosburg JE, Radanova L, Di Marzo V, Imming P, Lichtman AH Behavioural pharmacology (2012)
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      The antinociceptive triterpene β-amyrin inhibits 2-arachidonoylglycerol (2-AG) hydrolysis without directly targeting cannabinoid receptors. — Chicca A, Marazzi J, Gertsch J British journal of pharmacology (2012)
    15. [15]
      Hemp (Cannabis sativa L.) Phytochemicals and Their Potential in Agrochemical, Cosmetic, and Food Industries: A Review. — Trono D International journal of molecular sciences (2026)
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      Determination of cannabinoids in commercial hemp seeds and hemp seed oil products in Türkiye by LC-MS/MS. — Kacargil CU, Soyturk H, Aydin AA, Gören İE, Demirel G, Daglioglu N Forensic science international (2026)
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      Association effect of the phytocannabinoid beta-caryophyllene and indomethacin carried in topical nanoemulgels: an evaluation by — Weimer P, de Araújo Lock G, Amaral Antunes Nunes K, Rossi RC, Koester LS Natural product research (2025)
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      Recent challenges and trends in forensic analysis: Δ9-THC isomers pharmacology, toxicology and analysis. — La Maida N, Di Giorgi A, Pichini S, Busardò FP, Huestis MA Journal of pharmaceutical and biomedical analysis (2022)
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      A description of Cannabinoid levels in Cannabis oil by high-performance liquid chromatography-mass spectrometry in a reference laboratory of North-Italy. — Manca A, Palermiti A, Mula J, De Vivo ED, Zeaiter S, Simiele M et al. Phytomedicine : international journal of phytotherapy and phytopharmacology (2022)
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      Prevalence and concentrations of new designer stimulants, synthetic opioids, benzodiazepines, and hallucinogens in postmortem hair samples: A 13-year retrospective study. — Niebel A, Westendorf L, Krumbiegel F, Hartwig S, Parr MK, Tsokos M Drug testing and analysis (2022)
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      Antinociceptive effects of minor cannabinoids, terpenes and flavonoids in Cannabis. — Rodriguez CEB, Ouyang L, Kandasamy R Behavioural pharmacology (2022)
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      Global Trends in Cannabis and Cannabidiol Research from the Year 1940 to 2019. — Liu J, Chen H, Newmaster S, Wang S, Liu C Current pharmaceutical biotechnology (2021)
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      Do-It-Yourself medicine? The impact of light cannabis liberalization on prescription drugs. — Carrieri V, Madio L, Principe F Journal of health economics (2020)
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      High Prevalence of Cannabidiol Use Within Male Professional Rugby Union and League Players: A Quest for Pain Relief and Enhanced Recovery. — Kasper AM, Sparks SA, Hooks M, Skeer M, Webb B, Nia H et al. International journal of sport nutrition and exercise metabolism (2020)
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      Cannabidiol in sport: Ergogenic or else? — Gamelin FX, Cuvelier G, Mendes A, Aucouturier J, Berthoin S, Di Marzo V et al. Pharmacological research (2020)
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      Clinical uses of cannabis and cannabinoids in the United States. — Levinsohn EA, Hill KP Journal of the neurological sciences (2020)
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      Dronabinol use in France between 2004 and 2017. — Lejczak S, Rousselot H, Di Patrizio P, Debouverie M Revue neurologique (2019)
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      Synthetic cannabinoids and endometrial stromal cell fate: Dissimilar effects of JWH-122, UR-144 and WIN55,212-2. — Fonseca BM, Fernandes R, Almada M, Santos M, Carvalho F, Teixeira NA et al. Toxicology (2019)
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      β-caryophyllene, a dietary cannabinoid, complexed with β-cyclodextrin produced anti-hyperalgesic effect involving the inhibition of Fos expression in superficial dorsal horn. — Quintans-Júnior LJ, Araújo AA, Brito RG, Santos PL, Quintans JS, Menezes PP et al. Life sciences (2016)
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      Targeting the cannabinoid system for pain relief? — Chiou LC, Hu SS, Ho YC Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists (2013)
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      Development and validation of a high-performance liquid chromatography method for the evaluation of niflumic acid cross-reactivity of two commercial immunoassays for cannabinoids in urine. — Kovatsi L, Pouliopoulos A, Papadaki A, Samanidou V, Tsoukali H Journal of analytical toxicology (2010)
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      The role of the endogenous cannabinoid system in peripheral analgesia. — Guindon J, Beaulieu P Current molecular pharmacology (2009)
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      Cannabinoids stimulate prostaglandin production by human gestational tissues through a tissue- and CB1-receptor-specific mechanism. — Mitchell MD, Sato TA, Wang A, Keelan JA, Ponnampalam AP, Glass M American journal of physiology. Endocrinology and metabolism (2008)
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      Cannabinoid receptor and WIN-55,212-2-stimulated [35S]GTP gamma S binding and cannabinoid receptor mRNA levels in the basal ganglia and the cerebellum of adult male rats chronically exposed to delta 9-tetrahydrocannabinol. — Romero J, Berrendero F, García-Gil L, Ramos JA, Fernández-Ruiz JJ Journal of molecular neuroscience : MN (1998)
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      Pharmacological evaluation of iodo and nitro analogs of delta 8-THC and delta 9-THC. — Martin BR, Compton DR, Semus SF, Lin S, Marciniak G, Grzybowska J et al. Pharmacology, biochemistry, and behavior (1993)
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      Analgesic and antiinflammatory activity of constituents of Cannabis sativa L. — Formukong EA, Evans AT, Evans FJ Inflammation (1988)
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      Adulterants causing false negatives in illicit drug testing. — Mikkelsen SL, Ash KO Clinical chemistry (1988)
    45. [45]
      Comparative analgesic activity of various naturally occurring cannabinoids in mice and rats. — Sofia RD, Vassar HB, Knobloch LC Psychopharmacologia (1975)

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