The Relevance of Sex in the Association of Synthetic Cannabinoid Use With Psychosis and Agitation in an Inpatient Population

J Clin Psychiatry. 2019 Jul 2;80(4):18m12539. doi: 10.4088/JCP.18m12539.


Background: Current evidence suggests that women are more sensitive to the effects of cannabinoids. The aim of this study was to investigate the relevance of sex in the association of synthetic cannabinoid (SC) use with psychosis and agitation.

Methods: A retrospective chart review was conducted for patients admitted to a psychiatric unit (2014-2016) to extract information on demographic factors, use of substances, clinical symptoms, and pharmacologic treatments. Study groups were defined as SC users (anyone who reported use of SCs over the past 3 months), cannabis users (positive toxicology screen for Δ⁹-tetrahydrocannabinol [THC]), and controls (those who denied use of SCs over the past 3 months and had negative toxicology for THC).

Results: Digital charts of 983 patients were reviewed. A total of 162 subjects reported use of SCs over the past 3 months (76% male), and 292 subjects had positive toxicology screen for THC (67% male). A total of 38.9% of SC users (n = 63) had positive urine toxicology screen for THC. SC users had higher risks of psychotic presentations (adjusted odds ratio [AOR] = 3.390; 95% CI, 1.390-8.267) and agitation (AOR = 4.643; 95% CI, 1.974-10.918) compared to the controls. While women had lower rates of psychosis than men in the cannabis and control groups, the rates were markedly potentiated with SC use to high levels (79%) approximately equal to that seen in men (80%). There was also a significant interaction between SC use and sex for agitation (AOR = 0.308; 95% CI, 0.117-0.808). Female SC users were significantly more agitated than male SC users (73.7% vs 47.6%, respectively, P = .005).

Conclusions: SC users are more likely than nonusers to be psychotic or agitated in an inpatient setting. The potentiated rates of psychosis and agitation with SC use in women suggest that they may have a greater sensitivity to these synthetic compounds.​.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cannabinoids / pharmacology*
  • Dronabinol* / analysis
  • Dronabinol* / pharmacology
  • Female
  • Humans
  • Inpatients* / psychology
  • Inpatients* / statistics & numerical data
  • Male
  • Psychomotor Agitation* / diagnosis
  • Psychomotor Agitation* / epidemiology
  • Psychomotor Agitation* / etiology
  • Psychoses, Substance-Induced* / diagnosis
  • Psychoses, Substance-Induced* / epidemiology
  • Psychoses, Substance-Induced* / etiology
  • Psychoses, Substance-Induced* / psychology
  • Psychotropic Drugs / pharmacology
  • Risk Factors
  • Sex Factors
  • Substance Abuse Detection / methods
  • United States


  • Cannabinoids
  • Psychotropic Drugs
  • Dronabinol