Psychopathological symptoms associated with synthetic cannabinoid use: a comparison with natural cannabis

Psychopharmacology (Berl). 2019 Sep;236(9):2677-2685. doi: 10.1007/s00213-019-05238-8. Epub 2019 Apr 9.


Background: Synthetic cannabinoids (SCs) are a class of new psychoactive substances that have been rapidly evolving around the world throughout recent years. Many different synthetic cannabinoid analogues are on the consumer market and sold under misleading names, like "spice" or "incense." A limited number of studies have reported serious health effects associated with SC use. In this study, we compared clinical and subclinical psychopathological symptoms associated with SC use and natural cannabis (NC) use.

Methods: A convenience sample of 367 NC and SC users was recruited online, including four validated psychometric questionnaires: The Drug Use Disorders Identification Test (DUDIT), Insomnia Severity Index (ISI), Altman Mania Scale (Altman), and Brief Symptom Inventory (BSI). The two groups were compared with analysis of variance (ANOVA) and covariance (ANCOVA), chi2 tests, and logistic regression when appropriate.

Results: The SC user group did not differ in age from the NC user group (27.7 years), but contained less females (21% and 30%, respectively). SC users scored higher than NC users on all used psychometric measures, indicating a higher likelihood of drug abuse, sleep problems, (hypo)manic symptoms, and the nine dimensions comprising the BSI, somatization, obsessive-compulsive behavior, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. Odds ratios (95% CI) for the SC user group vs NC user group were, respectively, drug dependence 3.56 (1.77-7.16), (severe) insomnia 5.01 (2.10-11.92), (hypo-)mania 5.18 (2.04-13.14), and BSI psychopathology 5.21 (2.96-9.17).

Discussion: This study shows that SC use is associated with increased mental health symptomatology compared to NC use.

Keywords: Altman; BSI; Cannabis; DUDIT; ISI; Mental health; Psychiatry; Psychology; Questionnaire; Spice; Synthetic cannabis.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cannabinoids / administration & dosage
  • Cannabinoids / adverse effects*
  • Europe / epidemiology
  • Female
  • Humans
  • Male
  • Marijuana Abuse / epidemiology*
  • Marijuana Abuse / psychology*
  • Marijuana Smoking / epidemiology
  • Marijuana Smoking / psychology
  • Mental Disorders / chemically induced
  • Mental Disorders / epidemiology*
  • Mental Disorders / psychology*
  • Middle Aged
  • Psychopathology
  • Surveys and Questionnaires
  • Synthetic Drugs / administration & dosage
  • Synthetic Drugs / adverse effects*
  • Young Adult


  • Cannabinoids
  • Synthetic Drugs