Intended for healthcare professionals

Letters A voice from the streets about Spice

Guidance is needed on synthetic cannabinoid receptor agonists and cannabis

BMJ 2016; 353 doi: (Published 28 June 2016) Cite this as: BMJ 2016;353:i3491
  1. Ian Hamilton, lecturer
  1. Health Sciences, University of York, York YO10 5DD, UK
  1. ian.hamilton{at}

Millar’s personal account of “Spice” is a useful reminder that, although drugs are used by people from all socioeconomic groups, they acutely affect those who are socially disadvantaged.1 We’re collectively ignorant about a range of factors related to synthetic cannabinoid receptor agonists (SCRAs) and traditional forms of cannabis. We don’t have reliable information on how widely these substances are used, their potency, or how we can effectively treat people who develop problems through their use.

UK experts recently met at the University of York to share research findings.2 This group is concerned about the significant rise in people presenting to treatment agencies who cite cannabis as their primary drug problem.3 This may be due to using organic cannabis, SCRAs, or a combination of the two.

Clients have developed an “inverted expertise” on the drug—often being equipped with more up to date knowledge than the people trying to help them. The lack of research means that primary care and specialist treatment staff have no evidence base to provide effective interventions.4

Many healthcare workers still view organic cannabis as a benign substance, particularly in comparison with “harder” drugs such as heroin, while SCRAs such as “Spice” could until recently be purchased legally and were therefore perceived to be safe.

Participants at the York event concluded that a small number of people use a large quantity of cannabis frequently. We’ve all neglected this group of clients and, as a result, we don’t know how to effectively intervene. Guidance is urgently needed for workers who come into contact with people who experience problems from using cannabis.



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