title: Synthetic cannabinoid JWH-018 and psychosis: an explorative study.
abstract: BACKGROUND
  Aroma, Spice, K2 and Dream are examples of a class of new and increasingly popular recreational drugs. Ostensibly branded "herbal incense", they have been intentionally adulterated with synthetic cannabinoids such as JWH-018 in order to confer on them cannabimimetic psychoactive properties while circumventing drug legislation. JWH-018 is a potent cannabinoid receptor agonist. Little is known about its pharmacology and toxicology in humans. This is the first research considering the effects of JWH-018 on a psychiatric population and exploring the relationship between JWH-018 and psychotic symptoms.
  
  
  METHODS
  This paper presents the results of semi-structured interviews regarding the use and effects of JWH-018 in 15 patients with serious mental illness in a New Zealand forensic and rehabilitative service.
  
  
  RESULTS
  All 15 subjects were familiar with a locally available JWH-018 containing product called "Aroma" and 86% reported having used it. They credited the product's potent psychoactivity, legality, ready availability and non-detection in drug testing as reasons for its popularity, with most reporting it had replaced cannabis as their drug of choice. Most patients had assumed the product was "natural" and "safe". Anxiety and psychotic symptoms were common after use, with 69% of users experiencing or exhibiting symptoms consistent with psychotic relapse after smoking JWH-018. Although psychological side effects were common, no one reported becoming physically unwell after using JWH-018. Three subjects described developing some tolerance to the product, but no one reported withdrawal symptoms.
  
  
  CONCLUSIONS
  It seems likely that JWH-018 can precipitate psychosis in vulnerable individuals. People with risk factors for psychosis should be counseled against using synthetic cannabinoids.
authors.affiliation: Te Korowai-Whāriki, A Capital and Coast District Health Board Service, Ratonga Rua O Porirua, Regional Forensic Service, Raiha Street, P O Box 50-233 Porirua, New Zealand. Susanna Every-Palmer@moh.govt.nz
authors.forename: Susanna
authors.initials: S
authors.lastname: Every-Palmer
mesh_terms: D000328:Adult; D002186:Cannabinoids / Q000009:adverse effects* / Q000494:pharmacology; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects / Q000494:pharmacology; D007211:Indoles / Q000009:adverse effects* / Q000494:pharmacology; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000009:adverse effects* / Q000494:pharmacology; D009520:New Zealand; D011605:Psychoses, Substance-Induced / Q000453:epidemiology*; D011618:Psychotic Disorders / Q000150:complications* / Q000453:epidemiology; D043884:Receptor, Cannabinoid, CB1 / Q000819:agonists; D043885:Receptor, Cannabinoid, CB2 / Q000819:agonists; D019966:Substance-Related Disorders / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D002186:Cannabinoids; D013287:Illicit Drugs; D007211:Indoles; D009281:Naphthalenes; D043884:Receptor, Cannabinoid, CB1; D043885:Receptor, Cannabinoid, CB2; C552597:1-pentyl-3-(1-naphthoyl)indole