Intended for healthcare professionals

Rapid response to:

Practice What Your Patient is Thinking

A voice from the streets about Spice

BMJ 2016; 353 doi: (Published 07 June 2016) Cite this as: BMJ 2016;353:i2708

Rapid Response:

Synthetic cannabinoids agonists

This personal account of 'spice' is a useful reminder that although drugs are used by people from all socioeconomic groups they have an acute impact on those who are socially disadvantaged. We are collectively ignorant about a range of factors related to synthetic cannabinoid agonists as well as traditional forms of cannabis. We still don't have reliable information about how widely these substances are used, their potency or how they can be effectively treated once people develop problems as a result of their use.

A group of UK experts met this week at the University of York to share research findings and formulate a response to this issue (1). The group has been concerned for some time that there has been a significant rise in the number of people presenting to treatment agencies citing cannabis as their primary drug problem (2). It is not clear whether this is due to use of organic cannabis, synthetic cannabinoid agonist compounds such as 'spice' or a combination of the two.

The group is also concerned that there is a lack of research on this topic which means that primary care and specialist treatment staff have no evidence base to provide effective interventions for this client group (3).

While we acknowledge that for many the use synthetic or organic forms of cannabis will not be problematic there is a sub group who encounter problems. Both forms of cannabis have image problems in that many health care workers still view organic cannabis as a benign substance, particularly in comparison to 'harder' drugs such as heroin. While substances such as 'spice' known as 'legal highs' could until recently be purchased legally and were therefore perceived to be safe.

The one substance we do have clear evidence for in its ability to cause harm is tobacco. And we know that many cannabis users still combine tobacco with cannabis. Yet this group has largely been ignored in the public health drive to reduce tobacco use in the population.

The consensus of the experts who met this week in York was that a small number of people are using a large quantity of cannabis frequently. These people have a range of health and social problems which cannot be addressed purely by staff working in part of the system. We have collectively ignored them and as a result don't know how to effectively intervene. There is an urgent need to produce guidance for workers who come into contact with individuals who experience problems as a result of using cannabis.

2.Hamilton, I., Lloyd, C., Monaghan, M. and Paton, K., 2014. The emerging cannabis treatment population. Drugs and Alcohol Today, 14(3), pp.150-153.
3. Gates, P.J., Sabioni, P., Copeland, J., Le Foll, B. and Gowing, L., 2016. Psychosocial interventions for cannabis use disorder. The Cochrane Library.

Competing interests: No competing interests

11 June 2016
Ian Hamilton
University of York
Health Sciences